Citation Nr: 21000112 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 15-20 850 DATE: January 4, 2021 ORDER Entitlement to service connection for a bilateral foot disability is denied. Entitlement to a 50 percent disability rating for posttraumatic stress disorder (PTSD), combat with major depressive disorder, recurrent episode, is granted prior to August 13, 2019. Entitlement to a disability rating more than 70 percent for PTSD, combat with major depressive disorder, recurrent episode, from August 13, 2019 is denied. Entitlement to a disability rating more than 20 percent for degenerative joint disease of the left shoulder with residual scars prior to March 6, 2018 is denied. Entitlement to a 30 percent disability rating for degenerative joint disease of the left shoulder with residual scars from March 6, 2018 to August 13, 2019 is granted. Entitlement to a disability rating more than 30 percent for degenerative joint disease of the left shoulder with residual scars from August 14, 2019 is denied. Entitlement to a disability rating more than 10 percent for residual of right thumb fracture prior to August 14, 2019 is denied. Entitlement to a disability rating more than 20 percent for residual of right thumb fracture from August 14, 2019 is denied. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) prior to August 12, 2010 is granted. Entitlement to TDIU from August 12, 2010 is dismissed. REMANDED Entitlement to a disability rating more than 10 percent for degenerative joint disease of the right wrist status post right wrist fracture is remanded. FINDINGS OF FACT 1. A bilateral foot disability is not currently manifest and did not manifest at any point during the appeal period. 2. For the rating period prior to August 13, 2019, the Veteran’s PTSD, combat and major depressive disorder, recurrent episode, more nearly approximated occupational and social impairment with reduced reliability and productivity. 3. From August 13, 2019, the Veteran’s PTSD, combat and major depressive disorder, recurrent episode, is manifested by at most occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. 4. Prior to March 6, 2018, the Veteran’s degenerative joint disease of the left shoulder with residual scars was manifested by pain and limitation of motion of the arm no greater than the shoulder level. 5. From March 6, 2018, the Veteran’s degenerative joint disease of the left shoulder with residual scars is manifested by pain and limitation of motion of the arm to less than 25 degrees from the side; it is not manifested by ankylosis or impairment of the humerus. 6. Prior to August 14, 2019, the Veteran’s residual of right thumb fracture was manifested by painful motion, but was not manifested by a gap of more than 2 inches (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers. 7. From August 14, 2019, the Veteran’s residual of right thumb fracture is manifested by a gap of more than 2 inches (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers with no evidence of ankylosis. 8. Prior to August 12, 2010, the Veteran’s service-connected disabilities precluded him from securing and following a substantially gainful occupation. 9. From August 12, 2010, as the Veteran is already eligible for special monthly compensation and was awarded such in a rating decision dated October 2011, an award of TDIU can result in no further benefit, and there remains no case or controversy concerning whether the Veteran is entitled to any benefits that may be inferred from his claim. CONCLUSIONS OF LAW 1. A bilateral foot disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2019). 2. For the rating period prior to August 13, 2019, the criteria for a 50 percent rating, but no higher, for PTSD, combat and major depressive disorder, recurrent episode, are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411 (2019). 3. From August 13, 2019, the criteria for a disability rating in excess of 70 percent for PTSD, combat and major depressive disorder, recurrent episode, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2019). 4. Prior to March 6, 2018, the criteria for a disability rating in excess of 20 percent for degenerative joint disease of the left shoulder with residual scars are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2019). 5. From March 6, 2018 to August 13, 2019, the criteria for a 30 percent disability rating for degenerative joint disease of the left shoulder with residual scars are met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2019). 6. From August 14, 2019, the criteria for a disability rating in excess of 30 percent for degenerative joint disease of the left shoulder with residual scars are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2019). 7. Prior to August 14, 2019, the criteria for a disability rating more than 10 percent for residual of right thumb fracture are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5228 (2019). 8. From August 14, 2019, the criteria for a disability rating more than 20 percent for residual of right thumb fracture are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5228 (2019). 9. Prior to August 12, 2010, the criteria for a TDIU have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2019). 10. From August 12, 2010, there is no question of law or fact involving the award of entitlement to special monthly compensation based on award of TDIU; the appeal is moot. 38 U.S.C. § 7105(d)(5) (2012); 38 C.F.R. § 4.16 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1968 to June 1977. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified at a videoconference hearing held at the RO before the undersigned Veterans Law Judge (VLJ) with regard to the issues of entitlement to TDIU and entitlement to increased ratings for PTSD, degenerative joint disease of the left shoulder with residual scars, degenerative joint disease of the right wrist status post right wrist fracture, and residual of right thumb fracture. The Veteran did not request testimony as to the remaining bilateral foot disability issue on appeal. A transcript of the hearing is associated with the record. During the March 2018 Board hearing, the VLJ clarified the issues on appeal; clarified the concept of increased rating and TDIU claims; identified potential evidentiary defects which included the severity of the Veteran’s right wrist, PTSD, right thumb, and left shoulder disabilities; clarified the type of evidence that would support the Veteran’s claims; enquired as to the existence of potential outstanding records; and held the record open for 60 days for the submission of additional evidence. Thus, the actions of the VLJ supplement the VCAA and comply with any related duties owed during a hearing set forth in 38 C.F.R. § 3.103. The Board remanded the claims on appeal in December 2018. In a subsequent rating decision dated June 2020, the RO increased the rating for the Veteran’s PTSD with major depressive disorder to 70 percent effective August 13, 2019; increased the rating for the Veteran’s degenerative joint disease of the left shoulder with residuals scars to 30 percent effective August 14, 2019; and increased the rating for the Veteran’s residual of right thumb fracture to 20 percent effective August 14, 2019. However, as the increased ratings did not constitute a full grant of the benefits sought, the Veteran’s claims for higher evaluations remain in appellate status. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). The Veteran’s claims folder has returned to the Board for further appellate consideration. In December 2018, the Board also remanded claims of service connection for a cervical spine disability, right leg sciatica, and prescription of Piroxicam by VA causing truncal vagotomy (claimed as stomach surgery). In a subsequent rating decision dated June 2020, the cervical spine disability and right leg sciatica claims were granted, and in a July 2020 rating decision, the residuals of truncal vagotomy disability claim was granted. In view of the foregoing, these issues have been resolved and are no longer before the Board. See generally Grantham v. Brown, 114 F.3d 116 (Fed. Cir. 1997). Service connection for a bilateral foot disability Veterans are entitled to compensation from VA if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed.Cir. 2004). In the case of a Veteran who engaged in combat with the enemy in a period of war, lay evidence of in-service incurrence or aggravation of a disease or injury shall be accepted if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the lack of official record of such incurrence or aggravation. 38 U.S.C. § 1154(b); Libertine v. Brown, 9 Vet. App. 521, 524 (1996); Collette v. Brown, 82 F.3d 389, 392-94 (Fed. Cir. 1996). The phrase “engaged in combat with the enemy” requires that the veteran have personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. VAOPGCPREC 12-99 (October 18, 1999); Gaines v. West, 11 Vet. App. 353 (1998). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2019). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran contends that he has a bilateral foot disability that is related to his service, to include performing his duties as a pilot during combat service in Vietnam. See, e.g., the March 2018 Board hearing transcript, page 13. The Board notes that the Veteran’s service treatment records are absent complaints of or treatment for a foot disability. However, the Veteran’s service personnel records document his receipt of the Purple Heart from service in Vietnam. Under 38 U.S.C. § 1154(b), a combat veteran’s assertions of an event during combat are to be accepted if they are consistent with the time, place and circumstances of such service. 38 U.S.C. §. 1154(b) does not establish service connection for a combat veteran; it aids him by relaxing the adjudicative evidentiary requirements for determining what happened in service. As such, although the Board accepts the Veteran’s description of in-service combat experiences in Vietnam, the evidence must still establish by competent and probative evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563 (1996); Kessel v. West, 13 Vet. App. 9 (1999); Libertine v. Brown, 9 Vet. App. 521 (1996). The postservice evidence of record establishes that the Veteran does not currently have a bilateral foot disability. Notably, the Veteran was provided a VA examination in August 2019 to determine the etiology of his claimed bilateral foot disability. After examination of the Veteran and consideration of his medical history, the VA examiner declined to find that the Veteran had a bilateral foot disability. Pertinently, the VA examination report documents a normal foot examination and the Veteran denied a bilateral foot condition. There are no findings contrary to the VA examination during the appeal period. The Board finds the VA examination to be of great probative value with regard to the finding of an absence of a bilateral foot disability as a thorough examination was conducted. The Board notes that a February 2002 private treatment record from M.G., DPM documents a finding of plantar fasciitis and plantar calcaneal spur. The Board acknowledges the United States Court of Appeals for Veterans Claims (Court) case of Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (stating that “when the record contains a recent diagnosis of disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency”). In this case, as noted, the Board finds the August 2019 VA examination to be highly probative evidence as to whether the Veteran currently has a chronic bilateral foot disability. The referenced instance of plantar fasciitis and plantar calcaneal spur is inconsistent with subsequent records. Moreover, the Board notes that no foot symptoms were documented during the August 2019 VA examination. In this case, the Board finds that the most probative evidence weighs against a finding that the criteria have been met for a current bilateral foot disability. In this regard, the Board finds it highly probative that the VA examination indicates normal findings of the feet and that the examination was thorough. The Board has considered the Veteran’s statements that he has a bilateral foot disability. The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In addition, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or, (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)); Kahana v. Shinseki, 24 Vet. App. 428, 433, n.4 (2011). However, competence must be distinguished from probative weight. Although the Veteran is competent to relate what he experiences through the senses, the lay evidence is lacking in detail to support the conclusion that there is a bilateral foot disability. The Veteran’s lay assertions are therefore afforded less probative weight, and less credibility than the VA examination report. In this instance, the Board concludes that the most probative evidence establishes that the Veteran does not have a bilateral foot disability. The existence of a current disability is the cornerstone of a claim for VA disability benefits. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Therefore, in the absence of current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, there is no disability that resulted from a disease or injury. We emphasize that under the provisions of 1110 and 1131, there must be disability and such disability must be due to disease or injury. The Board acknowledges the Veteran’s report of injury to his feet from his combat service. However, the June 1977 separation examination is absent any finding as to impairment of the feet. Moreover, the normal findings postservice establishes that the Veteran does not currently have residuals of the disability (impairment). Under the circumstances, the Veteran has not met the regulatory requirements to establish service connection for a bilateral foot disability under any theory of entitlement and service connection must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. Here, however, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Ratings Pertinent legal criteria Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21 (2019). The Veteran’s entire history is reviewed when making disability evaluations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of “staged rating” is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). When a disability has undergone varying and distinct levels of severity during the appeal, it is appropriate to apply staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). PTSD with major depressive disorder The Veteran’s PTSD with major depressive disorder has been assigned a 30 percent rating prior to August 13, 2019 and 70 percent rating thereafter under 38 C.F.R. § 4.130, Diagnostic Code 9411. PTSD with major depressive disorder is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula for Mental Disorders, a 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. Id. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); or inability to establish and maintain effective relationships. Id. A 50 percent rating requires occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing effective work and social relationships. Id. A 30 percent rating requires occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 10 percent rating requires 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, or symptoms controlled by continuous medication. A Global Assessment of Functioning (GAF) score is a quantifiable assessment of overall functioning used by mental health clinicians that reflects an individual’s “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266 (1996) (both citing the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), p. 32 (1994)). Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the DSM-IV and replace them with references to the recently updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the AOJ on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). The RO certified the Veteran’s appeal to the Board in December 2017; therefore, the claim is governed by DSM-5. The Board notes that the use of GAF scores has been abandoned in the DSM-5 because of, among other reasons, “its conceptual lack of clarity” and “questionable psychometrics in routine practice.” See Diagnostic and Statistical Manual for Mental Disorders, Fifth edition, p. 16 (2013). In this case, as the Veteran’s claim is governed by DSM-5, GAF scores are not relevant for consideration. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran was provided a VA examination in May 2010. He reported irritability, depression, sense of worthlessness, loneliness, and low energy. He further reported that he was married twice and had been married to his second wife for 21 years (together for 30 years) and described the relationship as “good.” He did not have children. He had some friends from the military but did not go out with them. He attended Bible study and church once a week. He also rode his motorcycle with others. He was unemployed and had not looked for work in the past year due to his disabilities. He previously worked as a manager and customer service trainer. He was able to complete activities of daily living and instrumental activities of daily living. Upon examination, the VA examiner noted sleep impairment, hypervigilance, intrusive thoughts, irritability, exaggerated startle response and panic attacks. The examination was otherwise normal. The examiner opined that the Veteran’s mental health impairment was moderate in severity and suggested an exaggeration of symptoms. The mental health impairment was manifested by occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to PTSD signs and symptoms, but with generally satisfactory functioning. The Veteran was provided another VA examination in February 2011. He continued to indicate a good relationship with his wife and he also had contact once in a while with his half-sister. He was in contact with five pilots who were in his military unit and he visited another military friend. He also went to his Bible study group meetings. He also noted sleep impairment, depression, and feelings of guilt. Upon examination, the VA examiner reported soft or whispered speech, exaggerated physical movements, guarded attitude, constricted affect, depressed mood, impaired attention, sleep impairment, and panic attacks. He had morbid thoughts but denied suicidal intent or plan to harm himself. His memory was mildly impaired. Examination was otherwise normal. The examiner opined that the Veteran’s mental health impairment was manifested by reduced reliability and productivity. The examiner further noted that the Veteran’s psychiatric disorder would mildly to moderately impact the Veteran’s ability to obtain substantial and gainful employment. On VA examination in January 2015, the Veteran continued to report a good relationship with his wife and he was able to manage activities of daily living. He had an adopted brother who he did not see. He continued to socialize with his friends from service. The examiner opined that the Veteran’s mental health impairment was manifested by 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, or; symptoms controlled by medication. The examiner further noted symptoms of depressed mood, anxiety, panic attacks, and chronic sleep impairment. The examiner opined that the Veteran’s mental health symptoms would pose a mild to moderate impairment in an employment setting that required a high level of attention to detail and focusing of attention. On VA examination in August 2019, the Veteran reported low mood, irritability, hyperarousal, sleep impairment, avoidance, and emotional numbing. The examiner opined that the Veteran’s mental health impairment was manifested by occupational and social impairment with reduced reliability and productivity. The examiner documented mental health symptoms of depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, suicidal ideation, and impaired impulse control. The Board notes that medical treatment records document treatment for the Veteran’s PTSD with major depressive disorder. An interview report from D.P., PhD dated December 2017 noted the Veteran’s irritability, anxiety, and tangential thoughts. The Board further notes testimony from the Veteran during the March 2018 hearing as well as statements submitted by his wife which noted his depression, irritability, anxiety, social isolation, slow speech, memory loss, and sleep impairment. Based on the foregoing, the Board finds that a 50 percent rating is warranted for the Veteran’s PTSD with major depressive disorder prior to August 13, 2019. In this regard, the Board finds that the impact of the Veteran’s PTSD with major depressive disorder on his social and industrial functioning is sufficient to approximate the degree of impairment contemplated by a 50 percent rating during this period. See 38 C.F.R. § 4.7 (2019). Criteria for the assignment of a 50 percent rating, which have arguably been met or approximated include panic attacks, memory loss, disturbances of motivation and mood, and difficulty in establishing effective work and social relationships. The Board also finds that the evidence as whole indicates that the Veteran’s PTSD with major depressive disorder traits also include sleep impairment, hyperarousal, intrusive thoughts, feelings of isolation, and hypervigilance. In consideration of these symptoms with the Veteran’s other PTSD with major depressive disorder symptoms, the Board finds that these criteria approximate a 50 percent disability rating. As such, given the actual psychiatric symptoms shown in this case, the Board finds