Citation Nr: 25005752 Decision Date: 04/28/25 Archive Date: 04/28/25 DOCKET NO. 16-41 368 DATE: April 28, 2025 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU) prior to March 6, 2019, for accrued benefits purpose, is denied. FINDING OF FACT Prior to March 6, 2019, the Veteran's service-connected disabilities did not render him unable to obtain or maintain substantially gainful employment consistent with his education, work history, skills, and training. CONCLUSION OF LAW The criteria for entitlement to an evaluation of TDIU due to service-connected disabilities prior to March 6, 2019, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1968 to March 1971. Unfortunately, the Veteran died during the pendency of the appeal. The Veteran's surviving spouse has since been substituted as the appellant. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision issued by a VA Regional Office, the agency of original jurisdiction (AOJ). By way of background, during the pendency of the Veteran's appeal, the AOJ awarded a 100 percent rating for squamous cell carcinoma of the lung and Special Monthly Compensation (SMC) based on housebound effective March 6, 2019. March 2020 Rating Decision. In a February 2022 decision, the Board denied TDIU for the period prior to March 6, 2019, and found the issue moot for the period thereafter. The Veteran appealed the Board's February 2022 decision to the Court of Appeals for Veterans Claims (Court) which granted a joint motion for remand (JMR) and remanded the matter back to the Board for action consistent with the joint motion. In particular, the JMR stated the Board erred by failing to respond to arguments expressly raised in an April 2021 Informal Hearing Presentation (IHP). The representative cited to September 2012 and January 2014 VA examinations finding the Veteran's coronary artery disease resulted in fatigue with heavy exertion, and the Veteran's neuropathy resulted in pain and numbness in his legs. The representative additionally argued the evidence showed the Veteran lacked the mental ability to perform any substantially gainful employments citing a March 2014 VA examination and a September 2013 VA treatment record. The parties, at that time, did not dispute the Board's determination that TDIU was moot, effective March 6, 2019, and therefore, the matter is no longer before the Board on appeal here. In an October 2023 decision, the Board remanded the Veteran's claim for TDIU prior to March 6, 2019, clarifying that the AOJ should attempt to clarify dates of the Veteran's employment and submit a request for employment information to the Veteran's previous employer to complete a VA Form 21-4192 Request for Employment Information. The AOJ subsequently requested and obtained a completed VA Form 21-4192 and issued an April 2024 Supplemental Statement of the Case (SSOC) denying the Veteran's claim. The Board finds there was substantial compliance with the October 2023 remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Furthermore, the appellant's representative waived any AOJ consideration of evidence associated with the claims file since the issuance of the April 2024 SSOC. See October 2024 Third Party Correspondence; see also August 2024 Appellate Brief. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to March 6, 2019, for accrued benefits purpose, is denied. The Veteran's representative contends that TDIU is warranted from October 7, 2013, to March 5, 2019. A total disability rating for compensation purposes may be assigned where the schedular rating is less than total and where it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided that at least one disability is ratable at 40 percent or more and that there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). To meet the requirement of "one 60 percent disability" or "one 40 percent disability," the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. The instant appeal stems from the Veteran's informal claim for a TDIU, which was received on September 17, 2014. For the appeal period prior to March 6, 2019, the Veteran was service-connected for coronary artery disease (CAD), evaluated as 30 percent disabling; posttraumatic stress disorder (PTSD), evaluated as 30 percent disabling; diabetes mellitus, type II, with hypertension, evaluated as 20 percent disabling; peripheral neuropathy of the sciatic nerve, right lower extremity (RLE) evaluated as 10 percent disabling; peripheral neuropathy of the sciatic nerve, left lower extremity (LLE) evaluated as 10 percent disabling; peripheral neuropathy of the right femoral nerve, RLE evaluated as 10 percent disabling; and peripheral neuropathy of the left femoral nerve, LLE evaluated as 10 percent disabling. Although no disability was individuality rated at 60 percent or 40 percent, the diabetes mellitus and the left and right femoral and sciatic peripheral neuropathies are associated with the same etiology and therefore meet the 40 percent requirement for combined disabilities. For the entire appeal period, the Veteran has a combined disability rating of 80 percent, thereby meeting the schedular threshold for consideration of a TDIU. The Board notes that the appellant's representative asserts the period on appeal should begin on October 7, 2013, as the Veteran filed his informal claim for TDIU within one year of the May 2, 2014, rating decision which, in part, granted service connection for PTSD as of October 7, 2013. The May 2, 2014, rating decision, however, was a Legacy decision and, therefore, not subject to the "continuous pursuit" regulations of the Appeals Modernization Act, and the Veteran's claim continues to remain in the Legacy system. The effective date of an award based on a claim for increase of compensation "shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application." 