Citation Nr: 21000238 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 09-34 494 DATE: January 4, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to September 24, 2008, and in excess of 40 percent thereafter for left carpal tunnel syndrome with left thumb degenerative joint disease, status post arthroplasty (minor) (left wrist and thumb disorder) is denied. Entitlement to a rating in excess of 20 percent prior to September 24, 2008 and in excess of 60 percent thereafter for benign prostate hypertrophy (BPH) is denied. Entitlement to a total disability rating based on individual unemployability based on service-connected disabilities (TDIU) from May 4, 2007 to September 23, 2008 is denied. FINDINGS OF FACT 1. Prior to September 24, 2008, the Veteran’s left wrist and thumb disorder was manifest by mild incomplete paralysis of the median nerve. 2. From September 24, 2008, forward the Veteran’s left wrist and thumb disorder was manifest by severe incomplete paralysis of the median nerve. 3. Prior to September 24, 2008, the Veteran’s BPH was manifest by voiding dysfunction requiring the wearing of absorbent materials which must be changed less than two times per day. 4. From September 24, 2008, the Veteran’s BPH was manifest by voiding dysfunction requiring the use of an appliance and the wearing of absorbent materials which must be changed more than four times per day. 5. From May 4, 2007 to September 23, 2008, the record of evidence reflects that the Veteran’s service-connected disabilities alone did not render him incapable of obtaining and maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to September 24, 2008, and in excess of 40 percent thereafter for left carpal tunnel syndrome with left thumb degenerative joint disease, status post arthroplasty (minor) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.124a, Diagnostic Code 8515. 2. The criteria for entitlement to a rating in excess of 20 percent prior to September 24, 2008 and in excess of 60 percent thereafter for BPH have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.115a, 4.115b, Diagnostic Code 7527. 3. The criteria for entitlement to TDIU have not been met from May 4, 2007 to September 23, 2008. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.16(a), (b). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1961 to March 1965 and from April 1974 to December 1996. He died in March 2016. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In March 2011, the Veteran and his friend, V.I., testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. Most recently, in April 2016, the Board issued a death dismissal for these issues. In April 2020, the appellant was substituted as the claimant. 38 U.S.C. § 5121A. The Board notes that the Veteran initially submitted claims for increased ratings on May 4, 2007. During the pendency of this appeal, the Board found that the issue of entitlement to a TDIU had been raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Although the RO granted entitlement to TDIU effective September 24, 2008, the issue of whether the Veteran met the requirements for a TDIU from May 4, 2007 to September 23, 2008 remains before the Board. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Left wrist and thumb disorder The Veteran’s left wrist and thumb disorder is rated as 10 percent disabling prior to September 24, 2008, and as 40 percent disabling thereafter under Diagnostic Code 5228-8515. 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 evaluation assigned. The additional code is shown after a hyphen. Diagnostic Code 5228 pertains to limitation of motion of the thumb. Diagnostic Code 8515 pertains to impairment of the median nerve. The medical evidence of record indicates that the Veteran’s left arm is his minor extremity. Under Diagnostic Code 8515, as it pertains to the minor hand, a 60 percent evaluation is warranted for complete paralysis of the median nerve, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of the wrist weakened; pain with trophic disturbances ; severe incomplete paralysis warrants a 40 percent evaluation, moderate incomplete paralysis warrants a 20 percent evaluation, and a 10 percent evaluation is warranted for mild incomplete paralysis. 38 C.F.R. § 4.124a. The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be of the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Words such as “mild,” “moderate,” “moderately severe,” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Use of terminology such as “severe” by VA examiners and others, although 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. Pursuant to DC 5224, as to both the dominant and non-dominant hand, favorable ankylosis of the thumb is rated as 10 percent disabling, and unfavorable ankylosis of the thumb is rated as 20 percent disabling. A Note also advises that consideration should be given to whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. 