Citation Nr: 21029697 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-50 104 DATE: May 14, 2021 ORDER Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran has been unable to secure or follow a substantially gainful occupation by reason of service-connected disabilities during the appeal period. CONCLUSION OF LAW The criteria for entitlement to a TDIU rating have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2006 to October 2006. The Veteran submitted a VA Form 21-8940 (Application for Increased Compensation based on Unemployability) in April 2018. In February 2020, the Veteran testified at a Board of Veterans' Appeals (Board) virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. This matter was previously remanded in a February 2021 Board decision for further development and readjudication relating to an increased rating claim for major depressive disorder (MDD). The Board notes a mischaracterization in the February 2021 remand order, as readjudication of MDD was not necessary, having had a 70 percent disability rating restored just two months prior, based, in part, on the retrieval of outstanding records from the Social Security Administration (SSA). All other required development has been completed and the matter was returned to the Board for consideration on the merits. Accordingly, there has been substantial compliance with the remand directives and the matter is again before the Board. See Stegall v. West, 11 Vet. App. 268 (1998). At the February 2020 Board hearing, the Veteran testified that he had been out of work for five years due to the service-connected residuals of rhabdomyolysis, a muscle condition causing the breakdown of muscle tissue. The Veteran stated that this condition renders him unable to walk for long periods, prevents him from working out, and causes chronic pain. He indicated that he is unable to operate machinery or drive by himself. Additionally, the Veteran has stated that this condition has caused him to experience depressive symptoms due to his inability to work and reduced functional abilities, to the point that he reported experiencing "breakdown issues." 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). The Veteran is service connected for MDD associated with residuals of rhabdomyolysis, 70 percent disability rating from June 25, 2015; and residuals of rhabdomyolysis (also claimed as muscle disease), 0 percent disability rating from October 25, 2006, and 20 percent disability rating from June 29, 2020. Based upon the above, the Veteran's combined disability rating during the relevant appeal period was 70 percent from June 25, 2015, and 80 percent from June 29, 2020. As such, the Veteran's service-connected disabilities have met the schedular criteria for a TDIU rating for the period on appeal. "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 U.S. Court of Appeals for Veterans Claims (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 Veteran received a Social Security Administration (SSA) disability decision dated in March 2019, which found that he is disabled and unable to sustain full-time employment due to his combined impairments effective in September 2016. It is noted that such a finding is not binding on any determinations made by the VA. VA and SSA use different definitions and standards for determining disability and SSA also considers limitations from all disabilities, versus considering disabilities that are related to service or a service-connected disability. SSA specifically considered severe impairments of obesity, a somatoform disorder, alcohol abuse disorder, and osteoarthritis of the knees and shoulders, disabilities for which the Veteran is not service connected. While SSA records are considered in the totality of the evidence, no SSA decision is determinative relating to any finding made herein. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure or follow substantially gainful employment due to the service-connected disabilities. The reasons follow. The Veteran's rhabdomyolysis was the Veteran's cause for medical discharge after two months of active duty service in 2006. Since that time, the Veteran's symptoms have primarily been treated with medication management and prescribed painkillers. Although he has been limited from heavy exertional activities, the record does not generally demonstrate physical limitations that would prevent the Veteran from being able to work. For example, the Veteran has generally been found to ambulate independently with a steady gait and has remained independent in activities of daily living, including during VA hospital treatment in April 2018. The Veteran was noted to move all extremities, and he reported no active joint pain or swelling. He indicated that he was still capable of driving and was found to ambulate with no difficulty. The Veteran underwent a VA examination for assessment of muscle injury disability in May 2018. He was noted to have a non-penetrating muscle injury with no cardinal signs and symptoms of muscle disability. He was found to have full strength on muscle testing and no muscle atrophy. The examiner noted the Veteran to have only mild, persistent, asymptomatic elevated creatine kinase (CK) levels in his blood resulting from rhabdomyolysis. The examiner stated that the functional impact of the Veteran's muscle condition was that he was medically advised to avoid dehydration and strenuous exercise. He