Citation Nr: 21032723 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 12-17 420 DATE: May 27, 2021 ORDER An initial disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture is denied. A total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that the symptoms from the Veteran's service-connected residuals of right great toe fracture do not more closely approximate moderately severe or severe foot injury, or complete loss of the foot. 2. The Veteran completed two associate degrees and several years of college coursework in computer science. He has experience in retail, security, and as a delivery driver and has not worked since 2011. 3. As of October 10, 2010, the Veteran's service-connected disabilities included posttraumatic stress disorder (PTSD), ratable as 70 percent disabling, asthma, ratable as 30 percent disabling, lumbar strain, ratable as 20 percent disabling, status post bunionectomy, left great toe, ratable as 10 percent disabling, residuals of right great toe fracture, ratable as 10 percent disabling, and tinnitus, ratable as 10 percent disabling. 4. The preponderance of the evidence shows that the Veteran is not unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.27, 4.71a, Diagnostic Code 5010-5284. 2. The criteria for assignment of a TDIU due to service-connected disabilities have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2006 to October 2010. This case is before the Board of Veterans' Appeals (Board) on appeal from a July 2011 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO granted service connection for residuals of a surgically-repaired right great toe metatarsal fracture and assigned an initial disability rating of 10 percent, effective from October 10, 2010. In October 2011, VA received the Veteran's Notice of Disagreement (NOD). In May 2012, the RO issued a Statement of the Case (SOC). In June 2012, VA received the Veteran's VA Form 9 appeal to the Board. In July 2016 the Board remanded the case for further development and adjudicative action. Additionally, the Board inferred a claim for TDIU as part and parcel of the claim for increased rating for residuals of right great toe fracture. Rice v. Shinseki, 22 Vet. App. 447 (2009). In a June 2018 decision, the Board denied the Veteran's claim for a disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture and a TDIU. Regarding the claim for increased rating for residuals of right great toe fracture, the Board stated that the Veteran did not have a diagnosis of pes planus in analyzing entitlement to a higher rating under alternative diagnostic codes. Regarding the claim for a TDIU, the Board concluded that the Veteran could still perform sedentary work. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (CAVC or Court). In a May 2020 Memorandum Decision, the Court vacated the Board's June 2018 decision and remanded the case for further development in compliance with the directives specified in decision. Specifically, the Court concluded that the Board had inaccurately stated that the Veteran did not have a diagnosis of pes planus. Furthermore, in regard to the claim for a TDIU, the Court observed that, under the recent Court decision in Withers v. Wilkie, 30 Vet. App. 139 (2018), the Board must provide a definition of sedentary work as applied to the Veteran's individual disability picture and vocational history. In September 2020, the Board remanded the case back to the RO for additional development and adjudication. Increased Rating 1. Entitlement to an initial disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture. The Veteran contends that an initial disability rating in excess of 10 percent is warranted for his service-connected residuals of right great toe fracture. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. When the evidence is in relative equipoise, the veteran is accorded the benefit of the doubt. 38 U.S.C. § 5107(b). When an appeal arises from the initially assigned disability rating, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Moreover, staged ratings are appropriate in any increased-rating claim in which distinct time periods with different ratable symptoms or differing levels of severity can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). A finding of functional loss due to pain, however, must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion (ROM) testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with ROM measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Effective February 7, 2021, the regulations governing disability ratings for musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, although not all of the diagnostic criteria were affected. Any changes to the criteria that are applicable to the claims on appeal are indicated below. The Veteran's service-connected residuals of right great toe fracture are currently rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5284. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. The hyphenated codes for the Veteran's residuals of right great toe fracture reflect that post-traumatic arthritis is the service-connected disability under Diagnostic Code 5010 and foot injuries, other is the basis of the rating assigned under Diagnostic Code 5284. Under Diagnostic Code 5284, a 10 percent disability rating is provided for a moderate foot injury. A 20 percent disability rating is provided for a moderately severe foot injury. A 30 percent disability rating is provided for a severe foot injury. The Note to Diagnostic Code 5284 indicates that a maximum 40 percent rating will be assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a. Words such as "severe" and "moderate" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. The Veteran also has a diagnosis of degenerative arthritis of the right great toe. Degenerative arthritis established by x-ray findings is rated under Diagnostic Code 5003 and is based on limitation of motion of the affected joint or joints. When limitation of motion is noncompensable under a limitation of motion code, but there is satisfactory evidence of painful motion, as is the case here, a 10 percent rating may be assigned for each major joint or group of minor joints so affected. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joints or two or more minor joint groups, will warrant a rating of 10 percent. If there are occasional incapacitating exacerbations, a 20 percent rating is assigned for the arthritis without limitation of motion involving two or more major joints or two or more minor joint groups with incapacitating episodes. The above ratings are to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. Under 38 C.F.R. § 4.45, for purposes of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae are considered groups of minor joints. During the period on appeal, the Veteran received an initial VA examination in February 2011. At that time, the Veteran reported 6/10 pain, which was exacerbated by "physical activity, stress, and rest." Exacerbations were relieved "spontaneously and by nothing." The Veteran indicated pain and stiffness but no stiffness, swelling, and fatigue while at rest, and no weakness, stiffness, swelling, or fatigue while standing or walking. Functional impairments included "limping, cannot walk or run normally, [and] constant pain." The Veteran reported use of orthotics. However, the Veteran walked with a "normal" gait during the examination. Examination of the right foot revealed "painful motion and tenderness." There was active motion in the metatarsophalangeal (MTP) joint in the right great toe. Furthermore, the examiner concluded that the Veteran did not require use of orthotics. X-rays revealed "mild degenerative changes" of the first the MTP joint in the right great toe. The Veteran next received a VA examination in February 2015. Diagnoses included right hallux valgus, right great toe fracture residuals, and degenerative arthritis. During this examination, the Veteran denied residual pain to his right great toe. However, he stated that he "will develop plantar pain with overuse." The examiner concluded that the Veteran's residuals of right great toe fracture was mild in severity. Nonetheless, disturbance of locomotion was a contributing factor of disability. In this regard, the examiner noted that the Veteran developed plantar pain "with protracted walking/running" which "slows his gait down." No additional functional loss during flare-ups was noted. Finally, the examiner observed that the Veteran may have decreased performance in jobs requiring protracted walking or running. The Veteran most recently received a VA examination for his residuals of right great toe fracture in January 2017. Diagnoses from this examination included right hallux valgus, right fracture first distal phalanx (great toe) with residuals, and right great toe degenerative arthritis. Furthermore, the Veteran received a diagnosis of bilateral pes planus. Regarding his symptoms, the Veteran reported "pain in the right great toe with prolonged standing, and prolonged walking"; these activities could also aggravate right great toe pain in the form of a flare-up. Additionally, the Veteran reported that he could not run due to right great toe pain. The examiner recorded severity of the right great toe hallux valgus as mild to moderate. There was pain on physical examination of the right foot, but the pain did not contribute to functional loss. In this regard, the examiner reasoned that the "Veteran has [a] normal gait" and there was "[n]o evidence of displaced fracture on radiograph." The examiner noted no functional loss associated with the right great toe. The Veteran has not alleged, and the evidence does not show, that his residuals of right great toe fracture have worsened in severity since the January 2017 VA examination. Based on the foregoing, an initial disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture is not warranted. In this regard, the Veteran's symptoms from the residuals of right great toe fracture do not more closely approximate symptoms of a moderately severe or severe foot injury, or complete loss of the foot. No examiner opined that the Veteran's foot condition during the period on appeal was greater than moderate in severity. Although functional impairments included pain on prolonged standing and walking and inability to run as reported by the Veteran there was no evidence of a limp