Citation Nr: 1004565 Decision Date: 01/29/10 Archive Date: 02/16/10 DOCKET NO. 99-23 367 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for a left shoulder disorder, to include as secondary to injury due to use of crutches associated with status post bilateral bunionectomies with bilateral hammer toe and pes planus. 2. Entitlement to a total disability evaluation based upon unemployability (TDIU) due to service-connected disability. ATTORNEY FOR THE BOARD A. Hinton, Counsel INTRODUCTION The Veteran served on active duty from July 1976 to November 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi, which denied the benefits sought on appeal. The Veteran appealed as to an August 2001 rating decision denying entitlement to TDIU; and as to an April 2003 rating decision denying service connection for a left shoulder condition. In November 2003, the Veteran submitted a motion for reconsideration to the Board on several claims including with respect to service connection for a left shoulder disability; and to TDIU. In January 2004, the Board denied the Veteran's motion for reconsideration. In August 2003 and again in March 2005 the Board remanded the case with respect to other matters-other claims not before the Board at this time-requiring deferral of the TDIU claim. In September 2006 the Board in part remanded the two issues on appeal, for a statement of the case for the left shoulder claim, and deferral of the TDIU claim pending development on other claims. Lastly, in July 2008 the Board remanded the case in part for further development regarding the left shoulder claim, with deferral of the TDIU claim pending other ordered actions. FINDINGS OF FACT 1. The competent evidence is against a finding that: a left shoulder disorder was present in service; any current left shoulder disorder is related to service, or was caused by or aggravated by a service-connected disability; and that any left shoulder disorder constituting arthritis manifested itself to a compensable degree within a year following separation from active duty. 2. The Veteran's service-connected disabilities do not preclude him from obtaining and retaining all forms of substantially gainful employment consistent with his education and work experience. CONCLUSIONS OF LAW 1. A left shoulder disorder was not incurred in or aggravated during military service; is not proximately due to or the result of a service-connected disease or disability; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2009). 2. The criteria for entitlement to a TDIU due to service- connected disabilities have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.340, 3.341, 4.16(a)(b)(2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters The Veterans Claims Assistance Act of 2000 (VCAA), codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented at 38 C.F.R. § 3.159, amended VA's duties to notify and assist a claimant in developing the information and evidence necessary to substantiate a claim. Under 38 U.S.C.A. § 5103, VA must notify the claimant of any information or evidence not of record that is necessary to substantiate the claim, as well as what parts of that information or evidence VA will seek to provide, and what parts VA expects the claimant to provide. 38 C.F.R. § 3.159(b). VA must provide such notice to a claimant prior to an initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (AOJ), even if the adjudication occurred prior to the enactment of the VCAA. See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). VCAA requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all elements of a claim for service connection, so that VA must provide notice that a disability rating and an effective date will be assigned if service connection is awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Though notification to the Veteran may not have met all of the requirements of the VCAA and related case law, the matter decided below may be addressed at this time, without further remand, because no errors in notice are prejudicial, and the Veteran has been provided all information needed for a reasonable person to prove these claims. In any event, the Federal Circuit recently vacated the Court's previous decision in Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), concluding that generic notice in response to a claim for an increased rating is all that is required. See Vazquez- Flores v. Shinseki, No. 08-7150 (Fed. Cir. Sep. 4, 2009). VA notified the Veteran of the information and evidence needed to substantiate and complete a claim by way of a number of letters dated between March 2002 and January 2008. These documents in combination provided notice of what part of that evidence is to be provided by the claimant, and notice of what part VA will attempt to obtain. The RO informed the Veteran of the specific rating criteria which would provide a basis for the service connection and TDIU claims on appeal and decided below. The RO has provided adequate notice of how effective dates are assigned. The claim was subsequently readjudicated most recently in an October 2008 supplemental statement of the case. To the extent the appellant did not receive full notice prior to the initial decision, after pertinent notice was provided, the claimant was afforded a meaningful opportunity to participate in the adjudication of the claim on appeal. The claimant was provided the opportunity to present pertinent evidence. The record contains service treatment and personnel records, and records of medical treatment received privately and from VA, and VA examination reports. VA most recently examined the Veteran for compensation purposes in January and February 2007 addressing the unemployability issue, and in September 2008 addressing the left shoulder service connection claim. At those examinations the examiners specifically addressed the questions of employability and service connection, respectively. Findings from these examinations are adequate for the purposes of deciding the respective clams on appeal. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) Finally, a remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). In this regard, the Board is satisfied as to compliance with the instructions from its June 2008 remand. Specifically, the RO was instructed (1) to schedule the Veteran for an orthopedic examination of the left shoulder disability, (2) and readjudicate the claims for service connection for left shoulder disability and TDIU, to include whether forwarding of the TDIU claim to the Director, Compensation and Pension Service was warranted. The Board finds that the RO has complied with these instructions. Stegall, supra. In sum, there is no evidence of any VA error in notifying or assisting the appellant that reasonably affects the fairness of this adjudication. VA has fulfilled its duty to assist the claimant by obtaining identified and available evidence needed to substantiate the claims, and, as warranted by law. Significantly, the Veteran has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). II. Service Connection for Left Shoulder Disorder In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, there must be (1) medical evidence of 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 of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). In the absence of proof of a present disability, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Pain alone is not a disability for VA purposes. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). If a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If a condition noted during service is not shown to be chronic, or the fact of chronicity in service is not adequately supported, then a showing of continuity of symptomatology after discharge is required to support the claim. Id. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability, shown to be proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to 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); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). For cases in which a veteran served continuously for ninety (90) days or more during a period of war, or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of 10 percent within one year from date of termination of such service, then such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Arthritis includes degenerative joint disease. Lay statements are considered to be competent evidence when describing the symptoms of a disease or disability or an injury. However, if the determinative issue involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The evidence does not show that the Veteran possesses medical expertise and he does not argue otherwise. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C.A. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). If there is an approximate balance of positive and negative evidence regarding any issue material to the claim, the claimant shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C.A. § 5107; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. §§ 3.102. On the other hand, if the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. The Veteran claims entitlement to service connection for a left shoulder disorder, which, as reflected in a September 2008 VA examination report, most recently has been diagnosed as left rotator cuff tear with degenerative changes at the acromioclavicular joint. The Veteran maintains that the claimed left shoulder disorder resulted from injury to the left shoulder in 2001 caused by use of crutches required after surgery on his service-connected right foot. The Veteran does not claim that a left shoulder disorder was incurred in service, and on review of the service treatment records there is no competent evidence of any left shoulder injury, disease, or disorder in service. At the time of his October 1978 examination at expiration of term of service (ETS), the Veteran did not report having had any problems with his left shoulder. Although he noted swollen or painful joints, he indicated that this related to feet and left knee problems. On examination, the evaluation for the upper extremities and other musculoskeletal system was normal except for pes planus of the feet. After service, the pertinent medical evidence are contained in VA and private treatment and examination reports, including treatment records associated with claims for Social Security Administration disability benefits. VA treatment records show that the Veteran underwent surgery on his right foot in January 2001. The report of an April 2001 VA examination of the left knee and both feet shows that the Veteran had had a right bunionectomy and release of multiple hammer toes in January 2001; and was still non-weight-bearing in a short leg cast and on crutches. He reported that using his crutches aggravated his lower back. There is no indication in that report of any complaints or findings referable to the left shoulder. VA treatment records show that the Veteran was seen in September 2001 with a complaint of left shoulder pain for five weeks. He reported he did not injure his arm, he just woke up one day with pain. He was seen in October 2001 with a complaint of left shoulder pain for three months. He was unable to reach above his head and across to the right shoulder. When seen in December 2001, the Veteran reported complaints of some left shoulder pain, which started about six months before, and which was rather spontaneous, with no trauma etiology. The provider diagnosed probable neuroma between the third and fourth metatarsal heads, and mild impingement, left shoulder. The report of VA orthopedic/joints examinations in October 2001 (prior to the October 2001 treatment visit above) and in April 2002 show no complaints or findings referable to the left shoulder. The