Citation Nr: 18158039 Decision Date: 12/18/18 Archive Date: 12/14/18 DOCKET NO. 15-25 791 DATE: December 18, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. Entitlement to a compensable rating for pterygium is denied. Entitlement to a compensable rating for headaches prior to July 12, 2016 is denied. Entitlement to a 50 percent rating, but no greater, for headaches as of July 12, 2016 is granted, subject to the laws and regulations controlling the disbursement of monetary benefits. Entitlement to a rating in excess of 50 percent for major depressive disorder is denied. In an August 2015 rating decision, the RO denied an increased rating in excess of 10 percent for both right and left knee osteoarthritis and denied an increased rating in excess of 10 percent for both right and left shoulder degenerative joint disease. In his October 2015 notice of disagreement, the Veteran expressed disagreement with the evaluation of the disabilities as well as the effective date of the awards. As no increased rating was granted for either the Veteran’s knee or shoulder disabilities in the August 2015 rating decision, the Veteran may have intended to claim an earlier effective date for service connection for the disabilities. Effective March 24, 2015, when a claimant indicates a desire to apply for VA benefits, but the communication does not meet the standards of a complete claim for benefits, the communication will be considered a request for an application form for benefits under 38 C.F.R. § 3.150 (a). 79 Fed. Reg. 57,660, 57,695 (Sept. 25, 2014); 38 C.F.R. § 3.155(a) (2017). Therefore, the communication is referred to the AOJ for clarification and any appropriate action. 38 C.F.R. § 19.9 (b) (2017). REMANDED Entitlement to a rating in excess of 10 percent for left knee osteoarthritis is remanded. Entitlement to a rating in excess of 10 percent for right knee osteoarthritis is remanded. Entitlement to a rating in excess of 10 percent for left shoulder degenerative joint disease is remanded. Entitlement to a rating in excess of 10 percent for right shoulder degenerative joint disease is remanded. FINDINGS OF FACT 1. The Veteran does not have a bilateral hearing loss disability for VA purposes. 2. The Veteran’s pterygium does not result in any visual impairment, disfigurement, active conjunctivitis, or incapacitating episodes. 3. Prior to July 12, 2016, the evidence does not reflect that the Veteran had characteristic prostrating attacks of headache pain. 4. As of July 12, 2016, the Veteran’s headache condition manifest with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 5. The Veteran’s major depressive disorder manifests with symptoms including depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances, that cause no more than occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2017). 2. The criteria for entitlement to a compensable rating for pterygium have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 6034-6066 (2017). 3. The criteria for entitlement to a compensable rating for headaches prior to July 12, 2016 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100 (2017). 4. The criteria for entitlement to a 50 percent rating, but no greater, for headaches as of July 12, 2016 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100 (2017). 5. The criteria for entitlement to a rating in excess of 50 percent for major depressive disorder have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9434 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection 1. Entitlement to service connection for bilateral hearing loss Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2017). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection for an organic disease of the nervous system may be granted if such disease is manifested in service, or manifested to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1110, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). Sensorineural hearing loss is considered by VA to be an organic disease of the nervous system and is thus subject to presumptive service connection under 38 C.F.R. § 3.309(a) (2017). M21-1MR III.iv.4.B.12.a. Impaired hearing is considered a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2017). The Veteran was afforded a VA audiological examination to assess his hearing in August 2015. The examination showed pure tone thresholds, in decibels, as follows: In the right ear, 20 at 500 Hertz, 10 at 1000 Hertz, 20 at 2000 Hertz, 25 at 3000 Hertz, and 25 at 4000 Hertz. In the left ear, 20 at 500 Hertz, 15 at 1000 Hertz, 20 at 2000 Hertz, 25 at 3000 Hertz, and 20 at 4000 Hertz. The Veteran’s speech recognition scores were 100 percent bilaterally. Thus, the August 2015 VA examination does not support that the Veteran has impaired hearing considered a disability for VA purposes. There is no other audiological testing of record that supports impaired hearing at a level meeting the VA’s definition of disability. Therefore, the Board must deny the Veteran’s claim for service connection for hearing loss. The Veteran is reminded that should his hearing loss worsen, he may contact VA and petition to reopen his claim for disability compensation benefits. Increased Rating Disability evaluations 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. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2017). If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 2. Entitlement to a compensable rating for pterygium The Veteran currently has a noncompensable rating for pterygium under Diagnostic Code 6034. See 38 C.F.R. § 4.79 (2017). During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. The former criteria for Diagnostic Code 6034 instructed to evaluate based on visual impairment, disfigurement (diagnostic code 7800), conjunctivitis (diagnostic code 6018), etc. depending on the particular findings. The revised criteria for Diagnostic Code 6034 instruct to evaluate based on the General Rating Formula for Diseases of the Eye, disfigurement (diagnostic code 7800), conjunctivitis (diagnostic code 6018), etc. depending on the particular findings, and all ratings should be combined pursuant to 38 C.F.R. § 4.25. The Board notes that the General Rating Formula for Diseases of the Eye instructs to rate based on incapacitating episodes or visual impairment, whichever would afford a higher rating. Thus, the change to the rating criteria effectively just added consideration of incapacitating episodes because visual impairment was to be considered in the former criteria. Regarding combining ratings under 38 C.F.R. § 4.25, this language appears to clarify how the rating criteria should be applied and does not represent a substantive change; separate disabling effects should have been combined pursuant to 38 C.F.R. § 4.25 under the former criteria. For a compensable rating on the basis of incapacitating episodes under the General Rating Formal for Diseases of the Eye, a veteran must have required at least one but less than 3 treatment visits for his eye condition during the past 12 months. For the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. 38 C.F.R. § 4.79, Note (1). Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. 38 C.F.R. § 4.79 (2017). Here, the Veteran has not contended, and the record does not suggest, that the Veteran had undergone any treatment visits for his eye condition within 12 months of the effective date of the change in the rating criteria. Therefore, a compensable rating is not warranted based on incapacitating episodes. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a) (2017). Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1) (2017). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. 38 C.F.R. § 4.76(c) (2017). Here, on VA compensation and pension examination in both February 2012 and August 2015, testing showed the Veteran’s corrected distance vision to be 20/40 or better. He did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. Therefore, a compensable rating is not warranted for loss of visual acuity. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.77 (2017). Here, VA examination in both February 2012 and August 2015 noted no impairment of visual field. Therefore, a compensable rating is not warranted for impairment of visual field. Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78(a) (2017). Here, VA examination in both February 2012 and August 2015 noted no diplopia. Therefore, a compensable rating is not warranted for impairment of muscle function. Disfigurement of the head, face, or neck is rated under Diagnostic Code 7800. A compensable rating requires at least one of the following characteristics of disfigurement: a scar more than 13 cm in length, a scar at least 0.6 cm wide, surface contour of scar elevated or depressed on palpation, scar adherent to underlying tissue, or any of the following in an area exceeding 39 square cm: skin hypo- or hyper-pigmented, skin texture abnormal, underlying soft tissue missing, or skin indurated and inflexible. On VA examination in February 2012 the Veteran was noted to have a nasal corneal scar on the left. On VA examination in August 2015, he was noted to have a left nasal pterygium of about 1.5 millimeters and two microscopic inferior opacities and a right nasal pterygium of about 0.5 millimeters. Both the 2012 and 2015 VA examiners indicated that the condition did not result in any characteristics of disfigurement. Thus, the Board finds that the Veteran’s service-connected pterygium does not result in any characteristics of disfigurement such that a rating would be warranted under Diagnostic Code 7800. The Board acknowledges that the Veteran has expressed some subjective complaints with respect to his eyes. A May 2011 VA optometry treatment record notes a complaint of irritating, burning, and watery eyes. He reported no pain on examination and his conjunctiva were noted to be white and quiet. He was prescribed artificial tears and told to use a warm compress and vertical massage to treat his symptoms. When he filed his claim in July 2011 the Veteran reported he has a feeling of having something in his eyes, persistent redness, inflammation, tearing, irritation, and being sensitive to sunlight. At his February 2012 VA examination he reported he has irritation, dryness and redness. He reported using artificial tears five to six times per day. At his August 2015 VA examination he reported crusting and redness. Both the former and revised criteria for Diagnostic Code 6018 distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. 38 C.F.R. § 4.79 (2017). Both the former and revised criteria state that inactive chronic conjunctivitis is to be rated based on residuals such as visual impairment of disfigurement. The Board has considered whether the Veteran is entitled to a 10 percent rating for active disease process under Diagnostic Code 6018, but finds that the evidence does not support that the Veteran has chronic conjunctivitis or that his condition should be rated by analogy under that code. There are no objective findings of any inflammation, redness, or dryness in either of the Veteran’s eyes either in medical records or on VA examination in February 2012 or August 2015. The Veteran has made some subjective complaints, but there is no objective evidence of those complaints, nor any evidence that the Veteran has active chronic conjunctivitis. Based on the forgoing, the Board finds that a preponderance of the evidence is against a compensable rating for pterygium. 