Citation Nr: 21031344 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-07 328 DATE: May 21, 2021 ORDER 1. Entitlement to referral for extraschedular consideration for a total disability rating for compensation based upon individual unemployability due to service-connected disabilities (TDIU) prior to June 13, 2016 is denied. 2. Entitlement to referral for extraschedular consideration for a TDIU rating due to service-connected disabilities other than posttraumatic stress disorder (PTSD), from October 21, 2015 to December 31, 2015, and from June 13, 2016 to August 30, 2016, is denied. 3. Entitlement to a TDIU rating from September 1, 2016 is denied. FINDING OF FACT The preponderance of the evidence is against a finding that Veteran was precluded from securing or following a substantially gainful occupation due to the service-connected disabilities throughout the appeal period. CONCLUSIONS OF LAW 1. The criteria for referral for an extraschedular TDIU rating were not met prior to June 13, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16(b). 2. The criteria for referral for an extraschedular TDIU rating due to service-connected disabilities other than PTSD were not met for the periods of October 21, 2015 to December 31, 2015, and June 13, 2016 to August 30, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16(b). 3. The criteria for entitlement to a TDIU rating have not been met from September 1, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from August 1988 to December 1988 and from September 1989 to March 1997. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in September 2019. A transcript of the hearing was prepared and associated with the claims file. This claim was denied in a Board of Veterans' Appeals (Board) decision in April 2020. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). Subsequently, the parties entered a Joint Motion for Remand in December 2020, which was granted by the Court in January 2021. The parties agreed that remand was necessary because the Board failed to provide adequate reasons and bases for its denial. Specifically, the parties stated that the Board needs to explain its understanding of "substantially gainful occupation" and to address factors relating thereto, as detailed in Ray v. Wilkie, 31 Vet. App. 58, 69 (2019). Relatedly, the parties stated that the Board must adequately discuss the Veteran's educational level, prior vocational history, and work experience, or relate those factors to the limitations caused by his service-connected disabilities. The matter is again before the Board. At the September 2019 Board hearing, the Veteran testified that he worked for 17 years between 1997 and 2014, at which point, he was precluded from securing or following a substantially gainful occupation due to his service-connected disabilities. The Veteran reported his work history in various construction and related industries, including weatherization and insulation of homes. The Veteran stated that he was unable to take certain work assignments because they involved work in restricted areas, such as crawlspaces, and he could not perform related duties due to his service-connected lumbar spine disability. The Veteran stated he has difficulty with prolonged sitting, and any other prolonged movement. The Veteran also stated that medications for his disabilities impacted his ability to work, because they would require him to lay down. The Veteran stated he owned his own business for seven years, separate from his various other employment experiences. He has also reported symptoms relating to PTSD, including irritability, sleep difficulties, anxiety, interpersonal and anger problems, social withdrawal, and discomfort in crowds. 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 submitted his application for TDIU in November 2015. The Veteran is service-connected for posttraumatic stress disorder (PTSD), which is 10 percent disabling from July 29, 2010, 100 percent disabling from October 21, 2015, 10 percent disabling from January 1, 2016, 100 percent disabling from June 13, 2016, 30 percent disabling from September 1, 2016, and 50 percent disabling from January 25, 2018; lumbar spine degenerative changes with spondylosis, which is 20 percent disabling from August 18,2011, and 40 percent disabling from January 25, 2018; left lower extremity radiculopathy, which is 20 percent disabling from August 81, 2011; right lower extremity radiculopathy, which is 10 percent disabling from August 18, 2011, and 20 percent disabling from January 25, 2018; urinary incontinence associated with degenerative changes of the lumbar spine, which is 20 percent disabling from May 25, 2018; tinnitus, which is 10 percent disabling from April 23, 2013; and bilateral hearing loss, which is noncompensable from April 23, 2013. Based upon the above, the Veteran's combined ratings are 60 percent prior to June 13, 2016, 100 percent from June 2016, 70 percent from September 2016, 80 percent from January 2018, and 90 percent from May 2018. As such, the Veteran's service-connected disabilities meet the schedular criteria for a TDIU rating from September 1, 2016 but do not meet the schedular criteria prior to June 13, 2016. When the percentage requirements are not met, entitlement to a TDIU rating may be considered on an extraschedular basis when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability or disabilities. 