Citation Nr: A19001558 Decision Date: 09/26/19 Archive Date: 09/25/19 DOCKET NO. 180806-16593 DATE: September 26, 2019 ORDER Service connection for diabetes mellitus due to herbicide exposure is denied. Service connection for radiculopathy of the right lower extremity as secondary to the service-connected lumbar spine disability is denied. Service connection for radiculopathy of the left lower extremity as secondary to the service-connected lumbar spine disability is denied. A rating in excess of 20 percent for degenerative joint disease, lumbar spine, with intervertebral disc syndrome from April 6, 2010 to December 9, 2017 is denied. A rating in excess of 10 percent for traumatic arthritis, right knee from August 30, 2007 to December 9, 2017 is denied. A rating in excess of 10 percent for traumatic arthritis, left knee from August 30, 2007 to December 9, 2017 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) by reason of service-connected disabilities is denied. FINDINGS OF FACT 1. The preponderance of evidence is against finding that the Veteran was exposed to herbicides during service. 2. The preponderance of evidence is against finding that the Veteran has had radiculopathy of the right lower extremity at any time during or approximate to the pendency of the claim. 3. The preponderance of evidence is against finding that the Veteran has had radiculopathy of the left lower extremity at any time during or approximate to the pendency of the claim. 4. Forward flexion of the lumbar spine was, at worst, to 50 degrees with no incapacitating episodes necessitating physician prescribed bed rest. 5. Neither the Veteran’s right or left knee disabilities were manifested by limitation of flexion to 30 degrees or less. 6. The evidence does not reveal factors outside the norm resulting in unemployability due to the Veteran’s service-connected lumbar spine and knee disabilities based on the Veteran’s education, training, and prior work experience. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for radiculopathy of the right lower extremity due to the service-connected lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for radiculopathy of the left lower extremity due to the service-connected lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for a rating in excess of 20 percent for the lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.71a, Diagnostic Codes 5242 and 5243. 5. The criteria for a rating in excess of 10 percent for the right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5260. 6. The criteria for a rating in excess of 10 percent for the left knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5010-5260. 7. The criteria for TDIU are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1961 to January 1963. These matters come before the Board of Veterans’ Appeals (Board) from a December 2007 legacy rating decision denying an increased rating for the right and left knee disabilities, a February 2009 legacy rating decision denying TDIU, a June 2010 legacy rating decision denying service connection for right and left lower extremity radiculopathy and an increased rating for the lumbar spine disability, and an April 2011 legacy rating decision denying service connection for diabetes mellitus. In January 2017, the Veteran elected the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (codified at 38 C.F.R. § 19.2(d)). The Veteran selected the Higher-Level Review lane when he opted in to the Appeals Modernization Act (AMA) review system by submitting a Rapid Appeals Modernization Program (RAMP) election form. Accordingly, a January 2018 RAMP rating decision considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this rating decision to the Board and requested the Evidence Docket at the Board to afford him 90 days to submit additional evidence. Due to the RAMP election form, the January 2018 RAMP rating decision is the rating decision currently on appeal and replaces those legacy rating decisions identified in the preceding paragraph for procedural purposes. In the January 2018 RAMP rating decision, the Agency of Original Jurisdiction (AOJ) found that the Veteran had a diagnosis of diabetes mellitus. The Board is bound by this favorable finding. 84 Fed. Reg. 138, 167 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.104(c)). The Board acknowledges that the Veteran referenced his claim for a helpless child in a February 2018 correspondence. The Board informs the Veteran that his helpless child claim was denied in a December 2013 Board decision and therefore was no longer in appellate status at the time he elected into RAMP. Therefore, this claim will not be discussed. The Board also acknowledges that evidence was added to the claims file during a period of time when new evidence was not allowed. Therefore, the Board may not consider this evidence. 84 Fed. Reg. 138, 182 (Jan. 18, 2019) (codified at 38 C.F.R. § 20.300). The Veteran may file a Supplemental Claim and submit or identify this evidence. 84 Fed. Reg. 138, 182 (Jan. 18, 2019) (codified at 38 C.F.R. § 3.2501). If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board also acknowledges that in August 2019 the AOJ issued a decision addressing issues addressed in this appellate decision. The Board, however, moves forward with issuing this decision as it has appellate jurisdiction. Service Connection 1. Service connection for diabetes mellitus is denied. The Veteran contends that his diabetes is due to handling herbicides while working as a supply handler during service. In a statement received by VA in August 2011, the Veteran stated that they sent supplies to units in Vietnam and Agent Orange was on the list. When a veteran develops diabetes mellitus, type II and it has been shown that the veteran was exposed to herbicides, to include Agent Orange, during service, then presumptive service connection is established. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Service connection for diabetes mellitus, type II may also be established on a direct basis. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. This requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The AOJ found that the Veteran has a current diagnosis of diabetes. Therefore, the question in this case is whether the Veteran was exposed to herbicides during service. The Board finds that the evidence weighs against in-service herbicide exposure. Review of the Veteran’s military personnel record indicates that presumptive exposure under 38 C.F.R. § 3.307(a)(6)(iii) does not apply based on the Veteran’s dates of service and duty locations. Nonetheless, herbicide exposure may be established on a facts-found basis. In a March 2017 VA memorandum, the AOJ provided that all efforts to corroborate herbicide exposure at the Veteran’s duty stations (Fort Benning, Georgia; Fort Hood Texas Army Post; and Dachau, Germany) had been exhausted. The AOJ found that the information provided by the Veteran, which was that he worked in a warehouse during service, would not assist in verifying herbicide exposure and was insufficient to refer to the appropriate records repository for further research. The Board finds that the AOJ did not error by not undertaking further efforts to refer the Veteran’s alleged herbicide exposure for further research. The Veteran is not competent to state that he came into contact with or was contaminated by herbicides. His lay statements have not been corroborated by any official documents. See Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010) (a layperson’s assertions indicating exposure to gases or chemicals during service are not sufficient evidence alone to establish that such an event actually occurred during service). The Board finds the Veteran’s assertion that he was exposed to herbicides is not consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154(a). Furthermore, the Board finds that there is no error in the AOJ not providing the Veteran with a VA examination. Absent evidence of in-service exposure to herbicides, no examination is required. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Based on the foregoing, the Board finds that the preponderance of evidence is against this service connection claim because there is no evidence of an in-service event and the claim must be denied. As such, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for radiculopathy of the right lower extremity is denied. 3. Service connection for radiculopathy of the left lower extremity is denied. The Veteran contends that he has lower extremity radiculopathy secondary to his service-connected lumbar spine disability. He claims that his “legs are asleep most of the time.” See July 2009 Notice of Disagreement (submitted on a VA Form 9). Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. This still requires that there be a current diagnosis of a disability. The Board concludes that the Veteran does not have a current diagnosis of radiculopathy of the lower extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A May 2010 VA electrodiagnostic study evaluated the Veteran for possible bilateral lumbosacral radiculopathy and reported that the Veteran had chronic low back pain but denied radicular pain. The Veteran reported that he had tingling in his anterior thighs and anterolateral legs. Nerve conduction studies were normal. The clinician conducting the study found no electrical evidence of either acute or chronic radiculopathy in both the right and left side, as well as no evidence of sensory motor polyneuropathy in the lower extremities. At an April 2010 VA examination, the Veteran reported sharp radiating pain to his legs. A sensory examination of the Veteran’s lower extremities was normal. The examiner also reviewed the May 2010 VA electrodiagnostic study cited above. The examiner made a diagnosis of back pain with no objective evidence of radiculopathy. At a May 2011 VA examination, the Veteran reported sharp radiating pain in his buttocks. The sensory examination of the Veteran’s lower extremities was normal, and the examiner found no other abnormalities in the extremities. At a November 2012 VA examination, the sensory examination of the Veteran’s lower extremities was normal. The examiner indicated that there were no signs or symptoms of radiculopathy. The examiner made a diagnosis of degenerative disease of the lumbar spine with no radiculopathy. At a March 2014 VA examination, the Veteran reported numbness in both feet. His examination demonstrated that the lower extremities were normal. The examiner opined that there was no evidence of radiculopathy. The examiner cited a January 2005 lumbar spine MRI showing no evidence of disc herniation nerve root impingement, as well as the already cited electrodiagnostic study showing no radiculopathy. Thereafter, at two more VA examinations conducted in June 2015 and June 2016, the sensory examination of the Veteran’s lower extremities remained normal. The examiner continued to find no signs or symptoms of radiculopathy. VA treatment records during the appellate period of January 2010 to December 2017 are absent for any diagnosis of radiculopathy of the lower extremities. Similarly, these records are not suggestive of complaints of radicular pain in the lower extremities. The Board finds that the Veteran’s statement in his July 2010 Notice of Disagreement lacks credibility. His statements in the record are inconsistent; he has episodically reported different types of pain in his buttocks, feet, and legs. In regards to affording the Veteran’s lay statements less weight, the Board also finds it highly probative that there are no ongoing reports of symptoms from the Veteran to his treating providers, despite treatment for chronic low back pain. See AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013) (recognizing widely held view that absence of an entry in a record may be considered evidence that a fact did not occur if it appears that the fact would have been recorded if present); cf. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Accordingly, the Board gives the Veteran’s lay statements little weight, especially in light of the overwhelming amount of objective medical testing conducted over the pendency of this appeal indicating no abnormalities in the lower extremities. Furthermore, while the Veteran believes he has radiculopathy in the lower extremities due to his service-connected lumbar spine disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple body systems and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As the record reflects that the Veteran has various comorbid conditions that could cause sensations of numbness in the lower extremities, the Board must give more probative weight to the objective neurological testing in the record conducted to detect radiculopathy, over the Veteran’s general lay assertions. The Board finds it dispositive to this decision that after six VA examinations no examiner found radiculopathy. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Veteran has not presented or identified any contrary medical opinion that supports these claims for service connection. Consequently, the Board adopts the findings from the VA examinations that have consistently shown no diagnosis of radiculopathy secondary to the lumbar spine in the lower extremities. Such findings are consistent with the May 2010 VA electrodiagnostic study demonstrating no neurologic abnormalities in the lower extremities. In sum, the majority of evidence weighs against a finding of a current diagnosis of radiculopathy of the lower extremities. Based on the foregoing, the Board finds that the preponderance of evidence is against these service connection claims because there is no evidence of a current disability secondary to the service-connected lumbar spine and the claims must be denied. As such, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 4. A rating in excess of 20 percent for degenerative joint disease, lumbar spine, with intervertebral disc syndrome from April 6, 2010 to December 9, 2017 is denied. The Veteran seeks a higher rating for his lumbar spine disability, claiming that his back is in pain all the time. The Veteran’s lumbar spine disability has been rated as 20 percent disabling throughout the appeal. Prior to June 12, 2015 the lumbar spine disability was rated under Diagnostic Code 5242 for degenerative arthritis of the spine, and thereafter was rated under Diagnostic Code 5243 for intervertebral disc syndrome (IVDS). Diagnostic Code 5242 is under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). Under the General Formula, a 40 percent rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Formula (Diagnostic Codes 5235 through 5243). Diagnostic Code 5243 for IVDS instructs that IVDS is to be evaluated either under the General formula or based on incapacitating episodes, whichever results in the higher rating. Under Diagnostic Code 5243, a 40 percent 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. A maximum 60 percent rating is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 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, General Rating Formula, Note (1). At an April 2010 VA examination, the Veteran reported decreased motion, stiffness, and pain in the low back. He reported that the pain was of a moderate severity occurring constantly and daily. He further indicated that there were flareups, but no details were provided in the examination report. There was no report of incapacitating episodes due to the lumbar spine disability. The Veteran further reported that he needed a cane or wheelchair to walk and he was unable to walk more than a few yards. Objective orthopedic testing demonstrated forward flexion of the lumbar spine to 65 degrees with no objective evidence of pain following repetitive use and no additional loss of motion after repetitive use testing. The examiner remarked that this examination was consistent with the Veteran’s last VA spine examination conducted in July 2009, and there was minimal improvement in the range of motion of the lumbar spine. At a May 2011 examination, objective orthopedic testing demonstrated forward flexion of the lumbar spine to 60 degrees with no objective evidence of pain following repetitive use and no additional loss of motion after repetitive use testing. The Veteran received two more VA examinations in November 2012 and June 2015. Objective orthopedic testing demonstrated forward flexion of the lumbar spine to 50 degrees, with pain starting at 50 degrees and no additional loss of motion following repetitive use testing. Pain was noted to cause functional loss with repetitive use over a period of time. The Veteran described the impact of flareups as prolonged walking and lifting. He also responded to flareups as “hurts in the morning.” The Veteran claimed he could not walk more than 1/4 mile and could not stand for more than 30 to 40 minutes. Neither the November 2012 nor June 2015 examinations found that there were incapacitating episodes over the past 12 months due to IVDS. In May 2017, the Director of Compensation and Pension Service rendered a negative determination regarding an extraschedular rating for the lumbar spine disability under 38 C.F.R. § 3.321. The Director recommended continuation of the 20 percent rating for the lumbar spine disability. The Director provided that the record showed limitation of motion, degenerative joint disease, guarding resulting in an abnormal gait, and pain on motion, which satisfies the criteria for a 20 percent rating under Diagnostic Code 5242. The Director stated that although the Veteran contended functional loss with severe restrictions in standing, walking, and lifting due to pain and limitation of motion, and additional pain after repetitive use testing was shown; the evidence did not demonstrate such level of disability and functional loss, including no findings of additional limitation of motion, fatigue, weakness, or incoordination. The Director further added that there were no objective findings indicative of a severe disability, to include no fatigue, muscle atrophy, muscle spasms, muscle weakness, or incoordination, and no indication of need for surgery. The Director ultimately concluded that there was no evidence demonstrating that the lumbar spine disability caused marked interference with employment or frequent hospitalizations, and resulted in impairment in occupational functioning and earning capacity that was not adequately represented by the current assigned rating and therefore an extraschedular rating was not recommended. VA treatment records during the appeal period from April 2010 to December 2017 document chronic low back pain; they contained no range of motion measurements nor reports of flareups. In addition, an antalgic gait was documented in VA examinations and VA treatment records. At no time, did VA examinations or VA treatment records document any type of ankylosis of the spine. Based on the foregoing, the AOJ did not error in denying a rating in excess of 20 percent. There is no documentation that forward flexion of the lumbar spine was ever limited to 30 degrees or less. Throughout the appeal, the Board finds that the Veteran’s functional impairment of the spine was consistent with, at worst, forward flexion to 50 degrees. This documented limitation of motion does not meet the rating criteria for a rating of 40 percent or higher. Of further note, the Board finds the Veteran’s statements regarding use of a wheelchair for his lumbar spine disability and his claims to the effect that he is wheelchair bound are uncredible. The Board may consider multiple factors when assessing the credibility and weight of lay evidence, including statements made during treatment, self-interest or bias, internal consistency, and consistency with other evidence. See Caluza v. Brown, 7 Vet. App. 498, 512 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996) (per curium); Pond v. West, 12 Vet. App. 341, 345 (1999); Madden v. Gober, 125 F.3d 1477, 1480-81 (1997). Here, VA treatment records demonstrate that the Veteran was not prescribed a wheelchair by a treating provider due to his lumbar spine disability. VA treatment records reveal that the Veteran made a request for a wheelchair to a VA nurse who then placed the order. Shortly thereafter, in a March 2010 VA primary care note, the Veteran reported use of a wheelchair due to pain; his treating provider told him that he needed to walk and stop using a wheelchair. The provider further wrote in the treatment notes that the Veteran was referred to rehabilitation services due to his request of a wheelchair and that he needed to ambulate as much as possible and that his condition did not warrant use of a wheelchair. In March 2016, the Veteran requested a motorized wheelchair, which was denied by his treating provider because his doctor stated that he did not need a motorized wheelchair. Of further note, the most recent VA treatment records associated with the claims file, from 2014 to 2017, repeatedly indicated that the Veteran walked with a cane and his VA clinician had instructed him to continue being active and walk as tolerated. He was offered participation in the VA MOVE program but declined. As VA treatment records demonstrated that no doctor prescribed a wheelchair, that the Veteran was not attending VA appointments in a wheelchair, and that his treating providers wanted the Veteran to be active and mobile, the Board finds that the Veteran’s statements regarding a wheelchair lacks credibility and should not be afforded any weight. Furthermore, neither Diagnostic Code warrants a higher rating for use of assistive devices. The Board acknowledges the Veteran’s reports of pain and self-reported functional limitations with walking and standing. However, the occurrence of pain while performing such activities is the expected, practical effect of the symptoms of pain and limited range of motion that have been clinically observed and are compensated by the assigned 20 percent rating. The Board further notes that pain throughout the range of motion or the presence of pain alone does not warrant a higher rating. Cf. Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011) (observing that pain ‘must actually affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance’ [under] 38 C.F.R. § 4.40 in order to constitute functional loss’ warranting a higher rating). The General Formula is clear that a higher rating is based on objectively measured range of motion. The Board has considered the DeLuca and Mitchell factors; however, the limitation of motion documented during the four VA examinations does not meet the criteria required for a 40 percent rating. The Board has given consideration to a higher rating under Diagnostic Code 5243 based on incapacitating episodes due to IVDS; however, there is no evidence of incapacitating episodes nor physician prescribed bed rest to warrant a higher rating. As a result, application of the General Rating Formula is appropriate in this case. To the extent that the Veteran argues his symptomatology is more severe than shown on examination, his statements must be weighed against the other evidence of record. Here, the specific examination findings of trained health care professionals are of greater probative weight than the Veteran’s general lay assertions; and the weight of objective evidence documented through four VA examinations preponderates against the claim that a higher rating is warranted. As to flareups, this cannot be the basis for a higher rating. The Veteran has had four VA examinations conducted over a five year period. His reports of flareups are described as prolonged walking and standing. The Board has considered the holding in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017), and finds it does not afford the Veteran a higher rating. Functional impairment during a flareup is well documented in the record by the Veteran’s repeated contentions of limitation with prolong standing and walking. The Board acknowledges that competent medical evidence has reported a gait dysfunction. As already stated, the occurrence of pain while performing certain physical activities is the expected, practical effect of the symptoms of pain and limited range of motion that have been clinically observed and are compensated by the assigned 20 percent rating. Here, the four VA examinations essentially demonstrate forward flexion of the spine to 50 degrees. Similarly, his contention regarding lifting is to be expected based upon the limitation of forward flexion already documented in the record and is adequately compensated by the assigned 20 percent rating. As to his contention of a flareup described as “hurts in the morning,” this is not consistent with additional functional loss contemplated by Sharp. The presence of pain alone does not warrant a higher rating; there is no indication from this statement as to any of the factors discussed in 38 C.F.R. § 4.40. Under the General Formula, higher ratings are based solely on range of motion or ankylosis, and the Veteran’s lumbar spine disability has never demonstrated that level of impairment during the appeal. Moreover, he has never sought treatment for a flareup nor reported such occurrences to treating providers. See AZ & Rucker, supra. While it is axiomatic in the jurisprudence that a veteran is competent to report his lay observations that come through his senses, the Board finds that further examination regarding flareups would not reveal factors beyond those already documented in the record. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). As to degenerative changes, this cannot be the basis for a higher rating. The Veteran is already in receipt of a compensable rating based on limitation of motion of the lumbar spine, no higher rating can be assigned under Diagnostic Code 5003 alone, due to painful motion in an arthritic joint. 38 C.F.R. § 4.71a, Diagnostic Code 5003. As for the claim of analgetic gait, this does not warrant a higher rating. An abnormal gait is contemplated by the rating criteria for a 20 percent disability rating. As the Veteran is already in receipt of a 20 percent rating, his gait dysfunction is adequately compensated. See 38 C.F.R. § 4.71, General Formula. In sum, the Board finds that the preponderance of evidence is against a rating in excess of 20 percent for the service-connected lumbar spine disability. As such, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. A rating in excess of 10 percent for traumatic arthritis, right knee from August 30, 2007 to December 9, 2017 is denied. 6. A rating in excess of 10 percent for traumatic arthritis, left knee from August 30, 2007 to December 9, 2017 is denied. The Veteran seeks a higher rating for his knee disabilities. He reports that his knees hurt and swell. He further reports trouble walking, getting up, and use of assistive aids to walk. The right and left knee disabilities are each rated under Diagnostic Code 5260 as 10 percent disabling. In addition, the Veteran’s left knee disability has been rated with a hyphenated diagnostic code (Diagnostic Code 5260-5010), for purposes of identifying that the limitation of flexion was related to arthritis; however, this does not change the basis of the rating criteria because the Veteran is already in receipt of a compensable rating for limitation of motion. See 38 C.F.R. §§ 4.27, 4.71a, Diagnostic Code 5010. Therefore, the presence of arthritis alone does not warrant a higher rating. Under Diagnostic Code 5260, a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. At a December 2007 VA examination, the Veteran reported pain, stiffness, and weakness in both knees. The Veteran also reported flareups of moderate severity occurring weekly, which he described the functional impact as having to lie down before getting up. The Veteran reported locking episodes less than once a year in both knees. The Veteran reported that he was able to stand for 15 to 30 minutes and unable to walk more than a few yards. The right knee flexion was to 70 degrees with pain throughout the range of motion. The examiner merely answered “yes” to loss of motion on repetitive use due to pain for the right knee, but then indicated that there was no additional loss of motion after repetitive use testing as flexion was still to 70 degrees. The left knee flexion was to 90 degrees with painful motion throughout the range of motion. The examiner merely answered “yes” to loss of motion on repetitive use due to pain for the left knee, but then indicated that there was no additional loss of motion after repetitive use testing as flexion was still to 70 degrees. The examiner noted effusion one time in the right knee, as well as inflammation (described as swelling and tenderness) in both knees. There were no episodes of dislocation or subluxation, no constitutional symptoms of arthritis, and no incapacitating episodes of arthritis. The examiner found no instability in either knee. There was no meniscus abnormality. The examiner reported a patellar abnormality, which he described as subpatellar tenderness, but did not specify what knee this was found in. The examiner noted that the Veteran always used a brace, cane, crutches, and walker as assistive aids for walking. At a July 2009 VA examination, the Veteran reported pain, stiffness, and decrease speed of joint motion in both knees. The Veteran did not report any episodes of dislocation, subluxation, or locking. He did not report effusion or symptoms of inflammation. The Veteran reported flareups which he described as moderate in severity occurring weekly and lasting for hours. The Veteran reported that flareups were brought on by walking and prolonged standing and his impression was the impairment due to these flareups was having to sit down. The Veteran reported that he was able to stand for 15 to 30 minutes and unable to walk more than a few yards. The right knee flexion was to 90 degrees with evidence of pain with active motion, and the left knee flexion was to 90 degrees with evidence of pain with active motion. Objective evidence of pain was noted following repetitive use testing, however, there was no additional loss of movement after repetitive use testing. The examiner found no constitutional symptoms of arthritis or incapacitating episodes of arthritis. The examiner also found that the right knee had no crepitus, no instability, no patellar abnormality, and no meniscus abnormality. The examiner noted that the Veteran always used a cane or crutches for walking. At the May 2011 VA examination, right knee tenderness and grinding was noted with no evidence of crepitation, clicks, snaps, masses, instability, patellar abnormality and meniscus abnormality. The right knee flexion was to 100 degrees with objective evidence of pain on active motion and following repetitive use, but no additional loss of motion after repetitive use testing. The left knee flexion was to 100 degrees with objective evidence of pain on active motion and following repetitive use, but no additional loss of motion after repetitive use testing. The examiner noted the Veteran was brought into the exam room in a wheelchair but could walk with the support of his wife. The Veteran claimed he could not walk more than 1/4 of a mile and could not stand more than 30 to 40 minutes. At the November 2012 VA examination, the Veteran reported flareups as “prolonged walking.” Arthritis was noted in both knees, as well as mild degenerative osteoarthritis with meniscal chondrocalcinosis in both knees. The right knee flexion was to 90 degrees with pain throughout the range of motion, and no additional loss of motion after repetitive use testing. The left knee flexion was to 90 degrees with pain throughout the range of motion, and no additional loss of motion after repetitive use testing. The examiner found functional impairment with both knees due to less movement than normal, pain on movement, and interference with sitting, standing and weight-bearing. The examiner further found normal joint stability in both knees; no subluxation or dislocation of either knee; and no meniscal condition or meniscal surgery of either knee. The examiner recorded arthroscopic surgery of the right knee about 20 years ago. The examiner noted that the Veteran regularly used crutches to ambulate. The examiner opined that there was mild to moderate impairment secondary to pain on walking or standing. At a June 2015 VA examination, the Veteran reported flareups that he described as “prolonged standing and walking.” The right knee flexion was to 80 degrees with no additional loss of motion after repetitive use testing, and the examiner opined that abnormal range of motion contributed to functional loss based on the inability to squat. The left knee flexion was to 90 degrees with no additional loss of motion after repetitive use testing, and the examiner opined that abnormal range of motion contributed to functional loss based on the inability to squat. The examiner further added that there was disturbance of locomotion from the bilateral knee disabilities. The examiner also found no joint instability or meniscal condition. The examiner opined that there was mild to moderate impairment secondary to pain on walking or standing. In May 2017, the Director of Compensation and Pension Service rendered a negative determination regarding an extraschedular rating for the right and left knee disabilities under 38 C.F.R. § 3.321. The Director recommended continuation of the 10 percent rating for these disabilities. The Director found that the record demonstrated limitation of motion, pain on motion, and degenerative joint disease, which satisfied the criteria for the currently assigned 10 percent ratings based on the presence of arthritis under Diagnostic Code 5010. The Director added that the record did not demonstrate limitation of flexion that more closely approximated a compensable rating under Diagnostic Code 5260, to include functional loss to warrant consideration of the next higher rating under this Diagnostic Code. The Director opined that although the Veteran contended functional loss with severe restrictions in standing and walking due to pain and limitation of motion, and pain after repetitive use testing was shown, the evidence did not demonstrate additional limitation of motion, fatigue, weakness, or incoordination after repetitive use testing. The Director further pointed out that there were no other objective findings indicative of a severe disability, to include no evidence of crepitus, muscle atrophy, muscle weakness, or incoordination, and no indication of need for surgery. The Director also noted that the Veteran had not been referred to or followed in the VA Orthopedics Clinic, and as of January 2017, he ambulated with a cane and had a slightly antalgic gait. The Director’s ultimate opinion was that there was no evidence demonstrating that degenerative joint disease of the right or left knee caused marked interference with employment or frequent hospitalizations, or resulted in impairment in occupational functioning and earning capacity that was not adequately represented by the current assigned ratings for each knee and therefore an extraschedular rating was not recommended. In a November 2017, the Director issued a second opinion, again denying an extraschedular rating for the knee disabilities under 38 C.F.R. § 3.321. The Director opined that the record presented no evidence of an exceptional or unusual disability picture, such as marked interference with employment, that would render application of the current assigned schedular ratings for the knees inadequate. The Director stated that the current ratings accurately addressed the symptoms and severity of the left and right knee disabilities. VA treatment records during the appeal period from August 2007 to December 2017 document chronic knee pain; they contained no range of motion measurements nor reports of flareups. VA treatment records also are not suggestive of any complaints of or treatment for swelling, effusion, locking, subluxation, or joint instability. Private medical records, received by VA in July 2008 and May 2009, contained a single complaint of knee pain tolerated with medication. Based on the foregoing, the AOJ did not error in denying a rating in excess of 10 percent for either knee. At no time has there been a demonstrated limitation of flexion of either knee to 30 degrees or less. Flexion of the right knee has had various measurements throughout the appeal, but the limitation appears to be an average of 85 degrees. Flexion of the left knee has a demonstrated consistent limitation to 90 degrees. As indicated above in Section 4, the Board finds the Veteran’s statements regarding use of a wheelchair or being wheelchair bound to be uncredible. The Board acknowledges the Veteran’s reports of pain and self-reported functional limitations with walking and standing. However, the occurrence of pain while performing such activities is the expected, practical effect of the symptoms of pain and limited range of motion that have been clinically observed and are compensated by the assigned 10 percent ratings for each knee. The Board notes that pain throughout the range of motion or the presence of pain alone does not warrant a higher rating. Cf. Mitchell, supra. The rating criteria for the knees based on limitation of motion is predicated upon objectively measured range of motion. The Board has considered the DeLuca and Mitchell factors; however, the limitation of motion documented during the five VA examinations does not meet the criteria required for a 20 percent or higher rating in either knee. The Board has considered the applicability of other Diagnostic Codes but finds they do not apply. The evidence does not show ankylosis, subluxation, lateral instability, genu recurvatum, or impairment of the cartilage, tibia or fibula. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, 5262, 5263. In particular, the Board finds that entitlement for a separate rating for a meniscus abnormality is not warranted at any time during the appeal. While the Veteran has at one time reported swelling, there is no competent medical evidence indicating effusion into the joint as contemplated by Diagnostic Code 5258. Moreover, the notation of a right knee arthroscopy for alleged swelling over 20 years ago is insufficient to demonstrate that swelling and effusion of the joint occurred with the severity, duration, and frequency to warrant a separate rating. This is especially true when there are no complaints by the Veteran to treating providers of these problems nor has any medical provider indicated joint swelling or effusion. Cf. Rucker, supra. Moreover, while a diagnosis of meniscal chondrocalcinosis was noted during the December 2012 VA examination, the examiner still found no meniscus abnormalities, along with no meniscus symptoms contemplated by the rating criteria. To the extent that the Veteran argues his symptomatology is more severe than shown on examination, his statements must be weighed against the other evidence of record. Here, the specific examination findings of trained health care professionals are of greater probative weight than the Veteran’s general lay assertions; and the weight of objective evidence documented through five VA examinations preponderates against these claims for a higher rating. As to flareups, this cannot be the basis for a higher rating under the facts of this case. The Veteran has had five VA examinations over an eight year period. His reports of flareups are described as prolonged walking and standing requiring him to sit down. The Board has considered the holding in. Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017), and finds it does not afford the Veteran a higher rating. Functional impairment during a flareup has already been documented in the record by the examination findings of a gait dysfunction and disturbance of locomotion, as well as the use of assistive aids to ambulate. As already stated, the occurrence of pain while performing such activities is the expected, practical effect of the symptoms of pain and limited range of motion that have been clinically observed and are compensated by the assigned 10 percent ratings for each knee. Moreover, needing to sit down is not equivocal to additional loss of motion. Here, the record has never demonstrated flexion of the knees to 30 degrees or less. The rating criteria for the knees is predicated upon objective range of motion testing and not a need to take breaks. Again, the Veteran’s difficulty with ambulation is based on limited range of motion and pain on motion, which have been sufficiently documented in the record and are adequately compensated by the assigned 10 percent ratings. The Board finds that further examination of flareups would not reveal factors beyond those already documented in the record. See Sabonis and Soyini, supra. As to arthritis of the knees, this does not provide a higher rating. As alluded to in the synopsis of the Director’s extraschedular consideration, 38 C.F.R. § 4.59 enables assignment of the minimum compensable rating with painful joints accompanied by any form of arthritis. See also Petitti v. McDonald, 27 Vet. App. 415, 425 (2015) (“Under 38 C.F.R. § 4.59, the trigger for a minimum disability rating is an ‘actually painful, unstable, or malaligned joint.’”). In this case, the Veteran has been assigned compensable ratings based on painful motion in his knees, because while he has abnormal flexion of the knees it is not to a compensable degree under the rating criteria. See 38 C.F.R. § 4.71a. The assignment of these compensable ratings took into account the Veteran’s limitation of motion hampered by pain and degenerative changes, as these symptoms were demonstrated by objective orthopedic testing on VA examinations. The Board stresses that pain, by itself, does not constitute functional loss. Rather, there must be actual limitation of motion that is caused by pain. See Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). Accordingly, the Veteran cannot receive a higher rating based on the presence of arthritis nor pain alone. In sum, the Board finds that the preponderance of evidence is against a rating in excess of 10 percent for the service-connected right and left knee disabilities. As such, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to TDIU is denied. The Veteran contends that his service-connected lumbar spine and knee disabilities rendered him unemployable. See June 2008 Claim (submitted on a VA Form 21-8940). The Veteran has not been employed during the pendency of this appeal. It is the established policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16. TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is an additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 3.340, 3.341, 4.16(a). Based on the above adjudication, the Veteran does not meet the schedular requirements for TDIU under 38 C.F.R. § 4.16(a) at any time during the appeal. When the percentage requirements are not met, but the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, the Director of the VA Compensation Service (Director) should consider whether a TDIU may be awarded on an extraschedular basis. 38 C.F.R. § 4.16(b). Here, the AOJ did not submit the Veteran’s TDIU claim for extraschedular consideration because the AOJ found that the evidence failed to show that he was unemployable due to his service-connected disabilities. The ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one; that determination instead is for the adjudicator. See 38 C.F.R. § 4.16; see also Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376 (2013). In determining whether unemployability exists, consideration may be given to a veteran’s level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. As to education, the Veteran has completed high school. As to previous work experience, in December 2014, the Veteran submitted a partially completed VA Form 21-8940 indicating that he worked until he could not work anymore, he described his last occupation as “swimming pool chemicals,” and he stated in the remarks section “my back hurt too much to continue doing what I was paid to do.” Then in March 2015, the Veteran resubmitted VA Form 21-8940, indicating his last employer was OC from 1988 to 1998 and reported that his last occupation was “fix computers.” Then in April 2015, the Veteran completed VA Form 21-4192 (Request for Employment Information in Connection with Claim For Disability Benefits), indicating that he was employed from 1981 to 1998 as an operator. In addition, VA examinations conducted in July 2009, April 2010, and May 2011 reported that the Veteran was “unemployed but not retired.” The AOJ was able to obtain a completed VA Form 21-4192 from OC. That employer indicated that the Veteran was employed from April 1973 to November 1998 as a chemical plant operator. The employer provided that the Veteran retired in November 1998, and that no concessions were made during employment due to disability. In weighing the evidence, the Board finds that VA Form 21-4192 completed by OC is entitled to more weight over the Veteran’s inconsistent lay statements regarding his work experience. As outlined above, the Veteran has submitted inconsistent statements regarding his employment. As OC has no personal or financial interest in the claim, the employer’s statements have inherent credibility over the Veteran’s inconsistent lay statements. See Buchanan v. Nicholson, 451 F3.d 1331, 1336-37 (Fed. Cir. 2006) (“The Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc.”); see also Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (“The credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character.”). Consequently, the Board finds that for 25 years the Veteran worked as a chemical plant operator. The Board finds that the Veteran voluntarily retired and the evidence of record weighs against a finding that the ending of this employment was due to the service-connected lumbar spine or knee disabilities. As to the competent medical evidence regarding unemployability, the Veteran submitted an undated letter, received by VA in June 2008, from his private doctor indicating that the Veteran had long-standing degenerative arthritis of the knees and back, and the Veteran was unable to work due to those conditions. There also was a corresponding June 2008 private treatment note indicating, in part, a complaint of “currently unable to work secondary to arthritis of the knees and low back, no problems with medications.” The July 2009 VA examiner stated the lumbar spine disability presented the problem of low back pain and the effect on usual occupation was not employed. Of further note, effects of the lumbar spine disability on usual daily activities was preventing exercise and sports and moderate effect on chores and shopping. The examiner stated that the knee disabilities presented the problem of “bilateral knee condition” and the effect on usual occupation was not employed. Of further note effects of the knee disabilities on usual daily activities was preventing exercise, sports, and driving, and moderate effect on chores and shopping The April 2010 VA examiner stated that the lumbar spine disability presented the problem of back pain and the effect on usual occupation was not employed. The examiner noted effects unusual daily activities with a severe impact on exercise; moderate effect on chores and sports; mild effect on shopping, recreation, and traveling; and no impact on feeding, bathing, dressing, toileting, and grooming. The May 2011 VA examiner opined that there was mild functional impairment for physical employment secondary to the lumbar spine and bilateral knee disabilities. The examiner further indicated there was no impairment for sedentary employment due to the spine and bilateral knee disabilities. The examiner recorded the Veteran’s contentions that he cannot walk more than 1/4 mile and cannot stand for more than 30 to 40 minutes. The November 2012 VA examiner said that the lumbar spine disability had no impact on the Veteran’s ability to work, but noted there was mild functional impairment for physical employment secondary to the lumbar spine disability. The examiner said that the bilateral knee disabilities impacted the Veteran’s ability to work because there was mild to moderate impairment secondary to knee pain with walking or standing. The examiner further provided that the Veteran claimed that he could not walk more than 1/4 mile and could not stand for more than 30 to 40 minutes. The June 2015 VA examiner said that the lumbar spine disability impacted the Veteran’s ability to work because there was mild functional impairment for physical employment secondary to the lumbar spine disability. The examiner further provided that the Veteran claimed that he could not walk more than 1/4 mile and could not stand for more than 30 to 40 minutes. The examiner said that the bilateral knee disabilities impacted the Veteran’s ability to work because there was moderate impairment secondary to knee pain with walking or standing. In addition, the VA treatment records indicated that the Veteran did not have any cognitive barriers, had no problems taking care of himself, and for the majority of the appeal lived alone except for a period of time where his son came to live with him. Based on the foregoing, the Board finds that the AOJ did not error in not referring the claim for extraschedular consideration. It is important to remember that the Board has no authority to assign a TDIU rating under 38 C.F.R. § 4.16(b) absent prior referral to the Chief Benefits Director or Director, Compensation and Pension Service, for extraschedular consideration. See generally Bowling v. Principi, 15 Vet. App. 1 (2001). Accordingly, the Board’s focus will be on whether the AOJ failing to refer this case consisted of a duty to assist error. In weighing the medical evidence of record, the Board finds that the majority of evidence generated during this appeal due to the Veteran continuously pursuing his increased rating claims for the lumbar spine and knee disabilities resulted in several VA examinations which documented, at most, moderate impairment due to these disabilities on physical employment due to pain. This evidence has to be weighed against the one entry in the record of the June 2008 private opinion. Simply put, there is more evidence against the claim, than that in favor, of there being total occupational impairment. By virtue of using terms like “mild” and “moderate,” the VA examiner has essentially opined that there is not total occupational impairment. Accordingly, while the Veteran may experience limitations with the physical activities of walking and standing, they do not result in total occupational impairment sufficient for an award of TDIU. In addition, the Board affords little weight to the June 2008 private medical opinion because the corresponding June 2008 private treatment note indicates that the private doctor did not perform any orthopedic testing. This treatment note indicates that the Veteran presented to this appointment for follow-up on hypertension, as well as, to obtain evidence regarding his unemployability due to his arthritis in his knees and low back. The section for review of the musculoskeletal system in the private treatment note was left blank. Consequently, the private doctor did not conduct a thorough orthopedic examination compared to the five VA examinations conducted in July 2009, April 2010, May 2011, November 2012, and June 2015. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As a result, the Board affords more weight to the objective orthopedic testing conducted over five separate VA examinations throughout the appeal period. See also White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Van Slack v. Brown, 5 Vet. App. 499, 502 (1993) and Chisem v. Brown, 4 Vet. App. 169 (1993) (noting there is no “treating physician rule” requiring the Board to give additional evidentiary weight to opinions of doctors who have evaluated or treated the Veteran over time, but it is permissible for the Board to bear this length of treatment in mind when considering just how familiar with the Veteran’s condition the clinician may be). The Board finds the most probative evidence is the examiner statements in the May 2011, November 2012 and June 2015 VA examinations specifying there was mild to moderate impairment with certain physical tasks and no impairment with sedentary activities. Such opinion is consistent with his earlier examinations noting only moderate or mild impairment with certain daily activities, like chores and shopping that do require some amount of physical exertion. As a result, the Board reads the statements from the examiner in the May 2011, November 2012 and June 2015 VA examinations as clarifying his opinion, from earlier examinations, that there is mild to moderate impairment with these physical activities, but they are not precluded. To the extent that these VA examinations recite the Veteran’s subjective belief that he cannot walk more than 1/4 mile and could not stand for more than 30 to 40 minutes, this does not constitute a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In sum, the June 2008 private opinion is afforded less weight because it does not adequately address significant clinical evidence throughout the period on appeal and it is not based on rigorous orthopedic testing compared to that conducted at five separate VA examinations over the duration of this appeal. In turn, the Board finds most probative the opinion from the examiner who has conducted the May 2011, November 2012, and June 2015 VA examinations and affords his opinion that there is mild to moderate impairment with physical activity, namely standing and walking, the most weight. Taking into account the Veteran’s education, training, and work history as a chemical plant operator, the Veteran has demonstrated the ability to do semiskilled work for almost three decades. In conjunction with there being, at most, moderate impairment with prolonged standing and walking, the evidence as a whole does not demonstrate that the Veteran service-connected lumbar spine and knee disabilities produced unemployability based on his employment history. The central inquiry is whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. Pederson v. McDonald, 27 Vet. App. 276, 286 (2015). Here, the Veteran has demonstrated a stable work history in preforming semiskilled work. Although, he may not be able to return to his prior position as a chemical plant operator given the functional limitations of standing and walking, the inquiry for TDIU is not whether a veteran can do his prior or current job. See Faust v. West, 13 Vet. App. 342 (2000). The determination as to whether TDIU is appropriate must be based on all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). The opinions contained in the May 2011, November 2012, and June 2015 VA examinations indicate that the veteran could perform employment activities that were not physically demanding and to the extent walking and standing would be required there would be moderate, but not total, impairment. As to any contentions in the record of the Veteran having difficulty in obtaining employment, the regulation does not require or authorize the assignment of a TDIU for a disabled veteran who encounters difficulty either obtaining or retaining substantially gainful employment. Accordingly, the Board concludes a TDIU is not warranted for any difficulty the Veteran may of had in securing a substantially gainful occupation during the appeal. See Van Hoose v. Brown, 4 Vet. App. 361 (1993); see also Faust v. West, 13 Vet. App. 342 (2000). Here, the majority of evidence indicates that the Veteran is capable of performing the physical and mental acts required by employment, albeit with moderate impairment in standing and walking. The Board also emphasizes in reaching this decision that non-service-connected disabilities and age cannot be considered. Therefore, the Veteran’s contentions regarding non-service-connected disabilities and old age must be disregarded. As to the Veteran’s contentions that he cannot bend, walk for long distances, requires assistive aids for ambulation (e.g., crutches), and experiences a high level of pain; the Veteran is already compensated for the symptomatology associated with his service-connected lumbar spine in knee disabilities by the assigned schedular ratings during the appeal period. The impairment of industrial capacity due to these service-connected disabilities has already been taken into consideration by their assigned ratings. The Board emphasizes that the rating schedule is intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In addition, as to any contention regarding being in a wheelchair, the Board has found such lay contentions uncredible as indicated above in Sections 4 through 6. The Board has considered the Veteran’s assertions that he is unable to work. However, the Veteran does not possess expertise in medical or vocational matters and, thus, cannot competently opine on the question of whether his lumbar spine and knee disabilities actually rendered him unemployable during the period in question. Based on the facts surrounding his unemployability, the Board finds that the evidence does not reveal factors outside the norm resulting in unemployability due to the Veteran’s service-connected lumbar spine and knee disabilities based on the Veteran’s education, prior work experience, and competent medical evidence. As such, there was no error not referring this claim for extraschedular consideration based on the majority of competent medical evidence demonstrating only moderate impairment with certain physical activities, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. D. The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.