Citation Nr: 21028390 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-32 666 DATE: May 11, 2021 ORDER Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), prior to October 2, 2015, is denied. FINDING OF FACT Prior to October 2, 2015, the preponderance of the evidence is against a finding that Veteran was not rendered unable to secure or follow substantially gainful employment as a result of service-connected disabilities. CONCLUSION OF LAW The criteria for the award of a TDIU have not been met, prior to October 2, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.1, 4.3, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1963 to June 1977. This matter comes before the Board of Veterans' Appeals (Board) following a Joint Motion for Partial Remand (JMPR) entered by the parties in November 2019. The Board previously denied this claim in an August 2018 decision. Thereafter, the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In December 2019, the Veteran and the Secretary of VA (parties) entered into a joint motion for partial remand (JMPR), which was granted by Court that same month. The parties found that the Board erred when it failed to provide adequate reasons or bases to support its decision when it denied entitlement to TDIU prior to October 2, 2015. Specifically, the parties stated that the Board's conclusion that the Veteran was capable of sedentary occupations that require activities such as reading, writing, and answering the phone, appeared inconsistent with its discussion of the Veteran's work, history, education, skills, and training. The parties further stated that the Board must address whether the Veteran could secure and maintain a substantially gainful sedentary occupation given his history, education, skill, and training. The Veteran previously testified before the undersigned Veterans Law Judge (VLJ) at a July 2017 video conference Board hearing. While this matter relates exclusively to the period prior to October 2, 2015, the Board notes that, unfortunately, the Veteran passed away in February 2019. Subsequently, the appellant, the Veteran's wife, was recognized as a substitute claimant in April 2019. Following grant of the JMPR in December 2019, the appellant testified before the undersigned VLJ in a virtual Board hearing in January 2021. The Board acknowledges a letter from the Veteran's representative, dated and received December 3, 2020, which objected to a VA compensation and pension examination relied upon by the Regional Office in a prior denial of this matter. Without specifically providing any date on which an examination occurred or for what disability the examination related to, the representative stated that she objects to the examination report generally, but lacked sufficient information to make a more detailed objection because she was unable to determine the qualifications of the examiner from the record. However, the Board recognizes the objection and will rely only on facts other than what is documented in the VA examination reports during the relevant period in this determination. In VA Forms 21-8940 (Application for Increased Compensation based on Unemployability), the Veteran alleged that he was unemployable due to his service-connected disabilities prior to October 2, 2015. Specifically, during the July 2017 Board hearing, the Veteran testified that his PTSD, urinary incontinence, and loss of bowel and sphincter control caused his unemployability. The Veteran's representative contended that TDIU was warranted as of August 16, 2010, the date that the Veteran became service connected for a psychiatric disorder. At the January 2021 Board hearing, the appellant testified that the Veteran had to leave his prior employment as a driver for a transportation company in 2008, in part, because his mental health symptoms were becoming too difficult, specifically his ability to deal with people and maintain concentration. She stated that issues with incontinence created problems and embarrassment for the Veteran. The appellant also stated that these issues would prevent the Veteran from performing a sedentary position that required extended sitting, taking notes, and answering phones. TDIU Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the schedular requirements. Specifically, if there is only one such disability, the disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and enough additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Prior to October 2, 2015, the Veteran was service-connected for loss of bowel sphincter control, occasional, associated with urinary incontinence due to adenocarcinoma of the prostate, status post radical retropubic prostatectomy (30 percent disability rating from December 1, 1998); urinary incontinence due to adenocarcinoma of the prostate (60 percent disability rating from December 1, 1998); acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) (30 percent disability rating from August 16, 2010), duodenal ulcer with esophageal ulcer and hiatal hernia (20 percent disability rating from March 26, 1985); fracture of the nose with obstruction, left side (10 percent disability rating from June 23, 1977); sinusitis, maxillary, bilateral and ethmoid sinus (0 percent disability rating from June 23, 1977); and erectile dysfunction associated with urinary incontinence (0 percent disability rating from June 25, 2009). Based upon the above, the Veteran's combined disability rating during the relevant appeal period was 80 percent from December 1, 1998, and 90 percent from August 16, 2010. As such, the Veteran met the schedular criteria for a TDIU rating for the entire period on appeal. The Board notes that the Veteran was not service-connected for multiple other disabilities, such