Citation Nr: A25019727 Decision Date: 03/04/25 Archive Date: 03/04/25 DOCKET NO. 220815-267971 DATE: March 4, 2025 ORDER Entitlement to service connection for an aortic aneurysm is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. The Veteran's aortic aneurysm did not originate in service and is not otherwise etiologically related to service. 2. The Veteran's service-connected disabilities are not of such severity to prevent him from securing or following any substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an aortic aneurysm have not been met. 38 U.S.C. §§ 101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service in the Army from May 1969 to May 1971. The Veteran's service commendations include the Purple Heart, Vietnam Service Medal with four Bronze Stars, and the Republic of Vietnam Gallantry Cross Unit Citation with Palm Device. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2022 rating decision issued by a VA Regional Office (RO). On August 15, 2022, the VA received a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) to the July 2022 rating decision in which the Veteran selected to have a hearing by a Veterans Law Judge. The Veteran appeared for a hearing before a Veterans Law Judge on December 10, 2024. Consequently, the Board may consider evidence submitted through the July 18, 2022, notification of the July 2022 rating decision in this case, and any evidence submitted at the hearing and within 90 days of the hearing. The Board will not consider evidence added to the record in between the date of the July 2022 rating decision notification and the date of the hearing or added to the record more than 90 days after the date of the hearing. If evidence was added to the record during an ineligible period identified above, the Board has not considered that evidence. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. Specific instructions for filing a supplemental claim are included with this decision. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claims of entitlement to a TDIU and service connection for an aortic aneurysm, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to service connection for an aortic aneurysm is denied. The Veteran contends that his aortic aneurysm is related to his active military service, including exposure to herbicide agents in the Republic of Vietnam. On May 22, 2020, the VA received the Veteran's VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, requesting service connection for "Aneurysm - Heart/Veins/Arteries.". A July 2020 rating decision and a March 2021 rating decision both denied service connection for an aortic aneurysm. A July 2022 rating decision again denied service connection for an aortic aneurysm. The RO found that new and relevant evidence had been received to reconsider the service connection claim. The Board is bound by this favorable finding. 38 C.F.R. § 3.104(c). As favorable findings, the July 2022 decision notes that the Veteran was diagnosed with an aortic aneurysm and that exposure to herbicide agents is conceded due to the Veteran's service in Vietnam. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, is presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The presumption of service connection requires exposure to an herbicidal agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). Turning to the relevant evidence, a May 2015 VA treatment record reports an ultrasound was performed and found no evidence of an abdominal aortic aneurysm. An October 2017 VA emergency room note reports the Veteran complained of substernal chest pain intermittently for approximately one month. A computed tomography (CT) scan of the chest showed that the Veteran's ascending aorta was dilated to 3.9 cm, which was noted to require monitoring by his primary care physician. At discharge the Veteran was provided guidance on his aortic aneurysm. The guidance explained that an aneurysm is a stretching or bulge in a blood vessel. The abdominal aorta is part of the aorta, the major blood vessel that takes blood from your heart to the rest of your body. Thus, an abdominal aortic aneurysm is a stretching or bulging of the abdominal aorta. A May 2018 VA treatment record reports the Veteran's aortic aneurysm was currently asymptomatic. He had no chest pain, palpitations, or shortness of breath. In May 2020, the Veteran submitted a toxic non-metal chemical profile that was performed by Great Plains Laboratory. The results of the screen show 0.39 micrograms per gram of 2,4-Dichlorophenoxyacetic Acid (2,4-D). The lower limit of quantification was 0.20 micrograms per gram 0.20, the 75th percentile was 0.50 micrograms per gram, and the 95th percentile was 1.6 micrograms per gram. The report indicates that 2,4-Dichlorophenoxyacetic Acid (2,4-D) is a very common herbicide that was a part of Agent Orange used by the U.S. in the Vietnam War. It is most commonly used in agriculture on genetically modified foods, and as a weed killer for lawns. The report notes that exposure to 2,4-Dichlorophenoxyacetic Acid (2,4-D) via skin or oral ingestion is a known endocrine disruptor, and can block hormone distribution and cause glandular breakdown, and is associated with neuritis, weakness, nausea, abdominal pain, headache, dizziness, peripheral neuropathy, stupor, seizures, brain damage, and impaired