that level of overall psychiatric impairment is shown to be consistent with a 50 percent rating. However, the Board finds that prior to August 13, 2019, the Veteran is not entitled to a higher disability rating for his PTSD with major depressive disorder. In this regard, the Board notes that the Court of Appeals for the Federal Circuit (Federal Circuit) held in Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013) that “in the context of a 70 percent rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” The Board acknowledges the Veteran’s report of irritability and difficulty getting along with co-workers as well as panic attacks. However, there were no findings such as obsessional rituals which interfered with routine activities; speech intermittently illogical, obscure or irrelevant; spatial disorientation, and neglect of personal appearance and hygiene. Also, while he has evidenced morbid thoughts, he has consistently denied suicidal ideation. Moreover, prior to August 13, 2019, the Veteran reported having a good relationship with his wife, communication with friends, and participation in a Bible study group and church. As such, while the Board acknowledges the Veteran’s social impairment, the evidence does not indicate an inability to establish and maintain effective relationships prior to August 13, 2019. In light of the foregoing, the Board concludes that, while the Veteran demonstrates some of the criteria listed for a 70 percent disability rating, the evidence of record does not show that his overall level of severity more closely approximates the criteria for a 70 percent disability rating under 38 C.F.R. § 4.130 prior to August 13, 2019. Moreover, there are no other factors which would lead the Board to conclude that a 70 percent disability rating is warranted for this period. Rather, his level of functioning is greater than that contemplated by the 70 percent rating category. The Board also finds that the finds that a 100 percent disability rating is not warranted for the Veteran’s PTSD with major depressive disorder at any time during the period under consideration (prior to or after August 13, 2019). While the Board accepts that the Veteran’s PTSD with major depressive disorder traits significantly affect his functioning, the lay and medical evidence of record does not demonstrate both total occupational and social impairment. In this regard, the evidence does not demonstrate symptoms such as gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform acts of daily living, disorientation to time or place, or memory loss for names of close relatives or own name, or other symptoms on a par with the level of severity exemplified in these manifestations. On the contrary, the Veteran has overall been found to have appropriate thought process and communication and has been oriented to time and place. He has also denied being a danger to himself and others. As such, the Board finds that the record as a whole does not support the existence of symptoms such that there is total occupational and social impairment. The Board further notes that as indicated above, the evidence of record reflects that the Veteran has symptomatology including sleep impairment, hyperarousal, intrusive thoughts, feelings of isolation, and hypervigilance. These symptoms are fully contemplated in the assigned evaluations. However, the Board finds that such symptoms do not more nearly approximate a 100 percent rating as they are not of such a severity or frequency to result in total occupational and social impairment. The Board further finds the VA examination findings in particular to be of great probative value in that the examiners did not indicate that the Veteran’s psychiatric disorder was manifested by total occupational and social impairment at any time during the period on appeal. Based on the above, the Board finds that a 50 percent disability rating is warranted prior to August 13, 2019 and a disability rating greater than 70 percent thereafter is not warranted. Degenerative joint disease of the left shoulder with residual scars The Veteran’s degenerative joint disease of the left shoulder with residual scars is rated as 20 percent disabling prior to August 14, 2019 and 30 percent thereafter pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5201 (arm, limitation of motion). The evidence demonstrates that the Veteran’s degenerative joint disease of the left shoulder with residual scars is manifested by limitation of motion of the left shoulder. The Board also notes that the competent and probative evidence does not document ankylosis of the left shoulder or impairment of the clavicle, scapula, or humerus. Therefore, Diagnostic Codes 5200, 5202, and 5203 which pertain to ankylosis of the shoulder and impairment of the humerus clavicle, and scapula, respectively, are not for consideration. As such, the Board finds that Diagnostic Code 5201 is the most appropriate Diagnostic Code for application. Diagnostic Code 5201 provides a 20 percent rating for limitation of arm motion at shoulder level for both the major and minor joint; a 30 percent rating for limitation of arm motion midway between the side and shoulder level for the major joint and a 20 percent rating for the minor joint; and a 40 percent rating for limitation of arm motion to 25 degrees from the side for the major joint and a 30 percent rating for the minor joint. As reflected in the record, the Veteran is right handed, and therefore his left shoulder is the minor joint. See, e.g., the January 2015 VA examination report. Normal forward elevation, or flexion, of the shoulder is from 0 to 180 degrees. Normal shoulder abduction is also from 0 to 180 degrees. Normal external rotation and internal rotation are from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. The Veteran was provided a VA examination in March 2011. He reported progressive left shoulder pain, stiffness, weakness, and loss of normal range of motion. He was unable to engage in routine calisthenics such as pullups and pushups due to shoulder symptoms. He did not use assistive devices. The left shoulder disability had severe effects on chores, shopping, exercise, sports, recreation, and traveling and moderate effects on feeding, bathing, dressing, toileting, and grooming. He did not report flare-ups. Range of motion testing revealed flexion to 40 degrees, extension to 40 degrees, abduction to 40 degrees, internal rotation to 40 degrees, and external rotation to 60 degrees. The examiner noted crepitus but no effusion. There was objective evidence of pain with active motion and repetitive motion. Repetitive motion testing revealed additional loss of motion of 10 degrees. On VA examination dated January 2015, the Veteran reported daily left shoulder pain located to the anterior joint region with intermittent popping. Although he did not report flare-ups, he reported functional loss manifested by increased pain when lifting an object with the left arm as well as when putting on shirts, reaching down for objects, and driving. He did not use assistive devices. Range of motion testing revealed left shoulder flexion to 80 degrees, abduction to 70 degrees, external rotation to 50 degrees, and internal rotation to 80 degrees. The limited range of motion interfered with overhead work, heavy lifting, reaching, and pulling. Pain was noted on examination but did not result in or cause functional loss. There was no evidence of pain with weight bearing. There was objective evidence of localized tenderness to palpation on the lateral left deltoid and acromioclavicular joint regions. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with three repetitions with no additional loss of range of motion or functional loss. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. There was no finding of ankylosis. Hawkins’ Impingement, Empty-can, External rotation/infraspinatus strength, and lift-off subscapularis tests were positive. There was no finding of left shoulder instability, dislocation, or labral pathology or a clavicle, scapula, acromioclavicular or sternoclavicular joint condition suspected. The Veteran did not have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus, nor did he have malunion of the humerus with moderate or marked deformity. On VA examination dated August 2019, the Veteran reported left shoulder pain, stiffness, and limited range of motion. He reported flare-ups manifested by an inability to move the shoulder as well as functional loss manifested by inability to lift the hand above the shoulder or head or in any type of rotational activity or carry any weight. He did not use assistive devices. Range of motion testing revealed left shoulder flexion to 75 degrees, abduction to 65 degrees, external rotation to 45 degrees, and internal rotation to 80 degrees. Pain was noted on examination for flexion, abduction, external rotation, and internal rotation and caused a functional loss manifested by inability to raise the hand above the head or shoulder and difficulty dressing. There was objective evidence of localized tenderness or pain on the anterior and posterior that was moderate in severity and consistent. There was evidence of pain with weight bearing and crepitus. There was no objective evidence of pain with nonweight bearing and passive range of motion results were the same as active range of motion. The Veteran was able to perform repetitive use testing with three repetitions with no additional loss of motion. Pain, weakness, fatigability, or incoordination caused flexion to 45 degrees, abduction to 45 degrees, external rotation to 30 degrees, and internal rotation to 60 degrees. Flare-ups resulted in flexion, abduction, external rotation, and internal rotation to 25 degrees. There was no finding of ankylosis. Hawkins’ Impingement, Empty-can, External rotation/infraspinatus strength, and lift-off subscapularis tests were positive. The examiner noted shoulder instability, dislocation, or labral pathology but did not identify a history of recurrent dislocation. Crank apprehension and relocation test was positive. The examiner also noted a clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition but the Veteran did not have an acromioclavicular joint condition or any other impairment of the clavicle or scapula. There was tenderness on palpation of the acromioclavicular joint and cross-body adduction testing was positive. The Veteran did not have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus or malunion of the humerus with moderate or marked deformity. The Board notes that medical treatment records document the Veteran’s treatment for his left shoulder disability. Private evaluations dated September 2017 and January 2018 by Dr. J.H. documented flexion, abduction, and external rotation to 30 degrees. Hawkins’ impingement, Neer’s impingement, empty can, and Speed’s testing were positive. The Board also notes a June 2015 private treatment record from Dr. E.B. which noted the Veteran’s left shoulder pain. The Veteran also testified as to his left shoulder disability at the March 6, 2018 Board hearing. He specifically noted inability to lift and move the left shoulder as well as carry objects and that it affected his ability to sleep. The hearing transcript indicates that the Veteran was minimally able to lift his left arm from his side and likely did not reach 25 degrees from the side. See the March 2018 Board hearing transcript, page 14. Based on the evidence of record, the Board finds that prior to March 6, 2018, the Veteran’s left shoulder symptomatology does not warrant an evaluation in excess of 20 percent under Diagnostic Code 5201. A higher 30 percent disability rating is warranted when functional equivalent of limitation of shoulder abduction is to 25 degrees from the side. Deluca, 8 Vet. App. at 204-207; Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In order to warrant a higher evaluation, the impairment must approximate limitation to 25 degrees from the side. See Deluca and Mitchell, supra; see also Sharp v. Shulkin, 29 Vet. App. 26 (2017) (addressing what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups). Here, the Veteran reported the presence of pain. However, the pain did not functionally limit motion to 25 from the side. Furthermore, pain is contemplated in the assigned evaluation. Therefore, although the Veteran reported limitation in reaching overhead and generally limited use of his left arm, the statements do not establish limitation of function to 25 degrees from the side. The Board finds the VA examination reports in particular to be of significant probative value as these were based on thorough examinations of the Veteran and further do not reveal limitation of motion to 25 degrees from the side. As limitation of left shoulder abduction to 25 degrees from the side is not demonstrated, a higher rating is not warranted as to the Veteran’s degenerative joint disease of the left shoulder with residual scars. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. The Board also finds that from March 6, 2018, a 30 percent rating is warranted for the Veteran’s degenerative joint disease of the left shoulder. In this regard, the Board notes the March 6, 2018 Board hearing transcript in which the undersigned Veterans Law Judge noted the Veteran’s inability to move his left arm to 25 degrees from the side. The Board finds that such a finding is supported by the Veteran’s subsequent August 2019 VA examination during which limitation abduction during a flare-up was limited to 25 degrees from the side. As such, in resolving the benefit of the doubt in the Veteran’s favor, the Board finds that a 30 percent rating for the Veteran’s degenerative joint disease of the left shoulder is warranted from March 6, 2018. The Board further notes that 30 percent is the maximum rating permissible under Diagnostic Code 5201 for the Veteran’s degenerative joint disease of the left shoulder with residual scars. As discussed above, while Diagnostic Code 5200 pertaining to ankylosis of the shoulder and Diagnostic Code 5202 pertaining to impairment of the humerus allow for a higher rating, such findings have not been evidenced. Accordingly, a rating higher than 30 percent for the Veteran’s degenerative joint disease of the left shoulder is not warranted from March 6, 2018. Here, the effective date of the changed evaluation is based upon facts found, consisting of the