report of a March 2003 VA examination shows that the Veteran reported that he developed pain in the left shoulder while on crutches after right foot surgery in 2001. After examination the report contains pertinent diagnoses of (1) tear rotator cuff, left shoulder, and (2) osteoarthritis, left acromioclavicular joint. The examiner opined that the Veteran had a chronic tear of the left rotator cuff and some osteoarthritis in the left acromioclavicular joint. The examiner opined that he did not believe that these were the result of using crutches postoperative bunionectomy. The report of a September 2008 VA examination shows that the Veteran reported that after his January 2001 foot surgery and associated with his subsequent use of crutches (from January 2001 through June 2001), he had an onset of left shoulder pain in March 2001. He reported that he continued to have left shoulder pain. He denied having any problems with right shoulder pain. He reported complaints of having difficulty with activities requiring use of the arm overhead. The examiner reviewed and discussed pertinent treatment and examination records in the claims file between 2001 and 2005, as well as current X-ray examination results showing minimal degenerative changes of the acromioclavicular joint. After examination, the report contains a diagnosis of left rotator cuff tear with degenerative changes at the acromioclavicular joint. The examiner opined indicating that it was not likely ("not as least as likely as not") that the left shoulder condition was either caused by or aggravated by use of an axillary crutch during recovery from service-connected foot surgery. The examiner based this opinion in major part on the rationale that there was no supporting documentation or evidence in the medical records that the left rotator cuff tear was caused by or aggravated by the use of an axillary crutch during recovery from the foot surgery. The examiner also indicated concurrence with the same opinion given by a different examiner at the March 2003 VA examination. The present examiner concluded that the preponderance of the evidence did not support a conclusion that the left shoulder condition was due to the use of the axillary crutches after the foot surgery. On review, while the record shows that the Veteran has a chronic left shoulder condition, the preponderance of the evidence is against the finding that this condition is related to service-nor is this claimed-or to a service- connected disability. There is no indication of any referable left shoulder problems in the service treatment or examination records in service, or at separation. Thereafter, there are no medical records showing any left shoulder condition until the report of the September 2001 VA treatment record when the Veteran reported having a left shoulder pain for the previous five weeks. This lengthy period after service without treatment is evidence against a finding of continuity of symptomatology following service, and it weighs heavily against the claim with respect to a nexus directly to service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). The treatment records show no indication that any of the different treating physicians attributed the Veteran's left shoulder condition to the use of crutches following surgery for his service-connected foot in 2001. The opinions given on this subject by the VA examiners at the March 2003 and September 2008 VA examinations were that the Veteran's left shoulder condition was not secondary to the use of crutches after the 2001 surgery. These examiners based their opinion on examination and a review of the record that is reflected in the discussion above. The March 2003 and September 2008 VA medical opinion are very persuasive, as they were based on correct facts and are supported by rationale. There are no contrary opinions. Further, there is no evidence of any arthritis-as may be referable to the findings of degenerative changes-within the first year after service so as to warrant service connection on the basis of the relevant regulatory presumption. See 38 C.F.R. §§ 3.307, 3.309. While the Veteran has provided lay evidence of a link, VA regards lay statements to be competent evidence of descriptions of symptoms of disease, disability, or injury, but not the determination of an issue involving a question of medical expertise. 38 C.F.R. § 3.159; Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992); but see Jandreau v. Nicholson, 492 F.3d1372, 1377 (Fed. Cir. 2007) (lay diagnosis is competent if: (1) lay person is competent to identify the medical condition; (2) lay person is reporting a contemporaneous medical diagnosis; or (3) lay testimony of symptoms at the time supports a later diagnosis by a medical professional). The Veteran's opinion in this matter is of little value because the determination involves a question that only medical experts may address. After considering all the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a left shoulder disorder. Therefore, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). III. TDIU The Veteran is seeking a TDIU rating on the basis that as a result of impairment caused by the symptoms of his service- connected disabilities, he is unable to follow a substantially gainful occupation. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation 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, the disability shall be ratable at 60 percent or more, and that, if there are two or more service- connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16(a). If the schedular rating is less than 100 percent, the issue of unemployability must be determined without regard to the advancing age of the Veteran. 38 C.F.R. §§ 3.341(a), 4.19 (2009). Factors to be considered are the Veteran's education, employment history and vocational attainment. Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). 