38 C.F.R. § 4.16(b). The Board does not have the authority to assign an extraschedular TDIU rating in the first instance. See Bowling v. Principi, 15 Vet. App. 1 (2001). However, it may determine whether the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability or disabilities, and then refer the issue to the Director of the Compensation Service, for a determination in the first instance as to whether the Veteran is entitled to a TDIU rating on an extraschedular basis under 38 C.F.R. § 4.16(b). Accordingly, the Board will analyze whether the evidence of record demonstrates the need for a referral to the Director of the Compensation Service for extraschedular consideration prior to June 13, 2016. Additionally, as noted above, the record reflects that there were two periods between 2015 and 2016 during which the Veteran received temporary 100 percent disability ratings for his PTSD. These periods coincide with the Veteran's admission in the domiciliary residential rehabilitation treatment program through VA. Treatment records suggest that these admissions were an alternative to incarceration following violations of the terms of the Veteran's probation resulting from a felony charge in 2006. The Board notes that a grant of a 100 percent schedular rating does not necessarily render the issue of entitlement to a TDIU rating moot, as a TDIU rating could, in certain circumstances, render the Veteran eligible for special monthly compensation (SMC). SMC may be warranted if the Veteran has a 100 percent disabling rating for a single disability, and VA finds that a TDIU rating is warranted based solely on disabilities other than the disability that is rated at 100 percent. See Buie v. Shinseki, 24 Vet. App. 242 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). The Veteran's service-connected disabilities, other than PTSD, during his residential rehabilitation admissions do not meet the schedular requirements for TDIU. As such, during the periods of October 21, 2015 to December 31, 2015, and from June 13, 2016 to August 30, 2016, the Board will consider whether the Veteran's service-connected disabilities other than PTSD warrant referral for extraschedular consideration. "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 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. Initially, the Board notes significant contradictions in the Veteran's reporting of pertinent facts over time. In VA treatment records from June 2007 and September 2007, the Veteran reported that he was currently unemployed, although in September 2007, the Veteran stated he was doing odd jobs for relatives. In a September 2007 VA treatment record, it shows that the Veteran reported that he was studying to become a personal trainer. In an October 2007 VA treatment record, the Veteran once again stated that he was unemployed, but that he was engaged in studies to become a personal trainer. In a June 2008 VA treatment record, when asked "Are you dissatisfied with your current employment situation," the examiner documented that it was, "Not applicable," which the Board would infer that the Veteran was not employed. In a September 2010 VA treatment record, the Veteran reported that he was employed as a construction worker, and referenced his employers and supervisors. The Veteran reported his felony conviction as an impediment to finding work. The Veteran also referenced that he has been self-employed, providing insulation, for four years. These facts contradict the Veteran's reported work and education history as documented in his November 2015 VA Form 21-8940. For example, the Veteran stated in the November 2015 VA Form 21-8940 that he began and concluded his training as a personal trainer in 2006, however in VA treatment records from 2007, the Veteran reported ongoing studies involving personal training. In November 2015, the Veteran stated he was self-employed from 2007 to 2014 (approximately seven years), but in September 2010, the Veteran reported he had been self-employed since approximately 2006, and also stated that he was working for an employer. There are other multiple, inconsistent facts reported by the Veteran. For example, in a November 2015 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability, the Veteran completed the form, as this was when he was self-employed. He wrote he last worked on March 15, 2014. However, one month later, at a December 2015 VA examination for the lumbar spine disability, the Veteran stated that he last worked in January 2015 for his own company in carpentry. The Veteran stated that he stopped working due to his lumbar spine pain. In a June 2016 VA treatment record, the Veteran stated that the last time he worked was in June 2015 in a temporary job pouring concrete. When the Veteran was asked what the barriers to employment for him were since then, the Veteran responded saying physical and mental issues, as well as transportation problems. In a June 2016 VA treatment record, it shows the Veteran reported owning his business for 10 years, although in previous statements, he claimed owning his own business for seven years. In another June 2016 VA treatment record, it shows the Veteran characterized his previous three years of employment beginning in approximately 2013, as part-time or temporary employment. At the August 2016 VA examination for PTSD, the Veteran stated that he had worked the equivalent of one half of the months since his September 2010 VA examination for PTSD. In an October 2016 VA treatment record, it shows the Veteran stated that he had worked construction for eight to nine years, and that he last worked two years ago (in approximately 2014). In a December 2018 Social Security Administration (SSA) record, the Veteran stated that he ran his own business from 2008 to 2015. SSA records do not show that the Veteran had earnings from 2013 onwards, which is inconsistent with various statements from the Veteran where he reported working in 2014. Additionally, as discussed in greater detail below, examination findings indicate that the Veteran's subjective reporting has been inconsistent with objective findings on occasion. As the statements from the Veteran have changed over time and are contradictory to one another and to the record, the Board affords them no probative value, and