Citation Nr: 20028079 Decision Date: 04/22/20 Archive Date: 04/22/20 DOCKET NO. 10-34 800 DATE: April 22, 2020 ORDER Entitlement to a non-initial rating in excess of 10 percent for a left elbow disorder is denied. Entitlement to a non-initial rating in excess of 10 percent for a right elbow disorder is denied. Entitlement to an initial rating in excess of 10 percent for a right hand disorder is denied. Entitlement to an initial rating in excess of 10 percent for a left hand disorder is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Considering the complaints of pain, the Veteran’s left elbow disorder has not resulted in flexion limited to 90 degrees or extension limited to 45 degrees. 2. Considering the complaints of pain, the Veteran’s right elbow disorder has not resulted in flexion limited to 90 degrees or extension limited to 45 degrees. 3. Considering the complaints of pain, the Veteran’s right hand arthritis has not resulted in X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations; and there is no ankylosis of any digits of the hand or limitation of motion of individual digits. 4. Considering the complaints of pain, the Veteran’s left hand arthritis has not resulted in X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations; and there is no ankylosis of any digits of the hand or limitation of motion of individual digits. 5. The Veteran does not meet the minimum threshold requirements for a TDIU on a schedular basis; his service-connected disabilities are not sufficient to preclude all forms of substantially gainful employment consistent with his education and occupational background at any time during the pendency of this claim. CONCLUSIONS OF LAW 1. The criteria for a non-initial rating in excess of 10 percent for a left elbow disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5206, 5207. 2. The criteria for a non-initial rating in excess of 10 percent for a right elbow disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5206, 5207. 3. The criteria for an initial rating in excess of 10 percent for a right hand disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5216-5230. 4. The criteria for an initial rating in excess of 10 percent for a left hand disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5216-5230. 5. The criteria for establishing entitlement to TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1973 to May 1996. These matters were remanded by a December 2012 Board decision for further development. The matters have since been returned to the Board for appellate review. In the December 2012 the Board directed the agency of original jurisdiction (AOJ) to provide the Veteran with VA examinations to assess the current severity of his bilateral elbow and bilateral hand disorders. Also, the AOJ was to develop the Veteran’s claim of TDIU and provide him with a VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability). VA contacted the Veteran’s last known address, phone number, and electronic mail address in February 2015, January 2016, January 2017, March 2017, July 2018, October 2018, and April 2019. In an August 2017 report of general contact, the Veteran called VA and requested a VA examination in November 2017 because he was in China and would be in the United States during that time. In December 2017, in a report of general information, the Veteran called VA and stated he is unable to report for examinations because he will not be in the United States. VA requested the Veteran to report for a VA examination at the United States Embassy in Beijing or Shanghai in the People’s Republic of China. The Veteran declined to appear at either Embassy, stating that the drive is too far, and he does not like “big cities.” The Veteran stated that he will return to the United States at the end of 2020. The Board notes that the requested VA examinations were not conducted as a result of the Veteran’s refusal to attend a VA examination at the nearby United States Embassies. VA gave the Veteran the requisite notice to schedule the examinations and the Veteran chose to not have those examinations done. In light of this, the Board finds that the Veteran refused to report for VA examinations without showing good cause for his refusal to report. The Court has emphasized that “[t]he duty to assist in the development and adjudication of a claim is not a one-way street.” Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); see also Kowalski v. Nicholson, 19 Vet. App. 171, 178 (2005). In this instance, the duty to assist was frustrated by the Veteran’s refusal to report for VA examinations that were needed to produce evidence essential to his claim. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). More generally, disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. In addition, the intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. This regulation also provides that the intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability, and that crepitation should be noted carefully as points of contact which are diseased. Thus, when assessing the severity of a musculoskeletal disability that, as here, is at least partly rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). And although VA is required to apply 38 C.F.R. §§ 4.40 and 4.45, pertaining to functional impairment for disabilities evaluated on the basis of limitation of motion, where the Veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, these regulations are not for application. Johnston, 10 Vet. App. at 84-85. Moreover, pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. 1. Entitlement to a non-initial rating in excess of 10 percent for a left elbow disorder is denied. 