Citation Nr: 22018129 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 19-05 788 DATE: March 28, 2022 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU) due to a service-connected disability is denied. Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder and somatic symptom disorder is denied. Entitlement to service connection for major depressive disorder is dismissed as moot. FINDINGS OF FACT 1. The Veteran's service-connected post-traumatic stress disorder (PTSD) did not singly render him unable to secure and follow a substantially gainful occupation before June 24, 2020, and he has been in receipt of a 100 percent combined rating on and after that date. 2. The evidence persuasively weighs against finding bipolar disorder was shown at any time during the appeal period. 3. The evidence persuasively weighs against finding somatic symptom disorder was shown at any time during the appeal period. 4. The Veteran's claim for entitlement to service connection for major depressive disorder was granted in a November 2021 rating decision. CONCLUSIONS OF LAW 1. The criteria for entitlement to a TDIU are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.1, 4.3, 4.16, 4.19, 4.25, 4.26. 2. The criteria for service connection for bipolar disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for somatic symptom disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for dismissal of entitlement to service connection for major depressive disorder are met. 38 U.S.C. §§ 7104, 7105. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2004 to June 2007 These matters come to the Board of Veterans' Appeals (Board) from January and July 2017 rating decisions issued by the Agency of Original Jurisdiction (AOJ). In September 2021, the Board remanded the appeal for another medical opinion which was obtained in November 2021. The Board finds that there has been substantial compliance with its directives and may now proceed with a decision. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to a TDIU. The Veteran contends his service-connected PTSD precluded him from obtaining and maintaining a substantially gainful occupation. See October 2017 NOD; December 2021 Appellate Brief at 3. The question for the Board is whether the Veteran has established entitlement to a TDIU at any time across the appeal period, from September 2016. For the reasons discussed below, the Board concludes the Veteran did not meet the schedular requirements for a TDIU before June 24, 2020, and referral for consideration for an extraschedular TDIU was not warranted. For the period of time on and after that date, he has been compensated as 100 percent disabled for multiple disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows the Veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38C.F.R. §§ 3.340, 3.341, 4.16. In order to be granted a TDIU, the Veteran must have a single disability rated at 60 percent or more. If the Veteran does not, he or she can be granted a TDIU for multiple disabilities rated together at 70 percent or more with at least one of the disabilities rated at 40 percent or more. 38 C.F.R. § 4.16(a). An extraschedular TDIU may be assigned in the case of a Veteran who fails to meet the percentage requirements but who is unemployable by reason of one or more service-connected disabilities. 38 C.F.R. § 4.16(b). Assignment of a TDIU evaluation requires that the record reflect some factor that "takes the claimant's case outside the norm" of any other Veteran rated at the same level. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). "The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment." Id. The phrase "unable to secure and follow a substantially gainful occupation" has two components: First, an economic component which essentially contemplates 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. Ray v. Wilkie, 31 Vet. App. 58, 71-74 (2019). Second, there is a non-economic component dealing with the Veteran's ability to secure and follow employment. For this second component, attention must be given to: (a) the Veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Id. As sedentary work is defined as "doing or requiring much sitting," the Board finds that sedentary employment is a job where the worker primarily sits down. MERRIAM-WEBSTER'S COLLEGEIATE DICTIONARY 1123 (2003). The Board does not have jurisdiction to award an extraschedular TDIU in the first instance. Rather, it must refer the claim to the Director of Compensation Service (the Director) for extraschedular consideration when "there's sufficient evidence to substantiate a reasonable possibility the Veteran is unemployable because of service-connected disabilities." Snider v. McDonough, 35 Vet. App. 1, 2 (2021). The Board has jurisdiction to decide an extraschedular TDIU claim if, and only if, the Director determines that an extraschedular evaluation is not warranted. Anderson v. Shinseki, 22 Vet. App. 423, 426 (2009). The record reflects the issue of unemployability was raised while a September 2016 PTSD increased rating claim was pending. The Board has since issued a September 2021 decision denying the assignment of a greater than 50 percent rating for PTSD. This means the Board found his PTSD symptoms did not cause total social and occupational impairment. 