finds that the inconsistent statements have negatively impacted the Veteran's overall credibility. The Veteran has indicated that he had to stop working due to limitations caused by his back disability and associated radiculopathy in his legs. However, treatment records in late 2015 describe the Veteran's history of low back pain as stable with flares improved by the use of a TENS unit. Treatment since that time has remained relatively conservative, and the Veteran has maintained his mobility and independence. The Veteran presented to the ER in December 2015 with leg tremors, but this issue was later found to be associated with nonservice-connected hypertension. On examination in the same month, the Veteran reported that he was not able to flex more than 50 degrees due to pain; however, the examiner observed the Veteran sitting in his chair and leaning forward to take his shoes off while bending to greater than 90 degrees. The examiner documented that the Veteran's subjective reports did not match objective findings. In 2016, the Veteran participated in physical therapy, including therapeutic exercises, and reported that exercise helps to relieve muscle tightness in his back. The Veteran reported that he enjoyed woodworking and was able to garden, mow the lawn, and ride a bike. The Veteran continued to report walking and biking as a means of transportation in 2017, as the Veteran did not have a driver's license. He reported going on vacation, visiting local friends in late 2017, and again visiting friends for multiple weeks in Texas in February 2018. Upon his return, the Veteran reported that he enjoyed his time traveling. Treatment records showed the Veteran to have a steady and independent gait. In January 2019, the Veteran reported going on daily walks for approximately 30 minutes at a time. In March to May of 2019, he reported going on bicycle rides with a friend/neighbor. He added that, most days, he was biking on his own and he enjoyed finding himself in new locations, and going further distances. He reported that he was preparing for Register's Annual Great Bicycle Ride Across Iowa (RAGBRAI) in the summer, a bike ride across Iowa that spans several hundred miles over the course of a week. In August 2019, the Veteran continued to report biking daily. The Veteran began to work on losing weight and, by November 2019, he reported that he had lost 40 pounds and was "riding his bike a lot." In 2020, the Veteran reported continued physical activity through bicycling, as well as building or repairing a bike at times. In VA examination reports for the Veteran's lumbar spine disability from July 2012, December 2015, April 2018, and December 2019, it was variably noted that the Veteran's lumbar spine disability impacted his ability to work. The examiners noted that the Veteran would not be able to tolerate occupational tasks that required prolonged walking, standing, or repetitive bending or flexing. The December 2015 VA examiner noted that the Veteran stated he quit his carpentry job in January 2015 due to his lumbar spine disability. As mentioned above, the Veteran reported that medication for this disability requires him to lay down and that this impacts his ability to work. However, the limitations noted by the examiners appear to be primarily based on the Veteran's own reports of difficulty with prolonged sitting and standing, which are not supported by the Veteran's reported activity levels during treatment. For example, in 2019, the Veteran reported increasing his bicycling distances, biking nearly every day, and training for RAGBRAI. By November, he had lost 40 pounds, intentionally. However, in an affidavit submitted in the middle of this period, in September 2019, the Veteran reported that he was unable to sit or stand for more than 15 to 20 minutes at a time and that weakness in his extremities caused his legs to give out. During treatment the previous month, the Veteran reported that he was biking on a daily basis. He has also maintained independence in activities of daily living and reported the ability to garden, mow his lawn, and travel out of state for extended periods. Routine treatment and therapy records do not reflect the Veteran's need to frequently change positions in order to relieve pain or gain comfort. As noted, during the December 2015 examination, the Veteran's subjective reports did not match objective findings. Although the VA examiners note that the Veteran's lumbar spine disability impacts certain types of occupational tasks, they do not conclude that the Veteran is precluded from securing or following a substantially gainful occupation due to his service-connected lumbar spine disability, and the Veteran's physical capabilities appeared to be greater than the Veteran represented. The Veteran also contends that he is precluded from securing or following a substantially gainful occupation due to his service-connected PTSD. During the relevant period, the Veteran has received treatment for symptoms of PTSD and recovery from substance abuse. He has attended individual and group therapy sessions and reported symptoms of irritability, anxiety, sleep difficulties, social withdrawal, and difficulty interacting with others. As noted, he has a history of substance abuse and incarceration, and was jailed briefly in 2016 for violating a no-contact order. However, the Veteran has demonstrated improved functioning with treatment over the course of the relevant period with the primary focus of his therapy being on maintaining abstinence, which he has successfully done except for an isolated instance in 2016. On mental status examination in late 2015, the Veteran was found to be fully alert and oriented with intact concentration, a normal and coherent thought process, no perceptual abnormalities, fair judgment and insight, and no suicidal ideation. He was