Citation Nr: 25002467 Decision Date: 02/20/25 Archive Date: 02/20/25 DOCKET NO. 15-03 863 DATE: February 20, 2025 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The evidence of record is not in approximate balance but is persuasively weighted against finding that the Veteran's right knee disability manifested to a compensable degree within a presumptive period following separation from service, was noted during service with a continuity of symptomatology since service, or was incurred in or is causally related to service. 2. The evidence of record is not in approximate balance but is persuasively weighted against finding that the Veteran's left knee disability manifested to a compensable degree within a presumptive period following separation from service, was noted during service with a continuity of symptomatology since service, or was incurred in or is causally related to service. 3. The Veteran's service-connected disabilities do not prevent him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.309. 2. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.309. 3. 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, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from January 1974 to January 1977. This matter before the Board of Veterans' Appeals (Board) is on appeal from an August 2013 rating decision. The Veteran testified at a hearing before a Veterans Law Judge (VLJ) in April 2018. A transcript of the proceeding is of record. The Veterans Law Judge who held that hearing has since left the Board. By correspondence dated October 31, 2022, the Veteran was informed that the VLJ who conducted his hearing is no longer employed by the Board; he was instructed to reply to the correspondence within 30 days if he sought to have another hearing. Because the Veteran did not reply within this timeframe, the Board has interpreted this silence as the Veteran's desire to proceed with adjudication without the need for a hearing. By way of procedural history, this matter was previously before the Board in July 2018. At that time, the Board reopened the Veteran's claims for entitlement to service connection for a right and left knee disability but denied service connection for both claims. The Veteran subsequently appealed the Board's decision to the Court of Appeals for Veterans' Claims (the Court). The parties filed a Joint Motion for Partial Remand (JMPR) which the Court granted in May 2019, vacating the Board's decision and remanding both claims due to the Board's failure to provide an adequate statement of reasons and bases for its decision. Thereafter, these issues appeared back before the Board in October 2019. The Board remanded on the issues of entitlement to service connection for a left and right knee disabilities, as well as entitlement to TDIU, to afford the Veteran the opportunity to present for a new VA examination and to seek outstanding treatment records. These matters were again remanded by the Board in December 2022 and October 2023 for further evidentiary development and adjudication. The Board finds there was substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (the Board must ensure compliance with its remand orders); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (although under Stegall VA is required to comply with remand orders, substantial compliance, not absolute compliance, is required). The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further than they have included or identified relevant evidence. VA requested records for which the Veteran submitted a proper release and/or adequately identified. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). 1. Service connection for a right knee disability 2. Service connection for a left knee disability Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other). Factual Background & Analysis The Veteran contends that his left and right knee conditions are directly related to service. The Veteran contends that his knees were injured during service when a large generator fell on his legs causing him to seek emergency medical attention and resulting in the use of crutches and limited duty for two weeks. The medical evidence demonstrates that the Veteran has a current diagnosis of degenerative arthritis of the bilateral knees. Service treatment records (STRs) are absent for complaints, symptoms, injury, or diagnoses related to a knee condition. There is a record dated August 14, without a corresponding year, showing that the Veteran was treated at the emergency room at Womack with the complaint of "c/f nv." A January 1977 separation examination indicates that the Veteran reported no changes in his physical condition, and the clinical evaluation indicated no abnormalities. STRs indicate complaints of other health problems during service, such as chest pains, sore throat, swollen testicles, eye problems, a twisted ankle, and a pulled leg muscle, but there is no mention of any problems with his knees. In July 2000, a lay statement from M.W. was received. The statement indicates that he witnessed the Veteran "hurt himself in the motor pool at Fort Bragg, NC while moving a generator," and that he believes "he injured his leg because he could not walk but [he is] not sure of the extent of his injury." He stated that he recalls that the Veteran was "taken to the hospital by Jeep," but that he has "no knowledge of the severity or any treatment that he received after his injury." In a January 2012 statement, the Veteran stated that since discharge from service he has suffered chronic pain in his knees, and that prior to service he never had problems with his knees. Regarding his records, he indicated that when he was injured he was taken to the Army Hospital at Fort Bragg and that he did not know if that played a part in his records not showing his injury or treatment. In an August 2013 general medical disability benefits