Citation Nr: 21023394 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-38 382 DATE: April 20, 2021 ORDER Entitlement to an initial disability rating greater than 10 percent for hepatitis C is denied. Entitlement to a compensable disability rating for bilateral maxillary sinusitis is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s hepatitis C, during the pendency of the claim, was not manifested by 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. 2. The Veteran’s chronic sinusitis, during the pendency of the claim, was not manifested by one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 3. The Veteran is service connected for generalized anxiety disorder (GAD), rated 30 percent disabling, prior to August 7, 2014, and 50 percent disabling, from August 7, 2014; hepatitis C, rated 10 percent disabling; and bilateral maxillary sinusitis, rated 0 percent disabling; thus, he does not meet the schedular criteria for a TDIU. 4. Referral for consideration of a TDIU on an extraschedular basis is not warranted as the Veteran’s service-connected disabilities were not shown to result in an inability to obtain or maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating greater than 10 percent for hepatitis C have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.114, Diagnostic Code (DC)7354. 2. The criteria for entitlement to a compensable disability rating for bilateral maxillary sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.321, 4.97, DC 6513. 3. The criteria for entitlement to a TDIU, to include referral of consideration of a TDIU on an extraschedular basis, were not met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from January 1974 to January 1976. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision issued by a VA Regional Office (RO). As a preliminary matter, the Board notes that in the most recent Power of Attorney appointment (VA Form 21-22), the Veteran selected the Disabled American Veterans (DAV) as his representative. See September 2019 VA Form 21-22. However, later that same month, the VA sent correspondence to the Veteran indicating that VA could not accept his VA form 21-22 because the second page, including the signature page, were illegible. The clarification letter dated September 11, 2019 sent to the Veteran, requested that he either submit a new VA Form 21-22 appointing Disabled American Veterans (or another representative), or return the form indicating that the Veteran wished to represent himself. The Board stated in the clarification letter that if no response was received within 30 days, the Board would assume that the Veteran wished to represent himself and appellate review of his claim would resume. At the time of this decision, no correspondence regarding representation has been received from the Veteran. Therefore, the Board considers the Veteran to be proceeding pro se. This case was last before the Board in May 2018, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denials and returned the case to the Board. The Board now finds there has been at least substantial compliance with the Board’s remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2020). Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. Where there is a question as to which of two evaluations shall be applied, the higher evaluations will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Generally, the degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 C.F.R. § 4.1. 1. Entitlement to a disability rating greater than 10 percent for hepatitis C is denied. The Veteran generally asserts that his hepatitis C warrants a disability rating greater than 10 percent. The Veteran’s hepatitis C is currently rated 10 percent disabling under diagnostic code (DC) 7354. The appeal period before the Board begins August 7, 2009, which was the date VA received the initial claim for service connection. Under Diagnostic Code 7354, a noncompensable rating is assigned for asymptomatic HCV. A 10 percent rating requires 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. 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. A 40 percent rating requires daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, 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 four weeks, but less than six weeks, during the past 12-month period. A 60 percent rating requires daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, 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 six weeks during the past 12-month period, but not occurring constantly. A 100 percent rating requires serologic evidence of HCV infection and the following signs and symptoms due to the HCV infection: near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). According to Note (1) in this Diagnostic Code, evaluate sequelae such as cirrhosis or malignancy of the liver, under an appropriate Diagnostic Code, but do not use the same signs and symptoms as the basis for evaluation under Diagnostic Code 7354 and under a Diagnostic Code for sequelae. This would violate VA's anti-pyramiding regulation. See 38 C.F.R. § 4.14. Note (2) provides that for purposes of evaluating conditions under Diagnostic Code 7354, an "incapacitating episode" means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Based on review of the evidence, the criteria for an increased rating for hepatitis C are not met. The Veteran