Citation Nr: 18155165 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 14-15 945 DATE: December 3, 2018 ORDER Entitlement to an evaluation in excess of 40 percent prior to November 6, 2009; and in excess of 40 percent from January 1, 2010 for lumbar spine foraminal stenosis is denied. Entitlement to an evaluation in excess of 20 percent prior to June 15, 2010; in excess of 100 percent from June 15, 2010; in excess of 30 percent from September 1, 2011; in excess of 60 percent from January 3, 2017; and in excess of 30 percent from February 26, 2018 for status post left knee meniscectomies is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. Prior to November 6, 2009, the Veteran’s lumbar spine disability was not shown to be manifested with unfavorable ankylosis of the entire thoracolumbar spine, or with incapacitating episodes having a total duration of six weeks during that past 12 months. 2. From January 1, 2010, the Veteran’s lumbar spine disability was not shown to be manifested with unfavorable ankylosis of the entire thoracolumbar spine, or with incapacitating episodes having a total duration of six weeks during that past 12 months. 3. Prior to June 15, 2010, the Veteran’s left knee disability was not shown to be manifested with ankylosis favorable angle in full extension, or in slight flexion between 0 and 10 degrees; with severe recurrent subluxation or lateral instability; with flexion limited to 15 degrees; or with extension limited to 20 degrees. 4. From June 15, 2010, the Veteran’s left knee disability was assigned the maximum schedular rating pursuant to 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5055. 5. From September 1, 2011, the Veteran’s left knee disability was not shown to be manifested with chronic residuals consisting of severe painful motion or weakness in the affected extremity; with ankylosis in flexion between 10 and 20 degrees; or with extension limited to 30 degrees. 6. From January 3, 2017, the Veteran’s left knee disability was shown to be manifested with chronic residuals consisting of severe painful motion or weakness in the affected extremity. 7. From February 26, 2018, the Veteran’s left knee disability was not shown to be manifested with chronic residuals consisting of severe painful motion or weakness in the affected extremity; with ankylosis in flexion between 10 and 20 degrees; or with extension limited to 30 degrees. 8. The evidence of record demonstrates that the Veteran’s service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation in excess of 40 percent prior November 6, 2009 and in excess of 40 percent from January 1, 2010 for lumbar spine foraminal stenosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.71a, DC 5235-5243. 2. The criteria for entitlement to an evaluation in excess of 20 percent prior to June 15, 2010; in excess of 100 percent from June 15, 2010; in excess of 30 percent from September 1, 2011; in excess of 60 percent from January 3, 2017; and in excess of 30 percent from February 26, 2018 for status post left knee meniscectomies have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.71a, DC 5055, 5256-5261. 3. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from December 1976 to December 1996. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, the Veteran testified before the undersigned Veterans Law Judge via video conference. A transcript of the hearing is associated with the claims file. During the pendency of the appeal, in a May 2011 rating decision, the RO granted an increase in evaluation for the left knee. The RO assigned an evaluation of 100 percent from June 15, 2010 due to the Veteran’s total knee replacement surgery. An evaluation of 30 percent was assigned from September 1, 2011. In December 2017, the Board issued a Remand of both the left knee and lumbar spine issues. The Remand directed the RO to schedule updated VA examinations to determine the current severity of the Veteran’s left knee and lumbar spine disabilities. The VA examinations were conducted in February 2018 and a new rating decision was issued in September 2018. The RO increased the evaluation of the left knee from 30 percent to 60 percent from January 3, 2017 and then assigned an evaluation of 30 percent from February 26, 2018. After a period of convalescence (for which he was assigned a temporary 100 percent evaluation), the back was assigned an evaluation of 40 percent from January 1, 2010. Additionally, the RO granted service connection for right lower extremity radiculopathy and for a scar residual of thoracolumbar surgery; however, these two matters are not under appeal before the Board. The Board finds that the RO has substantially complied with the December 2017 Board Remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). However, as the RO’s actions do not constitute a full grant of the benefits sought and the Veteran has not expressed satisfaction with the increased ratings, the issue remains on appeal. Ab v. Brown, 6 Vet. App. 35, 39 (1993). Increased Rating The Veteran contends that his VA examination should not have been on the same day that he was discharged from the hospital because he was under the influence of pain medication. The Veteran added that the examiner could not see the decrease in flexibility and pain that he endures on a daily basis while attempting to carry out daily activities. See VA Form 9 dated April 2014. Disability rating are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In rating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A claim for increased rating remains in controversy when less than the maximum available benefit is awarded. Ab v. Brown, 6 Vet. App. 35 (1993). Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In a decision, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall resolve reasonable doubt in favor of the claimant. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to a rating increase for lumbar spine foraminal stenosis Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater 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 evaluation is warranted if forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Normal ranges of motion of the thoracolumbar spine are flexion from 0 to 90 degrees, extension from 0 to 30 degrees, lateral flexion from 0 to 30 degrees, and lateral rotation from 0 to 30 degrees. 38 C.F.R. § 4.71, Plate V. Additionally, back disabilities may be rated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes. 38 C.F.R. § 4.71a. Under the current Formula for Rating IVDS based on Incapacitating Episodes, a 10 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least one week but less than two weeks during a 12-month period on appeal. A 20 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least two weeks but less than four weeks during a 12-month period on appeal. A 40 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period on appeal. A 60 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. 38 C.F.R. § 4.71a, DC 5243. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, DC 5243, Note (1). A. Prior to November 6, 2009 The Veteran was assigned a 40 percent rating for his lumbar spine disability under DC 5237 as his forward flexion of the thoracolumbar spine was 30 degrees. The Veteran’s treatment records reveal an October 2009 orthopedic consult where continued low back pain was noted and the pain was aggravated by prolonged walking and standing. Limited range of motion was also noted, a specific degree of limitation was not mentioned. There is no evidence showing that unfavorable ankylosis of the thoracolumbar spine or of the entire spine and there is no evidence showing IVDS that caused incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. Accordingly, a rating in excess of 40 percent prior to November 6, 2009 is not warranted. B. From November 6, 2009 to January 1, 2010 The Veteran was assigned a temporary 100 percent evaluation for his lumbar spine disability as he had back surgery at a VA hospital on November 6, 2009, pursuant to 38 C.F.R. § 4.30. There is no suggestion in the record that this period of convalescence required an extension beyond January 1, 2010, nor has the Veteran claimed that such was needed. C. From January 1, 2010 The Veteran was assigned a 40 percent rating for his lumbar spine disability under DC 5237 as his forward flexion of the thoracolumbar spine was 30 degrees. The Veteran was afforded an additional VA examination in February 2018. The examiner diagnosed the Veteran with lumbosacral strain, degenerative arthritis of the spine, IVDS, spinal stenosis, and status post L5-S1 laminectomy and foraminotomy. Since his last VA exam, the Veteran reported that he has constant dull pain aggravated by bending and lifting which caused sharp pain. He received spinal injections, was prescribed Vicodin, and participated in pool therapy for pain management. The Veteran’s lumbar spine disability resulted in functional impairment as he was unable to do repetitive bending, moderate or heavy lifting, standing or walking for longer than 10 to 15 minutes. His initial ROM measurements were abnormal or outside of normal range. His forward flexion was 0 to 40 degrees, extension was 0 to 10 degrees, lateral flexion was 0 to 20 degrees, and his lateral rotation was 0 to 20 degrees. Pain and tenderness were noted on the exam. The repeated use ROM measurements are a forward flexion of 0 to 30 degrees, extension of 0 to 5 degrees, lateral flexion of 0 to 20 degrees, lateral rotation of 0 to 20 degrees. It was noted that pain, fatigue, weakness, and lack of endurance caused functional loss. The exam determined that the Veteran has guarding or muscle spasm of the thoracolumbar spine resulting in abnormal gait or abnormal spine contour. Muscle atrophy was present in the left quadricep muscle. Moderate radiculopathy on the right side was also noted. IVDS was noted on the exam, but without episodes of prescribed bedrest in the past 12 months. The Veteran regularly