Citation Nr: 20031583 Decision Date: 05/05/20 Archive Date: 05/05/20 DOCKET NO. 15-17 164 DATE: May 5, 2020 ORDER Entitlement to an initial disability rating of 40 percent, but no higher, for service-connected lumbar spine disability is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to September 13, 2016, the most probative evidence establishes that the Veteran’s service-connected lumbar spine disability was manifested by forward flexion of the lumbar spine limited to 30 degrees or less. 2. Since September 13, 2016, the most probative evidence establishes that the Veteran’s service-connected lumbar spine disability has been manifested by favorable ankylosis of the entire thoracolumbar spine. 3. At no point during the appellate period has the Veteran’s service-connected lumbar spine manifested in unfavorable ankylosis of the entire thoracolumbar or entire spine or intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during any 12-month period. 4. Prior to September 13, 2016, the record does not contain plausible evidence the Veteran’s service-connected resulted in an inability to secure or follow substantially gainful employment sufficient to warrant referral for extraschedular consideration. 5. Since September 13, 2016, the Veteran has been in receipt of a 100 percent combined schedular rating, and the evidence fails to demonstrate that any single service-connected disability has resulted in an inability to secure or follow substantially gainful employment CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating of 40 percent, but no higher, for service-connected lumbar spine disability have been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. § 4.71a, Diagnostic Code 5242 (2018). 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. § 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1980 to February 1983. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision issues by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In the May 2015 VA form 9, Substantive Appeal, the Veteran did not request an optional Board hearing. His representative later requested a videoconference Board hearing in a March 2016 request, but when a hearing was scheduled in September 2018, the Veteran stated he would be unable to attend due to being out of town. In October 2018, the Board send the Veteran correspondence seeking clarification on whether the Veteran still wished to attend a Board hearing. In November 2018, the Veteran responded with correspondence withdrawing his hearing request. Accordingly, the Veteran’s hearing request has been withdrawn, and the Board shall proceed with adjudication of this appeal without a Board hearing. 38 C.F.R. § 20.704 (2018). The undersigned Veterans Law Judge has been assigned to adjudicate this appeal pursuant to 38 C.F.R. § 19.3(a) (2018). In April 2020, the RO sent out correspondence stating that the claims remanded by the Board in December 2018 were being recertified, and “[the Veteran] will be advised by the Board concerning [his] request for a hearing.” This letter’s reference to an outstanding hearing request was an administrative error, as the Veteran’s November 2018 correspondence clearly demonstrated his intent to withdraw his Board hearing request, and no additional requests for a Board hearing have been received. Consequently, adjudication of the appeal will proceed without a Board hearing. Neither the Veteran nor his representative has raised any issues with VA’s duty to notify or VA’s duty to assist in obtaining documentary evidence. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. In its December 2018 decision, the Board remanded the Veteran’s lumbar spine increased rating claim for a new VA examination on the basis that the September 13, 2016 VA examination did not comply with the United States Court of Appeals for Veterans Claims’ (Court) holding in Correia v. McDonald, 28 Vet. App. 158 (2016). As noted in the March 2020 Supplemental Statement of the Case, the Veteran did not attend a VA examination scheduled in September 2019. The Veteran declined to attend because he was in the middle of moving and he requested that the matter proceed with further adjudication. See September 2019 QTC notice. The Board does not find the Veteran’s explanation to be good cause for missing the VA examination; nevertheless, the provisions of 38 C.F.R. § 3.665 are not for application, as a VA examination was not strictly required to resolve this appeal. As discussed below, the current VA examinations of record, conducted in June 2013 and September 2016, are sufficient to increase the Veteran’s rating for his service-connected lumbar spine disability to 40 percent under the criteria set forth in 38 C.F.R. § 4.71a. The Veteran is already receiving the highest rating under the law based on range of motion findings, and cannot achieve a higher rating without evidence of unfavorable ankylosis of the entire thoracolumbar spine or entire spine. In light of these considerations, there is no need for a Correia-compliant VA examination, as the Veteran cannot achieve a higher rating based on range of motion findings alone. See e.g., Spencer v. West, 13 Vet. App. 376, 382 (2000). The June 2013 and September 2016 VA