38 C.F.R. § 4.130, DC 9411. Although the Veteran's work history around the date VA received his September 2016 PTSD increased rating claim is the Board's primary focus when deciding a TDIU, this claim involves allegations of erratic work history as far back as March 2008. In March 2008, the Veteran got a job as a correctional officer, which he alleged he had to resign because he attacked his supervisor. See Transcript dated June 2021 at 18 (testifying he became unglued, and several other cadets had to pull him off his supervisor). The Board notes it found this report not credible as other evidence in the record indicated the event had not occurred as described. See September 2021 Board decision at 10 (noting VA counseling records contemporaneous to the event included express denials of violent behavior while a cadet correctional officer); See also April 1, 2008, VA Medical Center (VAMC) Record by S.D., Ph.D. For the period from July 2010 through January 2011, he worked as a casino security officer. He discussed this job during regular VA counseling sessions; he reported problems performing the physicalbut not mentalacts required by this job. See August 5, 2010, VAMC Record (Veteran reported he had a seizure at work), November 24, 2010, Record (noting Veteran had stomach problems that had to be reviewed by a medical professional). His monthly income amounted to $1,600 monthly (about $9,600 annual). See March 2017 SSA Work History Report at 4 (reporting he worked 40 hours weekly at $10/hour). The Board notes the periods of employment for this job overlap with his next job. Id. at 1. Given the Veteran had reported working as casino security guard before the dates reported to SSA, the Board finds the period of employment he provided to SSA may have been in error. In January 2011, the Veteran got a new job with a company that helps manage the logistics (in the area of inventory control) for big companies, like Walmart. He believed it was going to be seasonal work, but his performance was impressive enough to be asked to keep working for the company. See Records by P.S., SW, dated October 7, 2011 (noting Veteran reported his employer asked him to stay on with the company); November 8, 2011 (noting Veteran reported he was promoted to inventory control specialist, which is a management position); February 2017 VA 21-8940 (noting full-time employed from 2010 through 2012, earning $800 monthly). He resigned his position due to dissatisfaction with changes to his management structure. See February 17, 2012, Record by P.S., SW (noting Veteran reported he would have stayed on the job had his district manager not made certain decisions). Also, his annual income for this job was $15,360. See March 2017 Social Security Administration (SSA) Work History Report at 3 (reporting he worked 32 hours weekly at $10/hour). In February 2012, the Veteran started working as a shipyard welder, which continued through October 2016. See July 2017 VA Form 21-4192 (noting employment from January 2013, with highest earnings at $44,165). While he has reported behavior problems prevented him from working, to include an altercation with a foreman, the Board found those reports not credible because they conflicted with other evidence in the record. See September 2021 Board Decision at 10 (noting the Board favored counseling records from 2009 to October 2016 over recent assertions of behavior problems while working). The record shows the Veteran last worked in October 2016. While at home, he fell off a ladder while changing a lightbulb; he broke his right heel. See October 20, 2016, VAMC Record by E.J.L., MD. He was placed on limited duty and his employer granted medical leave (through February 2017). See July 2017 VA Form 21-4192. During medical leave, he received pain management treatment. During one of his treatment visits, he talked about his work: he reported he had been on medical leave since his foot injury and was not sure he would keep his job. See October 2016 VAMC Record by C.S.A., Ph.D. During a November 2016 VAMC visit to a mental health provider, he reported he was losing his job due to a foot injury and was pursuing a higher disability rating. Following a January 2017 visit with a VA psychologist, he was suspected of exaggerating symptoms; specifically, comments that suggest he is a threat to his children when they are alone with him. See January 9, 2017, Record by Dr. L.C.M. The Veteran ended his employment in February 2017 due to medical reasons. See July 2017 VA Form 21-4192. While the Veteran did not work from October 2016, his ability to work was evaluated by at least four medical professionals from January 2017 to November 2021, to include examinations in January 2017, April 2017, March 2019, and November 2021. The January 2017 examiner noted the Veteran was able to work up to the time he injured his foot; suggesting his PTSD symptoms did not preclude him from working. See VA DBQ at 6. Similarly, the April 2017 VA examiner emphasized the Veteran had demonstrated he can maintain employment up to the time he injured his foot (October 2016). He added the Veteran remained unemployed due to his foot injurynot his PTSD symptoms. See April 2017 VA DBQ at 8. Likewise, the May 2017 VA examiner indicated the Veteran's PTSD symptoms, to include anxiety, difficulty maintaining relationships, and adapting to stressful circumstances, did not preclude him from working. See VA DBQ at 7. In June 2017, SSA decided the Veteran is disabled due to physical and mental impairments. See SSA Disability Determination Explanation (DDE), Determination (finding Veteran's ability to perform light sedentary work eroded by inability to ambulate 50 feet). A February 2019 psychological evaluation by J.L, PhD, a private provider, concludes the Veteran is unemployable. Dr. J.L. explained the Veteran has cognitive limitations, to include memory loss, limited ability to concentrate, that render him unemployable. Also, he