Citation Nr: 21030168 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 18-49 654 DATE: May 18, 2021 ORDER An effective date prior to April 4, 2013, for the grant of service connection for sarcoidosis is denied. A 30 percent rating, but no more, for sarcoidosis is granted, subject to the payment of monetary benefits. A separate 10 percent rating for cirrhosis of the liver as a manifestation of sarcoidosis is granted, subject to the payment of monetary benefits. Service connection for bilateral hearing loss is denied. A total disability rating due to individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran had active duty from July 1968 to April 1970. 2. The Veteran filed a claim for service connection on April 4, 2013, for lung and liver lesions; service connection for sarcoidosis was granted the date of the claim. 3. Sarcoidosis manifested by frequent coughing spells, treated by daily use of inhaler and occasionally prescribed corticosteroids; sarcoidosis also manifested by cirrhosis of the liver, with right sided abdominal pain. 4. A current diagnosis of bilateral hearing loss has not been shown. 5. The Veteran's service-connected disabilities do not preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to April 4, 2013, for the grant of service connection for sarcoidosis have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.157, 3.400 (2020). 2. The criteria for a 30 percent rating, but no more, for sarcoidosis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.10, 4.21, 4.97, Diagnostic Codes (DCs) 6600, 6846 (2020). 3. The criteria for a 10 percent rating for cirrhosis of the liver as a manifestation of sarcoidosis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.10, 4.14, 4.21, 4.97 DC 6600, 4.114 DC 7312 (2020). 4. Bilateral hearing loss was not incurred in service. 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2020). 5. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1110, 1521, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Although new VA-generated evidence has been added to the claims file since last adjudication of the Agency of Original Jurisdiction (AOJ), in a March 2021 correspondence the Veteran waived AOJ jurisdiction and expressed he wished the Board to consider the evidence in the first instance. The issue of entitlement to a TDIU has been added to the claims file as associated with his increased rating claim for sarcoidosis, as the Veteran claimed he was unable to work in part due to this disability. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Effective Date Turning to the relevant laws and regulations, unless specifically provided otherwise in the statute, the effective date of an award based on an original claim for compensation benefits shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101(a). A "claim" is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit. 38 C.F.R. §§ 3.1(p), 3.151. The essentials for any claim, whether formal or informal, are: 1) an intent to apply for benefits; 2) and identification of the benefits sought; and 3) a communication in writing. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). The date of a receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). The Veteran is currently assigned an effective date of April 4, 2013, for the effective date of service connection for sarcoidosis. That date corresponds to the date the VA received the claim for service connection. As he separated from service in April 1970, he is not entitled to an effective date within one year of his discharge from service. The Board has considered statements from the Veteran that sought treatment at a VA facility in 1970 for vitiligo, and a reportedly medical professional told him it was cosmetic and not something he could file a claim for. However, the appeal he is seeking an earlier effective date for is sarcoidosis, not vitiligo. He was not diagnosed with sarcoidosis until many years after separation from service. Thus, regardless of whether his statements are accurate, the effective date of service connection is the date of filing or the date entitlement arose, whichever is later, and in 1970 he did not have a current disability of sarcoidosis, which was first diagnosed over thirty years after separation. Additionally, a review of the record fails to show any correspondence that could be construed as a claim for sarcoidosis prior to April 4, 2013. Therefore, the claim for an earlier effective date is denied. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Sarcoidosis, Respiratory The Veteran claims he is entitled to a compensable rating for sarcoidosis. The respiratory symptoms may be rated under DC 6846 for sarcoidosis or DC 6600 for chronic bronchitis. To warrant a higher rating, the evidence must show: Forced Expiratory Volume in one second (FEV-1) of 71- to 80-percent predicted, or; FEV-1/Forced Vital Capacity (FVC) of 71 to 80 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) 66- to 80-percent predicted (10 percent under DC 6600); FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted (30 percent under DC 6600); pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids (30 percent under DC 6846); FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit) (60 percent under DC 6600); or, pulmonary involvement requiring systemic high dose (therapeutic); or, corticosteroids for control (60 percent under DC 6846). Turning to the evidence, first examining whether a higher rating under DC 6846 is warranted, August 2019 and March 2020 VA examiners both found pulmonary involvement of sarcoidosis. The April 2019 VA examiner listed chronic hilar adenopathy, stable lung infiltrates, and night sweats as associated with sarcoidosis, which required daily treatment with inhalational anti-inflammatory medication. The Veteran also described during the examination that he had a chronic cough, with coughing attacks whenever he became overheated, and shortness of breath after walking up a flight of stairs or walking