questionnaire (DBQ), the examiner indicated that the Veteran has a diagnosis of degenerative arthritis of the bilateral knees since 2013. The examiner reviewed the Veteran's file and conducted an in-person examination. The examiner stated that the Veteran's degenerative arthritis of the bilateral knees is not related to service. In a January 2015 VA Form 9, the Veteran stated that he is not surprised that his records are not complete and indicated that when he was taken to the hospital his medical records were stored at a sick call facility. He stated that since it was an emergency, he went to the hospital without his records and that he was told that hospital staff would send documents of his injury to be added to his record but that it never happened. In the April 2018 hearing, the Veteran testified that prior to service he did not have any issues with his knees, and that during service, while he was working in the motor pool, moving a generator from a truck, the generator fell on him, landing on both legs. He stated that he was taken by jeep to the Army Hospital, where he received treatment. He stated that he believes that his records from the hospital were never merged with his service records. The Veteran testified that he was released from the hospital on the same day, and that after two weeks he was still having problems with his knee but did not want people to know, so he faked it and tried to cover it up until he left service. He stated that the generator was "pretty big" and was not something that could be picked up by one person. The Veteran testified that he is treated at the VA and that he has spoken to his doctor about his knee condition resulting from service. He stated that they have concurred with the Veteran that it was related to service but have not documented it. The Board will first address whether the evidence establishes that bilateral knee arthritis was shown to be chronic in service and that a nexus exists between his present diagnoses and in-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 496 (1997). In doing so, the Board must assess not only competency of the Veteran's statements, but also their credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). As discussed above, the Veteran stated throughout the record that he his current knee conditions are a result of the claimed in-service incident where a generator fell on his legs. In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995). In this regard, the Veteran, by his own account, indicated that as a result of the claimed incident he had to use crutches and was on limited duty for two weeks, and that after that time he hid his knee problems. However, as noted above, while STRs document complaints of and treatment for other health problems, they do not indicate any complaints, symptoms, injuries, or diagnoses related to his knees, nor do they mention an accident involving a generator or knee injury. STRs are also absent for any indication that the Veteran was on limited duty or was using crutches for two weeks. The Board acknowledges the Veteran's contentions that his records are not complete because his records from the hospital were not associated with his service records; however, the Board finds it highly unlikely that STRs would be completely silent for an incident or sequelae resulting from an event causing the Veteran to require the use of crutches and be placed on limited duty for two weeks. Here, it is highly implausible that had the Veteran incurred a chronic during service that has been present for nearly 50 years that symptoms or treatment would not be noted or documented at some point during his service. It also stands to reason that he would have reported this fact to any medical professional and that this would be noted in the two decades between separation from service and his initial claim in 1999. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) (the lack of contemporaneous medical evidence may be considered as one factor in assessing the credibility of lay statements); See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Rather, in an October 1982 statement responding to an information request from VA the Veteran stated, "I have no disabilities." Consequently, the Board finds the Veteran's statements lack credibility as they are wholly inconsistent with the medical evidence of record and, therefore, affords minimal probative weight to his contentions. See McDowell v. Shinseki, 23 Vet.App. 207, 214 (2009) (noting "this Court's caselaw that has long held that the Board has a duty to find facts and assess the weight and credibility of the evidence"). It is determined that the evidence does not demonstrate bilateral knee arthritis incurred during service with a continuity of the same symptomatology to the present. Additionally, VA and private treatment records show the Veteran was assessed with degenerative joint disease of the bilateral knees as early as December 2000, more than 23 years after his separation from service. While the Veteran is competent to report having experienced symptoms of knee pain and self-medicating for the pain since service, he is not competent to establish that his symptoms were manifestations of his current bilateral knee arthritis. For those reasons, presumptive service connection cannot be established for arthritis as a qualifying chronic disease under the provisions of 38 C.F.R. § 3.309(a). Turning to the elements of direct service connection, following the Board's most recent decision, an in-person VA examination was conducted in May 2024. After this examination of the Veteran and review of the claims file, the examiner provided a November 2024 VA medical opinion stating that it is less likely than not that that any right or left knee disability had its onset during or was caused by events or injuries during the Veteran's service, to include the duties