Citation Nr: 21001663 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 14-02 463 DATE: January 11, 2021 ORDER Entitlement to an initial evaluation in excess of 20 percent for lumbar spine degenerative disc disease and arthrosis prior to August 8, 2018, is denied. Entitlement to an evaluation in excess of 60 percent for lumbar spine degenerative disc disease and arthrosis with bilateral lower extremity radiculopathy on or after August 8, 2018, is denied. Entitlement to an initial evaluation in excess of 10 percent for left lower extremity radiculopathy prior to August 8, 2018, is denied. Entitlement to an initial evaluation in excess of 10 percent for right lower extremity radiculopathy prior to August 8, 2018, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Prior to August 8, 2018, the Veteran did not have forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. He also did not have incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 2. Beginning on or after August 8, 2018, the Veteran did not have unfavorable ankylosis of the entire spine. 3. Prior to August 8, 2018, the Veteran had no more than mild incomplete paralysis of the left sciatic nerve. 4. Prior to August 8, 2018, the Veteran had no more than mild incomplete paralysis of the right sciatic nerve. 5. The Veteran met the schedular requirement for TDIU, and his service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 20 percent for lumbar spine degenerative disc disease and arthrosis prior to August 8, 2018, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 2. The criteria for an evaluation in excess of 60 percent for lumbar spine degenerative disc disease and arthrosis with bilateral lower extremity radiculopathy beginning on or after August 8, 2018, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 3. The criteria for an initial evaluation in excess of 10 percent for radiculopathy of left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.120, 4.123, 4.124a, Diagnostic Code 8520. 4. The criteria for an initial evaluation in excess of 10 percent for radiculopathy of right lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.120, 4.123, 4.124a, Diagnostic Code 8520. 5. The criteria for TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1973 to October 1978. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision. The Veteran testified at a hearing before the Board in May 2016; however, a transcript of that proceeding could not be produced due to technical difficulties. The Veteran was notified in July 2016 and was offered the opportunity for another hearing. The Veteran subsequently testified at a second hearing in September 2016 before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. In October 2017 and June 2020, the Board remanded the case for further development. That development was completed, and the case has since been returned to the Board for appellate review. In a March 2020 rating decision, the Agency of Original Jurisdiction (AOJ) increased the evaluation for lumbar spine degenerative disc disease and arthrosis, to include radiculopathy of the bilateral lower extremities (which were previously separately rated as radiculopathy of the left lower extremity and radiculopathy of the right lower extremity) from 20 percent disabling to 60 percent disabling, effective from August 8, 2018. Because that evaluation is less than the maximum award allowed under VA law and regulations, the claim for an increased evaluation remained on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Evaluation Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Lumbar Spine In this case, the Veteran’s service-connected lumbar spine degenerative disc disease and arthrosis is currently assigned a 20 percent evaluation prior to August 8, 2018, and a 60 percent evaluation thereafter, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5243. Diagnostic Code 5243 indicates that degenerative arthritis should be evaluated under the General Rating Formula for Diseases and Injuries to the Spine (General Rating Formula). Under the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diagnostic Codes 5235-5243. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). For VA compensation purposes, normal range of motion for the thoracolumbar spine is 90 degrees of forward flexion, 30 degrees of extension, 30 degrees of left and right lateral flexion, and 30 degrees of left and right lateral rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees, consisting of the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. See 38 C.F.R. § 4.71a, General Rating Formula, Note (2) and Plate V. Under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, a 10 percent evaluation is warranted for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurologic manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. Id., Note (2). 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 all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). 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. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, 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. Diagnostic Code 5010 states that traumatic arthritis is to be rated as degenerative arthritis under Diagnostic Code 5003, which in turn, states that the severity of degenerative arthritis, established by X-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. When there is arthritis with at least some limitation of motion, but to a degree which would be noncompensable under a limitation-of-motion code, a 10 percent rating will be assigned for each affected major joint or group of minor joints. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that increased evaluations are not warranted for the Veteran’s service-connected lumbar spine disability for either period on appeal. Initially, the Board notes that there is no evidence of record that the Veteran had forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine prior to August 8, 2018. In fact, during a May 2013 VA back examination, the Veteran demonstrated forward flexion to 65 degrees. During a May 2018 VA examination, the Veteran had forward flexion to 70 degrees. Moreover, the May 2018 VA examiner specifically noted that there was no ankylosis of the spine. In addition, the evidence does not show that the Veteran had incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months prior to August 8, 2018. The May 2013 VA examiner reported that the Veteran did not have IVDS of the thoracolumbar spine. The May 2018 VA examiner related that the Veteran did have IVDS of the thoracolumbar spine; however, the examiner noted that the Veteran did not have any incapacitating episodes over the past 12 months due to IVDS. As such, the Veteran has not been shown to have met the criteria for an increased evaluation under the Formula for Rating IVDS Based on Incapacitating Episodes prior to August 8, 2018. Since August 8, 2018, the evidence does not show that the Veteran had unfavorable ankylosis of the entire spine. During an August 2018 VA examination, the Veteran had forward flexion from 0 to 40 degrees and extension from 0 to 5 degrees. In addition, the August 2018 VA examiner specifically reported that there was no ankylosis of the spine. Further, the Veteran is already assigned a 60 percent evaluation beginning on August 8, 2018. 60 percent is the maximum schedular evaluation under the Formula for Rating IVDS Based on Incapacitating Episodes. As such, the Veteran has not been shown to have met the criteria for an increased evaluation under the Formula for Rating IVDS Based on Incapacitating Episodes beginning on or after August 8, 2018. The Board has also considered the provisions of 38 C.F.R. § § 4.40, 4.45, 4.59, and the holding in DeLuca. However, increased evaluations for the Veteran’s lumbar spine disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran’s symptoms and impairment are supported by pathology consistent with the assigned 20 and 60 percent evaluations, and no higher. In this regard, the Board observes that the Veteran complained of constant, aching pain on numerous occasions. However, the effect of the pain in the Veteran’s lumbar spine is contemplated in the currently assigned evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant increased evaluations. During the May 2013 VA examination, the Veteran demonstrated forward flexion to 65 degrees with objective evidence of painful motion beginning at 60 degrees. The VA examiner did note that the Veteran had additional limitation in range of motion of the thoracolumbar spine following repetitive use testing and that he had functional loss and/or functional impairment of the thoracolumbar spine. The examiner also indicated that the Veteran had less movement than normal; weakened movement; excess fatigability; incoordination or impaired ability to execute skilled movements smoothly; pain on movement; disturbance of locomotion; and interference with sitting, standing, and/or weight-bearing. However, following repetitive use testing, he maintained forward flexion to 45 degrees. The May 2013 VA examiner also noted that the Veteran had normal muscle strength testing and no muscle atrophy. During the May 2018 VA examination, the examiner noted that the Veteran’s range of motion itself did not contribute to a functional loss; however, the examiner did find that pain noted on examination caused functional loss in forward flexion and extension of the thoracolumbar spine. Following repetitive use testing, the examiner reported that there was no additional loss of function or range of motion. The May 2018 VA examiner did indicate that pain and weakness caused functional loss and estimated forward flexion limited to 60 degrees. The May 2018 VA examiner further noted that the Veteran had normal muscle strength bilaterally, with the exception of bilateral hip flexion and knee extension, in which the Veteran had active movement against some resistance. The examiner also reported that the Veteran did not have muscle atrophy. The August 2018 VA examiner noted that the Veteran’s range of motion contributed to functional loss, such that the Veteran had difficulty lifting and bending. The examiner also related that pain caused function loss on range of motion. However, the August 2018 VA examiner further reported that there was no additional loss of function or range of motion following repetitive use testing. In addition, the examiner reported that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The August 2018 VA examiner noted that muscle strength testing was normal and that the Veteran did not have muscle atrophy. The Board finds that the effect of the pain in the Veteran’s back is contemplated in the currently assigned 20 and 60 percent evaluations and that he does not more nearly approximate the criteria for higher evaluations during either period on appeal. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant increased evaluations for either period on appeal. Based on the foregoing, the Board finds that the weight of the evidence is against increased ratings for the Veteran’s service-connected lumbar spine disability prior to August 8, 2018 or thereafter. As such, the benefit-of-the-doubt rule does not apply, and the claims are denied in this regard. Gilbert, 1 Vet. App. 49 (1990). Radiculopathy The Veteran is currently assigned separate 10 percent evaluations for left and right lower extremity radiculopathy prior to August 8, 2018, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under Diagnostic Code 8520, mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating. Moderate incomplete paralysis is assigned a 20 percent rating, moderately severe incomplete paralysis warrants a 40 percent evaluation, and severe incomplete paralysis with marked muscular atrophy warrants a 60 percent rating. With complete paralysis of the sciatic nerve, which warrants an 80 percent rating, the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, the rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, can receive a maximum rating of moderate incomplete paralysis, except for tic douloureux or trifacial neuralgia, which may be rated up to complete paralysis. 38 C.F.R. § 4.124. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. Special consideration should be given to any psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, and injury to the skull. 38 C.F.R. § 4.120. The words “slight,” “mild,” “moderate,” and “severe” as used in the various diagnostic codes are not defined in the VA 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. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to evaluations in excess of 10 percent for his left and right lower extremity radiculopathy prior to August 8, 2018. Initially, the Board notes that the evidence of record does not demonstrate manifestations consistent with the criteria for increased ratings for the sciatic nerve of either lower extremity. Rather, the evidence of record documents that there was no atrophy, no abnormal muscle tone or bulk, no complete paralysis, no organic changes, and no foot drop. In fact, the evidence shows that the Veteran had no more than mild incomplete paralysis of the left and right sciatic nerves prior to August 8, 2018. In a May 2013 VA back examination report, a VA examiner indicated that the Veteran had mild intermittent pain and mild paresthesias and/or dysesthesias of the bilateral lower extremities. He did not have constant pain or numbness of the bilateral lower extremities. The VA examiner found that the Veteran had mild radiculopathy of the left and right sciatic nerves. In a December 2015 VA peripheral nerves examination report, a VA examiner reported that the Veteran had moderate intermittent pain and moderate paresthesias and/or dysesthesias in his bilateral lower extremities and moderate numbness of his left lower extremity. The examiner noted that he did not have constant pain in either lower extremity or right lower extremity numbness. The examiner reported that reflex and sensory examinations were normal, with the exception of decreased sensory findings to light touch in the bilateral feet or toes. The examiner found that the Veteran had mild incomplete paralysis of the left and right sciatic nerves. The Board notes the Veteran’s complaints of pain, tingling, and numbness throughout the appeal. However, the objective evidence of record does not indicate more than mild radiculopathy of the sciatic nerve of the left lower extremity. Moreover, the May 2013 and December 2015 VA examiners both described the Veteran’s left sciatic radiculopathy as moderate, and their findings and test results support the conclusion that the impairment was no more than mild in severity. For these reasons, the Board finds that the preponderance of the evidence is against a finding that higher evaluations are warranted for the left and right lower extremity radiculopathy prior to August 8, 2018. TDIU All veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. For VA purposes, total disability exists 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, 4.16(b). A total disability rating for compensation may be assigned, where the schedular rating is less than total, when a veteran is, in the judgment of the rating agency, 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. 38 C.F.R. § 4.16(a). Nevertheless, even when the percentage requirements are not met, entitlement to TDIU on an extraschedular basis may be granted in exceptional cases when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. 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). For VA purposes, the term “unemployability” is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2317 (Jan. 21, 1992). 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). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. See Van Hoose, 4 Vet. App. at 363. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Veteran is service-connected for lumbar spine degenerative disc disease and arthrosis, to include radiculopathy of the bilateral lower extremities (60 percent disabling effective from August 8, 2018); posttraumatic stress disorder (PTSD) (30 percent disabling effective from July 10, 2009); lumbar spine degenerative disc disease and arthrosis effective from July 10, 2009, to August 8, 2018); left greater trochanteric tenosynovitis (limitation of extension) associated with lumbar spine degenerative disc disease and arthrosis (10 percent disabling effective from July 10, 2009); right greater trochanteric tenosynovitis (limitation of extension) associated with lumbar spine degenerative disc disease and arthrosis (10 percent disabling effective from July 10, 2009); bilateral hearing loss (10 percent disabling effective from July 10, 2009); tinnitus (10 percent disabling effective from July 10, 2009); radiculopathy of the right lower extremity (10 percent disabling effective from May 8, 2013, to August 8, 2018); radiculopathy of the left lower extremity (10 percent disabling effective from May 8, 2013, to August 8, 2018); right knee joint osteoarthritis (10 percent disabling); left knee joint osteoarthritis (10 percent disabling); right greater trochanteric tenosynovitis (limitation of adduction) (10 percent disabling); left greater trochanteric tenosynovitis (limitation of adduction) (10 percent disabling); right greater trochanteric tenosynovitis (limitation of flexion) (noncompensable evaluation); and left greater trochanteric tenosynovitis (limitation of flexion) (noncompensable evaluation). His combined evaluation is 80 percent prior to August 8, 2018, and 90 percent thereafter. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to TDIU. As indicated above, the Veteran meets the schedular criteria for TDIU. The Veteran initially contended that he was unable to secure or follow a substantially gainful occupation as a result of his service-connected low back and left and right knee disabilities. See April 2013 statement. During the September 2016 hearing, the Veteran explained that he used to be a painter, but that he was unable to work because he was unable to carry one- and five-gallon buckets and cleaning supplies. He also indicated that he was unable to work for six years due to his back pain, PTSD, and resultant inability to sleep. In this case, the evidence clearly indicates that the Veteran was limited in his ability to perform physical activity due his service-connected lumbar spine disability, left and right knee disabilities, and PTSD. The evidence also shows that he would have had difficulty in obtaining and performing any less physical demanding or sedentary employment. In this regard, the December 2015 VA peripheral nerves examiner opined that the Veteran’s right and left lower extremity radiculopathy caused an inability to perform repetitive twisting, bending, and lifting of heavy loads. In addition, she found that he was unable to sit, stand, or walk for prolonged periods of time. The May 2018 VA back examiner concluded that the Veteran’s lumbar spine disability impacted his ability to work. Specifically, the examiner noted that he was unable to lift, bend, and run. In addition, he noted that the Veteran was unable to stand or walk for long periods of time. The August 2018 VA back examiner also opined that the Veteran’s lumbar spine disability impacted his ability to work. He noted that the Veteran had functional impairment, including bending, lifting, and carrying loads. A September 2018 VA audiologist opined that the Veteran’s hearing loss impacted his ordinary conditions of daily life, including his ability to work. The examiner noted that the Veteran’s hearing had gradually worsened and that he found himself asking people to repeat themselves. A September 2018 VA knees examiner indicated that the Veteran’s left and right knee disabilities impacted his ability to perform occupational tasks. The examiner noted that light and sedentary work was possible; however, physical activity was limited by his bilateral knee arthritis. Based on the foregoing, the evidence demonstrates that the Veteran would be limited in performing physical activities. Moreover, while perhaps possible, the Veteran would have had difficulty performing sedentary employment due to an inability to sit or stand for long periods of time. Furthermore, the Veteran’s prior work experience consisted mainly of physical labor and did not involve sedentary employment. He also does not have any training or higher education that would provide him with the skills necessary to obtain sedentary employment or perform the duties typically associated with such employment. While the Board may not consider the effects of nonservice-connected disabilities on his ability to function, the record contains ample evidence of the impairment resulting from the Veteran’s service-connected right knee disability. Based on all of the evidence of record and resolving all reasonable doubt in favor of the Veteran, the Board finds that the combined effects of the Veteran’s service-connected disabilities preclude substantially gainful employment. Accordingly, entitlement to TDIU is warranted. The Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.