Citation Nr: 20043797 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 15-01 405 DATE: June 29, 2020 ORDER Entitlement to a rating higher than 10 percent for right ankle degenerative joint disease prior to January 8, 2015, is denied. A rating of 20 percent from January 8, 2015, is granted. Entitlement to a rating higher than 10 percent for left ankle degenerative joint disease prior to January 8, 2015, is denied. A rating of 20 percent from January 8, 2015, is granted. Entitlement to a rating higher than 10 percent for instability of the right knee is denied. Entitlement to a rating higher than 10 percent for right knee degenerative arthritis prior to January 8, 2015, is denied. A rating of 20 percent from January 8, 2015, as opposed to July 14, 2016, is granted. Entitlement to a rating higher than 10 percent for left knee degenerative arthritis is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to July 17, 2019, is denied. A TDIU from July 17, 2019, is granted. FINDINGS OF FACT 1. Prior to January 8, 2015, the Veteran’s right ankle disability more nearly approximated “moderate” limitation of motion. As of January 8, 2015, it is factually ascertainable that the Veteran’s right ankle disability had worsened and more nearly approximated “marked” limitation of motion. 2. Prior to January 8, 2015, the Veteran’s left ankle disability more nearly approximated “moderate” limitation of motion. As of January 8, 2015, it is factually ascertainable that the Veteran’s left ankle disability had worsened and more nearly approximated “marked” limitation of motion. 3. At no point during the appeal period has the Veteran’s right knee instability more nearly approximated “moderate” instability. 4. Prior to January 8, 2015, even after considering functional loss due to factors such as pain and flare-ups, the evidence does not show that the Veteran’s right knee extension was limited to 15 degrees or more, nor did it show flexion limited to 45 degrees or more. There is no evidence of removal or dislocation or semilunar cartilage, impairment of the tibia, ankylosis, or genu recurvatum in the right knee. As of January 8, 2015, it is factually ascertainable that the Veteran’s right knee disability had worsened as his extension was limited to 15 degrees. 5. Throughout the appeal period, the Veteran’s left knee disability has manifested by painful motion without flexion limited to 30 degrees or extension limited to 10 degrees. There is no evidence of removal or dislocation or semilunar cartilage, impairment of the tibia, ankylosis, joint instability or genu recurvatum in the left knee. 6. Prior to January 8, 2015, consistent with this decision, the Veteran was service-connected for right knee degenerative arthritis, rated as 10 percent disabling; right knee instability, rated as 10 percent disabling; left knee degenerative arthritis, rated as 10 percent disabling; left ankle degenerative arthritis, rated as10 percent disabling; right ankle degenerative arthritis, rated as 10 percent disabling; hypertension, rated as 10 percent disabling; hallux valgus, rated as noncompensable; anterior scar, rated as noncompensable; limitation of extension in the left knee, rated as noncompensable. His total rating was 50 percent. 7. From January 8, 2015 to July 17, 2019, the Veteran was service-connected for right knee degenerative arthritis (limitation of extension), rated as 20 percent disabling; right knee instability, rated as 10 percent disabling; left knee degenerative arthritis (limitation of extension), rated as 10 percent disabling; left ankle degenerative arthritis, rated as 20 percent disabling; right ankle degenerative arthritis, rated as 20 percent disabling; hypertension, rated as 10 percent disabling; hallux valgus, rated as noncompensable; anterior scar, rated as noncompensable; limitation of extension in the left knee, rated as noncompensable. His total rating was 60 percent. 8. Since July 17, 2019, the Veteran has been service-connected for depressive disorder, rated as 50 percent disabling; right knee degenerative arthritis (limitation of extension), rated as 20 percent disabling; right knee instability, rated as 10 percent disabling; left knee degenerative arthritis (limitation of extension), rated as 10 percent disabling; left ankle degenerative arthritis, rated as 20 percent disabling; right ankle degenerative arthritis, rated as 20 percent disabling; hypertension, rated as 10 percent disabling; hallux valgus, rated as noncompensable; anterior scar, rated as noncompensable; limitation of extension in the left knee, rated as noncompensable. His total rating is 80 percent. 9. Prior to July 17, 2019, the Veteran’s service-connected disabilities did not preclude him from securing and following substantially gainful employment. As of July 17, 2019, the Veteran’s service-connected disabilities have rendered him unable to secure and follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating higher than 10 percent for right ankle degenerative joint disease, prior to January 8, 2015, have not been met. Beginning January 8, 2015, the criteria for a 20 percent rating, but no higher, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5271-5010. 