was further recommended to continue cardiovascular fitness with isotonic exercises and to avoid isometric exercises and prolonged workouts. Despite these medical recommendations, the Veteran reported jogging for exercise in September 2018. During treatment in April 2019, the Veteran reported that he cannot work out or walk for long periods due to chronic muscle and joint pain. The Veteran's rhabdomyolysis was described as mild, despite elevated CK levels and reduced renal function. In September 2019, the Veteran reported that some days he is energized to exercise, and some days he is not. On medical examination in October 2019, the Veteran was again noted to ambulate independently. During hospitalization in December 2019 for a separate issue, the Veteran was again noted to have elevated CK levels. He received intravenous (IV) fluids and his CK levels improved. His medications were adjusted, he was noted not to require acute care, and was discharged in stable condition. During the Veteran's hospitalization, he was noted to have no motor or sensory abnormalities, full muscle strength in all extremities, and no gait irregularities, balance impairment, or weakness. In February 2020, the Veteran was noted to be independent in activities of daily living and matters of self-care and to have no gait impairment. He continued to record normal sensation and full strength, and he was also found to have a pain-free and normal range of motion. The following month, he denied muscle aches and joint swelling/deformity. The Veteran injured his right wrist in April 2020 and reported that he felt weakness in his right hand thereafter; however, the Veteran did not indicate weakness/numbness in his opposite hand or either lower extremity. The Veteran underwent another VA examination for his muscle condition in June 2020. The Veteran stated that his residual symptoms of rhabdomyolysis were worsening and that he experienced muscle aches all over and that five minutes of walking would cause fatigue and tired muscles. The Veteran reported that he was hospitalized three times in the prior year for abnormally high enzyme levels in his blood. The Veteran was noted to have cardinal signs/symptoms attributable to muscle injuries, including weakness, loss of power, fatigue and/or pain, and lowered fatigue threshold. However, the Veteran was found to have full strength on muscle testing and he exhibited no muscle atrophy. The examiner stated that fatigue would render the Veteran unable to report to work or complete assigned tasks at least six times per month. This appears to be a recitation of the Veteran's reporting as no further rationale was provided. A concurrent VA examination for kidney disorder showed the Veteran to have renal dysfunction but no signs or symptoms or renal dysfunction. This included no frequent attacks of colic with infection; no symptomatic renal tubular disorder; no kidney, uretal, or bladder calculi; no neoplasms or metastases; no hypertension or heart disease due to renal dysfunction; and no need for regular dialysis. The examiner indicated that renal dysfunction does not impact the Veteran's ability to work. The Veteran underwent separate VA examinations the following month for the muscle and kidney disabilities. On examination for muscle injuries, the Veteran again was noted to have cardinal signs and symptoms of muscle disability, but to have full muscle strength and no atrophy. On examination of the kidneys, the Veteran's renal dysfunction was noted to have resolved and renal function had returned to normal. The examiner indicated that the Veteran's kidney disability did not impact his ability to work. In April 2018, the Veteran stated that he was unable to work due to being on prescribed oxycodone. Although the Veteran is prescribed painkillers, he has denied abuse of his medication. He has stated that medication makes him sleepy at times, but routine treatment records have routinely found the Veteran to be fully alert and oriented. The Veteran has generally reported his energy levels to be "ok" or "so-so" with relatively stable functioning over time. He has also denied concentration difficulties and has had his concentration described as adequate and intact on mental status examination. The Veteran has remained independent in his activities of daily living and has generally presented with intact cognitive functioning. While medication use may prevent the Veteran from the use of certain machinery, it does not appear to preclude the Veteran from all forms of substantially gainful employment. As to the Veteran's major depressive disorder, his mental health history is remarkable for multiple instances of involuntary inpatient treatment extending back prior to the relevant period, largely associated with episodes of alcohol abuse. The first such instance occurred in December 2015 when the Veteran was drinking alcohol and threatened to kill himself with a gun. The Veteran's wife called the police and the Veteran was handcuffed and tasered. Following detox prior to discharge, the Veteran described situational stressors and reported mood swings, racing thoughts, and difficulty sleeping without his medication. However, the Veteran was described as alert and cooperative with normal memory, attention, and concentration, no evidence of psychosis, intact judgment, and no suicidal ideation. A second such incident occurred in April 2018 when the Veteran