Citation Nr: 20034475 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 14-20 681 DATE: May 18, 2020 ORDER 1. A rating in excess of 10 percent prior to December 11, 2018, and in excess of 20 percent thereafter, for a right knee disability is denied. 2. A separate 10 percent rating for right knee symptomatic removal of cartilage is granted, subject to the applicable laws and regulations governing the payment of monetary benefits. 3. A total disability rating based on individual unemployability (TDIU) is denied.   FINDINGS OF FACT 1. The Veteran’s right knee disability is manifested by painful motion, limitation of motion, weakness, incoordination, stiffness, and swelling. 2. Since December 11, 2018, the Veteran’s right knee has been limited to 15 degrees extension. 3. The Veteran has symptomatic removal of right knee cartilage. 4. The Veteran is not prevented from securing and following substantially gainful employment as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. Prior to December 11, 2018, the criteria for a rating in excess of 10 percent for a right knee disability were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5010, 5257. 2. Since December 11, 2018, the criteria for a rating in excess of 20 percent for a right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5010, 5261. 3. The criteria for a separate 10 percent rating for symptomatic removal of right knee cartilage are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5259. 4. The criteria for a TDIU are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1969 to November 1971. The case is on appeal from a July 2011 rating decision. In December 2016, the Veteran testified at a Board hearing. In a January 2018 decision, the Board remanded the right knee rating and TDIU claims for additional development. Thereafter, in a July 2019 rating decision, the RO increased the Veteran’s right knee disability rating to 20 percent as of December 11, 2018. This staged rating does not represent the maximum disability rating assignable for this disability, and the Veteran has not indicated that the current staged ratings are the maximum benefit sought. As higher ratings are available and a claimant is presumed to be seeking the maximum available rating for disabilities, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). I. Right Knee Rating 1. A rating in excess of 10 percent prior to December 11, 2018, and in excess of 20 percent thereafter, for a right knee disability. Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Disabilities of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). DC 5010 is assigned for traumatic arthritis and is rated under DC 5003. 38 C.F.R. § 4.71a, DC 5010. DC 5003 provides that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate DCs for the specific joints involved. 38 C.F.R. § 4.71a, DC 5003. When, however, the limitation of motion of the specific joints involved is noncompensable under the appropriate DCs a 10 percent rating is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. 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 evaluation 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 evaluation is authorized 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. Arthritis established by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, DCs 5260 and 5261. DC 5260 provides for a noncompensable rating for limitation of flexion limited to 60 degrees; a 10 percent rating is warranted for limitation of flexion limited to 45 degrees; a 20 percent rating is warranted for limitation of flexion limited to 30 degrees; and a 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. Ratings for limitation of extension of the knee are under 38 C.F.R. § 4.71a, DC 5261. DC 5261 provides for a noncompensable rating for limitation of extension limited to 5 degrees; a 10 percent rating is warranted for limitation of extension limited to 10 degrees; a 20 percent rating is warranted for limitation of extension limited to 15 degrees; a 30 percent rating is warranted for extension limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. Under DC 5257, a 10 percent rating is warranted for either slight recurrent subluxation or slight lateral instability; a 20 percent rating is warranted for moderate recurrent subluxation or moderate lateral instability; and a 30 percent rating is warranted for severe recurrent subluxation or severe lateral instability. 38 C.F.R. § 4.71a, DC 5257. VA’s General Counsel has stated that when a knee disorder is rated under 38 C.F.R. § 4.71a, DC 5257 and an appellant also has limitation of knee motion which at least meets the criteria for a noncompensable evaluation under 38 C.F.R. § 4.71a, DCs 5260 or 5261, separate evaluations may be assigned for arthritis with limitation of motion and for instability. However, General Counsel stated that if an appellant does not meet the criteria for a noncompensable rating under either DC 5260 or DC 5261, there is no additional disability for which a separate rating for arthritis may be assigned. VAOPGCPREC 23-97 (July 1, 1997). If a rating is assigned under the provisions for other knee impairment (38 C.F.R. § 4.71a, DC 5257), a separate 10 percent rating may be assigned where some limitation of motion, albeit noncompensable, has been demonstrated. See VAOPGCPREC 9-98. In addition, DCs 5258 and 5259 are potentially applicable to rating knee disabilities. DC 5258 provides for a 20 percent evaluation for semilunar, dislocated cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a, DC 5258. DC 5259 provides for a 10 percent rating for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, DC 5259. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). An effective date for an increased rating should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that the disability first manifested. Accordingly, the effective date for an increased rating-as well as for an initial rating or for staged ratings-is predicated on when the increase in the level of disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); DeLisio v. Shinseki, 25 Vet. App. 45, 56 (2011). In determining when an increase is “factually ascertainable,” all of the evidence must be looked to, including testimonial evidence and expert medical opinions, and an effective date must be assigned based on that evidence. See McGrath v. Gober, 14 Vet. App. 28, 35-36 (2000); VAOPGCPREC 12-98. Thus, “it is the information in a medical opinion, and not the date the medical opinion [that] was provided that is relevant when assigning an effective date.” Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010); see also Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Factual History The Veteran is seeking higher ratings for his right knee disability. Prior to the present June 2010 claim for increase, the Veteran had been rated as 10 percent disabling for this right knee disability since November 25, 1971. In an August 2010 statement, he reported that the knee swells and fills with liquid occasionally. He also stated that he was told he needs a knee replacement. In a July 2011 statement, the Veteran reported being on a VA waiting list pending knee replacement in 18 months. During the December 2016 Board hearing, he reported that his knee locks and pops occasionally and he has to be careful when walking because he has stumbled on several times. He stated that he does not wear a knee brace because he was told it would cause increased wear on his left knee. The Veteran also stated that he has not had knee replacement surgery yet because he has not had an opportunity to have surgery. The Veteran reported that he was working as a community and parking enforcement officer until 2010. He also reported that he was put on desk duty, but could not continue working because the job required him to run when handling emergency calls. The Veteran’s private treatment records show that a private treatment provider denied the presence of right knee effusion in April 2010. In May 2010, a private treatment provider reported the presence of minimal right knee effusion. The Veteran’s Social Security Administration (SSA) records include an examination from March 2011. The examiner reported range of motion from 5 degrees to 110 degrees. The examiner also reported the presence of severe crepitus and joint line pain. The Veteran was afforded a VA examination in regard to this claim in June 2011. The Veteran reported experiencing right knee symptoms of giving way, instability, pain, stiffness, weakness, incoordination, and warmth. He also reported experiencing locking episodes less than once per year. He denied episodes of dislocation or subluxation. The Veteran further reported using a cane and experiencing flareups once every one or two months lasting 3 to 7 days in duration. He estimated that the flareups result in a 50 percent reduction in range of motion, but denied experiencing incapacitating episodes. He also estimated that he could stand for 15 to 30 minutes at a time and walk for less than a half mile. The examiner reported right knee range of motion from zero degrees to 110 degrees with objective evidence of pain on motion and following repetitive motion. The examiner also reported an x-ray suggested mild genu varus deformity. The examiner denied the presence of crepitation, clicks or snaps, grinding, instability, and abnormal weight-bearing. The Veteran was afforded another VA knee examination in January 2013. The Veteran reported receiving SSA disability due to his right knee. He also reported he is able to perform activities of daily living and denied experiencing instability and using assistive devices. The examiner reported right knee range of motion from zero degrees to 110 degrees and pain on palpation, but denied objective evidence of painful motion. The examiner denied additional loss of range of motion on 3 repetitions of testing. The examiner found right knee symptoms of functional impairment of less movement than normal, pain on movement, swelling, and deformity. The examiner did not report the presence of weakened movement, excess fatigability, incoordination, atrophy, instability of station, disturbance of walking, or interference with sitting, standing, and weight-bearing. The examiner reported normal knee stability and strength on testing. The