as hearing loss, headaches, gastroenteritis, eye problems, and malaria, which cannot be considered for purposes of consideration of entitlement to TDIU. "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16. In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts he personally observed or described; this includes recalling what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran was unable to secure or follow substantially gainful employment prior to October 2, 2015. The reasons follow. The Veteran reported that his last full-time work occurred in June 2008 as a driver for a transportation company. He would later indicate that he left this job because the business lacked the funds to continue to employ him and that he did not leave his last job due to disability. The Veteran testified in 2017 that he could not get other jobs as a driver due to his age. Treatment records do not indicate significant medical issues in 2008 that caused the Veteran to leave his job. The Veteran presented to a VA hospital with complaints of depression in January 2009. Although the Veteran was not service connected for a psychiatric disorder at this time, the Board will discuss this treatment to the extent it reflects on the Veteran's overall functioning during the relevant period. The Veteran reported worsening depression over the prior month. He stated that he was unable to sleep more than two hours a night, had low energy, decreased appetite, difficulty concentrating, and thoughts of hopelessness. He mentioned that he felt less depressed during the day when he was busy with his daily chores, but as the evening approached, his spirits went down. The Veteran mentioned several life stressors contributing to his symptoms, including 1) having two children addicted to drugs; 2) having a daughter who lived a lifestyle "which is not agreeable with the patient;" 3) having lost his daughter to cardiac arrest in 2008; 4) having lost his home in a fire in 2007; and 5) having financial difficulties during the recession. The Veteran stayed in the hospital for three nights, during which time he was prescribed medication and reported improved sleep. Despite the Veteran's reported symptomology, he exhibited relatively normal findings on mental status examination during admission. The Veteran was fully alert and oriented and had a coherent, linear, and goal-directed thought process; intact judgment and insight; no suicidal ideation; and no perceptual abnormalities. He was described as cooperative and able to establish good rapport with treating providers. The Veteran reported that he was able to continue functioning in his work as a part-time commercial fisherman. The Veteran reported improved depression and insomnia and was discharged home in stable condition. The Board notes that during the Veteran's hospitalization, the Veteran had no problems associated with urinary or fecal incontinence. While his history of prostate cancer was noted, the Veteran was found to have normal functioning in both the urinary system and gastrointestinal system. Providers specifically did not check boxes to indicate frequent urination, urine/stool incontinence, nocturia, diarrhea, or a change in bowel habits. The Veteran was documented to be independent in matters of self-care. On follow-up a week later, the Veteran reported that his strengths at the time were his faith and his employment as a commercial fisherman. In early February 2009, the Veteran reported improved depressive symptoms but continued sleep difficulties. On mental status examination, he exhibited calm, cooperative behavior, and was again found to have a coherent, goal-directed thought process, adequate impulse control, intact judgment and insight, and no psychomotor agitation. The Veteran exhibited generally stable functioning thereafter. During VA treatment in July 2009, the Veteran mentioned having occasional urinary "dribbling" with concomitant "rawness" in his groin area, which he was treating with an over-the-counter powder. Additionally, the Veteran reported that he urinated two to three times during the night and experiences occasional constipation. However, he did not indicate these issues interfered with his activities of daily living, and he described no gastrointestinal issues. The Veteran denied dysuria or any other changes in bowel or bladder habits. At this time, the Veteran also reported that daytime sleepiness was impacting his work as a driver, despite having generally reported that he no had not worked since mid-2008. The Veteran was seen by a VA urologist in March 2010, who recommended continuing current management and a one-year follow-up. In April 2010, the Veteran reported frequent urination during the daytime and twice at night. No mention was made of incontinence or limitations to the Veteran's general functioning. He denied dysuria or other changes in bladder or bowel habits. In November 2010, the Veteran presented to a VA mental health clinic after being absent for more than a year. The Veteran reported decreased functioning with low mood and poor sleep and further indicated that he was non-compliant with medication. The only reason he provided for discontinuing his medication was that he was "feeling better." Still, the Veteran presented as alert, well-oriented, calm, and cooperative, and he denied hopelessness and depressed feelings. He reported that psychosocial stressors with his family had ceased and that he had been forced to retire from his job due to medical issues. By March 2011, the Veteran had restarted his medication and, despite ups and downs, he reported improved depression and adequate sleep. The Veteran reported a decline in target symptoms and presented as calm, cooperative, and