used a cane for balance and a back brace for support and comfort. Diagnostic testing revealed arthritis of the spine. There was no evidence of ankylosis. The Veteran’s treatment records show a January 2014 rheumatology note where a spine exam was conducted. The exam found no evidence of atrophy, asymmetry, erythema, or scoliosis. His active ROM in degrees was flexion 60, extension 10, lateral bending 25, and rotation 45. A July 2013 thoracolumbar exam showed no evidence of atrophy, asymmetry, erythema, or scoliosis. His active ROM in degrees was flexion 50, extension 5, lateral bending 25, and rotation 45. The Veteran also testified at a Board hearing in August 2017. The Veteran testified that his back pain is debilitating. He stated that he is able to bend to the knees, but experiences pain when putting on his shoes. There is no evidence showing that unfavorable ankylosis of the thoracolumbar spine or of the entire spine and there is no evidence showing IVDS that caused incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. Accordingly, a rating in excess of 40 percent from January 1, 2010 is not warranted. In reaching the above decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert, 1 Vet. App. at 54; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to a rating increase for status post left knee meniscectomies DC 5256 provides that ankylosis of the knee with favorable angle in full extension, or in slight flexion between 0 and 10 degrees warrants a 30 percent rating, in flexion between 10 and 20 degrees warrants a 40 percent rating, in flexion between 20 and 45 degrees warrants a 50 percent rating, and extremely unfavorable, in flexion at any angle of 45 degrees or more warrants a 60 percent rating. DC 5257 provides for assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent evaluation for severe recurrent subluxation or lateral instability. DC 5258 provides for a 20 percent rating for a dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the knee joint. DC 5259 provides for a 10 percent rating for symptomatic residuals of removal of a semilunar cartilage. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, DCs 5260 and 5261. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. DC 5260 provides for a zero percent evaluation where flexion of the leg is only limited to 60 degrees. For a 10 percent evaluation, flexion must be limited to 45 degrees. A 20 percent evaluation is warranted where flexion is limited to 30 degrees. A 30 percent evaluation may be assigned where flexion is limited to 15 degrees. DC 5261 provides for a zero percent evaluation where extension of the leg is limited to five degrees. A 10 percent evaluation requires extension limited to 10 degrees. A 20 percent evaluation is warranted where extension is limited to 15 degrees. A 30 percent evaluation may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent evaluation, extension must be limited to 30 degrees. And finally, where extension is limited to 45 degrees a 50 percent evaluation may be assigned. DC 5055 provides for a 100 percent rating for one year following implantation of prosthesis. Afterwards, a 30 percent rating is assigned for chronic residuals consisting of intermediate degrees of residual weakness, pain or limitation of motion in the affected extremity. A 60 percent rating, the maximum rating, is assigned for chronic residuals consisting of severe painful motion or weakness in the affected extremity. 38 C.F.R. § 4.71a, DC 5055. A. Prior to June 15, 2010 The Veteran’s left knee disability was assigned a 20 percent rating under DC 525-5258 as the Veteran had prior knee surgeries accompanied with pain and arthritis. The Veteran was afforded a VA examination in November 2009. Symptoms of the knee disability noted by the examiner were giving way, pain, stiffness, weakness, decreased speed of joint motion, and popping and buckling. There was no evidence of instability, deformity, incoordination, ankylosis, or subluxation. Swelling and tenderness were also noted on the exam. The examiner determined that the Veteran had moderate flare-ups every three to four months precipitated by excess walking, standing, or yard work. The Veteran used a cane and wheelchair for his condition. During the active ROM testing, pain was noted. The measurements in degrees were left flexion 0 to 90 with normal extension. Additional limitation and pain was noted with repetitive motion. The measurements in degrees were left flexion 0 to 80 with normal extension. Based upon a review of the records, there is no evidence to support a rating in excess of 20 percent. The evidence does not show ankylosis, instability, or subluxation. The Veteran’s flexion was from 0 to 80 with repetitive motion and his extension was normal. Accordingly, a rating in excess of 20 percent prior to June 15, 2010 is not warranted. B. From June 15, 2010 The Veteran underwent a total left knee replacement surgery in June 2010. The Veteran was assigned the maximum schedular rating under