reflexes. The report indicates that small amounts of 2,4-dichlorophenoxyacetic acid may be found in many urine samples because of widespread environmental contamination. The report does not indicate that exposure to 2,4-Dichlorophenoxyacetic Acid (2,4-D) was related to the Veteran's aortic aneurysm. The Veteran was provided a VA artery and vein conditions examination in July 2020. The examiner reported the Veteran was diagnosed with an aortic aneurysm in October 2017. The examiner reported the Veteran's aortic aneurysm was not symptomatic, did not preclude exertion, and was not 5 centimeters or greater. A June 2021 VA treatment record reports a CT of the Veteran's chest found a mildly dilated ascending thoracic aorta measuring up to 4.1 cm, previously measured 4 cm on a CT from October 25, 2019, without significant change. An April 2022 VA treatment record reports the Veteran had an aortic aneurysm. He had not chest pain, no shortness of breath, and no palpitations. At the Veteran's December 2024 Board hearing, the Veteran's representative asked him if his doctor or any doctor suggested that his aortic aneurysm could have been related to his exposure to Agent Orange. The Veteran's response was the following: "They looked, but for some reason, it doesn't show up as it does." He stated that "I've been told by my wife's holistic doctor that Agent Orange does contribute to it, and that's why I got those, that test I sent you today." The Board assumes that the Veteran was referring to the February 2020 toxic non-metal chemical profile, as he resubmitted the lab results on December 11, 2204. The Board acknowledges that the Veteran has been diagnosed with an aortic aneurysm, and as noted above, the Veteran was exposed to herbicide agents during service. The heart conditions for which service connection will be presumed are limited to ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina). 38 C.F.R. § 3.309(e). Notably, the Veteran's vascular disease of aortic aneurysm is not one of the listed diseases associated with exposure to certain herbicide agents. Thus, the Veteran's aortic aneurysm cannot be presumptively service-connected due to herbicide agent exposure. The Board acknowledges that the Veteran was not provided a VA medical opinion for his service connection claim for an aortic aneurysm, as was noted by the Veteran's representative at his December 2024 Board hearing. In determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumptive period; (3) whether there is an indication that the disability or symptoms may be associated with service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159 (c)(4). The third factor, in particular, is a low threshold. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this regard, the Board finds that neither the Veteran nor the Veteran's representative has submitted sufficient evidence to indicate that his aortic aneurysm is related to an event, injury, or disease that occurred in service. Accordingly, the Board finds that no further development of the claims for service connection for his aortic aneurysm is required. The Board acknowledges the Veteran's contention that his aortic aneurysm is related to his active military service. However, he is not competent to provide a nexus opinion in this case, as the issue regarding the etiology of his aortic aneurysm is medically complex and requires specialized knowledge and experience. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Veteran is not competent to address the etiology of his aortic aneurysm. Consequently, the Board gives more probative weight to the medical evidence that shows the Veteran was first diagnosed to have an aortic aneurysm in 2017, which was more than 46 years after his separation from service. Moreover, the Veteran testified that doctors had considered whether his aortic aneurysm could have been related to his exposure to Agent Orange but "it doesn't show up as it does." He also stated that his wife's holistic doctor told him that "Agent Orange does contribute to it," but he has provided no evidence to clarify, support, or confirm this statement. The Board concludes that, while the Veteran has a diagnosis of an aortic aneurysm, and evidence shows that herbicide exposure occurred, the evidence weighs against finding that the Veteran's diagnosis of aortic aneurysm began during service or is otherwise related to an in-service injury, event, or illness. For the reasons and bases stated above, the Board finds that service connection is not warranted for the Veteran's aortic aneurysm. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's service connection claim for an aortic aneurysm is denied. 2. Entitlement to a TDIU due to service-connected disabilities is denied. A July 2022 rating decision denied entitlement to a TDIU. In August 2022, the Veteran appealed that decision, contending he is entitled to a TDIU due to his service-connected disabilities. A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation because of service-connected disabilities. 38 C.F.R. § 4.16(a). A substantially gainful occupation has been defined as "an occupation that provides an 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." Faust v. West, 13 Vet. App. 342 (2000). In Ray v. Wilkie, the Court defined the term "unable to secure and follow a substantially gainful occupation" as having two components: one economic and one noneconomic. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Marginal employment shall not be considered substantially gainful employment. See 38 C.F.R. § 4.16. TDIU consideration requires contemplation of factors such as the veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. If there is only one such disability that precludes a Veteran from being able to secure or follow substantially gainful occupation, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). The Veteran is service connected for PTSD with major depressive disorder, rated at 30 percent from August 22, 2007 and 70 percent from May 20, 2020; post operative residuals of splenectomy, rated at 30 percent from May 19, 1971; scar and residuals of shell fragment wound of the abdomen with retained foreign body, rated at 10 percent from May 19, 1971; leg scars, rated at 10 percent from May 19, 1971 to August 22, 2007; left leg scar, rated at 10 percent from August 22, 2007; right leg scar, rated at 10 percent from August 22, 2007; hepatitis C, rated at 10 percent from April 30, 2023; ruptured left eardrum, rated as noncompensable from May 19, 1971; and nose scar, rated as noncompensable from May 19, 1971. The Veteran has a combined disability rating of 50 percent from May 19, 1971; 70 percent from August 22, 2007; and 90 percent from May 20, 2020. Therefore, the issue before the Board is whether the Veteran is entitled to a TDIU on a schedular basis for the period from May 20, 2020, the date the Veteran filed an intent to file a service connection claim for an aortic aneurysm. 38 C.F.R. § 4.16(a). The Board notes that an October 2016 rating decision denied entitlement to a TDIU. However, as the Veteran did not file a notice of disagreement to the October 2016 decision, that decision is now final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. Turning to the relevant evidence, in July 2016, the Veteran submitted a VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability) in which he reported that his service-connected PTSD prevented him from securing or following any substantially gainful occupation. The Veteran indicated that his disability affected full-time employment, he last worked full time, and became too disabled to work on December 31, 2013. He reported that he last worked 40 hours per week as an insurance salesman from August 1976 to December 2013. His highest gross earnings per month as $20,000. He reported his time lost from illness as 180 days. The Veteran reported his highest education level was completing three years of college. He reported that he left his last job because of his disability and indicated that he had not tried to obtain employment since he became too disabled to work. In July 2020, the Veteran submitted another VA Form 21-8940 in which he reported that his service-connected PTSD prevented him from securing or following any substantially gainful occupation. The Veteran indicated that his disability affected full-time employment on December 31, 2019, he last worked full time on March 5, 2020, and became too disabled to work on January 1, 2019. He reported that he last worked 40 hours per week as an insurance salesman from September 1976 to March 2020. His highest gross earnings in one year was $240,000 in 2004. His total earned income for the past 12 months was $38,000. He reported that he lost 5 years from his job due to illness. The Veteran reported his highest education level was completing three years of college. He reported that he left his last job because of his disability and indicated that he had not tried to obtain employment since he became too disabled to work. In September 2022, the Veteran submitted another VA Form 21-8940. However, because the September 2022 VA Form 21-8940 was submitted outside of the evidentiary window for the AMA hearing lane and, thus, is not relevant to whether the Veteran was entitled to a TDIU during the period on appeal, which was prior to the July 18, 2022, notification of the July 2022 rating decision denying TDIU. Therefore, no further analysis of the September 2022 VA Form 21-8940 is warranted. In July 2020 and April 2022, the VA sent the Veteran correspondence requesting that he submit a completed VA Form 21-4192, Request for Employment Information, for each of the employers listed on his VA Form 8940. To date, a completed VA Form 21-4192 has not been received by the VA. Because the Veteran failed to ensure that the requested VA Form 21-4192 was completed and returned, evidence regarding the Veteran's prior employment, including the reason for terminating his employment and time lost from his job due to disability are not available. The Board notes that the Veteran has been inconsistent in reporting the time lost from his job due to illness. The Veteran submitted three applications for TDIU on a VA Form 21-8940 with each listing a different amount of time lost from the job due to illness. However, a September 2022 VA Form 21-8940 was submitted outside of the evidentiary window for the AMA hearing lane and, thus, is not relevant to whether the Veteran was entitled to a TDIU during the period on appeal, which was prior to the July 18, 2022, notification of the July 2022 rating decision denying TDIU. Therefore, no further analysis of the September 