described as pleasant and appropriate. The Veteran has reported a remote suicide attempt by drug overdose in 1996; however, he has repeatedly and convincingly denied suicidal ideation during the relevant period. Such unremarkable findings on mental status examination remained fairly stable thereafter, and the Veteran was noted to actively participate in group therapy sessions. He has routinely been described as cooperative and reasonable with good communication. As noted above, he has been able to travel, visit friends, and engage in activities such as gardening, mowing his lawn, and bike riding. Aside from the periods when the Veteran was in the domiciliary residential rehabilitation treatment program, the record does not show acute exacerbations of the Veteran's condition that has required inpatient or emergency treatment. In late 2018, the Veteran reported that he had been in group therapy for multiple years and that each time he revisits the materials, he is able to understand it more and how it applies to his recovery. Treatment notes document that the Veteran implemented healthy coping skills to address his stressors, including biking. He was noted to make progress by setting boundaries in his interpersonal relationships, and he reported making a new friend that he talks to and bikes with. In late 2019, the Veteran prepared and presented a speech for other veterans based on his participation in the residential rehabilitation program. He noted that it was therapeutic to reflect on his past mistakes and efforts he has made not to let his low moments define him today. On examination in December 2019, the Veteran reported problems socializing and not liking crowds, but he acknowledged having friends and a girlfriend, and he was described as polite, engaged, and fully oriented. Recent records show stable functioning and that the Veteran has prioritized improving his physical health with regular exercise. The Veteran's VA PTSD examinations from August 2016, April 2018, and December 2019 variably note that the Veteran's PTSD may reduce his work efficiency or reliability, but noted that the Veteran is able to complete his activities of daily living and manage his financial affairs. This evidence weighs against a finding that the Veteran is precluded from securing or following a substantially gainful occupation due to the service-connected PTSD. In a February 2017 private treatment record, Ms. Laurie Goff, a nurse, opined that the Veteran is unemployable due to his service-connected lumbar spine, PTSD, and bilateral hearing loss disabilities. The Board affords this opinion no probative value, as Ms. Goff merely provides a conclusory statement, and does not provide a rationale to substantiate her opinion. In December 2018 statements, the Veteran and his father contended that the Veteran's service-connected lumbar spine disability, bilateral lower extremity disabilities, and PTSD preclude the Veteran from securing or following a substantially gainful occupation. The statements mention the Veteran's physical difficulties in moving and the impact of his PTSD on social relationships. The Board finds that the Veteran's physical and psychological disabilities are considered by, and accounted for, by the ratings for these respective disabilities. As noted above, the Veteran's statements are not probative based on his history of inconsistent claims. However, the father's claims are also contradicted by the evidence of record as it relates to the Veteran's functional abilities. For example, the father stated that the Veteran's chronic weakness and numbness cause his legs to give out without warning. He stated that the Veteran uses a cane, but still struggles to stand for more than 15 to 20 minutes at a time. He stated that the Veteran is unable to do yardwork and most household chores and that moderate exertion causes extreme pain that can lead to the Veteran "being laid up for a week." He described the Veteran as a recluse with no friends. These claims are contradicted by the Veteran's treatment records and his reported activities. The Veteran has maintained a steady gait without the use of a cane. He reported routine bike rides of a half hour or more, increasing his distances over time, and eventually progressing to daily rides and training for RAGRAI, none of which resulted in significant exacerbations or incapacitating episodes. The Veteran has reported enjoying woodworking and being able to garden and mow his lawn. The Veteran has reported making a new friend and visiting old friends both in and out of state. Accordingly, the statements of the Veteran's father are not probative. In a July 2019 vocational employability assessment, Ms. Brittany McKenna opined that it was at least as likely as not that the Veteran's service-connected disabilities render him unemployable since 2014. Ms. McKenna noted that the Veteran does not have any computer-related skills, and has no other transferable skills that could enable him to be employed elsewhere. Based on the record, including lay statements from the Veteran and his father, medical treatment records, and VA examinations, she opined that the Veteran is precluded from securing or following a substantially gainful occupation due to his service-connected disabilities. In an addendum statement provided in response to the Board's April 2020 decision, Ms. McKenna stated that inconsistencies in her report relating to the Veteran's work history may be reflective of sporadic employment, which included frequent changes. She stated that the Veteran's service-connected disabilities require him to alternate between sitting and standing every 20 minutes and prevent him from successfully sitting to complete sedentary employment. and that chronic pain would likely hinder his ability to concentrate and follow through on completing occupational tasks. Ms. McKenna