38 C.F.R. §4.71a, DC 5224. Pursuant to DC 5228, as to both the dominant and non-dominant hand, for limitation of motion of the thumb, where there is a gap of less than one inch between the thumb pad of the dominant hand and nondominant hand and the fingers, with the thumb attempting to oppose the fingers, and a noncompensable disability rating is assigned. Where that gap is one to two inches, a 10 percent disability rating is assigned to both the dominant and nondominant hand. Where that gap is more than two inches, a maximum 20 percent disability rating is assigned to both the dominant and nondominant hand. 38 C.F.R. § 4.71a, DC 5228. In classifying the severity of ankylosis of the thumb, the following rules are set forth in 38 C.F.R. § 4.71a: (1) ankylosis of both the carpometacarpal and interphalangeal joints, with either joint in extension or in full flexion or with rotation or angulation of a bone, is to be rated as amputation at metacarpophalangeal joint or through proximal phalanx; (2) ankylosis of both the carpometacarpal and proximal interphalangeal joints, even though each is individually in favorable position, is to be rated as unfavorable ankylosis; (3) with only the carpometacarpal or interphalangeal joint of a thumb ankylosed, and there is a gap of more than 2 inches between the thumb pad and fingers, with the thumb attempting to oppose the fingers, is to be rated as unfavorable ankylosis; and (4) with only the carpometacarpal or interphalangeal joint of a thumb ankylosed, and there is a gap of 2 inches or less between the thumb pad and fingers, with the thumb attempting to oppose the fingers, is to be rated as favorable ankylosis. 38 C.F.R. § 4.71a. Disabilities of the musculoskeletal system are primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. It is important that when evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. § 4.45. It is the intent of the schedule to recognize painful motion with joint or periarticular pathology as productive of disability. It is also the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. At a November 2007 VA examination, the Veteran stated he experienced daily numbness in his left ring and middle fingers. He denied left hand weakness and left thumb pain. The examiner noted the Veteran had undergone an arthoplasty of the left thumb. Upon physical examination, the Veteran experienced decreased sensation to touch and pinprick in the left middle and ring fingers. The Veteran was able to make a fist and grasp objects. He had trouble opposing the left thumb with the left small finger. There was a distance of about 2 centimeters and opposing the left thumb with the left ring finger left a distance of up to 1 centimeter. The Veteran denied pain when he moved the left finger. No ankylosis or muscular atrophy was reported. The examiner noted a 4 centimeter scar on the left thumb, which was healed, nontender, slightly irregular, and without adherence. The examiner made an assessment of mild left carpal tunnel syndrome and degenerative joint disease of the left thumb, status post arthroplasty. See November 2007 Examination Reports. In September 2008, the Veteran reported his left thumb and ring finger were locked in a downward position. See September 2008 Manatee Telephone Contact. An October 2008 statement, the Veteran’s friend stated she observed that the Veteran was unable to hold onto anything, resulting in his frequent dropping of glasses. She also stated that two of the Veteran’s left-hand fingers appear to be stuck, and he could not straighten those fingers. See October 2008 L.J.L. Statement. An August 2010 examination report reflects the Veteran was unable to make a full fist or to grasp objects. No muscular atrophy was noted. The Veteran’s left thumb flexion was limited to about 40 percent. He could not oppose his thumb to any of his fingers, with a distance of about two inches. The examiner noted the Veteran had unrelated trigger fingers and contracture of the left small and ring fingers, which caused difficulty and limitation of the left hand and required surgical intervention. The examiner further noted it was difficult to separate the findings from the service-connected and nonservice-connected conditions. See August 2010 VA Examination Report. At the March 2011 Board hearing, the Veteran testified that he was unable to move his left fingers and thumb, which made him unable to hold anything with his left hand. See March 2011 Hearing Transcript. A June 2011 VA examination report reflected the Veteran experienced numbness, pins and needles, pain, and weakness in his left hand and fingers. June 2011 VA General Medical Examination Report. In September 2012, the Veteran reported no pain, numbness, paresthesias and/or dysesthesias in his left upper extremity. Muscle strength testing was reduced in his left wrist