Citation Nr: A25041254 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 240915-473470 DATE: May 6, 2025 ORDER Entitlement to service connection for asthma is denied. Entitlement to an increased rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to an increased rating in excess of 30 percent for migraines is denied. Entitlement to an increased rating in excess of 20 percent for seizures is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran does not have diagnosed asthma that was incurred in or due to his time in service. 2. The Veteran's PTSD is not manifested by total occupational and social impairment. 3. The Veteran's headaches are not manifested by frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. The Veteran's seizure disorder is not manifested by least 1 major seizure in the past 6 months or 2 in the last year; or averaging at least 5-8 minor seizures weekly 5. The most probative evidence of record indicates the Veteran is still gainfully employed. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for asthma have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.010. 2. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411. 3. The criteria for rating in excess of 30 percent for a migraine disability have not been met. 38 U.S.C. §§ 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.85, 4.130, DC 8100. 4. The criteria for entitlement to a rating in excess of 20 percent for a seizure disability have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.124a, DC 8910. 5. 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, 4.3, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 2007 to November 2011. These matters are on appeal from October and December 2023 rating decisions by a Department of Veterans Affairs (VA) regional office (RO). In the September 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the October and December 2023 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. As a preliminary matter, the Board notes in his September 2024 Form 10182, the Veteran appealed residuals of a TBI from the October 2023 rating decision. However, the October 2023 rating decision deferred a decision on that matter and was not a final, appealable decision. Therefore, this matter will not be addressed in this decision. Additionally, the Veteran appealed issues stemming from a January 2023 rating decision, including increased rating for migraines and scars. In this case, the Veteran's increased rating for migraines claim was addressed in the October 2023 rating decision. Thus, this matter will be addressed in this decision. However, the matter of a compensable rating for scars from the January 2023 rating decision will not be addressed since the September 2024 Form 10182 was not timely filed as to the January 2023 rating decision. Service Connection Claim Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service connection can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. For chronic diseases shown as such in service or within the applicable presumptive period, subsequent manifestations of the same chronic disease at any later date are service connected unless attributable to an intercurrent cause. 38 C.F.R. § 3.303 (b). For a chronic disease to be considered to have been "shown in service," there must be a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. When the condition noted in service or within the presumptive period is not a chronic disease, a showing of continuity of symptomatology after discharge is required. Id. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, also known as the Honoring our PACT Act of 2022 (hereinafter referred to as the PACT Act), which expands VA health care and benefits for Veterans exposed to burn pits or other toxic substances during military service. As it pertains to this case, the PACT Act lists several diseases or illnesses that can be considered presumptively service-connected if a Veteran was exposed to burn pits or other toxic substances during the Vietnam, Gulf War, and post 9/11 eras. Veterans who were exposed to burn pits or toxic substances specifically during the Gulf War and post 9/11 eras are eligible for presumptive service connection if they have a current disability diagnosed as brain cancer, glioblastoma, respiratory cancer of any type, gastrointestinal cancer of any type, head cancer of any type, lymphoma of any type, lymphatic cancer of any type, neck cancer, pancreatic cancer, reproductive cancer of any type, kidney cancer, melanoma, asthma (diagnosed after service), chronic rhinitis, chronic sinusitis, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease (ILD), pleuritis, pulmonary fibrosis, sarcoidosis, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). See Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Pub. L. 117-168, 136 Stat. 1759 (2022). The Veteran contends he has asthma that was incurred in or due to his time in service. The Veteran has not been diagnosed with asthma. The Veteran's military personnel records indicate he had qualifying service in Southwest Asia, including in Iraq and Afghanistan. However, the Veteran's service treatment records (STRs) do not indicate he had ongoing complaints of or treatment for asthma or breathing problems while in service. Indeed, in a September 2009 post-deployment health assessment, the Veteran said his health was good and denied coughing lasting more than three weeks and trouble breathing and in a September 2011 examination, the Veteran denied asthma or any breathing problems. The Veteran was scheduled for an examination for his asthma in December 2023. However, the Veteran did not appear for his examination and did not offer any good cause for his absence. Under 38 C.F.R. § 3.655 (a), when entitlement to a benefit cannot be established without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination or reexamination, action shall be taken in accordance with 38 C.F.R. § 3.655 (b) or (c) as appropriate. Title 38 C.F.R. § 3.655 (b) applies to original or reopened claims or claims for increase, while 38 C.F.R. § 3.655 (c) applies to running awards, when the issue is continuing entitlement. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. Therefore, there is no objective evidence indicating it is at least as likely as not the Veteran's asthma was due to his time in service. In addition to there being no medical evidence indicating a link between asthma and his time in service, the Veteran's record does not indicate he has been diagnosed with asthma. The Board has carefully and sympathetically reviewed the Veteran's entire file, including his medical treatment records. While it was noted in records that the Veteran was prescribed albuterol for breathing, an objective diagnosis of asthma was not made. (See e.g. September 2023 treatment records.) Additionally, the record does not indicate an objective diagnosis of asthma. Indeed, several records explicitly indicate the Veteran does not have asthma. (See e.g. May 2017, November 2017 treatment records.) Thus, even with qualifying service for presumptive service connection, service connection cannot be granted on any basis without a current diagnosis of the claimed disability. In this case, while the Veteran asserts he has asthma, the Veteran is a lay person and not competent to say he has this diagnosed medical condition. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). For these many reasons, the claim is denied. In this regard, it is important for the Veteran to understand that filing a claim for a disability in which the existence of the problem is not seen undermines his credibility with the Board regarding all claims. Increased Rating Claims Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Veteran. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). PTSD Claim The Veteran contends his PTSD is worse than indicated by his 70 percent rating. The Veteran's PTSD is rated under DC 9411. Under DC 9411, a 70 percent rating is prescribed when there is evidence of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. Important for this case, a 100 percent rating is prescribed when there is evidence of total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations, grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation as to time or place; and memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Veteran. App. 436, 442-3 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). Regarding the ameliorative effect of medication on the Veteran's disability, the United States Court of Appeals for Veterans Claims (Court) has held that the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shineski, 26 Vet. App. 56, 63 (2012). Conversely, if the diagnostic code (DC) does specifically contemplate the effects of medication, then Jones is inapplicable. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016). The Board notes that the plain language of the criteria for noncompensable and 10 percent ratings under the General Rating Formula for Mental Disorders specifically contemplate the effects of medication. See 38 C.F.R. § 4.130, DC 9411. Consequently, the Board's evaluation of the Veteran's PTSD may include the ameliorative effects of medication. See Jones, 26 Vet. App. 56, 63 (2012); McCarroll, 28 Vet. App. 267, 271-73 (2016). The Veteran had an examination for his PTSD in September 2023. The examiner saw the Veteran via video call. The Veteran said he was frustrated with his hearing and his seizures and migraines contributed to fatigue and leading him to feel down and defeated. The examiner said it was not possible to differentiate which symptoms were attributed to his TBI and his PTSD. The examiner opined the Veteran's PTSD led to occupational and social impairment with reduced reliability and productivity. The Veteran reported he had been married for about three years with two sons. The Veteran reported he had worked as a carpenter until June 2023 and left that position prior to moving and was now working as an auto technician. The Veteran had been at his job for approximately two months and reported work had been "okay." The Veteran reported past hospitalizations for suicide attempts and was current in mental health treatment, attending monthly sessions. The Veteran reported being on medication but that he was not currently consuming alcohol. The examiner indicated the Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood. The Veteran said he previously downplayed his symptoms. The Veteran reported difficulty getting and keeping jobs, avoids others due to prior issues with aggression, and said he continued to have nightmares. The Board has reviewed the remainder of the Veteran's file, including his medical treatment records. The Veteran has consistently been found to be oriented, with fluent speech, intact comprehension, logical and linear thoughts, coherent speech, with no hallucinations, delusions, suicidal or homicidal ideations. The Veteran has been consistently found to have fair insight and judgment with his memory grossly intact with adequate grooming and hygiene. (See e.g. October 2022, December 2022, January 2023, June 2023, September 2023 treatment records.) In terms of his occupational impairment, the Board notes the Veteran is still working and is still employed full-time. While the Veteran indicated difficulty finding and holding on to jobs, he worked previously as a carpenter and is now reported to be working as an auto technician, indicating that while he had difficulty, he was able to still find and hold a job, showing that he was not totally occupationally impaired due to his mental health. In terms of his social