Citation Nr: 18147888 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-19 343 DATE: November 6, 2018 ORDER Entitlement to an initial disability rating of 70 percent, but no higher, for a service-connected acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), mood disorder, and polysubstance abuse disorder (hereafter referred to simply as an “acquired psychiatric disorder”), is granted. Entitlement to an initial disability rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity is denied. Entitlement to an initial disability rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity is denied. Entitlement to a disability rating in excess of 20 percent for a service-connected lumbar spine disorder is denied. Entitlement to a disability rating in excess of 10 percent for a service-connect right knee condition is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) from July 25, 2011, but not earlier, is granted. FINDINGS OF FACT 1. The Veteran’s service-connected acquired psychiatric disorder is shown to result in occupational and social impairment, with deficiencies in most areas. 2. The Veteran’s service-connected radiculopathy of the right lower extremity is no greater than mild in severity. 3. The Veteran’s service-connected radiculopathy of the left lower extremity is no greater than mild in severity. 4. The Veteran’s service-connected lumbar spine disorder results in forward flexion greater than 30 degrees but not greater than 60 degrees. 5. The Veteran’s service-connected right knee condition is characterized by degenerative arthritis, which does not result in significant loss of motion. 6. The Veteran’s service-connected disabilities have precluded him from obtaining or retaining substantially gainful employment from July 25, 2011, but not earlier. CONCLUSIONS OF LAW 1. The evidence of record being in equipoise, the criteria for an initial disability rating of 70 percent, but no higher, for a service-connected acquired psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for an initial disability rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. 3. The criteria for an initial disability rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. 4. The criteria for a disability rating in excess of 20 percent for a service-connected lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5242-5243. 5. The criteria for a disability rating in excess of 10 percent for a service-connected right knee condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5260-5010. 6. The criteria for an award of a TDIU, effective July 25, 2011, but not earlier, have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1988 to August 1990. This case is on appeal before the Board of Veterans’ Appeals (Board) from April 2010, May 2011, and February 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. In August 2018, the Veteran appeared and provided testimony before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the claims file. A review of the record shows that additional medical evidence was submitted subsequent to the April 2016 supplemental statement of the case (SSOC). However, the VLJ kept the record open for an additional 30 days after the August 2016 Board hearing. Given that all of this evidence was submitted within that timeframe, no further action is necessary. Neither the Veteran nor his representative has raised any specific issues with the duty to notify or the duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Also, neither the Veteran nor his representative has raised any issues concerning the hearing held before the undersigned. Bryant v. Shinseki, 23 Vet. App. 488, 492 (2010). The Veteran seeks increased disability ratings for his service-connected acquired psychiatric disorder, radiculopathy of the right lower extremity, radiculopathy of the left lower extremity, lumbar spine disorder, and right knee condition. The Veteran also seeks entitlement to a TDIU. In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence of record, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). The evidence is in equipoise concerning the application of a 70 percent disability rating for the Veteran’s service-connected acquired psychiatric disorder and a 40 percent disability rating for the Veteran’s service-connected lumbar spine condition. Similarly, the evidence indicates that the Veteran is unable to obtain or maintain gainful employment. Therefore, the Board grants the Veteran’s claims for increased disability ratings for his service-connected acquired psychiatric disorder and lumbar spine disorder, in addition to a TDIU. However, the preponderance of the evidence does not support the assignment of higher disability ratings for the Veteran’s service-connected radiculopathy of the right and left lower extremities or right knee condition. Thus, those appeals are denied. I. Increased Ratings The Veteran seeks increased disability ratings for a service-connected acquired psychiatric disorder, radiculopathy of the right and left lower extremities, a lumbar spine disorder, and a right knee condition. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). a. Acquired Psychiatric Disorder The Veteran contends that his service-connected acquired psychiatric disorder warrants an initial disability rating in excess of 50 percent throughout the entire appeal period, which began on July 25, 2011, the date service connection was established. The Board finds that the evidence is in equipoise concerning the application of a 70 percent disability rating throughout the entire period on appeal, and hereby grants the claim. Under the General Rating Formula for Mental Disorders, PTSD is evaluated under Diagnostic Code 9411. 