in good spirits. He stated that he spends most of his time fishing and gardening. During treatment in September 2011, a review of the gastrointestinal and genitourinary systems was unremarkable, and the Veteran noted no urgency, urinary frequency, nocturia, dysuria, diarrhea, constipation, or abdominal pain. He presented as calm, cooperative, and in good spirits. He was noted to be absent of target psychiatric symptoms and stated that he was doing well with nothing to complain about. The Veteran denied hopelessness, helplessness, or a depressed mood. He stated that he was functioning well without irritability, anxiety, anhedonia, or problems sleeping. He reported that he spends most of his time gardening and trapping. On follow-up in March 2012, the Veteran presented as calm, cooperative, and in good spirits. He reported that he was currently absent of depressive symptoms and denied hopelessness, helplessness, and depressed mood. He reported occasional problems with excessive worry and sleep problems but otherwise reported functioning well without irritability, anxiety, or anhedonia. He stated that he does much better when he takes the medication as scheduled. He again reported spending most of his time gardening and trapping. In July 2012, the Veteran reported relatively stable function, despite some "ups and downs" since his house again burned down a few months prior. He reported some decline in mood and functioning, but not for any extended period of time while on medication. He presented as alert, oriented, calm, cooperative, and in good spirits. He reported dealing with his current psychosocial stressors without excessive worry, mood swings or other problems and stated that he was "trying to find the good in a bad situation." During follow-up treatment at VA in July 2013, the Veteran presented as alert, well oriented, casually dressed and groomed, calm, cooperative and in good spirits. He reported that he was doing a lot better since he was able to get some sleep. He indicated he was currently absent of target symptoms and functioning well with minimal problems or complaints. He denied hopelessness, helplessness, depressed mood, irritability, anxiety, anhedonia, mood swings, sleep disturbances, or other problems or complaints. The Veteran stated that since his rest improved, other symptoms have ceased. He described being able to function in the community and was interacting well with family and others. The record reflects continued stable functioning through October 2015. In June 2014, the Veteran reported having some good and bad days with continued sleep difficulties, but he denied depressive symptoms and reported functioning well with no significant changes in psychosocial stressors. He again presented as alert, oriented, calm, and cooperative with a goal-directed and coherent thought process. Treatment records in August 2015 show that the Veteran had no genitourinary or gastrointestinal issues and denied urinary urgency, frequency, nocturia, diarrhea, constipation, dysuria, or abdominal pain. During treatment in September 2015, the Veteran reported that he was not taking any medication for his depression or insomnia. He reported approximately three hours of sleep nightly with occasional bad dreams. He said he currently takes no medication for depression or insomnia. The Veteran said he stays busy cooking, hunting, fishing, gardening, and spending time with family. He stated that he and his wife were raising his deceased daughter's two sons, ages 7 and 11. The Veteran stated that he used to be a commercial fisherman but now enjoyed fishing as a hobby and that he was a deacon in his church. Veteran said his anger was improved, but he could not tolerate crowds or loud noise. He stated that he loved people and that he was "friendly but not sociable" and that he enjoyed being alone but was not a loner. The Veteran was alert and oriented with good insight and judgment, no suicidal ideation, and no evidence of psychotic thinking. The Board notes that the Veteran and the appellant have generally not alleged that the Veteran's service-connected conditions relating to his history of hernia, sinusitis, fractured nose, and erectile dysfunction precluded him from employment during the relevant period. Treatment records are absent of regular treatment for these disabilities and do not indicate significant exacerbations prior to October 2015. In October 2015, the Veteran reported that hernia symptoms were not bothersome to him. Following the appellant's January 2021 Board hearing, the appellant submitted a private assessment from vocational consultant Shannon Hollander, MRC, CRC, in March 2021, based on a review of the record and a telephone interview with the appellant. The consultant opined that the Veteran was unable to secure and follow substantially gainful employment from at least August 16, 2010 due to his combined service-connected disabilities. The examiner provided a summary of certain treatment records, clinical findings, the Veteran's job history, and the consultant's interview with the appellant. The consultant also discussed the general requirements of sedentary work per the Dictionary of Occupational Titles. The consultant concluded: It is my vocational opinion that [the Veteran's] service-connected conditions render him unable to perform all employment, even sedentary unskilled work, to include his past occupations, which were light in physical demand. His past work did not provide any acquired skills that would have readily transferred to sedentary work. Due to frequent restroom breaks, fatigue, depression, panic episodes, and hypervigilance, [the Veteran] was more likely than not unable to maintain adequate concentration to remain on task