DC 5055. As the maximum schedular rating was granted, an increase in rating is not warranted. C. From September 1, 2011 The Veteran was assigned a 30 percent rating under DC 5055 as his left knee replacement surgery manifested with intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran’s treatment records include a rheumatology visit in May 2014 where ongoing knee pain was noted. In July 2013, the Veteran had a knee exam where his ROM flexion was 135 degrees and his extension was 0 to 10 degrees. There was no evidence of gross deformity, atrophy, effusion, edema, or erythema. The Veteran had another knee exam in January 2014. His ROM was flexion of 90 degrees and extension of 0 to 10 degrees. Based upon the review of the record, there is no other evidence to support a rating in excess of 30 percent. As there is no evidence to show ankylosis, instability, subluxation, or to indicate the flexion and extension of the knee during this time, a rating in excess of 30 percent from September 1, 2011 is denied. D. From January 3, 2017 The Veteran was assigned a 60 percent rating under DC 5055 as his left knee replacement surgery manifested with chronic residuals consisting of severe painful motion or weakness in the affected extremity. The Veteran was afforded a knee and lower leg VA examination in January 2017. Initial ROM measurements for the left knee were determined to be abnormal or outside the normal range. His left knee flexion was between 0 and 90 degrees and his extension was between 90 to 0 degrees. The Veteran’s left knee limitations resulted in an inability to squat. Pain and knee joint tenderness was also noted on the exam. The ROM repeated use measurements for flexion were between 0 to 80 degrees and extension was 80 to 0 degrees. The examiner determined that the Veteran’s total left knee replacement resulted in chronic residuals consisting of severe painful motion or weakness. There was no evidence of crepitus, muscle atrophy, ankylosis, instability, or subluxation. A September 2017 primary care note noted that the Veteran’s left knee was infected, it did not heal correctly after surgery, and it never regained full ROM and function. The Veteran also testified at a Board hearing in August 2017. The Veteran testified that he has limited motion, swelling and pain since his knee surgery. He stated that he can bend his knee around 80 degrees and sits back when driving. The evidence of record supports a rating of 60 percent as the January 2017 VA examiner determined that the Veteran’s total knee replacement surgery resulted in chronic residuals of severe pain and weakness. However, there is no evidence to support a rating in excess of 60 percent as the Veteran did not have any other surgeries to again replace his left knee. Accordingly, a rating in excess of 60 percent from January 3, 2017 is not warranted. E. From February 26, 2018 The Veteran is assigned a 30 percent rating under DC 5055 as his left knee replacement surgery manifested with intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran was afforded a VA examination in February 2018. The examiner diagnosed with Veteran with status post knee replacement and status post left meniscectomies. The Veteran reported chronic pain and restricted ROM since his knee surgery. The Veteran also reported buckling without popping and locking. The Veteran reported flare-ups with stiff, dull aching pain. The examiner noted functional loss and impairment of the knee as the Veteran was not able to run, jump, kneel, or squat. Initial ROM measurement found a flexion of 0 to 80 degrees and extension 80 to 0 degrees with pain noted during flexion. Pain was noted with weight bearing and there was tenderness and pain on palpitation. After repeated use, pain, fatigue, weakness, and lack of endurance limited functional ability. The Veteran’s ROM measurements were flexion of 0 to 75 degrees and extension of 75 to 0 degrees. His flare-up ROM measurements were flexion of 0 to 70 degrees and extension of 70 to 0 degrees. Additional factors contributing to the disability noted by the examiner were atrophy of disuse and disturbance of locomotion. There was no evidence of joint instability or recurrent subluxation. The examiner determined that the residuals of the total knee replacement were intermediate degrees of residual weakness, pain or limitation of motion. The Veteran used a cane to assist with balance and support with ambulation. The VA treatment records show that the Veteran visited the VA pain clinic in May 2018. A knee exam was conducted and found no atrophy or erythema. The ROM was restricted in knee flexion at 90 degrees. Based upon a review of the record, there is no evidence to support a rating in excess of 30 percent. There is no evidence showing ankylosis, instability, or subluxation. The evidence does not show that the residuals of the knee surgery are chronic in nature. While the evidence shows complaints of pain and restricted ROM, the evidence does not support a 60 