was again taken to a VA hospital by police after threatening suicide at a family gathering. The Veteran reported that his mother and brother got in an altercation and he got caught in the middle of it. The Veteran was drinking, became upset by the argument, and threatened to stab himself. A neighbor reportedly called the police. The Veteran was admitted for suicidal ideation, anxiety, alcohol intoxication, and mood stabilization. Upon admission, the Veteran was anxious but in no apparent distress. He exhibited poor judgment and limited insight. However, he was cooperative, denied suicidal ideation and stated that he drinks only occasionally. He stated that he threated to kill himself as a dramatic statement wanting to talk to somebody about the stressors in his life. His judgment and insight were later assessed as unimpaired. A third incident occurred in April 2019, when the Veteran called emergency services and expressed suicidal ideation with no plan before hanging up. A wellness check was ordered and local police brough the Veteran to the emergency department under the Baker Act. The Veteran reported alcohol use and was admitted for observation. The following day, the Veteran reported doing well. He stated that he had been drunk, got in a fight with his brother, and locked himself in his car and called 911. He stated that he was not going to commit suicide and that he would never hurt his family by killing himself. The Veteran reported depressive and anxious symptoms, exacerbated by his physical disabilities. He stated that he is easily stressed and gets anxiety in crowded venues. He denied feelings of hopelessness or worthless and had intact cognitive functioning with intact concentration and memory. A final incident occurred in December 2019 when the Veteran got into a physical altercation with his stepson, the police were called, and the Veteran was again taken to the VA hospital for assessment. The Veteran reported that he was drunk but that he did not assault anybody and denied suicidal ideation. He denied any past suicidal behavior or attempts. He stated that he had a heavy drinking problem three years prior but that his drinking had slowed down. The Veteran was found to be alert, oriented, and cooperative with an organized thought process, no signs of psychosis, appropriate attention and concentration, and no abnormal psychomotor behavior. The Veteran's admission eventually turned voluntary as the Veteran stayed to receive treatment for physical issues. He was discharged after two days. The Board notes that these relatively isolated incidents, occurring four times in the past six years, were all associated with the Veteran's intoxication. In each instance, the Veteran quickly returned to baseline functioning with treatment, including intact cognitive functioning, cooperative behavior, and denial of suicidal ideation. VA examiners have indicated the Veteran's depressive symptoms to largely overlap with alcohol use and that one cannot differentiate between symptoms of his depression and alcohol use disorder without resorting to speculation. During the relevant period, however, treatment records show that the Veteran has significantly reduced his alcohol intake and the Veteran's history of inpatient admissions is not consistent with the Veteran's mental functioning predominantly demonstrated over the course of the relevant period. As discussed below, no examiner has indicated the Veteran's depression to entirely preclude employment. On VA examination in 2020, the Veteran denied a history of prolonged depressive symptoms lasting for weeks or more at a time, but indicated that depressive and anxious symptoms have been consistently present (but in a milder form) since he was diagnosed with muscle disease in the military. The Veteran's persistent symptomology primarily includes depression, anxiety, and irritability, exacerbated by his physical pain. In late 2017, the Veteran reported that he was looking for work and had applied to be a driver for a transportation company. Following his April 2018 hospitalization, records reflect relatively stable functioning and independence with his activities of daily living. He continued to report job-seeking efforts in early 2018. In November 2018, the Veteran reported that he was planning on returning to school through vocational rehabilitation with VA. Treatment records in January 2019, described the Veteran as pleasant and he reported "doing ok mentally." He indicated that he was continuing to work on paperwork for school attendance. During a counseling session in June 2019, the Veteran reported that he was doing "pretty good." He reported that he was thinking about going to school for culinary arts. He discussed fishing with his family and getting good sleep, reported that his drinking had slowed down, and that he needs to be more active and to have things to occupy his time. The Veteran's wife also reported that the Veteran had reduced his alcohol consumption and that he was "doing okay" overall. The Veteran was described as cooperative and exhibited a euthymic mood, fair judgment, and no suicidal ideation. The Veteran applied for vocational rehabilitation through VA in June 2019. Treatment records from September 2019 show that the Veteran was alert, oriented, and cooperative with no abnormal behavior, no psychosis or delusions, an organized thought process, appropriate attention and concentration, adequate