examinations are otherwise adequate for adjudicative purposes, as they rendered the necessary physical findings to allow for a fair and just assignment of a disability rating during the appellate period. VA’s duty to obtain adequate VA examinations has been satisfied. Under 38 U.S.C. § 7104 (2018), Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Increased Rating for Lumbar Spine Disability The Veteran is currently in receipt of an initial 20 percent rating for his service-connected lumbar spine disability under 38 C.F.R. § 4.71a, Diagnostic Code 5242. He seeks a higher initial rating for the entire appellate period. To warrant a higher disability rating of 40 percent under the General Rating Formula for Diseases or Injuries of the Spine (General Formula), inter alia, the evidence must show forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. To warrant a higher 50 percent rating under the General Formula, the evidence must show unfavorable ankylosis of the thoracolumbar spine. To warrant a total 100 percent schedular rating under the General Formula, the evidence must show unfavorable ankylosis of the entire spine. See 38 C.F.R. § 4.71a. Pursuant to Note (5) of the General Formula, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Following a complete review of the electronic claims file, the Board finds that the Veteran is entitled to a higher 40 percent rating for his service-connected lumbar spine disability under the General Formula for the entire appellate period. To this extent only, the Veteran’s appeal is granted, as explained in the analysis below. A. Prior to September 13, 2016 The Veteran was afforded a VA examination in June 2013 to assess the nature and severity of his lumbar spine disability. The Veteran lay reported moderate-to-severe lumbar spine pain with prolonged standing greater than 1 hour and with repetitive lifting and bending. He experienced flare-ups of lumbar spine pain when moving kegs of beer while working as a bartender. Range of motion testing showed forward flexion of the lumbar spine limited to 50 degrees; however, there was objective evidence of painful motion at 15 degrees. Repetitive use testing was performed and showed forward flexion limited to 50 degrees, with no additional limitation in range of motion of the thoracolumbar spine following repetitive use testing. The VA examiner stated that less movement than normal, weakened movement, pain on movement, and interference with sitting, standing and/or weight-bearing resulted in functional loss/impairment of the thoracolumbar spine. Moreover, the aforementioned range of motion findings do not demonstrate that the joint was immobile or fixed in place. The Board notes that ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)); Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) (ankylosis is “stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint,” citing Stedman’s Medical Dictionary 87 (25th ed. 1990)). Thus, this examination shows no ankylosis (favorable or unfavorable) of the thoracolumbar spine. As noted above, painful motion began at 15 degrees when testing range of motion in the forward flexion position. Painful motion can equate to limitation of motion. See VAOPGCPREC 9-98 (“Under section 4.59, painful motion is considered limited motion even though a range of motion is possible beyond the point when pain sets in.”) (citing Hicks v Brown, 8 Vet. App. 417, 421 (1995)). Resolving reasonable doubt in the Veteran’s favor, and utilizing the point where painful motion began as indicative of his limitation of forward flexion, the Board finds that June 2013 VA examination findings demonstrate thoracolumbar spine forward flexion limited to 15 degrees, sufficient to warrant a higher disability rating of 40 percent prior to September 13, 2016 under the General Formula. The Board has fully reviewed the Veteran’s VA treatment records and Social Security records, but finds no evidence of unfavorable ankylosis of the entire thoracolumbar or entire spine to allow for a General Formula rating higher than the currently awarded 40 percent for the Veteran’s service-connected lumbar spine disability prior to September 13, 2016. B. Since September 13, 2016 Since September 13, 2016, the Veteran has received a 20 percent rating under the General Formula for his service-connected lumbar spine disability. On September 13, 2016, the Veteran was afforded an additional VA examination to assess the nature and severity of his service-connected lumbar spine disability. The Veteran described difficulty walking and standing up during flare-ups of low back pain. Range of motion testing could not be performed secondary to pain. The VA examination was being conducted during a flare-up of the Veteran’s low back disability. The VA examiner charted that pain on examination caused functional loss. The VA examiner noted favorable ankylosis of the entire thoracolumbar spine. As favorable ankylosis is sufficient to warrant a higher 40 percent rating under the General Formula, the Board shall grant a higher 40 percent rating since September 13, 2016 on this basis for the Veteran’s service-connected lumbar spine disability. The Board has fully reviewed the Veteran’s VA treatment