demonstration during the hearing. Prior to that date, the evidence did not reflect restriction that would warrant a higher evaluation. Residual of right thumb fracture The Veteran’s residual of right thumb fracture is rated as 10 percent disabling prior to August 14, 2019 and 20 percent thereafter pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5228 (thumb, limitation of motion). The Board notes that the Veteran’s service-connected right thumb disability is manifested by pain and limitation of motion. As such, the Board finds that Diagnostic Code 5228 is the most appropriate Diagnostic Code for consideration. Under Diagnostic Code 5228, for limitation of motion of the thumb, with a gap of more than two inches (5.1 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, a 20 percent rating is warranted for either a major or minor extremity. With a gap of one to two inches (2.5 to 5.1 cm), with the thumb pad attempting to oppose the fingers, a 10 percent rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5228. On VA examination dated March 2011, the VA examiner noted the Veteran’s history of right thumb fracture during service, and the Veteran reported progressive stiffness and weakness in his right thumb with limited range of motion and pain. The Veteran did not use assistive devices. The residual of right thumb fracture caused mild effects on chores, shopping, exercise, sports, recreation, traveling, feeding, bathing, dressing, toileting, and grooming. Range of motion testing revealed right thumb metacarpophalangeal (MCP) joint motion to 40 degrees and interphalangeal (IP) joint motion to 40 degrees. The examiner noted a gap between the pad of the thumb and the fingers with the thumb attempting to oppose the fingers for the following: index finger of 2 cm, long finger of 3 cm, ring finger of 4 cm, and little finger of 5 cm. There was no objective evidence of pain with motion or repetitive motion as well as no additional loss of motion upon repetitive motion testing. Strength testing was 3/5 and the Veteran had impaired dexterity for twisting, probing, writing, touching, and expression. On VA examination dated January 2015, the VA examiner recorded diagnoses of closed avulsion fracture, base of medial aspect of proximal phalanx of right thumb, status post open reduction with pull out wire fixation as well as degenerative joint disease of the right thumb, status post excision of sesamoids. The Veteran reported constant right thumb pain located to the carpometacarpal (CMC) joint as well as chronic stiffness. He did not report flare-ups, but he reported functional loss manifested by inability to tie his shoes, buttoning his clothes, and modifying his writing and gripping techniques. He did not use assistive devices. Range of motion testing revealed MCP extension to zero degrees and flexion to 40 degrees as well as IP extension to zero degrees and flexion to 65 degrees. There was a gap measurement of 0.5 cm between the pad of the thumb and the fingers. Pain was noted on examination but did not result in functional loss. There was tenderness to palpation over the CMC joint and MCP joint. The Veteran was able to perform additional range of motion testing with at least three repetitions with no additional loss of motion. Pain, weakness, and incoordination significantly limited functional ability with repeated use. Grip strength was 4/5. There was no finding of ankylosis. On VA examination dated August 2019, the Veteran continued to report minimal right thumb range of motion and pain. He reported flare-ups due to weather changes as well as functional loss manifested by loss of thumb movement for grip, dexterity, and fine motor movements. He did not use assistive devices. Range of motion testing revealed MCP extension to zero degrees and flexion to 20 degrees as well as IP extension to zero degrees and flexion to 20 degrees. The examiner noted a gap of 3.5 cm between the pad of the thumb and the fingers. Pain was noted on examination and caused functional loss. The Veteran was able to perform additional range of motion testing with at least three repetitions with no additional loss of motion. However, the examiner noted that repeated use over time would result in MCP extension to zero degrees and 10 degrees flexion as well as IP extension to zero degrees and 10 degrees flexion as well as gap of 3.5 cm between the pad of thumb and the fingers. Range of motion during a flare-up was estimated to result in MCP extension to zero degrees and 5 degrees flexion as well as IP extension to zero degrees and 5 degrees flexion as well as gap of 4.0 cm between the pad of thumb and the fingers. Grip strength was 4/5. There was no finding of ankylosis. The examiner did not report objective evidence of pain on nonweight bearing and passive range of motion results were the same as active range of motion. The Board notes that medical treatment records document treatment for the Veteran’s residual of right thumb fracture. Specifically, September 2017 and January 2018 reports from Dr. J.H. note decreased abduction of the right thumb as well as a gap of 15.5. cm between the tip of the right thumb and the tip of the fifth finger. There was tenderness over the right CMC joint and the Veteran had poor manual dexterity with the right hand. He could not touch any finger to the right thumb. Dr. J.H. recorded gaps of .5 cm for the index finger, 1.0 cm for the long finger, 3.0 cm for the ring finger, and 4.0 cm for the little finger. IP flexion was to 35 degrees and extension was to zero degrees. The Board also notes the Veteran’s testimony during the March 2018 Board hearing regarding his residual of right thumb fracture. The Veteran testified as to his limited movement and that he had to hold objects differently due to right thumb pain. The Board finds that prior to August 14, 2019, the 10 percent disability rating for the residual of right thumb fracture is appropriate as there is no objective evidence of a gap of more than two inches (5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers which is required for a higher 20 percent rating under Diagnostic Code 5228. The Board in particular finds the March 2011 and January 2015 VA examinations of great probative value as thorough examinations were provided and did not indicate a gap of more than 5.1 cm. Although the Board acknowledges the findings of Dr. J.H. in the September 2017 and January 2018 reports regarding the gap of 15.5 cm between the tip of the right thumb and tip of the little finger, there is no indication that there was a gap greater than 5.1 cm between the thumb pad and the fingers with the thumb attempting to oppose the fingers. As such, the record indicates that a higher disability rating is not warranted under Diagnostic Code 5228 prior to August 14, 2019. Further, the Board has considered the Veteran’s complaints of functional impairment. See DeLuca, supra. However, the Board places greater probative value on the objective clinical findings which are against a higher disability rating. We have specifically considered the reports of functional loss. However, the functional impairment, even if accepted as credible, does not provide a basis for an increased rating