associated with his MOS and the Veteran's account of having a generator fall on his legs during service. They explained that, per a July 2006 physical therapy initial evaluation, the Veteran reported pain in the bilateral knees that has been present for "10+ years" which puts the onset of the bilateral knee pain approximately 1996, nearly 19 years after separating from service. They emphasized that there is no evidence a generator injury caused a permanent disability during service and no evidence it precipitated the bilateral knee arthritis diagnosis. The record review revealed no history of the Veteran complaining of knee pain in service and no evidence of significant duty limitations that precluded successful fulfillment of his MOS duties. They recognized that there is evidence of an injury to the left knee which occurred in December 1996, nearly 20 years after service. A January 1997 treatment note references a left knee twisting injury one month prior with a stable left knee examination at that time. They noted that there was no evidence of right knee injury or complaint at the time of that examination. This intervening medical evidence led them to conclude that the normal knee examination at separation from service and their examination demonstrates a separate course of injury contributing to the current conditions in the bilateral knees that are unrelated to service. The Board is deferential to the findings and conclusions made by the ophthalmologist who authored the November 2024 VA medical opinion. Their medical opinion was based on an accurate review of the evidence and their specialized medical training and expertise. The Board ultimately affords this opinion and the medical determination made therein significant probative weight. The underlying rationale for the negative nexus finding reflects consideration of pertinent medical records and explains why the Veteran's current knee diagnoses are medically unrelated to the claimed in-service injury. They explained how there is evidence of a left knee injury being incurred approximately 20 years after service and a normal right knee examination at that time. They ultimately found no medical evidence to support a nexus between any current knee disabilities and the Veteran's service. The Board also references VA medical opinions obtained in May and July 2023 which similarly found no nexus between any current bilateral knee disabilities and the Veteran's service. These examiners cited to intervening causes and risk factors of vitamin D deficiency and the Veteran's morbid obesity as more plausible explanations for his current degenerative arthritis. These opinions helped informed the Board's analysis. But ultimately, it is November 2024 VA medical opinion which offered a clear conclusion and reasoned medical explanation that was based on the available facts and the clinician's medical expertise which is dispositive as to the nexus element of this claim. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); 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"). It is acknowledged that in a May 2018 opinion, the Veteran's physician stated that the Veteran has had severe knee arthritis throughout the time he has been a patient in their clinic, in 2003. The physician stated that "it is impossible to say with certainty what caused him to develop severe arthritis, but trauma can contribute to early onset of arthritis." He stated that the Veteran reported that "while he was on active duty a generator fell on his legs, resulting in a severe injury, though with no identified fractures." The physician stated that "it is possible that this injury was one of the factors involved in his development of knee arthritis in later years" and that there "have been other non-service related factors as well, including his weight, but the trauma may have played a role." The Board notes that this opinion is based on the Veteran's reports of an incident in service and indicated other possible causes of the Veteran's condition. Thus, due to speculative language, this opinion is not sufficient to establish a nexus. See McLendon v. Nicholson, 20 Vet. App. 79, 85 (2006) (stating that speculative medical opinion as to causation cannot establish medical nexus to service). Because of the qualified and uncertain nature of the opinion given, the Board places more probative value on the conclusions and finding made by the examiner who provided the November 2024 VA medical opinion. A December 2023 VA medical opinion was also obtained which came to the opposite conclusion. The examiner determined that it is at least as likely as not that bilateral knee disabilities had their onset during or were caused by events or injuries during the Veteran's service. As a rationale, the examiner cited to the two lay statements from comrades which communicated that they saw the Veteran using crutches after the generator accident in 1976. They also formed their opinion based on the absence or missing treatment notes, his lay reports of a continuation of knee pain since service, and his current diagnoses of arthritis and eventual bilateral knee replacements. They noted further that the Veteran was retired medically with VA Durham due to his knee pain in 2011 and that they would "give the Veteran the benefit of the doubt and assume his knee pain occur during service." Here, the Board puts more probative weight on the November 2024 VA medical opinion. This opinion contains a more detailed analysis of the pertinent evidence particularly that, per a July 2006 physical therapy initial evaluation, the Veteran reported pain in the bilateral knees that has been present for "10+ years" which puts the onset of the bilateral knee pain approximately 1996, nearly 19 years after separating from service and around the same time as the documented December 1996 left knee injury. In that regard, the December 