stated that physical limitations preclude him from working as a personal trainer and that, if he were to obtain computer skills, the Veteran expressed difficulty building professional relationships and getting along with supervisors and coworkers. Despite this addendum, the Board still finds the vocational assessment to be of limited probative value, as it overstates the extent of the Veteran's physical limitations, notably, that the Veteran is incapable of sitting or standing for more than 20 minutes at a time and that chronic pain would hinder his ability to complete tasks. This is rebutted by a series of statements from the Veteran over the course of multiple years indicating that the Veteran is able to routinely go on bicycle rides for a half hour or more at a time, requiring activity in excess of sedentary exertional levels, and without debilitating pain, while even training for RAGBRAI. The Veteran has also been able to travel, garden, mow his lawn, and maintain his activities of daily living. Despite some social limitations, the Veteran has demonstrated the ability to socialize appropriately, participate in group therapy, and present a speech to fellow veterans. The Veteran has friends and has generally been described as pleasant and cooperative with appropriate behavior. Such findings highlight significant contradictions between the Veteran's functional abilities and Ms. McKenna's assessment. At the September 2019 Board hearing, the Veteran testified that his bilateral hearing loss disability and tinnitus impact his ability to work due to minor difficulty in telephone communication. The Veteran was issued hearing aids by VA in 2010. During a 2013 VA examination, the Veteran reported difficulty hearing conversation, but did not specify that this was restricted to telephone calls. The Veteran was seen for a hearing aid evaluation in 2015 but has otherwise not required routine and recurrent treatment. He indicated that he wore hearing aids in the past but had lost them and gone long periods without them. The Veteran's speech/language skills were described as adequate for activities of daily living. Separate treatment records observed the Veteran to have hearing aids and to do well with them. The examination report indicated that the Veteran's tinnitus does not impact his ability to work. Tinnitus was noted not to impact the Veteran's ability to work. The Veteran has not received more than routine follow-up treatment for these disabilities. The treatment records show numerous telephone exchanges with the Veteran concerning scheduling and treatment, which do not indicate hearing difficulties or communication problems. Also, the Veteran was able to communicate effectively during his September 2019 virtual hearing without noticeable problems associated with hearing loss or tinnitus. Routine treatment records do not reflect communication issues when interacting with the Veteran, and the Veteran has been an active participant in group therapy sessions. As such, the Board finds that the preponderance of the evidence is against a finding that the Veteran's service-connected hearing disabilities cause the Veteran vocational limitations. In a January 2020 statement, the Veteran's representative contended that the December 2019 VA examination report found that the Veteran's PTSD exacerbated his service-connected urinary incontinence, which impacted the Veteran's ability to work. However, the record does not support that the December 2019 VA examination report contains such a statement. Rather, the December 2019 VA examiner indicated that the Veteran's urinary incontinence does not impact his ability to work. The Veteran has not made recurrent complaints or required recurrent treatment for this issue, and he has been able to maintain high activity levels, including routine bike rides, without noted incontinence issues. The totality of the evidence is against a finding that the Veteran has been unable to secure and follow all forms of substantially gainful employment for the entirety of the appeals period. Despite radiculopathy and back pain, the Veteran has maintained high activity levels, including the ability to garden, bike, mow his lawn, travel, and maintain his activities of daily living. The record does not show that medication has caused significant limitations to the Veteran's functional abilities. Despite his symptoms associated with PTSD and substance abuse, the Veteran has demonstrated significant improvement with continued treatment. He has generally demonstrated intact cognitive functioning and presented as cooperative and pleasant with appropriate behavior. He has reported making a new friend, visiting old friends, and improving his ability to manage interpersonal relationships. He has engaged actively in therapy and presented a speech on his experience to help other veterans. Furthermore, as partially described above, the record does not support a finding that the Veteran's service-connected disabilities other than PTSD rendered the Veteran unable to obtain or follow all forms of substantially gainful employment during the Veteran's temporary 100 percent disability ratings assigned for PTSD that were associated with his residential rehabilitation treatment. As the Veteran's physical disabilities are not found to preclude the Veteran from employment during the appeal period as a whole, the evidence does not show significant and sustained exacerbations of the Veteran's service-connected conditions other than PTSD during these periods that show a reduction in his overall functional abilities. Although the Veteran reported symptoms generally consistent with those reported throughout the longitudinal evidence, the evidence during this period indicate the Veteran to ambulate without the use of an assistive device and to be independent in his activities of