38 C.F.R. §§ 4.130. A 50 percent disability rating is warranted when the psychiatric condition produces occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-term and long-term memory (retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability rating is warranted when there is 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 the inability to establish and maintain effective relationships. Id. A 100 percent disability rating is warranted if there is 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 to time or place; memory loss for names of close relatives, own occupation, or own name. Id. In applying the above criteria, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102; Mittleider v. West, 11 Vet. App. 181 (1998) (citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence which does so)). In determining the level of impairment under 38 C.F.R. § 4.130, a rating specialist is not restricted to the symptoms provided under the diagnostic code, and should consider all symptoms which affect occupational and social impairment, including those identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-4 or DSM-5). Mauerhan v. Principi, 16 Vet. App. 436 (2002). If the evidence demonstrates that a claimant suffers symptoms or effects that cause an occupational or social impairment equivalent to those listed in that diagnostic code, the appropriate, equivalent rating is assigned. Id. Effective August 4, 2014, the VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM-4. The amendments replace those references with references to the recently updated “DSM-5.” As the Veteran’s claim was certified to the Board after August 4, 2014, the DSM-5 is applicable to this case. 38 C.F.R. § 4.125; 79 Fed. Reg. 45,093 (August 4, 2014). During an appointment in July 2011, the Veteran stated that his depression was minimal and denied increased irritability. Nonetheless, he indicated that his hypervigilance remained but was at a reasonable level that still permitted him to go out. The Veteran also reported a recent altercation with a roommate, but claimed that this was not based on psychosis. A witness to the incident confirmed that the Veteran handled the situation the only way he could have. In August 2012, the Veteran stated that he was doing well despite mental health issues. He reported no psychotic symptoms and indicated that he was attending church regularly. The Veteran stated that he has days where he gets depressed, but that he does not feel hopeless or helpless. The Veteran underwent a VA psychological examination in February 2013. The Veteran reported irritability and fluctuations in mood but no suicidal or homicidal ideation. The examiner noted anxiety and but stated that the Veteran has not made an attempt to secure employment in recent years despite making significant improvements in his mental health. The examiner diagnosed the Veteran with PTSD, mood disorder not otherwise specified in partial remission, polysubstance abuse in sustained full remission, and borderline features. The examiner also stated that it is possible to distinguish the symptoms attributable to each disorder, with PTSD characterized by re-experiencing, avoidance, and hyperarousal, and reduced energy resulting from the mood disorder. The examiner opined that the Veteran’s psychological conditions result in occupational and social impairment with reduced reliability and productivity. The examiner concluded that 30 percent of the Veteran’s occupational impairment is due to PTSD, 30 percent to mood disorder, 0 percent to polysubstance abuse disorder, and 40 percent to borderline features. In August 2013, the Veteran attended his first counseling session in nine months. The Veteran reported that he had been doing well since getting a puppy, and that he felt less depressed and paranoid. He also indicated that he was involved with church and his family. In December 2013, Dr. R.G., a private psychiatrist, submitted a letter in which he opined that the Veteran would be unable to secure gainful employment due to his psychological conditions. Dr. R.G. dated these symptoms back to February 2006, when the Veteran was hospitalized for suicidal depression. Dr. R.G. noted the Veteran’s diagnoses of PTSD and major depression with a history of psychosis, and found that he suffered from persistent irrational fears, delusions and hallucinations, persistent danger of hurting himself or others, depression affecting his ability to function independently and appropriately, deficiencies in mood, suicidal ideation, difficulties adapting to stressful circumstances, and inability to establish and maintain effective relationships. In January 2015, Dr. C.M., a private psychiatrist, conducted an evaluation of the Veteran. Dr. C.M. found that the Veteran has good days and bad days, and opined that his psychiatric impairments would cause him to miss work more than three days per month. Dr. C.M. concluded that the Veteran is moderately limited in most social functioning areas, but has marked limitations in the ability to complete a normal workweek without interruptions from psychologically based symptoms, sustain a routine without supervision, and work in proximity to others without being distracted by them. Dr. C.M. also noted deficiencies in mood, difficulties adapting to stressful circumstances, unprovoked hostility and irritability, and depression affecting the Veteran’s ability function independently, appropriately, and effectively, and inability to establish and maintain effective relationships. The Veteran was afforded a second VA psychological examination in March 2016. The examiner diagnosed the Veteran with PTSD and an unspecified substance abuse-related disorder; though symptoms attributable to these conditions are distinguishable, examiner opined that all of the Veteran’s current symptoms stem from PTSD. The examiner reviewed the Veteran’s medical records, noting anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, and difficulty in adapting to stressful circumstances. Examiner also noted that the Veteran worked until 2005, when he had to leave due to back and knee impairments. Based on this information, the examiner opined that the Veteran demonstrates occupational and social impairment with reduced reliability and productivity. However, the