38 U.S.C. § 5110(a). The effective date for increased rating shall be the earliest date of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year of such date; otherwise, the effective date for increased rating shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 3.400(o)(1). Accordingly, the Board finds the period on appeal begins September 17, 2014, plus consideration of the one-year lookback period. The term "substantial gainful employment" is not defined in the rating schedule, but it must be employment beyond "marginal" or "sheltered." That is, the Veteran must be making beyond the poverty threshold and "a protected work environment" means, "a lower-income position that due to the Veteran's service-connected disability or disabilities is shielded in some respect from competition in the employment market." Labruzza & McBride v. McDonough, 37 Vet. App. 111 (2024). Further, "substantial gainful occupation" has both economic and noneconomic components. Ray v. Wilkie, 31 Vet. App. 58 (2019). In assessing the Veteran's ability to secure and follow a substantially gainful occupation, the Board is to consider the Veteran's history, education, skill, and training as well as physical abilities and mental abilities required by the occupation at issue. Id. Such specific physical ability factors include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. Id. Specific mental ability factors include memory, concentration, ability to adapt to change, handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. Id. The central question is "whether the [V]eteran's service-connected disabilities alone are of sufficient severity to produce unemployability," not whether the Veteran could find employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Here, the record shows that the Veteran graduated high school in 1967 and completed community college coursework in business administration without obtaining a degree. While in the Army, the Veteran's military occupational specialty was a parachute rigger with additional education and training as a wheeled vehicle mechanic. DD-214. Post-service, the Veteran indicated that he performed work as an insurance agent and as a mail carrier prior to beginning employment with American Airlines in November 1977. The Veteran was employed for over thirty years with American Airlines retiring in November 2012. December 2012 VA 21-4192. The Veteran held the positions of fleet service worker, crew chief, and crew coordinator. The Veteran loaded and unloaded airplanes as a fleet service worker, supervised fleet service workers as a crew chief, and supervised crew chiefs for 9 to 10 gates as a crew coordinator. See July 2023 Vocational Report. The Veteran stated he became too disabled work in November 2012 and that the most he earned was in one year was $95,000 in 2010. The record supports that the Veteran was retired and otherwise not working throughout the period on appeal here. From an economic perspective, the Veteran's education and job history renders him suitable for work as an insurance agent, mail carrier, and an airport utility worker to include in supervisory roles as a crew chief and coordinator. Concerning the noneconomic component, a June 2012 VA examination determined that the Veteran's diabetes mellitus type II was managed by a restricted diet and a prescribed oral hypoglycemic agent. The Veteran had no weight loss or loss of strength attributable to diabetes, and the examiner found that the Veteran's condition did not impact his ability to work. A September 2012 VA examination regarding the Veteran's heart disease found that the Veteran experienced fatigue with heavy exertion. A March 2013 VA treatment record indicates the Veteran complained of a cough and desired nasal spray and an allergy pill. The Veteran denied chest pain or shortness of breath and also complained that he had nightmares about war. The Veteran denied any suicidal ideation. The Veteran stated he was watching his diet and joined a senior citizen recreation club where he exercised and reported losing eight pounds. In August 2013, the Veteran presented complaining of left sided chest pain that started while cooking. The Veteran noted that he exercised regularly and could walk 0.8 miles and never experienced chest pain with exertion. An exercise stress test in March 2013 was noted to have not achieved max target heart rate due to betablocker, but no chest pain or ischemic changes were found. The Veteran was found to have atypical chest pain and was discharged the following day after a chest x-ray and EKG. August 2013 VA Treatment Record. A September 2013 mental health treatment record indicates the Veteran had been suffering from depressive symptoms since returning from Vietnam that were worsening over the previous five years due to what the Veteran perceived as debilitating health problems. The Veteran denied thoughts of