Citation Nr: 21000282 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 12-15 214 DATE: January 5, 2021 ORDER Entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome and chondromalacia with gouty arthritis is denied. Entitlement to compensation for a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s right knee patellofemoral syndrome and chondromalacia has been manifested by painful motion with flexion limited to, at worst, 80 degrees and 10 degrees extension even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without recurrent subluxation, effusion, ankylosis, impairment of the tibia and fibula, or genu recurvatum. 2. The Veteran failed to complete a VA Form 21-8940 and the evidence is insufficient to establish whether he was gainfully employed during the appeal period. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome and chondromalacia with gouty arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5017, 5261. 2. The criteria for entitlement to compensation for TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1980 to November 1989 and October 1993 to January 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony before a Veterans Law Judge in August 2013. In September 2017, the Veteran was informed that the Veterans Law Judge who had presided over the Board hearing was no longer employed by the Board, and the Veteran was offered an opportunity for a new hearing, to which he did not respond. In July 2019, the Veteran indicated that he did not wish to appear at another Board hearing. Therefore, the Board may proceed with the matters. This matter previously came before the Board in November 2017, October 2019, and July 2020. The Board notes that, in an August 2019 rating decision, the agency of original jurisdiction (AOJ) recharacterized the Veteran’s right knee disability as right knee patellofemoral syndrome and chondromalacia with gouty arthritis and evaluated the disability by analogy under diagnostic codes 5017 and 5261 for gout and limitation of extension. 1. Entitlement to increased rating in excess of 10 percent for right knee patellofemoral syndrome and chondromalacia with gouty arthritis is denied. The Veteran asserts that he is entitled to an increased rating for his right knee condition, specifically because his symptoms are more severe than contemplated by the currently assigned ratings. Disability evaluations are determined by evaluating the extent to which a veteran’s service connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations (ratings) shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology, and evidenced by visible behavior of the claimant undertaking the motion. The Board must give consideration as to whether, in addition to limitation of motion, upon repetitive use, there is increased disability or functional loss due to any weakness in the affected extremity. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. Limited movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, and interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court of Appeals for Veterans Claims (Court) held that before a VA examiner opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation based on the fact that the examination was not performed during a flare, the examiner must “elicit relevant information as to the veteran’s flares or ask her to describe the additional functional loss, if any, she suffered during flares and then estimate the veteran’s functional loss due to flares based on all the evidence of record, including the veteran’s lay information, or explain why she could not do so.” Here, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the August 2019 and September 2020 VA examinations tested active and passive range of right knee motion and on weight-bearing and nonweight-bearing as well as repetitive range of motion. The September 2020 VA examiner found that the examination was medically consistent with the Veteran's statements describing functional loss during a flare-up and the August 2019 VA examiner found that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional impairments during flare-up. The December 2010 and June 2012 VA examinations tested range of motion of the right knee and repetitive range of motion. The Veteran’s right knee patellofemoral syndrome and chondromalacia with gouty arthritis has been rated by analogy pursuant to Diagnostic Code 5017-5261. Where the particular service-connected disability is not listed, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27. Diagnostic Code 5017 provides that the diseases under diagnostic code 5017 will be rated on limitation of motion of the affected parts, as arthritis. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 provides for a zero percent rating where flexion of the leg is limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees, a 50 percent rating may be assigned. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. VA's General Counsel has also stated that separate ratings under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). VA treatment records reflect a medical checkup from July 2010 notes the Veteran suffering from chronic right knee pain and unable to ambulate. The medical note also describes the Veteran as having torn menisci and torn cruciate ligaments in the right knee. The checkup however did not measure for range of motion. A follow up examination in June 2010 also noted chronic right knee pain and effusion, but did not measure for range of motion. The Veteran was then administered a magnetic resonance imaging (MRI) scan which revealed severe tricompartmental degenerative joint disease with anterior lateral tibial plateau compression fracture and bone edema. A subsequent medical checkup from October 2011 listed the Veteran as suffering from “Knee: arthralgia,” a medical term for joint pain. The Veteran was provided a VA examination for his right knee in December 2010. The examiner noted that the Veteran relied on a knee brace to help stabilize him, and only took it off while sleeping. The examiner also noted that the Veteran had no swelling, effusion, tenderness, or laxity in his right knee. Right knee range of motion was measured at flexion to 80 degrees and extension to zero degrees extension. There was objective evidence of pain on active motion of the right knee. There were no additional limitations on motion of the right knee. The Veteran subsequently underwent another VA examination for right knee in June 2012. This examination confirmed the Veteran’s diagnoses of end-state degenerative joint disease of the right knee with resulting compression of anterior lateral tibial plateau; bilateral meniscus tears of the right knee; and tears of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). The examiner noted that the Veteran had been receiving injections of Hyalgan, a lubricating solution, to treat his right knee condition. The Veteran reported limitations in his activities, including an inability to walk a mile and climb tall ladders. Additionally, the Veteran reported occasional swelling which was however manageable through wrapping and icing. The Veteran was still wearing his knee brace at that time. The examiner then took range of motion measurements at 140 degrees flexion with no objective evidence of pain upon motion; and 45 degrees or greater of extension. The Veteran was able to perform repetitive-use testing with a minimum of three repetitions. The Veteran was noted as not having any additional limitation in range of motion of the right knee, however the examiner did note the Veteran having functional loss/functional impairment of the right knee, in the form of swelling and interference with sitting, standing, and weight-bearing. The examiner further noted that the Veteran’s knee condition did not impact his ability to work. A November 2016 VA examination reflects the Veteran's reports of right knee pain, swelling and difficulty standing or moving around often. Range of motion testing revealed flexion to 120 degrees and extension to zero degrees, that there was pain on flexion and extension and evidence of pain with weight bearing. Repetitive motion testing revealed flexion to 110 degrees and extension to zero degrees due to pain, fatigue and lack of endurance. The examination was not conducted during a flare-up, that pain, fatigue and lack of endurance would case functional loss during flare-ups and that flexion would be to 110 degrees and extension would be to zero degrees. Objective examination was negative for evidence of crepitus or ankylosis. Range of motion contributed to limited running, prolonged walking and sitting, squatting, kneeling and getting up from sitting. The Veteran later underwent another VA exam in August 2019. In this examination, the Veteran reported functional impairment of the right knee caused by pain with activities that involved repetitive kneeling/squatting, climbing, prolonged standing, walking, and running. The examiner measured the Veteran’s right knee range of motion at 120 degrees flexion and zero degrees extension. Both flexion and extension exhibited pain and caused functional loss. Pain and lack of endurance significantly limited functional ability with repeated use over a period of time, with flexion to 105 degrees and extension to 5 degrees. Pain and lack of endurance also significantly limited functional ability with flare-ups, with flexion to 90 degrees and extension to 10 degrees. The examiner noted there was objective evidence of pain on passive range of motion testing and on non-weight bearing testing of the right knee. The Veteran was then administered another VA examination in September 2020. The examiner noted pain flare-ups of the right knee occurring weekly. The flareups were moderate in intensity and lasted several hours. The flareups were triggered upon prolonged walking and were alleviated by rest. The examiner opined that there was no evidence of pain on passive range of motion testing of the right knee. The range of motion measurements for the right knee were 0 to 120 degrees flexion and 120 to 0 degrees extension. The examiner marked these measurements as “abnormal or outside of normal range”. The VA examiner properly conducted repetitive times three testing in accordance with DeLuca was carried out and the test was negative for any additional degrees of limitation of motion on repeated use or during flare ups. Considering the pertinent evidence in light of the applicable criteria, the Board finds that the current symptomatology associated with the Veteran’s service-connected right knee patellofemoral syndrome and chondromalacia with gouty arthritis does not warrant a rating in excess of 10 percent under Diagnostic Codes 5260 or 5261 based on limitation of flexion or extension as flexion is not limited to 45 degrees and extension is not limited to 10 degrees during the appeal period. Extension was found to be to 10 degrees, at worst, in the August 2019 VA examination. Additionally, flexion of the left knee has been less than normal, as it was measured to be to 80 degrees, at worst, in the December 2010 VA examination. Such range of motion does not amount to a 10 percent rating, even in consideration of painful motion and other factors. While the VA examinations tended to show pain and lack of endurance, there is no indication that there was any additional weakness, incoordination, or fatigability during repetitive testing. While the evidence tends to show that the Veteran does