Citation Nr: 21038040 Decision Date: 06/23/21 Archive Date: 06/23/21 DOCKET NO. 07-39 494 DATE: June 23, 2021 ORDER Entitlement to an effective date of June 14, 2000, for the grant of a total disability rating based on individual unemployability (TDIU) on an extraschedular basis is granted. Entitlement to an effective date earlier than June 14, 2000, for the grant of a TDIU on an extraschedular basis is denied. FINDINGS OF FACT 1. From June 14, 2000, to October 4, 2001, the evidence is in equipoise regarding whether the Veteran's service-connected disabilities, particularly including prescribed narcotic medication for pain, rendered him unable to secure or follow a substantially gainful occupation. 2. Prior to June 14, 2000, the Veteran did not meet the requisite schedular percentage requirements for TDIU and he was not unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date of June 14, 2000, for the grant of a TDIU on an extraschedular basis have been met. 38 C.F.R. §§ 1155, 5110; 38 C.F.R. §§ 3.155(a), 3.157, 3.400, 4.16(a). 2. The criteria for entitlement to an effective date earlier than June 14, 2000, for the grant of a TDIU on an extraschedular basis have not been met. 38 C.F.R. §§ 1155, 5110; 38 C.F.R. §§ 3.155(a), 3.157, 3.400, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1973 to February 1976. His awards and decorations included the Parachute Bridge. In February 2007, the RO granted the Veteran's claim of entitlement to a TDIU effective October 4, 2001. The Veteran disagreed with the effective date and appealed to the Board. The procedural history of this matter, which includes several appeals to the United States Court of Appeals for Veterans Claims (Court), has previously been set forth in detail in several Board decisions. Most recently, a June 2020 Board Remand discussed the procedural history to that point, including the October 2019 Joint Motion for Remand (JMR). In the June 2020 Board Remand, the above-referenced claim was remanded to the RO for further evidentiary development and readjudication. The RO has substantially complied with the Board's remand instructions, so the Board may proceed to the merits. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) held in Washington, D.C., in December 2015 with respect to the issue on appeal. The claims file includes a transcript of the hearing. The claims file also includes transcripts of a September 2001 Decision Review Officer hearing, a December 2002 Board hearing, and a November 2005 Board hearing. The 2002 and 2005 hearings were held before a VLJ who has since retired from the Board. A. General Principles Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the claimant. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). In deciding the Veteran's claim, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). If the evidence is credible, the Board, as fact finder, must determine the probative value or weight of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value. Provided that it offers an adequate statement of reasons or bases, the Board may favor one medical opinion over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). B. Summary of Claim and Procedural Posture The Veteran seeks entitlement to an effective date earlier than October 4, 2001, for the grant of TDIU. As the Board explained in its March 2016 and July 2018 decisions, the Veteran's disability rating during the period in question did not meet the threshold for a grant of TDIU on a schedular basis. Therefore, the determinative issue before the Board is whether the Veteran is entitled to an effective date earlier than October 4, 2001, for the grant of TDIU on an extraschedular basis. See November 2017 CAVC Memorandum Decision (affirming the denial of an earlier effective date for the 60 percent rating for the back disability and affirming the denial of a schedular TDIU). C. Governing Law: TDIU Under the governing law and regulations outlined above, the Board generally reviews the evidence dating back to one year prior to the date of the claim to determine whether, within that one-year period, an increase in a disability was factually ascertainable. See 38 C.F.R. § 3.400(o)(1)-(2). However, because the Board denied entitlement to a TDIU in a final June 6, 1991 decision, the Board will now consider the evidence received since that decision. A Veteran may be awarded a TDIU upon a showing that he is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. As previously noted by the Board in its March 2016 decision and the Court's November 2017 decision, the Veteran did not meet the percentage standards permitting award of a schedular TDIU prior to October 4, 2001 (the period on appeal). 38 C.F.R. §§ 3.340, 3.341, 4.16(a). A TDIU may also be assigned on an extra-schedular basis, pursuant to the procedures set forth in 38 C.F.R. § 4.16(b), for veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in section 4.16(a). It is that aspect of the appeal currently before the Board. In September 1989, when the RO denied the Veteran's claim of entitlement to a TDIU, the Veteran did not meet the TDIU rating percentages. Service connection was in effect for the following disorders: the residuals of lumbar spine injury, rated as 20 percent disabling, incontinence of bladder, rated not compensable, and impotence, rated not compensable. The Board has since granted an increase to 40 percent for the residuals of lumbar spine injury effective February 20, 1992. The other ratings for this period remain noncompensable. The crux of the matter in any TDIU claim (schedular or extraschedular) is whether the Veteran was unemployable due to service-connected disability. In this case, the relevant time period is from June 6, 1991, when the Board issued a final decision on a prior increased rating (TDIU) claim and October 4, 2001, the effective date assigned when the TDIU claim was granted. Substantially gainful employment is that which results in earnings above the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. The ability to work sporadically or to obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). However, marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Id. The question of whether the Veteran is "unable to secure and follow a substantially gainful occupation" under section 4.16(b) has two components: one economic and one noneconomic. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the Veteran's history, education, skill, and training; the Veteran's physical abilities (both exertional and non-exertional) and associated limitations, if any; and the Veteran's mental abilities and associated limitations, if any. See Ray, supra. VA must assess whether the Veteran is "capable of performing the physical and mental acts required by employment." Id. at 72. Advancing age and nonservice-connected disability may not be considered in the determination of whether a veteran is entitled to TDIU. 38 C.F.R. § 3.341(a), 4.19. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating for service-connected disability, in itself, is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the Veteran can perform the physical and mental acts required by employment, not whether the Veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). D. The Factual Background In July 1991, the Veteran was evaluated by the orthopedic clinic. He complained of pain in his back and legs since 1974, when he was involved in a parachute accident. It was noted that two and a half years earlier, he had also sustained an "on the job" injury to his back. On physical examination, the Veteran's gait was hunched over, deep tendon reflexes were intact, and straight-leg raising was positive at 20 degrees bilaterally. He was given an assessment of low back pain without bowel/bladder complaints. An October 1991 report notes an April 1991 magnetic resonance image (MRI) indicated "asymmetric protrusion." At that time, the private physician opined that the Veteran was not a surgical candidate. VA outpatient treatment records also indicate low back treatment. In January 1992, the Veteran complained of pain in his low back with radiation of pain into his right leg. On physical examination, straight-leg raising was positive at 20 degrees, there were no motor deficiencies in the lower extremities, and there were no changes in his bowel habits. Degenerative joint disease in the L5-S1 and rule-out nerve root impingement along the S1 were assessed. In February 1992, it was noted that the Veteran had a history of chronic low back pain since a parachute injury in 1974, and was currently unemployed due to his back pain. He complained of impotence and of occasional urinary incontinence over many years. On physical examination, straight-leg testing was positive, deep tendon reflexes were symmetric, there was tenderness on palpation, and paraspinal muscle spasms