as the Veteran maintained a gap of less than 5.1 cm between the thumb pad and the fingers with the thumb attempting to oppose the fingers. The Board further finds that the 10 percent rating adequately compensates the Veteran for any functional impairment attributable to his right thumb disability. See 38 C.F.R. §§ 4.41, 4.10 (2019). Accordingly, a 20 percent disability rating of the Veteran’s residual of right thumb disability is not warranted. Similarly, a disability rating in excess of 10 percent is not warranted any other applicable diagnostic code. As noted, the Veteran does not have ankylosis of the right thumb. Therefore, a rating in excess of 10 percent under Diagnostic Code 5224, for ankylosis is not warranted prior to August 14, 2019. With regard to the period from August 14, 2019, the Board finds that a rating in excess of 20 percent for the Veteran’s residual of right thumb fracture is not warranted. In this regard, a maximum 20 percent rating is warranted for limitation of motion of the thumb. There is no indication from the record that the Veteran has ankylosis of the thumb, let alone any other digits on the right hand. As such, a rating in excess of 20 percent for the Veteran’s residual of right thumb fracture is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5228 (2019). TDIU Pertinent legal criteria Under the applicable criteria, total disability ratings for compensation based upon individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). 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. The central inquiry is “whether a veteran’s service- connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether a veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose, 4 Vet. App. at 363. TDIU prior to August 12, 2010 Prior to August 12, 2010, the Veteran’s service connected disabilities were the following: PTSD with major depressive disorder (rated as 50 percent disabling), degenerative arthritis of the cervical spine (rated as 30 percent disabling); migraines (rated as 50 percent disabling); left knee arthritis (rated as 10 percent disabling); degenerative joint disease of the left shoulder with residual scars (rated as 20 percent disabling); residuals of status post truncal vagotomy (rated as 20 percent disabling); right leg sciatica (rated as 20 percent disabling); residual of right thumb fracture (rated as 10 percent disabling); degenerative joint disease of the right wrist status post right wrist fracture (rated as 10 percent disabling); degenerative disc disease of the lumbar spine (rated as 10 percent disabling); left testicular spermatoceles (rated as noncompensable); scar, status post vagotomy (rated noncompensable); bilateral tinea pedis (rated noncompensable); and scars, left thigh status post shrapnel wound (rated noncompensable). The Veteran’s combined disability rating is 90 percent. He therefore satisfies the schedular requirement for consideration of TDIU. Prior to August 12, 2010, the Veteran was 64 years old. He reported during a May 2010 VA mental health examination that he completed his BS in aeronautical studies in 1977, he had been unemployed for the past three years, and his occupation was a manager and customer service trainer. He contends that his service-connected disabilities, in particular his PTSD with major depressive disorder as well as his physical disabilities, preclude him from obtaining substantial gainful employment. A review of the medical evidence and lay evidence indicates that the Veteran’s service-connected disabilities, specifically his PTSD with major depressive disorder as well as physical impairment from his orthopedic service-connected disabilities, render him unable to obtain substantial and gainful employment. In support of his claim, the Veteran submitted private treatment evaluations dated September 2017 and January 2018 from Dr. J.H. who indicated that the Veteran’s left shoulder, right wrist, and right thumb disabilities are sufficient to preclude the Veteran from obtaining substantial and gainful employment. Dr. J.H.’s rationale was based on the finding of the Veteran’s inability to perform even simple grasping with his dominant right hand due to the residual of right thumb fracture as well as his severe weakness, pain, and limitation in range of motion of the left shoulder. Dr. J.H. also noted the pain due to the Veteran’s service-connected cervical spine, lumbar spine, left knee, and headaches disabilities. The Board further notes a December 2017 private medical opinion from Dr. D.P. who opined after a psychological examination of the Veteran that the Veteran’s mental health symptoms render him incapable of maintaining substantial gainful employment. In rendering the opinion, Dr. D.P. noted the Veteran’s depression, anxiety, sleep impairment, irritability, and occupational and social impairment. The Board finds the evaluation reports from Dr. J.H. and Dr. D.P. were based on thorough review of the Veteran’s medical history and current condition. Although these reports are dated subsequent to August 12, 2010, the Board finds that the Veteran evidenced these same symptoms during the period prior to August 12, 2010. Notably, the Veteran’s disability ratings for the PTSD with major depressive disorder and the orthopedic disabilities were the same prior to August 12, 2010 and at the time of the reports from Dr. J.H. and Dr. D.P. In light of the foregoing, the Board finds that the Veteran’s limitations from his service-connected disabilities, in particular his PTSD with major depressive disorder as well as his migraines, cervical spine, lumbar spine, left shoulder, right wrist, right thumb, and left knee disabilities render him unable to obtain substantial and gainful employment. Accordingly, the Board concludes that entitlement to a TDIU is warranted prior to August 12, 2010 and the Veteran’s claim is therefore granted. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. TDIU from August 12, 2010 In June 1999, VA’s General Counsel (OGC) issued VAOPGCPREC 6-99 addressing questions of whether a claim for a TDIU may be considered when a schedular 100 percent rating is already in effect for one or more service-connected disabilities. Essentially, that OGC precedent opinion held that receipt of a 100 percent schedular rating for a service-connected disability rendered moot any pending claim for a TDIU, requiring dismissal of the TDIU claim. See also Green v. West, 11 Vet. App. 472, 476 (1998); Vettese v. Brown, 7 Vet. App. 31, 34-35 (1994); and Smith v. Brown, 10 Vet. App. 330, 333-34 (1997) (dismissal is the proper remedy to employ when an appeal has become moot). In Bradley v. Peake, 22 Vet. App. 280 (2008), the Court, taking a position contrary to the one reached in VAOPGCPREC 6-99, held that, although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of TDIU predicated on a single disability may form the basis for an award of special monthly compensation. See Bradley v. Peake, 22 Vet. App. 280 (2008) (holding that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114(s) by having an “additional” disability of 60 percent or more (“housebound” rate)); see 38 U.S.C. § 1114(s) (2012). In view of the issuance by the Court of its