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) (emphasis added). Consideration may not be given to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Being unable to maintain substantially gainful employment is not the same as being 100 percent disabled. "While the term 'substantially gainful occupation' may not set a clear numerical standard for determining TDIU, it does indicate an amount less than 100 percent." Roberson v. Principi, 251 F.3d 1378 (Fed Cir. 2001). Service connection is in effect for the following disabilities: (1) bilateral pes planus, currently evaluated as 30 percent disabling; (2) mechanical back pain with scoliosis and degenerative changes, currently evaluated as 20 percent disabling; (3) status post repair of patellar tendon, left knee, with traumatic arthritis, currently evaluated as 10 percent disabling; (4) residuals, left foot bunionectomy, currently evaluated as 10 percent disabling; (5) hammertoes, right foot, currently evaluated as 10 percent disabling; (6) hammertoes, left foot, currently evaluated as 10 percent disabling; and (7) residuals, right foot bunionectomy, currently evaluated as 10 percent disabling. After combining these ratings under 38 C.F.R. § 4.25, the Veteran does meet the minimum schedular threshold requirement (of a combined disability rating of 70 percent or more) to be considered for a TDIU rating for the period since submitting his claim. 38 C.F.R. § 4.16(a), (b). Therefore, the remaining question is whether the service- connected disabilities, in and of themselves, precluded the Veteran from securing or following a substantially gainful occupation. See 38 C.F.R. § 4.16(a). Factors to be considered are the Veteran's education, employment history, and vocational attainment. Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991). 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) (emphasis added). Consideration may not be given to the impairment caused by nonservice- connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. As noted above, marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Although neither the United States Code nor the Code of Federal Regulations offers a definition of "substantially gainful employment," VA Adjudication Procedure Manual, M21- 1, Part VI, para. 7.09(a)(7) defines that term as "that which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the Veteran resides." Further, marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a); see also Faust v. West, 13 Vet. App. 342, 356 (2000). Assignment of a TDIU evaluation requires that the record reflect some factor that "takes the claimant's case outside the norm" of any other veteran rated at the same level. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough for a grant of a TDIU. In itself, a disability rating is recognition that the impairment makes it difficult to obtain or keep employment. But the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Id. If he is not so capable, then a grant of TDIU is warranted; not otherwise. In the Veteran's application for increased compensation based on unemployability submitted in February 1997, he indicated that he was not able to work since January 1977 due to symptoms associated with his service-connected disabilities of his knee and foot. On the application form the Veteran reported that he completed four years of high school education, and training in cosmetology from 1980 to 1984. He reported that he last worked full-time in January 1997, when his occupation was mail handler. In a VA Form 21-8940, "Veteran's Application for Increased Compensation Based on Unemployability", submitted in April 2004 after his appeal on that matter was perfected, he indicated that he was not able to work since January 1977 due to symptoms associated with his service-connected disabilities of his back, knees, and feet. On the application form the Veteran reported that he completed four years of high school education, and training in cosmetology from 1980 to 1984. He reported that he last worked full- time in January 1997, when his occupation was hair stylist. The Board has reviewed and considered all of the competent medical evidence on file, which includes the reports of service treatment records, VA and private treatment records, and reports of VA examinations. The most probative evidence on the issue of entitlement to TDIU is contained in reports of VA examinations dated in January and February 2007, which contain opinions specifically addressing this question. The report of the January 2007 VA examination shows that the examiner examined the Veteran for his back, knees, and feet. During the examination the Veteran reported complaints of low back pain on prolonged standing, with problems bending his back at times. These symptoms were intermittent. The examiner noted that there had been no physician prescribed bed rest in the previous year. The Veteran reported that the pain did not radiate into his legs. He described the back pain as lasting four to five hours and which he described as "aching." He rated the intensity as 9/10. He did not take any medication for the back. He reported that he had flare-ups three to four times a week, which lasts five to six hours with a severity of 9/10. Alleviating factors included relaxing: sitting or laying down. He reported he had no associated features or symptoms. The Veteran reported that he did not use aids to ambulate and did not use any braces. He reported that he did not know how far he could walk and he was not unsteady or have any history of falls. There had been no injury or surgery to the back. He did not have problems with daily activities involving any of the areas examined. The Veteran stated that he worked as a hair stylist until January 1987, and quit due to problems with his back, feet, and right hand, with right hand surgery in 1998. The Veteran reported that he sustained a left knee tear of