records and Social Security records, but finds no evidence of unfavorable ankylosis of the entire thoracolumbar or entire spine to allow for a General Formula rating higher than the currently awarded 40 percent for the Veteran’s service-connected lumbar spine disability since September 13, 2016. C. Additional Considerations The Board has considered whether the Veteran can achieve a higher disability rating for his service-connected lumbar spine utilizing the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2018). To warrant a higher rating than the currently assessed 40 percent evaluation under the IVDS criteria, the evidence must show that the Veteran’s service-connected lumbar spine disability has resulted in incapacitating episodes having a total duration of at least 6 weeks during any 12-month period throughout the pendency of the appeal. Pursuant to Note (1) under the IVDS Formula, an incapacitating episode is defined as “a period of acute signs and symptoms due to [IVDS] that requires bed rest prescribed by a physician and treatment by a physician.” There is no evidence of record indicating that the Veteran’s physicians have prescribed bed rest to treat the Veteran’s service-connected lumbar spine, yet alone for a period of at least 6 weeks during any 12-month period during the appellate period. The June 2013 VA examiner found no evidence of IVDS. The Board acknowledges that the September 2016 VA examiner check marked that the Veteran experienced IVDS with incapacitating episodes of at least 2 weeks but less than 4 weeks in the last 12 months. The VA examiner based this conclusion on the Veteran’s lay reports of bed rest during episodes of acute pain. However, this conclusion is not based on physician prescribed bed rest, as required by the regulation, and as such, it is not probative in this appeal. As there is no probative evidence indicating that the Veteran has experienced IVDS during the appellate period, yet alone, incapacitating episodes for a total duration of at 6 weeks during a 12-month period, the Veteran is not entitled to a higher rating under Diagnostic Code 5243. A separate rating under the IVDS Formula is also not for application, as it would violate the prohibition against pyramiding. See 38 C.F.R. § 4.14 (2018); see also the note under Diagnostic Code 5243, 38 C.F.R. § 4.71a (2018) (“Evaluate [IVDS] (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25.”). The Board has also considered whether the Veteran can achieve a higher initial rating for his service-connected lumbar spine disability under Diagnostic Code 5003. However, the Veteran is already receiving a rating higher than the maximum 20 percent rating allowed by this diagnostic code, and a separate rating cannot be awarded due to the prohibition against pyramiding. See 38 C.F.R. § 4.14 (2018). Lastly, the Board notes that Note (1) to the General Formula directs than any associated objective neurologic abnormalities associated with the Veteran’s service-connected lumbar spine disability should be evaluated separately under the appropriate diagnostic code. In this case, the Veteran was awarded service connection for his lumbar spine disability in a June 2013 rating decision, and he appealed the initial rating assigned, thereby resulting in the present appeal. In a separate September 2016 rating decision, the Veteran was awarded separate 40 percent ratings for radiculopathy affecting each lower extremity. The Veteran did not challenge the rating or effective date assigned for the award of service connection for left and right lower extremity radiculopathy. In John v. Shulkin, No. 16-2487 (U.S. Vet. App. Jan 31, 2018), a single judge memorandum decision authored by the now Chief Judge, the Court held that an appeal of a denial of a low back evaluation does not give rise to an appeal of lower extremity radiculopathy that was first evaluated and assigned after the original appeal was initiated. The Court held that when a neurological abnormality secondary to an service-connected lumbar spine disability is granted during the pendency of the appeal for the increased low back evaluation, the Veteran is required to file a Notice of Disagreement as to the evaluation—and implicitly, the effective date— of the neurological abnormality, if he wishes to initiate an appeal of that issue. See id. at *13-16; see e.g., Ephraim v. Brown, 82 F.3d 399, 402 (Fed. Cir. 1996) (concluding that a claim based on a disorder newly diagnosed during the appeal of the evaluation assigned for a different service-connected disorder starts a new, jurisdictionally separate claim when the new disorder had not been diagnosed and considered at the time of filing of the prior notice of disagreement). In the notification letter accompanying the September 2016 rating decision granting service connection for bilateral lower extremity radiculopathy, the Veteran was clearly told that if he disagreed with any adjudicative determinations in the September 2016 rating decision, he was required to complete the enclosed VA form 21-0958, Notice of Disagreement. In November 2016, he submitted a Notice of Disagreement but only challenged the date of the staged rating for his service-connected left knee disability. In