and productive. Additionally, due to involuntary bowel movements and urinary incontinence requiring frequent and unpredictable restroom breaks he required unscheduled breaks beyond the regularly scheduled breaks, which was excessive and prevented him from maintaining adequate pace and productivity. He would have had difficulty performing the job duties of even sedentary work due to difficulty interacting with others due to isolation and irritability. As a result, it is my vocational opinion that, in combination with the limitations from his service-connected conditions, [the Veteran] did not possess the necessary skills or physical abilities to secure or follow any sedentary occupation, regardless of skill level or duties involved. The Board notes that determinations regarding employability are an issue reserved to the adjudicator based on a totality of the evidence of record and not on any one examination or opinion. However, the Board notes contradictions between the vocational consultant's opinion and the longitudinal record during the relevant period that limits its probative value and suggests the opinion does not accurately portray the Veteran's physical and mental abilities prior to October 2, 2015. It appears that that vocational expert was overly reliant on specific statements from the Veteran and appellant that indicated very severe symptomology that is otherwise not supported in the longitudinal evidence. To that end, while the Veteran and appellant are competent to report observed symptoms, their credibility has been diminished as a result of recurrent inconsistencies in the reporting of events relating to this TDIU claim. The Veteran submitted three, separate VA Forms 21-8940 during the relevant period, the first of which was received in May 2009. Therein, the Veteran reported that he last worked in June 2008 as a driver. He stated that the date that he became too disabled to work was also his last day of work in June 2008. When asked what service-connected disabilities prevent him from securing or following any substantially gainful occupation, he listed all of his service-connected conditions at the time, which did not include a psychiatric disorder. However, he reported that he did not leave his last job due to disability. He indicated that he had one year of college and no additional education or training. Just two months later, in the July 2009 TDIU application, the Veteran reported that that he last worked in 2008 and that he did not leave his last job due to his disability. The Veteran wrote that he left his last job due to lack of funds, which would indicate that someone had to be terminated and it was him. He reported that he became too disabled to work in January 2009, corresponding with his psychiatric hospitalization. He stated that he had one year of college education and additional training in industrial maintenance. Notably, when asked what service-connected disability prevented him from securing or following any substantially gainful occupation, the Veteran wrote "do not actually," which the Board understands to mean that the Veteran's service-connected disabilities did not preclude him from employment at that time, and that the Veteran attributed his unemployability to his psychiatric condition, for which he was not service-connected at the time. This is supported by his reported date of disability onset corresponding with his January 2009 hospitalization. However, these statements significantly contradict basic facts represented in the Veteran's prior application in May 2009. In a final TDIU application received in November 2010, the Veteran again reported that he last worked full time in June 2008 and that he did not leave his last job due to disability. When asked what service-connected disabilities prevent him from securing or following any substantially gainful employment, the Veteran wrote "all of them." He stated that his disabilities began to affect his full-time employment in January 2009 but did not indicate a specific date in which he became too disabled to work. He reported a high school education with 42 hours of college coursework and no additional education or training. These statements reveal substantial discrepancies relating to material facts that are relevant to TDIU consideration, including education/training, and what disabilities were impacting the Veteran's ability to work and when. The inconsistent facts documented in these applications damage the Veteran's overall credibility. Furthermore, the treatment record also contradicts the Veteran's reported work history and when he became too disabled to work. In January and February 2009, the Veteran reported that he was working part-time as a commercial fisherman. Treatment records in July 2009 indicate that the Veteran noticed that daytime sleepiness was causing difficulty with his work as a driver, which he previously reported to have last performed in June 2008. The appellant's testimony is also contradicted by the Veteran's past reporting and the evidence of record. At the January 2021 hearing, the appellant stated that the Veteran stopped working in 2008, in part, due to his mental health symptoms, including difficulty dealing with people and concentration issues. However, on multiple TDIU applications, the Veteran denied that he left his 2008 employment due to disabilities and stated that his employer did not have the funds to keep him. Additionally, the appellant originally suggested at the January 2021 hearing that the Veteran stopped working in 2015, and only recalled that he stopped working in 2008 when prompted by the representative. Despite reflecting on his employment history, she made no mention of his reported work as a commercial fisherman in 2009. Whether inadvertent or otherwise, these contradictions weaken the credibility of the Veteran and appellant, and, therefore, the vocational consultant's assessment which is heavily dependent on the facts reported by the Veteran and the appellant. For this reason, the Board finds the contemporaneous clinical findings of record along with the Veteran's statements made while seeking treatment to be more probative than the Veteran's testimony or the appellant's testimony made several years after the fact. The contemporaneous medical reports were made by medical professionals who personally observed the Veteran and the Veteran's contemporaneous report of his functioning during medical treatment is highly probative, as he made such statements while seeking medical treatment. Such statements tend to be exceptionally trustworthy. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The treatment records generally reflect relatively mild symptomology and do not indicate the severe level of impairment suggested by the appellant or the vocational consultant that the Veteran was precluded from all forms of substantially gainful employment. Notably, the consultant indicated the Veteran had difficulty socializing, dealing with others, and maintaining focus and concentration. However, the treatment records do not show the Veteran to having difficulty interacting appropriately and effectively with others. He was routinely reported to be calm, cooperative, and in good spirits, often despite concurrent depressive symptoms. Clinical findings did not include descriptions of irritability to impair the Veteran's social functioning. Although the Veteran did not like crowds, he indicated that he was friendly and loved people, even if he was not "sociable." He also reported serving as a deacon in his church. He described being able to function in the community and interacting well with family and others. The Veteran's recent work history included driving a bus, which would have required regular interaction with the public. He stated that he did not leave his prior work due to disabilities, even if he did not enjoy the interaction with the public. The record does not show inappropriate or antisocial behavior prior to October 2015. The Veteran was hospitalized for depressive symptoms and insomnia in 2009, prior to attaining service-connection for any psychiatric disorder. Even during this hospitalization, records reflect intact cognitive functioning and the Veteran reported that he was capable of maintaining his ongoing work as a commercial fisherman. Additionally, recurrent mental status examinations do not indicate the Veteran to have had significant difficulties maintaining concentration. Despite some depressive symptoms and sleep difficulties, the Veteran routinely was found to be fully alert and oriented with no cognitive deficits, intact insight and judgment, and a linear, coherent, goal-oriented thought process. He reported that he did not experience sustained periods of decreased mood or functioning while using medication. These issues did not prevent the Veteran from maintaining his activities of daily living, as indicated by his reporting that he filled his days with parenting, church, gardening, cooking, fishing, trapping, and hunting. Such findings do not support the conclusions of the vocational consultant. Likewise, the notion that the Veteran's loss of bowel control and urinary incontinence limited the Veteran physically, or kept him off-task so much that it would preclude employment, is not supported by the longitudinal treatment records prior to October 2, 2015. Rather, the Veteran rarely referenced these issues during his routine treatment records. The Veteran indicated that these issues did not cause him to leave his employment in 2008 and that driving was suitable for his symptoms. During his 2009 hospitalization, which covered multiple days, there was documentation of incontinence issues, and the Veteran was noted to have normal gastrointestinal and genitourinary functioning. Thereafter, the Veteran was not treated for exacerbations of these conditions to indicate a decrease in overall functional abilities through October 2, 2015. Instead, the Veteran generally required only annual check-ups with a urologist with routine, conservative management. On multiple occasions, including as recently as August 2015, the Veteran recorded no genitourinary or gastrointestinal issues and denied urinary urgency, frequency, nocturia, diarrhea, constipation, dysuria, or abdominal pain. Despite the vocational consultant's suggestion, treatment records do not show that the Veteran had issues with recurrent involuntary bowel movements, although he reported some occasional constipation. When the Veteran reported urinary incontinence during medical treatment, he mentioned occasional "dribbling." While the Veteran reported frequent daytime urination and nocturia about two to three times per night, he did not mention the need to change pads or clothing on a regular basis outside of his reporting on VA examination, as referenced in the vocational consultant's report. Regardless, the Veteran's reported activity levels did not show an inability to stay on task or perform certain physical activities. Such findings are not indicative that the Veteran would have been unable to maintain adequate production and pace. As stated, the Veteran reported that he served as a deacon at his church and filled his days primarily with parenting, gardening, trapping, hunting, and fishing. Accordingly, the preponderance of the evidence is against a finding that the Veteran was unable to secure or follow substantially gainful employment as a result of his service-connected conditions, and