were also present. It was the physician's impression that the Veteran had chronic low back pain with evidence of chronic cauda equina symptoms. The claim is complicated by the fact that it is well documented the Veteran incurred a serious occupational (non-service related) back injury in February 1989. The Veteran currently is receiving Social Security Administration (SSA) disability benefits largely as a result of this injury. The Veteran also applied for Workers Compensation benefits related to this occupational injury. In April and May 1993, the Veteran underwent orthopedic consultations for the purpose of determining his qualified injured worker status (in association with a workers' compensation claim for the post-service February 1989 occupational injury). The examining physician noted that, on February 1, 1989, while at his job site, the Veteran was struck in the head by a piece of heavy scaffolding. The impact caused him to fall and strike his right elbow. He also reported pain in the low back area. The diagnoses were strain/sprain of the cervical spine superimposed over degenerative changes; sprain/strain of the right shoulder with impingement syndrome; musculoligamentous sprain/strain of the thoracolumbar spine superimposed over degenerative changes and disc protrusion at L5-S1 per MRI scan; and right olecranon bursitis with possible fracture of the olecranon spur. On examination of the lumbar spine, there was normal spinal alignment and palpable tenderness around the thoracolumbar spine region, sacroiliac joint bilaterally, and buttocks bilaterally. There was no allodynia or evidence of paravertebral muscle spasm. Lumbosacral spine ranges of motion were: 50 degrees forward flexion, 10 degrees backward extension, and 15-20 degrees bilateral rotation. The Veteran was able to walk on the heels and toes, perform a full squat, and sit up without difficulty. His straight leg testing was negative at 80 degrees bilaterally. Knee and ankle jerks were present and equal, bilaterally. Following the examination, the examining physician considered the Veteran to be an injured worker in need of vocational rehabilitation. In November 1993, the same examiner reported that training as a smog technician was a reasonable vocational goal. See November 1993 Vocational Rehabilitation Opinion (opining that the Veteran could train to be a smog technician and would be able to perform the duties which include frequent standing and walking, carrying, occasional driving, frequent lifting and carrying, occasional pushing and pulling, occasional twisting at the waist, kneeling, and crawling, with constant reaching in front, frequent reaching below shoulder level, and occasional reaching overhead). On November 1996 VA examination, the Veteran complained of low back pain with multiple joint aches/pains, occasional right lower extremity numbness, and not being able to bend over well or lift. He had no bowel/bladder changes. On physical examination, he had no postural abnormalities or fixed deformities, and good musculature of the back. Lumbosacral spine ranges of motion were: 65 degrees forward flexion, 10 degrees backward extension, 25 degrees bilateral lateral flexion, and 20 degrees bilateral rotation. Neurologically, his motor strength was 5/5 for ankle plantar and dorsiflexion, knee flexion and extension, and hip flexion; a pinprick test was intact. L5-S1 DDD with spondylosis was diagnosed, and the examiner opined that while this disability had "significantly decreased [the Veteran's] ability to do manual labor... it should not necessarily prevent him from working at sedentary occupations." On March 1997 VA examination, the Veteran complained of constant low back pain with right lower extremity pain and occasional weakness/numbness. He also complained of being unable to bend over or lift well. He had no bowel or bladder incontinence. On physical examination, there were no postural abnormalities or fixed deformities. He was mild to moderately tender to palpation over the lumbosacral spine. Lumbosacral ranges of motion were: 65 degrees forward flexion, 20 degrees backward extension, and 30 degrees bilateral lateral flexion and bilateral rotation; there was some grimacing with difficulty straightening on motion. Neurologically, his motor strength was 5/5 for extensor hallucis longus, tibialis anterior, gastrosoleus, and knee flexion and extension. Light touch was intact from L4-S1 and reflexes were symmetrical for Achilles and patellar. Severe L5-S1 DDD was diagnosed. In June 1998, the Veteran's Social Security disability benefits were continued, primarily as a result of affective (mood) disorder. The secondary diagnosis was autistic disorder and other pervasive developmental disabilities. On March 1999 VA examination, the Veteran complained of constant and excruciating pain, weakness, fatigue, lack of endurance and stiffness in his low back. He also complained of radiating pain down to the right lower extremity, which caused some intermittent numbness in his right thigh area. He reported that he could brush his own teeth and bathe, but had difficulty dressing himself and could not shower. He reported that he was unable to perform household chores or participate in many daily activities, as he refrained from all activities that required prolonged sitting, standing, walking, bending, turning, or lifting. He also reported that he had not been employed since February 1, 1989. On physical examination, the examiner noted that the Veteran was uncooperative and would not comply with the range of motion testing of the lumbar spine. Consequently, the VA examiner was unable to comment on whether he had painful motion. The Veteran was able to sit up from a supine position though, suggesting a 90-degree lumbar flexion. It also appeared that the Veteran had muscular spasm in the lumbosacral spine in both paraspinal areas and tenderness in the midline and paraspinal areas of the lower lumbosacral region. The examiner could not comment on any weakness. The musculature of the back was otherwise normal, but posture was abnormal in that there was a mild loss of lumbar lordosis. Neurologically, the Veteran's motor function was within normal limits. Residuals of a lumbar injury/lumbosacral strain and DDD of L5-S1 were diagnosed. The examiner opined that the Veteran's condition mildly affected him in any activities that would require prolonged standing, walking, sitting, repetitive bending, or lifting. The examiner also noted that there was "equivocal objective neurological impairment due to disc disease, in that there [was] evidence of straight leg raising impairment at 30 degrees on bilateral lower extremities, but [that the] remainder of the neurologic examination [was] intact, without other signs of radiculopathy." The examiner noted that the effect on the Veteran's usual occupation was not pertinent, because he was unemployed. In September 2001, the Veteran testified before a Decision Review Officer. He testified that, upon awakening, he has to hold on to supports in order to avoid falling because he would feel "like a million volts of electricity [was] going through [his] legs." He indicated that, on some mornings, he could not immediately get out of bed or walk. He testified that, as the day progresses, he would regain movement and the pain would decrease. He testified that he remained cautious to avoid aggravating his symptoms. He also reported taking narcotic pain killers. On October 4, 2001 VA examination, the Veteran complained of sharp, throbbing, and burning pain in the upper and lower back. He did not use a cane, brace, walker, or any type of abdominal or cervical support. He reported difficulty walking, standing, sitting, bending, and lifting. He also stated that he could barely dress himself, and could not walk, drive, shop, push a lawn mower, or garden. He could brush his teeth, shower, and take out the trash. However, he stated that since the pain was constant, he was afraid "he might hurt himself or others if he [continued] to have pain and [suffering]." On physical examination on October 4, 2001, the Veteran walked with his head flexed and stood with a forward list. When asked to stand straight and walk in an upright manner, he was able to do so but complained of pain. There was no right or left paralumbar muscle spasm or evidence of scoliosis, but there was dorsal kyphosis and lumbar lordosis. Lumbosacral spine ranges of motion were: 60 degrees forward flexion, -20 degrees backward extension, 20 degrees bilateral lateral bending, and 20 degrees bilateral rotation. The examiner noted that he was "not convinced" that the Veteran was demonstrating full effort. Straight leg testing was negative on the left side at 90 degrees and positive on the right at 60 degrees. Patrick's test was positive, bilaterally, for low back pain. On neurological examination, there