2022 VA Form 21-8940 is warranted. The Veteran reported the following periods on the forms as time lost due to illness: 180 days on the July 2016 form and 5 years on the July 2020 form. At his July 2020 VA PTSD examination, he reported that he had been able to adjust to changes in the insurance industry during his 43-career, and he denied having ever experienced any significant impairment in expertly and efficiently completing his assigned duties. At his July 2022 VA PTSD examination, he reported that he took time off for disability for six months, but also reported that he did not miss much time from work due to any emotional issues. A review of the record reveals that the Veteran experienced stress at work as an insurance salesperson due to being reprimanded for inappropriate signatures, not due to PTSD. A February 2008 VA examination report describes the following: "[The Veteran] states that he had no problems with the people that he worked with, although he did go out on disability due to stress on the job. He did miss a period of six months of work at the time back in 2004. Nonetheless, this gentleman has never been fired or quit from a job, although he was reprimanded on the job which led to that stress in the situation." A May 2013 VA psychiatry note reports the Veteran had been put on probation at work in 2004 and that "things were stressful." He reported that he was on disability for 6 months due to depression. An August 2016 VA behavioral health note documents the following statement from the Veteran: "Back in 2004 I had a situation at work where I was put on probation for a year because there was an inappropriate logistic issues [sic] with signatures and I was put on probation and then I received disability for stress through my primary care doctor." The Veteran indicated the treatment lasted for 6 months during the probation period. In July 2020, the Veteran was provided a VA PTSD examination. The examiner opined that the Veteran had 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. The Veteran stated that throughout his four decades of employment in the insurance industry he had generally been able to develop adequate report with coworkers and the customers he served. He stated there were perhaps only several clients that he could recall having had difficult relationships with during his career. He currently spends his time almost exclusively at home at home and while at home he generally occupies his time either completing household chores, spending time with his wife, completing yardwork, completing basic household repairs, occasionally watching television, playing golf on occasion, and occasionally venturing into the community to complete necessary errands or scheduled medical appointments. His skills in insight and judgment were assessed as intact, his skills in concentration and memory were found to be mildly impaired. In July 2022, the Veteran was provided another VA PTSD examination. The examiner opined that the Veteran had 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. The Veteran reported that his relationships at work were good. He indicated that he rarely ever missed time from work due to emotional issues. The Veteran stated that only occasionally might feel down now and then. He stated that he feels depressed over his golf game and gets angry with himself. He reported he did not isolate or withdraw for long periods. The examiner reported the Veteran's reasoning, judgment, and memory were intact. In December 2024, during a permissible evidentiary window for the AMA hearing lane, the Veteran's representative submitted a private psychological evaluation report, prepared by Dr. C.R., a clinical psychologist, on July 25, 2022. Dr. C.R. did not review the Veteran's VA claims folder. She described the records she reviewed as "multiple pages of medical and mental health progress notes (dated in September and October of 2019, and in July of 2020), from the VA Healthcare System" describing the Veteran's treatment for PTSD, major depressive disorder, and anxiety. Dr. C.R. conducted a videoconference with the Veteran and the Veteran's wife. When asked about having trouble remembering things, such as appointments or to take medications, the Veteran stated, "I can keep my schedule in my head." The Veteran indicated his memory was pretty good. When asked about having difficulty completing tasks/work in a timely manner, the examiner stated, "I don't think so." Dr. C.R. assessed the Veteran's immediate, recent, and delayed memory and concluded that, overall, the examinee exhibited good memory skills. In terms of leisure time/recreational activities, the Veteran reported he had been trying to play golf once a week. The Veteran's grooming and hygiene appeared fair. In terms of language organization, the Veteran showed no major problems in expressing himself. Dr. C.R. reported that, overall, the Veteran presented with a good attitude and was cooperative, exhibiting an open interaction style. The Veteran presented no clear evidence (either from history or observation) of a formal thought disorder. The Veteran's abstract thinking was fairly good. Dr. C.R. reported that, overall, the Veteran's thought processes appeared coherent throughout the examination. Overall, the Veteran exhibited fairly good judgment and insight, as evidenced by his