flexion and extension, grip, and pinch. The examiner noted no muscular atrophy. A sensory examination reflected decreased sensation in the Veteran hand and fingers. The Veteran’s left median nerve was noted to be normal. See September 2012 Peripheral Nerves Conditions Disability Benefits Questionnaire (DBQ). A November 2012 VA wrist examination report reflects the Veteran’s left wrist range of motion was limited to 60 degrees of palmar flexion and 50 degrees dorsiflexion. No ankylosis was recorded. See November 2012 Wrist Conditions DBQ. A November 2012 VA hand and fingers examination report recorded the Veteran had limitation of motion in his left thumb, with a gap between the thumb pad and fingers of more than two inches. The Veteran experienced functional loss of his thumb and fingers, with less movement than normal, weakened movement, excess fatigability, incoordination, pain, and atrophy of disuse. Grip strength of the left hand was rated as 4/5. Left thumb carpometacarpal joint ankylosis was recorded, resulting in an inability to grasp or perform fine motor skills. See November 2012 Hand and Fingers Conditions DBQ. Prior to September 24, 2008, the Board finds that the preponderance of the evidence weighs against entitlement to a rating in excess of 10 percent, as the evidence does not support a finding of moderate incomplete paralysis of the median nerve. Rather, the findings of the November 2007 VA examination characterize the Veteran’s carpal tunnel syndrome as mild, with no pain, numbness, or weakness. Moreover, the Veteran’s sensation was slightly decreased, and he was able to make a fist and grasp objects. Further, prior to September 24, 2008 a 20 percent rating was not warranted under DC 5224 or DC 5228. The November 2007 VA examination revealed no ankylosis of the left thumb, and the Veteran did not have a gap of more than two inches (5.1 centimeters) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Rather, there was a distance of only about 2 centimeters opposing the left thumb with the left small finger, and opposing the left thumb with the left ring finger left a distance of up to 1 centimeter, with the Veteran denying pain. From September 24, 2008, forward, the Board finds that the evidence of record does not demonstrate that the Veteran’s left wrist and thumb disorder resulted in complete paralysis of the median nerve. Rather, the medical evidence of record indicates that the Veteran’s left hand did not demonstrate the clinically detectable features of complete paralysis described in the rating criteria. In this regard, the findings show the Veteran’s left wrist and thumb disorder resulted in decreased strength and sensation, with reduced grip strength and range of motion. The Board finds this to be consistent with the severe incomplete paralysis of the median nerve, and not demonstrative of complete paralysis. Thus, a rating in excess of 40 percent is not warranted under DC 8515. DCs 5224 and 5228 provide for maximum ratings of 20 percent; therefore, a higher rating is not available under these codes. The Veteran is also not entitled to a separate rating under Diagnostic Codes 5228-5230, in addition to the rating assigned under DC 8515, as the manifestations of his carpal tunnel syndrome in terms of his hand and fingers limitation of motion and weakness overlap under Diagnostic Codes 5228-5230 and Diagnostic Code 8515, such that separate ratings are not warranted. All of the Veteran's right hand and finger symptomatology is fully compensated under Diagnostic 8515. An additional rating for limitation of motion of individual digits would constitute pyramiding as he would be compensated twice for the same symptomatology. The evaluation of the same "disability" or the same "manifestations" under various diagnoses is prohibited. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Given the evidence mentioned above, the Board finds that the criteria for a rating in excess of 10 percent prior to September 24, 2008, and to a rating in excess of 40 percent thereafter for the Veteran’s left wrist and thumb disorder have not been met. As the preponderance of the evidence weighs against the claims, the benefit of the doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. BPH The Veteran’s BPH has been rated as 20 percent disabling prior to September 24, 2008, and as 60 percent disabling thereafter pursuant to 38 C.F.R. § 4.115b, Diagnostic Code 7527, for prostate gland injuries, infections, hypertrophy, or postoperative residuals. Diagnostic Code 7527 instructs to rate as voiding dysfunction or urinary tract infection, whichever is predominant. The criteria for voiding dysfunction and urinary tract infection are found in § 4.115a. The rating criteria for urinary tract infection provides a 10 percent rating when the disability requires long-term drug therapy, one to two hospitalizations per year and/or requires intermittent intensive management. A 30 percent rating is warranted when there is recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management. Poor renal function due to urinary tract infection is to be rated as renal dysfunction. 