killing himself but continued to have frequent thoughts of life not being worth living. He endorsed nightmares, hypervigilance, exaggerated startle response, and feeling cut off from others. He also had some irritability at times. The Veteran again stated he liked to go to the gym and walked for fitness. The Veteran endorsed smoked marijuana nearly every day until he stopped approximately 15 years prior. The Veteran also stated he began using crack approximately 20 years prior and that on average uses about once every 4 to 6 weeks. The Veteran additionally reported getting fired for having alcohol on his breath 15 years ago after he refused to undergo a requested urine drug screen. The Veteran was nonetheless rehired three months later. The Veteran reported drinking rarely at the time. September 2013 VA Treatment Record. The Veteran stated he worked for American Airlines for 30 years before his retirement in November 2012 where he had ascended to crew chief level. Id. The September 2013 provider indicated that the Veteran had little formal mental health history and appeared to have had chronic trauma symptoms including some depression since Vietnam that have been exacerbated in last 5 years by health problems. Id. Underlying maladaptive personality traits may also have been exacerbating his symptoms as indicated by drug use as well as tendency towards rigid thinking and dramatic statements. However, the provider indicated the Veteran had maintained long term employment and marriage, suggesting some good coping skills given chronicity of symptoms. The Veteran's prognosis was fair though it was unclear if substance use was directly contributing to symptoms and that it may impede recovery. The provider stated that factors favoring recovery include history of sustained employment and marriage, intact cognition, and supportive spouse. Id. A December 2013 mental health treatment record indicates the Veteran appeared to be struggling with phase of life change since retirement and ongoing depressive symptoms. The Veteran reported that he had disturbing nightmares of late, generally about people dying, sometimes violently, and he cited this as his primary problem. December 2013 VA Treatment Record. The provider indicated the Veteran did not endorse the full range of PTSD symptoms at the time and diagnostic clarification was more likely with repeated visits. The Veteran reported retiring after 33 years not due to medical disability, but rather due to stress. Id. Since then, the Veteran described that he does not have much shape to his life, so wonders what the reason to stay around is. Id. The Veteran indicated some substance use (marijuana, cocaine, alcohol), but the provider indicated it did not appear to rise to abuse level at the time. Veteran also described he would go to the senior gym occasionally but not on a regular basis. Id. The Veteran reported traveling to visit family members in other states, both alone and with his wife. The Veteran used his retirement flight benefits and did not describe particular anxiety in travelling or being around crowds, or with unknown others, or with being enclosed in plane. Id. The Veteran also reported having lots of friends and talked about volunteering. Id. Treatment options were discussed with the Veteran to include working with a psychiatrist to assist with sleep medication and depressive symptoms. Id. The provider indicated there was no acute distress during this contact and no endorsed suicidal or homicidal ideation. The Veteran did not endorse any psychotic symptoms and appeared fully oriented to setting. Id. In January 2014, the Veteran reported feeling depressed, angry and irritable especially after having arguments with his wife wherein he reported that they do not get along well. January 2014 VA Treatment Record. The Veteran was previously started on prazosin for nightmares which he never started, and he hadn't been on any medicine for his mood. Id. Treatment options were discussed, and the Veteran was started on Zoloft for his mood symptoms. Id. A January 2014 VA examination regarding the Veteran's hypertension found that the Veteran's hypertension did not impact the Veteran's ability to work. A January 2014 examination regarding the Veteran's bilateral lower extremity diabetic neuropathy indicates the Veteran reported having pain in his hamstrings and lower legs. Upon examination, the Veteran was found to have mild pain, mild intermittent pain, and mild numbness in his bilateral lower extremities. January 2014 VA Examination. The Veteran's strength testing and deep tendon reflexes were normal. The Veteran had decreased light touch testing in his feet and toes. Id. The examiner found mild incomplete paralysis of the femoral and sciatic nerves. Id. Regarding functional impact, the examiner found that the Veteran's diabetic peripheral neuropathy also did not impact his ability to work. Id. A February 2014 mental health treatment record indicates the Veteran reported no significant improvement in his mood and that he was partially compliant with medicine. The Veteran reported feeling depressed, angry, and irritable especially after he had arguments with his wife. February 2014 VA Treatment Record. Psychoeducation was undertaken wherein the importance of treatment was explained. Id. The Veteran denied suicidal or homicidal ideation and