during any VA examination. Furthermore, the Veteran denied pain of the right great toe during the February 2015 examination and the January 2017 examiner concluded that pain of the right great toe resulted in no additional functional loss. Accordingly, the criteria for an initial disability rating in excess of 10 percent for the service-connected residuals of right great toe fracture have not been met. Entitlement to a higher disability rating under alternative diagnostic codes has been considered. As noted above, the Veteran also has diagnoses of right hallux valgus, right foot first MTP degenerative arthritis, and pes planus, which are evaluated under Diagnostic Codes 5280, 5003, and 5276, respectively. Importantly, the rule against pyramiding prohibits the assignment of separate disability ratings for the same symptom. In other words, the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating service-connected disabilities. 38 C.F.R. § 4.14. It is possible to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). However, the maximum rating available under Diagnostic Code 5280 is 10 percent. Therefore, no additional benefit would flow to the Veteran from application of Diagnostic Code 5280 in place of Diagnostic Code 5010-5284. Furthermore, given that the Veteran's symptoms of right hallux valgus and residuals of right great toe fracture are not separate and distinct, assignment of a 10 percent rating under Diagnostic Code 5280 in addition to the 10 percent rating currently assigned under Diagnostic Code 5010-5284 would amount to impermissible pyramiding. 38 C.F.R. § 4.14. Regarding the right foot right MTP joint arthritis, arthritis of a single MTP joint in the right foot is an inadequate basis for a compensable rating for arthritis. In this regard, under the express language of 38 C.F.R. § 4.45(f), more than one minor joint must be affected to warrant a compensable rating for arthritis with noncompensable limitation of motion, or no limitation of motion. See Spicer v. Shinseki, 752 F.3d 1367 (Fed. Cir. 2014). Therefore, as the Veteran's degenerative arthritis of the right great toe only affects a single minor joint, no further consideration of a rating for arthritis is warranted. Finally, as noted above, the Veteran has a current diagnosis of bilateral pes planus. To date, VA has not received a claim for service connection for bilateral pes planus and the pes planus affects a different part of the right foot the plantar surface of the foot than the residuals of right great toe fracture. Nonetheless, in the November 2020 remand, the Board sought a VA opinion regarding whether the diagnosed pes planus was proximately due to or aggravated by the service-connected residuals of right great toe fracture. A VA opinion was associated with the claims file in March 2021. The March 2021 examiner opined that the Veteran's pes planus was less likely than not proximately due to or aggravated by the service-connected residuals of right great toe fracture. In this regard, the examiner provided the following as reasoning: There is no evidence the vet's toe condition caused bilateral pes planus and aggravated the arches beyond natural progression. The vet is morbidly obese. Due to the effects of gravity, weight, activities, shoes, genetic predisposition etc. the longitudinal arch is expected to collapse/sag over time causing worsening flattening. The vets pes planus is likely to represent progressive age-related and weight related change. There's no evidence in the e-file to support the assumption that the toe fracture and ORIF [open reduction with internal fixation of the foot] caused is arches to collapse or sag more aggressively than normal. I cannot correlate aggravation of this condition without completely speculating. The above opinion is fully articulated, based on review of the entire claims file, applies pertinent information from the Veteran's medical history, and accompanied by a reasoned analysis. Therefore, the opinion is afforded high probative value with regard to causation/aggravation. Although the Veteran may believe that his service-connected residuals of right great toe fracture caused or aggravated his bilateral pes planus, his opinion is not competent in this regard. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given the above, the most probative evidence of record shows that the Veteran's pes planus was not caused or aggravated by his service-connected residuals of right great toe fracture. Accordingly, no separate or alternative rating is available for pes planus under Diagnostic Code 5276. TDIU 2. Entitlement to a TDIU due to service-connected disabilities. The Veteran seeks a TDIU due to his service-connected disabilities. 