Citation Nr: 21026833 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 00-01 657 DATE: May 4, 2021 ORDER Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDING OF FACT The Veteran's service-connected disabilities were not of such severity that they effectively precluded substantially gainful employment for which the Veteran's education and occupational experience would otherwise qualify him. CONCLUSION OF LAW The criteria for entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1971 to April 1975. This appeal has a long procedural history and has been before the Board previously. Most recently, in August 2019, following a 2018 decision to vacate and remand a prior Board decision issued by the U.S. Court of Appeals for Veterans Claims (the Court or CAVC), the Board remanded the claim back to the agency of original jurisdiction (AOJ) for further development. Specifically, the regional office (RO) was to obtain updated VA treatment records; obtain updated medical exams to assess the current nature and severity of the Veteran's service-connected right ulnar neuropathy, including the functional impact of that disability on his ability to work, with a complete rationale; and refer the file to the Director, Compensation Service, for consideration of entitlement to an extraschedular TDIU. The RO complied to the extent possible and an opinion from the Director, Compensation Service, was received in November 2020. Thereafter, the RO issued a supplemental statement of the case (SSOC) denying TDIU dated in November 2020. The Board finds there has been substantial compliance with the August 2019 remand instructions, and the claim is ready for disposition on the merits. See Stegall v. West, 11 Vet. App. 268, 271(1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance). The Board has thoroughly reviewed all the evidence in the Veteran's VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the CAVC. See 38 U.S.C. § 7104 (d)(1) (2012); Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the CAVC has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-1381 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. Timberlake, supra. Further, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Total disability is considered to exist when there is any impairment, which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. See 38 C.F.R. § 3.340(a)(1). A total disability rating for compensation purposes may be assigned based on individual unemployability: that is when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one service-connected disability, it must be rated 60 percent or more; if there are two or more service-connected disabilities, at least one disability must be rated 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). Individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran's advancing age. See 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). When the Board conducts a TDIU analysis, it must consider the Veteran's education, training, and work history. Pederson v. McDonald, 27 Vet. App. 276 (2015). Further, the regulations permit the grant of entitlement to TDIU where employment is marginal. See 38 C.F.R. § 4.16 (a). Marginal employment shall not be considered substantially gainful employment. Id. Marginal employment generally will be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Id. Marginal employment may also be held to exist, on a facts-found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Id. Consideration will be given in all claims to the nature of the employment and the reason for termination. Id. When the threshold criteria for consideration of a schedular TDIU are not met, the issue of entitlement to a TDIU may be submitted to the Director of the Compensation Service for extraschedular consideration of whether the Veteran is unable to secure or follow a substantially gainful occupation because of service-connected disabilities. See 38 C.F.R. § 4.16(b); Fanning v. Brown, 4 Vet. App. 22 (1993). The Board cannot assign an extraschedular rating in the first instance. Bagwell v. Brown, 9 Vet. App. 337 (1996). The Veteran's service-connected conditions and ratings are as follows: Pilonidal cyst, at 10 percent disabling effective July 1, 1994; Right ulnar neuropathy, at 10 percent disabling effective May 1, 1998 Osteoarthritis of the right wrist secondary to right ulnar neuropathy, noncompensable from May 1, 1998; at 10 percent disabling effective August 11, 2005; and noncompensable effective December 1, 2019; and Noncompensable scars, right side of neck, tail bone, and right wrist effective July 9, 2015. Prior to August 11, 2005, the Veteran's combined evaluation was 20 percent. Effective August 11, 2005, the Veteran's combined evaluation was 30 percent, and effective December 1, 2019, his combined evaluation was 20 percent once again. Thus, the Veteran did not meet the threshold as outlined in 38 C.F.R. § 4.16(a) for consideration of TDIU on a schedular basis at any time during the period on appeal. As previously noted, the Board remanded the case to the Director of the Compensation Service to evaluate whether extraschedular TDIU consideration was warranted. In a November 2020 Advisory Opinion, the Director determined that "the cumulative evidence does not support a finding of extra-schedular TDIU based on service-connected conditions alone." Although the Board may not in the first instance award a TDIU on an extraschedular basis, the Board is not bound by an adverse determination by the Director regarding extraschedular entitlement