examiner found that the Veteran was functioning well despite his PTSD, opining that his condition is mild and would not be expected to affect his ability to do simple, repetitive work. Two of the Veteran’s friends, D.D. and D.A.D., submitted letters in August 2016. They indicated that the Veteran’s PTSD causes him to get very defensive and angry, and that he suffers from bouts of depression and paranoia. Though the Veteran takes medications to control his psychological conditions, they do not work when he gets stressed and he can take several days to recover from one of these episodes. At the August 2016 Board hearing, the Veteran reported short term memory loss, nightmares, irritability, trouble with crowds, and depression. He also endorsed suicidal thoughts, with two previous hospitalizations for suicide attempts. The Veteran also indicated that he will get angry quickly and has verbal altercations with others once or twice per week. Dr. C.M. conducted another evaluation of the Veteran in August 2016. Dr. C.M. found that the Veteran has good days and bad days, and opined that his psychiatric impairments would cause him to miss work more than three days per month. Dr. C.M. concluded that the Veteran is moderately limited in most social functioning areas, but has marked limitations in the ability to accept instructions and respond appropriately to criticism from supervisors, sustain a routine without supervision, and work in proximity to others without being distracted by them. Dr. C.M. also noted deficiencies in mood, difficulties adapting to stressful circumstances, unprovoked hostility and irritability, and depression affecting the Veteran’s ability function independently and appropriately, as wells as intermittent inability to perform activities of daily living. After careful review of the evidence, the Board finds that a 70 percent disability rating is warranted for the entire period on appeal. While the conclusions of the February 2013 and March 2016 VA examiners are more consistent with the assignment of a 50 percent evaluation, the opinions provided by Dr. R.G. and Dr. C.M., and the statements of the Veteran and his two friends, suggest a greater degree of impairment. Given that PTSD, like all psychiatric disorders, is a variable condition, with symptoms that wax and wane from one day to the next, the Board finds that the evidence of record is in equipoise. As such, the Board thereby affords the benefit of the doubt to the Veteran, and assigns the higher evaluation. However, the Board declines to assign a disability rating in excess of 70 percent because the evidence of record does not show total occupational and social impairment. Indeed, the Veteran is able to live alone and care for his pet dog. Moreover, the Veteran reports that he attends church regularly and socializes with his family, all of which are activities that are inconsistent with a 100 percent disability rating. Accordingly, the Board concludes that the Veteran is entitled to a 70 percent disability rating, but no higher, under Diagnostic Code 9411 for the entire period on appeal. b. Radiculopathy of the Bilateral Lower Extremities The Veteran alleges that his service-connected radiculopathy of the right and left lower extremities warrants initial disability ratings in excess of 10 percent throughout the entire appeal period, which began on January 14, 2011, the date service connection was established. Given the evidence showing a substantially similar degree of impairment in both lower extremities, these conditions will be referred to together as “radiculopathy of the bilateral lower extremities.” The Veteran’s radiculopathy of the bilateral lower extremities is currently rated under Diagnostic Code 8520, which addresses paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. Id. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. The term “incomplete paralysis,” with respect to peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the lesion or to partial regeneration. Where the involvement is wholly sensory, the rating should be for mild, or at the most, moderate symptomatology. 38 C.F.R. § 4.124a. In January 2011, the Veteran underwent a VA examination in connection with his claim for a lumbar spine disorder. The Veteran complained of radiating pain in both lower extremities, accompanied by numbness and a burning sensation. Examination revealed that both extremities were normal to light touch; however, they exhibited decreased sensation to pain and pinprick. Based on these findings, the examiner concluded that the Veteran’s radiculopathy of the bilateral lower extremities was associated with his degenerative disc disease of the lumbar spine. During an appointment in October 2011, the Veteran reported constant lower back pain, which was band-like across the lumbar region. He also indicated that this pain radiated to the lower extremities, and was accompanied by numbness. The Veteran was afforded a second VA examination in connection with his claim for a lumbar spine disorder in March 2016, during which he denied radicular pain. Based on recent X-rays of the Veteran’s lumbar spine, the examiner opined that his degenerative disc disease was mild, with no significant evidence of nerve root compression. As such, the examiner concluded that the condition affecting the Veteran’s bilateral lower extremities is most likely neuropathy due to nonservice-connected diabetes rather than radiculopathy. In a March 2016 VA addendum opinion, the examiner noted that the Veteran had been diagnosed with radiculopathy of the bilateral lower extremities since 2011. However, the examiner found that his radiculopathy was currently asymptomatic. This conclusion was based on successive X-rays of the Veteran’s lumbar spine showing that his degenerative disc disease had been stable since 2011, with only mild disc degeneration and no significant stenosis or nerve root impingement. The examiner opined that the Veteran’s current symptoms are more likely neuropathy resulting from uncontrolled diabetes and heavy drinking. Additionally, the examiner found that the Veteran’s current leg weakness is likely the result of his torn ACL, and that the numbness in his bilateral toes is likely due to diabetes since radiculopathy tends to affect one side of the nerve root. At the August 2016 Board hearing, the Veteran reported numbness, tingling, tiredness, and weakness in both lower extremities. Although this condition exists bilaterally, the Veteran indicated that his right side was affected to a greater degree. The Veteran stated that his radiculopathy will flare up three to four times per month, and that it is so severe that it has actually caused him to fall in the shower. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against the finding that the Veteran’s radiculopathy of the bilateral lower extremities warrants a higher disability rating at any point during the appeal period. In the present case, the Board finds that the opinions provided by the VA examiner in March 2016, particularly the addendum opinion, carry the most weight. Both of these statements note that the Veteran’s degenerative disc disease of the lumbar spine has not significantly worsened since 2011, and attribute his current symptoms to neuropathy due to nonservice-connected diabetes rather than radiculopathy. Indeed, the addendum opinion even stated that the Veteran’s radiculopathy was currently asymptomatic. By contrast, the January 2011 VA examiner diagnosed the Veteran with radiculopathy of the bilateral lower extremities based solely on sensory testing, and never addressed to what possible extent the Veteran’s diabetes could have contributed to his symptoms. As such, the Board affords the greatest probative weight to the opinions of the March 2016 VA examiner, and adopts her conclusion that the Veteran’s radiculopathy of the bilateral lower extremities has not worsened during the appeal period. The Board also acknowledges the statements of the Veteran, which allege that the condition affecting his bilateral lower extremities has significantly worsened during the appeal period. While lay witnesses are competent to provide evidence regarding matters that can be perceived by the senses, they are not competent to provide an opinion regarding etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (2007); see also Barr, 21 Vet. App. 303 (lay testimony is competent to establish the presence of observable symptomatology). Although the Veteran attributes his current symptoms to radiculopathy, the March 2016 VA examiner opined that his complaints are more likely than not caused by neuropathy, which is in turn linked to a nonservice-connected condition. The Board finds that the opinions of the March 2016 VA examiner are more probative than the Veteran’s lay assertions because she has expertise, education, and training that the Veteran is not shown to have. As such, her assessment of the Veteran’s radiculopathy, and her opinion as to the origin of his current complaints, warrants more weight. Therefore, the Board finds that the evidence of record does not support the application of a higher disability rating under Diagnostic Code 8520 for any portion of the appeal period. Although the Board acknowledges the Veteran’s statements that his radiculopathy of the bilateral lower extremities has worsened over the appeal period, the majority of the evidence is inconsistent with his assertions. Accordingly, the appeal is denied. c. Lumbar Spine Disorder The Veteran claims that his service-connected lumbar spine disorder warrants a disability rating in excess of 20 percent throughout the entire appeal period, which began up to one year prior to March 3, 2010, the date the current claim was received. The Veteran’s lumbar spine disorder is currently rated under Diagnostic Code 5242-5243, which provides the criteria for degenerative arthritis of the spine and intervertebral disc syndrome (IVS). 38 C.F.R. § 4.71a. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional one to identify the basis for the rating assigned; the additional diagnostic code is shown after the hyphen. Id. Disabilities of the spine are evaluated under a General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). The criteria of the General Rating Formula are applied with and without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). When evaluating joint disabilities rated on the basis of limitation of motion, the VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Instead, Mitchell explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, the VA must determine the overall functional impairment due to these factors. The General Rating Formula pertinent to the thoracolumbar spine assigns a 20 percent disability rating if there is forward flexion of the thoracolumbar spine greater than 30 degrees but less than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is warranted if there is forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, Diagnostic Code 5242. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, General Formula, Note (2); see also Plate V. Unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision, restricted opening of the mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Formula, Note (5). IVS is rated either under the General Rating Formula or alternatively under the Formula for Rating IVS on Incapacitating Episodes, whichever method results in a higher disability rating. The Formula for Rating IVS Based on Incapacitating Episodes provides a 20 percent disability rating for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). In February 2010, an MRI of the Veteran’s lumbar spine revealed disc desiccation and bulging at L4-L5 and slight bulging of the annulus fibrosis at L5-S1. An X-ray of the Veteran’s lumbar spine taken a couple days later found mild to moderate L5-S1 facet hypertrophy and sclerosis, with mild upper/mid lumbar spondylosis. However, there was no evidence of bony compression or loss of