38 C.F.R. § 4.115a. Under 38 C.F.R. § 4.115a, a voiding dysfunction can be rated according to urine leakage, frequency, or obstructed voiding. Id. For urine leakage, a 20 percent rating for a voiding dysfunction is warranted when wearing absorbent materials which must be changed less than two times per day is required. A 40 percent rating is warranted for requiring the wearing of absorbent materials which must be changed two to four times per day. A 60 percent rating is warranted for requiring the use of an appliance, or wearing of absorbent materials which must be changed more than four times per day. Id. For urinary frequency, 10 percent rating contemplates daytime voiding intervals between two and three hours, or; awakening to void two times per night. A 20 percent rating contemplates daytime voiding intervals between one and two hours, or; awakening to void three to four times per night. A 40 percent rating contemplates daytime voiding intervals of less than one hour, or; awakening to void five or more times per night. Id. For a rating under obstructed voiding, a noncompensable rating contemplates obstructive symptomatology with or without stricture disease requiring dilatation one to two times per year. A 10 percent rating is warranted for marked obstructive symptomatology, such as hesitancy, slow or weak stream, decreased force of stream, with any one or combination of the following: (1) post void residuals greater than 150 cc.; (2) uroflowmetry; markedly diminished peak flow rate, less than 10 cc/sec; (3) recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring periodic dilatation every two to three months. A 30 percent rating contemplates urinary retention requiring intermittent or continuous catheterization. Id. A November 2007 VA examination report reflects the Veteran experienced urinary frequency every two to three hours during the day, and every two hours at night. The Veteran further reported some dribbling at the end of urination, but no urinary incontinence. The examiner noted a history of prostate biopsies, all of which were benign. See November 2007 VA Genitourinary Examination Report. In September 2008, the Veteran reported increased BPH symptoms. Specifically, he reported waking up every 90 minutes to urinate with severe urgency and would experience dribbling. See September 2008 Manatee Telephone Contact. The Veteran further reported more difficulty with urinary frequency and urgency over the preceding months, requiring him to wear diapers. See September 2008 Manatee Physician Note. At an August 2010 VA examination, the Veteran reported urinary incontinence, requiring him to wear absorbent materials which must be changes more than four times per day. He also reported his urinary frequency as every hour during the day, and eight to ten times at night. The examiner noted there was no history of urinary tract infections or renal dysfunction. See August 2010 VA Genitourinary Examination Report. In March 2011, the Veteran testified he was prescribed 260 absorbent undergarments per month by VA, which he had to consistently supplement as that amount was not enough. He further testified to experiencing urinary frequency of seven to eight times per night, and every 20 to 30 minutes during the day. He also described frequent incontinence and leaking, requiring him to wear black clothes to hide the leaks from appearing. See March 2011 Hearing Transcript. At a June 2011 VA examination, the Veteran reported wearing a diaper, which he had to change up to five times per day. June 2011 VA General Medical Examination Report. A November 2012 examination report reflected the Veteran experienced voiding dysfunction, which required the use of an appliance. The Veteran had a Foley catheter implanted the week prior to the examination. Prior to the Veteran’s catheterization, he required absorbent materials which must be changed more than four times per day. His urinary frequency was also recorded as daytime voiding interval of less than one hour, and nighttime awakening to void five or more times. The examiner noted there was no history of recurrent symptomatic urinary tract or kidney infections. See November 2012 VA General Medical Examination Report. After careful review of the evidence, the Board finds that a rating in excess of 20 percent is not warranted prior to September 24, 2008. In this regard, the Veteran had no reported urinary tract infections, so his voiding dysfunction was considered his predominant disability. See 38 C.F.R. § 4.115b, Diagnostic Code 7527. The Board finds that, prior to September 24, 2008, the Veteran had nighttime voiding, at worst, three