to a TDIU. Wages v. McDonald, 27 Vet. App. 233 (2015). Moreover, the fact the Board previously determined such referral was warranted does not mean the claim will succeed on the merits, because the standard for referral is necessarily "based on a[n] evidentiary threshold that is lower than that for the decision to award an extraschedular rating." Ray v. Wilkie, 31 Vet. App. 58, 62 (2019) (holding that the Board is not bound to grant an extraschedular benefit even if the Board itself previously determined that referral to the Director was appropriate); see also Anderson v. Shinseki, 22 Vet. App. 423, 427-429 (2009) (discussing why initial determinations in extraschedular analysis by the regional office and determinations by the Director are not binding on the Board even if favorable to the Veteran). The Board previously determined that taking into consideration the Veteran's high school education level, previous work experience limited to positions requiring manual labor, and May 2018 VA examination findings suggesting that his right wrist osteoarthritis (either alone or in combination with his right ulnar neuropathy) may have rendered the Veteran unemployable for at least part of the appeal period, there was sufficient evidence to trigger the Veteran's procedural right to referral to the Director for extraschedular consideration, but this did not involve a weighing of the favorable and unfavorable evidence to make a final determination on entitlement to extraschedular TDIU. Therefore, the Board has made its own determination whether the evidence supports a finding that the Veteran is entitled to TDIU under 38 C.F.R. § 4.16(b). The question is whether his service-connected disabilities preclude him from obtaining or engaging in substantially gainful employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The pertinent question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Id. This is so because a disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. Id. The Veteran asserts he is entitled to TDIU and argues that his service-connected disabilities, mainly his right wrist condition, precluded him from obtaining and maintaining gainful permanent employment since 1999. The Veteran completed a high school education before joining the military, but did not pursue further education. See December 1999 Income-Net Worth and Employment Statement. Further, his work history has been established to include experience as a cabinet maker and 8 years as a mobile home factory worker. See December 1999 Income-Net Worth and Employment Statement. The Veteran's claim indicated, and he has reported, that he last worked on June 26, 1999. See February 2000 DRO Hearing Testimony; see also May 2001 Social Security Administration Decision. Therefore, the Board will use June 27, 1999 as the first day he ceased working. Here, the most probative evidence of record shows that the Veteran was capable of securing and following a substantially gainful occupation. Additionally, the evidence also shows that while the Veteran's disabilities may have caused some degree of occupational impairment, the overall evidence indicates that the Veteran had the physical ability (both exertional and non-exertional) and the mental ability to perform activities, as indicated below. VA examination findings of August 4, 1999, note examination of the right hand and wrist revealed no disturbance of the contours of the wrist, a well-healed incision, knuckle pads over the interphalangeal articulations in the proximal joint, mallet finger still present in the fifth finger, full contact with the palm at proper points from the palmar creases with fist making, exceptionally strong right grip, with 40 degrees dorsiflexion, 30 degrees palmar flexion, 30 degrees ulnar deviation, 10 degrees radial deviation, supination restricted in the last 10 degrees, and pronation was complete. The Veteran did have hypalgesia and hypesthesia along the ulnar distribution of the palm, little and ring fingers, and a portion of the mid-finger and he also complained of some numbness at the base of the thumb. The examiner noted good function of the interosseous musculature and no atrophy of hypothenar eminence or thenar eminence. The examiner opined that the Veteran's surgical procedure improved the function of his right wrist and prevented symptoms from reoccurring from degeneration that would have surely occurred had he not had surgery. The examiner further noted his disability is meaningful considering his occupation as a cabinet maker. VA examination findings of August 18, 1999, note the Veteran reported numbness of the ulnar aspect of the right hand, more so on the dorsum of the hand than on the palm, and of the fourth and fifth digits of the right hand, since his surgery. He did not clearly describe any weakness of the right upper extremity. He complained of pain in the right wrist. The examiner noted that according to the operative note, the right posterior interosseous nerve was identified and cut during surgery. On physical examination, he had a well-healed surgical scar, and motor, strength and muscle tone of all major muscle groups in both upper extremities were within normal limits. Sensory, pinprick sensation was decreased in the distribution of the right ulnar nerve in the right hand. Otherwise, pain and touch sensation were intact in the upper extremities. Reflexes, biceps and triceps tendon jerks were 1+ and symmetrical. The examiner noted that Veteran underwent electrodiagnostic testing of the right upper extremity