a mile. The March 2020 VA examiner found the same symptoms as well as persistent symptoms of a cough. The March 2020 VA examiner found that the Veteran treated his symptoms with daily inhalational bronchodilator medication, as well as oxygen therapy at night for sleep. A review of private medical record show occasional treatment for sarcoidosis and upper respiratory symptoms with corticosteroids. September 2009 private treatment records show he was prescribed both antibacterial and steroid medication for respiratory symptoms. A September 2020 private medical record contained a review of his sarcoidosis treatment and the medical professional summarized it was improved by use of steroids. A March 2021 private medical assessment found that the Veteran was on multiple steroids and had progressively worsening symptoms. His medication was listed as albuterol, breo ellipta, budesonide, and montelukast. In totality, the record shows some use of prescribed steroids to treat respiratory symptoms, and VA examiners, private physicians, and lay evidence all show persistent symptoms, mainly a cough. As such, the medical evidence supports a 30 percent rating under DC 6846 for pulmonary involvement with intermittent corticosteroids. Nonetheless, the same evidence cited above fails to show that systematic, high dose (therapeutic) corticosteroids are used for control of sarcoidosis which would warrant a rating in excess of 30 percent. Rather private medical records show occasional use for symptom flareups. Additionally, although he has consistently reported night sweats in VA examinations, private, and VA medical records, and they are a symptom associated with a 100 percent rating for sarcoidosis, he has not exhibited the progressive pulmonary disease with fever, and weight loss despite treatment also required for that rating. The Veteran stated in March 2021 that the record showed weight loss, cardiac symptoms, and fever; however, the record does not show such symptoms. As such, a rating of 30 percent, but no more, is warranted under DC 6846. Additionally, a rating in excess of 30 percent under DC 6600 is not warranted. The August 2019 VA examiner measured pulmonary functionality as FVC 75; FEV-1 88; FEV-1/FVC 74; DLCO 92, with DLCO being the best reflection of his disability. The March 2020 VA examiner relied on the same test results but found the FEV-1/FVC to best reflect the Veteran's level of impairment. In this case, the PFTs are not sufficient to warrant the next highest rating under DC 6600 of 60 percent. Neither examiner conducted exercise capacity testing, so maximum oxygen consumption capability has not been measured; however, a review of the VA and private medical records failed to show either oxygen consumption capability or pulmonary functions measured as sufficiently impaired to warrant a rating of 60 percent under DC 6600. As such, the medical evidence does not support a higher rating on this basis. In sum, a 30 percent rating under DC 6846, but no more, is warranted. Sarcoidosis, Liver Extra-pulmonary manifestations of sarcoidosis are to be rated under the body system involved. Here, the Veteran's initial claim was for lesions of the lung and liver. An August 2019 VA examiner assessed the Veteran's liver, with the only listed diagnosis as sarcoidosis. Given the original claim was lesions of the lung and liver, and was recharacterized as sarcoidosis when service connected, and the diagnosis for both the lung and respiratory examinations was sarcoidosis, the grant of service connection thus should encompass its manifestation of his liver. The symptomatology best corresponds to DC 7312 for cirrhosis of the liver, biliary cirrhosis, or cirrhotic phase of sclerosis cholangitis. To warrant a compensable rating under DC 7312, the evidence must show: cirrhosis of the liver with symptoms such as weakness, anorexia, abdominal pain, and malaise (10 percent); or, cirrhosis of the liver with portal hypertension and splenomegaly, with weakness, anorexia, abdominal pain, malaise, and at least minor weight loss (30 percent). Turning to the evidence, an August 2019 VA examiner found that the Veteran had sarcoidosis. The examiner referenced a March 2012 chest CT scan suggesting underlying cirrhosis, but a subsequent liver biopsy demonstrated mild steatohepatitis. The Veteran reported intermittent right upper quadrant pain and the dietary restriction of no alcohol. However, private medical records show that he had a confirmed diagnosis of cryptogenic cirrhosis from September 2016. Thereafter, private medical records continue to show monitoring of the Veteran's liver cirrhosis, and right-sided abdominal pain. Given the evidence of cirrhosis, and the continued complaints of right quadrant abdominal pain, a separate 10 percent rating under DC 7312 for the manifestations of sarcoidosis in the Veteran's liver is well supported by the evidence. However, the August 2019 VA examiner, and both private and VA medical records failed to document the portal hypertension and splenomegaly, with weakness, anorexia, malaise, and at least minor weight loss associated with the next highest 30 percent rating. As such, the medical evidence supports a separate 10 percent rating for the manifestations of sarcoidosis in the liver. In granting a higher rating for respiratory complaints and a separate rating for liver involvement, the Board has considered the Veteran's lay statements as well as the medical findings. In sum, a 30 percent rating is warranted for the respiratory symptoms of sarcoidosis, and a separate 10 percent rating is warranted for liver manifestations. Service Connection Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Turning to the evidence, the first element of service connection a current disability is not met, as the evidence fails to show that the Veteran has hearing loss as a disability in either ear for VA purposes. In a May 2016 VA examination, the Veteran reported no functional impact of hearing loss. The