percent rating. Accordingly, a rating in excess of 30 percent from February 26, 2018 is denied. In reaching the above decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert, 1 Vet. App. at 54; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to a TDIU A claim for a TDIU is part of an increased rating claim when such a claim is raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, there is evidence suggesting that the Veteran’s service-connected disabilities interfere with his ability to maintain employment. As the record now raises a question of whether the Veteran is unemployable due to his service-connected disabilities, a claim for a TDIU is properly before the Board. A total disability rating may be assigned when the schedular rating is less than 100 percent where a veteran 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, that disability is rated 60 percent or more, or if there are two or more disabilities, there shall be at least one disability rated 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16. In determining whether a Veteran is unemployable for VA purposes, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hersey v. Derwinski, 2 Vet. App. 91 (1992); Faust v. West, 13 Vet. App. 342 (2000). A veteran need not show 100 percent unemployability in order to be entitled to a TDIU. Robertson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). From September 1, 2011, the Veteran has established service connection for lumbar spine foraminal stenosis, rated 40 percent disabling; status post knee replacement, rated 30 percent disabling; psoriasis, rated 10 percent disabling; right lower extremity radiculopathy, rated 10 percent disabling; lattice degeneration of the retina, maxillary sinusitis, right inguinal herniorrhaphy, urethral stricture, and residual scars, each rated noncompensable. The Veteran’s combined rating for compensation purposes was 70 percent, including the bilateral factor, effective September 1, 2011. 38 C.F.R. §§ 4.25, 4.26. Therefore, the Veteran met the schedular rating criteria for TDIU beginning September 1, 2011. 38 C.F.R. § 4.16 (a). The remaining inquiry is whether he was unable to secure or follow substantially gainful occupation due solely to service-connected disabilities. The evidence of record shows that the Veteran last worked in 2002 when he stopped working due to his service-connected lumbar spine condition. The Veteran is an accountant by trade who earned a Business degree with the assistance of the VA. During the August 2017 Board hearing, the Veteran testified that his back pain is debilitating, as he cannot sit, lay, or stand which has kept his from meaningful employment. The Veteran testified that he last worked in 2002 or 2001 at First American Title. He had difficulty sitting and standing at the job as he made thousands of copies daily. He added that his bosses complained daily about how much time he spent at the doctor and they were concerned with the amount of time he was missing from work. He also added that he stays in the house in the bed when he has bad days. In an October 2012 letter from the Veteran, he asserted that his health has prevented him from working. He stated that he gets tired and he goes to bed. In a December 2010 letter to the Veteran’s state representative, he said that although he completed vocational rehabilitation, his knee and back surgeries have set him back. He added that he was still in an extreme amount of pain. In another letter sent by the Veteran in July 2010, he stated that he volunteered with Social Security in 2009 for two months, but was let go because of the amount of time he missed due to sickness and medical appointments. A February 2010 Vocational Rehabilitation correspondence documents that the Veteran was not job ready as he was recovering from his back surgery. It was noted that his recovery was taking longer than anticipated. During a November 2009 VA exam, the examiner noted that the Veteran left his job as a quality assurance clerk in 2002 due to his back disability. Based on the foregoing, the Board finds that the totality of the evidence supports a finding that the Veteran’s service-connected disabilities render him unemployable. Specifically, the evidence suggests that the Veteran’s lumbar spine disability impacted his ability to perform tasks due to debilitating pain. The evidence shows that the Veteran made an effort in 2009 to return to the workforce, but was unable to maintain a volunteer job due to missing multiple days of work due to pain and medical appointments. The Veteran has been unable to use his Business degree as his lumbar spine disability and other service-connected disabilities have prevented him from securing and following substantially gainful employment. Therefore, the Board finds that the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability. Accordingly, TDIU is warranted beginning September 1, 2011. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hartford, Associate Counsel