2023 VA medical opinion does not discuss the relevance of the January 1997 treatment note noting a left knee twisting injury. Moreover, as explained, above the Veteran's lay statements regarding an in-service incurrence of bilateral knee symptoms with a continuity to the present have been found to be uncredible and inconsistent with the medical evidence. The December 2023 VA medical opinion's positive nexus finding is substantially based on this lay evidence and the Veteran's self-reports. More probative value is placed on the November 2024 VA medical opinion which cites to objective medical findings to support its conclusions. D'Aires v. Peake, 22 Vet.App. 97, 107 (2008) (it is the responsibility of the Board to assess the credibility and weight to be given to evidence). The Board has considered the Veteran's lay statements and the statement from M.W. but finds the Veteran's STRs and the delay in filing his claim to be highly STRs probative. The Board finds that the lay statement from M.W. is outweighed by the STRs. The Veteran had previously testified that the generator could not be moved by one person alone, but the statement from M.W. does not mention the size of the generator, whether others were assisting, or if a generator did fall on the Veteran. He stated that he believes the Veteran injured his leg because he could not walk. Regardless, neither the Veteran nor M.W. are competent to opine whether this incident caused the Veteran's current disabilities as they do not have the requisite medical training to do so. See Jandreau v. Nicholson, 492 F3d. 1372, 1376-77 and n.4 (Fed. Cir. 2007) (recognizing that the competence of a layperson to offer evidence on a medical issue is limited to where doing so does not require reliance on specialized medical knowledge or expertise). Overall, the Board finds that the Veteran's contentions and the lay statements are outweighed by the competent and probative medical evidence of record to include the November 2024 VA medical opinion specifically. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). In sum, the evidence is persuasively weighted against finding that the Veteran has a right or left knee disability that is causally related to his service. Therefore, service connection for these claims are denied and the benefit of the doubt doctrine is not for application. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a TDIU Legal Criteria A "schedular" TDIU may be assigned where the schedular rating is less than total if it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of 1) a single service-connected disability ratable at 60 percent or more, or 2) as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.34l, 4.16(a). Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system such as orthopedic disabilities, will be considered as one disability for TDIU purposes. The Veteran has two service connected disabilities of adjustment disorder with mixed anxiety and depressed mood rated at 50 percent from May 3, 2014 and pseudofolliculitis barbae rated at 30 percent from February 5, 1997. The Veteran meets the schedular percentage requirement as of May 3, 2014. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In determining the severity of impairment, 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). Consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment shall not be considered substantially gainful employment for purposes of entitlement to TDIU. 38 C.F.R. § 4.16(a). Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Id. Consideration shall be given in all claims to the nature of the employment and reason for termination. Id. Factual Background & Analysis The Veteran contends that his service-connected disabilities prevent him from seeking and maintaining meaningful, gainful employment. On April 27, 2012, the Veteran submitted a VA Form 21-8940, application for TDIU, contending that he is unemployable due to his service-connected chronic right and left knee disabilities. The Board notes, as discussed above, his right and left knee conditions are not service connected. After review of the evidentiary record, the Board finds that the functional limitations imposed by the Veteran's service-connected disabilities do not render him unable to secure and follow a substantially gainful occupation. The evidence of record does not demonstrate that the Veteran's service-connected disabilities would preclude him from being able to engage in substantially gainful employment. An August 30, 2011 statement from the Office of Personnel Management (OPM) indicates that they reviewed his medical records and found that the Veteran was disabled for his position as an inventory management specialist, due to severe degenerative joint disease of the knees. In April 2012, the Veteran submitted a TDIU application indicating that the Veteran last worked in September 2011. The application indicates that the most the Veteran earned was $54,000 in 2011 working as an inventory management specialist. The application indicates that the Veteran left his last job due to his disability and that he completed 3 years of college. The August 2013 DBQ indicates that the Veteran's skin condition does not impact his ability to work. It indicates that the Veteran's scars (regardless of location) or disfigurement of the head, face, or neck does not impact his ability to work. The examiner indicates that the Veteran's left and right knee conditions have an effect on physical employment; however, the Veteran is not service-connected for his knee conditions, as discussed above. In a November 2014 PTSD DBQ, the examiner indicated 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. Records from SSA received in July 2013 indicate that the Veteran has been found to be disabled and that VA medical records indicated that the Veteran uses a cane due to severe degenerative changes of the bilateral