examination report shows that the pure tone thresholds, in decibels, were reported as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 20 20 25 25 LEFT 20 15 20 30 30 The average pure tone threshold was 23 in the right ear, and 24 in the left ear. Speech audiometry revealed speech recognition ability of 100 percent bilaterally. During an August 2019 VA examination, he reported that his hearing loss could be frustrating, and that on occasion he misunderstood his wife, especially with background noise, although overall felt he could hear fairly well, but thought he was heading in the direction of hearing difficulties. The pure tone thresholds, in decibels, were reported as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 20 25 25 20 35 LEFT 25 25 20 25 35 The average pure tone threshold was 26 in the right ear, and 26 in the left ear. Speech audiometry revealed speech recognition ability of 98 percent in the left ear and 100 percent in the right ear. A review of the private and VA medical records fail to show a qualifying audiological evaluation other than those contained in the examinations above. Although a separate VA examination evaluating the functional impact of tinnitus was undertaken Aon pril 2021, a full audiological evaluation was not conducted. As such, the evidence does not show that the Veteran experienced auditory thresholds in any of the applicable frequencies of 40 decibels or greater; or the auditory thresholds for at least three of the frequencies at 26 decibels or greater; or speech recognition scores using the Maryland CNC Test that were less than 94 percent, in either ear. Thus, the first element is not met of a current disorder, and service connection is denied. The Board has considered the Veteran's lay statements and Board hearing testimony that that his disorder was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to whether he has hearing loss as defined by VA regulations due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16. Substantially gainful employment is that employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment will not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned, if the scheduler rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40 percent or more and the combined rating is 70 percent or more. 38 C.F.R. § 4.16(a). The central inquiry is whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). As of this decision, the Veteran is service connected for sarcoidosis at 30 percent, an anxiety disorder with posttraumatic stress disorder (PTSD) at 30 percent from October 4, 2018 and 50 percent since September 21, 2020, vitiligo at 10 percent from April 4, 2013, now manifestations of sarcoidosis in the liver, tinnitus at 10 percent from June 17, 2014, and migraines at 10 percent from October 4, 2018. The combined rating, including with the issues granted above, was 40 percent from April 4, 2013, 50 percent from June 17, 2014, 70 percent from October 4, 2018, and 80 percent from September 21, 2020. Service connection for the Veteran's psychiatric disability and migraines were granted as secondary to his service-connected sarcoidosis and are therefore derived from the same etiology. Thus, the combined rating of sarcoidosis, liver manifestations of sarcoidosis, migraines, and psychiatric disability are considered one disability for the purposes of assessing TDIU eligibility. Therefore, he meets the requirements of as of October 4, 2018, but that is not the end of the analysis. When a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities but fails to meet the percentage requirements for a TDIU, the case may be referred to the Director, Compensation Service (Director) for consideration of assignment of a TDIU on an extraschedular basis. 38 C.F.R. § 4.16(b). However, the evidence does not support that his disability picture was so exceptional that the case should be submitted to the Director for extraschedular consideration. A review of his medical records fails to show that the Veteran was hospitalized for sarcoidosis, vitiligo, or tinnitus at any point during the appeal period. Additionally, there are limited records showing that he missed work, and he had not been fired from work for any of those disabilities. Rather, he retired from a full-time work due to age, not disability, in 2010. A May 2016 VA examiner found that tinnitus had no functional impact. There are no other VA examinations that evaluate the functional impact or symptomatology of any of the relevant disabilities during the period prior to October 4, 2018. Although outside this period, an August 2019 VA examiner found that although he was retired, he would have lost 0-1 weeks of work time in the last twelve months due to sarcoidosis, and that he would be unable to perform a job that required strenuous physical activity due to shortness of breath and cough from sarcoidosis. The Veteran submitted a June 2014 statement about how his skin condition and breathing made it difficult to find employment and submitted a number of March 2018 statements in which colleagues and friends detailed his severe coughing. Collectively, both medical and lay evidence fail to show an exceptional disability picture, excessive lost time from work, that he was fired, or that he was frequently hospitalized for any of his service-connected disabilities for this period. The Veteran also maintained a part-time job, and while it is unclear the hours he works (March 2021 application for TDIU claimed 10 hours per week, but the employer responded in April 2021 that he worked 20-25 hours per week the prior year). Part time work is not substantially gainful employment, but taken with the other evidence of record, his service-connected disabilities do not rise to the level of functional impairment such that referral for extraschedular consideration prior to October 4, 2018, is warranted by the evidence. Turning next to the period since October 4, 2018, there is some disparity as to the amount the Veteran