2. The criteria for entitlement to a rating higher than 10 percent for left ankle degenerative joint disease, prior to January 8, 2015, have not been met. Beginning January 8, 2015, the criteria for a 20 percent rating, but no higher, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5271-5010. 3. The criteria for entitlement to a rating higher than 10 percent for instability of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5267. 4. The criteria for entitlement to a rating higher than 10 percent for right knee degenerative arthritis prior to January 8, 2015, have not been met. The criteria for a 20 percent rating, but no higher, as of January 8, 2015, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5261-5010. 5. The criteria for entitlement to a rating higher than 10 percent for left knee degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5260-5010. 6. Prior to July 17, 2019, the criteria for a TDIU have not been met. Since July 17, 2019, the criteria for a TDIU have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.7, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from May 1970 to April 1974. He testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing in November 2017. A transcript of the hearing is of record. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The veteran’s entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). 1. Entitlement to a rating higher than 10 percent for right ankle degenerative joint disease; entitlement to a rating higher than 10 percent for left ankle degenerative joint disease. The Veteran’s right and left ankle degenerative joint disease has been evaluated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5271-5010. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Thus, in this case, Diagnostic Code 5010, which pertains to traumatic arthritis and is rated pursuant to Diagnostic Code 5003, acknowledges the disability resulting from the Veteran’s in-service bilateral ankle injuries, and Diagnostic Code 5271, which pertains to limitation of motion, contemplates the current manifestations of the Veteran’s disability. In other words, his bilateral ankle degenerative joint disease is rated on the basis of limited motion. Under Diagnostic Code 5271, a 10 percent rating is assigned for moderate limitation of motion of the ankle, and a 20 percent rating is warranted for marked limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Veteran’s VA treatment records document painful ankles but do not contain range of motion measurements. Instead, as much is documented in VA examination reports of record conducted in June 2012, July 2016, and November 2018. On VA examination in June 2012, a diagnosis of bilateral ankle degenerative arthritis with calcaneal spurs was noted. The Veteran denied experiencing flare-ups. He has bilateral plantar flexion to 40 with no objective evidence of painful motion; and bilateral dorsiflexion to 15 degrees with no objective evidence of painful motion. There was no additional loss of motion on repetitive use testing. No functional loss or functional impairment of the ankle was found. There was no pain on palpation of the joint, muscle strength testing on the right ankle was 4/5, indicating active movement against some resistance, and 5/5 on the left, indicating normal strength. Joint stability testing was normal. There was no ankylosis found. On VA examination in July 2016, the examiner stated that the Veteran’s diagnosis had changed to bilateral ankle degenerative joint disease, which was a progression of the previous diagnosis. The Veteran endorsed flare-ups of ankles. The examiner stated “the flare-ups can be described as constant sharp pain, stiffness, swelling, warmth, tingling and restriction of motion. Occurs at least once yearly.” The Veteran described his functional loss as “unable to stand or walk for longer periods of time, loss of balance, he fell one time as a result of losing his balance.” On range of motion testing, the Veteran has dorsiflexion of the right ankle to 5 degrees and plantar flexion to 20 degrees. The Veteran had dorsiflexion in the left ankle to 10 degrees and plantar flexion to 35 degrees. Pain was noted on exam during rest/non-movement bilaterally. Objective evidence of moderate tenderness over lateral aspect of the right ankle was noted. Pain with weight bearing and crepitus was also noted bilaterally. On repetitive use testing, the Veteran experienced decreased range of motion in the right ankle but not the left. In the right ankle, he had plantar flexion to 20 degrees and dorsiflexion to zero. Pain and lack of endurance was noted. The examiner found that pain, weakness, fatigability, and incoordination significantly limited the Veteran’s limitation of motion during flare-ups, but did not describe as much in terms of range of motion. Muscle strength testing was 4/5 bilaterally. No ankylosis was found and ankle instability/dislocation was not suspected. Regular use of a brace and cane was noted with occasional use of crutches. Most recently, the Veteran was afforded a VA examination for his ankles in November 2018. He