3. Entitlement to a compensable rating for headaches The Veteran currently has a noncompensable rating for headaches under Diagnostic Code 8100. See 38 C.F.R. § 4.124a. Under the Schedule of Ratings for neurological conditions and convulsive disorders, a 10 percent rating is assigned for characteristic prostrating attacks averaging one in two months over the last several months. A noncompensable rating is warranted with less frequent attacks. A 30 percent evaluation is warranted for characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent evaluation is warranted for migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Governing case law and regulations have not defined “prostrating.” However, for reference, the Board notes that “prostration” is defined as “extreme exhaustion or powerlessness.” See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d. ed. 2012). A November 2011 VA treatment record relates that the Veteran reported he has been having migraine headaches almost three times a week for the past six months. He described the intensity as an 8 out of 10 and indicated that they tend to occur in the early evening and are relieved by Tylenol migraine or BC powder, but take a while to go away. He reported associated nausea and some blurring of vision before headaches. A December 2011 VA treatment note states that the Veteran reported that Sumatriptan had helped a great deal to relieve him of his headaches. On VA examination in February 2012, he reported having two to three nonincapacitating headaches a week but no incapacitating headaches. When he has a headache he reported pulsating or throbbing head pain, pain on both sides of the head, nausea, and sensitivity to light, with a duration of less than a day. The examiner indicated that the Veteran does not have characteristic prostrating attacks of headache pain and the condition does not impact his ability to work. In February 2012 he had a neurology consultation for his headaches. He reported two to three headaches a week with a pain of 7 out of 10 and a duration of two hours. He is noted to have good results with Imitrex. An April 2012 VA treatment note states that the Veteran reported he was unable to tolerate the prophylactic medication prescribed by the neurologist. On VA examination in July 2015, the Veteran is noted to have reported a history of migraines two to three times a week, none incapacitating, and to use Imitrex tablets, which control his migraine symptoms. He reported the same headache symptoms and duration as on VA examination in February 2012. The examiner indicated that the Veteran does not have characteristic prostrating attacks of headache pain and the condition does not impact his ability to work. On July 12, 2016 a private doctor spoke with the Veteran and reviewed his medical records to complete a VA disability benefits questionnaire with respect to the Veteran’s headache condition. The doctor stated that the Veteran’s headache symptoms include constant head pain, pulsating or throbbing head pain, pain worsens with physical activity, nausea, sensitivity to light and sound, changes in vision, and dizziness. The doctor stated that the Veteran has prostrating headaches two to three times a week lasting five to 12 hours, and that when the headaches occur the Veteran must lie down in a dark environment for several hours at a time. He noted the Veteran reported his headache pain to be 10 out of 10. He checked that the Veteran has very frequent and prolonged attacks of migraine headache pain and indicated that he would miss three or more days of work per month, would leave early 3 or more days per month, and more than three days per month would not be able to stay focused for at least 7 hours of an 8-hour workday due to headaches. In a letter dated June 28, 2016, the Veteran’s supervisor for the past year stated that at least twice a week the Veteran has requested to leave early or missed work due to headaches. The Board finds that giving him the benefit of the doubt, the Veteran is entitled to a 50 percent rating for headaches as of July 12, 2016. The July 2015 VA examiner opined that the Veteran does not have prostrating attacks of headache pain, whereas the July 12, 2016, private doctor’s report supports that the Veteran does have completely prostrating and prolonged attacks. Further, the Veteran’s supervisor at work reported that the Veteran either leaves early or misses work at least twice a week. As the supervisor dated the letter June 28, 2016 and indicated that he had supervised the Veteran for approximately a year, and there is no other evidence available as to the exact date on which the Veteran’s headaches were of a severity and frequency that he was missing so much work, the Board finds that the earliest effective date that can be assigned for the award of the 50 percent rating is July 12, 2016. Prior to July 12, 2016, the Board finds that the evidence does not support a compensable rating for the Veteran’s headache condition. For a 10 percent rating, a veteran must have characteristic