underwent a VA examination in October 2011 where the Veteran’s diagnosis of hepatitis C was confirmed. During the examination, the Veteran reported current symptoms to include intermittent fatigue and malaise with daily pain. The Veteran denied weight loss, nausea, and anorexia. The examiner noted there were no signs of liver disease and no history of organ transplants or other surgeries. In addition, the examiner noted that the Veteran had not experienced any incapacitating episodes. Lastly, the examiner opined that the Veteran’s hepatitis C condition had “no significant effect on usual occupation” nor on normal daily activities. The Veteran was afforded another VA examination in July 2019 in which again the Veteran’s hepatitis C diagnosis was confirmed. It was reported by the Veteran that since treatment began for his hepatitis C with resolution of the virus, his condition has been stable without recurrence. It was further reported that no continuous medications were needed. The examiner also reported that the Veteran currently experienced no symptoms of chronic liver disease nor has the Veteran experienced any incapacitating episodes. An addendum medical opinion was provided in August 2020 on the sole inquiry of functional impact of the Veteran’s hepatitis C. The examiner opined that the Veteran’s “hepatitis C virus infection was treated and resolved therefore there is no evidence of chronicity or complication…that will interfere with his ability to obtain a regular employment or with his activities of daily living”. Applying the rating criteria, it appears that key requirements for the next higher 20 percent rating have not been met. On at least one VA examination, the condition was noted as being in total remission. The Veteran currently has no symptoms associated with hepatitis C such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, or right upper quadrant pain. Additionally, the Veteran did not have incapacitating episodes as defined by regulation, as he did not have periods of acute signs and symptoms "severe enough to require bed rest." "Require" is defined as "to demand as necessary or essential: to have a compelling need for." Merriam-Webster's Collegiate Dictionary 1058 (11th ed. 2012). Furthermore, the definition of "incapacitating episode" requires both bed rest "and" treatment by a physician for the period of acute signs and symptoms that require the bed rest. The medical evidence of record does not show that the Veteran experienced a period of acute signs and symptoms that required treatment from a physician at all. It follows that preponderance of the medical evidence does not demonstrate or approximate what warrants an initial rating greater than 10 percent. See DC 7354. In the September 2014 Supplemental Statement of the Case, the AOJ considered rating the Veteran’s hepatitis C condition on an extraschedular basis under 38 C.F.R. § 3.321, ultimately finding it was not warranted. As such, the Board must also determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. Thun v. Peake, 22 Vet. App. 111, 115 (2008); Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) ("[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted"); Morgan v. Wilkie, 31 Vet. App. 162 (2019) (holding that the "VA's duty to maximize benefits requires it first to exhaust all schedular alternatives for rating a disability before the extraschedular analysis is triggered," inclusive of the availability of service connection for disability claimed secondary to the service-connected disability). In this case, the schedular rating for the Veteran’s hepatitis C is adequate because it contemplates all hepatitis C manifestations that he has ever reported. Specifically, fatigue, pain, and malaise. Therefore, referral for extraschedular consideration is not warranted. For these reasons, the preponderance of the evidence weighs against the claim for increase. Under these circumstances, VA’s benefit-of-the-doubt doctrine does not apply, and the claim must be denied. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). 2. Entitlement to a compensable disability rating for bilateral maxillary sinusitis is denied. The Veteran generally asserts that his chronic bilateral maxillary sinusitis warrants a compensable disability rating. Specifically, he asserts that his condition has gotten worse over time, as such he is entitled to a compensable disability rating. The Veteran’s sinusitis disability is currently rated as noncompensable under 38 C.F.R. § 4.97, DC 6513. The appeal period before the Board begins one year prior to March 30, 2010, the date VA received the claim for an increased rating. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The General Rating Formula for Sinusitis under DC 6513 provides a 10 percent rating for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is assigned for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is assigned following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. A Note to the General Rating Formula for Sinusitis provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97. The Veteran was afforded a VA examination in November 2010. At which time the Veteran reported intermittent but frequent episodes of nasal congestion, occasional breathing difficulty, and pain over the maxillary sinuses. The Veteran denied excessive mucous secretions and runny nose. The examiner noted that the Veteran currently uses over the counter medications and has had no history of incapacitating episodes. However, the Veteran did report experiencing non-incapacitating episodes within the past year. Specifically, he reported having one episode per year with a duration of five or six days. The examiner noted that the Veteran had been a chronic smoker until the Veteran reported stopping a month prior to the examination. The Veteran reported being retired as of September 2009 from Smart Modular Technology at which he worked for over fifteen years. Also, he indicated that the cause of his retirement was due medical problems associated with his hepatitis C. The examiner opined that the Veteran’s sinusitis condition would not affect normal daily activities. However, the examiner did not provide an opinion as to the functional impact on employment, only referring to the Veteran as currently retired at the time of the examination. In compliance with the Board’s May 2018 remand directives, the Veteran was afforded another VA examination in July 2019. The examiner confirmed the Veteran’s diagnosis of chronic maxillary sinusitis. The examiner noted that pain and tenderness of the affected sinus were the conditions associated with the Veteran’s diagnosis. The examiner noted that the Veteran had not experienced any incapacitating nor non-incapacitating episodes of sinusitis within the past twelve months. It was further noted that the Veteran had not undergone any sinus surgery and X-rays of the sinus area indicated that there was no acute sinus disease. The Veteran was afforded an addendum medical opinion for the functional impact of his sinusitis condition in August 2020. The examiner opined that “there is no evidence of chronic sinusitis…there is no evidence of chronicity or complication…that will interfere with his ability to obtain a regular employment or with his activities of daily living”. Upon review of the record, the Board finds that a compensable rating is not warranted at any point during the period under review. The Veteran's sinusitis has manifested with intermittent nasal congestion, pain, and episodes of sinusitis that did not require prolonged antibiotic treatment. The record does not show three or more incapacitating episodes of sinusitis per year requiring prolonged antibiotic treatment. An incapacitating episode of sinusitis is defined as an episode that requires bedrest and treatment by a physician. See 38 C.F.R. § 4.97, DC 6513, Note. The record also does not show more than six non-incapacitating episodes of sinusitis per year characterized by headaches, pain, and purulent discharge or crusting; or the need for sinus surgery. The Board has also considered the Veteran's lay statements indicating that his sinusitis is serious; intermittent but frequent episodes of nasal congestion, occasional breathing difficulty and pain over the maxillary sinuses with non-incapacitating episodes at least once per year with a duration of five or six days. However, to the extent that the Veteran describes symptoms or circumstances tantamount to incapacitating episodes, there is no evidence that the episodes required a physician's care with prescribed bedrest. Rather, treatment records did not note any prescription or recommendation for bed rest. It follows that the preponderance of the medical evidence does not demonstrate or approximate what warrants a compensable disability rating. See DC 6513. The Board notes, that in the September 2014 Supplemental Statement of the Case, the AOJ considered rating the Veteran’s chronic maxillary sinusitis condition on an extraschedular basis under 38 C.F.R. § 3.321, ultimately finding it was not warranted. As such, the Board must also determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. Thun v. Peake, 22 Vet. App. 111, 115 (2008); Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) ("[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted"); Morgan v. Wilkie, 31 Vet. App. 162 (2019) (holding that the "VA's duty to maximize benefits requires it first to exhaust all schedular alternatives for rating a disability before the extraschedular analysis is triggered," inclusive of the availability of service connection for disability claimed secondary to the service-connected disability). In this case, the schedular rating for the Veteran’s chronic maxillary sinusitis is adequate because it contemplates all sinusitis symptoms that he has reported. Specifically, frequent nasal congestion, difficulty breathing and pain. Therefore, referral for extraschedular consideration is not warranted. In sum, the competent and probative evidence in this case reflects that the Veteran has had no more than one non-incapacitating episode per year of sinusitis characterized by intermittent but frequent nasal congestion, difficulty breathing and pain in the maxillary sinus area. A compensable disability rating is therefore not warranted. Under these circumstances, VA’s benefit-of-the-doubt doctrine does not apply, and the claim must be denied. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). TDIU Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16(a). The Veteran’s TDIU claim stems from a specific claim for said benefits received by VA August 13, 2010. His contention has been that the combined effect of his service-connected disabilities renders him unemployable. See August 2010 claim for TDIU; See also October 2014 Statement in Support of Claim. Currently, the Veteran is service connected for generalized anxiety disorder at 50 percent, hepatitis C at 10 percent, and bilateral maxillary sinusitis rated as noncompensable for a combined evaluation of 60 percent from August 7, 2014. Prior to August 7, 2014 the Veteran’s combined evaluation for compensation was 40 percent from August 7, 2009. Therefore, during the entire period on appeal, the Veteran does not have a have single service-connected disability ratable at 60 percent or more and there are not sufficient additional service-connected disabilities to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). However, where the percentage requirements of section 4.16(a) are not met, if the evidence establishes that the Veteran was unable to secure and follow a substantially gainful occupation by reason of service-connected disability, the case will be referred for extraschedular consideration. 38 C.F.R. § 4.16(b). The Board does not have the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Rather, the Board’s sole inquiry is whether referral for extraschedular consideration is warranted in light of the evidence showing the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability. 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). In determining whether a Veteran is unemployable for VA purposes, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2016); Hersey v. Derwinski, 2 Vet. App. 91 (1992); Faust v. West, 13 Vet. App. 342 (2000). A Veteran need not show 100 percent unemployability in order to be entitled to a TDIU. Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). For reasons outlined below, the Board finds referral for extraschedular consideration not warranted here because during the entire period on appeal, the preponderance of the evidence does not support that the Veteran was unable to maintain substantially gainful employment due solely to service-connected disabilities. The Veteran’s educational history includes a high school education and two years of college. The Veteran also underwent Quality Audit and Environmental Health Safety Audit training in 2008. His military occupational specialty was Motor Transport Operator. His post-service employment history includes work as a Quality Lead Auditor at Smart Modular Technologies where he worked from 1997 until 2008. The Veteran has generally stated that his service-connected disabilities have prevented him from working. However, he has not specified which disability or disabilities impaired his prior employment or how he was unable to function as a full-time employee. In addition, he has indicated that he lost no time from work due to illness during this timeframe. See June 2019 Application for TDIU. However, private treatment records document that the Veteran contracted hepatitis C while in service and the virus became active sometime in 2009. The Veteran’s service treatment records further indicate that he was treated for hepatitis C while on active duty in March and June 1975 resulting in the need for hospitalization. Upon receiving treatment, the Veteran was released back to his unit with temporary duty restrictions once symptoms had resolved. Further treatment records from September 2009 note that the Veteran has not required hospitalization for his hepatitis C condition since his time in service. In correspondence dated in March 2010, Dr. N.O.V. noted that the Veteran had not been able to work for the past seven months due to increased anxiety as a result of the news of the reemergence of his hepatitis C infection coupled with aggravation of his anxiety condition. She went on to opine “right now his psychiatric treatment limited him in a way that he spends all [] day at home”. More recent private treatment records indicate the Veteran’s psychological disorders are in remission with no suicidal or homicidal ideations. See Dr. C.M. records July 2020 and July 2019. Medical treatment records from October 2009 indicate the Veteran underwent an excision of a right chest mass which was found to be a sebaceous cyst. In addition, the Veteran had a liver biopsy performed later that same month on October 20, 2009 showing a high viral load indicating the presence of the virus that causes hepatitis C. See December 1, 2009 Gastroenterology Outpatient Note. Treatment for his hepatitis C began shortly thereafter in January 2010 once the Veteran was taught how to self-administer medications requiring injection. See January 19, 2010 Gastroenterology Education Note. VA treatment records reflect that the Veteran also has nonservice-connected disabilities of hypertension, diabetes mellitus type 2, depressive disorder, asthma, allergic rhinitis, lateral epicondylitis, myositis, and macular degeneration. The Veteran has undergone several VA examinations which discussed the functional impact of his service-connected disabilities. In September 2009, the Veteran underwent a VA mental disorders examination in which the examiner noted the Veteran was currently employed but had lost about three weeks of time from work due to medical or sick leave and appointments to include placement on medical leave as a result of an “anxiety crisis”. However, the examiner went on to state that there was no total occupational and