to four times per night. A higher, 40 percent, rating based on urinary frequency is not warranted because the Veteran did not have night time voiding 5 or more times or daytime voiding intervals less than one hour. 38 C.F.R. § 4.115a. Additionally, the Board finds that a rating in excess of 20 percent is not warranted based on obstructed voiding. For obstructed voiding, the only higher rating available is a 30 percent rating, which is based on urinary retention requiring intermittent or continuous catheterization. There is no evidence of record which shows the Veteran experienced urinary retention during this time period. Furthermore, there is no evidence the Veteran began to wear absorbent materials prior to September 24, 2008, precluding a higher rating based on urine leakage. The Board notes that, effective September 24, 2008, the Veteran was in receipt of the maximum 60 percent schedular rating for voiding dysfunction (rated as urine leakage, urinary frequency, or obstructed voiding). 38 C.F.R. § 4.115a. Although a disability rating in excess of 60 percent is available under Diagnostic Code 7527 when urinary tract infractions with poor renal function predominates, in this case, voiding dysfunction has been the predominant symptom since September 24, 2008. As there is no evidence the Veteran’s BPH had caused urinary tract infections with renal dysfunction at any point during the appeal period, a rating in excess of 60 percent is not warranted. In sum, the Board finds that the criteria for entitlement to a disability rating in excess of 20 percent prior to September 24, 2008, and to a rating in excess of 60 percent thereafter for BPH, have not been met. As the preponderance of the evidence weighs against the claims, the benefit of the doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. TDIU Total disability ratings for compensation based on individual unemployability may be assigned where the schedular rating is less than total if it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of (1) a single service-connected disability ratable at 60 percent or more, or (2) 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. 38 C.F.R. §§ 3.340, 3.341, 4.16(a); Mittleider v. West, 11 Vet. App. 181 (1998). Entitlement to TDIU requires the presence of impairment so severe that it is impossible for the average person to secure and follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching a determination, the central inquiry is whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to age or the impairment caused by nonservice- connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. As stated above, the Veteran was in receipt of a TDIU effective September 24, 2008. From May 4, 2007 to September 23, 2008, the Veteran was service-connected for right carpal tunnel syndrome, left carpal tunnel syndrome, and sinusitis, each rated as 10 percent disabling; left knee degenerative joint disease and BPH, each rated as 20 percent disabling. He was also service connected for hypertension, bilateral hearing loss, erectile dysfunction, left groin scar, and right ankle scar, each rated as noncompensable, effective December 16, 1996. The Veteran’s combined evaluation for this time period was 60 percent disabling. Thus, from May 4, 2007 to September 23, 2008 he did not meet the schedular criteria for TDIU under 38 C.F.R. § 4.16(a). Nevertheless, the Veteran could be entitled to a TDIU during this time if it is established that he was unable to secure or follow substantially gainful employment as a result of the effects of the service-connected disabilities. 38 C.F.R. § 4.16(b). Therefore, the Board must determine whether the Veteran’s service-connected disabilities precluded him from engaging in substantially gainful employment, or work that is more than marginal, which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). The fact that a Veteran was unemployed or had difficulty obtaining employment is not determinative. The ultimate question is whether the Veteran, because of service-connected disabilities, was incapable of performing the physical and mental acts required by employment, not whether the Veteran could find employment. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). An inability to work due to advancing age may not be considered. 38 C.F.R. §§ 3.341(a), 4.19. In making its determination, VA considers such factors as the extent of the service-connected disability, and employment and educational background. 38 C.F.R. §§ 3.340, 3.341, 4.16(b), 4.19. The Board is required to obtain the Director’s decision before the Board may award extraschedular TDIU. Wages v. McDonald, 27 Vet. App. 233 (2015). The regulation requires that, in cases of Veterans who evidence suggests are unemployable by reason of service-connected disabilities and who fail to meet the threshold percentage requirements of 38 C.F.R. 4.16(a), the case is to be submitted to VA’s Director of Compensation Service for consideration of whether entitlement to a TDIU is warranted on an extraschedular basis. 