Citation Nr: 22034026 Decision Date: 06/09/22 Archive Date: 06/09/22 DOCKET NO. 20-17 847 DATE: June 9, 2022 ORDER Entitlement to an evaluation in excess of 30 percent for coronary artery disease (CAD) prior to October 20, 2021, and an evaluation in excess of 60 percent thereafter is denied. Entitlement to service connection for erectile dysfunction to include as secondary to coronary artery disease is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to October 20, 2021, the Veteran's coronary artery disease has not been manifested by a workload of 3.0 to 5.0 METs nor an episode of congestive heart failure; nor an LVEF of 30 to 50 percent. After October 20, 2021, the Veteran's coronary artery disease has not been manifested by a workload of 3.0 METs or less nor chronic congestive heart failure; nor an LVEF of less than 30 percent. 2. The weight of the evidence indicates that the Veteran's erectile dysfunction is due to his service-connected coronary artery disease. 3. The persuasive evidence of record indicates that the Veteran's service-connected disabilities do not render him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating for CAD in excess of 30 percent prior to October 20, 2021, and for an evaluation in excess of 60 percent, thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.100, 4.104, Diagnostic Code (DC) 7005. 2. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1965 to August 1967. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in February 2022. The hearing transcript is of record. 1. Entitlement to an evaluation in excess of 30 percent for CAD prior to October 20, 2021, and an evaluation in excess of 60 percent thereafter is denied. A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on the facts found, a practice known as 'staged ratings.' Fenderson v. West, 12 Vet. App. 119, 12627 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran's service-connected heart disability is rated under 38 C.F.R. § 4.104, Diagnostic Code 7005. VA recently amended the rating criteria for cardiovascular disabilities, effective November 14, 2021. The General Counsel of VA has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the appellant. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. As such, VA must generally consider the claim pursuant to both versions during the course of an appeal. See VAOPGCPREC 3-2000; 65 Fed. Reg. 33422; DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Under DC 7005, the pre-amendment criteria, a 60 percent rating is warranted when there is evidence of more than one episode of acute congestive heart failure in the previous year, or; when a workload of greater than three metabolic equivalents of task (METs) but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; when there is left ventricular dysfunction with an ejection fraction (LVEF) of 30 to 50 percent. A 100 percent rating is warranted when there is evidence of chronic congestive heart failure, or; when a workload of three METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; when there is left ventricular dysfunction with an ejection fraction of less than 30 percent. Under the new rating criteria, the Veteran's heart condition is rated using the general rating formula for diseases of the heart. A 60 percent rating is assigned if workload of 3.1-5.0 METs results in heart failure symptoms. A maximum 100 percent rating is assigned if workload of 3.0 METs or less results in heart failure symptoms. June 2017 VA treatment records noted that the Veteran was exercising three to four times a day without any falling off in exercise tolerance. He denied any chest pain or shortness of breath. It was noted that the Veteran saw his cardiologist for a stress test and results were normal. A VA examination was provided in December 2017. The Veteran was diagnosed with coronary artery disease, and it was noted that the Veteran underwent a bypass in February 2012. The Veteran needed continuous medication to control his heart condition, but it was noted that the Veteran did not have congestive heart failure. The examiner found that the Veteran had an LVEF of 60 to 65 percent. An interview-based MET test was performed, and the examiner found that the Veteran was capable of an activity level of 5.0 to 7.0 METs with symptoms of fatigue and angina. December 2017 VA treatment records noted that the Veteran exhibited an LVEF of 60 to 65%. In subsequent December 2017 records the Veteran reported three episodes of lightheadedness and palpitations in the last six months that made him nervous to exercise. The Veteran was provided with a VA examination in July 2019. He required continuous medication to control his heart condition. The Veteran did not have congestive heart failure. The examiner cited a July 2009 echocardiogram which indicated an LVEF of 60 percent. An interview-based MET test was performed, and the examiner found that the Veteran was capable of an activity level of 5.0 to 7.0 METs with symptoms of fatigue. In July 2019 VA treatment records an LVEF of 62% was recorded. In December 2019 VA records the Veteran denied chest pain and shortness of breath. December 2020 VA records indicated that the Veteran