was no evidence of sensory or motor loss in the lower extremities. The examiner also noted that the Veteran was able to sit in an upright position, so he assumed that his extension was at least 0 degrees, even if he would not go through the full motion. All deep tendon reflexes were normal and equal; motor strength was within normal limits; and sensory examination was intact. Severe degenerative arthritis of the lumbar spine with right radiculopathy and DDD with L5 nerve root involvement were diagnosed. Regarding the Veteran's functional capacity, the examiner opined that the Veteran could lift and carry 20-25 pounds occasionally and 15-20 pounds frequently, and he could sit, stand and walk for 4-6 hours in an 8-hour workday. He could not climb ladders, stoop, kneel, or crouch, and the examiner advised against walking on uneven terrain. He noted that these conclusions were "based purely on his orthopedic evaluation," and that he did not take into consideration motivation or any other issues that the Veteran might have. The Veteran testified before the Board in December 2002 in connection with his claims for service connection and entitlement to TDIU. He testified to pain which was becoming progressively worse and radiated to his lower extremities. He also testified to numbness and tingling in both lower extremities, but more pronounced on the right side. He testified that his symptoms caused him to walk with a limp and, sometimes, prevented him from walking at all. He did not discuss any ongoing problems with urinary incontinence. He testified before the Board again in November 2005, also in connection with service connection and increased rating (including TDIU) claims. With respect to symptoms of his back disability, the Veteran testified that he had urinary incontinence and erectile dysfunction, but did not discuss onset or frequency. He also stated that he had not worked since the 1989 on-the-job injury to his head. He stated in his testimony that he had tried to obtain employment, but when he revealed his medical history (including the back injury, head injury, a neck injury, and high blood pressure) potential employers would tell him he was an insurance risk and would not hire him. A private physician, Dr. G.B., also provided testimony at the November 2005 Board hearing. The physician testified that imaging results beginning in 1996 show definitive degenerative changes at the L5-S1 level and are consistent with the symptoms of pain, weakness, and numbness reported by the Veteran in earlier treatment records and in his testimony. The physician opined that the Veteran was unable to work due solely to his lumbar spine disability. He indicated that the earlier, 1996 employability opinion by the VA examiner supported his conclusion, but he did not provide any additional rationale beyond the fact of unemployment since 1989. Subsequent to that Board hearing, Dr. G.B. submitted a November 2005 report on his independent medical evaluation in which he reiterated his above conclusions and included a detailed summary of the Veteran's medical history that he felt particularly relevant. Notably, the only medical record during the relevant time period that he identified that mentioned erectile dysfunction or urinary incontinence was the 1992 reference noted above. The private physician did not discuss the frequency or severity of the urinary incontinence, nor did he provide any opinion regarding the severity of the back injury or the radicular/neurological symptoms associated with that injury. He again stated an opinion that the Veteran's service-connected back disability rendered him unemployable since 1987. He reasoned that the Veteran had advanced degenerative arthritis during that period (which he opined warranted a 60% disability rating), was unable to perform physical labor, had only a high school education, and was not otherwise suited to sedentary employment. In November 2005, C. N. B., M.D., opined that the Veteran had been unemployable since 1987. Dr. B. noted that the Veteran had a high school education and manual labor training but did not have the educational abilities to perform alternative work. In December 2014, following a review of the evidence, including records from the Social Security Administration and the opinion from Dr. B., the Director of the VA Compensation and Pension Service concluded that a TDIU on an extraschedular basis was not warranted. The record also contains a November 2015 private retrospective opinion by Dr. E.T., a licensed psychologist and rehabilitation counselor. The private psychologist provided an overview of the Veteran's medical and social history. She stated that "[h]e does not possess any transferrable skills to sedentary work." The report next includes an assessment of the Veteran's current psychological status, opining that the Veteran's psychological symptoms result in "social, personal and occupational impairment." (The Board notes that the Veteran is not service-connected for any acquired psychological disabilities.) The private psychologist then states the question for consideration: Whether the Veteran was totally disabled and individually unemployable due solely to service-connected conditions prior to October 4, 2001, and, if so, as of what date? The following seven pages of her report consist of summaries of the available medical records. Thereafter, she offers an opinion that the Veteran "was totally disabled based on his service-connected orthopedic/neurological problems related to his low back since 1987." She notes the presence of degenerative disc disease at the L5-S1 level and the Veteran's complaints of persistent low back pain radiating to his right lower extremity. She identifies a note indicating persistent back and right leg pain with little relief from pain medication. She also mentions a 1987 note indicating "very bad pain in right hip and low back, chronic problems since service injury, difficulty walking." She noted the Veteran's 1989 on-the-job injury and recounted his post-service earnings. She then reiterates her opinion that the Veteran was not able to maintain or sustain substantial, gainful work activity subsequent to 1987. Dr. E.T. also provided testimony at the December 2015 Board hearing. She testified that the Veteran had worked in physical labor, as a meter reader, and as a driver, but had no skills that were transferrable to sedentary employment. When asked about the Veteran's symptoms, she testified that "he had difficulty with sleep patterns, falling asleep and staying asleep." She mentioned awakening from pain, restlessness, "bouts of irritability", anger, and difficulty concentrating. She restated her opinion on employability and explained that it was based on "very bad pain in his right hip and low back" as well as his employment history. She referred to the rationale in her November 2015 report as support for her conclusion. The Veteran and his wife also provided pertinent lay testimony at the December 2015 Board hearing. The Veteran testified that he had bladder incontinence in 1991 for which he wore "brief stitching". He testified that he had to use the restroom five or six times including during the night. He testified that he had to change the padding more than three or four times a day. He also testified that, at that time, he had back pain that interfered with his ability to walk and erectile dysfunction. He took pain pills which, he stated, prevented him from being able to work. His wife gave similar testimony. She testified that the Veteran had urinary incontinence "maybe once out of the week[, but] no more than two times out of the week." She confirmed that he used absorbent padding. She also recounted his medications and stated the pain medication made him "irritable" and would cause him to sleep "a lot." On his formal claim for a TDIU (VA Form 21-8940, dated in September 1995), the Veteran reported that he had one year of college education and that he had not worked since February 2, 1989. He reported that he had sustained an injury affecting his head, back, neck, spine, shoulder, and elbow. Evidence received in October 1995 shows that in October 1990, the Veteran was granted Social Security disability benefits. The primary diagnosis was an affective (mood) disorder, and the secondary diagnosis was sprains and strains. It was noted that the Veteran's disability had begun February 1, 1989. In conjunction with his Social Security application, the Veteran reported the following work experience: mobile home construction from September 1987 through January 1989; truck driving from August 1983 to November 1986; utility work with television or telephones from September 1978 to December 1981; and a city water meter reader from August 1976 to August 1978. In addition, he stated that he had attended barber school from February 1982 to June 1983. E. Analysis