on July 6, 1999. Motor and sensory nerve conduction velocities measured for the right median nerve were within normal limits. In testing the right ulnar nerve, there was evidence of a right ulnar neuropathy which he was unable to localize very well. The examiner stated that it is as likely as not that the dorsal cutaneous branch of the right ulnar nerve was severed during the surgery in May 1998, resulting in sensory loss involving the ulnar distribution of the right hand. The examiner said this is a pure sensory branch of the right ulnar nerve and no motor deficit results from this. From a neurological standpoint, since there is no motor deficit, this would result in only very minimal functional disability due to the numbness of the fourth and fifth digits of the right hand. During an April 2002 VA exam, the Veteran reported numbness of the ulnar aspect of his right hand mainly on the back of the hand since surgery. The examiner noted a well-healed surgical scar, strength and muscle tone of all major muscle groups in both upper extremities were within normal limits, and there was diminished pinprick sensation over the ulnar aspect of the dorsum of the right hand. Otherwise, pain and touch sensation were intact in upper extremities, and biceps and triceps tendon jerks were 1+ and symmetrical. The examiner provided a diagnosis of posttraumatic incomplete partial mononeuropathy of dorsal cutaneous branch of right ulnar nerve resulting in sensory loss only of ulnar aspect of dorsum of right hand. There was no weakness or paralysis secondary to this, and the examiner said this was a pure sensory nerve. A follow-up VA examination in September 2005 noted the Veteran reported stiffness and pain in the right wrist and that he could "only use it for 2-3 hours a day with such activities as hammering nails and lifting," also noting some numbness and tingling in the wrist but not the fingers. The Veteran reported pain at times going up toward the elbow but stating there was no shooting pain from the elbow down. The examiner noted the Veteran wore a wrist brace. On physical examination, deep tendon reflexes were 1-2+ and equal in the upper extremities. Motor exam revealed normal results for strength and all muscles tested including those innervated by the ulnar and median nerves. The examiner noted decreased pinprick in a C-6 distribution. The Veteran had good sensation within the ulnar nerve distribution. The Veteran had a negative Tinel's at the elbow and positive Tinel's at the right wrist. VA examination findings of November 3, 2008, note that after his surgery in 1998, the Veteran has been left with significant limitation of palmar and dorsiflexion on the right. It was noted that nerve conduction studies in 2005 had been done that showed no evidence of radial, median or ulnar damage. He has been wearing a soft brace on the right wrist since 1999. Pain medications are propoxyphene. He was only able to palmar flex the right wrist 20 degrees and dorsiflexion was to 40 degrees. Range of motion (ROM) over three repetitions did not increase pain or diminish flexibility or movement. Ulnar deviation of the right wrist was limited to 30 degrees and radial deviation of the right wrist was normal to 20 degrees. ROM over three repetitions did not lessen flexibility or cause increased pain. There was a well healed 4-inch scar on the dorsum of the right wrist. Neurologically he had a negative Tinel's sign on the right and normal sensory exam of the digits in the right hand, palm and dorsum of the right hand. There was no heat, inflammation or tenderness about the joint. The examiner stated that there appears by nerve conduction study and sensory examination as well as motor exam not to be any neurologic deficit. The examiner noted that the Veteran is unemployed and will not be returning to work. The Veteran's right wrist brace interfered with his daily activities. VA examination findings of October 30, 2014 note the Veteran's report of trouble with his right wrist for years and that he now thinks he has arthritis. He reported mild intermittent pain and paresthesias and/or dysesthesias of the right upper extremity. Muscle strength testing was normal. There was no atrophy. Deep tendon reflexes were normal. Sensory exam was normal. There was mild incomplete paralysis of the right ulnar nerve noted. All other nerves were noted to be normal. The examiner said he had mild symptoms of right ulnar nerve, wears a brace and has problems mainly due to arthritis which he says is "all over." The examiner stated that the ulnar nerve problem does not affect his ability to use his hand in active physical or sedentary work. VA examination findings of May 11, 2018 note the Veteran's report of severe pain all the time with swelling and tenderness for which he uses Tylenol #3 and a right wrist brace. The examiner noted that a 2018 x-ray showed arthritis. On physical examination, palmar flexion was to 22 degrees, dorsiflexion was to 35 degrees, ulnar deviation was to 15 degrees and radial deviation was to 5 degrees. The examiner noted he has limited range of motion, thus cannot flex or extend the wrist properly. There was evidence of pain with weight bearing and with non-weight bearing. There was no crepitus. There was no additional loss of function or range of motion after three repetitions. The examiner noted pain and weakness significantly limit functional ability with repeated use over a period of time but was unable to describe in terms of range of motion and said that it is likely that use over time