social impairment due to his mental disorder and the Veteran was competent to manage his own financial affairs. The examiner further opined that the Veteran did have reduced reliability and productivity due to his anxiety disorder because of his recent “anxiety crisis”. In an August 2014 VA examination for mental disorders, the examiner opined that the Veteran has “occupational and social impairment with reduced reliability and productivity”. The examiner further noted that the Veteran had no memory or concentration difficulties, was well dressed and “fairly groomed”. During the examination, the Veteran reported having worked for fifteen years as a quality system auditor at “Tech Corp” but stopped working due to “liver condition”. In February 2015, the Veteran was afforded another VA mental disorders examination in which, once again the examiner opined that the Veteran had “occupational and social impairment with reduced reliability and productivity”. The Veteran reported that had been married for over twenty years, had two adult children, and described his relationship with them as “good”. It was further noted that the Veteran had no history of legal problems and no evidence of substance abuse or dependence. It was further noted that the Veteran presented with some memory difficulties but “otherwise cognitive functions are preserved”. Lastly, the examiner opined that the Veteran was capable of managing his own financial affairs. For the Veteran’s other service-connected conditions of hepatitis C and chronic maxillary sinusitis, the Veteran has been afforded VA examinations in October 2011, July 2019, November 2010, and August 2020. These VA examinations, as noted above, all concluded that these conditions had no effect on daily or occupational activities. Most importantly, in the August 2020 VA addendum medical opinion, the examiner opined “[t]here is no evidence of chronic sinusitis and hepatitis C virus infection was treated and resolved therefore there is no evidence of chronicity or complication from both conditions that will interfere with his ability to obtain a regular employment or with his activities of daily living". In rendering a closer examination of the evidence, the Board finds the evidence does not support TDIU. See Ray, 31 Vet. App. 58 (holding that the Board’s referral decision under 38 C.F.R. § 4.16(b) does not require the Board to award an extraschedular TDIU). Rather the evidence shows the Veteran had significant psychological limitations, but his service-connected disabilities alone would not preclude employment and would not require solely marginal employment. Here, the Veteran’s education, training, and work history demonstrated that he has the capacity to engage in occupations such as quality auditor and truck driver which primarily involve activities such as sitting at a desk; using a computer or performing clerical work; using a telephone; meeting with clients or constituents; and driving a car or truck. 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 evidence does not show, nor has the Veteran alleged that he suffers from any physical impairments due to his service-connected conditions. In fact, the current medical evidence of record indicates the Veteran’s hepatitis C and maxillary sinusitis do not negatively impact his functional ability in any way. 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. The medical evidence overwhelmingly indicates, however, that while the Veteran's generalized anxiety disorder caused him psychological difficulties, at worst examiners have found that the Veteran's anxiety disorder resulted in occupational impairment with reduced reliability and productivity. In addition, upon review of the Veteran’s Social Security Administration (SSA) records, he began receiving SSA disability benefits in September 2009 for “affective disorders” which includes depressive disorder. As noted above, this condition is not service connected. Importantly, the Veteran’s SSA benefits were not awarded based on any anxiety-related disorders. See November 2010 SSA Report. The Veteran’s SSA reports further indicated that he last worked in September 2009 and began to receive SSA benefits that same day once his depressive disorder became severe enough to warranty SSA disability benefits. The Board does not doubt that the Veteran’s service-connected disabilities cause impairing symptomatology to include potentially missing time from work. However, this impairment of function is recognized by the ratings assigned to each of his service-connected disabilities. The evidence does not show that his service-connected disabilities were of such severity to preclude his participation in any form of substantially gainful employment. Additionally, the Veteran has other impairing nonservice-connected disabilities with serious functional impact. However, as noted above, consideration cannot be given to the impairing effects of nonservice-connected disabilities. Considering the Veteran’s past work history, training, and skills and considering the medical evidence in this case, the Board finds referral for extraschedular TDIU is unwarranted. Under these circumstances, VA’s benefit-of-the-doubt doctrine does not apply, and the claim must be denied. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). T. Berry Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.