underwent a cardiac ablation and was doing well. A final VA examination for the heart was provided in October 2021. Continuous medication was required for the heart condition and there was no evidence of congestive heart failure. An echocardiogram was not performed. An interview-based test was performed as an exercise stress test was not required as part of the Veteran's current treatment plan and the test was not without significant risk. The examiner found that the Veteran was capable of an activity level of 3.0 to 5.0 METs with symptoms of fatigue, angina, and dyspnea. At the February 2022 hearing, the Veteran stated that he took continuous medication for his heart condition. He stated that he had some chest pain and shortness of breath and that the cardiologist encouraged him to keep active. The Veteran reported a cardiac ablation and stated that he was scheduled for a catheterization. In February 2022 private treatment records, it was noted that the Veteran was doing well with minor complaints. The Veteran denied any significant symptoms of exertional chest pain, pressure, or tightness. He denied any orthopnea, paroxysmal nocturnal dyspnea, or lower extremity edema. He reported rare dyspnea on exertion and left arm discomfort with exertion. No palpitation or syncope were reported. LVEF was recorded at 68 percent. The Board notes that section 4.104 was amended during the appellate period, effective November 14, 2021. The Board may not apply the amended version prior to the effective date of November 14, 2021. On review of the record, the Board finds that the evidence weighs against a rating in excess of the currently assigned 30 percent prior to October 20, 2021. METs testing in December 2017 and July 2019 showed a workload of 5.0 to 7.0 METs. This demonstrates that the Veteran's METs level was always above 5.0 METs at this time. Objective medical evidence of record also consistently reveals that the Veteran's LVEF was 60 percent or higher in VA examinations and VA treatment records. The evidence of record also indicates that the Veteran did not have congestive heart failure at any time during this period. Accordingly, the Board does not find that a higher rating is warranted prior to October 20, 2021. Turning to the period after October 20, 2021, the Board finds that an evaluation in excess of 60 percent is not warranted under the pre- or post-amendment criteria. The objective medical evidence of record consistently reveals readings of three to five METs and LVEFs greater than 50 percent. To point, in October 2021 the Veteran had an activity level of 3.0 to 5.0 METs. No LVEF was recorded in this examination, however, February 2022 private treatment records contained an LVEF of 68 percent. No chronic heart failure was noted at any point. Regarding the evaluation of the heart condition under the new criteria after November 14, 2021, the Board finds that an increased evaluation is not warranted. After careful review, the Veteran's heart condition has not been persuasively shown to limit his workload to 3 METs or less resulting in symptoms of heart failure. As noted above, the VA examinations showed that the Veteran was able to achieve a workload of greater than 3 METs before experiencing symptoms consistent with heart failure. The Veteran has not contested these findings. There is no persuasive evidence that he experienced symptoms more nearly approximating the criteria for a 100 percent rating under the amended General Ratings Criteria. In sum, the evidence of record does not support an award of an increased rating for the Veteran's coronary artery disease, under either the old or new rating criteria. Neither the Veteran nor his representative have raised any other issues relating to this claim, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the record). 2. Entitlement to service connection for erectile dysfunction to include as secondary to coronary artery disease is granted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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). In addition, service connection for certain chronic diseases, may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). In a December 2017 VA examination the Veteran was diagnosed with erectile dysfunction. Second, the Board finds that the second element of service connection is met as the Veteran is properly service connected for coronary artery disease. Third, the Board finds that the evidence of record supports a finding that the erectile dysfunction is caused by the service-connected coronary artery disease. The Veteran was provided a VA examination to evaluate his erectile dysfunction condition in December 2017. The examiner denied nexus between the Veteran's erectile dysfunction and his PTSD, but in doing so found that his erectile dysfunction and coronary artery disease were comorbid conditions. The examiner cited medical literature that discussed the risk factors for erectile dysfunction and found that the Veteran's coronary artery disease contributed to his erectile dysfunction. In a February 2022 private treatment record, the Veteran's physician also stated that it was more than 50 percent likely that