intervertebral disc height, and the sacroiliac joints were unremarkable. The Veteran was afforded a VA examination in April 2010. The Veteran complained of pain and stiffness, both of which he described as severe. The Veteran ambulated with a cane and stated that he has flare-ups that can last for hours or days. The Veteran also stated that motion was painful and claimed muscle spasms. Upon examination, range of motion was limited to 56 degrees flexion and 28 degrees extension. Sensation is normal, but the straight leg raising test was positive on right. The Veteran reported no incapacitating episodes in the last 12 months, but indicated that his condition affects his ability to bend, stoop, squat, and kneel, and interferes with household chores like vacuuming, sweeping, picking things up from the floor, and work activities. The Veteran also reported having to modify activities like bathing and dressing due to lower back pain. The Veteran underwent a second VA examination in January 2011. An X-ray of the Veteran’s lumbar spine showed gross disc space narrowing but no significant bony abnormalities. The examiner opined that the findings were similar to the previous imaging from February 2010. Nonetheless, the Veteran complained of decreased motion, stiffness, spasms, and pain radiating to the lower extremities. The Veteran also stated that he has episodes where there is so much pain he cannot get out of bed, which occur about twice per month and happen when he “overdoes it.” Upon examination, there was objective evidence of pain on range of motion but no additional limitations after three repetitions. Extension was at 20 degrees and flexion was at 30 degrees. However, the Veteran admitted that he was anxious about giving the maximum effort for fear his back would “catch.” Thus, the examiner estimated that flexion was actually at 60 degrees but concluded that the other measurements were reliable. In May 2011, an X-ray of the Veteran’s lumbar spine revealed slight but stable disc space loss at L4-L5. There was also no evidence of fracture or spondylosis. In July 2011, an MRI of the Veteran’s lumbar spine found mild disk desiccation at L2-3 and more significantly at L4-5 and L5-S1, compatible with mild disk degeneration. There was also broad based disc bulging at the L3-4 level, along with bilateral facet hypertrophy and possible entrapment of the exiting right L3 nerve root. There was no definite L4 entrapment in the lateral recess. At L4-5, there was bilateral facet hypertrophy producing mild lateral recess stenosis with no definite nerve root entrapment. At L5-S1, there was mild disc degeneration with no evidence of significant stenosis. However, bilateral facet arthropathy was present at this level. At an appointment in October 2011, the Veteran reported that he suffered from constant lower back pain, which he described as band-like across the lumbar region. He stated that the pain is worsened by physical activity, walking, sitting, vacuuming, and doing dishes. The Veteran also indicated that the pain interfered with sleep but denied incontinence, new weakness, and falls. However, the Veteran reported that he was still able to perform his activities of daily living. An X-ray of the Veteran’s lumbar spine from February 2016 showed moderate lower lumbar facet joint degenerative changes, along with minimal to mild spondylosis and probable mild degenerative disc changes at the L4-S1 levels. There was no evidence of compression fractures, subluxation, or scoliosis. The reviewing physician opined that these findings were unchanged since May 2011. The Veteran was afforded a third VA examination in March 2016. The Veteran did not report flare-ups, but stated that he could not fully bend forward. Upon examination, forward flexion was limited to 70 degrees and extension was full. There was no evidence of pain with weight bearing, and the Veteran was able to perform repetitive use testing without loss of function or range of motion. The examiner found that the Veteran’s functional ability was not limited by pain, weakness, fatiguablility, or incoordination, and the straight leg raising test was negative bilaterally. Additionally, the Veteran did not use an assistive device and his gait was normal. Based on X-ray findings from February 2016, the examiner concluded that the Veteran’s degenerative disc disease was mild and that there was no significant evidence of nerve root compression. At the Board hearing in August 2016, the Veteran stated that “bad discs” in his lower back keep him from bending, and that he has to get up and move every half hour. The Veteran also claimed that his back will lock up and that he can only stand for 45 mins before he has to sit down. The Veteran indicated that he can walk for about two city blocks and that he uses a cane prescribed by the VA. He went on state that he suffers incapacitating episodes four or five times per month where he cannot get out of bed. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against the finding that the Veteran’s lumbar spine disorder warrants a disability rating in excess of 20 percent at any point during the appeal period. In order to meet the requirements of 40 percent disability rating under Diagnostic Code 5242, the evidence must show that forward flexion of lumbar spine is limited to 30 degrees or less, or demonstrate the presence of favorable ankylosis. Here, there is no evidence of ankylosis in any of the imaging of the Veteran’s lumbar spine. Additionally, forward flexion of the lumbar spine was measured at 56 degrees in April 2010 and 70 degrees in March 2016. However, both of these measurements are consistent with the current 20 percent disability rating. The Board notes that the January 2011 VA examiner measured forward flexion of the lumbar spine at 30 degrees. However, he noted that the Veteran was not giving his full effort during that examination. Significantly, the Veteran did not press forward due to pain, but rather out of the fear that his back