daily living. Following his discharge from residential treatment, the Veteran resumed more demanding physical activities, such as biking, gardening, and mowing the lawn. Accordingly, the weight of the evidence is against an award of TDIU relating to the Veteran's service-connected disabilities other than PTSD from October 21, 2015 to December 31, 2015, and from June 13, 2016 to August 30, 2016. Regarding the Veteran's education, training, skills, and work history, the Veteran reported that he completed four years of high school. The Veteran reported that he was seeking a degree in elementary education in 1989 following his first period of active duty, but quit college that year before his second period of active duty. He also reported that he had education/training as a personal trainer in 2006. As discussed above, reporting of the Veteran's work history has varied over time; however, he has indicated working extensively in construction following his discharge from the military in 1997, specializing in insulation, but also with experience in carpentry and concrete. The Veteran has variably reported that he stopped working sometime between 2014 to 2015, due to back pain. However, separate records have indicated that the Veteran was incarcerated from August 2014 to October 2015, which suggests contributory factors to the Veteran's work stoppage. The Veteran expressed interest in pursuing additional education in 2016, but the record does not demonstrate that he has done so. Overall, the Veteran's diverse work history, including self-employment, demonstrates a capacity for learning and adaptability that are not hindered by his service-connected disabilities. He has maintained independence and reported continued learning, growth, and improvement with continued therapy. 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 pain, stiffness, and weakness, associated with his lumbar spine disability and radiculopathy. However, the Veteran has required conservative treatment with some physical therapy, medication management, and routine follow-up. The Veteran has maintained independence in his activities of daily living and has reported the ability to go on daily bike rides, mow his lawn, work on building his bike, garden, woodwork, and travel. The Veteran's activity levels demonstrate that he is at least capable of light physical activity. For all these reasons, the totality of the evidence shows that the Veteran is capable of performing work at least at the "light" exertional level. The Department of Labor's Dictionary of Occupational Titles (DOT) defines light work as exerting up to 20 pounds of force occasionally (i.e. up to one-third of the time), and/or 10 pounds of force frequently (i.e. from one-third to two-thirds of the time), and/or a negligible amount of force constantly to lift, carry, push, pull, or otherwise move objects. According to the DOT's definition, when walking or standing are involved to a significant degree, the job is classified as light even when the weight lifted is negligible. A job is also classified as light when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls, or when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. The Board finds no prejudice to the Veteran in considering this definition for purposes of deciding the Veteran's claim. The treatment record does not indicate the Veteran's service-connected disabilities to limit him beyond restrictions of light work, as evidenced by his activity levels, discussed above. 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 has a history of interpersonal conflict, anxiety, and anger issues, and does not like being in crowds. However, treatment records generally demonstrate the Veteran to be fully alert and oriented with intact concentration, no perceptual abnormalities, a coherent thought process, fair judgment and insight, and no suicidal ideation. He has been described as cooperative with pleasant behavior and has exhibited improved functioning with treatment. The Veteran has been able to travel, engage actively in group therapy, and present a speech to his fellow veterans. As such, the Veteran's mental limitations could be reasonably accommodated by restricting the Veteran from jobs that require work in crowds or routine face-to-face interaction with the general public. Additionally, the Veteran should avoid occupations that involve executive decision-making or supervisory/managerial duties. Such limitations would limit the Veteran's exposure to triggers and interpersonal conflict. These limitations would not preclude competitive employment and, therefore, the Board finds that the Veteran has the mental ability to perform 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, 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 require little exertional activity and no face-to-face interaction with the public or supervisory duties. Furthermore, the Veteran would be capable of performing certain assembly line or manufacturing positions, jobs that would not exceed the limits of light exertional activity, would require little social interaction, and would be routine and repetitive in nature. 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 the reasons described above, the Board finds that the preponderance of the evidence is against a finding that the Veteran is precluded from all forms of substantially gainful employment due to service-connected disabilities and, therefore, is not entitled to a TDIU rating or a referral for consideration of an extraschedular TDIU rating throughout the appeal period. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, it is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, entitlement to a TDIU rating or a referral for consideration of a TDIU rating on an extraschedular basis is not warranted. 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.