cause pain and weakness, but that range of motion is not changed due to use over time per the history. The examiner noted that no flare ups were reported. Muscle strength testing was normal, and there was no muscle atrophy and no ankylosis. Arthritis was noted to be documented on imaging reports. The examiner said the right wrist is very stiff and hurts all the time, and as a result the Veteran cannot use the wrist. His grip is bad, and he will drop things due to pain, and a lack of mobility makes him unable to perform most tasks. VA examination findings of January 10, 2020 note the Veteran's report of symptoms worsening over the years with current symptoms of stiffness, weakness, pain, and numbness and shooting pain on the ulnar portion of the wrist and little finger. Current treatment was reported as Gabapentin, Naproxen and wrist brace. The examiner noted that the Veteran had no symptoms attributable to a right upper extremity peripheral nerve condition. Muscle strength testing was normal at 5/5 except for grip which was 3/5 and pinch that was 4/5. There was no muscle atrophy. Deep tendon reflexes were normal at 2+ except for brachioradialis which was 0. Sensation to light touch was normal. There were no trophic changes. The examiner noted functional impact due to intermittent shooting pain and frequent numbing of the ulnar portion just above the right wrist down to the 4th and 5th fingers. The examiner noted difficulty lifting, carrying, pushing, pulling, doing housework and yard work. All of this is due to pain, swelling and stiffness of the right wrist. The examiner stated that the impact on sedentary activities was minimal. In an addendum dated August 24, 2020, the examiner noted that VA medical records indicate the Veteran was prescribed the opioid, Codeine 300 mg, one tablet by mouth 3 times daily as needed from 2010-2019. The examiner said the most frequently observed adverse reactions of codeine include drowsiness and relaxed and calm feeling, light headedness, dizziness and sedation and that side effects such as these can have a profound effect on job performance and safety to self and fellow employees. The Veteran's prior employment required working with many tools from hammers and screwdrivers to skill saws, climbing ladders, and concentration. Codeine instructions warn against driving or doing other tasks or actions that require one to be alert. Dangers of working while under the influence of Codeine include falling from high places, lacerations, loss of limb using saws and severe injury or loss of life while climbing up and down ladders, using a skill saw, or driving to and from work. Since April 2019, the Veteran is taking Gabapentin for nerve pain and Naproxen for pain. In an addendum dated September 4, 2020, the examiner reported the Veteran has mild paresthesias and/or dysesthesias of the right upper extremity and that the severity of the Veteran's right ulnar nerve is mild incomplete paralysis. In June 2009, the Veteran met with a vocational rehabilitation counselor for the VA. The counselor reported the Veteran complained of many symptoms, wore a wrist brace, and used a cane to ambulate. However, the Veteran did not wish to participate in vocational services as he felt he was too disabled to work. The counselor noted the Veteran presented to show his compliance with his medical/mental health care, but did not wish to work or believed he could work. As a result, the vocational counselor did not meet with him long enough to determine his vocational abilities. See June 9, 2009 VA treatment records Additionally, Social Security Administration (SSA) records are available and show the Veteran pursued disability for various physical complaints; he claimed he was disabled due to kidney problems, arthritis, gout, bilateral knee disorder, hypertension, neuropathy, cyst on tailbone, and depression. An SSA Administrative Law Judge found that the Veteran has significant limitations in his capacity for lifting, carrying, standing, walking, bending and crawling, and this restricts him to less than a full range of sedentary work, and that he does not have the ability to perform the tasks of employment on a daily basis, eight hours a day. A Vocational Expert noted that the Veteran could not sustain any combination of sitting, standing, or walking, nor consistent pace to perform even the minimal demands of any type of work activity for 8 hours a day, 5 days a week. The consultative orthopedic examination in February 13, 2001 showing such limitations was based on possible gouty arthritis, both knees; effusion of both knees secondary to the gouty arthritis; and status postoperative carpal row excision, right wrist. Consequently, the Administrative Law Judge found that the claimant was disabled within the meaning of the Social Security Act and found he has been under a disability beginning June 26, 1999, and was entitled to Disability Insurance Benefits on the basis of his application and eligible for Supplemental Security Income payments by virtue of his application of December 27, 1999. The June 2001 Disability Determination indicates the award was based on osteoarthritis and allied disorders with a secondary diagnosis of gout. SSA and VA have different standards for determining whether a claimant is able to follow a substantially gainful occupation, as VA considers the impact of service-connected conditions only. Therefore, SSA decisions are not binding on VA. The Veteran's medical records and evidence in the file showed the following: A March 2010 telephone