the patellar tendon in service which was repaired. He reported complaints that his left knee "goes out." He had similar symptoms on the right knee, which had a similar history of injury and surgery. He reported that he had aches at times and that his symptoms increase with prolonged standing and walking. He had occasional swelling. He currently was taking Motrin 800 mg. three times per day for his knee and feet. He reported that he did not have periods of flare-up or joint disease. He did not use any braces or aids to ambulate. He reported that he did not have inflammatory arthritis and his knees do not dislocate or sublux. The Veteran reported that he had problems with calluses and corns on his feet during service that were treated. He reported current complaints of painful calluses on the ball of his foot and that he could not stand or walk for long periods due to pain. He reported that he had flat feet. He did not have any pain at rest. He did not have flare ups or joint disease in the feet. He did not use any corrective shoes or inserts. On examination of the spine, the Veteran complained of some pain to light touch in the lower lumbar region. He exhibited the following ranges of motion: forward flexion zero to 90 degrees with pain at the end point; extension zero to 30 degrees, non-painful; left lateral flexion zero to 30 degrees, non-painful; right lateral flexion zero to 30 degrees with pain at the endpoint; and left lateral rotation and right lateral rotation both zero to 30 degrees with pain at the end point. The Veteran also complained of some back pain with rotation of his upper body at the hips. There was no objective evidence of pain, and repetitive motion did not change anything. Deep tendon reflexes revealed hyporeflexia throughout, both knee jerk and ankle jerk. Straight leg raising at 70 degrees bilaterally caused low back pain. Sensation was intact to light touch in both feet. In sitting position, straight leg raises to 80 degrees bilaterally caused no obvious pain. Testing revealed a 4/5 positive Waddell sign. X-rays of the lumbar spine were normal. Knee examination revealed a well-healed transverse scar over the patella. All ligaments were stable. Range of motion study showed zero degrees of extension with zero to 120 degrees of flexion with some subjective pain at the end point. There was no objective evidence of pain. Repetitive motion did not change anything. The Veteran had moderate subpatellar crepitus with motion. There was no joint line tenderness. Although this section of the examination report began with the descriptor "examination of the right knee" review of the remainder of the examination report reflects that the examination was of the left knee. Examination of the feet showed good hallux valgus correction apparently with only remaining 10 degrees of hallux valgus on both first metatarsal phalangeal joints. The Veteran had zero to 45 degrees of dorsiflexion at both metatarsal phalangeal joints with no flexion. Repetitive motion did not change anything and motion was non-painful. Both feet had callosities on the plantar surface of the midfoot near the metatarsal phalangeal joints on the second and third toe. There was a little remaining hammertoe deformity on the fourth toe of the left foot, but none on the right. This was passively correctable. There was very mild pes planus if any. There was no malalignment of the Achilles' tendon and there was no midfoot malalignment or deformity in either foot. There were no skin or vascular changes. The examiner opined that he was unable to determine functional limitations of standing, walking by looking at the feet. There was no evidence of painful motion, edema, instability, weakness, or tenderness, except slight tenderness over the callosities on the plantar surface of the feet. X-ray examination showed arthritic changes in the patellofemoral joint of the left knee with narrowing of the joint space and spurring; and narrowing of the medial and lateral compartments with mild spurring there. X-ray examination of the feet showed surgical changes from bunion surgery as well as excision of the head of the proximal phalanx of the PIP joint level on toes two, three, and four bilaterally. There was a little residual deformity of the left proximal interphalangeal (PIP) joint. After examination the report contains impressions of (1) no objective evidence of musculoskeletal disease found on back examination and X-rays; (2) status post patellar tendon repair left knee with traumatic patellofemoral arthritis, mild; and (3) status post bunion surgery and hammertoe correction of second, third, and fourth toes bilaterally, mild. At the conclusion of the report the examiner commented that he was unable to demonstrate any physical impairment of the back. The examiner opined that the Veteran did have some mild impairment regarding his left knee with some loss of motion and X-ray evidence of arthritis. The examiner commented that the Veteran continued to have some callus formation on his feet as described in the report, and discussed above. The examiner opined that he did not believe that the Veteran had any clinically significant pes planus, noting the Veteran did not require any crutches or braces or wheel chair to move from place to place. The examiner commented that there was no evidence that the Veteran had had permanent loss of use of his lower extremities or his feet. The examiner concluded with an opinion that he did not find objective evidence that the Veteran was unemployable due to his back, knee, or feet. The report of a February 2007 VA examination shows that the examiner evaluated the Veteran's service-connected back disorder with special attention to the secondary loss of use of a leg, need for specially adapted housing or vehicle, and for unemployability. The Veteran reported complaints that his back "locks up" at times, and he gets numb in the thighs at