judgment and insight, and no suicidal ideation. He reported good familial relationships and stated that he goes out fishing and plays video games. In October 2019, the Veteran signed a vocational rehabilitation plan with a goal of becoming a social worker and completing a bachelor's degree in psychology by October 2023. The Veteran underwent a psychological VA examination in October 2019. The examiner stated that, given the chronicity, progressiveness, and comorbidity of the Veteran's diagnoses, it is not possible to separate the individual effects of the Veterans depressive and alcohol use disorders without resorting to speculation. The Veteran reported depressive and anxious symptoms, but indicated that he and his family enjoy going fishing and to the movies, cookouts, and the beach. He reported his intent to begin attending school through vocational rehabilitation. On mental status examination, the Veteran's interpersonal interaction was appropriate, he was alert and oriented, and he exhibited intact attention and concentration, adequate insight and judgment, normal memory, a goal-directed and linear thought process, and no suicidal ideation. The examiner stated that the Veteran's condition was best characterized by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Records in the following months indicated that the Veteran was taking college classes. In December 2019, he reported that he was attending school and rarely drinking. Treatment notes stated that the Veteran was currently in college and that he was independent in activities of daily living. However, at some point in early 2020, the Veteran withdrew from school. During discussion with a social worker in March 2020, the Veteran stated that he stopped going to school and that his anxiety was too high and he could not complete the process of starting school. The social worker noted that the "Veteran reports he is waiting on letter from judge to see if he will get approved to be unemployable." The Veteran's observed mental functioning was otherwise unremarkable and the Veteran did not indicate any acute stressors. The Veteran's unremarkable findings on mental status examination continued the following month. The Veteran reported that his mood was "ok" and his motivation was good. Acute symptomology was not found. The Veteran underwent another VA psychological examination in July 2020. The Veteran reported continued depressive symptoms and sleep difficulties, relating to his physical health problems. The Veteran recounted his most recent hospitalization in December 2019, which he described as lasting two weeks. The Veteran was oriented and his behavior was appropriate. His thought process was appropriate and he did not appear confused. The examiner described the Veteran's disability to be characterized as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. In August 2020, the Veteran indicated that he was interested in becoming involved in community activity, including employment. He showed no signs of cognitive impairment, was noted to function independently, and stated that he gets along with his neighbors and landlord. Records continued to indicate no significant exacerbations of the Veteran's condition or excessive alcohol use. The Veteran underwent a final VA psychological examination in December 2020. He reported continued depressive symptoms with decreased motivation and social interaction. On examination, his behavior was appropriate and psychomotor function was unremarkable. He was described as polite and cooperative. The Veteran exhibited an organized and goal-directed thought process. His insight was adequate but his judgment "appeared potentially compromised based on his behavioral history (i.e., while drinking)." He denied suicidal ideation and his attention and concentration were adequate. He indicated that he could complete basic activities of daily living, as long as his pain symptoms are manageable. The examiner characterized the severity of the Veteran's disability as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Treatment records from early 2021 reflect continued stable functioning with no acute symptomology. As an initial matter, the Board notes that the Veteran's symptoms of pain and psychiatric symptoms are subject to a degree of subjectivity and the Veteran's reporting of his symptoms would be an important consideration in determining his overall functional capabilities. However, while the Veteran is competent to report his observed symptoms, inconsistencies in the Veteran's statements over time have reduced his overall credibility. In an April 2018 TDIU application, the Veteran reported that he became too disabled to work in October 2010, the same time of his last reported full-time employment as a driver. The Veteran reported that that PTSD, a muscle disorder, and back and knee disabilities prevented him from securing or following substantially gainful employment. In a July 2020 TDIU application, the Veteran reported that obstructive sleep apnea also prevents him from securing gainful employment and that he became too disabled to work in September 2016. He also reported that he had not attempted to obtain employment since he became too disabled to work. The Veteran reported that he completed one year of college. In an August 2020 TDIU application, the Veteran reported that he last worked full time as a driver for TransAm Trucking in September 