reported symptoms of pain in both ankles with decreased mobility. He has flare-ups where he cannot walk any distance and if he stands too long, his pain gets worse. On range of motion testing, he had bilateral dorsiflexion to 15 degrees and plantar flexion to 40 degrees. Pain was noted on examination for the right ankle only and caused functional loss in dorsiflexion and plantar flexion. Moderate localized tenderness around the ankle mortise was noted bilaterally. Pain with weight bearing and crepitus was also noted bilaterally. The Veteran was able to perform repetitive use testing with no additional functional loss. Regarding flare-ups, the examiner noted that pain, weakness, fatigability, and incoordination significantly limits the Veteran’s functional ability during flare-ups. The examiner described decreased range of motion during flare-ups. Specifically, the Veteran experiences bilateral ankle dorsiflexion to 15 degrees and plantar flexion to 40 degrees during flares. Contributing factors of disability are decreased mobility and being unable to walk long distances. Muscle strength testing was normal bilaterally and no muscle atrophy or ankylosis was found. Joint stability testing was normal bilaterally. There was no objective pain on non-weight bearing and passive range of motion testing was the same as active range of motion. When considering all of the evidence of record, the Board finds that a rating higher than 10 percent for each ankle is not warranted prior to January 8, 2015. However, a higher 20 percent rating for each ankle is warranted as of that date. On his January 8, 2015 VA Form 9, the Veteran stated that his ankle conditions had worsened since he first filed his appeal. He stated “I am unstable when I stand, and it is mandatory that I walk with a cane for stability with my knees and ankles. When the pain flares-up I must use crutches in order to walk.” As a result, the Veteran was afforded a VA examination in July 2016. The examination report confirms a worsening of the Veteran’s ankle disabilities. However, prior to the Veteran’s reports of worsening, the evidence showed that he experienced, at worst, bilateral plantar flexion to 40 with no objective evidence of painful motion; and bilateral dorsiflexion to 15 degrees with no objective evidence of painful motion. He also denied experiencing flare-ups. Normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. This means the Veteran’s bilateral ankle disability caused a loss of five degrees of dorsiflexion and five degrees of plantar flexion. To warrant a higher rating, the evidence would have to show that the Veteran’s limitation of motion was “marked.” Given that the Veteran denied experiencing flare-ups, there was only five degrees of loss of motion in dorsiflexion and plantar flexion, and the Veteran did not demonstrate painful motion, the Board finds that prior to January 8, 2015, it is not factually ascertainable that the Veteran experienced “marked” limitation of motion of the ankles, much less any level of ankylosis. The Board acknowledges the Veteran’s reports of pain in his ankles. See e.g. August 2013 Notice of Disagreement (NOD). Pain is contemplated by the assigned 10 percent rating. Pain alone, however, without functional loss, does not warrant a higher rating. As such, a rating higher than 10 percent for each ankle must be denied for this time period. As noted above, as a result of the Veteran’s reports of worsening, he was afforded an additional VA examination in July 2016 which confirmed his reports of worsening. The July 2016 VA examination shows that at worst, the Veteran experienced dorsiflexion in the right ankle to 5 degrees and plantar flexion to 20 degrees, and dorsiflexion in the left ankle to 10 degrees and plantar flexion to 35 degrees. Again, there is no evidence of ankylosis. Therefore, the question before the Board is whether the Veteran’s ankle disabilities more nearly approximate “moderate” or “marked” limitation of motion. The Board finds this level of limitation of motion, coupled with the Veteran’s use of a cane for stability, braces, and crutches during flare-ups, more nearly approximates “marked” limitation of motion. Both examinations performed since January 8, 2015, show that the Veteran experienced flare-ups where he has further decrease in mobility and cannot walk long distances. At no point has any level of ankylosis been shown, nor has the Veteran contended as much. The Board again acknowledges the Veteran’s reports of pain and lack of endurance in his bilateral ankles since January 8, 2015. These symptoms have been considered in awarding a higher 20 percent rating for each ankle. It is worth noting that on most recent VA examination, the Veteran demonstrated range of motion testing consistent with “moderate” limitation of motion. This would warrant a 10 percent rating. However, given that the Veteran has reported flare-ups including pain, and also demonstrated “marked” limitation of motion on examination in July 2016, the Board finds that a 20 percent rating is warranted as of January 8, 2015, for each ankle. A lower rating is not warranted despite the Veteran’s improved range of motion as the evidence shows that his symptoms vary. Thus, the Board finds all reasonable doubt in the Veteran’s favor and is assigning a 20 percent rating in each ankle, beginning January 8, 2015. Prior to January 8, 2015, a rating higher than 10 percent for each ankle is denied. However, as of January 8, 2015, it is factually ascertainable that the Veteran’s bilateral ankle disability worsened. Therefore, a 20 percent rating for each ankle, but no higher, is warranted from January 8, 2015. 