Citation Nr: 21002038 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 18-36 817 DATE: January 12, 2021 ORDER Entitlement to a rating in excess of 10 percent for degenerative joint disease left wrist is denied. Entitlement to a rating in excess of 10 percent for status post right wrist fracture with residual pain and weakness is denied. Entitlement to a 40 percent rating, but no higher, for peripheral neuropathy, left hand for the period prior to May 27, 2015 is granted. Entitlement to a 70 percent rating, but no higher, for peripheral neuropathy, left hand for the period since May 27, 2015 is granted. Entitlement to a 30 percent rating, but no higher, for peripheral neuropathy, right hand for the period prior to May 27, 2015 is granted. Entitlement to a 60 percent rating, but no higher, for peripheral neuropathy, right hand for the period prior to May 27, 2015 is granted. Entitlement to special monthly compensation (SMC) for loss of use of the bilateral hands is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) for the period prior to August 7, 2018 is denied. Entitlement to a TDIU for the period since August 7, 2018 is dismissed. FINDINGS OF FACT 1. The Veteran’s degenerative joint disease of the left wrist and status post right wrist fracture with residual pain and weakness are manifested by pain and limitation of motion but ankylosis is not shown. 2. For the period prior to May 27, 2015, the Veteran exhibited symptoms consistent with moderate incomplete paralysis of the of the right and left upper extremities. 3. For the period since May 27, 2015, the Veteran exhibited symptoms consistent with severe incomplete paralysis of the of the right and left upper extremities. 4. The preponderance of the evidence shows that the Veteran’s bilateral hand symptoms, although severe, do not manifest such that no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow with use of a suitable prosthetic appliance. 5. For the period prior to August 7, 2018, the Veteran’s service-connected disabilities did not preclude him from obtaining and retaining substantially gainful employment. 6. As a 100 percent combined schedular rating has been assigned for the period since August 7, 2018, the matter of entitlement to a TDIU rating is rendered moot. CONCLUSIONS OF LAW 1. The criteria for a disability rating more than 10 percent for degenerative joint disease of the left wrist have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5215 (2020). 2. The criteria for a disability rating more than 10 percent for status post right wrist fracture with residual pain and weakness are manifested by pain and limitation of motion have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5215 (2020). 3. The criteria for a 40 percent disability rating, but no higher, for peripheral neuropathy, left hand for the period prior to May 27, 2015 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 4. The criteria for a 70 percent disability rating, but no higher, for peripheral neuropathy, left hand for the period since May 27, 2015 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 5. The criteria for a 30 percent disability rating, but no higher, for peripheral neuropathy, right hand for the period prior to May 27, 2015 have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 6. The criteria for a 60 percent disability rating, but no higher, for peripheral neuropathy, right hand for the period since have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, Diagnostic Code 8513 (2020). 7. The criteria for entitlement to SMC due to loss of use of both hands have not been met. 38 C.F.R. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350 (2020). 8. The criteria for TDIU for the period prior to August 7, 2018, have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. § § 3.340, 3.341, 4.3, 4.16, 4.18, 4.19, 4.25 (2020). 9. The claim for a TDIU rating for the period since August 7, 2018 is dismissed. 38 C.F.R. § 4.16 (a) (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1958 to January 1960. This case comes before the Board of Veterans’ Appeals (the Board) on appeal from April 2014, March 2015 and May 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In the May 2018 rating decision, the RO increased the ratings for the service-connected left and right hand peripheral neuropathy. As the highest possible evaluation for these disabilities have not been assigned, the appeal continues. See AB v. Brown, 6 Vet. App. 35 (1993). In July 2015, the Veteran filed a claim for entitlement to SMC based on loss of use of the bilateral hands. In July 2015, the Veteran’s representative asserted that the claim for SMC based on loss of use of the bilateral hands should be considered as part and parcel of the increased rating claims on appeal; the Board agrees. See Akles v. Derwinski, 1 Vet. App. 118 (1991) (finding that the issue of entitlement to SMC is part and parcel of a claim for increased rating). As such, the Board has included the issue of entitlement to SMC for loss of use of the bilateral hands as an issue on appeal. In October 2018, the Board remanded these issues for additional development. Increased Ratings Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 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 (2012). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran’s entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2020). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the “staging” of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his bilateral wrist and hand disabilities. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. Disability of the musculoskeletal system is 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. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is 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. See 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). 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). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). Factual Background The Veteran filed a claim for increased ratings that was received by VA in June 2013. The Veteran underwent a wrist VA examination in December 2013. The Veteran reported that his hands were weaker and had gotten more painful. He also noticed decreased dexterity as he could no longer open jars, could not grasp anything and could not use cellophane to cover things up. He was left hand dominant. The Veteran reported having flare-ups as he had daily pain with overuse. Right wrist palmar flexion was from 0 to 60 degrees with evidence of pain beginning at 50 degrees. Right wrist dorsiflexion was from 0 to 50 degrees with evidence of pain beginning at 45 degrees. Left wrist palmar flexion was from 0 to 45 degrees with evidence of pain beginning at 45 degrees. Left wrist dorsiflexion was from 0 to 50 degrees with evidence of pain beginning at 45 degrees. The Veteran was able to perform repetitive use testing and there was additional limitation of motion after repetitive use as right wrist palmar flexion was from 0 to 50 degrees, right wrist dorsiflexion was from 0 to 50 degrees, left wrist palmar flexion was from 0 to 45 degrees and left wrist dorsiflexion was from 0 to 45 degrees. The Veteran had pain or localized tenderness. Muscle strength testing demonstrated active movement against some resistance (4/5) for both the left and right wrists. There was no ankylosis of either wrist joint. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s wrists disabilities impacted his ability to work as the Veteran reported that his wrists were painful, he had had numbness and that he had to take multiple breaks throughout the day. He also had difficulty using tools and machines. The Veteran underwent a VA peripheral nerves examination in December 2013. The Veteran reported that he had numbness and tingling in his hands and that he had difficulty with buttoning and tying ties. He had moderate constant pain and moderate intermittent pain. He had mild paresthesias and mild numbness. Muscle strength testing demonstrated active movement against some resistance (4/5) for pinch and grip. Bilateral wrist flexion and extension demonstrated active movement against some resistance (3/5). The sensory examination revealed decreased sensation in the hands and fingers. The examiner indicated that the Veteran had mild incomplete paralysis of radial, medial, and ulnar nerves on both the right and left. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran underwent a VA wrist examination in May 2015. The Veteran had bilateral wrist arthritis, a chronic sprain of the right wrist and a status post fracture of the right wrist. The Veteran reported having weakened movement, having difficulty buttoning his shirt, having difficulty tying his tie and could not open jars or a gas can. He tried to play golf but had to use special golf gloves as he could not grasp the club. He was no longer able to tie his own shoes. He continued to have his law practice but he could not type or write. He did mostly pro bono work as he had to cut back on his law practice. The Veteran reported having flare-ups as he had pain every day and had difficulty buttoning his shirt, opening cans and turning doorknobs. Right wrist palmar flexion was from 0 to 40 degrees, right wrist dorsiflexion was from 0 to 40 degrees, left wrist palmar flexion was from 0 to 40 degrees and left wrist dorsiflexion was from 0 to 40 degrees. The pain itself contributed to functional loss as he had pain when opening jars and turning doorknobs as well as performing fine motor movements. There was pain with weight bearing, tenderness on palpitation and evidence of crepitus. The Veteran was able to perform repetitive use testing and there was loss of function after repetitive use due to pain, fatigue, weakness, incoordination and lack of endurance. After 3 repetitions, right wrist palmar flexion was from 0 to 40 degrees, right wrist dorsiflexion was from 0 to 40 degrees, left wrist palmar flexion was from 0 to 40 degrees and left wrist dorsiflexion was from 0 to 40 degrees. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability or incoordination significantly limited ability after a period of time or during flare-ups. Muscle strength testing demonstrated active movement against some resistance (4/5) for both the left and right wrists. The Veteran also had atrophy of both wrists but there was no ankylosis. The Veteran regularly used a brace when writing or typing. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s wrists disabilities impacted his ability to work as the Veteran, who was an attorney, had to write and type and his wrist pain resulted in prolonging completion of tasks. The Veteran underwent a VA peripheral nerves examination in May 2015. The Veteran reported that he had worsening, burning numbness in his hands. He had moderate constant pain, intermittent pain, paresthesias and numbness. Muscle strength testing demonstrated active movement against some resistance (4/5) for wrist extension and flexion. Pinch and grip demonstrated active movement against some resistance (3/5). He had muscle atrophy. The sensory examination revealed decreased sensation in the inner/outer forearm and hands and fingers. The examiner indicated that the Veteran had moderate incomplete paralysis of radial, medial, and ulnar nerves on both the right and left. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s hand disabilities impacted his ability to work as the Veteran had pain when trying to open jars and bottles. The Veteran worked an attorney and had to write and type and his wrist pain resulted in prolonging completion of tasks. In a June 2015 opinion, a VA examiner indicated that the Veteran’s service-connected tinnitus impacted his ability to work. However, the Veteran did not have accompanying insomnia, depression, anxiety, hopelessness, cognitive distortions or suicidal ideation that would usually lead to unemployment. As a result, tinnitus should not be an issue in gaining and/or sustaining employment. The Veteran underwent a VA peripheral nerves examination in October 2017. The examiner noted that the Veteran had neuropathy and carpal tunnel syndrome. The Veteran reported that he marked pain and discomfort in his hands. He wore braces for both hands and wrists with only moderate relief. It was noted that the Veteran had total left wrist replacement surgery in November 2016. He had symptoms of tingling and numbness that had remained constant. The Veteran had moderate constant pain, intermittent pain, paresthesias and numbness. Muscle strength testing demonstrated active movement against some resistance (4/5) for right wrist extension, flexion and pinch. There was active movement against gravity (3/5) for right wrist grip, left wrist flexion, left wrist extension and left wrist pinch. Left wrist grip demonstrated active movement with gravity eliminated (2/5). He did not have muscle atrophy. The sensory examination revealed decreased sensation in the inner/outer forearm and hands and fingers. The examiner indicated that the Veteran had moderate incomplete paralysis of radial, medial, and ulnar nerves on both the right and left. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s hand disabilities impacted his ability to work as the Veteran had difficulty opening jars and turning keys and performing fine motor movements to include writing and typing. The Veteran underwent a VA wrist examination in October 2017. The Veteran had bilateral wrist arthritis, a chronic sprain of the right wrist and a status post fracture of the right wrist. It was noted that the Veteran fell on his left wrist in August 2016 which required 3 surgeries. He had marked limitation of both wrists and hands. He had difficulty with writing and typing. He worked as a pro bono attorney for individual charities and his wife was not writing and typing documents for him. He could no longer play piano. The Veteran reported that his wrists and hands were always numb and tingled. He also had chronic aches and pains in both hands although the left was significantly worse than his right hand. He had functional loss as he had pain with fine motor movements. Right wrist palmar flexion was from 0 to 40 degrees, right wrist dorsiflexion was from 0 to 40 degrees, left wrist palmar flexion was from 0 to 40 degrees and left wrist dorsiflexion was from 0 to 40 degrees. The pain itself contributed to functional loss as he had pain when writing or typing. There was pain with weight bearing, tenderness on palpitation and evidence of crepitus. The Veteran was able to perform repetitive use testing and there was loss of function of the left wrist after repetitive use due to pain, fatigue, weakness, incoordination and lack of endurance. After 3 repetitions, left wrist palmar flexion was from 0 to 30 degrees and left wrist dorsiflexion was from 0 to 30 degrees. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability or incoordination significantly limited ability after a period of time or during flare-ups. Muscle strength testing demonstrated active movement against some resistance (4/5) for both the left and right wrists. The Veteran also had atrophy of both wrists but there was no ankylosis. The Veteran constantly used a brace. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s wrists disabilities impacted his ability to work as the Veteran had difficulty opening jars, turning keys and performing fine motor movements to include writing and typing. The examiner noted that the Veteran’s service-connected bilateral wrist disability would result in marked prolonged completion of tasks. The Veteran’s service-connected scars did not impact his ability to work. The Veteran underwent a VA examination in September 2018. The examiner opined that the Veteran’s service-connected hearing loss and tinnitus impacted his ability to work. The Veteran underwent a VA examination in November 2018. The Veteran reported flare-ups as he had persistent pain in both wrists and hands which made fine motor movements difficult. The Veteran reportedly began having increased pain in both of his hands and wrists which made it difficult for him to write and type. He also had difficulty focusing on tasks as a result of his pain. The examiner noted that the Veteran’s bilateral wrist disability resulted in significant occupational difficulty. The Veteran underwent a VA wrist examination in September 2019. The Veteran had bilateral wrist arthritis, a chronic sprain of the right wrist and a status post fracture of the right wrist. It was noted that the Veteran had surgeries on his left wrist in June 2017, April 2018 and May 2019. He reported that he could not open and close his left hand and that he wore a brace constantly. He worked as a pro bono attorney and had been struggling with typing and fine motor movements. He works for Stand Up for Animals and had been unable to perform his duties which was caring for animals, preparing food and being advisory council. He did prepare documents for this organization but found that he was having trouble preparing his statements in a timely manner. Because of weakness, he was unable to grab and lift objects. He reported that he had difficulty driving as he had trouble gripping the wheel. He went to occupational therapy after his surgery but stopped as he did not find it helpful. The Veteran reported that had flare-ups as pain in the left wrist was 8/10 to 9/10 and pain in the right wrist was 7/10 to 8/10. He had functional loss as he had worsening pain and marked difficulty with fine motor movements. He also had chronic aches and pains in both hands although the left was significantly worse than his right hand. He had functional loss as he had pain with fine motor movements. Right wrist palmar flexion was from 0 to 30 degrees, right wrist dorsiflexion was from 0 to 25 degrees, left wrist palmar flexion was from 10 to 30 degrees and left wrist dorsiflexion was from 10 to 20 degrees. The pain itself contributed to functional loss. There was pain with weight bearing, tenderness on palpitation and evidence of crepitus. The Veteran was able to perform repetitive use testing and there was loss of function after repetitive use due to pain, fatigue, weakness, incoordination and lack of endurance. After 3 repetitions, right wrist palmar flexion was from 0 to 25 degrees, right wrist dorsiflexion was from 0 to 20 degrees, left wrist palmar flexion was from 10 to 20 degrees and left wrist dorsiflexion was from 10 to 10 degrees. The pain itself contributed to functional loss. The examiner found that pain, weakness, fatigability or incoordination significantly limited ability after a period of time and during flare-ups as right wrist palmar flexion was from 0 to 25 degrees, right wrist dorsiflexion was from 0 to 20 degrees, left wrist palmar flexion was from 10 to 20 degrees and left wrist dorsiflexion was from 10 to 10 degrees. Muscle strength testing demonstrated active movement against gravity (3/5) for right wrist flexion and extension as well as active movement with gravity eliminated (2/5) for left wrist flexion and extension. The Veteran also had atrophy of both wrists but there was no ankylosis. The Veteran constantly used a brace. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s wrists disabilities impacted his ability to work as the Veteran had worsening pain when performing fine motor movements and when writing and typing. He also had difficulty zipping up jackets and buttoning shirts, tying shoes and applying his braces. The Veteran’s service-connected scars did not impact his ability to work. The Veteran underwent a VA peripheral nerves examination in September 2019. The examiner noted that the Veteran had neuropathy and carpal tunnel syndrome. The Veteran reported that he had difficulty buttoning shirts and opening jars and cans. He also noted that he tended to drop objects. He had difficulty typing and writing which had resulted in slowed completion of tasks or tasks that could not be completed. He worked as an advisory legal counsel for a local organization and had to prepare documents as part of this work. He reported having marked pain and discomfort at night with his left being worse than his right. He wore braces for both hands and wrists with only moderate relief. It was noted that the Veteran had total left wrist replacement surgery in November 2016. He had symptoms of tingling and numbness that had remained constant. The Veteran had moderate constant pain and intermittent pain as well as severe paresthesias and numbness. Muscle strength testing demonstrated active movement against gravity (3/5) for right wrist flexion, extension, grip and pinch. Left wrist flexion, extension, grip and pinch demonstrated active movement with gravity eliminated (2/5). The sensory examination revealed decreased sensation in the inner/outer forearm and hands and fingers. The examiner indicated that the Veteran had moderate incomplete paralysis of median nerves on both the right and left. The Veteran also had severe incomplete paralysis of radial and ulnar nerves on both the right and left. The examiner found that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. The Veteran’s hand disabilities impacted his ability to work as the Veteran had worsening pain when performing fine motor movements and when writing and typing. He also had difficulty driving, zipping up his jacket, buttoning shirts, tying shoes and applying his braces. Left and Right Wrists The Veteran’s service-connected degenerative joint disease left wrist and status post right wrist fracture with residual pain and weakness disabilities currently have 10 percent disability ratings under Diagnostic Codes 5010-5215. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The hyphenated diagnostic code here indicates that the Veteran is service connected for traumatic degenerative arthritis due to trauma and limitation of motion of the right wrist. Traumatic arthritis, as shown by x-ray, is rated based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. When, however, the limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. Id., Diagnostic Code 5003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. Diagnostic Codes 5214 and 5215 assign disability ratings for the wrist. Under Diagnostic Code 5215 (the code under which the Veteran’s right wrist disability is rated), a 10 percent rating is warranted for limitation of dorsiflexion of the wrist to less than 15 degrees, or for palmar flexion limited in line with the forearm. This is the maximum possible schedular rating under Diagnostic Code 5215. Id. Higher ratings are available under Diagnostic Code 5214 for ankylosis of the wrist. Under Diagnostic Code 5214, a 30 percent rating is warranted where there is favorable ankylosis of the wrist in 20 to 30 degrees of dorsiflexion. A 40 percent rating is warranted where there is ankylosis of the wrist in any other position, except favorable. A maximum 50 percent rating is warranted where there is unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation. A note to Diagnostic Code 5214 states that extremely unfavorable ankylosis will be rated as loss of use of hands under Diagnostic Code 5125. 38 C.F.R. § 4.71a, Diagnostic Code 5214, 5125. Normal range of motion of the wrist includes dorsiflexion (extension) from zero to 70 degrees, palmar flexion from zero to 80 degrees, ulnar deviation from zero to 45 degrees, and radial deviation from zero to 20 degrees. 38 C.F.R. § 4.71a, Plate I. Based on the evidence, the Board does not find that the Veteran is entitled to an evaluation in excess of the current 10 percent disability ratings for his degenerative joint disease of the left wrist and status post right wrist fracture with residual pain and weakness. With respect to the applicable rating criteria, the Veteran is currently assigned 10 percent disability ratings under Diagnostic Code 5215. A 10 percent disability rating is the highest schedular rating available. As such, the Board is unable to grant higher schedular ratings under these criteria. The Board notes that Diagnostic Code 5214 (wrist, ankylosis of), which is the only other diagnostic code which specifically references the wrist, is not appropriate for application in this case because, as is discussed below, there is no evidence of ankylosis in the record. Ankylosis is “immobility and consolidation of a joint due to disease, injury, surgical procedure.” See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). As noted above, in evaluating any disability on the basis of limitation of motion, VA must consider the actual degree of functional impairment imposed by pain, incoordination, weakness, fatigue, and lack of endurance with repetitive motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). A review of the record therefore demonstrates that the Veteran experiences functional loss and limitation of motion due to his right and left wrist disabilities, however, ankylosis of the right or left wrist is not shown. As a result, while higher disabilities ratings are contemplated for ankylosis of the wrist under Diagnostic Code 5214, the evidence does not show that the Veteran’s right or left wrist has been manifested by symptoms consistent with ankylosis at any time during the course of the appeal, even upon consideration of the actual degree of functional impairment due to factors such as pain, weakness, fatigability, incoordination, and lack of endurance. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). As a result, the Board finds that rating in excess of 10 percent is not warranted for degenerative joint disease of the left wrist and status post right wrist fracture with residual pain and weakness. Left and Right Hands In a May 2012 rating decision, the Veteran was granted service connection for neuropathy of the right and left hands under Diagnostic Code 8515. The Veteran again filed a claim for increased ratings that was received by VA in June 2013. The Veteran’s service-connected peripheral neuropathy, left hand is rated as 20 percent disabling for the period prior to May 27, 2015 and as 40 percent disabling for the period since May 27, 2015. The Veteran’s service-connected peripheral neuropathy, right hand is rated as 20 percent disabling for the period prior to May 27, 2015 and as 30 percent disabling for the period since May 27, 2015. These evaluations are all rated under Diagnostic Code 8513, which pertains to paralysis of the median nerve. Under Diagnostic Code 8513 (all radicular groups), a disability rating of 20 percent is assigned for mild incomplete paralysis all radicular groups on the dominant and nondominant sides. A disability rating of 30 percent is assigned for moderate incomplete paralysis of the nondominant upper extremity, and a disability rating of 40 percent is assigned for moderate incomplete paralysis of the dominant upper extremity. A disability rating of 60 percent is also assigned for severe incomplete paralysis of the nondominant upper extremity, and a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. A disability rating of 80 percent is assigned for complete paralysis of the nondominant upper extremity, and a disability rating of 90 percent is assigned for complete paralysis of the dominant upper extremity. Diagnostic Code 8515 addresses complete and incomplete paralysis of the medial nerve. Under this diagnostic code, moderate incomplete paralysis warrants a 20 percent rating for the minor wrist and a 30 percent rating for the major wrist. Severe incomplete paralysis warrants a 40 percent rating for the minor wrist and a 50 percent rating for the major wrist. Complete paralysis with the hand inclined to the ulnar side, the index and middle fingers more extended than normal, considerable atrophy of the muscles of thenar eminence, the thumb in the plane of the hand; pronation incomplete and effective, absence of flexion of the index finger and feeble flexion of the middle finger, that cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of the thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbances warrants a 60 percent rating for the minor wrist and a 70 percent disability rating for the major wrist. See 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under Diagnostic Code 8514 (radial nerve), a 30/20 percent evaluation is warranted for moderate incomplete paralysis major/minor arm. A 50/40 percent evaluation is warranted for severe incomplete paralysis of the major/minor arm. A 70/60 percent evaluation is warranted for complete paralysis of the radial nerve with drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb or make lateral movement of the wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. Under Diagnostic Code 8516 (ulnar nerve), a 30/20 percent evaluation is warranted for moderate incomplete paralysis of the major/minor arm. A 40/30 percent evaluation is warranted for severe incomplete paralysis the major/minor arm. A 60/50 percent evaluation is warranted for complete paralysis of the ulnar nerve with the “griffin claw” deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type 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 wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). Period prior to May 27, 2015 For the period prior to May 27, 2015, the Veteran’s service-connected peripheral neuropathy, left and right hands are rated as 20 percent disabling which under Diagnostic Code 8513 is assigned for mild incomplete paralysis all radicular groups on the dominant and nondominant sides. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran’s favor, the Board concludes that a 40 percent disability rating, but no higher, for peripheral neuropathy of the left hand is warranted and a 30 percent disability rating, but no higher, for peripheral neuropathy of the right hand is warranted for the period prior to May 27, 2015. As noted above, under Diagnostic Code 8513, a disability rating of 60 percent is assigned for severe incomplete paralysis of the nondominant upper extremity, and a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. Notably, the December 2013 VA examination indicated that the Veteran had moderate constant pain and moderate intermittent pain as well as mild paresthesias and mild numbness. Additionally, the Veteran reported that he had numbness and tingling in his hands and that he had difficulty with buttoning and tying ties. Muscle strength testing was also diminished as it demonstrated active movement against some resistance (4/5) for pinch and grip while bilateral wrist flexion and extension demonstrated active movement against some resistance (3/5). The sensory examination also revealed decreased sensation in the hands and fingers. As