2. Entitlement to a non-initial rating in excess of 10 percent for a right elbow disorder is denied. The Veteran asserts that his bilateral elbow disorder is more severe than currently evaluated. Musculoskeletal impairment of the elbow, including limitation of motion, is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5205-5213. Different ratings are available for the dominant (major) and non-dominant (minor) side. Here, the Veteran is right-hand dominant. The Veteran’s bilateral elbow disability is rated under Diagnostic Code 5206, covering limitation of flexion of the forearm. A 10 percent rating is warranted for flexion limited to 100 degrees on the major and minor side. 38 C.F.R. § 4.71a, Diagnostic Code 5206. A 20 percent rating is warranted for flexion limited to 90 degrees on the major and minor side. Id. A 20 percent rating is warranted for flexion limited to 70 degrees on the minor side. Id. A 30 percent rating is warranted for flexion limited to 70 degrees on the major side and 55 degrees on the minor side. Id. A 40 percent rating is warranted for flexion limited to 55 degrees on the major side and 45 degrees on the minor side. Id. A 50 percent rating is warranted for flexion limited to 45 degrees on the major side. Id. Diagnostic Code 5207 provides that limitation of extension of the forearm warrants a 10 percent evaluation for extension limited to 45 to 60 degrees on the major and minor side. 38 C.F.R. § 4.71a, Diagnostic Code 5207. A 20 percent rating is warranted for extension limited to 75 degrees on the major and minor side. Id. A 20 percent rating is warranted for extension limited to 90 degrees on the minor side. Id. A 30 percent rating is warranted for extension limited to 90 degrees on the major side and 100 degrees on the minor side. Id. A 40 percent rating is warranted for extension limited to 100 degrees on the major side and 110 degrees on the minor side. Id. A 50 percent rating is warranted for extension limited to 110 degrees on the major side. Id. In a March 2010 VA elbow examination, the Veteran indicated that he experienced pain, giving way, and lack of endurance. The Veteran reported that he experienced flare-ups that include pain and are severe and constant with lifting items. The Veteran stated that the chronic bilateral elbow pain is greater in the right than left. The examiner observed the Veteran to be right hand dominant. The examiner also observed the Veteran to have no ankylosis of the elbow joints. Range of motion was found to be flexion of the right and left elbow to 127 degrees and full extension of the right and left elbow to 0 degrees. The examiner observed pain, fatigue, and weakness in the right and left elbow during initial range of motion. The examiner observed objective evidence of painful motion during examination. On additional range of motion testing, the examiner observed left elbow flexion to 124 degrees; right elbow flexion to 122 degrees; extension remained full to 0 degrees bilaterally. During this testing the examiner again observed pain, fatigue, and weakness in the bilateral elbows. The examiner identified that the Veteran’s right elbow flexion is most limited after repetitive use. The examiner did not observed instability of the joint. The examiner stated that a bilateral elbow X-ray was abnormal and showed mild degenerative changes in the joint. In the August 2010 substantive appeal, the Veteran stated that his bilateral elbow disorder effects his daily life and causes him to be unable to lift small items, such as a bag of sugar. He stated that the pain is constant, and he has to compensate when he must lift items. He stated that his condition meets the criteria of 20 percent based on the effects to the elbows’ daily functioning. In an August 2011 VA treatment record, the Veteran complained of pain in the bilateral arms from the elbows down. Upon review of the record, the Board finds that a disability rating in excess of 10 percent for each of the Veteran’s elbows is not warranted. To obtain a higher rating, it is necessary to show limitation of flexion to 90 degrees in the major or minor side. Similarly, to warrant a separate 10 percent rating for limitation of extension, extension limited to 45 degrees on the major or minor side would have to be shown. Here, however, the Veteran has not been found to have limitation of flexion to 90 degrees, even when pain on motion and repetition are considered. Additionally, the Veteran’s extension has been full, to 0 degrees bilaterally, even on repetitive motion testing and when pain on motion is considered. Thus, the Board finds that a higher or separate rating is not warranted for the Veteran’s bilateral elbow disorder at any time during the appeal period. No additional higher or alternative ratings under different Diagnostic Codes can be applied in this case. For the purposes of Diagnostic Code 5205, ankylosis is “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992). There is no evidence that the right or left elbow are ankylosed, and the March 2010 VA examiner affirmatively found to the contrary. Id. There is similarly no medical evidence of flail joint, joint fracture, or impairment of supination or pronation. 38 C.F.R. § 4.71a, Diagnostic Codes 5209, 5210, 5213. Finally, there is no medical evidence of impairment of the ulna or radius. 38 C.F.R. § 4.71a, Diagnostic Code 5211, 5212. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, because the preponderance of the evidence is against the Veteran’s claim, that doctrine is not helpful to the Veteran. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to an initial rating in excess of 10 percent for a right hand disorder is denied. 4. Entitlement to an initial rating in excess of 10 percent for a left hand disorder is denied. The Veteran asserts that his bilateral hand disorder is more severe than currently evaluated. The Veteran’s bilateral hand disorder is rated under Diagnostic Code 5010 for arthritis and can also be rated under Diagnostic Codes 5216 to 5230 as evaluation of ankylosis or limitation of motion of single or multiple digits of the hand. Diagnostic Code 5010 states that traumatic arthritis is to be rated as degenerative arthritis under Diagnostic Code 5003, which states that the severity of degenerative arthritis, established by X-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected, which in this case would be Diagnostic Codes 5216 to 5230. When there is arthritis with at least some limitation of motion, but to a degree which would be noncompensable under a limitation-of-motion diagnostic code, a 10 percent rating will be assigned for each affected major joint or group of minor joints. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. Ratings for arthritis cannot be combined with ratings based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. In a September 2009 VA treatment record, the Veteran stated that he continues to have locking up in his fingers in the bilateral hands during cold weather. On examination, the medical provider observed no joint tenderness, warmth, crepitus, or swelling. A March 2010 VA radiology report states that the Veteran’s bilateral hands show mild osteoarthritis. On the May 2010 VA hand examination, the Veteran stated that his fingers “lock up on me” all the time. He stated that this occurs with any type of activity and is aggravated by cold. He further stated that he has occasional pain in the joints of the hands with overuse. The May 2010 VA hand examiner stated that the Veteran is right hand dominant. On examination, the examiner observed the Veteran’s right and left index fingers to have normal range of motion. The examiner indicated there is objective evidence of pain in the right index finger. The examiner observed range of motion in the right and left long fingers to be normal with objective evidence of pain bilaterally. The examiner observed the Veteran’s left ring finger to have no limitation of motion but did have objective evidence of pain. The right ring finger is observed to have no limitation of motion and no objective evidence of pain. The left little finger is observed to have no limitation of motion but does show objective evidence of pain. The right little finger has no limitation of motion and no objective evidence of pain. Finally, the examiner observed the bilateral thumbs to have no gap between the thumb pad and the fingers and no objective evidence of pain. The examiner indicated there is no amputation of a digit or part of a digit, no ankylosis of one or more digits, no deformity of one or more digits, no decreased strength for pushing, pulling, and twisting, and there is no decreased dexterity for twisting, probing, writing, touching, and expression. On the August 2010 substantive appeal, the Veteran stated that his bilateral hand disorder continues to have increased pain with locking on a daily basis. He stated that when his fingers lock, he experienced tremendous loss of functional use. He stated that his disorder meets the criteria for a 20 percent disability rating based on the X-ray evidence showing arthritis in the bilateral hands. In an August 2012 VA treatment record, the Veteran complained of right hand mild pain. In a December 2014 VA treatment record, the Veteran complained that his left hand fourth finger “locks out” at night. The medical provider observed the left hand fourth finger to have no swelling, erythema, or tenderness. The medical provider observed no limited range of motion. In a later December 2014 VA treatment record, the Veteran again stated that he has been having difficulty in the bilateral hands due to arthritis. He stated that his fingers “lock up” on him. In a September 2019 VA treatment record, the Veteran reported increasing pain in the right hand. Upon review of the record, the Board finds that disability ratings in excess of 10 percent for of the Veteran’s left and right hand arthritis are not warranted. To obtain a higher rating, it is necessary to show X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Here, however, the Veteran has not been found to have involvement of two or more major joints or occasional incapacitating exacerbations. Thus, the Board finds that a higher rating is not warranted for the Veteran’s bilateral hand arthritis at any time during the appeal period. No additional higher or alternative ratings under different Diagnostic Codes can be applied in this case. For the purposes of Diagnostic Code 5216 to 5225, unfavorable ankylosis of multiple digits, favorable ankylosis of multiple digits, and ankylosis of individual digits, there is no evidence that there are any digits that have unfavorable or favorable ankylosis, and the May 2010 VA examiner affirmatively found evidence to the contrary. For the purposes of Diagnostic Codes 5228 to 5230 and limitation of motion of individual digits, there is no medical evidence that any digits have limitation of motion. 38 C.F.R. § 4.71a. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, because the preponderance of the evidence is against the Veteran’s claim, that doctrine is not helpful to the Veteran. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 5. Entitlement to a TDIU a denied. The issue of TDIU is before the Board as a part of the increased rating claims for the bilateral elbows and bilateral hands. See Rice v. Shinseki, 22 Vet. App. 447 (2009). TDIU may be assigned when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that: if the veteran has only one such disability, the disability must be rated at 60 percent or more, or, if the veteran has two or more disabilities, at least one disability is rated at 40 percent or more and additional disabilities bring the veteran’s combined disability rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor which takes his or her case outside of the norm. The sole fact that he or she is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). A veteran who fails to meet these percentage standards may still qualify for an extraschedular TDIU rating under 38 C.F.R. § 4.16(b). Under that provision, VA will grant a TDIU when the evidence shows that the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when the Board conducts a TDIU analysis, it must take into account the individual veteran’s education, training, and work history. See Hatlestad v. Derwinski, 1 Vet. App. 164, 168 (1991). 