2. Entitlement to a rating higher than 10 percent for instability of the right knee; entitlement to a rating higher than 10 percent for right knee degenerative arthritis prior to July 14, 2016; and a rating higher than 20 percent thereafter; entitlement to a rating higher than 10 percent for left knee degenerative arthritis. The Veteran is service-connected for right knee instability, rated as 10 percent disabling under Diagnostic Code 5257; right knee degenerative arthritis, rated as 10 percent disabling prior to July 14, 2016, and 20 percent disabling thereafter under hyphenated Diagnostic Code 5010-5260; and left knee degenerative arthritis, rated as 10 percent disabling under hyphenated Diagnostic Code 5010-5260. With respect to disabilities of the knee, 38 C.F.R. § 4.71a, Diagnostic Codes 5256 through 5263 set forth the relevant provisions. In this case, the evidence does not demonstrate ankylosis of the knee (Diagnostic Code 5256), impairment of the tibia and fibula (Diagnostic Code 5262) or genu recurvatum (Diagnostic Code 5263); thus, the Diagnostic Codes pertaining to such impairments are not applicable. Diagnostic Code 5257 rates on the basis of recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Slight recurrent subluxation or lateral instability of the knee is rated as 10 percent disabling; moderate recurrent subluxation or lateral instability of the knee is rated as 20 percent disabling; and severe recurrent subluxation or lateral instability of the knee is rated as a maximum 30 percent disabling. The Board observes that the words “slight,” “moderate,” and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Use of terminology by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Diagnostic Code 5258 provides for a 20 percent evaluation on the basis of dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. This is the only available evaluation under this diagnostic code. Similarly, under Diagnostic Code 5259, a 10 percent evaluation is warranted for symptomatic removal of the semilunar cartilage. This is the only available evaluation under this diagnostic code. At no point during the appeal period has the Veteran demonstrated dislocated or removed semilunar cartilage. As a result, consideration under Diagnostic Codes 5258 and 5259 is not warranted. The Veteran’s VA treatment records clearly document pain related to his knees. See e.g. September 2019, February 2018, October 2014 VA Treatment Records. They do not contain range of motion measurements. The Veteran was afforded a VA examination for his knees in May 2012. At that time, he endorsed flare-ups in the form of “severe knee pain with walking or standing for a long period of time.” On range of motion testing, he had flexion to 125 degrees in the right knee with no evidence of painful motion and extension to zero degrees (no limitation of extension). In the left knee, he had flexion to 140 degrees with no objective evidence of painful motion and extension to zero degrees (no limitation of extension). On repetitive use testing, the Veteran’s flexion was limited to 125 degrees with no additional loss of motion on extension in the right knee. In the left knee, the repetitive use testing was the same as the Veteran’s initial range of motion measurements – no limitation of motion in either flexion or extension. The examiner noted that the Veteran had did not have any functional loss or impairment of the knees. There was no pain on palpation. Muscle strength testing was 4/5 in the right knee and 5/5 in the left. Joint stability testing showed slight instability in the right and was normal in the left. There was no evidence or history of recurrent patellar subluxation/dislocation bilaterally. There was also no evidence of any meniscal conditions. There was no indication of use of assistive devices. A diagnosis of bilateral degenerative arthritis was noted. The examiner stated that the Veteran’s knees impacted his ability to run, kneel, squat, and climb stairs. As a result of the Veteran’s reports of his knees worsening on his January 8, 2015 VA form 9, he was afforded an additional VA examination in July 2016. A diagnosis of bilateral degenerative arthritis was again noted. The Veteran endorsed flare-ups in the right knee in the form of “sharp pain, stiffness, warmth, and restriction of movement.” Flare-ups in the left knee consisted of “sharp pain, stiffness, warmth, and restriction of movement.” Regarding functional loss, the Veteran stated that he was unable to stand for longer periods of time and unable to walk for longer periods of time. He reported being able to walk for 10-15 minutes before he started to feel pain in his