38 C.F.R. § 4.16(b). The Board finds that the Veteran was not unemployable due to his service-connected disabilities from May 4, 2007 to September 23, 2008, and, thus, referral to the Director is not warranted. The Veteran reported that he last worked on a full-time basis in security in March 2002. His position was “master control” at a private juvenile justice facility. He further stated that he had completed four years of college. See August 2007 VA Form 21-8940. In August 2007, the Veteran stated that his degenerative joint disease/arthritis prevented him from working. He specifically stated that his cervical spine, lumbar spine, nerve damage, right hip, and right knee disabilities prevented his employment. See August 2007 Statement in Support of Claim. Several buddy statements also referenced the Veteran’s neck, back, hip, and knee disorders, noting the Veteran was unable to sit or stand for long periods of time due to these disorders. See August 2007 C.D.A. Email Correspondence; August 2007 L.J.L. Email Correspondence. In support of his claim, the Veteran submitted an August 2007 statement by his private physician who found that his degenerative joint disease and arthritis have relentlessly progressed during the past 11 years and the Veteran was unemployable as a result. The physician referenced a January 2002 failed lumber spine laminectomy, January 2003 total right hip replacement surgery, and a January 2005 cervical decompressive laminectomy. See August 2007 C.A.T., M.D., Statement. A November 2007 VA examination report reflects that the Veteran’s left knee degenerative joint disease is painful and manifests in difficulty walking. The examiner noted, however, that the Veteran’s neck, back, and spinal stenosis also affected his walking. See November 2007 VA Examination Report. As a result of his carpal tunnel syndrome, he had difficulty picking up tiny objects with his right hand and sometimes had to use a big pen to write. He had some weakness in the right hand, but not the left. With respect to sinusitis, the Veteran reported that he had sinus infections requiring antibiotic treatment about twice a year. During that time, he was congested and sometimes got a fever and would have post-nasal discharge. Sometimes he also got a local headache in the sinus area, but he denied any incapacitating episodes. The November 2007 VA examination report also reflects the Veteran experienced urinary frequency every two to three hours during the day, and every two hours at night. He further reported some dribbling at the end of urination, but no urinary incontinence. In sum, the evidence of record reflects that the Veteran’s inability to obtain and maintain substantially gainful employment for the period of May 4, 2007 to September 23, 2008 was primarily due to his nonservice-connected disabilities of his cervical spine, lumbar spine, and right hip. In this regard, these disorders are what the Veteran mainly referenced when he discussed his claim for TDIU. Although there are medical records referencing the Veteran’s left knee degenerative joint disorder impacting his ability to walk, the same record also clarifies that his ability to walk is also impacted by his neck and back disorders. The August 2007 medical opinion lacks probative value as it does not specifically address the Veteran’s service-connected disabilities. The evidence does not show that the Veteran's service-connected disabilities alone prevented him from obtaining or maintaining substantially gainful employment in an occupation that did not require extensive walking and allowed regular access to a restroom, that is in keeping with his work history, vocational attainment and experience, and education. The Veteran had a college degree and worked in security as “master control.” As a result of his left knee disability, he had trouble walking. His carpal tunnel syndrome caused difficulty picking up tiny objects with his right hand and sometimes required that he use a big pen to write. He had sinus infections only about twice a year, with no incapacitating episodes, and he experienced urinary frequency every two to three hours during the day, with no incontinence. Accordingly, the Board finds that the Veteran’s service-connected disabilities did not prevent him from obtaining or maintaining substantially gainful employment from May 4, 2007 to September 23, 2008. In sum, entitlement to TDIU on a schedular basis must be denied, and referral for extraschedular consideration is not warranted. Because the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. 5107; 38 C.F.R. § 3.102. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. M. Stedman, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.