experience some painful and limited motion, a separate or higher rating is not warranted unless it actually results in additional functional loss. See Mitchell v. Shinseki, supra; DeLuca v. Brown, supra. In reaching this conclusion, the Board has considered the Veteran's subjective complaints, to include pain and interference with standing and walking; however, such do not result in functional loss beyond painful, limited motion. Additionally, the Board finds that there is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness, or incoordination, and the Board finds that the assignment of additional disability pursuant to 38 C.F.R. §§ 4.40 and 4.45 is not warranted. While the Veteran has essentially stated that he has reduced motion in his knee, he has not described a range of motion less than that found on examinations. In this regard, he has consistently reported flare-ups but described the flare-ups as consisting of pain that occurred approximately once per week that last for several hours. The Veteran’s statements do not show the requisite limitation of motion necessary for a higher or separate rating. Treatment records do not show greater limitation of motion than the examination findings. Given the above, even when considering the knee pain’s impact on physical activities, a higher or separate rating is not warranted based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5260, 5261. The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or separate rating under 5256, 5262, or 5263, respectively, for his right knee disorder. In addition, the Board notes that the Veteran is already in receipt of a separate rating for a right knee meniscal tear under Diagnostic Code 5258 and right knee gout, patellar or quadriceps tendon rupture under Diagnostic Code 5257. The Board has also considered the Veteran’s lay statements regarding symptoms experienced and observed, to include the Veteran’s reports of pain in right knee and recurrent flare-ups. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). As stated above, the Board has given consideration to the Veteran’s competent lay assertions. See Layno. However, the criteria needed to support higher ratings involve medical findings that are within the province and purview of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the Veteran’s lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. Moreover, the record shows that the symptoms the Veteran relayed to the VA examiners were noted in their examination reports and considered by the examiners in their assessments of the overall severity of the knee disability. Further, the Veteran’s subjective complaints were directly considered by the RO when assigning the current 10 percent rating for functional limitation resulting from pain and other factors. As such, the Veteran’s subjective complaints are fully contemplated by the currently assigned 10 percent rating. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. The Board ultimately lends great probative weight to the VA medical examiners’ opinion evidence. The examinations and opinions are adequate as they are predicated on an accurate reading of the service treatment records as well as the medical records contained in the Veteran’s claims file. The examiners considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale for the opinions stated, relying on and citing to the records reviewed. As such, Board finds that VA’s duty to assist with respect to obtaining a VA examination or opinion with respect to the issue on appeal has been met. 38 C.F.R. § 3.159(c)(4). The Board has also considered whether further staged ratings under Hart v. Mansfield, 21 Vet. App. 505 (2007) are appropriate for the Veteran’s service connected right knee patellofemoral syndrome and chondromalacia with gouty arthritis; however, the Board finds that his symptomatology referable to such disability has been stable throughout the period on appeal. The Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). For the foregoing reasons, the Board finds that a higher rating is not warranted for the Veteran's right knee patellofemoral syndrome and chondromalacia with gouty arthritis. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against other higher or separate ratings, that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 2. Entitlement to compensation for TDIU is denied. The Veteran generally contends that he is entitled to a TDIU. In October 2010, the Veteran filed a claim for a TDIU in which he claimed that he was unable to work due to his service connected right knee disorder. However, the Veteran has not submitted a VA Form 21-8940 and the other evidence of record suggests that the Veteran is currently employed. VA will grant a TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing and following all forms of substantially gainful employment, consistent with his education and occupational experience. 38 C.F.R. § 4.16. The Veteran must meet the schedular requirements or have an extra-schedular evaluation approved and be unemployable in fact by reason of service connected disability. A finding of TDIU is appropriate “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” 38 C.F.R. §§ 3.340(a)(1), 4.15. 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 to the impairment caused by non-service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such 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, 529 (1993). The record must reflect that circumstances, apart from non-service-connected conditions, place the claimant in a different position than other veterans having the same compensation rating. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in and of itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question is whether the veteran, in considering his or her service-connected disabilities, can perform the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. The existence or degree of non-service connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran's service-connected disabilities render him incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). Service connection has been granted for and adjustment disorder, rated as 70 percent disabling; bilateral foot gout, rated as 10 percent disabling prior to June 27, 2019 and 50 percent thereafter; diabetes mellitus, type II, rated as 20 percent disabling; right knee meniscal tear, rated as 20 percent disabling; right elbow gout, rated as 20 percent disabling; lumbar spine strain, rated as 10 percent disabling prior to May 1, 2018 and 20 percent thereafter; left elbow gout, rated as 20 percent disabling; right knee gout, patellar or quadriceps tendon rupture, rated as 20 percent disabling; tinnitus, rated as 10 percent disabling; left ankle scar, rated as 10 percent disabling; right and left foot gout, each rated as noncompensably disabling prior to May 1, 2018 and 10 percent thereafter; peripheral neuropathy of the right and left lower extremity, each rated as 10 percent disabling; status-post left ankle achilles tendon rupture, rated as 10 percent disabling; right and left elbow gout, rated as 10 percent disabling; right hand index finger gout, rated as 10 percent disabling; and right knee gout, rated as 10 percent disabling. The Veteran was also service connected for hypertension, status-post scalp cyst, chest scars, right leg scar, eczema, left elbow gout, right elbow gout, each rated as noncompensably disabling. The Veteran’s combined rating was 70 percent beginning on October 14, 2010, 80 percent beginning on November 17, 2017, 90 percent beginning on May 1, 2018 and 100 percent beginning on June 27, 2019. Therefore, the Veteran meets the schedular requirements under 38 C.F.R. § 4.16(a). In this instance, the AOJ sent the Veteran a VA Form 21-8940 (Veterans Application for Increased Compensation Based on Unemployability) in July 2016 and again in July 2020 and instructed him to complete this form. The Veteran did not complete the VA Form 21-8940, which would have provided relevant information regarding his claim of entitlement to a TDIU. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) ("The duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence."). The Board noted in its October 2019 remand that a VA Form 21-8940 had not been completed by the Veteran. While failure to complete the form is not fatal to a TDIU claim in and of itself, the failure to do so deprives the Board of information as to the Veteran's employment history, educational history and training, and income information necessary to properly address a claim for TDIU. The foregoing shows the Veteran was repeatedly given notice of the necessity of the submission of a Form 21-8940 and reminded of the important information it would be provide regarding his claim of entitlement to a TDIU. While failure to complete the form is not fatal to a TDIU claim in and of itself, the failure to do so deprives the Board of information as to the Veteran’s employment history, educational history and training, and income information necessary to properly address a claim for TDIU and admonished for the failure to make the submission. However, to date, the Veteran has not submitted the requested VA Form 21-8940. Given these facts, the Board finds that VA made reasonable efforts to obtain relevant employment information and that no further efforts are required for VA to comply with its duty to assist. See 38 U.S.C. § 5103A(a); 38 C.F.R. § 3.159(c)(1); Hayes v. Brown, 5 Vet. App. 60, 68 (1993) (noting that the VA’s duty to assist is not a “one-way street” and that a claimant has a duty to cooperate with the VA in developing evidence to support a claim). Accordingly, the Board finds that there has been substantial compliance with the prior remand instructions and no further action is necessary. See D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). As the Board finds that VA’s duties to assist and notify have been satisfied, and although there is still no Form 21-8940 on record, the Board will proceed to decide this claim on the basis of the evidence on record. (Continued on the next page)   However, because the Veteran failed to provide the requested VA Form 21-8940, the Veteran's file lacks specific information about how the Veteran's service-connected disabilities renders him unemployable. There is no evidence of when (or if) the Veteran became unemployed and there is very limited information regarding his past employment experience and educational background in the record. A June 2020 letter from a VA vocational rehabilitation counselor indicates that the Veteran had been employed as a medical support assistant since September 2017. VA treatment records dated in May 2019 and July 2019 indicate that the Veteran was currently working as a medical support assistant. However, there is no indication in the record whether the Veteran is currently gainfully employed. While the Board has tried to obtain additional evidence, the Veteran has not provided it. Given this, the Board finds that the most probative evidence shows that the Veteran is not unable to secure or maintain gainful employment due solely to his service-connected disabilities. In summary, the evidence of record does not persuasively show that the Veteran is unable to maintain substantially gainful employment due solely to his service-connected disabilities. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and entitlement to a TDIU is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.