encounter notes the Veteran reported he had a wrist claim pending to his providers and notes "he is doing some light work" and he is encouraged to do so but he reports he is still "limited from doing more." See March 5, 2010 VA treatment records. During a July 2010 physical therapy consult, the Veteran reports he likes to garden, but is limited secondary to pain in his bilateral knees and wrist. See July 8, 2010 VA treatment records. A September 2009 addendum note from a staff physician notes the Veteran is interested in working and "has been doing remodeling and carpeting work." See September 16, 2009 VA treatment records. Based upon the evidence of record, the Board finds the Veteran's service-connected disabilities, alone, are not shown to be so disabling as to preclude him from securing or following substantially gainful employment in keeping with his education and occupational experience. The Board finds that an award of TDIU benefits is not warranted in this case because the Veteran is capable of performing the physical and mental acts required by employment. In making this finding, the Board has considered the Veteran's service-connected disabilities, employment history, educational attainment, and all other factors having a bearing on this issue. The Board finds the VA examination reports which give the most current medical opinion and Veteran's current medical condition; the relevant medical evidence on record; the vocational rehabilitation report; as well as the Social Security Administration records and their determinations, describing the impact the Veteran's service-connected disabilities have on his ability to obtain or engage in substantially gainful employment, to be the most probative evidence of record. The VA examiners reviewed the claims file and provided a detailed rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The examiners considered the totality of the Veteran's symptoms and concluded that the Veteran is still able to perform physical and sedentary work. Importantly, disability ratings are based on the average impairment in earning capacity resulting from the disability. 38 U.S.C. § 1155; see also 38 C.F.R. § 4.1. It is necessary that the record reflect circumstances which place that veteran's case in a different category than other veterans with an equal rating of disability. Van Hoose, 4 Vet. App at 363. Here, importantly, the above record has established that the Veteran's usual field of employment as a cabinet maker or the occupation he held at the mobile home manufacturing plant, may be generally precluded by his impaired manual dexterity due to his wrist condition. However, this does not preclude any and all employment the Veteran is qualified for taking into consideration his high school education. First, there are many other manual labor jobs that do not require a great deal of hand mobility from which the Veteran would not be precluded from obtaining. Again, while he does have some limited wrist functioning, the fact is it is his nonservice-connected gouty arthritis of the knees was the basis of SSA's Vocational Expert concluding the Veteran could not sustain any combination of standing or walking. This was also noted during VA's June 2000 vocational rehabilitation assessment, where it was noted "[b]y far, the major disability and resulting limitations are associated with his Arthritis which mainly affects his knees and ankles." In other words, while he may be unable to work due to limitations on standing or walking, that is not relevant to the TDIU analysis as he is not service-connected for any lower extremity disorders. Further, as to his physical limitations, although the Veteran had stated he could not work due to his wrist condition, he has also stated during various treatment visits that he does all the household chores, including the dishes and cooking, and he stripped the flooring in his home all indicative of a level of physical exertion consistent with the ability to engage in a light or medium duty occupation. Second, the Veteran's Tylenol #3 prescription (given on an as needed basis), would not preclude occupations in which heavy machinery is not being utilized or activities such as climbing ladders are not done. While this means certain employment would not be available to the Veteran, this does not automatically lead to a conclusion other gainful employment is precluded. The fact the Veteran might not be able to pursue a former occupation because of these limitations does not mean TDIU is warranted. He does retain the physical capacity to perform other types of light or medium duty jobs. Accordingly, the Board finds that the Veteran's education and work history does not preclude him from undertaking gainful employment, exercising job functions that would not require him to undertake manually labor intensive work, such as hammering, nailing, gripping, and lifting heavy items with his wrist. Withers, 30 Vet. App. at 148 (noting that it is the Board's "duty to 'interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present."). Concerning the Veteran's pilonidal cyst which causes him discomfort in sitting and bending when active, the Board notes the Veteran does not contend nor does the record support that his pilonidal cyst physical symptoms interfered with his ability to sustain gainful employment. See February 2015 Notice of Disagreement (stating that he cannot obtain gainful employment due to his service-connected wrist condition). Further, VA medical treatment records show various references to pilonidal