was actually working during this time period. In the application for a TDIU in March 2021, he claimed he was working 10 hours per week, but the employer responded in April 2021 he was working 20-25 hours per week on average, with his last date of employment on September 15, 2020. That same form said the reason the Veteran was not working was an inability to grasp tools and lung issues, possible use as a trainer. It is unclear from that document whether he was thus terminated, in some part due to his service-connected sarcoidosis, or whether he stopped working voluntarily it had just been an impediment to his work while employed. In a September 2020 VA examination, the Veteran stated he had been offered a temporary, but full-time consulting position with the employer he had retired from in 2010, which he had accepted. Thus, it would appear from the record that he was not terminated due in part for sarcoidosis but instead decided to take the full-time job. Given that he described it as temporary, it is unclear if he was still working in that position, or how long he worked for, or his salary. As for education, he told a September 2020 private physician the he had an associate degree in business management and some vocational training in carpentry and masonry. As for his disabilities, the functional impact of his sarcoidosis has been described both earlier in this section and the increased rating section of the appeal. An August 2019 VA examiner found that although he was retired, he would have lost 0-1 weeks of work time in the last twelve months due to sarcoidosis, and that he would be unable to perform a job that required strenuous physical activity due to shortness of breath and cough from sarcoidosis. A March 2020 VA examiner found that it caused functional impairment that limited his daily activity, anytime he used more energy or physical activity he ended up with extreme coughing, shortness of breath. Thus, he would be unable to perform a job which required physical activity due to shortness of breath and cough from sarcoidosis. This level of functional impairment is generally reflected in his VA and private treatment records. Although, August 2014 VA medical records how he used to frequently exercise but had been difficult due to a knee replacement surgery, rather than sarcoidosis, and December 2020 private medical records showed that he was able to use the elliptical and workout without issues but had difficulty when working hard with warm weather. Private and VA medical records consistently show coughing, with occasionally severe coughing fits, as the primary respiratory symptoms associated with sarcoidosis. The Veteran also submitted various lay statements that relay witnessing his coughing fits. Next, as to the manifestations of sarcoidosis in the liver, an August 2019 VA examiner found no functional impact caused by the liver symptomatology. The Veteran reported some right upper quadrant pain, and could not drink alcohol, but a review of his VA and private treatment records fails to show any additional functional impact from this disability. Turning next to his psychiatric disability, an October 2019 VA examiner found that the Veteran's symptoms of depressed mood, anxiety, and chronic sleep impairment caused 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. During a September 2020 VA examination, the VA examiner noted symptoms of depressed mood, anxiety, panic attacks more than once a week, chronic sleep impairment, mild memory loss, and suicidal ideation. The Veteran endorsed having fleeting suicidal ideation thoughts, however, he did not have a plan or intent to complete. The Veteran described that prior to retiring from his full-time job in 2010, he had good work performance, with good coworker, customer, and supervisor relationships. He stated he made good friends at work. As noted above, he also told the examiner that he was offered a temporary consulting position with that same organization that year which he accepted, with full-time hours. The examiner assessed his psychiatric symptoms as causing 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. In August 2020, the Veteran was evaluated by a private medical health professional, who found multiple symptoms including an difficulty in establishing and maintaining effective working relationships an inability to establish and maintain effective work and social relationships, persistent delusions or hallucinations, grossly inappropriate behavior, neglect of personal appearance and hygiene, among many others, not all consistent with one another. The Veteran reported that he had retired from his former job in 2010 and had skin pigmentation issues and nightmares. He further stated he had taken odd jobs to stay busy, but needed inhalers constantly because if he became overheated, he could not breathe. Additionally, he continued that the frustration of being denied jobs and opportunities because of how he looked different greatly affected him, to the point where it led to feelings of suicide. The Veteran related that he bathed that day, heard mumbling and whispering sounds in adjacent rooms, had some panic attacks and strong paranoia and suspiciousness. As for ritual behaviors, he described locking doors and putting objects there that would be knocked over if door opened and was concerned about intruders. He also discussed insomnia and nightmares. The evaluator noted the he exhibited speech that was low and slow, with his affect sad, and mood depressed. The evaluator also reasoned he was at an increased risk at harming others due to low frustration tolerance which causes angry outbursts but not at increased risk for self-harm. The Veteran received treatment for his psychiatric symptoms at the VA for a period in 2014. His symptoms can be summarized a depressed mood, anxiety, and chronic sleep impairment. He also called in August 2017 about symptoms of yelling and isolation but declined to come into the VA facility for mental health