prostrating attacks averaging one in two months. Here, the evidence consistently indicates that the Veteran had headaches two to three times per week. However, the evidence does not support that the headache severity rose to the level of causing a prostrating attack. VA examiners in both February 2012 and July 2015 indicated that the Veteran’s reported headaches are not incapacitating and he has not experienced characteristic prostrating attacks of headache pain. The Veteran’s own statements to the VA and VA treatment records include only the Veteran’s reports that he has headaches, but do not support that those headaches result in characteristic prostrating attacks. In November 2011, the Veteran reported he treated his headaches with over-the-counter medication, describing the intensity as 8 out of 10. In February 2012, he described the intensity as a 7 out of 10 and reported the headaches last two hours. In July 2016 however, the Veteran was noted to describe his headache pain as a 10 out of 10, suggesting a worsening at that time. There is no description of the headache pain or its functional impact in the record prior to July 12, 2016 on which the Board can base a finding that the headaches, as reported by the Veteran, caused prostrating attacks. Based on the forgoing, the Board finds that a preponderance of the evidence is against finding that the Veteran is entitled to a compensable rating for headaches prior to July 12, 2016. However, giving him the benefit of the doubt, he is entitled to a 50 percent rating as of July 12, 2016.   4. Entitlement to a rating in excess of 50 percent for major depressive disorder The Veteran currently has a 50 percent rating for major depressive disorder assigned under Diagnostic Code 9434. See 38 C.F.R. § 4.130 (2017). Diagnostic Code 9434 provides major depressive disorder should be rated under the General Rating Formula for Mental Disorders. Under the General Formula, a 50 percent rating is provided where there is 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- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is provided for 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); inability to establish and maintain effective relationships. Id. A maximum 100 percent rating is provided for total occupational and social impairment due to symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; danger of hurting self or others; intermittent inability to perform activities of living (including maintenance of minimal hygiene); disorientation to time or place; or, memory loss for names of close relatives, occupation, or own name. Id. Symptoms listed in VA’s general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely the basis of social impairment. 38 C.F.R. § 4.126(b). In August 2014 the Veteran sought mental health treatment at the VA. Initial testing indicated that the Veteran’s reported symptoms met the criteria for minor depression or depression in partial remission. The Veteran reported that his depressive symptoms make it not at all difficult to do his work, take care of things at home, or get along with others. The Veteran reported contact with friends or relatives about once a month. A September 2014 VA treatment record notes that the Veteran has been employed for the same company for 10 years and has been married for 25 years. The psychologist noted the Veteran to be alert and cooperative with speech of normal rate and volume, fair eye contact, and normal psychomotor activity. His mood was anxious and affect restricted. His attention and concentration were normal and his thought processes linear and goal-directed. His judgment was noted to be fair and insight limited. At his next appointment later in September, at his next two appointments in October, and at an appointment in November he was noted to have a slightly anxious mood, constricted affect, fair insight, and good judgment. His speech and thought processes were normal, his appearance neat, and he was oriented. He reported stable mood and communication at his November appointment and treatment was discontinued. A July 2015 treatment record indicates that the Veteran scored a 33 on the Beck Depression Inventory, which has a range from 0 to 63, with severe depression indicated with a score above 29. In September 2015 the Veteran underwent a VA compensation and pension mental health examination. The examiner opined that the Veteran’s depressive disorder causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. He scored a 25 on the Beck Depression Inventory, indicating moderate depression. Symptoms of depression, apathy, anhedonia, irritability, decreased appetite, decreased concentration, fatigue, and decreased libido were listed. The examiner indicated the Veteran had the following symptoms: depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances. The Veteran reported starting a less stressful and less physically demanding job. He reported taking sick days and planned days off due to his depression but had not been disciplined and the condition had not negatively impact his performance. He also reported working a second job for additional income. He reported some tension in his marriage over finances, and said he was on good terms with his family. On examination, the examiner found the Veteran to be appropriately attired, cooperative, with on task attention, and goal-directed thought processes and content. He maintained eye contact and had speech of normal rate and pitch. His mood was dysphoric and affect congruent. His