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 as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Even when the percentage requirements are not met, entitlement to a total rating, on an extraschedular basis, may nonetheless be granted in exceptional cases, when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. §§ 3.321(b), 4.16(b). In Faust v. West, 13 Vet. App. 342 (2000), the Court defined "substantially gainful employment" as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran's earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to TDIU is whether a veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. In determining unemployability, consideration should be given to the veteran's prior education, training, and work experience, but not to age or impairment from nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Faust, 13 Vet. App. 342 (2000). Entitlement to a TDIU does not require 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). All reasonable doubt as to any material matter, including the degree of disability, will be resolved in favor of the claimant. 38 U.S.C. § 5107, 38 C.F.R. § 4.3. Pursuant to the November 2020 Board remand, in a January 2021 correspondence, the RO requested that the Veteran complete and submit an attached VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The RO did not receive a completed VA Form 21-8940 within 30 days of the January 2021 correspondence. As such, this decision will adjudicate the claim for a TDIU based on the evidence currently of record. The Veteran first met the schedular criteria for assignment of a TDIU as of October 10, 2010. As of that date, the Veteran's service-connected disabilities included posttraumatic stress disorder (PTSD), ratable as 70 percent disabling, asthma, ratable as 30 percent disabling, lumbar strain, ratable as 20 percent disabling, status post bunionectomy, left great toe, ratable as 10 percent disabling, residuals of right great toe fracture, ratable as 10 percent disabling, and tinnitus, ratable as 10 percent disabling. The combined schedular rating is 90 percent from October 10, 2010. As the Veteran had one disability ratable as at least 40 percent disabling and total service-connected disabilities ratable as at least 70 percent disabling as of October 10, 2010, the schedular criteria are met from that date. Accordingly, the only remaining question is whether the Veteran's service-connected disabilities preclude substantially gainful employment consistent with his education and work history. A December 2012 VA psychiatric examination report reveals that the Veteran graduated from high school and earned two associate degrees in art and science. Thereafter, the Veteran transferred to a four-year college as a biology major but dropped out after one year. After service, the Veteran reenrolled in college as a mathematics major. A September 2012 VA treatment note describes the Veteran as pursuing a computer science degree. As of a February 2015 VA psychiatric examination, the Veteran reported that "he has taken some college coursework over several years." The record provides no indication that he has received a bachelor's degree. Furthermore, the evidence of record suggests that the Veteran has not worked since 2011. See February 2015 VA psychiatric examination report. He had experience "in various jobs in retail, security, and pizza delivery." During service, the Veteran had a military occupational specialty (MOS) of mechanic. First, regarding the impact of the PTSD on the Veteran's employability, the December 2012 psychiatric examiner recorded symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, near-continuous panic or depression affecting the ability to function independently and effectively, chronic sleep impairment, mild memory loss, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, inability to establish and maintain effective relationships, suicidal ideation, obsessional rituals which interfere with routine activities, and impaired impulse control. However, the examiner concluded that the Veteran's symptoms resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Furthermore, the February 2015 examiner recorded symptoms of depressed mood, anxiety, panic attacks more than once a week, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, suicidal ideation, and obsessional rituals which interfere with routine activities. However, the examiner concluded that the Veteran's symptoms resulted in 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. Turning to the impact his service-connected musculoskeletal disabilities, during a February 2015 VA examination for his low back, forward flexion of the thoracolumbar spine was limited to 75 degrees with no pain noted on examination and no other range of motion (ROM) limitations; during a prior February 2011 examination, there was pain on forward flexion beginning at 45 degrees. The examiner noted that flexion was "slowed." Furthermore, the February 2015 examiner opined that the Veteran "[m]ay not be able to perform jobs that require rapid, repeated loading and unloading." During the February 2011 VA examination of his low back, the Veteran reported weakness of the spine, and "slight" fecal and urinary incontinence due to the spine; however, the fecal and urinary incontinence were not noted by the February 2015 examiner (who recorded "no bowel/bladder dysfunction") and, to date, have not served as the basis for a separate disability rating and warrant no further consideration. The February 2011 examiner found that fatigue and pain of the low back caused the greatest functional impact. At the time of February 2015 examination, the Veteran could still