Citation Nr: 21040899 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 12-11 416A DATE: July 7, 2021 ORDER Service connection for angina is denied. Service connection for arthritis is denied. Service connection for a respiratory disorder is denied. Service connection for obstructive sleep apnea (OSA) is denied. Service connection for a skin disorder is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Angina is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to herbicide agents, and is not caused or aggravated by the Veteran's service-connected anxiety disorder. 2. Arthritis is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to herbicide agents, did not manifest to a compensable degree within one year of separation from service, and is not caused or aggravated by the Veteran's service-connected anxiety disorder. 3. At no time during the pendency of the claim does the Veteran have a current disability of a respiratory disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. 4. OSA is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to herbicide agents, and is not caused or aggravated by the Veteran's service-connected anxiety disorder. 5. A skin disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to herbicide agents, and is not caused or aggravated by the Veteran's service-connected anxiety disorder. 6. The Veteran's service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for service connection for angina have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for arthritis have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for a respiratory disorder have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 4. The criteria for service connection for OSA have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 5. The criteria for service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 6. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to April 1968, to include approximately one year of service of the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In March 2016, the Board, as relevant, granted service connection for malaria and remanded the issues currently remaining on appeal for additional development. However, to date, the Agency of Original Jurisdiction (AOJ) has not implemented the award of service connection for malaria. As such, that matter is referred for appropriate action. In November 2017 and January 2019, the Board again remanded the case for additional development and it now returns for further appellate review. The Board observes that, since the issuance of the most recent supplemental statement of the case in September 2020, additional evidence, to include updated VA treatment records and VA hypertension and hearing loss/tinnitus examination reports, has been associated with the record. The Veteran has not waived AOJ consideration of such evidence. However, as such are irrelevant to the instant claims or contain findings duplicative to those previously considered by the AOJ, the Board finds that no prejudice results to the Veteran in proceeding with a decision at the present time. 38 C.F.R. § 20.1305(c). 1. Entitlement to service connection for angina, to include as due to exposure to herbicide agents or as secondary to service-connected anxiety disorder. 2. Entitlement to service connection for arthritis, to include as due to exposure to herbicide agents or as secondary to service-connected anxiety disorder. 3. Entitlement to service connection for a respiratory disorder, to include as due to exposure to herbicide agents and/or asbestosis, or as secondary to service-connected anxiety disorder. 4. Entitlement to service connection for OSA, to include as due to exposure to herbicide agents or as secondary to service-connected anxiety disorder. 5. Entitlement to service connection for a skin disorder, to include as due to exposure to herbicide agents or as secondary to service-connected anxiety disorder. The Veteran is seeking service connection for angina, arthritis, a respiratory disorder, OSA, and a skin disorder, which he contends manifested in service, are related to his acknowledged exposure to herbicide agents coincident with his service in the Republic of Vietnam, or are caused or aggravated by his service-connected anxiety disorder. He further claims that he has a respiratory disorder related to alleged in-service exposure to asbestos. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as arthritis, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, the law provides a presumption of service connection for certain diseases associated with exposure to herbicide agents, and that become manifest within a specified time period, even if there is no record of evidence of such disease during the period of service. 38 C.F.R. § 3.307(a)(6)(i). As relevant, veterans who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, are presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6). As the record reflects that the Veteran served in Vietnam during the requisite time period, he is presumed to have been exposed to herbicide agents. For those veterans who have been exposed to herbicide agents, certain diseases are acknowledged to be presumptively related to such exposure, provided that they manifest to a degree of 10 percent or more within a specified time period. 38 U.S.C. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). However, none of the Veteran's claimed disorders are included in the list of diseases acknowledged to be presumptively related to exposure to herbicide agents. Nonetheless, notwithstanding the foregoing presumption, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). However, pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. As an initial matter, the Board finds that the Veteran does not have a current diagnosis of a respiratory disorder, to include chronic obstructive pulmonary disease (COPD), at any time pertinent to the pendency of the claim, which was received in August 2010. In this regard, the Veteran was afforded a VA examination in September 2017, at which time the VA examiner recognized a history of an asymptomatic left lung nodular opacity identified in 2006 via imaging study, which had since resolved as evidenced by imaging conducted 10 years later. He also noted a history of intermittent dyspnea, but stated that such did not constitute a respiratory disorder. In support of such opinion, the examiner cited diagnostic imaging studies performed in 2006 and 2016, showing an initial possibility of a nodule, followed by normal results; normal pulmonary functioning testing performed at the examination; and a lack of a diagnosis in the Veteran's VA treatment records. Moreover, the Veteran denied experiencing respiratory symptoms at the time and no functional impairment was noted. However, as a November 2011 treatment record from the Veteran's private cardiologist reflected a diagnosis of COPD, an addendum opinion addressing such potential diagnosis was obtained in December 2019. Following a review of the evidence of record, the examiner found that such diagnosis was, in fact, a misdiagnosis. In support of this opinion, the December 2019 VA examiner explained that such diagnosis was not predicated on complete clinical data and, in fact, was contradicted by the fact that the Veteran's normal pulmonary function test and he was not being treated for any respiratory disorder. Furthermore, the Veteran, as a lay person, is not competent to diagnose a respiratory disorder as such requires the administration and interpretation of specialized diagnostic testing, an expertise that he does not possess. Thus, his opinion as to the presence of such a disability is afforded no probative weight. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Consequently, the Board finds that at no time during the pendency of the claim does the Veteran have a current disability of a respiratory disorder, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim. Thus, service connection for such claimed disorder is not warranted. As relevant to the remaining claims, the record reflects current diagnoses of chest wall pain, bilateral osteoarthritis of the hands, OSA, and seborrheic keratosis, actinic keratosis, and squamous cell carcinoma of the groin. See September 2017 and December 2019 VA Examination Reports. However, while his service treatment records reflect treatment for early syphilis with penile lesions (later characterized as chancroid) and malaria, such are negative for any complaints, treatment, or diagnosis referable to angina, arthritis, OSA, or a skin disorder. Furthermore, at the time of his March 1968 separation examination, the Veteran denied all relevant symptomatology, to include pain or pressure in the chest, palpitation or pounding heart, swollen or painful joints, arthritis or rheumatism, shortness of breath, frequent trouble sleeping, and skin diseases, and all systems were normal upon clinical evaluation (with the exception of a tattoo). However, he is presumed to have been exposed to herbicide agents coincident with his service in Vietnam, and is currently service-connected for anxiety disorder. Thus, the remaining inquiry is whether the Veteran's current disorders are related to his service in Vietnam, to include his acknowledged in-service exposure to herbicide agents, or are secondary to his service-connected anxiety disorder. In this regard, the Veteran was afforded VA examinations in September 2017 to determine the nature and etiology of his current disorders. At such time, the foregoing diagnoses were rendered; however, the examiner opined that such disorders did not have their onset in service and were not related to the Veteran's acknowledged in-service exposure to herbicide agents, the jungle environment in Vietnam, or treatment for chancroid or malaria, and were not related to, or aggravated by, his service-connected anxiety disorder. As pertinent to the Veteran's chest wall pain, the examiner observed that his STRs were negative for any relevant complaints, his pulse was normal at separation, and there was no medical documentation to support a finding that such was evaluated or diagnosed for greater than 20 years after his separation from service. Furthermore, he had a normal nuclear medicine stress test in March 2004 and a normal echocardiogram in 2017. The examiner further found that there was no evidence that the Veteran's chest wall pain was in any way related to exposure to herbicide agents, the jungle environment, or treatment for chancroid or malaria, and were not related to, or aggravated by, his service-connected anxiety disorder. In regard to the Veteran's osteoarthritis of the bilateral hands, the examiner noted that his STRs were negative for any chronic arthritic complaints such as hand pain, and his March 1968 separation examination showed a normal musculoskeletal examination. He further observed that the Veteran's arthritis condition was diagnosed after separation from service when he started receiving treatment at VA in 2000. In this regard, the examiner explained that osteoarthritis is often related to aging and trauma and, for many years, the Veteran was a truck driver and helped to unload trucks, thereby explaining the diagnosis of arthritis of the hands as such was related to the overuse of his hands due to his post-service job. The examiner further found that there was no evidence that the Veteran's osteoarthritis of the bilateral hands was in any way related to exposure to herbicide agents, the jungle environment, or treatment for chancroid or malaria, and were not related to, or aggravated by, his service-connected anxiety disorder. As pertinent to the Veteran's OSA, the examiner observed that his STRs did not document any respiratory complaints such as snoring, respiratory apnea, or daytime fatigue, and his March 1968 separation examination showed a normal cardiac and lung examination. Furthermore, he found that OSA was not diagnosed until at least the 1990's. In this regard, the examiner noted that a December 2006 private treatment record reflected a diagnosis of insomnia with sleep apnea and VA treatment records showed a diagnosis of sleep apnea in 2007, with a notation that a prior diagnosis had been rendered 10 years earlier. The examiner further found that there was no evidence that the Veteran's OSA was in any way related to exposure to herbicide agents, the jungle environment, or treatment for chancroid or malaria, and were not related to, or aggravated by, his service-connected anxiety disorder. With respect to the Veteran's skin disorder, the examiner noted that his STRs did not document a chronic skin condition, and his March 1968 separation examination showed a normal skin examination with the exception of a tattoo. He also noted that there was no medical documentation to support a finding that such disorder was evaluated or diagnosed for at least 20 years after service. In this regard, the examiner noted that VA treatment records were negative for an evaluation or diagnosis of a lower leg skin disorder and private treatment records reflected a diagnosis of keratosis of the lower legs in May 2008. Here, he explained that keratosis is a thickening and dryness of the keratin of the outer layer of the skin and can be related to aging. The examiner further found that there was no evidence that the Veteran's skin disorder was in any way related to exposure to herbicide agents, the jungle environment, or treatment for chancroid or malaria, and were not related to, or aggravated by, his service-connected anxiety disorder. However, as noted in the January 2019 remand, such opinions addressing the potential relationship between the Veteran's claimed disorders and his acknowledged in-service exposure to herbicide agents, and his service-connected anxiety disorder, were inadequate as they contained no rationale other than a conclusory statement that there was "no evidence" to support such relationships. Thus, the claims were remanded in order to obtain an addendum opinion addressing such matters. Thereafter, in December 2019, another VA examiner reviewed the record and opined that the Veteran's diagnosed disorders were not likely related to his acknowledged in-service exposure to herbicide agents as a review of the medical literature, including UpToDate, did not support such a nexus and the risk factors for such conditions did not include such exposure. He further opined that the Veteran's diagnosed disorders were not likely caused or aggravated by his service-connected anxiety disorder as a review of the medical literature, including UpToDate, did not support such a nexus and the risk factors for such conditions did not include anxiety disorder. Finally, the examiner further explained that the Veteran's squamous cell carcinoma of the left groin was not likely attributable to his in-service penile lesions, diagnosed as chancroid. In this regard, he noted that chancroid was successfully treated with antibiotics and there were no residuals, and the risk factors for squamous cell carcinoma do not include a history of chancroid. Finally, the examiner observed that the medical literature, to include UpToDate, did not support such a nexus as chancroid had no carcinogenic effect. The Board affords great probative weight to the January 2019 and December 2019 VA examiners' opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertions as to the onset and etiology of his claimed disorders; however, his report that such conditions had their onset in service are contradicted by the contemporaneous evidence, to include his own statements, and, thus, are not credible. Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006) (the lack of contemporaneous medical records, the significant time delay between the affiants' observations and the date on which the statements were written, and conflicting statements of the veteran are factors that the Board can consider and weigh against a veteran's lay evidence). Specifically, as noted previously, his STRs are negative for are negative for any complaints, treatment, or diagnosis referable to angina, arthritis, OSA, or a skin disorder. Moreover, at the time of his March 1968 separation examination, the Veteran denied all relevant symptomatology, to include pain or pressure in the chest, palpitation or pounding heart, swollen or painful joints, arthritis or rheumatism, shortness of breath, frequent trouble sleeping, and skin diseases, and all systems were normal upon clinical evaluation (with the exception of a tattoo). Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to his currently diagnosed disorders is a matter that requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). Furthermore, as a lay person, the Veteran does not have the requisite training and experience necessary to provide an opinion as to the etiology of his currently diagnosed disorders as such is a complex medical matter. See Jandreau, supra. In this regard, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert, supra. Accordingly, the Veteran's opinions as to the onset and etiology of his claimed disorders is not competent evidence and, consequently, is afforded no probative weight. Finally, the Board finds that the probative evidence of record fails to demonstrate that arthritis of the bilateral hands manifested to a compensable degree within one year of the Veteran's separation from service. In this regard, his service treatment records are negative for any complaints, treatment, or diagnosis referable to a bilateral hand disorder, he denied relevant symptomatology and his musculoskeletal system and upper extremities were normal upon clinical evaluation at separation in March 1968, and the first objective evidence of arthritis of the bilateral hands was many years after service. Moreover, while the Veteran reported experienced aching symptoms after service, such symptomatology has not been continuous and, as noted previously, he denied relevant symptomatology at the time of his separation from service. Consequently, presumptive service connection for arthritis of the lumbar and cervical spines, to include on the basis of a continuity of symptomatology, is not warranted Based on the foregoing, the Board finds that angina (chest wall pain), arthritis, OSA, and a skin disorder are not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to herbicide agents, and are not caused or aggravated by the Veteran's service-connected anxiety disorder. Furthermore, arthritis did not manifest to a compensable degree within one year of separation from service. Therefore, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claims for service connection for angina, arthritis, a respiratory disorder, OSA, and a skin disorder. As such, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 6. Entitlement to a TDIU. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran 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, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service (Director) for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). 38 C.F.R. § 4.16(b). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran's education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran's experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran's 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran's master's degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court held that the initial extra-schedular referral decision under § 4.16(b) should address whether there is "sufficient evidence to substantiate a reasonable possibility that a veteran is unemployable by reason of his or her service-connected disabilities." The Court also defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to include two components: one economic and one noneconomic. 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; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. During the period on appeal stemming from the Veteran's August 2009 claim, he is service connected for anxiety disorder, evaluated as 30 percent disabling; hypertension, evaluated as noncompensably disabling; and malaria, the award of which has not yet been implemented. In this regard, the Board observes that, without consideration of the latter disability, the Veteran's combined disability rating is 30 percent, which does not meet the threshold schedular criteria for a TDIU. 38 C.F.R. § 4.16(a). Nonetheless, regardless of the assigned rating for malaria, which, as noted in the March 2016 Board decision, is inactive, the Board finds that the Veteran's service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. In this regard, the Veteran reported in his August 2009 Veteran's Application for Increased Compensation Based on Unemployability (VA Form 21-8940) that he last worked as a truck driver from August 1999 until May 2009. He reported completing high school, but had no other education or training. At the July 2015 Board hearing, the Veteran again reported that he retired from working as a truck driver in 2009, but indicated that he completed one year of community college in addition to high school. In his VA Form 21-8940 and hearing testimony, the Veteran reported that he left his position of employment due to his anxiety disorder. In this regard, he indicated that he could not follow directions, perform on time deliveries, or properly operate equipment. However, the Veteran's alleged impairment associated with his anxiety disorder is contradicted by the highly probative assessments by various VA examiners, who, as psychologists, have expertise in evaluating psychiatric disorders. Specifically, at a May 2013 VA examination, it was determined that the Veteran's anxiety disorder resulted in, at most, 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. In this regard, the Veteran reported no trouble in regard to his anxiety while working, and the examiner found that he had no impairment in understanding and following instructions, retaining instructions and sustaining concentration to perform simple tasks, sustaining concentration to task persistence and pace, and responding appropriately to coworkers, supervisors, and the general public. Rather, it was determined that he only had mild impairment in responding appropriately to changes in the work setting. Thus, the examiner ultimately determined that the Veteran's anxiety disorder did not preclude occupational functioning in a sedentary, structured, solitary work environment that accommodates his nonservice-connected physical limitations, which, the Board notes, is consistent with his education and prior work history as a truck driver. Similarly, at a July 2017 VA examination, another examiner found that the Veteran's anxiety disorder resulted in, at most 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. Furthermore, she found that, while the Veteran would be markedly impaired in working in an environment that contained moving machinery or equipment, he would be, at most, moderately impaired in performing most work-related functions, to include frequent interactions with other people; driving; maintaining sustained concentration and focus; working in a fast-paced, complex, and/or frequently changing environment; and working in a position that required rigid adherence to a set work schedule, and had no impairment in his ability to sustain an ordinary routine, ask simple questions or request assistance, or make simple work-related decisions. Furthermore, while the Veteran has not alleged that his hypertension or malaria impact his ability to work, the Board observes that VA examinations conducted throughout the appeal period consistently show that the latter disability does not impact his ability to work and, as indicated previously, the latter disability is inactive. Finally, the Board notes that the Veteran has been inconsistent in his reasons for retiring. In this regard, as noted previously, he has alleged that his anxiety disorder rendered him employable while pursuing his claim for TDIU; however, at the May 2013 VA examination, he reported that he retired as his company cut back and he made as much money retired as working and, at the July 2017 VA examination, he reported that he could have continued working, but was forced out of his position (i.e., either resign or be terminated). Therefore, based on the foregoing, the Board finds that the Veteran's service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. Rather, as discussed previously, he has retained the ability to perform the mental and physical acts necessary to be successful in a position that is consistent with his high school education with one year of community college and prior employment as a truck driver. Consequently, while the Board has considered the applicability of the benefit of the doubt doctrine, the Board finds that the preponderance of the evidence is against the Veteran's claim for a TDIU. Therefore, that doctrine is not applicable in the instant appeal and such claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge 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.