denied experiencing any hallucinations. Id. A March 2014 VA examination diagnosed the Veteran with PTSD. The Veteran was found to have distressing dreams and intrusive thoughts, avoidance, persistent negative thoughts about the military, and hyperarousal symptoms of hypervigilance and exaggerated startle response. March 2014 VA Examination. The examiner stated that overall, the Veteran's PTSD symptoms were minimal, particularly those related to persistent negative thoughts and emotions. Id. The Veteran was also found to have major depressive disorder which accounted for depressed mood, worthlessness, and low energy. The examiner noted that the Veteran's physical conditions, to include diabetes, hypertension, hypercholesterolemia, and heart disease, as well as the associated need to take more medication than others his age, contributed to his depressive disorder. Id. The Veteran was also noted to have sleep disturbance associated with PTSD and his depressive disorder. Id. The Veteran stated during the exam that he enjoyed swimming, that he worked out at a senior gym periodically, and that he enjoyed riding bikes with his grandson in the summer. Id. The Veteran reported he retired from American Airlines in 2012 at the request of his wife and others. He described himself as not easy to get along with and related an instance in which a crew chief hit him on the head after he had turned his back. Id. The Veteran estimated that the onset of his psychologic symptoms began in Vietnam and that he has visited a psychiatrist every two months for medications and indicates he was not feeling significantly different. Id. The Veteran's substance abuse history was also noted. The Veteran stated he drank most heavily while working for the airline and again recounted that he lost his job due to insubordination for refusal to have urinalysis. Id. The Veteran reported smoking marijuana in Vietnam and smoking crack cocaine. Id. The examiner noted no problems with balance or gait and that the Veteran was pleasant and cooperative with all tasks. The Veteran's mood was anxious and dysphoric with mood-congruent affect. The Veteran's thought content and processes were intact with no hallucinations or delusions. The Veteran additionally denied suicidal ideation on the day of the exam, but the Veteran nonetheless stated that he thought about it often. Id. The Veteran stated he had never attempted suicide. The examiner summarized the Veteran's level of impairment as due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Id. An April 2014 mental health treatment indicates the Veteran again reported no significant improvement in his mood and complained of feeling depressed. The Veteran stated he was planning of volunteering somewhere to keep himself busy and that his wife tells him to get out and stop watching television. The Veteran was encouraged to become compliant with medication and to keep himself occupied. The Veteran was continued on Zoloft for mood symptoms. A December 2014 record indicates the Veteran was stable, had a steady gait, and was alert and oriented times four. A February 2015 record indicates the Veteran reported pain in his right arm and neck and that he denied any gait problems, chest pain, or shortness of breath. In a follow up appointment for right arm pain, the Veteran again reported having no difficulty with gait. The Veteran was found to have no weakness in his lower extremities and that he ambulates with a stable non spastic gait without assistance. February 2015 VA Treatment Record. A May 2015 mental health note states that the Veteran was non-compliant with medication. The Veteran reported doing fairly well and that his mood had been stable for the most. He denied feeling depressed, angry or irritable and that he stayed home most of the time. The Veteran stated he was planning to go out and look for some activities to keep himself busy. In November 2015, the Veteran again reported that he was doing fairly well and that his mood was stable for the most part. The Veteran reported feeling lonely and that he was thinking of finding some volunteer work. November 2015 VA Treatment Record. An October 2016 mental health note indicates the Veteran reported doing okay. The Veteran nonetheless continued to endorse depression and reported he missed working. The Veteran inquired if the provider could give him a letter stating that he cannot work due to depression. The Veteran denied suicidal/homicidal ideation and had no psychosis except for feeling like there is a shadow on the left side of his shoulder when nothing is there. The Veteran was observed to have a steady gait and was alert and oriented times four, non-delusional, and with goal directed thinking. October 2016 VA Treatment Record. In January 2017, the Veteran reported experiencing periodic nocturnal leg cramping. The Veteran underwent a normal non-invasive vascular exam with no symptoms of LE ischemia with exercise or at rest. The provider indicated there was no indication for further vascular workup or follow up and to reconsult as needed. The Veteran was advised to walk for 30 minutes 3 to 5 times per week and to work on tobacco cessation. January 2017 VA Medical Treatment Record. The Veteran reported not doing well in a February 2017 mental health treatment note. The Veteran mentioned the current state of politics and recent