is easily frustrated and has difficulties establishing work relationships. See Psychological Evaluation at 2, 5, 7. The Board assigned this opinion little probative weight as it lacked a rationale. See September 2021 Board Decision at 10 (noting Dr. D.L. did not address some evidence that conflicted with his conclusions). The Board notes Dr. J.L's psychological evaluation and DBQ captured the disability picture described by the Veteran during his June 2021 Board hearing. At that time, the Veteran described his PTSD disability picture which included difficulties concentrating, learning new things, carrying out instructions, and memory problems, like forgetting names, when to take medications, locations of items, and his wife helps him with those things. Also, behavior problems, to include getting easily frustrated, anger, and difficulties with supervisors. See Transcript dated June 2021 at 6, 9-10 (testifying he observed memory problems, to include names, when to take medication, and his wife helps him with those things). Finally, the November 2021 VA examiner reviewed the medical evidence up to and including Dr. J.L.'s February 2019 psychological evaluation and concluded the Veteran's psychiatric disabilities did not preclude him from working. The November 2021 examiner explained the Veteran's PTSD symptoms varied in severity over the years, but his symptoms were within the criteria of occupational impairment with reduced reliability and productivity. See Medical Opinion at 4. The examiner added the Veteran's psychiatric symptoms had a moderate impact on his employability and were not severe enough to preclude him from working. Id. A. Entitlement to a schedular TDIU. Turning to the Veteran's claim for a TDIU, the record shows the Veteran did not meet the percentage requirements for a schedular TDIU until June 24, 2020. Up to that date, he had one service connected disability rated 50 percent disabling (PTSD, from June 1, 2008). In order to qualify for a TDIU based on a single disability, it must be rated at least 60 percent disabling. 38 C.F.R. § 4.16(b). Because the percentage requirements for a TDIU were not met before June 24, 2020, consideration of one of before that date is not warranted. The issue of entitlement to a TDIU on and after June 24, 2020, is moot as the Veteran's service-connected disabilities have been rated 100 percent disabling. For the period on and after June 24, 2020, he has been in receipt of a 100 combined disability rating (PTSD, rated 50 percent disabling from June 2008; desquamative interstitial lung disease pneumonitis, rated 100 percent disabling from June 24, 2020). A 100 percent combined disability rating means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994). Given that VA has been compensating the Veteran as totally disabled, there is no need to otherwise rate him totally disabled on any other basis. Locklear v. Shinseki, 24 Vet. App. 311, 314 n.2 (2011) (finding entitlement to TDIU mooted from the effective date of a 100 percent schedular disability rating); see also Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). The Board notes its decision was made with entitlement to an SMC in mind. A TDIU is considered a lesser benefit than a 100 percent schedular rating, and the grant of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. An exception to this is when entitlement to special monthly compensation (SMC) is warranted, which can be predicated on a single-service connected disability rated as 100 percent disabling or a single TDIU based on a single disability (perhaps not ratable at the schedular 100 percent level) when considered with another disability separately rated at 60 percent or more. 38 U.S.C. § 1114(s); Bradley v. Peake, 22 Vet. App. 280(2008). Here, the evidence does not support finding an SMC at the housebound rate is warranted. The Veteran has not alleged nor does the record reflect he has been confined to his place of residence due to his service-connected PTSD or interstitial lung disease pneumonitis. See October 2020 VA DBQ Respiratory Conditions at 3, 8. Although the Veteran has referenced experiencing distress when around others, the evidence does not support finding his PTSD symptoms render him unable to leave his home. See Transcript dated June 2021 at 11. Therefore, the issue of entitlement to SMC at the housebound rate is not raised by the record. B. Entitlement to an extraschedular TDIU for the period before June 24, 2020. After reviewing the record, the Board finds a referral to the Director for consideration of an extraschedular TDIU before June 24, 2020, is not warranted in this case. First, the record does not show exceptional circumstances necessary for referral to the Director. The record does not suggest symptoms attributed to his psychiatric disabilities which were not contemplated by the relevant rating criteria (DC 9411). The symptoms he emphasized when discussing his employability included diminished mental capabilities, maintaining effective relationships with coworkers, accepting criticism, and controlling his impulses. See February 2019 Psychological Evaluation at 5, 7 (noting Veteran forgets things, like keys, and has difficulties concentrating); February 2019 VA DBQ at 2. The Board found those symptoms were contemplated by 9411 when it denied his PTSD increased rating claim. See September 2021 Board Decision at 15. Therefore, referral to the Director based on an exceptional disability picture is not warranted in this case. 38 C.F.R. § 3.321(b). Second, given that the Veteran maintained substantially gainful employment through October 