would “catch.” As such, the Board assigns little probative value to the 30 degree measurement, and instead accepts the January 2011 VA examiner’s estimate that the Veteran is capable of forward flexion to 60 degrees. This number is more consistent with measurements taken in April 2010 and March 2016, and well above the 30-degree forward flexion limit required for a 40 percent evaluation under Diagnostic Code 5242. Therefore, the evidence does not support the application of a disability rating in excess of 20 percent under Diagnostic Code 5242 at any point during the appeal period. The Board has also considered whether the Veteran is entitled to a higher disability rating under the rating criteria for IVS found in Diagnostic Code 5243, which assigns a 40 evaluation for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. The Veteran was diagnosed with IVS in February 2010. Although he indicated in January 2011 that his back condition kept him in bed approximately 2 days per month, the Board notes the Veteran has never had bedrest prescribed by a physician. As such, his lumbar spine disorder is not eligible for a separate disability rating under Diagnostic Code 5243. The Board thus declines to assign a higher evaluation for the Veteran’s lumbar spine disorder under any relevant diagnostic code. Although the Board acknowledges the Veteran’s statements that his lumbar spine disorder has worsened over the appeal period, the majority of the evidence is inconsistent with his assertions. Accordingly, the appeal is denied. d. Right Knee Condition The Veteran asserts that his service-connected right knee condition warrants a disability rating in excess of 10 percent throughout the entire appeal period, which begins up to one year prior to September 24, 2010, the date the current claim was received. The Veteran’s right knee condition is currently rated under Diagnostic Code 5260-5010, which provides the criteria for limitation of flexion and degenerative changes to the knee. 38 C.F.R. § 4.71a. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional one to identify the basis for the rating assigned; the additional diagnostic code is shown after the hyphen. Id. Diagnostic Code 5010 provides that arthritis due to trauma will be rated on limitation of motion of the affected parts, as degenerative arthritis, under Diagnostic Code 5003. Under Diagnostic Code 5003, arthritis established by X-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is applied for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Under Diagnostic Code 5260, a noncompensable rating is warranted when flexion of the leg is only limited to 60 degrees. A 10 percent rating is assigned when flexion is limited to 45 degrees. A 20 percent evaluation is warranted when flexion is limited to 30 degrees. A 30 percent rating is assigned when flexion is limited to 15 degrees. Id. Under Diagnostic Code 5261, a noncompensable rating is warranted when extension of the leg is limited to 5 degrees. A 10 percent rating is assigned when extension is limited to 10 degrees. A 20 percent rating is warranted when extension is limited to 15 degrees. A 30 percent rating is assigned when the evidence shows extension limited to 20 degrees. A 40 percent rating is warranted when extension is limited to 30 degrees. A 50 percent rating is assigned when extension is limited to 45 degrees. Id. Normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Separate ratings may be assigned for limitation of flexion, extension, instability, and a meniscal disability of the same knee under Diagnostic Codes 5260, 5261, 5237, 5258 or 5259. Lyles v. Shulkin, 16-0994, 2017 U.S. App. Vet. Claims LEXIS 1704 (Vet. App. Nov. 29, 2017); VAOPGCPREC 09-04 (September 17, 2004). In rating a disability of the musculoskeletal system, a number of factors are for consideration. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40; DeLuca, 8 Vet. App. at 206-07. In February 2011, the Veteran underwent a VA examination for his right knee condition. The Veteran complained of pain, stiffness, and weakness. However, on examination, there was no evidence of deformities, giving way, incoordination, or instability. The examiner found that the Veteran was able to stand for 15 to 30 minutes and walk for 5 to 10 minutes. He was prescribed a cane, which he used daily, and walked with a limp in his right lower extremity. The examination also revealed crepitus and tenderness, but no grinding, nor abnormalities of patella or meniscus. Right knee flexion was measured at 0 to 110 degrees but extension was normal. There was also no swelling or loss of range of motion with increased pain or weakness with repetition. An X-ray found changes due to ACL reconstruction but no effusion or acute bony abnormalities. There was also mild to moderate spurring at the medial tibial plateau and minimal spurring about the patella. However, the joint spaces appeared to be relatively maintained. An MRI of the Veteran’s right knee from April 2011 found no significant joint effusion, though hardware from an ACL reconstructive surgery limited evaluation of the surrounding region. The medial and lateral menisci were of normal signal intensity and morphology without evidence of a discrete tear. The patellar retinaculum was intact. The patella cartilage was also unremarkable, as was the medial and lateral compartment cartilage. There was no evidence of meniscal tear, but a possible graft tear. During an appointment later that month, the attending physician measure right knee flexion at 0 to 110 degrees, finding no evidence effusion or ACL instability. In August 2012, the Veteran stated that he was walking four miles per day for exercise. An X-ray of the Veteran’s right knee from February 2016 showed ACL reconstruction and mild to moderate 3 compartment osteoarthritic changes without clear evidence for joint effusion. The reviewing physician opined that these findings were unchanged from the previous X-ray in February 2011. The Veteran was afforded a