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 totally disabled. 38 U.S.C. § 4.16. Therefore, at the regional office (RO) level, rating boards are to submit to the Director of Compensation Service (Director) for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). The Board itself cannot assign an extraschedular rating in the first instance. Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996). However, the Board can adjudicate whether to refer a case to the Director for an extraschedular evaluation when the issue is either raised by the claimant or is reasonably raised by the evidence of record. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If, and only if, the Director determines that an extraschedular evaluation is not warranted, does the Board then have jurisdiction to decide the extraschedular claim on the merits. Anderson v. Shinseki, 22 Vet. App. 423, 427-8 (2009). In this case, the Veteran is service connected for tinnitus, rated as 10 percent disabling; a right elbow disorder, rated as 10 percent disabling; a left elbow disorder, rated as 10 percent disabling; right hand arthritis, rated as 10 percent disabling; left hand arthritis, rated as 10 percent disabling; a lung disorder, rated as 10 percent disabling; right eye cataract, rated as noncompensable; bilateral hearing loss, rated as noncompensable; and a left wrist ganglion cyst, rated as noncompensable. The Veteran’s combined rating is 50 percent. See 38 C.F.R. § 4.25. Therefore, the Veteran does not meet the schedular requirements for TDIU under 38 C.F.R. § 4.16(a). Accordingly, the only remaining question is whether referral for extraschedular TDIU is warranted under 38 C.F.R. § 4.16(b). On the March 2010 VA elbow examination, the examiner stated that the Veteran’s bilateral elbow disorder caused the Veteran to be unable to maintain gainful employment as an aircraft mechanic. The examiner stated that the Veteran is able to get through most daily activities but does so with moderate to severe pain and must pace and modify daily tasks. On the May 2010 VA hand examination, the Veteran stated that he would like to work as an aircraft mechanic again and that he has not worked since 2002, but states that he could not do his job anymore due to his bilateral hand disorder. The May 2010 VA hand examiner indicated that the Veteran’s bilateral hand disorder mildly effects his ability to perform chores, exercise, sports, recreation, and traveling. In a July 2010 statement, the Veteran stated the he does not believe VA understands how much his bilateral elbow and bilateral hand disorders affect his ability to be gainfully employed. He stated he has not worked since 2003. He stated that when he tries to lift items of minimal weight, he experiences pain. In a January 2011 VA treatment record, the Veteran stated that he is unable to work on airplanes due to his bilateral hand and bilateral elbow disorders. In a September 2011 correspondence, the Veteran stated that his bilateral hand and bilateral elbow disorders have a tremendous impact on his ability to secure any type of decent employment. He stated that he cannot do any type of work that requires lifting. He stated that he has work experience in maintenance. He stated that he does not have other qualifications to obtain employment. He stated that cold weather aggravates his arthritis. Upon review of the record, the Board finds that the preponderance of the evidence is against the claim. The Veteran did not complete VA Form 21-8940 as requested in January 2017. While failure to complete the form is not fatal to a TDIU claim in and of itself, his failure to do so deprives the Board of information as to the Veteran’s employment history, educational history and training, and income information needed to address a claim for TDIU. “The duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Further, the Veteran’s service-connected disabilities do not present a disability picture indicating that TDIU is warranted. The record reflects that the Veteran’s service-connected bilateral elbow disorder affects his ability to lift lightly weighted items. And the March 2010 VA examiner stated that the Veteran is unable to maintain employment as a mechanic as a result. However, the examiner stated that the Veteran is able to perform most daily activities with adjustments made to pace and modification of tasks. Also, the May 2010 VA examination shows that the Veteran’s fingers do not have ankylosis or limitation of motion. Although VA treatment records show that the Veteran’s bilateral hand disorder mildly affects his ability to perform chores, exercise, sports, recreation, and traveling, the record does not indicate that his bilateral hand disorder affects his ability to obtain or maintain employment. Therefore, there is insufficient evidence to conclude that the Veteran’s education, training, and experience preclude him from securing and maintaining all forms of substantially gainful employment due to service-connected disabilities. Thus, referral to the Director of Compensation Service is not warranted, and entitlement to TDIU must be denied. See 38 C.F.R. § 4.16(b). In sum, as the Veteran does meet the schedular criteria for a TDIU and does not warrant referral for extra-schedular consideration, the preponderance of the probative evidence is against a finding that he is unemployable due to his service-connected disabilities. Moreover, the Veteran failed to complete a VA Form 21-8940; thus, information from his prior education, training, and employment that may have supported his claim could not be considered. See Wood, 1 Vet. App. at 193. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, because the preponderance of the evidence is against the Veteran’s claim for a TDIU, that doctrine is not helpful to the Veteran. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson, Associate 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.