night, and sometimes when walking his left thigh would go numb. He reported having low back pain every day, with no radiation. Examination showed normal gait and station with good heel/toe/tandem walk. Motor strength was 5/5 with normal tone, bulk, dexterity, and coordination. Sensory testing showed subjected decrease to pin prick and temperature in the legs which did not conform to root or peripheral nerve distribution, except for bilateral lateral femoral cutaneous nerve distributions. After examination the examiner made an assessment of mechanical back pain; noting the Veteran had no neurologic deficits related to the lumbar spine. The Veteran did have findings of meralgia paresthetica, but this was unrelated to the back, knees, or feet. The examiner opined he could detect no objective evidence of true weakness, incoordination, fatigue or lack of endurance; and the Veteran had no neurologic deficits that would require special housing, special vehicle, or special treatment. The examiner concluded with an opinion that the Veteran had no neurologic problem that would render the Veteran unemployable. Review of the remainder of the medical evidence on file shows no findings inconsistent with findings of the above two recent VA examinations. On consideration of the totality of the evidence on file, including the opinions given at the two recent VA examinations discussed above, the preponderance of the evidence is against the Veteran's claim that his service- connected disabilities have resulted in an inability to work. Basically, the competent evidence on file does not show that the Veteran's condition due to his service- connected back, left knee, and bilateral foot disabilities is of a level of severity suggestive of impairment resulting in "sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993) (emphasis added). Notably, the only opinions on the issue of employability, discussed above, are against the Veteran's claim. A Social Security Administration (SSA) decision in August 2000 determined that pursuant to pertinent regulatory criteria under the Social Security Act, the Veteran was disabled for a period of time between January 1997 and December 1998. SSA records are not controlling for VA determinations. See Collier v. Derwinski, 1 Vet. App. 412 (1991); Murincsak v. Derwinski, 2 Vet. App. 363 (1992). SSA determinations are just that, determinations of SSA based on evidence evaluated pursuant to a set of SSA criteria, which is different from the criteria under which VA assesses the employability of the Veteran. The service-connected disabilities were all evaluated by the RO in rating decisions in the 2000s that were all appealed to the Board and there adjudicated in decisions dated in August 2003 (left knee), September 2006 (foot disabilities except pes planus), and July 2008 (bilateral pes planus, and mechanical back pain disability). The evaluations assigned or continued in those decisions signify varying levels of impairment and impact on the ability to work. The Board decisions are all final, and the Veteran has not later raised a claim that an increased disability rating is warranted for any disability. Nor on review does the evidence on file show this, or show that any of these disabilities impact the Veteran's ability to work so significantly as to warrant a TDIU. Moreover, to the extent that there are other non-service- connected disorders, none of the effects of such conditions may be considered in determining whether a grant may be made in this claim on appeal. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In sum, the evidence does not show that the Veteran is incapable of performing the physical and mental acts required by employment due to his service-connected disabilities. On considering whether a TDIU rating is warranted under 38 C.F.R. § 4.16(b), the evidence does not show-even when considering the limitations and exacerbations due to the Veteran's service-connected disabilities-that some factor exists that takes this Veteran's case outside the realm of the usual so as to render impracticable his schedular ratings. On this point, the schedular rating criteria are not shown to be inadequate to rate the Veteran's service-connected disabilities. The clinical evidence pertaining to the bunionectomy and hammertoe disabilities show they were evaluated to be mild in severity. As to the other service- connected disabilities, each is rated below the maximum allowable under the relevant diagnostic codes. See 38 C.F.R. Part 4, Diagnostic Codes 5010, 5242, 5260, 5276, 5280, and 5282. While the evidence may show that the service-connected back, left knee, and bilateral foot disabilities in combination may limit the Veteran to sedentary employment, this is insufficient by itself to show that service-connected disabilities preclude sedentary employment. In summary, the evidence is insufficient to show that there is some factor which places the claimant in a different position than other veterans with the same disability rating. See Van Hoose, supra. The preponderance of the evidence is against the claim that the Veteran is currently precluded from engaging in substantial gainful employment by reason of his service-connected disabilities. A TDIU is limited to consideration of service-connected disabilities. For the reasons set forth above, the Veteran's service- connected disabilities simply have not been shown to result in total disability. Entitlement to TDIU is thus not established. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C.A. § 5107 (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for a left shoulder disorder, to include as secondary to injury due to use of crutches associated with status post bilateral bunionectomies with bilateral hammer toe and pes planus is denied. A TDIU is denied. ____________________________________________ A. BRYANT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs