Citation Nr: 20008045 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 17-09 627 DATE: January 30, 2020 ORDER Entitlement to a disability rating greater than 10 percent for right knee arthritis due to strain is denied. Entitlement to a disability rating greater than 10 percent for right hip degenerative joint disease with limitation of extension on an extraschedular basis is denied. Entitlement to a disability rating greater than 20 percent for right hip limitation of flexion is denied. The rating reduction from 20 percent to 10 percent effective August 1, 2017, for right thigh impairment was proper. Entitlement to a 20 percent rating effective April 18, 2017, for right knee osteoarthritis with instability is granted. Entitlement to a disability rating greater than 10 percent for left knee arthritis is denied. Entitlement to a compensable disability rating for a left ankle disability is denied. Entitlement to a disability rating greater than 10 percent for right ankle sprain residuals is denied. Entitlement to a compensable disability rating for hammertoes of the right foot is denied. Entitlement to a disability rating greater than 10 percent for bilateral foot injury residuals is denied. Entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for a left ankle disability is dismissed. Entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for left knee arthritis is dismissed. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The record evidence shows that the Veteran’s service-connected right knee arthritis due to strain is manifested by, at worst, complaints of pain, flexion limited to 90 degrees, tenderness to palpation in the mid-patellar and lateral joint lines, reduced muscle strength, and x-ray evidence of arthritis. 2. The record evidence shows that the Veteran’s service-connected right hip degenerative joint disease with limitation of extension does not present such an exceptional or unusual disability picture with occupational impairment as to render impractical the application of regular schedular standards. 3. The record evidence shows that the Veteran’s service-connected right hip limitation of flexion is manifested by, at worst, complaints of pain, flexion to 30 degrees after repetitive range of motion testing, and reduced muscle strength. 4. In a rating decision dated on May 19, 2014, and issued to the Veteran and his representative on May 22, 2014, the Agency of Original Jurisdiction (AOJ) granted, in pertinent part, a claim of service connection for right thigh impairment, assigning a 20 percent rating effective June 30, 2010; this decision was not appealed and became final. 5. The 20 percent rating for the Veteran’s service-connected right thigh impairment was in effect for more than 5 years when it was reduced to 10 percent effective August 1, 2017. 6. Reexaminations disclosed sustained improvement in the Veteran’s service-connected right thigh impairment likely to be maintained under the ordinary conditions of life. 7. The record evidence shows that, prior to April 18, 2017, the Veteran’s service-connected right knee osteoarthritis with instability is manifested by, at worst, complaints of right knee instability. 8. The record evidence shows that, on VA knee and lower leg conditions DBQ on April 18, 2017, the Veteran’s service-connected right knee osteoarthritis with instability is manifested by, at worst, moderate lateral instability. 9. The record evidence shows that the Veteran’s service-connected left knee arthritis is manifested by, at worst, complaints of pain and x-ray evidence of arthritis. 10. The record evidence shows that the Veteran’s service-connected left ankle disability is not manifested by any compensable disability. 11. The record evidence shows that the Veteran’s service-connected right ankle sprain residuals are manifested by, at worst, moderate limited motion of the right ankle. 12. The record evidence shows that the Veteran’s service-connected hammertoes of the right foot are manifested by, at worst, complaints of pain and swelling only affecting the third and fourth toes. 13. The record evidence shows that the Veteran’s service-connected bilateral foot injury residuals are manifested by, at worst, moderate right foot pain and swelling with weight bearing. 14. In a rating decision dated on August 20, 2014, the AOJ granted, in pertinent part, the Veteran’s claims of service connection for a left ankle disability and for left knee arthritis (which was characterized as a left leg disability), assigning zero percent ratings effective June 30, 2010, for each of these disabilities; this decision was not appealed and became final. 15. In statements on a VA Form 21-256EZ dated on October 13, 2014, and date-stamped as received by VA on December 4, 2014, the Veteran requested increased ratings for his service-connected left ankle disability and left knee arthritis. 16. In the currently appealed rating decision dated on April 16, 2015, and issued to the Veteran and his representative on April 21, 2015, the AOJ denied the Veteran’s increased rating claims for a left ankle disability and for left knee arthritis. 17. In statements on a VA Form 21-0958, “Notice of Disagreement,” dated on June 18, 2015, and date-stamped as received electronically by VA on June 19, 2015, the Veteran disagreed with the effective date assigned for the grant of service connection for a left ankle disability and for left knee arthritis. 18. Service connection currently is in effect for right thigh limitation of flexion, evaluated as 20 percent disabling effective June 30, 2010, right hip degenerative joint disease with limitation of extension, evaluated as 10 percent disabling effective June 30, 2010, right knee osteoarthritis with instability, evaluated as 10 percent disabling effective June 30, 2010, left knee arthritis, evaluated as 10 percent disabling effective June 30, 2010, right knee arthritis due to strain, evaluated as 10 percent disabling effective June 30, 2010, right ankle sprain residuals, evaluated as 10 percent disabling effective June 30, 2010, bilateral foot injury residuals, evaluated as 10 percent disabling effective June 30, 2010, an inguinal hernia, evaluated as 10 percent disabling effective June 30, 2010, right thigh impairment, evaluated as 10 percent disabling effective August 1, 2017, a left ankle disability, evaluated as zero percent disabling effective June 30, 2010, and for hammertoes of the right foot, evaluated as zero percent disabling effective November 10, 2011; the Veteran’s combined disability evaluation for compensation (including the bilateral factor) is 70 percent effective August 1, 2017. 19. The record evidence is in relative equipoise as to whether the Veteran’s service-connected disabilities, alone or in combination, preclude him from securing or maintaining a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating greater than 10 percent for right knee arthritis due to strain have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5260-5010 (2018). 2. The criteria for entitlement to a disability rating greater than 10 percent for right hip degenerative joint disease with limitation of extension on an extraschedular basis have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251 (2018). 3. The criteria for entitlement to a disability rating greater than 20 percent for right hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252 (2018). 4. The reduction of the disability rating for right thigh impairment, by the May 2017 rating decision, was proper; the criteria for a reduction in the disability rating from 20 percent to 10 percent effective August 1, 2017, for right thigh impairment were met. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. §§ 3.344, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253 (2018). 5. The criteria for entitlement to a 20 percent rating effective April 18, 2017, for right knee osteoarthritis with instability have been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5257 (2018). 6. The criteria for entitlement to a disability rating greater than 10 percent for left knee arthritis have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5260 (2018). 7. The criteria for entitlement to a compensable disability rating for a left ankle disability have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271 (2018). 8. The criteria for entitlement to a disability rating greater than 10 percent for right ankle sprain residuals have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271 (2018). 9. The criteria for entitlement to a compensable disability rating for hammertoes of the right foot have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5282 (2018). 10. The criteria for entitlement to a disability rating greater than 10 percent for bilateral foot injury residuals have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5284 (2018). 11. The claim of entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for left ankle disability is dismissed as a matter of law. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400 (2018); Rudd v. Nicholson, 20 Vet. App. 296 (2006). 12. The claim of entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for left knee arthritis is dismissed as a matter of law. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400 (2018); Rudd v. Nicholson, 20 Vet. App. 296 (2006). 13. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.102, 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1952 to June 1954, including in combat during the Korean Conflict. He died in August 2017. The Appellant is his surviving spouse and an appropriate substitute claimant in his appeal. The Appellant appointed her attorney to represent her before VA by filing a completed VA Form 21-22a at the AOJ in March 2019. As noted elsewhere, in an August 2014 rating decision, the AOJ granted, in pertinent part, the Veteran’s claims of service connection for a left ankle disability and for left knee arthritis (which was characterized as a left leg disability), assigning zero percent ratings effective June 30, 2010, for each of these disabilities. This decision was not appealed and became final. 38 U.S.C. § 7105 (West 2012); 38 C.F.R. §§ 20.302, 20.1103 (2018). The Veteran also did not submit any relevant evidence or argument within 1 year of the August 2014 rating decision which would render it non-final for VA adjudication purposes. See Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2011) (explaining that, when statements are received within one year of a rating decision, the Board’s inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156 (b)). The AOJ subsequently assigned an earlier effective date of June 30, 2010, for a 10 percent rating for service-connected left knee arthritis in a February 2017 rating decision which was issued in March 2017. As is discussed in more detail below, because the Veteran is attempting impermissibly to disturb the finality of the August 2014 rating decision by filing earlier effective date claims for service connection for a left ankle disability and for left knee arthritis, these claims must be dismissed as a matter of law. See Rudd v. Nicholson, 20 Vet. App. 296 (2006) (prohibiting a collateral attack on a final rating action by filing a freestanding earlier effective date claim). The Board next notes that, in a May 2017 rating decision, the AOJ reduced the disability rating from 20 percent to 10 percent effective August 1, 2017, for the Veteran’s service-connected right thigh impairment. After the Veteran timely disagreed with this rating reduction, the AOJ then promulgated a Statement of the Case in which it listed one of the issues on appeal as an increased rating claim for right thigh impairment. The Board observes that, in Green v. Nicholson, 21 Vet. App. 512, 2006 WL 3438028 (Vet. App.), the United States Court of Appeals for Veterans Claims (Court) held that, in cases where a rating reduction is on appeal, “the Board must determine whether the reduction of the Veteran’s disability rating was proper and must not phrase the issue in terms of whether the Veteran was entitled to an increased rating, including whether the Veteran was entitled to restoration of a previous rating.” Id., at pp. 3. The Veteran in Green appealed the Board’s denial of a claim for restoration of a 100 percent rating for service-connected prostate cancer. Although the Board recognizes that single-judge memorandum decisions of the Court are not binding precedent, the unpublished single-judge memorandum decision of the Court in Green can be considered persuasive authority in this appeal. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. Increased Rating The Veteran, during his lifetime, and the Appellant, after the Veteran’s death, contended that his service-connected bilateral ankle disabilities, right thigh disabilities, bilateral knee disabilities, hammertoes of the right foot, bilateral foot injury residuals, and right hip disabilities are more disabling than currently evaluated. Neither the Veteran, during his lifetime, the Appellant, after the Veteran’s death, nor the Appellant’s attorney has raised any other issues nor have any other issues with respect to increased rating claims been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that Board not required to address issues unless specifically raised by claimant or reasonably raised by record evidence). 1. Entitlement to a disability rating greater than 10 percent for right knee arthritis due to strain The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent for right knee arthritis due to strain. Contrary to the Veteran’s lay assertions, the record evidence shows instead that this disability is manifested by, at worst, complaints of pain, flexion limited to 90 degrees, tenderness to palpation in the mid-patellar and lateral joint lines, reduced muscle strength, and x-ray evidence of arthritis. For example, on VA knee and lower leg conditions Disability Benefits Questionnaire (DBQ) in March 2015, the Veteran’s complaints included bilateral knee instability, right greater than left. He denied experiencing any flare-ups of right knee pain. Range of motion testing of the right knee showed flexion to 120 degrees and extension to 0 degrees. Physical examination of the right knee showed no pain with weight bearing, no tenderness to palpation or crepitus, 4/5 muscle strength, no muscle atrophy, ankylosis, or joint instability. The Veteran constantly used a cane for ambulation. X-rays showed arthritis. The VA examiner stated that the “Vet[eran is] unable to stand or walk for any length of time.” The diagnoses included right knee strain. On VA knee and lower leg conditions DBQ in April 2017, the Veteran’s wife reported that the Veteran’s knee “gives out while walking. He walks with a walker but only for 100 feet or so. She denies evidence of swelling of the joint. Vet[eran] is easily fatigued.” The Veteran suffered from dementia. Flare-ups of right knee pain were reported with an inability to stand or put weight on the right knee. Range of motion testing of the right knee showed flexion to 90 degrees and the Veteran was “unable to bear weight for more than [a] few minutes.” Repetitive range of motion testing of the right knee showed flexion to 70 degrees due to the DeLuca factors. Physical examination of the right knee showed pain with weight bearing, tenderness to palpation in mid patellar and lateral joint lines, no crepitus, 3/5 strength on flexion, 4/5 strength on extension, and no muscle atrophy or ankylosis. The VA examiner stated that the Veteran used a wheelchair “when out for more than an hour or so. Walker used with all ambulation.” X-rays showed right knee arthritis. This examiner also stated that the “Vet[eran is] unable to be weight bearing for more than [a] few minutes.” There was pain on passive range of motion testing of the right knee and in non-weight bearing. The diagnoses included right knee osteoarthritis. Despite the Veteran’s lay assertions to the contrary, the record evidence shows that his service-connected right knee arthritis due to strain is manifested by, at worst, complaints of pain, flexion limited to 90 degrees, tenderness to palpation in the mid-patellar and lateral joint lines, reduced muscle strength, and x-ray evidence of arthritis (as seen on VA examinations conducted during the appeal period). VA examination in March 2015 documented the Veteran’s report of not experiencing any flare-ups of right knee pain. He had an almost full range of motion on right knee flexion (120 degrees out of a possible 140 degrees) although the VA examiner stated that the Veteran was “unable to stand or walk for any length of time.” Physical examination of the right knee showed only reduced muscle strength and x-rays documented the presence of arthritis. Subsequent VA examination in April 2017 showed that the Veteran’s wife reported that he experienced flare-ups of right knee pain with an inability to stand or put weight on the right knee. Right knee flexion was limited to 90 degrees which was reduced to 70 degrees on repetitive testing due to the DeLuca factors. Physical examination of the right knee showed pain with weight bearing, non-weight bearing, and on passive range of motion testing, tenderness to palpation in mid patellar and lateral joint lines, 3/5 strength on flexion, and 4/5 strength on extension. X-rays again showed arthritis. The April 2017 VA examiner again concluded that the Veteran could not bear weight on his right knee “for more than [a] few minutes.” The physical examination findings noted during the appeal period support the assignment of a 10 percent rating under DC 5260-5010 because there was x-ray evidence of arthritis at both examinations. See 38 C.F.R. § 4.71a, DC 5260-5010 (2018). There is no indication that the Veteran’s right knee flexion is limited to 30 degrees or less or x-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups as is required for a higher 20 percent rating under this DC. Id. The Veteran’s right knee flexion was reduced to 70 degrees in April 2017 and x-rays only showed evidence of right knee arthritis at both of the examinations conducted during the appeal period. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 10 percent for the service-connected right knee arthritis due to strain. In summary, the Board finds that the criteria for a disability rating greater than 10 percent for right knee arthritis due to strain have not been met. 2. Entitlement to a disability rating greater than 10 percent for right hip degenerative joint disease with limitation of extension on an extraschedular basis The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent for right hip degenerative joint disease with limitation of extension on an extraschedular basis. The Board notes initially that, because the Veteran currently is in receipt of the maximum 10 percent rating available under 38 C.F.R. § 4.71a, DC 5251, for this service-connected disability, an extraschedular rating is for consideration. See generally 38 C.F.R. §§ 3.321, 4.71a, DC 5251 (2018). The Board also notes that consideration of an increased rating under other potentially applicable DCs for the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is not permitted. The Veteran already is in receipt of separate disability ratings under DCs 5252 and 5253. Thus, assigning an increased rating for service-connected right hip degenerative joint disease with limitation of extension other potentially applicable DCs would constitute pyramiding. The Board next notes that it is precluded from assigning an extraschedular rating in the first instance. Nevertheless, the record evidence does not support referring the Veteran’s increased rating claim for right hip degenerative joint disease with limitation of extension to the Director, Compensation Service, for consideration of extraschedular entitlement. In other words, there is no indication in the record evidence that the symptomatology attributable to the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is not contemplated within the Rating Schedule at DC 5251. Id. Nor is there an exception or unusual disability picture resulting in either marked interference with employment or frequent periods of hospitalization which renders application of the Rating Schedule impractical. See also 38 C.F.R. § 3.321(b)(1). The Board observes that the Court has promulgated a two-step process for determining whether referral to the Director, Compensation Service, for consideration of extraschedular entitlement is warranted under § 3.321(b)(1). Id.; see also Thun v. Peake, 22 Vet. App. 111, 115 (2008). The first step in Thun requires the Board to determine whether the disability picture presented by the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is contemplated adequately by the Rating Schedule by comparing the level of severity and symptomatology of this disability to the established rating criteria. If the Board finds that the disability picture presented by the Veteran’s service-connected right hip degenerative joint disease with limitation of extension (in this appeal) is not contemplated adequately by the Rating Schedule, then the Court in Thun held that the Board must determine whether there is an exceptional disability picture causing marked interference with the Veteran’s employment or requiring frequent periods of hospitalization. See Thun, 22 Vet. App. at 115. The Court in Thun concluded that a referral by the Board for consideration of extraschedular entitlement by the Director, Compensation Service, is appropriate only in situations where both Thun steps are met. Id. Applying the Thun analysis to the facts of the Veteran’s case, the Board finds that the record evidence does not support a referral to the Director, Compensation Service, for consideration of extraschedular entitlement because the disability picture presented by the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is compensated adequately by the Rating Schedule during the appeal period. For example, on VA hip and thigh conditions DBQ in March 2015, the Veteran reported bilateral hip pain, right greater than