a result and when affording the Veteran the benefit of the doubt, the Board finds that a 40 percent disability evaluation is warranted for the Veteran’s service-connected peripheral neuropathy of the left hand (dominant) and a 30 percent disability evaluation is warranted for the Veteran’s service-connected peripheral neuropathy of the right hand (minor) for the period prior to May 27, 2015. However, evaluations in excess of 40 percent and 30 percent for the peripheral neuropathy of the left and right hands for the period prior to May 27, 2015 have not been demonstrated by the evidence of record at any point. As noted above, under Diagnostic Code 8513 a disability rating of 60 percent is requires severe incomplete paralysis of the nondominant upper extremity while a disability rating of 70 percent is assigned for severe incomplete paralysis of the dominant upper extremity. While the Veteran exhibited constant and intermittent pain as well as numbness, the December 2013 VA examiner specifically indicated that the Veteran only had mild incomplete paralysis of radial, medial, and ulnar nerves on both the right and left. Additionally, the Board notes that ratings in excess of 30 percent (nondominant) and 40 percent (dominant) are available under Diagnostic Codes 8514 (radial nerve), 8515(medial nerve) and 8516 (ulnar nerve). However, these higher ratings are warranted for nerves which demonstrate severe incomplete paralysis which has not been demonstrated. As a result, the Board finds that 40 and 30 percent ratings, but no higher, is warranted for the period prior to May 27, 2015 as the Veteran has exhibited symptoms consistent with moderate incomplete paralysis in the right and left upper extremities. Period Since May 27, 2015 Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran’s favor, the Board concludes that a 70 percent disability rating, but no higher, for peripheral neuropathy of the left hand is warranted and a 60 percent disability rating, but no higher, for peripheral neuropathy of the right hand is warranted for the period since May 27, 2015. As noted above, under Diagnostic Code 8513, a disability rating of 30 percent is assigned for moderate incomplete paralysis of the nondominant upper extremity, and a disability rating of 40 percent is assigned for moderate incomplete paralysis of the dominant upper extremity. Notably, the September 2019 VA examination indicated that the Veteran had moderate constant pain and intermittent pain as well as severe paresthesias and numbness. Muscle strength testing demonstrated active movement against gravity (3/5) for right wrist flexion, extension, grip and pinch. Left wrist flexion, extension, grip and pinch demonstrated active movement with gravity eliminated (2/5). The sensory examination revealed decreased sensation in the inner/outer forearm and hands and fingers and the examiner also indicated that the Veteran had severe incomplete paralysis of radial and ulnar nerves on both the right and left. As a result and when affording the Veteran the benefit of the doubt, the Board finds that a 70 percent disability evaluation is warranted for the Veteran’s service-connected peripheral neuropathy of the left hand (dominant) and a 60 percent disability evaluation is warranted for the Veteran’s service-connected peripheral neuropathy of the right hand (minor) for the period since May 27, 2015. However, evaluations in excess of 70 percent and 60 percent for the peripheral neuropathy of the left and right hands for the period since May 27, 2015 have not been demonstrated by the evidence of record at any point. As noted above, under Diagnostic Code 8513 a disability rating of 80 percent is assigned for complete paralysis of the nondominant upper extremity, and a disability rating of 90 percent is assigned for complete paralysis of the dominant upper extremity. As noted above, at no point during the period on appeal has complete paralysis of the dominant or nondominant extremity been demonstrated. The September 2019 VA examiner specifically indicated that the Veteran had moderate incomplete paralysis of median nerves on both the right and left and severe incomplete paralysis of radial and ulnar nerves on both the right and left. As a result, the Board finds that 70 and 60 percent ratings, but no higher, is warranted for the period since May 27, 2015 as the Veteran has exhibited symptoms consistent with severe incomplete paralysis in the right and left upper extremities. SMC due to Loss of Use of Hands Laws and Regulations SMC under 38 U.S.C. § 1114 (k) is payable for each anatomical loss or loss of use of one hand, one foot, both buttocks, one or more creative organs, blindness of one eye having only light perception, deafness of both ears, having absence of air and bone conduction, complete organic aphonia with constant inability to communicate by speech or, in the case of a woman veteran, loss of 25% or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy), or following receipt of radiation treatment of breast tissue. This special compensation is payable in addition to the basic rate of compensation otherwise payable on the basis of degree of disability, provided that the combined rate of compensation does not exceed the monthly rate set forth in 38 U.S.C. § 1114 (l) when authorized in conjunction with any of the provisions of 38 U.S.C. § 1114 (a) through (j) or (s). When there is entitlement under 38 U.S.C. § 1114 (l) through (n) or an intermediate rate under (p) such additional allowance is payable for each such anatomical loss or loss of use existing in addition to the requirements for the basic rates, provided the total does not exceed the monthly rate set forth in 38 U.S.C. § 1114 (o). The limitations on the maximum compensation payable under this paragraph are independent of and do not preclude payment of additional compensation for dependents under 38 U.S.C. § 1115, or the special allowance for aid and attendance provided by 38 U.S.C. § 1114 (r). 