2016, there is no reasonable possibility the evidence would substantiate finding his PTSD symptoms precluded him from working. The record shows he has been employed from July 2010 to October 2016, with positions providing security services at a casino, managing inventory for large companies, like Walmart, Home Depot. He last worked as a shipyard welder. Based on his reports, his security job at a casino (July 2010 to January 2011) amounted to monthly income above the poverty threshold level for 2010 ($11,344 annual; $945 monthly). See U.S. Department of Commerce, Census Bureau, Poverty Thresholds, available at https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html (last accessed March 17, 2022). Although the Veteran reported his management position providing logistical services to Walmart, Home Depot (from January 2011 to January 2013) provided him $800 monthly, other credible evidence in the record shows his income was slightly higher than reported. He provided his income information to SSA, which indicated he earned about $1280 monthly; $15,360 annually. See March 2017 SSA Work History Report at 3 (reporting he worked 32 hours weekly at $10/hour). His income was above the poverty threshold levels for 2011 ($11,702), 2012 ($11,945). From 2013, his earnings as a welder (about $44,160 annual) were above the poverty threshold levels for 2013 ($12,119), 2014 ($12,316), 2015 ($12,331), and 2016 ($12,486). See March 2017 SSA Work History Report at 2 (reporting he worked 40 hours weekly at $23/hour). Even if the Veteran's income had not met the poverty threshold levels, he has not shown he was unable to perform the mental acts required by his work. Entitlement to a TDIU is based solely on a Veteran's service-connected disabilities. 38 C.F.R. § 4.16(a). While discussing his security job (July 2011 to December 2011) with a VA counselor, he did not express difficulties performing the mental tasks associated with his work. Reports of that kinds were expected to be found in the record, given that he discussed other difficulties performing his work. See August 5, 2010, VAMC Record (Veteran reported he had a seizure at work), November 24, 2010, Record (noting Veteran had stomach problems that had to be reviewed by a medical professional). So, he has demonstrated to the Board he had the ability to perform the mental acts required by his security work. Because he was not service-connected for any physical disabilitiesand he has not alleged his PTSD symptoms cause physical limitationsthe Board finds PTSD symptoms did not in any way limit his ability to perform the physical acts required by work. Similarly, the record shows the Veteran's PTSD symptoms did not preclude him from performing his management responsibilities from January 2011 to February 2012. His success at getting promoted to a management position leaves no doubt he was capable of performing the mental acts required of work. See Records by P.S., SW, dated October 7, 2011 (noting Veteran reported his employer asked him to stay on with the company); November 8, 2011 (noting Veteran reported he was promoted to inventory control specialist, which is a management position). Although managing people can be accompanied by additional stress, he did not allege his disability symptoms rendered him unable to work. Reports to that effect were expected to be found in the record given that he had discussed aspects of this job with a VA counselor many times during his visits. See February 17, 2012, Record by P.S., SW (noting Veteran reported he would have stayed on the job had his district manager not made certain decisions). Although the Veteran's hasty departure from his management position may raise the inference that factors, like stress, made it difficult to work, he has reported otherwise. Id. He left this job due dissatisfaction with changes in the company's management structurenot for reasons related to his disability. Because he was not service-connected for any physical disabilities, his PTSD did not in any way limit his ability to perform the physical acts required by work. Regarding the Veteran's employment as a welder (2013 through October 2016), the Board concluded in a prior decision that he left the job for reasons unrelated to PTSD. See September 2021 Board Decision at 10. Further, his reports of behavior problems at this job were found to lack credibility because they conflicted with other evidence in the record. Id. at 11. The record does not support finding his PTSD limited his ability to perform the physical acts required by work. Also, he was not service-connected for any physical disabilities during this portion of the appeal period. Third, the record shows the Veteran stopped working in October 2016 due to physical limitations caused by a non-service connected ankle injury. Although both SSA and VA recognized he has certain diminished cognitive abilities, like problems concentrating, they did not preclude him from obtaining and maintaining substantially gainful employment up to the time he injured his ankle. Given that the record does not support finding his mental capabilities worsened between October 2016 and June 2020, the Board concludes the record does not substantiate a reasonable possibility of finding he was unemployable up to June 24, 2020, solely due to PTSD. Snider, 35 Vet. App. at 13. The Board observes the November 2021 medical opinion did not discuss the Veteran's June 2021 Board hearing testimony, but the Board finds the error is harmless as his lay descriptions were captured by medical evidence that was considered by the November 2021 examiner; specifically, the February 2019 psychological evaluation and DBQ. In other words, the portions of his Board testimony that are relevant to a TDIU (memory, behavior problems) is duplicative of other evidence in the record. Given that the November 2021 examiner expressly discussed the February 2019 evaluation and DBQ, it is apparent to the Board he was informed of the relevant details of the Veteran's past medical history. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). So, the lack of reference to the June 2021 Board hearing testimony does not diminish the probative value of the November 2021 medical opinions. The Board notes it has searched the record for evidence that post-dates the February 2019 psychological evaluation which may have impacted the November 2021 opinion. No such evidence was found. The evidence incorporated into the record after February 2019 includes the November 2021 examiner's opinion and a duplicate of the February 2019 psychological evaluation, with some portions highlighted. Even if the Board concluded the Veteran's June 2021 Board hearing testimony provided new information that had not been considered by the November 2021 examiner, it does not alter the Board's conclusions. The Board's conclusion on this TDIU claim does not rely on the November 2021 opinion. When the Board previously denied the Veteran's PTSD increased rating claim, it found the Veteran demonstrated he has the mental capabilities to work despite his testimony to the contrary. See September 2021 Board Decision at 12-13. The Board does not view the evidence differently today. His demonstrated ability to obtain and maintain substantially gainful employment despite the limitations posed by his PTSD symptoms outweighs his statements to the contrary. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (the issue of whether a veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question). The Board recognizes the SSA found the Veteran unable to work from October 2016, but a review of the SSA file shows it considered the Veteran's physical limitations when deciding the claim. See May 2017 SSA DDE, Assessment of Vocational Factors. Disability determinations by SSA are not binding on VA. Damrel v. Brown, 6 Vet. App. 242, 246 (1994). Also, entitlement to a TDIU is based solely on a Veteran's service-connected disabilities. 38 C.F.R. § 4.16(a). So, physical limitations unrelated to PTSD cannot be considered when evaluating a TDIU. Given that SSA decided his claim is of little probative value towards finding his service-connected disabilities rendered him unable to secure or maintain substantially gainful employment. In sum, the Veteran has not established entitlement to a TDIU at any time across the appeal period. Neither is referral to the Director for consideration of an extraschedular TDIU warranted in this case. 2. Entitlement to service connection for an acquired psychiatric disorder, to include bipolar disorder and somatic symptom disorder. The Veteran contends he has bipolar disorder, and it is secondary to service-connected PTSD. See VA 21-526EZ. Although he did not expressly reference other psychiatric disorders in his claim, it was broadened to include all psychiatric disorders diagnosed during the appeal period. Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). The question for the Board is whether the Veteran has had bipolar disorder and/or somatic symptoms disorder at any time during the appeal period. For the reasons discussed below, the Board concludes the evidence does not support finding either disorder existed during the appeal period. Beginning with the Veteran's service, the record reflects he tried to enter service around October 2001 as part of a pre-trial diversion program, but was unable to do remain in service because he was still on probation. DD214 (nothing uncharacterized period of service, from October 2001 to January 2002); June 2004 Report of Medical History at 2 (Veteran reported he was on probation when he initially entered service). The entrance examination associated with this service shows he believed he was in good health at the time and does not mention the presence of any psychiatric disorder. See October 2001 Report of Medical History and Report of Medical Examination. The Veteran entered service again in June 2004. He again reported he is in good health, but had to be cleared for entry by a psychiatrist. See June 2004 Report of Medical Examination; June 2004 Report of Medical History; June 2004 Psychiatric Services Form (noting Veteran should be able to adjust to military life without difficulty). He served as an infantryman and earned a combat infantry badge while deployed to Iraq, from December 2005 to November 2006. See DD214; see also February 2019 Psychological Evaluation at 2 (noting Veteran reported participating in combat operations in Mosul, Iraq). When he redeployed to the U.S. , he informed service medical providers he was observing nightmares related to frightening, horrible experiences in Iraq. See March 2007 Post-Deployment Health Assessment at 3. He then underwent a psychological assessment which led to diagnoses of PTSD and major depressive disorder. See April 2007 Report of Mental Status Evaluation; April 2007 Memorandum, Department of the Army to Veteran (certifying Veteran was thoroughly evaluated and found to have PTSD, major depressive disorder). The military doctor who diagnosed PTSD, major depressive disorder recommended that the Veteran be discharged as he was at high risk for problematic behaviors, like assault, AWOL. Id. During his April 2007 separation examination, he reported observing psychiatric