the Veteran's erectile dysfunction was caused by his coronary artery disease. The Board finds the December 2017 opinion probative evidence in support of the Veteran's claim as it is provided upon review of the relevant facts (to include lay statements of symptomatology that the Board found probative) and are supported by explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in determining probative value of a medical opinion is whether the examiner was informed of the relevant facts); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). As it is supported by rationale and medical literature the Board finds that the opinion is adequate. As there is evidence of record indicating a nexus between the Veteran's erectile dysfunction and service-connected artery disease and no adequate opinion to the contrary, service connection is granted on a secondary basis. 3. Entitlement to a TDIU is denied. VA will grant TDIU when the evidence shows that a Veteran is precluded, by reason of service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. TDIU is granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. If there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. 38 C.F.R. § 4.16(a). If there are two or more such 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). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when a Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, and consideration is given to the Veteran's background including his employment and educational history. 38 C.F.R. §§ 3.321(b), 4.16(b). The Board does not have the authority to assign an extraschedular TDIU rating in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Rather, the issue must be referred to the Director of Compensation Service for such assessment in the first instance. Kuppamala v. McDonald, 27 Vet. App. 447, 457 (2015). Thereafter, the Board has jurisdiction to review the entirety of the Director's decision denying or granting an extraschedular rating and is authorized to assign an extraschedular rating when appropriate. Kuppamala, 27 Vet. App. at 457. For VA purposes, the term unemployability is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2,317 (Jan. 21, 1992). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; VanHoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. VanHoose, 4 Vet. App. at 363. The ability to work sporadically or 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, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16(a). The Board notes that the Court of Appeals for Veterans Claims (Court) recently issued a decision concerning TDIU. The Court noted that TDIU claims have two components that must both be met for a grant of TDIU, both economic and non-economic. As noted above, the economic consideration is a determination if the Veteran has earned annual income that does not exceed the poverty threshold for one person. The second component is determining whether a Veteran can secure and follow a substantially gainful occupation, attention must be given to the Veteran's history, education, skill, and training; whether the Veteran has the 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 to include factors including but not limited to the Veteran's limitations concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue to include factors including but not limited to the Veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The Veteran's service-connected disabilities are coronary artery disease, rated at 10 percent from April 17, 2013, 30 percent from September 14, 2017, and 60 percent from October 20, 2021; PTSD rated at 50 percent from September 14, 2017; obstructive sleep apnea rated at 50 percent from February 05, 2020; tinnitus rated at 10 percent from April 17, 2013; bilateral hearing loss rated at zero percent from April 17, 2013; and chest scar rated at zero percent from September 14, 2017. The Veteran's combined rating for his service-connected disabilities is 20 percent from April 17, 2013, 70 percent from September 14, 2017, and 90 percent from October 20, 2021; thus, the Veteran meets the schedular requirement beginning September 14, 2017. The Veteran's TDIU claim was addressed as part and parcel to his increased rating claim for his heart disability, filed September 14, 2017. Therefore, he met the criteria for a schedular TDIU for the entire appeal period. Addressing the economic component of TDIU, the probative lay and medical evidence establishes that the Veteran ceased substantially gainful employment from February 28, 2013. In an August 2021 claim for increased compensation based on unemployability, the Veteran stated that he ceased working full time on January 01, 2012, but continued working in a part time capacity until February 28, 2013. In an October 2021 request for information, the Veteran's former supervisor stated that after January 01, 2012, the Veteran worked approximately 20 hours per week and missed six months of work due to his disability. The supervisor stated that in the 12 months working the Veteran earned $12,881.48. "Substantially gainful employment" for TDIU purposes is met where the annual earned income exceeds the poverty threshold