left, with pain along the lateral side of the right leg from the right hip to the right knee. He experienced severe flare-ups of right hip pain 1-2 times per month lasting 1 2 days at at time. Range of motion testing of the right hip showed extension to 20 degrees. Physical examination of the right hip showed pain with weight bearing, tenderness to palpation in the lateral hip joint and down the right lower extremity, 3/5 muscle strength, no ankylosis, and no objective evidence of crepitus. The Veteran was unable to cross his legs due to limited adduction to 15 degrees. X-rays showed arthritis. The diagnoses included right hip osteoarthritis. On VA hip and thigh conditions DBQ in April 2017, the Veteran’s wife reported that he was “stable w/respect to hip movement.” The Veteran had dementia. The Veteran’s wife also reported that bilateral hip flare-ups made it impossible for him to get up. Range of motion testing of the right hip showed extension to 20 degrees. The VA examiner stated that the Vet held on to the examining table when performing range of motion testing. Physical examination of the right hip showed pain with weight bearing, tenderness to palpation along the joint line, no crepitus, 3/5 muscle strength, and no muscle atrophy or ankylosis. The Veteran used a walker for stability and a wheelchair for fatigue. X-rays showed arthritis. There was pain on passive range of motion testing and in non-weight bearing. The diagnoses included right hip osteoarthritis. Having reviewed the record evidence, the Board finds that a referral to the Director, Compensation Service, for consideration of extraschedular entitlement for the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is not warranted. The Board acknowledges initially that DC 5251 provides a single 10 percent rating for limitation of extension of the thigh (or hip). See 38 C.F.R. § 4.71a, DC 5251 (2018). The Board also acknowledges initially that the Veteran has been in receipt of a 10 percent rating for his service-connected right hip degenerative joint disease with limitation of extension since June 30, 2010 (the date that the AOJ granted service connection for this disability), including throughout the appeal period. The Board finds that the symptomatology attributable to the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is contemplated by the relevant rating criteria throughout the appeal period. For example, the record evidence shows that this disability is manifested by, at worst, extension to 20 degrees. This consistent finding on VA examinations in March 2015 and in April 2017 persuasively suggests that the Veteran’s symptomatology due to his service-connected right hip degenerative joint disease with limitation of extension is well within the relevant rating criteria (in this case, DC 5251). Id. The Board also notes again that the Veteran is in receipt of separate ratings under DCs 5252 and 5253 for other right hip and right thigh symptoms. In other words, because the symptomatology of the Veteran’s service-connected right hip degenerative joint disease with limitation of extension is contemplated within the relevant rating criteria, the first Thun step is not met and an analysis of the second Thun step is not required. Accordingly, the Board finds that the criteria for a disability rating greater than 10 percent for right hip degenerative joint disease with limitation of extension on an extraschedular basis have not been met. 3. Entitlement to a disability rating greater than 20 percent for right hip limitation of flexion The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 20 percent for right hip limitation of flexion. Contrary to the Veteran’s lay assertions, the record evidence shows that this disability is manifested by, at worst, complaints of pain, flexion to 30 degrees after repetitive range of motion testing, and reduced muscle strength. For example, on VA hip and thigh conditions DBQ in March 2015, the Veteran reported bilateral hip pain, right greater than left, with pain along the lateral side of the right leg from the hip to the knee, and an inability to stand “for any length of time.” The Veteran also reported that flare-ups of right hip pain kept him in bed. He experienced 1-2 severe flare-ups of right hip pain per month lasting 1-2 days at a time. Range of motion testing of the right hip showed flexion to 90 degrees, guarding to the left, and pain causing functional loss. Repetitive range of motion testing showed right hip flexion to 30 degrees. The VA examiner stated that the Veteran held on to the examining table when performing range of motion testing. Physical examination of the right hip showed pain with weight bearing, tenderness to palpation on the lateral hip joint and down the right lower extremity, 3/5 muscle strength, no ankylosis, and no objective evidence of crepitus. The Veteran constantly used a cane for ambulation. X-rays showed arthritis. The VA examiner concluded that the Veteran was “unable to stand, sit, or walk for more than [a] few minutes” due to his service-connected right hip disabilities. The diagnoses included right hip osteoarthritis. On VA hip and thigh conditions DBQ in April 2017, the Veteran’s wife reported that he was “stable with respect to hip movement.” The Veteran suffered from dementia. The Veteran’s wife reported that bilateral hip pain flare-ups made it impossible for him to get up. Range of motion testing of the right hip showed flexion to 90 degrees. Repetitive range of motion testing of the right hip showed flexion to 40 degrees. The VA examiner noted that the Veteran held on to the examining table when performing range of motion testing. Physical examination of the right hip showed pain with weight bearing, tenderness to palpation along the joint line, no crepitus, 3/5 muscle strength, and no muscle atrophy or ankylosis. The Veteran used a walker for stability and a wheelchair for fatigue. X-rays showed arthritis. There was pain on passive range of motion testing and in non-weight bearing. The diagnoses included right hip osteoarthritis. The Veteran contends that his service-connected right hip limitation of flexion is more disabling than currently evaluated. Contrary to these lay assertions, the record evidence shows that this disability is manifested by, at worst, complaints of pain, flexion to 30 degrees after repetitive range of motion testing, and reduced muscle strength throughout the appeal period. VA examination of the Veteran’s right hip in March 2015 documented the Veteran’s complaints of right hip pain, an inability to stand “for any length of time,” and flare-ups which kept him in bed for 1-2 days at a time 1-2 times a month. Right hip flexion was limited to 30 degrees on repetitive range of motion testing and the Veteran held on to the examining table while performing this testing. Physical examination of the right hip showed pain with weight bearing, tenderness to palpation on the lateral hip joint and down the right lower extremity, and 3/5 muscle strength. Subsequent VA examination in April 2017 showed that the Veteran’s wife reported that his hip movement was “stable” although flare-ups of hip pain made it impossible for him to get up. Right hip flexion was limited to 40 degrees on repetitive range of motion testing and the Veteran again held on to the examining table while performing this testing. Physical examination essentially was unchanged from March 2015 although there also was pain on passive range of motion testing and in non-weight bearing. There is no indication that the Veteran’s right hip flexion was limited to 20 degrees or less as is required for a disability rating greater than 20 percent under DC 5252. See 38 C.F.R. § 4.71a, DC 5252 (2018). As noted, the Veteran’s right hip flexion was limited to 30 degrees in March 2015 and to 40 degrees in April 2017 following repetitive testing at both of the VA examinations conducted during the appeal period. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 20 percent for service-connected right hip limitation of flexion. In summary, the Board finds that the criteria for a disability rating greater than 20 percent for right hip limitation of flexion have not been met. 4. Whether a rating reduction from 20 percent to 10 percent effective August 1, 2017, for right thigh impairment was proper The Board finds that the rating reduction from 20 percent to 10 percent effective August 1, 2017, for right thigh impairment was proper. See generally 38 C.F.R. § 3.344 (2018). The Appellant essentially challenges the propriety of the rating reduction for the service-connected right thigh impairment which the AOJ implemented in the currently appealed rating decision issued in May 2017. She specifically contends that there was no improvement in the symptomatology attributable to the Veteran’s service-connected right thigh impairment prior to his death and, as such, the rating reduction was improper. The record evidence does not support these assertions and shows that there was sustained improvement in the Veteran’s service-connected right thigh impairment on reexamination which is likely to maintained under the ordinary conditions of life (at least prior to the Veteran’s death in this appeal). In considering the propriety of the reduction, the Board observes that, in a May 2014 rating decision, the AOJ granted the Veteran’s service connection claim for right thigh impairment and assigned a 20 percent rating effective June 30, 2010. The AOJ concluded that a 20 percent rating was appropriate for this disability because the medical evidence showed that the Veteran experienced limitation of abduction of the right thigh with motion lost beyond 10 degrees. The AOJ finally concluded that June 30, 2010, was an appropriate effective date for a 20 percent rating for service-connected right thigh impairment because that was the date that VA received the Veteran’s claim. As noted elsewhere, the AOJ reduced the disability rating for the Veteran’s service-connected right thigh impairment from 20 percent to 10 percent effective August 1, 2017, in the currently appealed rating decision issued in May 2017. The Board notes here that the AOJ correctly followed the due process procedures for rating reductions outlined in 38 C.F.R. § 3.105(e). See 38 C.F.R. § 3.105(e) (2018). The 20 percent rating for right thigh impairment was in effect for more than 5 years when it was reduced to 10 percent effective August 1, 2017. See 38 C.F.R. § 3.44(c) (2018). The AOJ essentially concluded in the May 2017 rating decision that the rating reduction was warranted because reexamination of the Veteran’s service-connected right thigh impairment in April 2017 showed that he was able to cross his legs, motion of the right thigh was possible beyond 10 degrees, and he could toe-out more than 15 degrees on the right leg. The Board finds that the medical evidence supports the AOJ’s findings concerning sustained improvement in the Veteran’s service-connected right thigh impairment. As the AOJ noted in the May 2017 rating decision, VA hip and thigh conditions DBQ in March 2015 showed he was unable to cross his legs due to adduction limited to 15 degrees and right hip pain resulted in functional loss or functional impairment. Subsequent VA hip and thigh conditions DBQ in April 2017 showed no functional loss or functional impairment due to right hip pain. Range of motion testing of the right hip in April 2017 showed adduction to 20 degrees. The Veteran was able to cross his legs because post-test right hip adduction was not limited. Having reviewed the record evidence, the Board finds that the symptomatology attributable to the Veteran’s service-connected right thigh impairment improved on VA hip and thigh conditions DBQ in April 2017 when it was noted that this disability did not result in functional loss or functional impairment due to right hip pain. This examination also showed that the Veteran was able to cross his legs because post-test right hip adduction was not limited. Unfortunately, the Veteran died in August 2017, approximately 4 months after his VA hip and thigh conditions DBQ in April 2017. The Veteran’s service-connected right thigh impairment nevertheless demonstrated sustained improvement when the physical examination findings taken in April 2017 are compared with the prior physical examination findings taken in March 2015. The record evidence further does not show that the Veteran’s service-connected right thigh impairment is manifested by limitation of abduction with of the right thigh with motion lost beyond 10 degrees as is required for a 20 percent rating under DC 5253. See 38 C.F.R. § 4.71a, DC 5253 (2018). The Appellant finally has not identified or submitted any evidence that the Veteran’s service-connected right thigh impairment did not show sustained improvement under the ordinary conditions of life during the appeal period. In summary, the Board finds that the rating reduction from 20 percent to 10 percent effective August 1, 2017, for right thigh impairment was proper. 5. Entitlement to a 20 percent rating effective April 18, 2017, for right knee osteoarthritis with instability The Board next finds that the evidence supports assigning a 20 percent rating effective April 18, 2017, for right knee osteoarthritis with instability. The record evidence shows that the symptomatology attributable to the Veteran’s service-connected right knee osteoarthritis with instability worsened on that date. Prior to this date, the record evidence shows that this disability is manifested by, at worst, complaints of right knee instability. For example, on VA knee and lower leg conditions DBQ in March 2015, the Veteran’s complaints included right greater than left knee instability. He denied experiencing any flare-ups of right knee pain. Physical examination of the right knee showed no joint instability. He constantly used a cane for ambulation. X-rays showed arthritis. The diagnoses included right knee joint osteoarthritis. Despite the Veteran’s assertions to the contrary, the record evidence shows that, prior to April 18, 2017, his service-connected right knee osteoarthritis with instability is manifested by, at worst, complaints of right knee instability (as noted on VA examination in March 2015). It appears that the Veteran was awarded a 10 percent rating for his service-connected right knee osteoarthritis with instability due to his complaints of right greater than left knee instability on VA examination in March 2015. No joint instability was noted on physical examination of either knee at that time. There is no indication that, prior to April 18, 2017, the Veteran experienced at least moderate recurrent subluxation or lateral instability (i.e., at least a 20 percent rating) such that a disability rating greater than 10 percent is warranted for his service-connected right knee osteoarthritis with instability prior to this date. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 10 percent prior to April 18, 2017, for service-connected right knee osteoarthritis with instability. Thus, the Board finds that the criteria for a disability rating greater than 10 percent prior to April 18, 2017, for right knee osteoarthritis with instability have not been met. In contrast, the record evidence supports assigning a higher 20 percent rating effective April 18, 2017, for the Veteran’s service-connected right knee osteoarthritis with instability. See 38 C.F.R. § 4.71a, DC 5257 (2018). VA knee and lower leg conditions DBQ on April 18, 2017, showed – for the first time – that the Veteran experienced moderate lateral instability (i.e., a 20 percent rating under DC 5257) as a result of his service-connected right knee osteoarthritis with instability. Id. This examination also showed 1+ instability on right knee joint stability testing. The diagnoses included right knee osteoarthritis and right knee instability. There is no indication, however, that the Veteran experienced severe recurrent subluxation or lateral instability (i.e., a 30 percent rating under DC 5257) such that a disability rating greater than 20 percent is warranted effective April 18, 2017. Id. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 20 percent rating effective April 18, 2017, for right knee osteoarthritis with instability have been met. See also 38 C.F.R. § 3.102 (2018). 6. Entitlement to a disability rating greater than 10 percent for left knee arthritis The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent for left knee arthritis. Contrary to the Veteran’s lay assertions, the record evidence shows that his service-connected left knee arthritis is manifested by, at worst, complaints of pain and x-ray evidence of arthritis. For example, on VA knee and lower leg conditions DBQ in March 2015, range of motion testing of the left knee showed flexion to 80 degrees and extension to 0 degrees with pain causing functional loss. Physical examination of the left knee showed no tenderness to palpation or crepitus, 4/5 muscle strength, and no muscle atrophy, ankylosis, or joint instability. X-rays showed arthritis. On VA knee and lower leg conditions DBQ in April 2017, range of motion testing of the left knee showed flexion to 110 degrees. Physical examination of the left knee showed no pain with weight bearing, tenderness to palpation, or crepitus, 4/5 strength, no muscle atrophy or ankylosis, and no knee joint instability. There was pain on passive range of motion testing and in non-weight bearing. These physical examination findings support the assignment of a 10 percent rating for the Veteran’s service-connected left knee arthritis under DC 5260. See 38 C.F.R. § 4.71a, DC 5260 (2018). There was x-ray evidence of left knee arthritis on VA examination in March 2015 when left knee pain on range of motion testing caused the Veteran to experience functional loss. There was pain on passive range of motion testing and in non-weight bearing for the left knee on VA examination in April 2017 although there also was no pain with weight bearing or knee joint instability. There is no indication that the Veteran experienced left knee flexion limited to 30 degrees or less (i.e., a 20 percent rating) as is required for a disability rating greater than 10 percent under DC 5260. Id. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 10 percent for service-connected left knee arthritis. In summary, the Board finds that the criteria for a disability rating greater than 10 percent for left knee arthritis have not been met. 7. Entitlement to a compensable disability rating for a left ankle disability The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a compensable disability rating for a left ankle disability. Contrary to the Veteran’s lay assertions, the record evidence shows that the Veteran’s service-connected left ankle disability is not manifested by any compensable disability at any time during the appeal period. For example, on VA ankle conditions DBQ in March 2015, the Veteran complained of chronic ankle weakness primarily in the right ankle. “He is unclear when this condition began but it has persisted for many years.” Physical examination of the left ankle showed a normal range of motion, no pain with weight bearing or tenderness to palpation, no flare-ups, 4/5 muscle strength, and no ankylosis, instability, or dislocation. The Veteran constantly used a cane for ankle stability. X-rays showed no arthritis. The record evidence does not show – and the Appellant does not contend – that the Veteran experienced at least moderate limited motion of the left ankle (i.e., a 10 percent rating under DC 5271) as is required for a compensable disability rating for his service-connected left ankle disability. See 38 C.F.R. § 4.71a, DC 5271 (2018). The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a compensable disability rating for a service-connected left ankle disability. In summary, the Board finds that the criteria for a compensable disability rating for a left ankle disability have not been met. 8. Entitlement to a disability rating greater than 10 percent for right ankle sprain residuals The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent for right ankle sprain residuals. Contrary to the Veteran’s lay assertions, the record evidence shows that his service-connected right ankle sprain residuals are manifested by, at worst, moderate limited motion of the right ankle. For example, on VA ankle conditions DBQ in March 2015, the Veteran complained of chronic ankle weakness primarily in the right ankle. He experienced severe flare-ups of right ankle pain 2-3 times per month lasting 1 day at a time. Range of motion testing of the right ankle showed dorsiflexion to 15 degrees and plantar flexion to 35 degrees. The VA examiner stated that range of motion testing of the right ankle caused limping. There was additional limitation of motion on repetitive range of motion testing of the right ankle with dorsiflexion to 20 degrees and plantar flexion to 30 degrees. Physical examination of the right ankle showed pain with weight bearing, no tenderness to palpation, 3/5 muscle strength, and no ankylosis, ankle instability, or dislocation. X-rays showed no arthritis. The diagnosis was chronic/recurrent right deltoid ligament sprain. Because they demonstrate the presence of moderate limited motion of the right ankle, the physical examination findings obtained in March 2015 support the assignment of a 10 percent rating for the Veteran’s service-connected right ankle sprain residuals under DC 5271. See 38 C.F.R. § 4.71a, DC 5271 (2018). There is no indication, however, that the Veteran had marked limited motion of the right ankle as a result of his service-connected right ankle sprain residuals such that a disability rating greater than 10 percent is warranted under DC 5271. Id. The Veteran’s right ankle dorsiflexion actually improved on repetitive testing and showed a full range of motion to 20 degrees in March 2015. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 10 percent for service-connected right ankle sprain residuals. In summary, the Board finds that the criteria for a disability rating greater than 10 percent for right ankle sprain residuals have not been met. 9. Entitlement to a compensable disability rating for hammertoes of the right foot The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a compensable disability rating for hammertoes of the right foot. Contrary to the Veteran’s lay assertions, the record evidence shows that his service-connected hammertoes of the right foot are manifested by, at worst, complaints of pain and swelling only affecting the third and fourth toes. For example, on VA foot conditions DBQ in March 2015, the Veteran’s complaints included right hammertoes only affecting the third and fourth toes and a cold right foot. X-rays showed no arthritis. The diagnosis was right hammertoes. On VA outpatient podiatry treatment in April 2017, physical examination showed a hammertoe on the right second digit and the bilateral lower extremities “are cool to the touch.” Despite the Veteran’s assertions to the contrary, the record evidence shows only that his service-connected hammertoes of the right foot affect only single toes (the second, third, and fourth) and not all toes as is required for a minimum compensable disability rating under DC 5282. See 38 C.F.R. § 4.71a, DC 5282 (2018). VA examination in March 2015 found that this disability only affected the third and fourth toes of the right foot. Subsequent VA outpatient podiatry treatment in April 2017 found a hammertoe only on the right second digit. The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a compensable disability rating for service-connected hammertoes of the right foot. In summary, the Board finds that the criteria for a compensable disability rating for hammertoes of the right foot have not been met. 10. Entitlement to a disability rating greater than 10 percent for bilateral foot injury residuals The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent for bilateral foot injury residuals. Contrary to the Veteran’s lay assertions, the record evidence shows that this disability is manifested by, at worst, moderate right foot pain and swelling with weight bearing. On VA foot conditions examination in March 2015, the Veteran’s complaints included moderate bilateral foot swelling, right greater than left. Physical examination of the right foot in March 2015 showed pain and swelling with weight bearing. The Veteran was unable to wear a shoe on the right foot and ambulate with the right foot due to functional loss or during flare-ups of pain. He used a cane during flare-ups of right foot pain. On VA outpatient podiatry treatment in April 2017, the Veteran’s complaints included thick mycotic dystrophic elongated nails “which are tender at times with shoe gear irritation” on both feet. Physical examination of the bilateral lower extremities showed an unsteady gait, non-palpable dorsalis pedis and posterior tibialis pulses in the right foot, traceable dorsalis pedis pulse and non-palpable posterior tibialis pulse in the left foot, edema, and a painful callus at the first sub-metatarsal head of the right foot. Neurological examination showed tingling, numbness, and pins and needles sensation in the bilateral lower extremities. The Veteran’s feet were hypersensitive. The assessment included onychomycosis, foot pain, and poor circulation in the feet. In a letter dated in April 2016 which was received electronically by VA in October 2017, D. L. T., D.P.M., stated that the Veteran was under his care for a foot condition. A history of in-service frostbite while serving in combat in Korea was noted. Dr. D. L. T. stated, “[The Veteran’s] feet are very hypersensitive secondary to the frostbite.” Despite the lay assertions to the contrary, the record evidence shows only that the Veteran’s service-connected bilateral foot injury residuals are manifested by, at worst, moderate right foot pain and swelling with weight bearing. VA examination in March 2015 documented the Veteran’s complaints of moderate bilateral foot swelling, right greater than left, and showed that there was pain and swelling with weight bearing on the right foot. The Veteran was unable to wear a shoe on the right foot and ambulate with the right foot due to functional loss or during flare-ups of pain when he used a cane due to right foot pain. The Veteran’s VA and private outpatient treatment records document the presence of hypersensitivity in both feet. There is no indication that he experienced moderately severe or severe foot injuries as is required for a higher 20 or 30 percent rating under DC 5284. See 38 C.F.R. § 4.71a, DC 5284 (2018). The Appellant finally has not identified or submitted any evidence demonstrating entitlement to a disability rating greater than 10 percent for service-connected bilateral foot injury residuals. In summary, the Board finds that the criteria for a disability rating greater than 10 percent for bilateral foot injury residuals have not been met. Effective Date The Appellant contends that an earlier effective date than June 30, 2010, is warranted for the grant of service connection for a left ankle disability and for left knee arthritis. Neither the Appellant nor her attorney has raised any other issues nor have any other issues with respect to earlier effective date claims been reasonably raised by the record. See Doucette, 28 Vet. App. at 369-370. 11. Entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for a left ankle disability and for left knee arthritis The Board finds that the claims of entitlement to an earlier effective date than June 30, 2010, for a grant of service connection for a left ankle disability and for left knee arthritis must be dismissed as a matter of law. In Rudd v. Nicholson, 20 Vet. App. 296 (2006), the Court held that Appellants are prohibited from collaterally attacking a prior final rating decision by filing a freestanding earlier effective date claim. The Court specifically held that, once a rating decision has become final, as is the case here with the August 2014 rating decision which granted service connection and assigned separate zero percent ratings effective June 30, 2010, for a left ankle disability and for left knee arthritis, a claimant may not properly file, and VA has no authority to adjudicate, a freestanding earlier effective date claim in an attempt to overcome the finality of an AOJ decision. The Court reasoned in Rudd that to allow such claims would vitiate the rule of finality. See Rudd, 20 Vet. App. at 299. Although there are numerous exceptions to the rule of finality and application of res judicata within the VA adjudication system, a new and distinct claim for an earlier effective date is not one of them. See Rudd, 20 Vet. App. at 300; see also DiCarlo v. Nicholson, 20 Vet. App. 52, 56-57 (2006) (discussing the types of collateral attack authorized to challenge a final decision by the Secretary). In DiCarlo, the Federal Circuit specifically held that, “Except as provided by law, when a case or issue has been decided and an appeal has not been taken within the time prescribed by law, the case is closed, the matter is ended, and no further review is afforded.” Id., at pp. 55-56 (citations omitted). In this case, it is undisputed that the August 2014 rating decision, which granted service connection and assigned separate zero percent ratings effective June 30, 2010, for a left ankle disability and for left knee arthritis, is final. The Veteran did not initiate a timely appeal by a filing a Notice of Disagreement or otherwise disagree with this decision. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. He also did not submit any relevant evidence or argument within 1 year of the August 2014 rating decision which would render it non-final for VA adjudication purposes. See Buie, 24 Vet. App. at 251-52. Following the issuance of the August 2014 rating decision, the next relevant correspondence occurred when the Veteran requested increased ratings for his service-connected left ankle disability and left knee arthritis in statements on a VA Form 21-256EZ dated on October 13, 2014, and date-stamped as received by VA on December 4, 2014. The AOJ then denied increased ratings for each of these disabilities in the currently appealed rating decision issued in April 2015. This appeal followed. The Board notes here that, in statements on a VA Form 21-0958, “Notice of Disagreement,” dated on June 18, 2015, and date-stamped as received electronically by VA on June 19, 2015, the Veteran disagreed with the April 2015 rating decision, in pertinent part, with respect to the effective date assigned for the grant of service connection for a left ankle disability and for left knee arthritis. The Board cannot adjudicate the Veteran’s earlier effective date claims to the extent that they attempt to reopen a prior final rating decision without violating the Court’s express prohibition against freestanding earlier effective date claims found in Rudd. See Rudd, 20 Vet. App. at 296. Therefore, there is no legal entitlement to an effective date earlier than June 30, 2010, for the grant of service connection for a left ankle disability and for left knee arthritis and these claims must be dismissed. See also Sabonis v. Brown, 6 Vet. App. 426 (1994). 12. Entitlement to a TDIU The Board finally finds that the evidence reasonably supports granting the TDIU claim. See generally 38 C.F.R. § 4.16 (2018). The record evidence is in relative equipoise as to whether the Veteran’s service-connected disabilities, alone or in combination, preclude him from securing or following a substantially gainful occupation, entitling him to a TDIU. In other words, the record evidence both supports and goes against the TDIU claim. The Veteran, during his lifetime, and the Appellant, after the Veteran’s death, consistently maintained that he was unemployable solely as a result of his service-connected disabilities. The Board notes initially that service connection currently is in effect for right thigh limitation of flexion, evaluated as 20 percent disabling effective June 30, 2010, right hip degenerative joint disease with limitation of extension, evaluated as 10 percent disabling effective June 30, 2010, right knee osteoarthritis with instability, evaluated as 10 percent disabling effective June 30, 2010, left knee arthritis, evaluated as 10 percent disabling effective June 30, 2010, right knee arthritis due to strain, evaluated as 10 percent disabling effective June 30, 2010, right ankle sprain residuals, evaluated as 10 percent disabling effective June 30, 2010, bilateral foot injury residuals, evaluated as 10 percent disabling effective June 30, 2010, an inguinal hernia, evaluated as 10 percent disabling effective June 30, 2010, right thigh impairment, evaluated as 10 percent disabling effective August 1, 2017, a left ankle disability, evaluated as zero percent disabling effective June 30, 2010, and for hammertoes of the right foot, evaluated as zero percent disabling effective November 10, 2011. The Veteran’s combined disability evaluation for compensation (including the bilateral factor for partial disability affecting both knees, both ankles, and both feet) is 70 percent effective August 1, 2017. Thus, applying both the bilateral factor and the combined ratings table, the Veteran currently meets the schedular criteria for a TDIU. See 38 C.F.R. §§ 4.16(a), 4.25, 4.26 (2018). The Board also notes initially that, in statements on a VA Form 21 4192 date-stamped as received by VA on December 4, 2014, the Veteran reported that he had been retired since approximately July 1995, including throughout the appeal period, after working for more than 40 years in the logging industry. In April 2015, a VA clinician opined that the Veteran’s service-connected disabilities “would not render [him] totally incapable of obtaining and maintaining sedentary gainful employment. He is capable of sedentary employment such as that of administration, administrative assisting, clerical or triage of information in a business setting.” This clinician also stated, “The Veteran’s functional limitations in an occupational setting include, difficulty climbing stairs, prolonged walking and standing. Would be able to do sedentary functions such as sitting, talking, listening, triage of information.” The rationale for this opinion was based on a review of the Veteran’s claims file. Following VA outpatient treatment in April 2017, a VA podiatrist opined that the Veteran should not be working due to his current medical condition. In a July 2017 opinion, N. C., M.D., stated that the Veteran had been under his care since July 2014 “and [he] has a long standing medical history of bilateral hip osteoarthritis.” This physician opined that, in light of the Veteran’s medical history “and current state of health,” he was unemployable. This physician noted that the Veteran “exhibits significant physical limitations due to pain and weakness.” The Veteran, during his lifetime, and the Appellant, after the Veteran’s death, maintain that his service-connected disabilities, alone or in combination, preclude his employability. The record evidence is in relative equipoise as to whether his service-connected disabilities preclude his employability and entitle him to a TDIU. On the one hand, a VA clinician opined in April 2015 that the Veteran’s service-connected disabilities “would not render [him] totally incapable of obtaining and maintaining sedentary gainful employment.” Although this statement does not reflect the standard for determining entitlement to a TDIU, and in spite of the Veteran’s obvious physical limitations due to his service-connected disabilities, the April 2015 VA examiner nevertheless concluded that the Veteran could perform certain sedentary tasks. This opinion was fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). On the other hand, the Veteran’s VA treating podiatrist stated in April 2017 that his current medical condition due to his service-connected bilateral foot disabilities meant that he should not be working. Similarly, Dr. N.C., a private physician who had been treating the Veteran since July 2014, opined in July 2017 that, in light of the Veteran’s medical history “and current state of health,” he was unemployable. The July 2017 opinion from Dr. N.C. also was fully supported. Id. Resolving all reasonable doubt in the Veteran’s favor, the Board concludes that the record evidence sufficiently supports finding that the Veteran’s service-connected disabilities, alone or in combination, preclude his employability and entitle him to a TDIU. See 38 C.F.R. §§ 3.102, 4.16(a) (2018). In summary, the Board finds that the criteria for a TDIU have been met. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel 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.