decision in Bradley, which recognized that it was possible for a veteran first to be awarded TDIU based on a single disability and subsequently receive schedular disability ratings for other conditions that would not duplicate in the count of disabilities for special monthly compensation purposes (that is, separate disabilities that could combine for a 60 percent disability rating), in November 2009 the VA General Counsel partially withdrew VAOPGCPREC 6-99 to the extent it was inconsistent with Bradley. VA has a “well-established duty” to maximize a claimant’s benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant’s disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation under 38 U.S.C. § 1114. See Bradley, 22 Vet. App. at 294 (finding that special monthly compensation “benefits are to be accorded when a veteran becomes eligible without need for a separate claim”). Indeed, as noted in Bradley, VA must consider a TDIU claim despite the existence of a schedular total rating and award SMC under 38 U.S.C. § 1114(s) if VA finds the separate disability supports a TDIU independent of the other 100 percent disability rating. See id. Special monthly compensation is payable at the housebound rate where the veteran has a single service-connected disability rated as 100-percent disabling and, in addition, (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). Subsection 1114(s) requires that a disabled veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. The Court declared, however, if a veteran were awarded a TDIU based on multiple underlying disabilities and then later receives a schedular disability rating for a single, separate disability that would, by itself, create the basis for an award of a TDIU, that the order of the awards was not relevant to the inquiry as to whether any of the disabilities alone would render him unemployable and thus entitled to a TDIU based on that condition alone. Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). In this case, from August 12, 2010, the Veteran has a 100 percent schedular evaluation for prostate cancer. Further, during this period, the Veteran is also service connected for PTSD with major depressive disorder (rated as 50 percent disabling prior to August 13, 2019 and 70 percent thereafter), degenerative arthritis of the cervical spine (rated as 30 percent disabling); migraines (rated as 50 percent disabling); left knee arthritis status post knee replacement (rated as 10 percent disabling prior to February 18, 2014; 100 percent disabling from February 18, 2014 to March 31, 2015; and 30 percent thereafter); degenerative joint disease of the left shoulder with residual scars (rated as 20 percent disabling prior to August 14, 2019 and 30 percent thereafter); residuals of status post truncal vagotomy (rated as 20 percent disabling); right leg sciatica (rated as 20 percent disabling); erectile dysfunction (rated as 20 percent disabling); residual of right thumb fracture (rated as 10 percent disabling prior to August 14, 2019 and 20 percent thereafter); degenerative joint disease of the right wrist status post right wrist fracture (rated as 10 percent disabling); degenerative disc disease of the lumbar spine (rated as 10 percent disabling); left testicular spermatoceles (rated as noncompensable); scar, status post vagotomy (rated noncompensable); bilateral tinea pedis (rated noncompensable); scars, left thigh status post shrapnel wound (rated noncompensable); scar of the left knee (rated noncompensable); and scars of the right wrist (rated noncompensable). These evaluations combine to at least 60 percent during the rating period. 38 C.F.R. § 4.25. Thus, the Veteran is already entitled to SMC and indeed, in an October 2011 rating decision, the RO awarded SMC based on this criteria effective August 12, 2010. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). It follows that as the reasoning of Bradley is that TDIU must still be considered even if a veteran has already been awarded a separate 100 percent evaluation for a disability in order to potentially make the veteran eligible for special monthly compensation, and from August 12, 2010, as the Veteran in this appeal has already been awarded SMC based on the 100 percent evaluation for prostate cancer and separate evaluations combined to at least 60 percent for his remaining service connected disabilities, then consideration of TDIU no longer serves any useful purpose. As there remains no case or controversy concerning whether the Veteran is entitled to the benefit sought, the appeal with respect to the claim for TDIU from August 14, 2019 is moot and must be dismissed. Sabonis v. Brown, 6 Vet. App. 426 (1994). REASONS FOR REMAND Higher evaluation for degenerative joint disease of the right wrist status post right wrist fracture With regard to the Veteran’s claim of entitlement to a disability rating more than 10 percent for degenerative joint disease of the right wrist status post right wrist fracture, the Board remanded this claim in December 2018 to provide the Veteran a VA examination in order to determine whether the Veteran has neurological impairment associated with the service-connected right wrist disability. Pursuant to the Board remand, the Veteran was afforded a VA examination for his service-connected right wrist disability in August 2019. However, there is no indication from review of the examination report that neurological testing was conducted to determine whether the Veteran has a neurological disability associated with the service-connected right wrist disability such that a separate rating may be warranted. As such, the Board finds that remand is warranted to provide the Veteran with a VA neurological examination to determine whether the Veteran has a neurological disability associated with the service-connected right wrist disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to assess any neurological impairment associated with the Veteran’s degenerative joint disease of the right wrist status post right wrist fracture. The claims folder must be reviewed in conjunction with the examination. All testing deemTDIed necessary must be conducted and results reported in detail. Regarding any neurological impairment associated with the right wrist, the examiner must render an opinion as to the current severity of the Veteran’s neurological impairment. The examiner should note the symptomatology attributable to the neurological impairment and comment as to whether the symptoms are best described as mild, moderate, or severe incomplete nerve paralysis or complete paralysis. All opinions provided must be thoroughly explained, and an adequate rationale for any conclusions reached should be provided. 2. Review the claims folder to ensure that all of the foregoing requested development is completed, and arrange for any additional development indicated. Then readjudicate the claim on appeal. If any of the benefits sought remain denied, issue an appropriate supplemental statement of the case and provide the Veteran and his attorney with the requisite period of time to respond. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Arif Syed, 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.