38 C.F.R. § 3.350 (a). Loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis; for example: (a) Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 312 inches or more, will constitute loss of use of the hand or foot involved. (b) Complete paralysis of the external popliteal nerve (common peroneal) and consequent footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot. 38 C.F.R. § 3.350 (a)(2). The Veteran contends that his service-connected bilateral wrist and peripheral neuropathy of the bilateral hands manifests to a degree equivalent to loss of use of both hands. As noted above, to receive SMC due to loss of use of both hands, the evidence must show no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. 38 C.F.R. § 3.350 (a)(2). As reflected above, the Veteran’s bilateral wrist and bilateral hand disabilities result in significant impairment as the Veteran has reported that he could not open and close his left hand, wore a brace constantly and because of weakness, was unable to grab and lift objects. He also reported that he had difficulty driving as he had trouble gripping the wheel. However, the evidence does not demonstrate any evidence that functioning was so diminished that amputation with prosthesis would equally serve the Veteran. As reflected above, multiple VA examinations, most recently in September 2019, specifically indicated that there was no functional impairment such that no effective function remained other than that which would be equally well served by an amputation with prothesis. While the Veteran believes that his disabilities are so severe as to equate to loss of use of both hands, he is not competent to determine whether the actual remaining function manifested to a level that no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow with use of a suitable prosthetic appliance. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the numerous competent VA medical examiners. Based on the evidence cited above, the Board finds that the preponderance of the evidence is against the claim of entitlement to SMC for loss of use of the hands. As the preponderance of the evidence is against the claim for SMC due to loss of use of the hands, the benefit of the doubt rule does not apply. 38 C.F.R. § 5107; 38 C.F.R. § 3.102. TDIU Laws and Regulations Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (2019). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that the Veteran meets the schedular requirements. If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disability to bring the combination to 70 percent or more. 38 C.F.R. § 4.16(a) (2020). To meet the requirement of “one 60 percent disability” or “one 40 percent disability,” the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2020). In September 2014, the VA received the Veteran’s formal claim for entitlement to a TDIU. For the period prior to May 27, 2015, the Veteran’s service-connected disabilities consisted of a peripheral neuropathy, left hand disability (rated at 40 percent), a peripheral neuropathy, right hand disability (rated at 30 percent), a left wrist disability (rated at 10 percent), a right wrist disability (rated at 10 percent), a bilateral hearing loss disability (rated at 10 percent), a tinnitus disability (rated at 10 percent), a scar of the right hand (rated at 0 percent) and a scar of the left hand (rated at 0 percent). This results in the combined rating of 70 percent (with consideration of the bilateral factor). For the period from May 27, 2015 to August 7, 2018, the Veteran’s service-connected disabilities consisted of a peripheral neuropathy, left hand disability (rated at 70 percent), a peripheral neuropathy, right hand disability (rated at 60 percent), a left wrist disability (rated at 10 percent), a right wrist disability (rated at 10 percent), a bilateral hearing loss disability (rated at 10 percent), a tinnitus disability (rated at 10 percent), a scar of the right hand (rated at 0 percent) and a scar of the left hand (rated at 0 percent). This results in the combined rating of 90 percent (with consideration of the bilateral factor). For the period since August 7, 2018, the Veteran’s service-connected disabilities consisted of a peripheral neuropathy, left hand disability (rated at 70 percent), a peripheral neuropathy, right hand disability (rated at 60 percent), an adjustment disorder disability (rated at 30 percent), a left wrist disability (rated at 10 percent), a right wrist disability (rated at 10 percent), a bilateral hearing loss disability (rated at 10 percent), a tinnitus disability (rated at 10 percent), residuals of right thumb surgery (rated at 10 percent), residuals of left index finger surgery (rated at 10 percent), a painful scar post left hand surgery (rated at 10 percent), a scar of the right hand (rated at 0 percent), a scar of the left hand (rated at 0 percent), and a painful nonlinear scar post left hand surgery (rated at 0 percent), This results in the combined rating of 100 percent (with consideration of the bilateral factor). Period prior to August 7, 2018 Regarding the period for the period prior to August 7, 2018, the Veteran’s service-connected disabilities are at a combined 70 disability rating for the period prior to May 27, 2015 and a combined 90 percent disability rating for the period from May 27, 2015 to August 7, 2018. Having met the objective criteria for a TDIU, the remaining question before the Board is whether the Veteran’s service-connected disabilities preclude him from securing or following substantially gainful employment. 