for "one person," irrespective of the number of hours or days actually worked and without regard to any prior income history. Faust v. West, 13 Vet. App. 342, 355-56 (2000). In 2012 the poverty threshold for one person was $11,011. As the Veteran earned more than the poverty threshold, he is considered to have been gainfully employed until February 28, 2013. The forms indicated that the Veteran had worked in insurance sales for over a decade. Addressing the noneconomic component of TDIU, the Veteran had completed high school and did not obtain a college degree. No other training or skills were noted. The Veteran stated in the August 2021 application that the fatigue caused by his heart condition and his PTSD made him unable to continue on in his employment. The examiner determined in a December 2017 VA examination that the Veteran's erectile dysfunction did not affect his ability to work. The Veteran underwent a VA examination to evaluate his PTSD in December 2017. The examiner determined that the Veteran suffered from occupational and social impairment with reduced reliability and productivity. The Veteran reported one marriage spanning 50 years. He stated his marriage was good and had its ups and downs. He reported good relationships with his three children as well as one close friend. The symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, and disturbances of mood and motivation. The Veteran was well dressed and groomed and fully oriented. He was noted to be somber with constricted affect. The Veteran was provided with a VA examination to evaluate his heart condition in December 2017. The Veteran reported chest tightness with moderate activity but denied shortness of breath. The Veteran was capable of 5.0 to 7.0 METs of activity which included walking one flight of stairs, golfing, mowing the lawn, and heavy yard work. The examiner determined that the Veteran's heart condition did impact the Veteran's ability to work as he tired easily with moderate exertion. In a December 2017 VA treatment record, the Veteran reported experiencing three episodes of palpitations and lightheadedness in the past six months that made him nervous to exercise. The Veteran also reported being mildly depressed though he denied suicidal ideation. The Veteran underwent another VA examination for the heart in July 2019. The Veteran was noted to be capable of activity levels of 5.0 to 7.0 METs. The examiner determined that the Veteran's ability to work was not impacted by his heart condition. In December 2018 VA treatment records the Veteran stated that he was feeling more irritated after starting Sertraline. He endorsed more difficulty sleeping at night, increase in nightmares, low energy, and low motivation. He stated that he avoided going most places. In December 2019 VA records the Veteran denied chest pain or shortness of breath. December 2020 VA records indicated that the Veteran underwent a cardiac ablation and was doing well. In a February 2021 VA examination for sleep apnea the examiner found that the Veteran's sleep apnea did not impact his ability to work. The Veteran underwent a VA examination to evaluate his PTSD in March 2021. The examiner determined that the Veteran suffered from occupational and social impairment with reduced reliability and productivity. The Veteran reported depressed mood, anxiety, suspiciousness, anxiety, and suspiciousness around others. He also stated that he had difficulty motivating himself, difficulty maintaining social relationships, and trouble sleeping. The symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of mood and motivation, and difficulty maintaining work and social relationships. The Veteran was well dressed and groomed and fully oriented. He was friendly and engaged. The Veteran underwent a final VA examination to evaluate his PTSD in October 2021. The examiner determined that the Veteran suffered from occupational and social impairment with reduced reliability and productivity. The symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty adapting to stressful circumstances, and difficulty maintaining work and social relationships. The Veteran was friendly and well dressed. The examiner determined that the Veteran's isolation, irritability, and suspiciousness would interfere with work relationships and memory, concentration impairment, and depressed mood would interfere with work efficiency. The Veteran underwent another VA examination for the heart in October 2021. The Veteran was noted to be capable of activity levels of 3.0 to 5.0 METs which included activities such as light yard work, mowing the lawn, and brisk walking. The examiner determined that the Veteran was well developed, well nourished, and without acute distress. There were no signs of malaise or ascites. The examiner found that the Veteran's coronary artery disease caused dyspnea, fatigue, and angina with activities such as light yard work, mowing the lawn, brisk walking, and walking up a flight of stairs causing difficulty with any job requiring these activities. There was no effect on sedentary employment. In February 2022 private treatment records it was noted that the Veteran felt well with