The Veteran seeks entitlement to an effective date earlier than October 4, 2001 for the assignment of a TDIU. The Veteran asserts that he has been found disabled by the Social Security Administration and cites opinions from Dr. C. N. B., Dr. G.B., and Dr. E.T. that he has been too disabled to work since 1987. Therefore, he maintains that an effective date prior to October 4, 2001 for a TDIU is warranted. The Board finds that, giving the benefit of every doubt, an extraschedular TDIU is warranted from June 14, 2000. The claim will be granted to that extent. After carefully considering the claim in light of the record and the applicable law, the Board is of the opinion that the preponderance of the evidence is against that claim for the period prior to June 14, 2000. Accordingly, the appeal will be denied to the extent the Veteran seeks an effective date prior to June 14, 2000, for the award of TDIU. The Board gives no weight to the Veteran's own statements that he was unemployed due to back pain, such as in February 1992 and at the March 1999 VA examination. His opinions that back pain prevented employment are not consistent with the competent, objective findings in the medical records. For example, at the March 1999 VA examination, the Veteran reported that he refrained from any and all activities that would require prolonged sitting, standing, walking, bending, turning, and/or lifting, but the examiner determined after physical examination that those functions were only mildly impaired. Additionally, he has made other conflicting statements which reduce his overall credibility and the record establishes that numerous other factors affected his employability at that time which the Veteran's statements fail to address or even acknowledge. The Board also gives no probative weight in favor of the claim to the award of Social Security disability benefits and the medical opinions on which that award was based. The award and the opinions are primarily based on nonservice-connected conditions (e.g. affective (mood) disorder, autistic disorder, other pervasive developmental disabilities, and sprains and strains of not only the back, but also the neck, shoulder, and elbow). Therefore, the favorable Social Security determination has no probative weight on the issue of whether the service-connected disabilities alone caused the Veteran's unemployability. (The Board notes that the legal standards are also not identical.) This evidence of unemployability due primarily to nonservice-connected disabilities also supports the Board's determination that the fact of the Veteran's unemployment during the period is entitled to no probative weight in favor of his claim. See Van Hoose, 4 Vet. App. at 363. In other words, the evidence indicates nonservice-connected as at least part of the reasons for his actual unemployment, so the fact of unemployment does not weigh for or against the TDIU claim. Although the private experts who have given favorable opinions have all stated that the Veteran was unemployable due to his service-connected lumbar spine disorder as far back as 1987, the preponderance of the evidence is against such a finding. The evidence shows that the Veteran had been employed or been in school since he left the service and that he had secured and maintained a job in mobile home construction from September 1987 through January 1989. The probative evidence, such as his Social Security records, shows that he left that position following an injury on February 1, 1989. Although that injury reportedly affected multiple areas, including the thoracolumbar spine, the primary injury was to his head. His Social Security records show that he became disabled at the time of that injury and that the primary reason for his award of disability benefits involved his mental health. The evidence does not show that the Veteran left employment due to a low back disability or that such disability caused him to be unemployable or even that the disability interfered with his ability to work at that time. Despite its significance, none of the private experts have meaningfully addressed the role of the Veteran's February 1989 work injury with respect to his claim for a TDIU. (For example, Dr. E.T. mentioned the accident, but did not discuss its relevance or separate out the effects on employability of that accident from the service-connected disabilities.) Dr. C.N.B.'s opinion is entitled to no probative weight. In addition to the above discussed deficiency, specifically the conflict between the opinion that the Veteran was unemployable since 1987 versus his actual employment until 1989, the opinion otherwise fails to provide a convincing rationale connecting facts to the conclusion. The opinion fails to make any attempt to separate the effects of nonservice-connected conditions from service-connected disabilities. With respect to Dr. G.B., in addition to the above deficiencies, his opinion contains very little rationale beyond the fact of unemployment and the 1996 VA examiner's opinion on the feasibility of sedentary employment. The Board assigns it very little independent probative weight due to its lack of a reasoned rationale that is supported by the underlying medical and employment history. The Board gives no probative weight to the opinion of Dr. E.T, a psychologist and vocational rehabilitation expert. The Board interprets her report as placing undue significance on the Veteran's nonservice-connected mental health issues. Also, she relies heavily in her rationale on the fact of unemployment (and low earnings), rather than making any attempt to differentiate the various effects of the Veteran's nonservice-connected disabilities on his physical and mental capabilities from the effects of his service-connected disabilities (primarily the back disability). She fails to discuss or account for the Veteran's post-high school education and training (e.g. one year of college, barber school, recommendation for vocational training). In short, Dr. E.T.'s report primarily consists of a summary of medical evidence (relating to both service-connected and nonservice-connected conditions) and employment history followed by a conclusion, but fails to provide any coherent rationale that connects the recited evidence with her conclusion or that accounts for the evidence that undercuts her conclusion. In summary, the opinions of record that at first glance support the Veteran's claim have very little probative weight, individually and cumulatively. On the other hand, the opinions of record against the Veteran's claim are entitled to significant probative weight. For example, the 1993 reports from Dr. W. and the report of the 1996 VA examination essentially concur that the Veteran should be able to perform more sedentary work. Not only does the Veteran have a year of college education and formal training as a barber, his work history shows several marketable skills. Indeed, Dr. W. recommended the Veteran for vocational rehabilitation and even proposed a specific vocation. Such recommendations are consistent with a finding that the Veteran was capable of substantially gainful employment. Moreover, the Veteran testified in November 2005 that he had attempted to obtain employment (implying he believed he was physically capable of employment), but that he was unable to secure employment because he was an insurance risk (rather than that he was unqualified or physically incapable of the work). This, too, supports finding that the Veteran had marketable skills and the physical and mental capabilities (excluding the effects of nonservice-connected disabilities) to obtain and maintain some form of sedentary or non-physical gainful employment. The Veteran argued before the Court that the November 1996 VA examiner's opinion should not be given probative weight because, according to the Veteran, the examiner did not "mention the February 1992 diagnosis of chronic cauda equine syndrome, bladder incontinence, sexual dysfunction, or use of prescribed narcotic medication for treatment of the lumbar disorder." February 2017 Appellant's Brief at 23. The Veteran further argued that the opinion should not be given probative weight because the Veteran was not service-connected for degenerative joint disease of the lumbar spine, urinary incontinence, or impotence at the time of the exam. Id. The Veteran does not explain how the urinary incontinence or impotence would affect employability. There is no evidence that impotence would affect the Veteran's employability. The Veteran's testimony was that he had urinary frequency of 5-6 times per day (including at night) and used pads he had to change 3-4 times per day. There is other evidence of less frequent incontinence, but giving the Veteran the benefit of the doubt, the Board does not find that this would have a significant impact on