knees. SSA records indicate that the Veteran reads, watches TV, sings in his church choir, and teaches Sunday School. The SSA records indicate that the Veteran has some physical limitations, mainly due to his non-service-connected knee conditions. The SSA records indicate that the Veteran did not report problems with concentration or attention and indicate that he gets along well with authority figures and follows written and spoken instructions. With this evidence in mind, the record does not demonstrate that the Veteran's service-connected psychiatric and skin disabilities would preclude any form of sedentary employment during this time. The Board additionally notes that the Veteran was quite adamant during his April 2018 hearing testimony that he could not work due to his knee disabilities. Neither the Veteran nor his representative presented evidence or even contended that he could not work due to service connected disabilities. In that regard, VA regulations contain many factors to be considered as part of a TDIU analysis. See 38 C.F.R. §§ 4.16, 4.19. Whether a veteran can perform "sedentary work" or "sedentary employment" is not among them. In fact, neither the term nor any similar phrase is mentioned, much less defined, in any relevant VA statute or regulation. The Court has held that if the Board basis its denial of TDIU in part on the conclusion that a veteran is capable of performing sedentary work, then it must define that term considering the specific facts of each case, including a particular veteran's work history, education, and training. See Withers v. Wilkie, 30 Vet. App. 139, 150-51 (2018). Merriam-Webster online dictionary defines sedentary as "doing or requiring much sitting" (as it pertains to a job), and therefore, the Board adopts this definition in its analysis. See https://www.merriam-webster.com/dictionary/sedentary (last visited February 7, 2025). A "substantially gainful occupation" is "one that provides annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the veteran actually works and without regard to the veteran's earned annual income prior to his having been awarded a 100 percent rating based on individual unemployability." Faust v. West, 13 Vet. App. 342, 356 (2000). In evaluating a TDIU claim, the Board is not required to analyze actual opportunities available on the job market. See Pederson v. McDonald, 27 Vet. App. 276, 287 (2015). However, the Board does have a duty to rely on actual evidence of employability and analyze such evidence in concluding whether a veteran could perform work that would produce sufficient income to be other than marginal. See Beaty v. Brown, 6 Vet. App. 532, 537 (1994). Sedentary employment encompasses a wide variety of administrative and clerical jobs. Thus, the Board determines that, and with consideration of his service-connected disabilities only, along with his education, training, and employment history, that the Veteran would have been able to obtain or maintain various substantially gainful occupations which would provide him with a living wage. For example, he would be able to work as a data entry clerk, ticket taker at a movie theater or any number of sedentary professions which do not require an advanced degree or vocational training. The Board notes that the Americans with Disabilities Act (ADA), in addition to other federal and state laws, open the doors for people with disabilities to apply for, obtain, and maintain gainful employment. 42 U.S.C. §§ 12101, et seq. (2012). The ADA requires employments to make "reasonable accommodations" for people with disabilities in the application and employment processes unless such accommodation creates an "undue hardship" for the employer. 42 U.S.C. §12111 (9), (10). Such "reasonable accommodation" may include "acquisition or modification of equipment or devices... the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities." 42 U.S.C. §12111 (9). The Board finds that, while the Veteran's service-connected disabilities have some effect on his employment, the record does not indicate that the Veteran has been unable to obtain or maintain substantially gainful employment due solely to his service-connected disabilities. The Board also recognizes that the Veteran's service-connected disabilities may cause him to miss work at times, which is the purpose of the assigned compensable ratings for those disabilities. See 38 C.F.R. § 4.1 (stating that the percentage ratings in the rating schedule "represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations"). By the assigned schedular ratings during the appeal period, the Veteran has been compensated for the symptomatology associated with each of his service-connected disabilities. Thus, impairment of occupational capacity due to service-connected disabilities has already been taken into consideration via the disability ratings assigned. It is again emphasized that records obtained from OPM indicate that the Veteran was medically retired from his occupation as an inventory management specialist due to his knee disabilities which have been determined to be not service connected by this decision herein. The Board could not consider the functional impairment caused by these disabilities in making this determination for entitlement to a TDIU. The evidence ultimately then does not show that the Veteran is incapable of performing the physical and mental acts required by employment strictly due to his service-connected disabilities. For the above reasons, the evidence is not in an approximate balance but is persuasively weighted against finding that a TDIU is warranted. Rather, the evidence persuasively weighs against the Veteran's claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application, and the claim is denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mckone, Kyle 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.