responses regarding several different scenarios. The Veteran denied any current suicidal ideation, as well as any plans or intent for self-harm behavior. He reported no history of having been physical with another person as a result of anger. Although the Veteran made no errors on problems during testing, Dr. C.R. stated the Veteran had limited concentration skills due to lengthy pauses on responses. She noted that the Veteran's mental status examination revealed him to have some difficulties with tasks involving attention and concentration, as evidenced by taking more time than expected to complete tasks (requiring some pauses). Dr. C.R. stated that the Veteran appeared to have been in a compromised mental/emotional state by 1970. Dr. C.R. stated the Veteran's PTSD has been present since at least 1970, and most definitely present to a severe degree, eventually resulting in total occupational and social impairment. She reported that, while the Veteran is relatively stable, he continues to experience some problematic symptoms, for example, intrusive memories/flashbacks, intermittent irritability/anger, low mood, anhedonia, social interaction difficulties, and limited attention/concentration, which appear exacerbated in times of stress/challenge. In August 2022, the Veteran's representative also submitted a private psychiatric/psychological impairment questionnaire, prepared by Dr. C.R., on July 25, 2022. Dr. C.R. concluded that the Veteran's prognosis was poor as his condition of chronic PTSD that began as depressive disorder in the 1970s has shown little improvement. The Board notes that an August 1987 VA examination report indicates the Veteran voiced no nervous complaints and denied anxiety. Moreover, there were no signs of either depression, psychosis, or anxiety reaction, and his cognitive abilities were reported to be above average. Dr. C.R. listed the following clinical findings that supported her diagnosis: deficiencies in family relations; persistent irrational fears; deficiencies in work or school; depression affecting the ability to function independently, appropriately, and effectively; neglect of personal appearance and hygiene; intermittent inability to perform activities of daily living; deficiencies in mood; intrusive recollections of a traumatic experience; unprovoked hostility and irritability; inability to establish and maintain effective relationships; and deficiencies in judgment. Among other conclusions, Dr. C.R. reported the Veteran's ability to remember locations and work-like procedures would be impacted by his symptoms up to 1/3 of an 8-hour workday. She also reported the Veteran's ability to travel to unfamiliar places or use public transportation would be impacted by his symptoms more than 2/3 of an 8-hour workday. The Board finds that Dr. C.R.'s conclusion that the Veteran's PTSD has resulted in total occupational and social impairment is not supported by the evidence, including her own assessment of the Veteran. During her interview with the Veteran, he reported his memory was pretty good and that "I can keep my schedule in my head." When asked about having difficulty completing tasks/work in a timely manner, the Veteran stated, "I don't think so." Dr. C.R. reported that the Veteran's judgment, insight, and abstract thinking was fairly good and that his thought processes appeared coherent throughout the examination. Dr. C.R. reported the Veteran presented with a good attitude, was cooperative, and presented no clear evidence (either from history or observation) of a formal thought disorder. Although Dr. C.R. reported that the Veteran continued to experience problematic symptoms, including flashbacks, the Veteran reported that he had never had a flashback at his examination on July 5, 2022, which was conducted 20 days before Dr. C.R.'s interview with the Veteran. At that examination, the Veteran also stated that he does not become too anxious anymore. As previously noted, Dr. C.R. did not review the Veteran's VA claims folder. The Board finds that Dr. C.R.'s conclusions regarding the Veteran's abilities impacted by the Veteran's PTSD symptoms are not supported by the evidence, including her own assessment of the Veteran. She reported that the support for her clinical findings included her assessment that the Veteran had deficiencies in judgment. However, her assessment based on her interview with the Veteran found that he exhibited fairly good judgment and insight, as evidenced by his responses regarding several different scenarios. Moreover, the July 5, 2022, VA examination report indicates the Veteran' s insight and judgement appeared good. Although Dr. C.R. concluded that the Veteran's ability to remember locations and work-like procedures would be impacted by his symptoms up to 1/3 of an 8-hour workday and reported the Veteran's ability to travel to unfamiliar places or use public transportation would be impacted by his symptoms more than 2/3 of an 8-hour workday, during the Veteran's interview with Dr. C.R., he indicated his memory was pretty good. When asked about having difficulty completing tasks/work in a timely manner, the examiner stated, "I don't think so." Dr. C.R. assessed the Veteran's immediate, recent, and delayed memory and concluded that, overall, the examinee exhibited good memory skills. For the reasons described