deaths in his family. The Veteran's shrinking family made him sad and sometimes he wondered "why he was here." The Veteran continued to have some issues with energy, motivation, and sleep. The Veteran was otherwise noted to be pleasant cooperative and reactive. February 2017 VA Treatment Record. The Veteran was again observed to have a steady gait and was alert and oriented times four. The Veteran was non-delusional, with goal directed thinking and found to have no suicidal or homicidal ideation. Id. An April 2017 mental health note states that the Veteran was jovial and reported doing alright. The Veteran's sleep was good overall and he took medication on a regular basis. The Veteran denied any suicidal or homicidal ideation or psychosis. The Veteran had no major concerns and was otherwise pleasant and cooperative and reactive. Id. The Veteran again reported doing fine in a September 2017 mental health note. The Veteran talked about the world being screwed up and thinking that God is on his way back. The Veteran reported trouble falling asleep and feeling fatigued during the daytime. The Veteran was not interested in doing anything, but stated he eventually enjoyed things his wife otherwise forced him to do. September 2017 VA Treatment Record. The Veteran denied suicidal and homicidal ideation. The Veteran nonetheless talked about passive thoughts of what it would be like to die, as he had lost his parents and several siblings, but the provider indicated it was not in the context of self-harm. The Veteran stated he wants to live long enough to see "flying cars." Id. A December 2017 mental health note indicates the Veteran reported feeling blessed as he made some changes in his life and that the only thing that matters is God. The Veteran continued to report some depression as he felt sad about people never calling him and that he felt empty and not needed. The Veteran stated he was trying to find his place again and may start volunteering with Meals on Wheels. December 2017 VA Treatment Record. The Veteran reported doing well in a March 2018 mental health note and that he felt blessed to wake up each morning. The Veteran's only regular activity was going to church on Sundays, and he reported that he enjoyed spending time with friends and family and his wife of over 40 years. The Veteran planned on getting back into fishing soon and noted that while he sometimes felt down, his religious faith keeps him upbeat. The Veteran denied suicidal/homicidal ideation and denied any alcohol or illicit drug use. March 2018 VA Treatment Record. A September 2018 mental health note indicates the Veteran's mood remained mildly depressed. The Veteran reported that he had been doing alright though fell into a deep depression while watching politics the day prior. The Veteran noted he was miserable in his marriage and the only thing he does enjoy with his wife was taking family trips. They were considering taking a trip to Northern Ireland. Therapy treatment was discussed with Veteran to which he responded that he goes to church twice per week for service and Bible study classes and that he is not keen on coming to VA weekly as well. The Veteran denied suicidal/homicidal ideation. The Veteran stated he had never felt he would be better off dead because each morning he wakes things could be different. No alcohol or illicit drug use was reported. The provider stated the Veteran's depression is closely related to marital problems that could likely benefit from psychotherapeutic intervention to which the Veteran declined. September 2018 VA Treatment Record. The Veteran reported doing well in a December 2018 mental health record. The Veteran's mood was reportedly okay though he gets a little bit down occasionally. He stated he and his family enjoyed their trip to Ireland as he had a better time than expected. The Veteran denied suicidal/homicidal ideation stating that he had found a purpose in life by caring for his ailing brother. The Veteran did report visual hallucinations in his periphery seeing things at a glance with nothing there. The Veteran stated this was his mind playing tricks on him and had been happening for a couple of years. The Veteran denied audio hallucinations. December 2018 VA Treatment Record. The provider indicated that the Veteran was not currently taking any psychotropic medications and that his mood was overall stable, with mild intermittent depression. The provider indicated the Veteran was managing well via regular churchgoing and strong faith; he also felt purposeful helping his ill brother. The Veteran was counseled on smoking cessation; however, he was still in pre-contemplative stage of change. Id. A March 2019 pulmonary consult indicates the Veteran was referred for workup of abnormal lung imaging. The Veteran denied any dyspnea, cough, weight loss, or fatigue. The Veteran was noted to be able to do household chores, ADLs, and yard work without any dyspnea. The Veteran also denied any weakness, foot drop, or leg swelling in his extremities. March 2019 VA Treatment Record. The Veteran was assessed with a 2.9cm lesion in the right lower lobe concerning for malignancy. Id. The Veteran also submitted a July 2023 private psychological evaluation in support of his claim. The Veteran stated that he recalled developing PTSD symptoms soon after his return from military service. The