perform weightlifting in the gym, with the exception of deadlifts. Regarding the service-connected status post bunionectomy, left great toe, the Veteran is unable to "fully dorsiflex" the left great toe. However, it did not hinder his "walking/running/squatting." February 2015 VA examination report. Notwithstanding, the Veteran reported "inability to run and pain on prolonged standing and walking due to pain in his feet." January 2017 VA examination report. The functional impact of the residuals of right great toe fracture is described in detail in the section above but results in functional impairment similar to the impairment due to the left great toe. Per a January 2012 VA respiratory examination report, the service-connected asthma results in "inability to function during asthma exacerbation"; furthermore, the January 2013 examiner found that the Veteran "should avoid high risk activities for exacerbation of respiratory conditions." However, a February 2015 examiner noted that the Veteran had not had any exacerbations of his asthma within the past 12 months and concluded that the asthma had no functional impact on the Veteran's ability to work. Furthermore, the Veteran previously stated during a February 2011 examination that he "does not experience any overall functional impairment from this condition." Nonetheless, during the February 2015 examination, the Veteran noted "shortness of breath with exertion" and use of an albuterol inhaler "most, not all, days." Finally, during a December 2010 VA audiological examination, the Veteran denied any impairment from tinnitus. After considering all of the evidence of record, the Board concludes that the preponderance of the evidence shows that the Veteran's service-connected disabilities have not precluded performance of substantially gainful employment during the period on appeal. The determination of whether a veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the RO. See Geib v. Shinseki, 77 F.3d 1350, 1354 (Fed. Cir. 2013). Specifically, the VA examinations of record reveal that the Veteran still retains the ability to perform work consistent with his education and vocational history. First, regarding the Veteran's service-connected PTSD, there is no evidence that his psychiatric symptoms would interfere with his ability to perform simple tasks, such as those performed in a retail, security, or delivery environment. Furthermore, the December 2012 and February 2015 examiners found only "mild and transient symptoms" and "occasional decrease in work efficiency," respectively, due to PTSD. Although both examiners noted that Veteran would experience difficulty adapting to stressful circumstances, including in a work or worklike setting, neither examiner provided any indication that the Veteran would be wholly unable to adapt to a new work environment. Next, although the Veteran's lumbar strain was noted to cause interference with rapid, repeated loading and unloading, there is no indication in the record that the Veteran cannot still lift moderate, and even heavy, weights. Notably, at the time of the February 2015 VA examination for his low back, the Veteran was still lifting weights, with the exception of deadlifts, which put too much strain on his back. Moreover, although work in a delivery environment may require rapid, repeated loading and unloading, such tasks are not consistent with work in retail and security. Furthermore, although the Veteran has reported difficulty standing and walking for prolonged periods due to his disabilities of the feet, the evidence suggests that the primary cause of these impairments was pain of the plantar surfaces of the feet and not the right and left great toes. None of the VA examinations provide objective evidence of pain on standing or walking due to the right and left toes. Additionally, the evidence shows that the Veteran's asthma had, at most, functional impact during asthma exacerbations. There is no evidence that the Veteran experienced asthma exacerbations in connection with employment. As noted above, the Veteran has denied any impairment from tinnitus. Accordingly, the Board concludes that the most probative evidence of record demonstrates that the Veteran's service-connected disabilities did not preclude him from following a substantially gainful occupation. In this regard, the evidence shows that the Veteran can still perform work consistent with his employment history, such as work in retail or security. Furthermore, the evidence suggests that the Veteran may be able to perform in a job that requires a flexible combination of sitting and standing. With regard to the mental component of unemployability, there is no evidence of significant interference with employment; as noted above, no examiner has opined that the Veteran experienced greater than occasional decrease in work efficiency. As such, the preponderance of the evidence is against finding that the Veteran's service-connected disabilities are of such severity as to preclude his participation in any form of substantially gainful employment. As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Small, Attorney Advisor 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.