38 C.F.R. § 3.321, 3.340, 3.341, 4.16. Considering the governing legal authority in light of the above, the Board finds that the criteria for a TDIU are not met. The Veteran has maintained that he is unemployable due to the effects of his service-connected disabilities. However, most probative evidence clearly demonstrates that the Veteran’s service-connected disabilities did not preclude all forms of employment for the period prior to August 7, 2018. The Board notes that while the evidence of record does indicate that that Veteran’s service-connected disabilities interfered with employment that required physical exertion, they did not render the Veteran unable to obtain or maintain substantially gainful employment. As noted, multiple VA examinations found that the Veteran’s bilateral wrist and peripheral neuropathy disabilities impacted his ability to work an attorney as he had difficulty writing and typing which required his wife to do these tasks for him. However, the Board finds that the limitations noted by the VA examiners specifically address the physical limitations surrounding potential employment and these physical limitations alone again do not necessarily mean that the Veteran is not able to secure or follow a substantially gainful sedentary occupation. In this regard, the Board is cognizant that the conclusion as to whether someone is unemployable is not a medical determination, but rather a legal determination. Thus, the Board has looked to the specific symptoms and manifestations of his service-connected disabilities, particularly with respect to those likely to cause practical functional impairment in an occupational setting. Here, while the Veteran was previously employed as a pro bono attorney and he has significant limitations with typing and writing as evidenced by the VA examiners findings, it cannot be said, based on the overall degree of disability, that the Veteran is precluded from other forms of substantially gainful employment due to his service-connected disabilities. While the Board is sympathetic for the restrictions that encompassed his service-connected disabilities, the evidence clearly demonstrates that the Veteran’s service-connected disabilities did not preclude all forms of employment. Additionally, the medical evidence does not contain an opinion that the Veteran’s service-connected disabilities preclude him from obtaining or engaging in substantially gainful employment and the Veteran has not presented or identified any such existing medical evidence or opinion. The Board also notes that the Veteran has been awarded Social Security Administration (SSA) benefits. Although VA is required to consider the SSA’s findings, the Board is not bound by the findings of disability and/or unemployability made by other agencies, including SSA. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). Adjudication of VA and SSA claims is based on different laws and regulations. Thus, SSA’s determination has little probative value in this matter, and is not sufficient, in this case, to overcome the other evidence in the record. The statements of the Veteran as to his employability as a result of his service-connected disabilities have been considered and they are found to be competent, credible and probative as to the symptoms experienced and observed. However, they are outweighed by the evidence of record. Here, the central inquiry is whether the Veteran’s service-connected disabilities are of sufficient severity to preclude him from obtaining and maintaining all forms of substantially gainful employment. See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). As a result, the Board concludes that the most probative evidence of record weighs heavily against finding that the Veteran’s service-connected disabilities precluded him from obtaining or engaging in substantially gainful employment for the period prior to August 7, 2018. Based on the evidence in the claims file, the Board believes that the symptomatology associated with the service-connected disabilities is appropriately compensated via the combined 70 percent rating for the period prior to May 27, 2015 and the 90 percent rating for which he is assigned for the period from for the period May 27, 2015 to August 7, 2018. Loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321(a), 4.1. Indeed, 38 C.F.R. § 4.1 specifically states: ‘[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.’ See also Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992) and Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). In sum, the Board has found the Veteran to not be unemployable due to his service-connected disabilities. Accordingly, the criteria for entitlement to a TDIU for the period prior to August 7, 2018 are not met. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable and the claim is denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Period since August 7, 2018 As noted above, for the period since August 7, 2018, the Veteran’s service connected disabilities have a combined 100 disability evaluation. However, a grant of a 100 percent disability again does not always render the issue of TDIU moot. VA’s duty to maximize a claimant’s benefits includes consideration of whether his disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). This case, however, is distinguished from the case in Bradley, in that grant of a TDIU would not be predicated on a single disability but on multiple service-connected disabilities. Specifically, the grant of entitlement to TDIU would be based on the cumulative symptomatology associated with the Veteran’s service-connected disabilities. Therefore, the grant of TDIU would be based on impairment from several service-connected disabilities, and not just a single disability. As the Veteran for the period since August 7, 2018 had no single service-connected disability that is rated at 100 percent, and the Veteran’s TDIU would be predicated on multiple service-connected disabilities, the percentage rating criteria for SMC at the housebound rate have not been met at any point during the period under consideration in this appeal. As such, entitlement to a TDIU for the period since August 7, 2018 is considered moot, as the Veteran is already in receipt of a combined schedular evaluation of 100 percent, for the period since August 7, 2018 and the findings in Bradley are not applicable in this case. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001). As such, there remain no allegations of error of fact or law for appellate consideration, the Board has no jurisdiction to review this appeal for the issue of entitlement to TDIU for the period from August 7, 2018 and it is dismissed in this regard. 38 U.S.C. § 7105 (d)(5); 38 C.F.R. § 20.202. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James A. DeFrank, 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.