above, the Board affords no probative value to Dr. C.R.'s July 2022 private psychological evaluation report or her private psychiatric/psychological impairment questionnaire. At the Veteran's December 2024 Board hearing, the Veteran testified that he received his first pension check in April 2007. However, he continued to work, as he stated, "it was advantageous to do it because technically, it was a pay raise, and I was still collecting from my book of business." He stated that he could continue in the position as long as he met his quota each year. According to the Veteran, his employer changed the contracts three or four times during the period after he took his pension until he was terminated for not meeting his quota. The Veteran stated that he was working 20 to 25 hours per week towards the end of his employment. He indicated that his job was "a people business" and he was getting tired of dealing with people that were not responsible. He reported it was "very fatiguing." He indicated that he withdraws and tries to avoid people a few times a week. The Veteran stated that he was fatigued all the time because he had been diagnosed as being anemic. He stated that he does not look forward to socializing with people. The Veteran stated that he had occasional thoughts that he would be better off dead. The Veteran stated that he was terminated from his job with Prudential because he was not able to meet his quota selling insurance due to health issues and PTSD issues. In determining whether the Veteran is entitled to a TDIU, the Board has considered the Veteran's level of education, special training, and previous work experience. See 38 C.F.R. § 4.16. The Board finds that the Veteran's education, which was sufficient for him to complete three years of college, is not inconsistent with an ability to perform unskilled or semi-skilled work, such as a receptionist, dispatcher, or surveillance systems monitor, which do not involve exertional activities beyond the Veteran's residual functional capacity in view of his service-connected disabilities. The Veteran has past work experience in life insurance sales, as well as serving in the infantry during his military service. The Board finds that, although the Veteran may no longer be able to perform all this past work, his work history would not prevent him from securing or following an unskilled or semi-skilled occupation, which does not require special training and can be learned on the job. The available medical evidence reflects that the Veteran's disabilities functionally affect his employment, however, the evidence does not demonstrate that his service-connected disabilities preclude substantially gainful employment. In support of such finding, the Board assigns great probative value to the July 2020 and July 2022 VA medical examination reports. The examiners, licensed psychologists, thoroughly reviewed the Veteran's mental history and examined the Veteran in determining their assessments that the Veteran had less than total occupational and social impairment. The July 2020 and July 2022 examiners opined that the Veteran had symptoms resulting in 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. In July 2020, the Veteran reported having several friends, most of whom are veterans he had served with in the Army and with whom he interacts on a regular basis. The examiner reported the Veteran did not display any abnormal or inappropriate behavior during a 60-minute interview. His skills in insight and judgment were assessed as intact, his skills in concentration and memory were found to be mildly impaired. The Veteran stated that throughout his four decades of employment in the insurance industry he had generally been able to develop adequate report with coworkers and the customers he served. He stated there were perhaps only several clients that he could recall having had difficult relationships with during his career. In July 2022, the Veteran stated that only occasionally he might feel down now and then and that he did not isolate or withdraw for long periods. He maintained his grooming, paid his bills, and does chores. The examiner reported the Veteran's reasoning, judgment, and memory were intact. Although the Veteran stated at his December 2024 Board hearing that that he was working 20 to 25 hours per week towards the end of his employment, in July 2020, he reported that he last worked 40 hours per week as an insurance salesman from September 1976 to March 2020 While the Veteran's PTSD causes social and occupational impairment accounted for by the 70 percent rating that is already assigned, the competent medical evidence of record does not suggest that his psychiatric disorder actually prevents employment. Indeed, the ratings for his several service-connected disabilities contemplate their consequent functional impact on her earning capacity. 38 C.F.R. §§ 4.1, 4.15. For the reasons and bases stated above, the probative evidence of record does not show that, during the period on appeal, the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the Board finds that the most persuasive medical and other relevant evidence does not establish entitlement to a TDIU, so this claim must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, Associate Counsel 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.