cyst in the past medical history, but minimal active complaints. See 11/18/08, 01/25/16, 08/09/16, 02/09/17, 05/27/17 VA treatment records (noting pilonidal cyst as past medical history); but see April 15, 2015 VA treatment records (noting pilonidal cyst without abscess). As his symptoms were not interfering with his ability to work, it is clear that he could work in occupations other than those involving labor where experiencing symptoms of pain in his wrist would not interfere with the completion of work duties. As for the Veteran's scars associated with his right ulnar neuropathy, neck, and pilonidal cyst, the Board notes the Veteran consistently has placed an emphasis on his wrist condition for his inability to continue working in his former field of employment rather than his scars for his inability to work. See February 2015 Notice of Disagreement (stating that he cannot obtain gainful employment due to his service-connected wrist condition). He has not really alleged his scar symptoms would interfere with his ability to work, nor is that shown by the medical evidence. The Board has considered the Veteran's lay assertions that because of his right wrist symptoms, before he stopped working, he could only use his hand two to three hours per day; he had difficulty hammering, carrying, throwing, and lifting things; and he missed seven days of work per month. However, these assertions are outweighed by the most probative evidence of record, which indicates that his service-connected disabilities did not preclude him from obtaining substantially gainful employment due to functional impairment. Even if the Board deemed these statements credible, the most probative evidence of record outweighs the lay assertions that his service-connected disabilities preclude the Veteran from securing and maintaining substantially gainful employment. See, e.g. Madden v. Gober, 125 F.3d 1477, 1481 (1997) (the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration a veteran's statements, it may consider whether self-interest may be a factor in making such statements). Regardless of the Veteran claiming he could only use his hand 2-3 hours per day, none of the medical providers have ever opined such a level of functional impairment exists. Moreover, the Veteran has also reported to treatment providers over the years that he is also disabled and unable to work due to his knees and ankles, for which he is not service-connected. Even accepting as true that the functional impairments due to his service-connected disabilities arguably played a role in his decision to stop working, that does not mean TDIU is warranted, as the Veteran's service-connected disabilities alone are not, in the Board's determination, so disabling as to have rendered him or the average person similarly situated unable to secure or follow substantially gainful employment. While his physical symptoms "affect" or "impair" his ability to engage in prolonged manual labor, that does not equate to finding he is unemployable. As noted above, having limited manual dexterity does not preclude any and all employment involving manual labor. Further, the Veteran has claimed he could no longer work due to his wrist condition, but has reported he does all the household chores, including the dishes and cooking, and he stripped the flooring in his home all which require manual dexterity. Therefore, the record does not support the inability to sustain a light or medium duty position because of his wrist condition. The level of impairment is already represented by the disability ratings he is already assigned, which recognize that the disability would impair his earning capacity. That is different than concluding he cannot work, which is simply not supported by the record. Although the Veteran has not been employed since June 1999 and his service-connected disabilities may interfere with his performance of some types of work, the weight of the evidence shows that his service-connected disabilities would not prevent him from obtaining or maintaining substantially gainful employment. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough to establish that he or she is unemployable within the meaning of 38 C.F.R. § 4.16. "The question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment." Ray v. Wilkie, 31 Vet. App. 58 at 72 (quoting Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993)). Moreover, while the Board should consider the Veteran's work history, there is no requirement in the applicable regulations that a TDIU is warranted when a veteran is unable to work in the exact type of occupation he or she previously held. While the Board, in no way, underscores the functional impact of the Veteran's service-connected disabilities, after carefully considering all the evidence of record, the Board finds that the Veteran's service-connected disabilities alone, without consideration of his age and non-service-connected medical problems, would not prevent him from finding and maintaining substantially gainful employment. And again, the current assignment of the schedular ratings is recognition of the functional limitations caused by his disabilities, and those ratings contemplate the severity and overall impact the symptoms have on his life. As the preponderance of the evidence is against the Veteran's claim, the benefit-of- the-doubt rule is not for application, and entitlement to a TDIU must be denied. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mireya Martinez 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.