the assessment of the private vocational consultant is of little probative value. Regarding the Veteran's education, training, skills, and work history, the Veteran reported that he graduated high school and took some college courses but never obtained a degree. He also reported that he received industrial maintenance training from 1982 to 1984. The Veteran's work history included past work as a driver and commercial fisherman. The vocational consultant's report also indicated the Veteran to have experience as a staff attendant and security guard at a juvenile detention facility. The Veteran is not entitled to TDIU simply by demonstrating that he is not capable of his past work. Overall, the Veteran's diverse work history, education, and training demonstrate a capacity for learning, training, and adaptability that would not be hindered by his service-connected disabilities. Based on the Veteran's high school education, his history of college coursework, his history of jobs requiring public interaction, and his demonstrated communications with VA, the Board finds, without evidence to the contrary, that the Veteran was capable of sedentary tasks, such as reading, writing, and answering the phone. These are not specialized skills requiring vocational experience, but simple skills possessed by most entry-level workers and individuals who have completed high school and taken college courses. These attributes would have facilitated the Veteran's transition to a separate line of work that the Veteran was capable of performing prior to October 2, 2015. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges the Veteran required regular bathroom breaks and would experience some occasional urinary incontinence resulting in "dribbling," which was exacerbated by physical activity. However, the Veteran reported that his symptoms were conducive to his past work as a driver, which was performed above the sedentary exertional level, as described by the private vocational consultant. Additionally, the Veteran reported the ability to engage in a wide range of physical activities in spite of these symptoms, including gardening, fishing, hunting, cooking, and trapping. As such, the Veteran's symptoms, prior to October 2015, could be reasonably accommodated by restricting the Veteran to employment that he could perform primarily while seated, to include sedentary work, and which would provide ready-access to a restroom, as needed. Thus, the Veteran was physically capable of performing the requirements of substantially gainful employment during the relevant period. As to the Veteran's mental ability to perform substantially gainful employment, the Board acknowledges that, prior to October 2, 2015, the Veteran experienced recurrent depressive symptoms and sleep difficulties. He also reported that he did not like crowds. However, despite these issues, he was routinely found to be calm, cooperative, and in good spirits. He stated that he was friendly and loved people. He served as a deacon at his church and reported being able to function in the community and interacted well with family and others. Additionally, recurrent mental status examinations showed the Veteran was fully alert and oriented with no cognitive deficits, intact insight and judgment, and a linear, coherent, goal-oriented thought process. These findings all support that the Veteran would be capable of performing simple tasks associated with sedentary work. The Board finds that the Veteran's psychiatric symptoms could have been reasonably accommodated by restricting the Veteran from work in crowds or jobs requiring commercial driving, due to concerns over daytime sleepiness. As such limitations would not preclude all work, the weight of the evidence shows that the Veteran was mentally capable of performing substantially gainful employment. Based on the above assessment of the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the Board finds that the Veteran was capable of work that would result in income at the level of substantially gainful employment prior to October 2, 2015. For example, the Veteran was capable of performing jobs such as a telemarketer or customer service agent, where the employee makes or takes calls and primarily reads from a script, which does not require extensive training or experience, could be performed while seated, would allow the Veteran access to the restroom. A customer service agent interacts with customers to handle complaints, process orders, and answer questions. These positions can often be performed from home, while seated, with easy bathroom access. Additionally, the Veteran would have been qualified for certain sedentary positions, such as a church administrative assistant, that would require simple and routine levels of reading, writing, and telephone communication, not exceeding the physical and mental limitations described above. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran would have been able to perform. This is evidence against a finding that the Veteran was unable to obtain or follow all forms of substantially gainful employment due to his service-connected disabilities during the relevant period. For all these reasons, the Board finds the preponderance of the evidence is against a finding that the Veteran was precluded from securing or following all forms of a substantially gainful occupation due to his service-connected disabilities prior to October 2, 2015. As the preponderance of evidence of record weighs against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim of entitlement to a TDIU rating prior to October 2, 2015, is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Wonderling, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.