judgment was noted to be reliable and he demonstrated recent and remote memory. The Board finds that considering all of the Veteran’s symptoms, as he himself has described them, and their impact on his occupational and social functioning, a rating in excess of 50 percent is not warranted. The Veteran’s overall functioning approximates, at most, occupational and social impairment with reduced reliability and productivity. Occupationally, the Veteran has reported being employed throughout the period on appeal, initially with the same company for a decade, and later he reported gaining employment in a new job. An August 2014 VA treatment note indicates that the Veteran reported his depressive symptoms did not make it more difficult to do his work. At his September 2015 VA examination, he reported taking time off from work due to his depression, but indicated that the condition had not negatively impacted his job performance. The Board acknowledges that the September 2015 VA examiner did indicate that the Veteran had difficulty in adapting to stressful circumstances, including in a work or work-like setting. However, even accepting those difficulties, the Veteran has maintained employment with no indication of problems performing his job, although he has reported taking some time off due to depressive symptoms. Socially, the Veteran has maintained a more than two-decade marriage, and although he has reported financial and infidelity stressors, he reported working on communication and improving the relationship during the period on appeal. He has also reported having a good relationship with other family members. The 2015 VA examiner and treatment providers have consistently noted him to be cooperative and able to maintain eye contact. The Veteran himself has also not reported an inability to establish or maintain effective relationships. Further, on examination the Veteran has been noted to have goal-directed thought processes and content, normal speech, and neat appearance. He demonstrated recent and remote memory on examination in September 2015. He has consistently denied any suicidal ideation. Based on the forgoing, the Board finds that the Veteran’s overall functioning does not more closely approximate the impairment warranted for a rating in excess of 50 percent. Therefore, his claim is denied. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for left knee osteoarthritis and in excess of 10 percent for right knee osteoarthritis is remanded. The U.S. Court of Veterans Appeals for Veterans Claims (Court) has held that to be adequate a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59. Correia v. McDonald, 28 Vet. App. 158 (2016). That sentence directs that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. Unfortunately, the Veteran’s July 2015 examination of his knees does not include all of the required testing. Specifically, only one set of range of motion measurements is given. Therefore, a new examination is needed. 2. Entitlement to a rating in excess of 10 percent for left shoulder degenerative disc disease and a rating in excess of 10 percent for right shoulder degenerative disc disease is remanded. The Veteran’s July 2015 VA shoulder examination also does not include all of the required testing. See Correia, 28 Vet. App. 158. Specifically, only one set of range of motion measurements is given. Therefore, a new examination is needed. 3. Entitlement to a total disability rating on the basis of individual unemployability due to service-connected disabilities (TDIU). In his July 2016 brief, the Veteran’s attorney argued that the Veteran is entitled to TDIU. He argued that the Veteran is only able to work because he is receiving special accommodations for his service-connected disabilities. After giving the Veteran an opportunity to file a formal claim for a TDIU, the AOJ should adjudicate this matter in the first instance.   The matters are REMANDED for the following action: 1. Provide appropriate Veterans Claims Assistance Act notice with respect to the claim for a TDIU. Ask the Veteran to complete and return a VA Form 21-8940, Veteran’s Application for Increased Compensation Based upon Unemployability. Also ask the Veteran to furnish any additional information and/or evidence pertinent to the claim for a TDIU, and complete all necessary development. 2. Obtain the Veteran’s VA treatment records from September 2015 to present. 3. Arrange for the Veteran to undergo a new VA examination of his knee and shoulder disabilities. The examiner is asked to review all relevant records and conduct a clinical evaluation. Based on this review, the examiner is asked to provide an assessment of the current nature of the Veteran’s knee and shoulder disabilities. Range of motion of the right and left knees and right and left hips should be tested actively and passively, in weight-bearing and nonweight-bearing, and after repetitive use. The examiner should consider whether there is likely to be additional range of motion loss due to any of the following: (1) during flare-ups; and, (2) as a result of pain, weakness, fatigability, or incoordination. If so, the examiner is asked to describe the additional loss, in degrees, if possible. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. 4. Thereafter, readjudicate the Veteran’s pending claims in light of any additional evidence added to the record. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board for appellate review. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Christensen