examiner denied a history of recurrent patellar subluxation or dislocation and the presence of genu recurvatum. In September 2015, the Veteran saw a VA physician to establish care. He reported not having much right knee pain and using medication only occasionally for the knee. His subsequent VA treatment records do not include reports of or treatment for right knee symptoms. Pursuant to the January 2018 Board remand, the Veteran was afforded another knee examination a physician on December 11, 2018. The Veteran reported experiencing pain with pivoting, squatting, and running. He denied experiencing flareups. The physician reported right knee range of motion 15 degrees to 110 degrees with pain on flexion and extension, on weight-bearing, on passive range of motion, and on palpation. He denied objective evidence of pain on nonweight-bearing. The physician found no additional loss of range of motion on 3 repetitions of testing. He also reported that the Veteran underwent right knee meniscectomy in 1983 and experiences residual symptoms of persistent pain, but denied frequent episodes of locking or effusion. He further reported the presence of 3 right knee scars measuring 1.5 centimeters (cms) by 0.3 cms that are not painful or unstable. The physician also found that his right knee stability and strength was normal on testing. The physician denied right knee ankylosis, recurrent subluxation, and history of lateral instability. He concluded that the Veteran’s right knee disability limits his ability for prolonged standing, walking, climbing, and squatting and that he should avoid jobs requiring such motion. In July 2019, the December 2018 physician provided an addendum opinion. He found that, after review of the Veteran’s history, medical records, relevant research materials, it is not possible to assess the Veteran’s range of motion during flareups without directly observing or recording such testing during a flareup. He explained that it is not possible to provide an objective finding from a subjective report of reduced range of motion. He further explained that, for example if a range of motion was measured as 70 degrees objectively and the claimant stated the range of motion decreased by 95 percent with flareups, it would be erroneous to record the range of motion as 3.5 degrees. Thereafter, in a September 2019 statement, the Veteran’s representative submitted boilerplate for extraschedular consideration. However, the representative did not indicate why such consideration was warranted. In an April 2020 statement, the Veteran’s representative stated that the range of motion test results provided during the knee examinations were not adequate, but did not explain why it was inadequate. Analysis The Board finds that, excluding DC 5259, right knee ratings in excess of 10 percent prior to December 11, 2018, and in excess of 20 percent thereafter, are not warranted. Prior to December 11, 2018, the Veteran’s right knee disability was rated under DCs 5257-5010. Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned, with the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Thus, the Veteran’s right knee was assigned a 10 percent rating for impairment of one joint due to arthritis. See 38 C.F.R. § 4.71a, DCs 5003, 5010. The medical evidence of record does not show that he experienced right knee range of motion less than 5 degrees to 110 degrees prior to December 11, 2018. In addition, the assigned rating accounts for his symptoms of painful motion, limitation of motion, weakness, incoordination, stiffness, and swelling. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5003; DeLuca, 8 Vet. App. at 202. The Board notes that the Veteran reported experiencing flareups that result in a 50 percent reduction in his right knee range of motion during the June 2011 examination. However, the physician explained in the July 2019 addendum opinion that it is not possible to estimate objective range of motion findings from a subjective report of a percentage of reduced range of motion. In addition, the Veteran reported experiencing flareups only once every 30 to 60 days that last 3 to 7 days each, which constitutes only between 19 days and 85 days out of each year. Furthermore, he has not reported experiencing flareups since the June 2011 examination. Thus, prior to December 11, 2018, the lay statements and medical evidence of record do not establish impairment approximating right knee extension limited due to flareups to 15 degrees or more or flexion limited to 30 degrees or less even during flareups. See 38 C.F.R. § 4.71a, DCs 5260, 5261. Since December 11, 2018, the Veteran’s right knee disability was rated under DC 5010-5261, indicating that the disability is identified as arthritis rated for limitation of extension. The examination conducted on December 11, 2018 showed right knee range of motion of 15 degrees to 110 degrees. The Veteran was assigned a 20 percent rating based on limitation of extension and the assigned rating accounts for his symptoms of painful motion, limitation of motion, weakness, incoordination, stiffness, and swelling. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5003; DeLuca, 8 Vet. App. at 202. In addition, the Veteran denied experiencing flareups during the examination. An earlier effective date is not warranted for the 20 percent rating because December 11, 2018 is first date that the increased knee impairment is factually ascertainable. See Swain, 27 Vet. App. at 224; McGrath, 14 Vet. App. at 35-36; VAOPGCPREC 12-98. In this regard, the Veteran’s prior examinations and medical records do not indicate right knee extension limited to 15 degrees or less. He reported during VA treatment in September 2015 that his right knee was not very painful and only occasionally required medication. The medical evidence of record does not include any subsequent treatment for right knee symptoms and the Veteran did not report additional loss of range of motion prior to the December 2018 examination. However, the Board finds that a separate 10 percent rating under DC 5259 is warranted. In this regard, the December 2018 physician reported that the Veteran underwent a right knee meniscectomy in 1983 and experiences residual persistent pain. Therefore, an additional 10 percent rating under DC 5259 is allowable without pyramiding. See 38 C.F.R. § 4.71a, DC 5259; see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). This is the maximum rating under this DC. However, a rating under DC 5258 is not warranted because the evidence does not show that there is present dislocated cartilage as it was removed many years ago. The Board also considered if a separate rating for right knee instability is warranted. In this regard, the Veteran reported experiencing the right knee giving way and instability and using a cane during the June 2011 examination. During the December 2016 Board hearing, he reported that he sometimes stumbles. However, the medical evidence of record does not indicate the presence of subluxation or lateral instability and the examiners all reported that right knee stability testing was normal. While the Veteran reported using a cane and experiencing the right knee giving way and instability, there is no medical evidence indicating that this was the result of instability as opposed to weakness, fatigability, or other symptoms already compensated by his assigned rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5271; DeLuca, 8 Vet. App. at 202. Although the Veteran has reported during the appeal period that his right knee gives way and is unstable, greater evidentiary weight is placed on the physical examination findings than the Veteran’s lay statement. Cf. English v. Wilkie, 30 Vet. App. 347 (2018). Thus, the Board does not find that a separate rating for right knee instability is not warranted. The Board notes that the Veteran’s representative requested extraschedular consideration for his right knee disability. However, as explained above, the Veteran’s right knee symptoms are contemplated by the assigned ratings. The Veteran’s representative did not indicate any additional symptoms not contemplated by the rating criteria; thus, the contention is underdeveloped. As the Veteran’s right knee symptoms do not present an exceptional disability, extraschedular consideration is not warranted. See Thun v. Peake, 22 Vet. App. 111 (2008), aff’d sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Board also notes that the Veteran’s representative stated that range of motion testing provided during the examinations of record were inadequate. However, in the absence of a specific allegation outlining why a specific examiner is not competent to conduct a medical examination or provide a medical opinion, the VA examiners’ testing in this case is found to be correct and sufficient for deciding the claims. In sum, the Board finds the preponderance of the evidence shows that the Veteran’s right knee disability has manifested by painful motion, limitation of motion, weakness, incoordination, stiffness, swelling, and symptomatic removal of right knee cartilage and, since December 11, 2018, extension limited to 15 degrees. As the benefit-of-the-doubt doctrine is not further applicable, a rating in excess of 10 percent prior to December 11, 2018, and in excess of 20 percent thereafter, for a right knee disability is not warranted and a separate 10 percent rating for right knee symptomatic removal of cartilage is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. II. TDIU 2. A TDIU. Legal Criteria Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall 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). Marginal employment shall not be considered substantially gainful employment. In addition, 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. Therefore, rating boards should submit to the Director for extra-schedular 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 paragraph (a) of this section. The rating board will include a full statement as to the veteran’s service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue. 38 C.F.R. § 4.16(b). The Board is required to obtain the Director’s decision in the first instance before it may award extraschedular TDIU. Wages v. McDonald, 27 Vet. App. 233, 236 (2015). In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to: • The veteran’s history, education, skill, and training; • Whether the veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. Factors that may be relevant include, but are not limited to, the veteran’s limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and • Whether the veteran has the mental ability to perform the activities required by the occupation at issue. Factors that may be relevant include, but are not limited to, the veteran’s limitations, if any, concerning memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Analysis The Veteran contends that he is unable to work due to his service-connected disabilities. In a July 2011 TDIU application, he reported being unable to work due to his right knee. He also reported working in parking enforcement and security from April 2004 until October 2010 and becoming too disabled to work fulltime in June 2010. He further reported graduating high school and attending some college courses. During the December 2016 Board hearing, the Veteran reported being assigned a desk job toward the end of his employment, but being unable to perform the job because it required him to run in the event of an emergency call. The Veteran’s representative requested that the Veteran be afforded a psychiatric examination to determine the affect his service-connected psychiatric condition has on his ability to work. The Veteran is service connected for a right forearm disability that is rated noncompensable, a left hand index finger disability that is rated noncompensable, major depressive disorder that is rated as 10 percent disabling and the right knee disability discussed above. The schedular criteria under 38 C.F.R. § 4.16(a) are not presently met. In January 2011, the Veteran completed a functional report related to his claim for SSA disability. He reported that his right knee disability does not affect his ability to sit, reach, talk, hear, understand, or bend. He also reported that he can follow instructions without difficulty. An SSA examiner found that the Veteran was not prevented from sedentary work, but did not have sufficient transferable skills to perform such employment. The Veteran was afforded a VA psychiatric examination in January 2013. The examiner reported psychiatric symptoms of depressed mood, anxiety, chronic sleep impairment, and mild memory loss. The examiner found that his psychiatric symptoms resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. Pursuant to the January 2018 Board remand, the Veteran was afforded another psychiatric examination in January 2019. The examiner did not find that the Veteran currently has a psychiatric disorder. The examiner noted that the Veteran is not anxious, depressed, or irritable and denied the presence of any psychiatric symptoms. The Board finds that the Veteran is not prevented from working due to his service-connected disabilities. In this regard, his right knee disability prevents him from working in his prior job in security and parking enforcement. However, the evidence shows that his psychiatric disability would not prevent him from working in sedentary customer service employment. Sedentary work based on its commonly understood societal meaning is work requiring little physical exertion such as office work, white collar job, etc. In addition, the Veteran has a high school diploma and a lengthy positive employment history that would allow him to obtain entry level work in a sedentary customer service environment such as answering telephones in a call center. To the extent that sedentary employment requires some limited ability to walk and stand, the medical evidence does not show that the Veteran’s service-connected musculoskeletal disabilities result in mobility restrictions so severe that he could not perform such work. In addition, the psychiatric evaluations of record do not show that he could not successfully obtain and maintain employment in a customer service position. Thus, the Board finds that the Veteran is capable of working in an entry level, sedentary customer service position, including as a call center employee. (Continued on the next page)   The Board is sympathetic to the Veteran’s assertions regarding the impact his disabilities have on him, both professionally and personally. However, those problems are compensated by the schedular ratings for such disabilities. Van Hoose v. Brown, 4 Vet. App. 361 (1993). Moreover, while these disabilities cause some economic impairment, his assigned disability ratings contemplate his level of occupational impairment. A TDIU claim is not purely a medical question. Here, the Board has considered both the relevant medical evidence as well as the non-medical evidence such as work history and lay statements. In sum, the preponderance of the evidence shows that the Veteran has not been prevented from securing and following substantially gainful employment as a result of his service-connected disabilities. Therefore, the benefit-of-the-doubt rule is not applicable and a TDIU is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Jimerfield 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.