symptoms which included trouble sleeping, counseling, loss of memory, nervous trouble, depression. The military doctor who conducted the April 2007 separation examination concluded the symptoms are attributable to PTSD, major depressive disorder. See Report of Medical History at 3. No other psychiatric disorder was noted. See April 2007 Report of Medical Examination. References to bipolar disorder start to appear in the record following separation from service. During a September 2007 VAMC psychiatric assessment, the Veteran informed the examiner a military doctor had diagnosed bipolar disorder. Notwithstanding his reported medical history, the VA examiner ruled out the presence of bipolar disorder; instead, he was diagnosed with PTSD. See Record by K.L., PhD. The following year, in February 2008, the Veteran visited a VA clinic and again reported he had been diagnosed with bipolar disorder during service. See Record by K.M., LCSW. He was then referred for a VA psychological assessment. The psychiatrist who conducted the March 2008 assessment acknowledged the possibility of bipolar disorder but limited the diagnoses to PTSD, TBI, and dysthymia. See Record by W.C., MD. The January 2017 VA examiner is the only medical professional shown to have diagnosed bipolar disorder during the appeal period. He diagnosed both PTSD, and bipolar disorder, in partial remission. The diagnosis was based on a review of the record, which the examiner noted to have shown hypomanic episodes that occur infrequently. See VA DBQ at 1, 2. Regarding a link between bipolar disorder and PTSD, the January 2017 examiner indicated the etiology of bipolar disorders involves a person's genes. This means environmental factors, like trauma from war are not likely to play a part in the development of that disorder. Id. at 6. He also noted testing indicated the Veteran was exaggerating symptoms. Id. at 1. The Veteran's sincerity was questioned again during an April 2017 SSA examination. The SSA examiner indicated there is no medical basis for the Veteran to have some of the pain he reported during the examination, to include nearly falling down in pain when the evaluator touched his back. See SSA Evaluation by J.M.S, DO. Four more psychiatric examinations were conducted during to period from April 2017 to November 2021, to identify and diagnose existing psychiatric disorders; none of them diagnosed bipolar disorder. An April 2017 VA examiner did not diagnose bipolar disorder; instead, he diagnosed PTSD and somatic symptom disorder. After reviewing the examination as a whole, somatic symptom disorder appears to have been diagnosed because the April 2017 examiner did not find the Veteran's reports of severe pain to be consistent his demonstrated work history. See VA DBQ at 3, 7. The examiner who conducted the May 2017 VA examination did not diagnose bipolar disorder; instead, he concluded the Veteran has PTSD only. See VA DBQ at 2. Likewise, Dr. J.Lthe private provider who conducted a February 2019 Psychological Evaluation and DBQdid not diagnose bipolar disorder; instead, he diagnosed PTSD, major depressive disorder. See DBQ at 1; Psychological Evaluation at 3 (acknowledging the Veteran's problem list includes bipolar disorder). As noted, the February 2019 psychological evaluation and DBQ captured the disability picture described by the Veteran during his June 2021 Board hearing. The Board notes the Veteran's testimony was largely focused on discussing how his PTSD symptoms affected his occupational functioning; there was no discussion about the presence of any other co-existing psychiatric disorder. Id. The November 2021 VA examiner reviewed the medical evidence up to and including Dr. J.L.'s February 2019 psychological evaluation, and concluded that major depressive disorderbut not bipolar and somatic symptom disorderswas properly diagnosed. See Medical Opinion at 2. Beginning with bipolar disorder, the November 2021 examiner noted its diagnosis in January 2017 was not rendered based on a personal examination of the Veteran. The examiner appeared to emphasize this factor becauseaccording to the examinersome of the Veteran's PTSD symptoms can be mistaken for symptoms of bipolar disorder. For example, the PTSD symptom of irritable behavior and angry outbursts can be mistaken for hypomania. Hypomania is defined as an abnormality of mood resembling mania (persistent elevated or expansive mood, hyperactivity, inflated self-esteem, etc.) but of lesser intensity. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 891 (33rd ed. 2020). After explaining that the Veteran's PTSD symptoms also look like manifestations of bipolar disorder, the November 2021 examiner concluded bipolar disorder was mistakenly diagnosed. Id. He explained the symptom that formed the basis of the January 2017 diagnosis (mild hypomania) was based on a misinterpretation of the Veteran's PTSD symptoms. In support of this finding, the November 2021 examiner noted several other VA examiners conducted psychiatric examinations; none of them diagnosed bipolar disorder. Based on these factors, the examiner found bipolar disorder had not been shown at all. Id. Similarly, the November 2021 examiner concluded the Veteran's diagnosed somatic symptom disorder had been mistakenly based on existing PTSD symptoms; therefore, somatic symptom disorder had not been shown at all. Id. the November 2021 examiner noted several other VA examiners conducted psychiatric examinations; none of them diagnosed somatic symptom disorder. Based on these factors, the examiner found somatic symptom disorder had not been shown at all. Id. Regarding