knees. On range of motion testing, he had flexion to 75 degrees and extension to 10 degrees in the right knee. Pain was noted on examination on rest. He had flexion to 100 degrees and extension from 100 degrees to 5 degrees in the left knee. Pain was noted on examination on rest. There was evidence of localized tenderness/pain on palpation of the joint bilaterally. Pain was also noted with weight-bearing and there was objective evidence of crepitus bilaterally. On repetitive use testing, the Veteran had additional loss of motion in the right knee but not in the left. He had flexion from 15 degrees to 70 degrees and extension from 70 degrees to 15 degrees. The examiner noted that pain, weakness, fatigability or incoordination significantly limited the Veteran’s functional ability during flare-ups but stated that he was not able to describe the limitation in terms of range of motion. Factors that caused functional loss were pain, weakness, and lack of endurance. Muscle strength testing showed 4/5 strength bilaterally in flexion and extension. There was no muscle atrophy or ankylosis. No recurrent subluxation or instability was found bilaterally. Joint stability testing was normal. No meniscus condition was found. Regular use of a brace and cane was found as well as occasional use of crutches. The Veteran was again afforded a VA examination for his knees in October 2018. Symptoms at the time of examination included “progressive pain and decreased mobility within both knee joints, instability in right knee.” The Veteran endorsed flares at the time of examination and stated during flares he cannot walk any distances or bend or pick up things from the floor. On range of motion testing, he had flexion bilaterally to 120 degrees and extension from 120 degrees to zero degrees. Pain was noted on examination during flexion and extension. The Veteran was noted to have localized moderate tenderness around the knee joint related to his degenerative arthritis. Pain with weight-bearing was noted as well as objective evidence of crepitus. No additional loss of motion was found on repetitive use testing. The examiner stated that pain significantly limited the Veteran’s functional ability with repeated use over time. He opined the Veteran’s flexion in these instances and during flare-ups would be limited bilaterally to 120 degrees and extension would be from 120 degrees to zero degrees. Muscle strength testing was normal bilaterally. No atrophy or ankylosis was found. Joint stability testing was normal with no evidence of recurrent subluxation, lateral instability, or recurrent effusion. Constant use of a brace and cane was noted. The examiner stated “Veteran is service-connected for right knee instability. Veteran still has complaints of right knee instability, so the diagnosis was upheld.” There was no objective evidence of pain on non-weight bearing and passive range of motion testing was the same as active range of motion testing. As noted, the Veteran is current service-connected for limitation of extension as well as instability in the right knee. He is rated for limitation of flexion in the left knee. Regarding the propriety of the Veteran’s 10 percent rating for right knee instability under Diagnostic Code 5257, after having considered all of the evidence of record, the Board finds that a higher rating is not warranted at any time during the appeal period for instability. The Veteran objectively demonstrated instability in the right knee on VA examination in May 2012, however, since that time objective evidence of instability has not been demonstrated. Instead, as noted on most recent VA examination in October 2018, the Veteran continues to report that his right knee is unsteady. The other evidence of record, to include VA treatment records, does not show any falls related to the Veteran’s right knee or similar instances of instability. As such, the Board finds that the Veteran’s instability does not more nearly approximate “moderate” instability, much less “severe.” Therefore, the Veteran’s claim for a higher rating for his right knee instability must be denied. Turning to the Veteran’s limitation of extension, the Board notes that his right knee rating is staged. His right knee is rating as 10 percent disabling prior to July 14, 2016, and 20 percent thereafter. His left knee has consistently been rated as 10 percent disabling. When considering all of the evidence of record, the Board finds that a rating higher than 10 percent for the Veteran’s right knee is not warranted prior to January 8, 2015. However, as of that date, it is factually ascertainable that the Veteran’s right knee disability had worsened as shown on later VA examination in July 2016. Therefore, a 20 percent rating, but no higher, is warranted as of that date. Regarding the Veteran’s left knee, when considering all of the evidence of record, the Board finds that although the Veteran described a worsening of the pain in his left knee on his VA Form 9 in January 2015, the evidence since that time does not show that his pain caused functional loss sufficient to warrant a higher 20 percent rating. Prior to January 8, 2015, at