the Supplemental Statement of the Case issued the same day as the September 2016 rating decision, the RO notified the Veteran that they assigned separate 40 percent evaluations for right and left lower extremities due to lumbar spine related radiculopathy. These actions communicated to the Veteran that the radiculopathy and low back claims were jurisdictionally separate entities at different stages of the claim and appellate process. See John, at *15-16. The Veteran did not file a timely Notice of Disagreement challenging the evaluation and effective date assigned for his service-connected right and left lower extremity radiculopathy in the September 2016 rating decision. While the John decision is not binding on the Board, it serves as persuasive authority in the adjudication of this appeal because it is factually similar to the present matter. Notwithstanding Note (1) of the General Formula, the Veteran did not file a Notice of Disagreement to any adjudicative determination rendered in the September 2016 rating decision regarding his bilateral lower extremity radiculopathy. Accordingly, the Board is without the appellate jurisdiction to consider the propriety of the rating and effective date assigned for bilateral lower extremity radiculopathy in the September 2016 rating decision. In sum, the most probative evidence establishes that the Veteran’s service-connected lumbar spine was manifested by forward flexion of 30 degrees or less prior to September 13, 2014, and favorable ankylosis of the entire thoracolumbar spine since September 13, 2016, sufficient to warrant a higher 40 percent rating for the Veteran’s service-connected lumbar spine disability for the entire appellate period. To this extent, the Veteran’s appeal is granted. Entitlement to a TDIU The Veteran asserts that he is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining substantially gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. See 38 C.F.R. §§ 3.340, 3.341, 4.16 (2018). The Court has held that the term “unable to secure and follow a substantially gainful occupation” in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran’s ability to “follow and secure” employment. For the second component, attention must be given to: (a) the Veteran’s history, education, skill and training, (b) the Veteran’s physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Under 38 C.F.R. § 4.16(a), if there is only one service-connected disability, the disability must be rated at 60 percent or more to qualify for schedular TDIU. If there are two or more service-connected disabilities, there must be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a) (2018). Where a veteran does not meet the schedular TDIU criteria, a total rating may be assigned on an extraschedular basis upon a showing that s/he is unable to obtain or retain substantially gainful employment due solely to service-connected disabilities. 38 C.F.R. § 4.16(b) (2018). The Board is unable to award an extraschedular TDIU in the first instance, and instead must first determine whether referral to VA’s Director of Compensation Services is warranted. See Bowling v. Principi, 15 Vet. App. 1, 10 (2001). The determination of a referral is dependent on “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The evidence demonstrates that the Veteran is a high school graduate with two years of post-secondary education. The Veteran told the April 2017 VA psychiatric examiner that immediately following service, he worked for the Department of Corrections, and then worked briefly as a car salesman. Social Security records indicate that the Veteran was employed at a bank as a new account representative from 1987 to 2000. VA treatment records from June 2012 indicate that the Veteran was working on a full-time basis as a real-estate agent and bartender. At the June 2013 VA examination, the Veteran reported that he was working as a bartender 5 times per week, for 6 to 8 hours at a time. In September 2013 VA treatment records, it was noted that the Veteran was no longer working as a realtor, and was occasionally performing property management work. He was also taking on-call jobs for a catering company, where he was a bartender. His income had dropped 2/3 since he ended his employment as a realtor, but the income from his catering job was sufficient to pay his expenses. In the VA form 21-8940, Application for Increased Compensation Based on Unemployability, the Veteran self-reported that he worked 60 hours per week for a catering company from July 2005 to September 2015, with his highest monthly gross earnings being $3,300.00. The Veteran subjectively reported that he became too disabled to work on May 20, 2016. In November 2016, the catering company the Veteran formerly worked for submitted VA form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, certifying that the Veteran was employed from February 2013 to September 2015, on an at-call/part-time/seasonal basis, where he averaged 9 hours per week, and made $10,332.50 in the final year of his employment. See also 2015 W-2 ($9,597.50 in wages). The evidence is contradictory on the nature, duration, and scope of the Veteran’s employment with the catering company. He reported