the Veteran's diagnosed major depressive disorder, the November 2021 VA examiner found that it is secondary to PTSD. Id. Based on the opinion, the AOJ issued a November 2021 rating decision granting service-connection for major depressive disorder; the two disorders are rated together under DC 9411(PTSD) and found to be 50 percent disabling. The Board notes the Veteran's representative has contended this examiner is not qualified to provide medical opinions for VA because he is not listed in VA's Office of Disability and Medical Assessment (DMA). See December 2021 Appellate Brief at 2 (contending November 2021 examiner is not compliant with VHA Directive 1603). A. Entitlement to service connection for bipolar disorder and somatic symptom disorder. After reviewing the record, the Board finds both bipolar disorder and somatic symptom disorder were not shown during the appeal period. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). While both and bipolar and somatic symptom disorders were diagnosed during the appeal period, the November 2021 VA medical opinion persuasively explains why those diagnosis are not reliable. The Board observes the November 2021 medical opinion did not discuss the Veteran's June 2021 Board hearing testimony, but the Board finds the error is harmless as his lay descriptions were captured in other evidence expressly reviewed by the examiner, particularly the DBQ and February 2019 psychological examination by Dr. J.L. In other words, the disability picture described during the Board hearing is the same as described by other evidence in the record. Given that the November 2021 examiner expressly discussed the February 2019 evaluation and other evaluations as early as 2008, it is apparent to the Board he was informed of the relevant details of the Veteran's past medical history. Nieves-Rodriguez, 22 Vet. App. at 301. So, the lack of reference to the Board hearing testimony does not diminish the probative value of the November 2021 opinions. The Board notes it has searched the record for evidence that post-dates the February 2019 psychological evaluation which might have impacted or conflicted with the November 2021 opinion. No such evidence was found. The evidence incorporated into the record most relevant to this claim is a copy of the February 2019 psychological evaluation, with some portions highlighted by the Veteran or his representative. The Board recognizes the representative's argument that the November 2021 examiner is not qualified to render opinions for VA, but the Board finds that competent to provide medical opinions. The DMA's database lists examiners who provide compensation and pension examinations and have presumably completed the required training to provide such exams pursuant to VHA Directive 1603. First, VHA Directive 1603 does not have force of law as there is no indication in statute, regulation or caselaw that an examiner must be DMA certified in order to be competent to provide findings based on prior psychiatric examinations. Second, simply because a provider is not listed in the DMA's database does not inherently mean the provider is not competent to provide an opinion. To be competent to provide an opinion, an individual must have sufficient knowledge, training, or expertise to provide such an opinion. Jandreau v. Nicholson, 492 F.3d. 1372, 1377 n.4 (Fed. Cir. 2007). Given that the November 2021 examiner is a medical professional with an expertise in psychological disorders, he had the knowledge, training, and expertise to opine about the issues involved with this claim. Regarding the validity of the January 2017 diagnosis of bipolar disorder, the November 2021 VA examiner accurately noted it was diagnosed based on limited information. Even though there are instances a valid diagnosis could be made on limited data, the January 2017 VA examiner who diagnosed bipolar disorder did not provide much insight into the data that showed hypomania. Given that the November 2021 VA examiner persuasively explained how hypomania can be confused with the PTSD symptoms displayed by this Veteran, the Board finds the November 2021 opinion more probative; therefore, the Board doubts the validity of the January 2017 bipolar disorder diagnosis. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (noting that a medical opinion must "support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Doubts about whether bipolar disorder existed during the appeal period were resolved by the April 2017, May 2017, and February 2019 DBQs which did not note bipolar disorder among the Veteran's existing psychiatric disorders. See VA DBQs at 2. Given that three separate medical professionals evaluated the Veteran for existing psychiatric disorders, the Board expects to have found bipolar disorder to have been diagnosed by at least one of those medical professionals, if shown. Considering none of those examiners diagnosed bipolar disorder, it is a factor that weighs strongly against finding bipolar disorder existed during the appeal period. For example, the April 2017 examiner acknowledged a prior diagnosis of bipolar disorder but commented he has never been treated for that disorder; in the portion of the DBQ that asked about any existing disorder (other than PTSD), he noted somatic symptom disorder only. See VA DBQ at 2, 8. While the Veteran may believe he has had bipolar disorder during service, he has not demonstrated that he has the medical knowledge, training, or experience in accurately diagnosing specific psychiatric disorders. Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (Fed. Cir. 2007). In contrast, the medical professional who diagnosed him during service can render such an opinion; based on his report, PTSD and major depressive disorder were the only disorders to have existed at that time. See April 9, 2007, Report of Mental Status Evaluation. This evaluation weighs strongly against finding bipolar disorder manifested during service, as alleged. The Board observes the Veteran recalled he was told he was diagnosed with bipolar disorder during service; however, the Board favors the Veteran's STRs which do not show a bipolar disorder diagnosis. The Veteran is competent to report what he was told by medical professionals. Layno v. Brown, 6 Vet. App. 465, 467-70 (1994). But the conversation he recalls by memory conflicts with the medical records pertaining to his visits. They memorialized their conclusions in his STRs and did not mention bipolar disorder. Given that he reports treatment for bipolar disorder, references to its diagnosis were expected to be found in the record. See September 2007 VAMC Record by Dr. K.L.(noting Veteran reported a military doctor prescribed him medication to treat bipolar disorder). The Board concludes the STRs weigh strongly against finding bipolar disorder existed during service. Even if the Veteran's recollections were favored, records showing he was diagnosed with bipolar disorder before the appeal period does not, in and of itself, demonstrate he currently has functional impairments from that same disorder. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("In the absence of proof of a present disability there can be no valid claim."); Saunders, 886 F.3d at 1368. The Board finds the November 2021 VA medical opinion most persuasive on that matter. Lynch, 2021 U.S. App. LEXIS 37307, at *10. Regarding the validity of the April 2017 somatic symptom disorder diagnosis, the November 2021 examiner provided persuasively explained why the Board should doubt that diagnosis. He asserted the somatic symptom disorder diagnosis was based on an inaccurate interpretation of the Veteran's existing PTSD symptoms. But the examiner did not inform the Board of the PTSD symptoms that were misinterpreted with signs of a somatic disorder. Nevertheless, it is apparent to the Board that the April 2017 examiner diagnosed the disorder due to inconsistencies between the severity of his foot injury and reports of observed pain. See VA DBQ at 2-3. The SSA examiner who conducted the April 2017 disability assessment also noted complaints of pain that were not explained by medical evidence. Rather than diagnose somatic symptom disorder, the SSA examiner questioned the Veteran's credibility. See April 2017 SSA Evaluation by Dr. J.M.S (noting there is no diagnostic reason for the Veteran to have some of the pain he expressed during the interview, to include nearly falling down in pain when the evaluator touched the Veteran's back). Considered with testing conducted by a VA examiner showing the Veteran may be exaggerating symptoms, the Board finds sufficient evidence in the record to doubt the diagnosis of somatic symptom disorder. See January 2017 VA DBQ (noting testing scores aimed at detecting exaggerated symptoms indicate the Veteran may have done so during this examination). Doubts about whether somatic symptom disorder existed during the appeal period were resolved by the January 2017 DBQ , April 2017 SSA evaluation, May 2017, and February 2019 DBQs. They did not diagnose somatic symptom disorder. See VA DBQs at 2. Given that four separate medical professionals evaluated the Veteran for existing psychiatric disorders, the Board expects to have found a diagnosis of somatic symptom disorder. Considering none of those examiners mentioned that disorder, it indicates to the Board the disorder did not exist. So, doubt on this matter could not be resolved in the Veteran's favor. Lynch, 2021 U.S. App. LEXIS 37307, at *10. B. Entitlement to service connection for any other acquired psychiatric disorder. The evidence does not raise a claim for any other psychiatric disorder. Over the course of this appeal period, more than four medical professionals searched for signs of existing psychiatric disorders; the only disorders noted were major depressive disorder, PTSD, somatic symptom disorder, and bipolar disorder. Major depressive disorder and PTSD are already service-connected, and the evidence persuasively shows both bipolar and somatic symptom disorders were not shown at any time during the appeal period. There remain no other disorders to consider with this acquired psychiatric disorder claim. In sum, the Veteran has not established entitlement to service connection for any psychiatric disorder other than PTSD and major depressive disorder. So, consideration of service connection for other psychiatric disorders on a direct or secondary basis is not warranted at this time. 38 C.F.R. §§ 3,303, 3.310. 3. Entitlement to service connection for major depressive disorder is dismissed as moot. The AOJ issued a November 2021 rating decision granting service connection for major depressive disorder secondary to PTSD; the disorders were assigned a single 50 percent rating from June 2008. The grant of service connection for depression constitutes a full award of the benefits sought on appeal; therefore, the issue is no longer before the Board. Accordingly, the Veteran's service connection claim for major depressive disorder is dismissed. Grantham v. Brown, 114 F. 3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date). DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dean, Michael S. 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.