employability. Moreover, the Board has given weight to the November 1996 examiner's opinion with respect to the effect of his back disability on his employment which (the Veteran has alleged) is the primary obstacle to his gainful employment. See, e.g., February 1999 VA Examination (documenting Veteran's statement that back pain prevented him from working). Likewise, the Veteran's suggestion that the 1996 VA examination should be given no probative weight due to the failure to mention the "February 1992 diagnosis of chronic cauda equine syndrome" is without merit. Again, the 1996 VA examination has probative weight with respect to the impact of the Veteran's back disability on his employability. The Board also notes that the February 1992 "diagnosis of chronic cauda equine syndrome" (as the Veteran's representatives characterize it) was actually recorded as "evidence of chronic cauda equine syndrome." Therefore, the examiner's suggestion that further imaging studies were needed to confirm the diagnosis is consistent with the prior medical record. In addition, the examiner did not separate out the effects of the various pathologies of the back in rendering his employability opinion. His examination and opinion addressed the Veteran's back symptoms and their impact on his employability without separating then-service-connected conditions from non-service-connected conditions. As the Board interprets the report, the examiner addressed the Veteran's functional capabilities as revealed by the physical examination of the Veteran's back without regard to which diagnoses were service-connected and which were not. The Veteran has not identified any symptoms or functional effects that would be associated with the chronic cauda equine syndrome that were not addressed by the examiner. The examination was thorough, and the examiner's opinion was supported by a comprehensive physical evaluation and review of records. With respect to the impact of narcotics, the examiner did not explicitly address it, but it is not necessary that a medical opinion address every service-connected disability and address the effects of medication to be entitled to probative weight with respect to the effect on occupational functioning due to the physical condition. Moreover, as discussed in detail below, the Board finds that the greater weight of the evidence indicates that the silence on the part of the examiner was due to an absence of such effects, rather than omission of pertinent facts by the examiner. The Veteran also asserts that the record does not indicate that the examiner reviewed the claims file and prior medical records before opining on employability. The record reflects, however, that the RO requested that the examiner review the claims file, that the claims file was made available to the examiner, that the examiner treated the matter as "a BVA remand case which was reviewed", and that the examiner discussed pertinent medical history indicating a familiarity with the Veteran's medical record. Based on that information and reading the report as a whole, the Board concludes that the examiner had the claims file available and reviewed it as he, in his professional capacity, deemed appropriate. See also March 1997 VA Examination ("[P]revious examination on 11-25-96...was reviewed as was his C-File at the time of the previous examination."). The Board also notes that the claims file is "not a magical or talismanic set of documents", but is instead a tool for use by examiners and adjudicators. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303 (2008) ("Imposing on a physician a requirement that he read a compilation of documents that can run to thousands of [often irrelevant] pages...in order that his or her opinion not be summarily discounted, has no inherent value to the probity of the opinion."). The record here demonstrates that the VA examiner was sufficiently informed of the relevant medical history for his opinion to warrant probative value. Even assuming that a more complete discussion of pertinent medical history would have made the opinion more persuasive, the opinion has significant probative value as written. The Board recognizes and has considered the limitations of the examination in assigning it probative value, but finds that the 1996 VA examination does have probative value regarding the effect of the Veteran's back symptoms on his employability. The Veteran has similarly argued that the 1993 medical letters by Dr. G.W. should also be summarily discounted because of an alleged lack of review of the claims file or medical records and no discussion of "the February 1992 diagnosis of chronic cauda equine syndrome, bladder incontinence, sexual disfunction, or use of prescribed narcotic medication." February 2017 Appellant's Brief at 23-24. Again, even assuming Dr. G.W. did not review the claims file, his opinion may still be probative. Nieves, 22 Vet. App. at 303-304. Dr. G.W.'s report reveals a familiarity with key facts of the Veteran's medical history which he could only have gotten through reviewing the medical file or taking an accurate medical history from the Veteran. Both methods are acceptable means for non-VA physicians to obtain adequate historical context to render a valid opinion. See Nieves, 22 Vet. App. at 303 (citing Kowalski v. Nicholson, 17 Vet. App. 171, 179 (2005) for the proposition that the Board may rely on a private medical opinion that is based on an accurate medical history offered by the veteran). Again, the Veteran's argument is that the opinion should be dismissed as having no probative value. The Board has instead determined that the opinion does have probative value as it is based on an accurate medical history, a thorough physical examination, provides relevant findings regarding the symptoms associated with the Veteran's back disability, and contains persuasive reasoning why the Veteran's disabilities (including non-service-connected disabilities) did not render him unemployable at that time. Although some medical issues were not mentioned (e.g., urinary incontinence and sexual dysfunction), the opinion warrants probative value because of the discussion of the back disability and other conditions most pertinent to occupational functioning. The examiner did not discuss the Veteran's use of narcotics, but this does not render his opinions without probative value for two reasons. First, the examiner did provide a broad overview of the Veteran's condition outside the context of service-connected conditions and, as the Board reads the report, would have commented had the Veteran's use of pain medication substantially interfered with his occupational functioning. See, e.g., May 1993 Workers Compensation Exam (listing current medications as "blood pressure medication" where it would be expected that narcotics would be listed if, in fact, the Veteran was using narcotics in significant amounts to manage pain); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1335 (Fed. Cir. 2006) (lack of documentation in the medical record does not, in and of itself, render lay recollection not credible, but the fact may be considered along with other evidence); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (the silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). Second, the factors that the examiner did explicitly address are relevant to the Board in making a determination. There is no requirement that each medical opinion must address every factor that might affect a Veteran's occupational functioning. Rather, the Board has a duty to review the entire record and the opinions of various experts (e.g., audiologists and neurologists and orthopedic specialists) where a particular expert may have crucial information regarding conditions within his/her specialty, but may be unable to discuss issues outside his/her specialty. The 1993 opinions provide relevant, probative information regarding the Veteran's occupational functioning. Those opinions, particularly when viewed with the other evidence of record, support the finding that the Veteran was not unemployable prior to October 4, 2001, due solely to his service-connected disabilities. The Veteran's representative has argued that the Board's prior decision failed to adequately address the effect pain medication had on the Veteran's ability to obtain and maintain gainful employment. February 2017 Appellant's Brief at 24-25; see also November 2017 CAVC Decision at 15 (citing Fisher v. Principi, 4 Vet. App. 57, 60 (1993) in support of the proposition that that Board did not adequately address the evidence that the Veteran took narcotic medication for pain associated with his service-connected conditions). The Veteran relies on his own statements to substantiate his allegation that he took significant amounts of pain medication that affected his functioning. Id. (citing his February 