full-time employment, whereas the caterer described the Veteran’s employment as intermittent. The Board affords greater weight to the official records kept by the Veteran’s employer than the recollections and history offered by the Veteran. Accordingly, the Board finds that the Veteran’s employment with the caterer was marginal in nature during his last year of employment, as his annual income was below the 2015 federal poverty threshold for an individual. With the Veteran’s educational attainment and occupational history established, the Board shall proceed with the merits of the claim. A. Prior to September 13, 2016 Prior to September 13, 2016, the Veteran was only service connected for a left knee disability, rated as 10 percent disabling, and a lumbar spine disability, rated as 40 percent disabling, for a combined disability rating of 50 percent pursuant to 38 C.F.R. § 4.25. Thus, the Veteran’s service-connected disabilities did not satisfy the schedular TDIU criteria prior to September 13, 2016. See 38 C.F.R. § 4.16(a) (2018). The pertinent inquiry is whether the record contains plausible evidence that the Veteran’s service-connected disabilities, alone, precluded the Veteran from securing and following substantially gainful employment, sufficient to refer the matter to VA’s Director of Compensation Services for extraschedular TDIU consideration. After a complete review of the record, the Board finds that extraschedular referral is not warranted, as explained below. The medical evidence dated prior to September 13, 2016 does not establish that the Veteran lacked the residual physical capacity to perform substantially gainful employment consistent with his past occupational history and educational attainment. VA treatment records in June 2012 indicated that the Veteran experienced left knee discomfort and weakness only 4 times per year, when moving too quickly or moving awkwardly. At the June 2013 VA examination, the VA examiner reported that the Veteran exhibited moderate-to-severe back pain when standing greater than one hour or performing repetitive lifting and bending. The VA examiner also reported severe left knee pain after 6 to 8 hours of standing/walking. VA treatment records dated in June 2014 documented chronic intermittent left knee and low back pain. The Veteran used a cane and left knee brace to assist with ambulation. He had reduced left knee range of motion, but no ligamentous laxity. Examination of the lumbar spine revealed tenderness to palpation and reduced range of forward flexion. The Veteran presented to a VA physical therapist in August 2014 for treatment of chronic low back pain. He subjectively reported resting pain at 4/10 in the center of the low back and stated that occasionally his back “goes out.” The physical therapist stated that the Veteran’s lumbar range of motion was reduced by 50 percent due to pain, and lower extremity strength was reduced due to pain, although there was no atrophy of the lower extremities. In September and October 2015, the Veteran was admitted by his local VA medical facility following exacerbations of lumbar and left knee pain. The Veteran stated his pain had been manageable, until 3 to 4 weeks prior, when there was a sudden onset of low back pain while washing his vehicle. The Veteran began pain management treatment in May 2016. He underwent a left total knee arthroplasty on September 12, 2016. The medical evidence shows that the Veteran experienced chronic lumbar spine and left knee pain during the period prior to September 13, 2016, however it did not prevent the Veteran from performing all forms of substantially gainful employment consistent with his past occupational and educational experiences. The Veteran has a known history of working as a banker and a real estate agent, which requires clerical work in the form of drafting property listings, contracts, and banking documents, and working with the general public. He also worked as a bartender and caterer, which required customer service skills. Despite his complaints of pain, limiting his ability to stand and walk for prolonged periods, the Veteran has the skillset to satisfactorily perform sedentary customer service employment. He is competent in using computers, completing paperwork, and dealing with the needs of general public clientele. While the Veteran experienced difficulties performing the duties of a bartender and caterer, mainly because these positions required extended standing, the skillset for these jobs could be easily translated to sedentary office/customer service work, where the Veteran interacts with the public and assists with problem solving. The Board defines sedentary as work in an office-like setting, that is primarily performed in the sitting posture, working on the computer, using analytical skills, and completing administrative tasks. See Withers v. Wilkie, 30 Vet. App. 139 (2018). Based on the analysis above, the Board finds no plausible basis upon which to conclude that the Veteran’s service-connected lumbar spine and left knee disabilities have precluded the Veteran from securing and following all forms of substantially gainful employment in the period prior to September 13, 2016. Accordingly, the