Veteran reported he continued to have PTSD symptoms such as talking to himself, insomnia, nightmares, irritability, and anger. The Veteran stated that the symptoms greatly affected his ability to keep a job and that his wife eventually asked him to stop working due to stress. The Veteran's spouse reported that the Veteran experienced much anxiety and was angered easily. She further reported the Veteran's current counseling does not help his symptoms and that he can no longer volunteer because he cannot stand long enough to do that type of activity. At this time, the Veteran was noted to use a walker and could barely get from the bedroom to the kitchen. July 2023 Psychological Evaluation. The Veteran's spouse further stated that the Veteran required help in all activities of daily living due to his PTSD and peripheral neuropathy disabilities. The Veteran needed help with medication compliance, dressing, showering, toileting, and had to be watched 24 hours per day. Id. The July 2023 evaluation found the Veteran began to suffer PTSD symptoms such as depression, anxiety, irritability, nightmares, insomnia, and chronic suicidal ideations soon after military service. The evaluation states that the Veteran's PTSD symptoms worsened in 2013 as he was noted to have suicidal thoughts with a plan to stop his medications so that he would die from his ailments, or he would provoke his own murder. The record documents that the Veteran was experiencing hypervigilance, exaggerated startles response, flashbacks, irritability, and occasional hallucinatory experience in 2013. The July 2023 evaluation disagreed with the March 2014 VA examiner's summary that the Veteran's condition was productive of mild or transient symptoms pointing to the Veteran's symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, and mild memory loss which were noted in the same examination. Id. The July 2023 evaluation stated the March 2014 VA exam was also not consistent with the other mental health documentation before and after the exam which are reflective of more severe symptoms. The July 2023 evaluation opined that the Veteran's PTSD symptoms were severe and caused significant occupational impairment since November 2012, to include irritability, isolative behavior, ongoing substance abuse, suicidal thoughts, and hallucinations. Memory and concentration difficulties and his inability to maintain appropriate consistent relationships in the workplace were also found to further impair his ability to work. The July 2023 evaluation opined that the Veteran's PTSD is severe enough to prohibit the Veteran from working in any occupation but that his CAD, diabetes, and peripheral neuropathy render the Veteran totally disabled. The evaluation stated that due to the Veteran's medical and psychiatric symptoms, he has required extensive assistance with activities of daily living and mobility. The evaluation concluded that the Veteran's symptoms including PTSD, CAD, hypertension, and peripheral neuropathy became so severe that he was no longer able to work as of 2012. July 2023 Psychological Evaluation. The Veteran also provided a July 2023 Vocational Assessment Report in support of his claim. The 2023 report opined that the Veteran was unable to satisfy standards of pace, productivity, reliability, and interpersonal workplace communication due to symptoms associated with the Veteran's PTSD with major depressive disorder since at least November 2012. Specifically, the report noted that the Veteran's anxiety attacks, suspiciousness, hypervigilance, and intrusive thoughts were distracting and render him off task and unproductive. Additionally, the Veteran also suffered from depressed mood, a tendency to isolate, as well as anger and irritability, which impeded his ability to appropriately interact with the general public, coworkers, and supervisors. The report opined that the Veteran had concentration and memory impairments which impaired his ability to complete tasks efficiently and without errors. The Veteran's impaired sleep further exacerbated his already impaired concentration, leading to additional time off task. The report outlined the evidence above from March 2013 to December 2018 as well as the July 2023 psychological evaluation. The July 2023 report also indicated that the Veteran's limitations as a result of his coronary artery disease renders the Veteran unable to meet the physical requirements of the sedentary exertional level on a consistent and reliable basis since at least November 2012. The report states the Veteran's CAD resulted in dyspnea, dizziness, and fatigue with nominal physical activity and significant limitations in standing and walking for prolonged periods. The report additionally opined that the Veteran's CAD symptoms would be distracting to an extent that it would necessitate unscheduled breaks to rest and recover and would compromise the ability to sustain concentration for two consecutive hours. The report additionally opined that the Veteran's peripheral neuropathy of the lower extremities and diabetes mellitus type II with hypertension resulted in limitations in standing and walking for prolonged periods, due to bilateral lower extremity symptoms; instability; daytime fatigue due to compromised sleep and fluctuations in blood glucose and blood pressure levels; frequent urination; and the inability to maintain concentration, focus, and pace as a result of distracting pain, numbness, fatigue, and the need to frequently alter his position. The report indicated it disagreed with the January 2014 VA examination that determined the Veteran's diabetic peripheral neuropathy did not impact the Veteran's ability to work due to the symptoms outlined above. The report points to a February 2008 record indicating that his hypertension was poorly controlled and that he had chest discomfort after becoming angry with a coworker. The report also pointed to the Veteran's 2023 vocational interview wherein the Veteran noted he had sharp pains in his legs all the time and that he experienced discomfort when seated for extended periods leading to his position needing to be frequently alternated. The Veteran also reported an inability to walk or stand for prolonged periods and endorsed a fall history. July 2023 Vocational Assessment Report. The vocational report also opined the limitations and symptoms as a result of the Veteran's diabetes mellitus type II with hypertension, since at least November 2012, included the inability to maintain concentration focus and pace as a result of fatigue subsequent to fluctuations in blood glucose and blood pressure levels and intermittent sleep. The report cited the Veteran's 2023 vocational interview wherein the Veteran reported frequent urges to urinate throughout the day, nocturia, fatigue, and fluctuations in blood glucose and blood pressure levels that has impacted his sleep. The report concluded that although the Veteran had a long career with the airlines that spanned decades, the Veteran's history showed it was fraught with conflicts regarding his substance abuse, and ultimately, he was forced to retire due to his stress levels. Regardless of the Veteran's education and work history, the report concluded that the overall impact of the Veteran's service-connected condition of PTSD with MDD, CAD, diabetes with hypertension, and bilateral lower extremity peripheral neuropathy have caused such a negative vocational impact that the Veteran has been unable to secure or follow substantially gainful employment in any occupation, regardless of skill level, since at least November 2012 onward. In reviewing all the medical evidence, to include the July 2023 psychological evaluation and vocational report, the Board has considered the physical ability factors noted in Ray, to include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. See Ray, 31 Vet. App. at 58. During the period on appeal prior to March 6, 2019, the evidence indicates that the Veteran experienced pain and numbness in his lower extremities due to his service-connected neuropathies as well as fatigue with heavy exertion due to his service-connected heart disability. The record prior to March 6, 2019, however, also consistently indicates the Veteran had no gait issues. Soon after his retirement, the Veteran consistently reported exercising in 2013, and specifically reported he could walk .8 mile without chest pain. Furthermore, in January 2017 after complaining of nocturnal leg cramping, upon evaluation the Veteran was nonetheless advised to walk for 30 minutes 3 to 5 times per week. Furthermore, in March 2019, the Veteran denied any dyspnea or fatigue and that he was able to do household chores, ADLs, and yard work without any dyspnea. In short, the medical evidence of record indicates that the Veteran's physical disabilities would preclude labor-intensive work, but not sedentary work. In Withers v. Wilkie, the Court noted that 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. Here, the Veteran's education, training, and work history demonstrated that he has the capacity to engage in sedentary occupations such as insurance sales and serving as a supervisor, which primarily involve activities such as sitting at a desk and using a computer or performing administrative work. The Board acknowledges the July 2023 vocational report opines to the contrary but finds the contemporaneous medical evidence of record outlined above, to include the VA examinations of record determining that the Veteran's disabilities did not impact his ability to work, to be more probative. In particular, the July 2023 vocational report disagreed with the VA examinations of record principally based on the vocational interview wherein the Veteran described more severe symptomatology. While the severity of the Veteran's symptomatology became more severe after the current period on appeal, to include at the time of the Veteran's July 2023 interview, the Veteran's symptomatology as reflected in the contemporaneous medical evidence of record prior to March 6, 2019, does not suggest the Veteran was incapable of sedentary work. Indeed, as late as March 2019, the Veteran denied experiencing any dyspnea or fatigue and that he was able to do household chores, ADLs, and yard work without any dyspnea. While treatment records from September 2013 to March 2019 reflect his diagnosis of diabetes mellitus type II with hypertension, there is no indication that such disabilities were not well controlled during this time or impacted his ability to work. See, e.g., March 2013, December 2014, August 2017, August 2018, and February 2019 VA Treatment Records. The Board also considered the mental ability factors noted in Ray, to include