treatment. As for his service-connected migraines, the Veteran told a November 2020 VA examiner that he had migraine headaches occurring approximately every two weeks, lasting 1-2 days and requiring prostration. He claimed he experienced an aura, nausea and vomiting, with sensitivity to light and sound. This was managed by his primary care physician (PCP) with over the counter medication. His PCP had ordered several brain scans with no abnormal findings. The examiner agreed that this description of headaches was prostrating, rising to that level once every two months, and that it caused no functional impact. November 2014 VA medical records show complaints of headaches, as do April 2007 private medical records. A June 2020 private evaluation showed he had migraine headaches two-to-three times per month that were debilitating to the point that he had to lay still in bed with shades drawn, had severe vomiting with lack of energy, and that they have caused him to become a recluse over the years. He stated during his March 2021 Board hearing that they had increased to three times per week. Next, as to vitiligo, a March 2020 VA examiner stated it caused no functional impact. May 2014 VA medical records show that the Veteran stated his skin condition made him feel very self-conscious. He wrote in June 2014 correspondence that his skin condition impacted his ability to seek employment, and mentioned that in his August 2020 private psychiatric evaluation he believed he was not hired because of vitiligo, although as he worked in the same position for 20 years before retiring in 2010 it does not appear that it prevented him from being hired during the appeal period. Next, as stated above, a May 2016 VA examiner found no functional impact caused by tinnitus. He told an August 2019 VA examiner that tinnitus was mildly annoying but had learned to ignore it and put it aside, and that on occasion he would think his tinnitus was the doorbell ringing or become restless when he tried to sleep, but sleeping with a fan on to help lessened the tinnitus symptoms. He reiterated that the tinnitus was not disabling but rather, annoying, and did not report any impact on work activities. Further, he told an April 2021 VA examiner that tinnitus at times made it difficult to easily fall asleep, and that it was frustrating and could make him irritable. He described tinnitus during his March 2021 Board hearing as a continual, constant buzz, and that sometimes caused him to misinterpret words. Taken collectively, the Veteran's service-connected disabilities preclude manual labor or moderate levels of manual labor working in hot temperatures due to sarcoidosis. Migraines also cause missed time from work at their most severe. Additionally, his psychiatric disabilities show a level of social and functional impairment, but not nearly to the totally disabling level assessed by the August 2020 private evaluator. Specifically, the record indicates that the Veteran has been working in at least a part-time capacity throughout the appeal period, as well as potentially working full-time starting in September 2020. He was not fired, reprimanded, suspended, or demoted in his previous job he left in 2010 or part-time work during the appeal period. That he was offered a full-time consulting position from his previous employer indicates that they were pleased with his employment to want him to return, and not that he is fully disabled due to a psychiatric disorder. The August 2020 private evaluation is otherwise inconsistent with the record, to include a September 2020 VA examination. The private physician found him totally disabled due to his psychiatric symptoms, yet the Veteran told the VA examiner a month later that he worked 42 years in administrative, customer service, and management positions, with good work performance and with good coworker, customer, and supervisor relationships. He stated he made good friends at work and retired in 2010. He then was offered a temporary consulting position with the same organization that year which he accepted, with full-time hours. As such, the August 2020 private evaluation holds limited probative weight given it appears to overstate his symptomatology and its functional impact compared to all other available information. Given it is unclear if he has a full-time position for some of the appeal period, was able to work part time for the rest of the appeal period, and the evidence does not support that the combined functional impact of his disabilities would preclude him from working in an office environment with limited manual labor or virtually in computer-type work. The Veteran was working in such a roll in 2010 when he retired due to age, and when offered a similar consulting position in 2020, he was able to accept. There is no evidence that upon accepting that position, his service-connected disabilities caused him to be unable to follow or maintain the position. His disabilities cause functional impairment, as represented by their assigned ratings, but do not rise to the level of precluding him from securing and maintaining substantially gainful employment. As such, the evidence does not support the claim for a TDIU. The Board has considered the lay statements and testimony of the Veteran regarding his capacity to work throughout the entire period on appeal. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of symptomatology sufficient to satisfy the requirements of 38 C.F.R. § 4.16(a). Such competent evidence concerning the nature and extent of the Veteran's employability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which his employability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the impact of the Veteran's service-connected disabilities on his capacity to work and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective evidence of unemployability, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brendan A. Evans, 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.