2013, although he reported continued employment with the company through September 2015, and that he became too disabled to work in September 2016. He again reported that he had not attempted to obtain employment since his last full-time work. These applications contain internal inconsistencies relating to basic facts central to the Veteran's TDIU claim, including what disabilities prevent the Veteran from working, when he last worked, and his attempts at seeking employment thereafter. The Board notes that the Veteran is not service connected for sleep apnea or arthritic conditions of the back or knees. Contrary to the Veteran's 2020 TDIU applications, the Veteran's 2018 application states that the Veteran did seek employment as a driver after the date that he reported becoming too disabled to work. Contrary to the Veteran's 2018 application, the Veteran subsequently reported that he worked as a truck driver until at least 2015. A letter from TransAm Trucking, Inc. states that the Veteran was a contractor who hauled loads for the company and ceased his work for the company in August 2016. Additionally, the Veteran testified at his February 2020 hearing that he was hospitalized for one and a half weeks in December 2019 due to elevated CK levels. At his July 2020 VA examination, he stated that the December 2019 hospitalization was for two weeks for suicidal ideation. However, a discharge summary from the Veteran's December 2019 hospitalization shows that he was hospitalized for two days. The Veteran was not hospitalized for symptoms relating to his residuals of rhabdomyolysis, but was involuntarily committed relating to a domestic altercation during a period of alcohol abuse. On VA examination in June 2020, the Veteran reported that he was hospitalized three times in the past year for rising CK levels; however, this is not shown by the evidence of record. Furthermore, as stated by the October 2019 VA examiner, the Veteran's medical history is remarkable for multiple instances of psychological testing that confirmed the presence of patient misrepresentation of symptoms, or malingering. The examiner noted the Veteran's prior treatment records to show that the Veteran responds to cognitive questions in a manner that is "attempting to portray themselves as impaired when they are not or more impaired than then are." The Veteran was further noted to present as a person who "somaticizes psychological complaints and presents with a style suggestive of overreporting of symptoms. It is unclear if the response style is suggestive of deliberate deception (secondary gain has been identified by the pt as financial) or a possible cry for help." A validity test administered by the October 2019 examiner was in the borderline range, indicative of potential over-reporting of symptoms. As noted, the Veteran has reported expressing suicidal threats for dramatic effect when otherwise denying suicidal ideation. The Veteran also suggested that he was waiting for a TDIU determination before deciding whether to pursue additional educational opportunities in the future. Whether deliberate or not, such findings are detrimental to the Veteran's credibility and lessen the probative value of assessments that are based primarily on the Veteran's self-reporting. More probative value is assigned to concurrent medical findings made during treatment that reflect the Veteran's functional capabilities over the relevant period. Despite the Veteran's pain and fatigue symptoms, he has generally been found to have full strength, normal sensation, and a normal gait, and he has maintained independence in activities of daily living. The Veteran has received IV treatment to manage blood enzyme levels, but has generally been advised to simply stay hydrated and avoid heavy physical exertion. Other than a few acute exacerbations of the Veteran's psychological symptoms during the relevant period, associated with alcohol use, the Veteran's overall functioning has been generally stable. Despite ongoing anxious and depressive symptoms with some sleep difficulties, the Veteran has predominantly been found to be alert, oriented, and cooperative, with appropriate behavior, intact attention and concentration, adequate insight and judgment, normal memory, a goal-directed and linear thought process, and no suicidal ideation. Additionally, the Veteran has reported continued interest in employment and educational opportunities during the relevant period, indicating that he believes he could be physically and mentally capable of work as a social worker or in the culinary arts. He has reported jogging, going fishing, and going to movies, the beach, and cookouts. The preponderance of the evidence is against a finding that the Veteran is incapable of securing or following a substantially gainful occupation. Regarding the Veteran's education, training, skills, and work history, the Veteran reported that he graduated with his high school diploma in 2001. Upon graduation, the claimant enrolled in Lincoln Technical College to study AC/Refrigeration. He remained in school for one year. The veteran was working in a warehouse and a restaurant between the time that he left Lincoln Technical College and enlisted in the military. The Veteran worked as a truck driver with his CDL after service discharge and has reported that he last worked in 2015. Treatment records indicate that the Veteran could not retain his CDL due to his history of involuntary psychological inpatient admissions. The Veteran was enrolled in college courses, seeking to become a social worker in late 2019, but later reported that he stopped going to school due to high anxiety. Overall, the Veteran's work history and his education record demonstrate a capacity for learning, training, and adaptability that would not be hindered by his service-connected disabilities. These attributes would facilitate the Veteran's transition to a separate line of work that the Veteran is capable of performing. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges that the Veteran experiences recurrent pain symptoms and fatigue with repetitive and sustained physical exertion. However, treatment records predominantly reflect the Veteran's to have a normal gait, full strength, intact sensation, and a pain-free range of motion. He has demonstrated independence in his activities of daily living, the ability to ambulate independently, and to engage in activities such as fishing and jogging. The totality of the evidence shows that the Veteran is capable of performing work at least at the sedentary exertional level. Additionally, the Veteran should not work with heavy machinery or jobs that require commercial driving due to his dependence on pain medications for symptom management. The Department of Labor's DOT defines sedentary work as exerting up to 10 pounds of force occasionally (i.e. up to one third of the time), and/or a negligible amount of force frequently (i.e. from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. According to the DOT's definition, sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. This definition is consistent with the terminology used in the Veteran's SSA disability records and the Board finds no prejudice to the Veteran in considering the definition for purposes of deciding this claim. The longitudinal record indicates that the Veteran is capable of sedentary work. Accordingly, the weight of the evidence shows that the Veteran is physically capable of performing substantially gainful employment. As to the Veteran's mental ability to perform substantially gainful employment, the Veteran experiences fluctuating depressive and anxious symptoms, often associated with his physical pain symptoms. However, these symptoms have generally not resulted in significant functional limitations when the Veteran is not using alcohol. The Veteran's alcohol use has decreased in recent years and he has not required treatment resulting from alcohol use in approximately 17 months. The Veteran has routinely been described as exhibiting cooperative with appropriate behavior. He has reported getting along with neighbors and his landlord. He has demonstrated the ability to function effectively in public and to do community activities, such as shopping, and going to the movies, the beach, and cookouts. The Veteran's mental status examinations generally reflect the Veteran to be fully alert and oriented with a logical and goal-directed thought process, no perceptual abnormalities, intact memory, cognition, attention, and concentration, and no suicidal ideation. The Veteran has been found to have limited insight and judgment at times and has expressed anxiety and difficulty functioning during periods of increased stress. Accordingly, it appears that the Veteran's psychiatric symptoms can be reasonably accommodated by restricting the Veteran from jobs involving executive decision-making and managerial or supervisory duties. As such limitations would not preclude the Veteran from all forms of substantially gainful employment, the weight of the evidence shows that the Veteran is 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 is capable of work that would result in income at the level of substantially gainful employment. For example, the preponderance of the evidence is against a finding that the Veteran's service-connected disabilities would preclude him from jobs that involve data entry. With data entry, the Veteran is primarily responsible for entering data into a system. These jobs can usually be done from home without significant training or experience. These occupations require very little exertional effort. Based on the Veteran's education history, his recent college experience, and intact cognitive functioning, the Veteran has, or is capable of quickly gaining, the basic computer skills needed for such a position. Alternatively, there are jobs that can be performed at home, such as a telemarketer, where the employee makes calls and reads a script, which does not require extensive training or experience, and would require minimal exertional activity. Similarly, 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. The Veteran also appears capable of performing certain cashier positions, or work as a library, theater, or museum attendant, positions that would not exceed the demands of sedentary work and would involve only simple and repetitive tasks. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran could perform. This is evidence against a finding that the Veteran is precluded from 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 is precluded from securing or following all forms of substantially gainful occupation due to his service-connected disabilities. As the probative 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 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.