worst, the Veteran’s right knee extension was limited to 10 degrees and flexion limited to 70 degrees. Although the Veteran endorsed flare-ups on VA examination in May 2012, he did not endorse any additional loss of motion during flare-ups. Instead, he stated his pain would increase. At no point prior to January 8, 2015, does the evidence show that the Veteran’s right knee flare-ups caused his flexion to be limited to 30 degrees or extension limited to 15 degrees such that a higher rating is warranted. On January 8, 2015, the Veteran reported that his knees had worsened. His later July 2016 VA examination confirmed that his right knee had worsened as extension was limited to 15 degrees. Because the Veteran described the worsening on his VA Form 9, the Board finds that a 20 percent rating, but no higher, is warranted as of January 8, 2015. Since that time, the evidence does not show that the Veteran’s extension was limited to 20 degrees or more. Similarly, the Veteran has demonstrated right knee flexion limited to, at worst, 70 degrees, including during flare-ups. In order to warrant a higher rating for limitation of motion based on flexion, the evidence would have to show that the Veteran’s flexion was limited to 30 degrees. Even when considering pain, as much has not been demonstrated. Regarding the Veteran’s left knee, the Board notes that at worst, the Veteran has demonstrated flexion limited to 75 degrees. As noted, based on range of motion alone, a compensable rating for limitation of flexion would not be warranted. However, the Veteran is currently assigned a compensable rating for painful flexion as he has also demonstrated degenerative arthritis. He has not demonstrated any level of instability in his left knee, nor has he contended as much. Therefore, there is no other Diagnostic Code under which the Board can award the Veteran a higher rating for his left knee. The Board acknowledges the several lay statements made by the Veteran in connection with his knees, including the testimony he provided at his Board hearing. At his hearing, the Veteran reported pain in his knees that had intensified. He reported a grinding feeling in his knees, which was worse on the left, than the right. He also reported “popping” in which he takes a step and pain radiates. He reported that he is in constant aching pain as a result of his bilateral knees. See Board Hearing Transcript, p.5. He reported taking natural supplements to reduce his pain. He stated that while working, his flares would make it where he had to “pick up my leg and put it on the brake pedal and put it up and take it off the brake pedal.” He further stated: And put this foot on the clutch and stuff like that because of the intense. And at those times, it was really crazy because I had crutches that I kept in my truck. I had my cane for when I got out and I used the crutches but the post, I worked for the post office, and they didn’t allow you to have crutches on the dock. But I could take my cane and stuff like that. So, in that sense, after a while I had to, and this is one of the reasons why I quit my job because I just couldn’t tolerate the pain and the agony that I was in 24/7. So that has to do with the flares you would say. The Board does not dispute that the Veteran’s knees were and continue to be painful. As much has been documented throughout the appeal period and the Veteran is competent to state his knees are painful. However, in order to warrant a higher rating, the evidence must show that the Veteran’s pain caused functional loss. The Veteran is competent to report certain obvious symptoms of disability, but not to identify a specific level of disability. Barr v. Nicholson, 21 Vet. App. 303 (2007); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). Competent evidence concerning the nature and extent of the Veteran’s service-connected disabilities has been provided by the medical professionals who have examined him. The overall medical findings adequately address the criteria under which this disability is evaluated. The Board accords the objective medical findings greater weight than subjective complaints of increased symptomatology. Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Veteran’s range of motion has been tested on VA examination several times in connection with his appeal. He also had the opportunity to describe the flare-ups he experienced. It is well-documented that during flare-ups, the Veteran experienced an increase in pain impacting the function of his knees. However, the evidence does not show that even when considering pain and limitation of function, the pain in his knees as well as his limitations including inference with standing and walking, are of sufficient severity to warrant higher ratings than those assigned. In reaching these conclusions for Diagnostic Code 5260 and 5261, the Board has considered any additional functional limitation due to factors such as pain, weakness, incoordination, or fatigability. Indeed, the Veteran’s use of assistive devices such as a brace and cane are due to symptoms related to impairment of range of motion and thus are contemplated by the schedular rating criteria and the current rating. Cf. Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018) (“All the symptoms for which a cane or walker could serve as a proxy are contemplated by § 4.120 as impairments of motor and sensory function. In other words, the symptoms of sciatica that cause the Appellant to use assistive devices such as a cane or walker are contemplated by the schedular rating criteria and therefore do not satisfy the first part of Thun’s first element.”). In sum, the even after considering the functional loss caused by pain as well as impairments to standing and walking, a rating higher than 10 percent for the Veteran’s left knee is not warranted at any time during the appeal period. A rating higher than 10 percent for limitation of extension of the Veteran’s right knee is not warranted prior to January 8, 2015. However, as of that date, it is factually ascertainable that the Veteran’s limitation of extension was sufficiently limited in the right knee to warrant a 20 percent rating. At no point during the appeal period has the Veteran’s right knee instability been shown to be moderate, such that a rating higher than 10 percent is warranted. 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). A total disability rating may be assigned where the schedular rating is less than total when the disabled person 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, this disability shall be ratable at 60 percent or more, or 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. See 38 C.F.R. § 4.16(a). In this instance, prior to January 8, 2015, the Veteran’s total combined rating was 50 percent. Therefore, even if the Board were to construe the Veteran’s various joint disabilities as “one disability” as they affect the same body system, he does not meet the schedular criteria for that time period. Similarly, from January 8, 2015 until June 17, 2019, his total combined rating was 60 percent. Even if the Board were to consider his multiple joint disabilities as “one disability” he has other service-connected disabilities. These additional disabilities are not sufficient to bring the Veteran’s combined rating to 70 percent or more. As such, he also does not meet the schedular criteria for that time period. However, since June 17, 2019, the Veteran has been service-connected for depressive disorder, rated as 50 percent disabling, along with his other disabilities, for a combined rating of 80 percent. He therefore meets the schedular criteria for that time period. Nevertheless, even when a Veteran does not meet the percentage standards for schedular TDIU, he may be considered for TDIU on an extraschedular basis pursuant to 38 C.F.R. § 4.16(b). However, the Board does not have the authority to assign extraschedular TDIU in the first instance. See 38 C.F.R. § 4.16(b). The Veteran filed a Veterans Application for Increased Compensation Based on Unemployability in November 2016. He reported last working full-time as a CDL driver on January 31, 2016, with gross earnings of $4,000 per month. In 2016, the federal poverty level was $16,020 for a two person household. The evidence shows that the Veteran was married in 2016. Further, the Veteran has not contended, nor does the evidence suggest, that this employment was marginal or in a sheltered setting. Therefore, the Board need not address whether a TDIU is warranted prior to that time period. On his TDIU application, the Veteran stated it was his major depression, bilateral tinnitus, bilateral knees, and bilateral ankles which made him unable to secure and follow any substantially gainful employment. He completed the 11th grade and is in receipt of a GED. He did not attend college and does not have any additional training. VA treatment records from July 2019 state “the Veteran reported that he retired as a truck driver in 2016 after 20 years of employment. He stated that prior to driving trucks, he worked for the Postal Service for 12 years. The Veteran explained that he loved working and he was forced to retire due to his physical limitations. He added that he has had difficulty adjusting to retirement.” The claims file reveals that the Veteran has recent experience working as a truck-driver, but the Board finds he would not be precluded from sedentary employment prior to July 17, 2019. Merriam-Webster online dictionary defines “sedentary” as (a) “doing or requiring much sitting” or (b) “not physically active.” https://www.merriam-webster.com/dictionary/sedentary. The Board employs this definition in the current analysis. Withers v. Wilkie, 30 Vet. App. 139, 147 (2018). As noted above, prior to July 17, 2019, the Veteran was service-connected for degenerative arthritis of the bilateral knees, right knee instability, bilateral ankle degenerative joint disease, hallux valgus of the left foot, a scar, hypertension, and acne. The file does not contain any indication that during the appeal period, the Veteran’s hallux valgus, scar, hypertension, or acne impacted his ability to perform any type of occupational tasks. See e.g. June 2015 Foot Conditions DBQ, December 2015 Hypertension DBQ. Indeed, the Veteran did not contend as much on his TDIU