minor complaints. The Veteran denied significant symptoms of exertional chest pain, pressure, or tightness. He denied orthopnea, nocturnal dyspnea, or lower extremity edema. The Veteran admitted to rare dyspnea and left arm discomfort on exertion. No palpitation or syncope were noted. A review of the evidence of record, taken in total, does not suggest that the Veteran was unable to obtain or maintain substantially gainful employment solely due to his service-connected disabilities including coronary artery disease, PTSD, OSA, bilateral hearing loss, and tinnitus. There is insufficient persuasive evidence to substantiate a reasonable possibility that the Veteran is unemployable due to his service-connected disabilities. As demonstrated above, the VA medical professionals that evaluated the Veteran in December 2017 and October 2021 did not find that he was completely precluded from substantially gainful employment. Although the examiners identified functional limitations such as fatigue with exertional physical activity and difficulty maintaining work and social relationships, the examiners clearly found such symptoms did not render the Veteran unable to work entirely. VA treatment records consistently indicated that the Veteran denied symptoms associated with his heart condition. He continuously denied chest pain, chest pressure, shortness of breath, etc. It was also noted in February 2022 private treatment records and the December 2017 and July 2019 VA examinations that the Veteran was healthy enough to participate in moderate exertional activities before experiencing heart symptoms. Further, the Veteran has not identified or submitted any evidence demonstrating that his service-connected disabilities preclude him from securing and maintaining substantially gainful employment. Meaning there is no evidence that the Veteran's unemployability was due to his service-connected disabilities, nor is there evidence that the Veteran would be unable to obtain gainful employment due to his service-connected disabilities in light of his education and employment history. Though the Veteran may be precluded from most physically demanding occupations, there is no indication within the evidence that the Veteran would be precluded from sedentary employment. Regarding sedentary employment, in a recent decision, the Court noted that the VA has not explicitly defined the meaning of "sedentary employment." Withers v. Wilkie, 30 Vet. App. 139 (2018). Until VA provides such a definition, "the meaning and relevance of the term will have to be discerned on a case-by-case basis from the medical and lay evidence presented and in light of each Veteran's education, training, and work history." Id. at 149-150. Merriam-Webster online dictionary defines "sedentary" as (a) "doing or requiring much sitting" or (b) "not physically active." https://www.merriam-webster.com/dictionary/sedentary. The Board employs this definition in the current analysis. The record did not indicate that the Veteran was incapable of prolonged periods of sitting or any other conditions related to sedentary employment. The October 2021 VA examiner specifically noted that the Veteran's condition would not affect sedentary employment activities. The Veteran's many decades in insurance sales indicate that he has the skills necessary to obtain and maintain substantially gainful employment in a sedentary work setting. Additionally, though it was determined that his PTSD would make it difficult for the Veteran to be fully efficient in completing occupational tasks and interacting with coworkers, it was not determined that the Veteran would be unable to work. The Veteran was consistently noted to be friendly, alert, and well oriented at VA examinations. Lastly, as a lay person the Veteran is not competent to identify a specific level of disability according to the appropriate diagnostic code or to assess whether the symptoms preclude employment. Such competent evidence concerning the nature and extent of the Veteran's service-connected disabilities, and in particular his occupational impairment, have been provided by the VA medical professional who examined him. As such, the Board finds the Veteran's subjective complaints not competent medical evidence for this purpose. Thus, his assertions standing alone have little probative value and the Board assigns more weight to the medical opinions provided by VA examiners as well as the VA treatment records. Although there is evidence of functional limitation caused by the Veteran's heart condition, PTSD, and other service-connected disabilities, the evidence of record persuasively weighs against finding functional impairment from the Veteran's service-connected disabilities to be so severe as to preclude substantially gainful employment. Therefore, the record does not contain sufficient evidence to substantiate a reasonable possibility that he is unemployable by reason of his service-connected disabilities. Accordingly, the criteria for granting entitlement to individual employability thereafter are not met. 38 C.F.R. § 4.16 (b). As the evidence is persuasively against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.