Veteran’s claim shall not be referred for extraschedular consideration, and entitlement to a TDIU prior to September 13, 2016 is denied. B. Since September 13, 2016 The Board notes that the Veteran applied for a TDIU in September 2016 alleging that his service-connected lumbar spine, left knee, chronic pain, and psychiatric disabilities, collectively, precluded him from securing or following substantially gainful employment. This claim for a TDIU was denied in a May 2017 rating decision, and the Veteran did not perfect an appeal of the claim. Instead, the present claim for entitlement to a TDIU since September 13, 2016 was raised by the Board in its December 2018 decision, as part and parcel with the increased rating claims for the Veteran’s service-connected left knee and lumbar spine disabilities. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Since September 13, 2016, the Veteran has been in receipt of a total 100 percent combined schedular rating. The receipt of a 100 percent schedular disability evaluation for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU. See Bradley v. Peake, 22 Vet. App. 280 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley recognized that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). Bradley, 22 Vet. App. at 293-94 (noting that although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of a TDIU predicated on a single disability when considered together with another disability separately rated at 60 percent or more may warrant payment of special monthly compensation under 38 U.S.C. § 1114 (s)). However, Bradley also explains that a 100 percent combined evaluation does not qualify as “a service-connected disability rated as total” under the statute. 38 U.S.C. § 1114 (s); Bradley, 22 Vet. App. at 290. Thus, the Board must consider whether a single service-connected disability, alone, can provide a basis for award of a TDIU in this case, sufficient to warrant entitlement to special monthly compensation and maximize the Veteran’s benefits. After reviewing the evidence of record, the Board finds that the Veteran is not unemployable due solely to any single service-connected disability since September 13, 2016. In this regard, the Board notes that the Veteran asserts that he is unemployable due to a combination of his service-connected disabilities. See September 2016 VA form 21-8940. Similarly, the Veteran reported to the Social Security Administration that he was disabled due to the combined effects of his lumbar spine, bilateral knee, and psychiatric disabilities. Neither the Veteran nor his representative have argued that he is entitled to a TDIU based on any single disability since September 13, 2016, nor have they cited to any evidence of record to support such a contention. The Board has fully reviewed the record and finds no probative evidence proving the Veteran would be incapable of securing and following substantially gainful employment due to limitations from any single service-connected disabilities since September 13, 2016. The VA examiner who conducted the September 2016 VA examination stated that the Veteran’s low back, bilateral lower extremity radiculopathy, and left knee disabilities would interfere with standing, walking, climbing, and kneeling. An April 2017 VA examiner who assessed the Veteran’s hearing loss and tinnitus charted the Veteran’s lay reports of impairment resulting in ear spasms/popping, a buildup of ear wax, and difficulty hearing conversations (requiring things to be repeated). An April 2017 VA examiner who assessed the Veteran’s knees stated he would have partial impairment with running, jumping, climbing, exercising, prolonged standing, and walking long distances. A June 2017 VA examiner found no employment impairment caused by the Veteran’s erectile dysfunction. The Veteran’s VA treatment records document chronic complaints of knee pain, low back pain, and psychiatric symptoms; however, the Veteran’s treating physicians have never indicated that any of the Veteran’s individual service-connected disabilities result in employment limitations/restrictions. While the above referenced evidence demonstrates chronic impairment caused by the Veteran’s service-connected disabilities, and compensated under the schedular rating criteria, there is no evidence of record which establishes that any single service-connected disability precludes the Veteran from securing or following substantially gainful employment consistent with his past educational attainment and occupational history. In sum, the record reflects that combined effect of more than one of the Veteran’s service-connected disabilities have rendered the Veteran unemployable since September 13, 2016. In addition, the Veteran has reported that his various service-connected health conditions have precluded his employment, but he has not identified a single disability that alone causes unemployability during the period since September 13, 2016, and the evidence does not otherwise support this contention. Accordingly, the Veteran’s claim seeking entitlement to a TDIU since September 13, 2016 is denied. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Galante, 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.