application. It is worth noting that on his TDIU application, the Veteran described his tinnitus as impacting his ability to work. He is not service-connected for tinnitus and, as a result, the Board may not consider any impact the Veteran’s tinnitus has in determining whether he is able to secure and follow substantially gainful employment. Similarly, the Veteran also stated on his application that his depressive disorder impacts his ability to work. The Board may not consider the impact of his major depression until July 17, 2019, the effective date of the award of service connection for depressive disorder. The evidence shows that prior to July 17, 2019, the Veteran’s joint disabilities severely impacted his ability to perform physical labor. However, they did not preclude sedentary work such that it can be said that the Veteran was precluded from securing and following any gainful employment. As of July 17, 2019, after resolving all reasonable doubt in his favor, the Board finds that the Veteran’s service-connected disabilities have precluded him from securing and following any substantially gainful employment. Prior to July 17, 2019, the record evidence shows that the Veteran’s ankle and knee disabilities made it impossible for him to ambulate without assistance (brace and cane) and he was unable to stand/ambulate for extended periods of time. See June 2016 VA Knee & Ankle Examination Reports. He also experienced decreased mobility, difficulty bending, and he was unable pick things up from the floor from a standing position. See October 2018 VA Knee & Ankle Examination Reports. Regarding the effects of the Veteran’s knees in an occupational environment, the October 2018 examiner stated “decreased mobility. Has difficulty getting out of a chair. Persistent pain in both knees. Cannot bend or pick up things from floor. Unsteady on knees and has to use a cane. Does not affect sedentary work.” At his Board hearing, the Veteran reported that while driving an 18 wheeler at his last employment, he had to “pick up my leg and put it on the brake pedal and put it up and take it off the brake pedal.” The Board concedes that the Veteran’s service-connected lower extremity disabilities made it unsafe to drive and therefore driving a tractor trailer would not be possible as a result of the Veteran’s knee and ankle disability. However, the record does not contain evidence that the Veteran’s service-connected disabilities impacted his ability to perform the acts required by sedentary employment, as defined above, prior to July 17, 2019. As noted, with regard to joint disabilities, the Veteran is service-connected for disabilities of the lower extremities only. The probative evidence does not show that these disabilities impact his ability to sit, answer phones, type on a computer, or any other activities involving the upper extremities. The Board concedes that the Veteran’s most recent work experience was driving a tractor trailer. However, VA treatment records from June 2019 document that the Veteran has extensive work experience including driving a truck, being a mail carrier, and working as an oil worker. Those types of jobs involve interacting with customers, understanding orders, sorting through mail/paperwork, and ensuring that orders are fulfilled and signed for. Although the Veteran does not have direct experience in sedentary employment, the Board finds that several of the duties learned during his physical employment translate well into sedentary work. As such, a TDIU prior to June 17, 2019, is not warranted. However, as of June 17, 2019, the Board finds that the Veteran’s service-connected disabilities precluded him from securing and following substantially gainful employment. The records evidence shows that in addition to the Veteran’s joint disabilities precluding him from physical labor, his depressive disorder would preclude him from sedentary work as well. VA treatment records show that the Veteran’s depressive disorder significantly impacts his ability to concentrate, making it difficult to “take care of things at home.” He also tends to isolate and has difficulty getting along with others. See e.g. September 2019 VA Treatment Records. He has little interest or pleasure in doing things, feels down and depressed almost constantly, has trouble falling and staying asleep, and has little energy as a result of his depressive disorder nearly every day. See March 2019 Patient Health Questionnaire. Thus, prior to June 17, 2019, the Veteran was not precluded from securing and following sedentary employment as defined by the Webster Dictionary, as a result of his service-connected disabilities. See Withers, supra. However, since June 17, 2019, the evidence shows that the Veteran’s depressive disorder impacted his ability to interact with others such that it would not be reasonable to assume that the Veteran could secure and follow substantially gainful employment. As a result, a TDIU prior to June 17, 2019, is denied. However, a TDIU is granted as of June 17, 2019. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Martha R. Luboch, 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.