impairment, the Veteran remains married and has three children. The Veteran did report avoiding others and keeping to himself, but there is no indication in the file the Veteran has family trouble or is no longer getting along with his spouse or children, showing the Veteran is not totally social impaired. In this regard, it is important for the Veteran to understand that his own prior statements regarding the nature of the disorder do not support a higher rating. The Veteran must understand that a 70% disability rating will cause the Veteran many problems. In this case, as discussed above, the Veteran has been found to not have trouble with his speech, thoughts, and did not have any problems with his hygiene. The Board finds in this case the Veteran's symptoms such as depressed mood, anxiety, sleep impairment, and disturbances of motivation and mood do not arise to the level of severity warranting a 100 percent rating. The Veteran's symptoms do not include symptoms approximating gross impairment in thought processes or communication; persistent delusions or hallucinations, grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation as to time or place or severe memory loss. While the Veteran reported in his most recent examination that he previously downplayed his symptoms, neither the Veteran nor the examiner in the most recent examination indicated the Veteran has symptoms severe enough to warrant a higher rating. Indeed, the examiner even found the overall impact of the Veteran's PTSD symptoms was less severe than those warranting his current 70 percent rating. Thus, the Board does not find a higher 100 percent rating is warranted and the claim is denied. Migraine Claim The Veteran contends his migraines are worse than indicated by his 30 percent rating. The Veteran's migraines are rated under DC 8100. Under DC 8100, a noncompensable rating is warranted for headaches with less frequent attacks. A 10 percent disability rating is warranted for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on average once a month over the last several months. A 50 percent disability rating is warranted for headaches with frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. The rating criteria for the maximum 50 percent rating contains several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson v. Wilkie, 30 Vet. App. 245, 253 (2018). The phrase "completely prostrating" in the 50 percent rating criteria generally means the migraine attack must render the veteran entirely powerless. Id. The completely prostrating attacks in the 50 percent rating criteria must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and regarding severe economic inadaptability, nothing in DC 8100 requires the claimant be completely unable to work to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). In rating headaches or migraines under DC 8100, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) ("[a]bsent a clear statement [in the diagnostic code] setting out whether or how the Board should address the effects of medication...the Board may not deny entitlement to a higher disability rating on the basis of relief provided by medication.") The Veteran had an examination for his headaches in November 2022. The examiner saw the Veteran via video call and reviewed his record. The Veteran reported his headaches had progressed over the years and reported mild to moderate headaches daily. The Veteran reported taking medication, including ibuprofen and Tylenol for his headache and described his pain as pulsating with pain on both sides of his head which was worse with physical activity. The Veteran also endorsed nausea and sensitivity to light and sound with headache pain lasting less than one day. The Veteran reported the headaches lasted from 30 minutes to all day and that sometimes, he had no choice but to lie down due to pain. The Veteran got migraines that severe once or twice every three months. The examiner found the Veteran had characteristic prostrating attacks of migraine/non-migraine headache pain once every month but did not have prostrating and prolonged attacks productive of severe economic inadaptability. The examiner did report the Veteran lost two to four weeks of work in the last 12 months due to his headaches and when the Veteran had a severe migraine, he was precluded from all activities. The Veteran had another examination for his headaches in August 2023. The examiner saw the Veteran via video call and reviewed his record. The Veteran reported his headaches were stable but that he still took over the counter pain medication for his headaches, having sensitivity to light. The Veteran said his headaches typically lasted less than one day. The examiner said the Veteran had prostrating attacks once in two months but did not have prolonged and prostrating attacks of migraine or non-migraine pain. The examiner said the Veteran lost zero to one week of work in the past 12 months due to his migraines and that while the migraines were debilitating at times, the Veteran was usually able to work through the migraines and said he actually did better if he stayed active. In an August 2023 TBI evaluation examination, the Veteran reported his headaches were debilitating at times, resulting in missed time from work. The Board has also reviewed the remainder of the Veteran's file, including his treatment records. However, those records do not show the Veteran suffers from frequent headaches that are completely prostrating and prolonged attacks productive of severe economic inadaptability. Similarly, while the Veteran's examinations show he clearly suffers from problems with headaches, the examiners opined the Veteran's headaches do not lead to completely prostrating and prolonged attacks productive of severe economic inadaptability, even when considering his statements about having to lie down and miss work and contemplating how much time the Veteran missed from work. The Board notes the Veteran's reported symptoms and that he reported in August 2023 that his headaches were debilitating at times, causing him to miss work. However, the evidence does not show the attacks were prolonged and the Veteran himself has said that his headaches are often better with activity and in his August 2023 examination, he also reported he is usually able to work through his migraines, though his ability to concentrate is decreased. Additionally, the Board has considered the statements from the Veteran that he took medication for his headaches. However, the Veteran did not report that the medication helped his symptoms, lessened them, or impacted the severity of his migraines in any way. The Board has not considered any potential ameliorative effects of the Veteran's headache medication in finding that his symptoms do not warrant a higher, 50 percent rating. In fact, it is important for the Veteran to understand that not all evidence in this file supports the current evaluations and, at some points, suggests pyramiding as some of the problems the Veteran is having (PTSD, TBI, seizures, and headaches) are similar in nature or cause similar problems. The record indicates that at some points, in support of one specific claim, he will cite a problem that is being compensated with another disability evaluation. Seizure Claim The Veteran contends his seizures are worse than indicated by their 20 percent rating. The Veteran's seizures are rated under DC 8910. Under DC 8910 for grand mal seizures is rated under the General Rating Formula for Major and Minor Epileptic Seizures. The General Rating Formula provides a 10 percent rating for a confirmed diagnosis of epilepsy with a history of seizures. A 20 percent rating is assigned for at least 1 major seizure in the last 2 years; or at least two minor seizures in the past 6 months. A 40 percent rating is assigned for at least 1 major seizure in the past 6 months or 2 in the last year; or averaging at least 5-8 minor seizures weekly. A 60 percent rating is assigned for averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week. An 80 percent rating is assigned for averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly. And a 100 percent rating is assigned for averaging at least 1 major seizure per month over the last year. 38 C.F.R. § 4.124a, DC 8910. A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness. DC 8911 Note (1). A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head ("pure" petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type). DC 8911 Note (2). When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy. 38 C.F.R. § 4.124a, DC 8910, Note (1). In the presence of major and minor seizures, rate the predominating type. 38 C.F.R. § 4.124a, DC 8910, Note (2). There will be no distinction between diurnal and nocturnal major seizures. 38 C.F.R. § 4.124a, DC 8910, Note (3). When, as here, the diagnostic code contemplates the effect of the medication, the disability is to be rated as the symptoms are with the medication. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016); see also Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) (discussing when the ameliorating effects of medication conversely may not be considered, i.e., when not expressly contemplated in the applicable diagnostic code). DC 8910 contemplates the effects of medication on the seizures, as evidenced by Note (1) that directly addresses situations when there are no symptoms, but medication is still needed. As such, there is no need for the Board, nor a clinician, to determine the condition's severity should the Veteran not take his medication. The Veteran had an examination for his seizures in November 2022. The examiner saw the Veteran via video call and reviewed his record. The Veteran reported he was taking Depakote for his seizures continuously but had not had any other treatment. The most recent seizure activity was in October 2022. The Veteran did not have minor seizures and had at least one major seizure in the past two years with an average of at least one in three months over the past year. The Veteran had not had minor psychomotor seizures but had a major psychomotor seizure at least two in the past year with the average frequency being at least one in three months over the past year. The Veteran had another examination for his seizures in August 2023. The examiner saw the Veteran via video call and reviewed his record. The Veteran's seizures were reported stable with medication. The Veteran's most recent seizure activity was in April 2023. The Veteran did not have minor seizures but did have major seizures at least one in the past two years with an average frequency of at least one in the past six months. The Veteran did not have minor or major psychomotor seizures. In an August 2023 TBI evaluation, the Veteran reported two or more seizures in the past six months. But the Veteran also reported seizures had been occurring infrequently. The Board has also reviewed the Veteran's treatment records. October 2022 records confirm the Veteran was seen for seizure follow up. The Veteran also reported he was having seizures once every few months. In August 2023, a record indicated he called for a seizure follow up but needed to establish care at the new neurology practice. In this case, the Board does not find a higher rating is warranted. While the August 2023 examiner noted the frequency of the Veteran's seizures was one in six months, the examiner noted the Veteran only had one major seizures in the past two years which is rated as 20 percent disabling. The Board finds that the most probative evidence of record does not indicate the Veteran suffers from seizures frequently or severe enough to warrant a higher rating. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). TDIU Claim The Court has held that a request for a total disability rating based on individual unemployability (TDIU), whether expressly raised by the Veteran or reasonably raised by the record, is not a separate "claim" for benefits, but rather, can be part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). The law provides that a total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). 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. 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 age or to the impairment caused by nonservice-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such a determination, 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). The fact that a veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361. Provided a veteran does not meet these minimum percentage rating requirements of § 4.16(a) for consideration of a TDIU, he may still be entitled to this benefit on an extra-schedular basis under § 4.16(b) if it is established he is indeed unemployable on account of his service-connected disabilities. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. If the record supports the claim, the Board must first forward the case to the Director of the Compensation Service for extraschedular consideration. The Board upon receipt of that determination is not bound to accept it, and may resolve the question of extraschedular entitlement of its own accord. See Wages v. McDonald, 27 Vet. App. 233, 236 (2015) (the findings of the Director of Compensation Service on extraschedular consideration are not evidence, but rather a decision of the AOJ reviewed de novo by the Board). The Board notes that, for a Veteran to prevail on a claim for TDIU on an extraschedular basis, it is necessary the record reflect some factor which places the case in a different category than other Veterans with an equal rating of disability. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie 31 Vet. App. 58, 73 (2019) directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. . In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. However, this difficulty due to his service-connected disabilities is not, in of itself, sufficient to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361, Ray, supra. The Veteran meets the schedular requirements for a TDIU and is service connected for PTSD, migraines, seizures, tinnitus, hearing loss, a TBI scar, and TBI residuals. However, the most probative evidence of record indicates the Veteran is still gainfully employed. In April 2019, the Veteran said he last worked full time in December 2018 and became too disabled to work in April 2015. The Veteran said he previously worked full time as a ground's keeper and at a truck service company. In July 2023, the Veteran said he last worked full time in May 2023, but that he relocated and walked away for health reasons. The Veteran has a high school education with special training at a trade school for welding and auto mechanics. The Veteran said he couldn't work anymore because he was a liability to his employer. However, in an August 2023 TBI evaluation, the Veteran reported he was working as an automotive technician and in a September 2023 PTSD examination, the Veteran reported he worked as a carpenter until June 2023 and left his position prior to moving to Florida and that he now worked as an automotive technician and had been in the position for approximately two months. While it is possible for a TDIU to be awarded if a Veteran is still working but is not gainfully employed and is making wages below the poverty line, there is no indication this is the situation for this Veteran. In this case, the Veteran reported working full time as a carpenter. He then said that he left employment due to his relocation and his service connected disabilities, but then subsequently reported employment as an automotive technician. There is no indication in the record that the Veteran is not still gainfully employed. Therefore, a TDIU is not warranted. Regarding the claims above, the Board acknowledges and has considered the Veteran's statements that his conditions bother him, that he has asthma due to his time in service, that his service connected disabilities are worse than indicated by their current ratings, and that he is entitled to a TDIU. However, while the Veteran is competent to report the symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as the nature, etiology, or severity of his complex medical conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, while the Board has carefully considered the Veteran's statements about his symptoms, these statements must be weighed against the objective evidence of record, which does not indicate the Veteran has asthma that warrants service connection, that his claimed disabilities are incorrectly rated, or that he warrants a TDIU. It is important for the Veteran to understand that these medical findings provide highly probative evidence against this claim that the Board cannot, unfortunately, ignore, outweighing the Veteran's beliefs that his conditions warrant service connection or higher ratings. This does not mean the Veteran's headaches, PTSD, and seizures do not bother him. Clearly, the Veteran continues to struggle with these conditions; the only question is the degree of severity. A high disability evaluation is a clear indication of VA's recognition of the many problems the Veteran is having with these disabilities. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Except as otherwise noted, because the evidence is not in approximate balance or nearly equal, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Snoparsky, 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.