second VA examination in March 2016. The examiner noted the Veteran’s previous diagnoses of degenerative arthritis in the right knee and a traumatic ACL tear with subsequent reconstruction. Upon examination, there was no evidence of pain on weight bearing, crepitus, or localized tenderness; nonetheless, flexion was measured at 0 to 120 degrees while extension was measured at 120 to 0 degrees. However, the Veteran was able to perform repetitive use testing without functional loss, and there was no evidence of ankylosis or joint instability. Lastly, the examiner found that the Veteran used a cane occasionally, and could not stand or walk for more than 20 mins or walk more than half a mile. During the August 2016 Board hearing, the Veteran stated that he has a partial ACL tear, which causes weakness and requires him to wear a brace. The Veteran also indicated that he feels right knee weakness about once per month, when the knee feels like it will give out. After careful consideration of the claims file, the Board concludes that the preponderance of the evidence is against the finding that the Veteran’s right knee condition warrants a higher disability rating at any point during the appeal period under any applicable diagnostic code. The Board notes that there has been repeated range of motion testing throughout the period on appeal. However, flexion in the Veteran’s right knee has never been measured at less than 110 degrees, while extension has always been measured to zero. As such, the Veteran is not entitled to a compensable rating under Diagnostic Code 5260 or 5261. Nonetheless, X-ray evidence shows osteoarthritic changes in the Veteran’s right knee. Given the noncompensable disability ratings that would be applied under Diagnostic Codes 5260 and 5261, these findings result in a 10 percent disability rating under Diagnostic Code 5010. This is the disability rating that is currently assigned for the Veteran’s service-connected right knee condition, and represents the maximum compensation available for his impairment with the available evidence. Although the Board acknowledges the Veteran’s statements concerning the limitations he experiences as a result of his right knee disability, these difficulties are encompassed by the 10 percent disability rating. Therefore, the Board finds that the evidence of record does not support the application of a higher disability rating under Diagnostic Code 5260-5010 for any portion of the appeal period. Although the Board acknowledges the Veteran’s statements that his right knee condition has worsened over the appeal period, the majority of the evidence is inconsistent with his assertions. Accordingly, the appeal is denied. e. Conclusion In conclusion, based on the medical evidence as well as lay testimony, the Board finds that the evidence is in equipoise concerning the assignment of an initial disability rating of 70 percent under Diagnostic Code 9411 for the Veteran’s service-connected acquired psychiatric disorder. Thus, that appeal is granted. However, the weight of the evidence does not support the finding that the Veteran’s service-connected lumbar spine disorder is entitled to an evaluation in excess of 20 percent. Similarly, the preponderance of the evidence is against the application of an initial disability rating in excess of 10 percent for the Veteran’s service-connected radiculopathy of the right and left lower extremities. Moreover, the weight of the evidence does not support the finding that the Veteran’s service-connected right knee condition warrants a disability rating in excess of 10 percent. To the extent that any higher level of compensation is sought for these issues, the preponderance of the evidence is against the claim. Hence the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49; 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Accordingly, the Veteran’s claims for increased disability ratings for a lumbar spine condition, radiculopathy of the bilateral lower extremities, and a right knee condition are denied. II. TDIU The Veteran seeks a TDIU, claiming that he is unable to obtain or retain gainful employment due to his service-connected conditions. Total disability is considered to exist when there is any impairment that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the VA’s Schedule for Rating Disabilities, 38 C.F.R. Part 4, prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). The law also provides that a total disability rating based on individual unemployability due to service-connected disability may be assigned where the veteran is rated at 60 percent or more for a single service-connected disability, or rated at 70 percent for two or more service-connected disabilities and at least one disability is rated at least at 40 percent, and when the disabled person is unable to secure or follow a substantially gainful occupation as a result of the service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Factors to be considered are the veteran’s education and employment history and loss of work-related functions due to pain. Ferraro v. Derwinski, 1 Vet. App. 326, 330, 332 (1991). Individual unemployability must be determined without regard to any nonservice-connected disabilities or the veteran’s advancing age. 38 C.F.R. § 3.341(a); see also 38 C.F.R. § 4.19 (age may not be a factor in evaluating service-connected disability or unemployability); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran is service-connected for an acquired psychiatric disorder, rated at 70 percent disabling from July 25, 2011; a lumbar spine disorder, rated at 20 percent disabling from January 14, 2011; a right knee condition, rated at 10 percent disabling from April 18, 2006; and radiculopathy of the right and left lower extremities, each rated at 10 percent disabling from January 14, 2011. With the ratings assigned herein, the Veteran has had a total combined disability rating of at least 70 percent but less than 100 percent since July 25, 2011, thereby satisfying the schedular requirements for a TDIU from that date. See February 2013 rating decision. All veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). Where the veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extraschedular rating is for consideration where the veteran is unemployable due to service-connected disability. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). Thus, the Board must evaluate whether there are circumstances in the Veteran’s case, apart from any nonservice-connected conditions and advancing age, which would justify a total rating, based on unemployability. Van Hoose, 4 Vet. App. at 363; see also Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). The fact that a veteran may be unemployed or has difficulty obtaining employment is not determinative. The ultimate question is whether the veteran, because of service-connected disability, is incapable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. Moreover, as already noted, an inability to work due to non-service-connected disabilities or age may not be considered. 38 C.F.R. §§ 4.14, 4.19. In making its determination, the VA considers such factors as the extent of the service-connected disabilities, and employment and educational background. 38 C.F.R. §§ 3.321(b), 3.340, 3.341, 4.16(b), 4.19. In his October 2010 TDIU application, the Veteran reported that he completed high school and attended college for two years. Although the Veteran’s last full-time job as a laborer ended in July 2005, he indicated that worked part time at a several retail stores until September 2008. The Veteran stated that he can no longer work due to his lumbar spine disorder and right knee condition. In December 2013, Dr. R.G., conducted a psychological examination of the Veteran. Dr. R.G. assessed moderate to marked limitations in every functioning area. Dr. R.G. dated these symptoms back to February 2006, when the Veteran was hospitalized for suicidal depression. Based on his examination findings, Dr. R.G. concluded that the Veteran would be unable to perform gainful employment due to the symptoms and limitations stemming from his psychiatric impairment. In January 2015, Dr. C.M. conducted a psychological evaluation of the Veteran. Dr. C.M. found that the Veteran has good days and bad days, and opined that his psychiatric impairments would cause him to miss work more than three days per month. Additionally, Dr. C.M. assessed moderate to marked limitations in every functioning area. Based on his examination findings, Dr. C.M. concluded that the Veteran would be unable to perform gainful employment due to the symptoms and limitations stemming from his psychiatric impairments. In March 2016, the VA physical examiner concluded that the Veteran would be able to perform sedentary work in a situation where he could get up and stretch his back every 30 to 60 minutes. The examiner also stated that the Veteran could work short distances but could not be on his feet all day. In March 2016, the VA psychological examiner opined that the Veteran was functioning well despite his PTSD and other conditions. The examiner went on to say that the Veteran’s psychiatric conditions were mild at this time and would not be expected to affect his ability to do simple, repetitive work. During the August 2016 Board hearing, the Veteran testified that he has not worked since 2005. In his last job, he was employed as a welder for about seven months; however, he got into an argument with a supervisor and was fired. Prior to this, the Veteran reported that he worked in construction and did other manual labor. He did this off and on for several years, but indicated that he always had problems getting along with people. The Veteran indicated that he had no other job experience aside from physical labor, which he can no longer perform due to his disabilities. He also stated that he had been receiving benefits from the Social Security Administration since 2006. Dr. C.M. conducted another evaluation of the Veteran in August 2016. He found that the Veteran has good days and bad days, and opined that his psychiatric impairments would cause him to miss work more than three days per month. Additionally, Dr. C.M. assessed moderate to marked limitations in every functioning area. Based on his examination findings, Dr. C.M. concluded that the Veteran would be unable to perform gainful employment due to the symptoms and limitations stemming from his psychiatric impairments. After careful consideration of the claims file, the Board concludes that the Veteran has been unable to obtain or retain gainful employment since July 25, 2011, the date he satisfied the schedular requirements for a TDIU. The Board notes that the opinion evidence is unanimous that the Veteran would be restricted to sedentary work due to his service-connected lumbar spine disorder, right knee condition, and radiculopathy of the bilateral lower extremities. Given the Veteran’s employment history as a welder and manual laborer, the Board finds it unlikely that the combined effects of his physical disabilities would allow him to secure or follow a substantially gainful occupation consistent with his experience. Even if this were not the case, the opinions of Dr. R.G. and Dr. C.M. indicate that the Veteran’s service-connected acquired psychiatric disorder would cause problems with supervisors and coworkers, in addition to causing him to miss multiple days per month. As such, the Board concludes that the symptoms described by the Veteran, and noted by the examiners, due to his multiple service-connected disabilities render him unemployable. Therefore, the Board finds that the preponderance of the evidence supports the Veteran’s contention that he is unemployable due the effects of his service-connected disabilities. Accordingly, entitlement to a TDIU is granted from July 25, 2011, the date the Veteran satisfied the schedular requirements. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD MJS, Associate Counsel