1990 hearing testimony, his July 1991 statement, his September 2001 hearing testimony, his December 2002 hearing testimony, and his statement recorded in a May 2006 VA examination report). In his Appellant's Brief, he argues that he "has consistently indicated that he must use heavy, narcotic medication to treat his persistent and intractable pain." Id. at 24. However, he has not identified medical records that substantiate his claim that he used "heavy, narcotic medication" during all, most, or even some of the period on appeal. Review of the record reveals that, at least for the time period on appeal, again, prior to October 2001, the Veteran has overstated his reliance on "heavy, narcotic medication." The Veteran has pointed to the absence of discussion of these alleged "heavy" narcotics in the 1993 examinations and the November 1996 VA examination as omission of pertinent medical information and, so, as grounds for assigning the opinions no probative value (see discussion above). An alternative explanation, more consistent with the medical record (as opposed to the Veteran's own reports in the context of seeking benefits), is that the Veteran was not using narcotics with a frequency and in an amount that significantly affected his occupational functioning and also that the medications the Veteran recalls affecting his functioning were for non-service-connected conditions (e.g., his headaches and depression). The Veteran's representative has cautioned the Board against making a medical determination regarding whether the amount and frequency of the Veteran's narcotic medication use would have impacted his occupational functioning and, if so, to what extent. See April 2020 Appellant's Informal Brief. The Board notes that this is not, however, a medical determination. As discussed at more length below, the greater weight of the evidence affirmatively establishes that the Veteran was not using significant narcotic medication from at least October 1991 to June 2000. This is a fact substantiated by the actual medical records regarding prescribed medications and dosages, and the Board's interpretation of the various opinions regarding the Veteran's occupational functioning during that period is consistent with the contemporaneous medical records as to exactly what he was prescribed and for what medical condition. The Board does not have to make a determination as to how much the narcotic pain medication affected the Veteran's functioning during this period because, with a brief exception in February 1992, the Veteran was not using narcotic pain medication for any purpose, much less for his service-connected lumbar spine condition. The fact that the Veteran was taking other medications (e.g. Lithium) during this period, provides an explanation for why the Veteran recalls the difficulties functioning due to medication during this time in a way that does not impugn his motives. In short, the Board's statement is simply to note there is an alternative explanation for the discrepancy between the Veteran's statements regarding use of narcotic medication and his recollection of his medical status/functional abilities decades ago. Importantly, that explanation is supported by the contemporaneous medical records and does not require that the Veteran was lying or even substantially incorrect in his recollections (see below, his statements generally came before and after the period on appeal, times when he was actually using narcotic medications), nor does it require the Board to make any medical judgment regarding the effect of the narcotic medications the Veteran did take. Specifically, the explanation is supported by the fact that medical records, including those that explicitly list his medications, fail to document the use of medication as the Veteran claims and/or the effects he claims and/or during the times he claims. Importantly, the Board emphasize again, the period on appeal is from June 1991 to October 2001. The Veteran's first testimony supporting the use of pain medications that significantly affected his occupational functioning was at a February 1990 DRO hearing prior to the period on appeal. See April 2020 Appellant's Informal Brief. He did submit a July 1991 statement in which he stated that he would take "extremely strong pain medication which impair[ed his] function." This does provide some indication that his statements cover the pertinent time period and are contemporaneous with his alleged reliance on "heavy, narcotic medication." But the Board has evaluated these statements in light of the contemporaneous medical records. There is documentation of the use of pain medication with narcotics in 1989. See May 1989 Private Progress Note ("headache pain has been diminished with the use of Tylenol #3" which is Tylenol with codeine; "Tylenol #3 has been renewed for treatment of intense headache pain"). However, a subsequent July 1989 private progress note indicates, as the Board interprets it, as switching to an NSAID (Naprosyn) for pain ("Continue Naprosyn as needed") with no mention of further prescription or use of Tylenol #3. See also August 1989 Private Progress Note (noting the Veteran "has failed to benefit from nonsteroidal anti-inflammatory medication, as well as amitriptyline, which is sometimes useful for treatment of chronic pain syndromes"; noting multiple diagnoses, including "substantial pain involving headache, neck and back, as well as both arms and both legs", which the neurologist recommended be treated by "an internal medicine specialist and a psychologist or psychiatrist" and which conditions rendered the Veteran "temporarily totally disabled"); September 1989 Private Progress Note (documenting low back pain radiating to the legs bilaterally among current complaints as well as tenderness and limitation of motion of the back, but not diagnosing any back condition and instead diagnosing only post-traumatic head syndrome with headache, diminution of memory and hearing loss and cervical myofascial sprain/strain syndrome and not mentioning current pain medication); January 1990 Private Progress Note (failing to diagnose or discuss low back symptoms or any pain medication, but noting significant problems with residuals of head injury, neck, and a fracture in the elbow related to the work injury, all of which rendered the Veteran "temporarily and totally disabled"). This use of narcotic pain medication was prior to the period on appeal and, as noted above, there were indications in those records that he was then switched to non-narcotic pain management. Medical records early in the appeal period support this interpretation. See October 1991 Orthopedic Report (recommending that, if his symptoms increase, "he should have access to prescription nonsteroidal anti-inflammatory medicines"). There are indications that the Veteran occasionally was prescribed narcotic pain medication during the period, but also convincing evidence that the use was only occasional. Compare February 1992 VA Progress Note (listing Naprosyn and Percocet as pain medications in a note diagnosing chronic low back pain with evidence of chronic cauda equina) with May 1993 Workers Compensation Exam (listing current medications as including only "blood pressure medication"); August 1994 Psychiatric Triage Evaluation (list of current medications does not include narcotic pain medication); Progress Notes from 1996 through 1998 (listing medications and documenting treatment, but not documenting any prescription for or use of any narcotic pain medication); May 1998 SSA Psychiatric Evaluation (documenting use of Lithium and Navane, an anti-psychotic, but failing to indicate the use of any pain medication, e.g. narcotics, that had any effect on mental functioning); and March 1999 VA Examination (documenting the Veteran's report of treatment with physical therapy and "intermittent treatment with analgesic medications and muscle relaxants, since 1974 to the present time"). Moreover, the June 2000 treatment note relied upon by the Veteran's representatives as documentation of the use of narcotic pain medication specifically indicates that the Veteran reported "back pain [that has] been there off and on for 20 [years], worse in last 3 days." See June 2000 VA Urgent Care Note (noting NSAIDS contraindicated, indicating plan to inject with demerol for immediate relief which was documented the same day, and newly prescribing Vicodin for "severe pain otherwise only Tylenol 500 mg to 1 gm"). The Veteran returned as directed and reported taking three Vicodin a day. See June 2000 VA Urgent Care Note. In July 2000, the Vicodin was discontinued and replaced with a prescription for Percocet. See July 2000 VA Attending Note. Therefore, the greater weight of the evidence indicates back pain that was typically not treated with narcotic medication from June 1991 to June 2000, though there was brief use of Percocet in 1992, and regular use of narcotic pain medication began on June 14, 2000. Based on this evidence, the Board finds the contemporaneous documentation of medication use from 1991 through June 2000 shows only occasional, temporary use of narcotic pain medication (and, pursuant to these records, only in 1992). While this contrasts with the Veteran's recollections of the medication he used and its effects on him, the Board notes that there are many medical records documenting his poor cognitive functioning during the early part of the period (including memory issues) and psychiatric records throughout that period both documenting problems with memory and also the use of significant medications like Lithium and anti-psychotics like Navane. In other words, the Veteran's recollection is not supported by contemporaneous documentation, the Veteran is not competent to opine on which of his multiple medications caused the subjective symptoms he experienced, and there are indications in his psychiatric and neurological treatment records that he might not be a reliable historian (e.g. there are documented memory issues). In short, the best and most convincing evidence of his use of medications during this period indicates that he did not use narcotic pain medication at all from roughly 1993 through June 2000 and had only occasional use of narcotic pain medication in 1991 and 1992. The Board has considered the evidence of some use of narcotic pain medication during this period in considering his overall level of impairment. The August 2020 VA examiner's opinion provided general information that patients taking narcotic medication often have impaired awareness and arousability and that the use of narcotic medication would have depressed his occupational functioning due to these usual effects. Notably, the VA examiner did not opine that occupational functioning would be completely impaired, but merely "depressed" while using the medication. As discussed above, the Veteran's use of narcotic pain medication from June 1991 to June 2000 was infrequent according to the contemporaneous medical records. While it would have interfered with employment, the evidence is against finding that the Veteran was rendered unable to obtain or maintain gainful employment during this period, including during the brief periods he was prescribed narcotic medications (two months in 1991 and a short time in 1992). The Veteran's representatives argue that the August 2020 VA examiner's opinion "reflects probative medical evidence in support of the finding that [the Veteran] was totally disabled and unemployable prior to October 4, 2001." See April 2021 Appellant's Informal Brief. However, the Veteran's representatives acknowledge that the examiner "did not explicitly state that [the Veteran's] service-connected back disability and effects of narcotic medication rendered him unemployable in all substantially gainful environments." Id. Of course, the Veteran's representatives are right that she was not asked this question and, in any case, it is the Board's province to make the determination of unemployability. The representatives place great weight on her opinion that narcotics would have "depressed" the Veteran's occupational functioning due to their side effects "especially in the area of his mental functioning." Id. This does not have probative value with the entire period on appeal, however, as the Board has found that the greater weight of the evidence establishes that the Veteran used narcotic medications briefly in 1991 and 1992, then more regularly starting in June 2000. Therefore, while the opinion does provide some support for finding unemployability when the Veteran was using narcotic medication to manage pain, he was not regularly using narcotic pain medication until June 2000. The Board has discussed above (and below) the reasons why the brief use of narcotic pain medication in 1991 and 1992 would not have rendered the Veteran unemployable in that time frame, even if it would have adversely affected his occupational functioning during the brief periods he was using it. More importantly, for the majority of the period on appeal prior to June 2000, the Veteran was not using narcotic pain medication and, so, the effects of narcotic pain medication as described by the VA examiner are irrelevant to evaluating his employability from 1993 to June 2000. The Veteran's representatives also rely on the August 2020 VA examiner's statement that "from 1991 to 2001, the patient was on narcotic medications for his lower back pain and service-connected disabilities." See April 2021 Appellant's Informal Brief. The Board does not interpret this as a medical opinion that the Veteran was using narcotic medications consistently during the entire period. Instead, the opinion simply addresses what disabilities the narcotic pain medications were prescribed to treat when the Veteran was taking them during that period. As discussed at length, the contemporaneous treatment records establish limited use in 1991 and 1992, followed by a long period without any use of narcotic pain medications, and then regular use beginning in June 2000. The VA examiner's opinion must be interpreted in light of the entire record. She did not identify any treatment records or other evidence from 1993 to June 2000 which would suggest the Veteran was using narcotic pain medication during that time, nor did she provide any reasoning or rationale that would support the inference the Veteran's representatives invite the Board to make. In short, the VA examiner did not provide a medical opinion regarding when and how frequently the Veteran was taking narcotic pain medication. Her opinion addressed the purpose of the medication and the effects of it when he used it. As already discussed, the Board finds the contemporaneous records (particularly including medication lists and other discussions of all current medications per the Veteran's own statements in the course of seeking medical care) provide the best evidence of when the Veteran was using narcotic pain medication. Briefly, the April 2021 Appellant's Informal Brief also argues that "there is no remaining controversy as to whether he was prescribed, and took, narcotic pain medication for his service-connected disabilities prior to October 4, 2001." While true as far as it goes, the statement ignores that "prior to October 4, 2001" encompasses roughly a decade and, as discussed, the Veteran did not continuously, regularly, or frequently use narcotic pain medication for most of that period. The Board's June 2020 remand, to the extent it resolved the controversy regarding usage of pain medication, specifically referenced "the prescription pain medication documented in the record". This is entirely consistent with the Board's finding that the documented usage was for a brief period in 1991, briefly in 1992, and then beginning with regularity in June 2000. And, in fact, the remand specifically references 1989 records (prior to the appeal period), an April 1991 record, and June and July 2000 records. To the extent the Board made any findings regarding usage, the usage referenced by the Board was "documented" usage with references to documentation in 1989, 1991, and 2000. The Board's current findings (including additional instances in 1991 and 1992) are, if anything, more favorable to the Veteran than the statements in the June 2020 remand which the Veteran's representatives would construe as binding factual findings of the Board. In short, the Board's fact-finding on the issue of the specific time periods during which the Veteran used narcotic pain medication are consistent with its prior statements on that issue in the June 2020 remand. To the extent the Veteran's representatives are hinting that these findings would require notice and further remand, the Board rejects the contention. The Board has neither reversed nor purported to reverse any prior factual findings or credibility determinations. See Smith v. Wilkie, 32 Vet. App. 332, 334 (Apr. 27, 2020) ("the principles of fair process require the Board to provide claimants notice and an opportunity to respond when it purports to reverse prior assertions that evidence is credible or otherwise satisfactory to establish a fact necessary to the claim"). As discussed above, there are multiple opinions regarding the Veteran's occupational functioning during this time period. While they do sometimes indicate the Veteran is incapable of employment due to his overall condition (particularly including cognitive and/or psychiatric disabilities), they tend to provide substantial, probative evidence against the Veteran's claim of unemployability due to his service-connected disabilities. For example, the October 1991 Orthopedic Report identified subjective factors of disability including neck pain with radiation, elbow pain with radiation, and "constant slight low back pain with radiation into the right buttock" and objective factors of disability included tenderness of the lumbar region and diminished range of motion and altered spinal mechanics. Even with these subjective and objective factors of disability, the physician opined that the Veteran's cervical and lumbar regions precluded the Veteran only from "very heavy work" (and his elbow had further impact). Although the physician opined that the Veteran could not return to his work as an interior sheller, the report indicates that other, less physically intensive labor would be suitable. In addition, the November 1993 Vocational Rehabilitation Opinion indicates that the Veteran could train to be a smog technician and would be able to perform the duties of that position which were described as including frequent standing and walking, carrying, occasional driving, frequent lifting and carrying, occasional pushing and pulling, occasional twisting at the waist, kneeling, and crawling, with constant reaching in front, frequent reaching below shoulder level, and occasional reaching overhead. This opinion is consistent with the medical examinations and other medical evidence of record from the period as already discussed above. The Board has already discussed the findings, relevance, and probative value of these reports and the 1996 VA examination and the February 1999 VA examination, all of which support finding that the Veteran's service-connected disabilities, including medications taken to treat them, did not prevent him from performing the physical and mental tasks required of gainful employment. The records even note an occupation for which the Veteran's experience, training, education, and physical abilities suited him. As already discussed, there is significant evidence that the facts of his actual unemployment and his inability to obtain and maintain employment were due to non-service-connected disabilities. See, e.g., July 1990 Private Psychiatric Evaluation (listing employment history (reading water meters, truck driver, carpenter) and noting: "He stated that he did not feel that he ever had any difficulty in holding down jobs and that he had not quit often, nor gotten fired. At the present time, he is not looking for employment due to his physical limitations and to his lack of emotional control."); October 1991 Orthopedic Report (noting significant impact of non-service-connected neck and elbow disabilities); see also August 1989 VA 21-8940 (noting became unemployable in February 1989 due to "back and hip"); March 1990 SSA Disability Determination and Transmittal (noting primary diagnosis of "cervical strain/sprain" and secondary diagnosis of "post-traumatic head syndrome); February 1990 Residual Physical Functional Capacity Assessment; June 1998 SSA Determination and Transmittal (noting primary diagnosis of "Affective (Mood) Disorder" and secondary diagnosis of autistic disorder and other pervasive developmental disorders). The evidence indicates that the Veteran is not a reliable historian with respect to his recollections of the types and amounts of medications he took (including what those medications were for) during the period June 1991 to June 2000, and that he did not use narcotic medications for the management of pain associated with his service-connected disorders prior to June 2000 with a frequency and in an amount that rendered him unemployable. He has certainly used such pain medications at times, but the contemporaneous medical records prior to June 2000 simply do not show he was prescribed "heavy, narcotic medications" that significantly affected his occupational functioning during the time being considered (with brief exceptions in 1991 and 1992 already discussed). The greater weight of the evidence is against finding that the medications the Veteran did take for management of his service-connected conditions rendered him unemployable, including when the effects of the medication are considered in combination with other symptoms and functional limitations associated with those conditions. In making these findings, the Board notes that the Veteran's statements on which his representatives rely are from February 1990 (prior to the period on appeal), July 1991 and September 1991 (with contemporaneous evidence indicating he was no longer using narcotic medication at all by October 1991), and December 2002 (after the period on appeal). See April 2020 Appellant's Informal Brief. In other words, the Board has not determined that the Veteran has fabricated any testimony or been untruthful. The record establishes that he generally was taking narcotic medications at the time he gave the statements. But the statements were generally outside the appeal period. The limited exceptions are the 1991 statements at the very beginning of the appeal period which indicated he did not tolerate the codeine well and an October 1991 treatment note indicating he was no longer taking narcotic medications. What the Board has found is that the Veteran's recollection of his medication use (including type, frequency, and dosage) for a decade during which he had documented significant cognitive and psychological difficulties affecting his memory and during which he often took strong medications for his nonservice-connected psychiatric difficulties, is not sufficiently reliable to outweigh the contemporaneous medical evidence that, except for the noted exceptions, he was not taking narcotic medication during this time period (although he did before and after). The preponderance of the evidence is against the claim that the Veteran was unemployable due to his service-connected disabilities, prior to June 14, 2000. In making this determination, the Board has conducted an independent review of the record and has not considered or given any probative weight to the findings of the Director of the VA Compensation and Pension Service. Because the greater weight of the evidence is against the claim, the Veteran does not meet or more nearly approximate the extraschedular criteria for an effective date prior to June 14, 2000. Accordingly, an effective date earlier than June 14, 2000, for a TDIU is not warranted, and the appeal is denied. In arriving at this decision, the Board has considered the doctrine of reasonable doubt. However, that doctrine is only invoked where there is an approximate balance of evidence which neither proves nor disproves a claim. In this case, the preponderance of the evidence is against the Veteran's claim. Therefore, the doctrine of reasonable doubt is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. However, the Board finds that the evidence is in equipoise regarding the period beginning June 14, 2000. Contemporaneous medical records document a significant worsening of back pain with treatment on that day with demerol and a new prescription for Vicodin. Later notes indicate the Veteran was taking significant amounts of Vicodin, but was switched to Percocet due to ineffectiveness of Vicodin. Therefore, for the period June 14, 2000, to October 4, 2001, the evidence indicates significantly worsened pain that warranted prescription of narcotic medication to manage the newly severe pain. Giving the Veteran the benefit of every doubt, this worsened back pain and the effects of the new prescription of pain medication would have prevented the Veteran from obtaining and maintaining gainful employment. Consequently, entitlement to a TDIU from June 14, 2000, is granted. F. Duties to Notify and Assist There was some suggestion before the Court and upon return of the matter to the Board that an opinion regarding the purpose and effect of the narcotic medication should be obtained. The Board remanded this matter to the RO in June 2020 to obtain an appropriate opinion. The record now contains a July 2020 VA examiner's opinion on that issue. The Veteran and his representatives have not questioned the adequacy of the opinion, but have argued that the current record is sufficient to decide the claim. See, e.g., April 2021 Appellant's Informal Brief. The Board agrees. The Veteran has not raised any other specific issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The Board discussed VA's compliance with the duties to notify and assist in its March 2016 decision, which analysis the Board adopts and incorporates herein. The Veteran and his representatives have not raised, either before the Board or before the Court, any alleged deficiencies in VA's efforts to fulfill its duties to notify and assist, or any deficiencies in the conduct of the Board hearings. Therefore, the Board need not further discuss VA's compliance with the duties to notify and assist. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kerry Hubers 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.