memory, concentration, ability to adapt to change, handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. See Ray, 31 Vet. App. at 58. The medical evidence of record prior to March 6, 2019, demonstrates that the Veteran's PTSD and major depressive disorder would certainly affect the Veteran's memory, concentration, ability to handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. As to the ultimate functional impact of the Veteran's mental health diagnoses, the Board acknowledges that the March 2014 PTSD VA examination and the July 2023 psychological evaluation reached differing conclusions as to the functional impact of the Veteran's psychological disability at that time. The July 2023 psychological evaluation ultimately opining that the Veteran's psychological disability rendered him unemployable since November 2012. The Board notes that entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a veteran may "secure and follow a substantially gainful occupation" based on all evidence of record. See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019). Further, it is within the purview of the Board to evaluate the medical evidence and favor one medical opinion over another. See D'Aries v. Peake, 22 Vet. App. 97, 107 (2008); see also Guerrieri v. Brown, 4 Vet. App. 467, 471 (1993) (explaining that "the credibility and weight to be attached to these opinions... is, in the first instance, within the province of the adjudicators"). Here, the Board finds the March 2014 VA examination more persuasive as to the functional impact of the Veteran's psychological disability at the time of that examination. The Board disagrees with the July 2023 evaluation's opinion that the medical evidence of record both prior to and after the March 2014 VA examination is inconsistent to that found within the VA examination. Indeed, the July 2023 evaluation correctly notes that the March 2014 VA examination expressly listed the very symptomatology to which the July 2023 evaluation considers to be more productive of an increased severity of PTSD symptoms to include depression, anxiety, irritability, hypervigilance, exaggerated startle response, persistent negative thoughts, substance abuse, and some suicidal ideation. Furthermore, a prior September 2013 treatment record also considered the Veteran's depression, anxiety, substance abuse, and thoughts of life not being worth living. Upon evaluation, the September 2013 provider stated the Veteran had nonetheless maintained long term employment and marriage, suggesting some good coping skills given chronicity of symptoms. The provider indicated that the Veteran's prognosis was fair though it was unclear if substance use was directly contributing to symptoms and that it may impede recovery. The provider stated that factors favoring recovery include history of sustained employment and marriage, intact cognition, and a supportive spouse. A subsequent May 2015 record also indicates the Veteran reported doing fairly well with a stable mood and denied feeling depressed, angry, or irritable. The Board also finds significant that the July 2023 psychological evaluation expressly found that the Veteran's PTSD symptoms such as depression, anxiety, irritability, nightmares, insomnia, and chronic suicidal ideations began soon after the Veteran completed his military service in 1971, and the Veteran nonetheless worked for over thirty years with one company before retiring in November 2012. The Board acknowledges the reported incidents with substance abuse and coworkers during this timeframe, but the Veteran nonetheless advanced withing the company holding the positions of fleet service worker, crew coordinator, and crew chief prior to retiring in November 2012. The Board further notes that additional medical evidence of record indicates the Veteran reported doing well with no corresponding change in his diagnoses during a multitude of mental health visits during the period on appeal. See May 2015, November 2015, October 2016, April 2017, December 2017, March 2018, and December 2018 VA Treatment Records. Indeed, the Veteran enjoyed spending time and taking trips with his family and caring for his ailing brother as recently as December 2018 which is suggestive of the ability to adapt to change and getting along with others. Based on the foregoing, the Board finds that the evidence does not indicate that the Veteran is unemployable because of his service-connected disabilities alone or in combination such that TDIU is warranted prior to March 6, 2019. The Veteran would clearly not have been able to engage in work requiring heavy exertion due to his service-connected disabilities, but it does not appear that an insurance sales position or a supervisor position for which he had the education, training, skills, and work history would be precluded by his service-connected disabilities. The Board acknowledges that the Veteran's physical and mental service-connected disabilities would certainly cause some functional impairments. However, the Board finds the impairing effects caused by the Veteran's service-connected disabilities are contemplated and compensated by the disability ratings afforded those conditions. As such, entitlement to TDIU is not warranted. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Knopp, Derek A. 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.