Citation Nr: 21004238 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-19 167 DATE: January 26, 2021 ORDER Prior to January 17, 2012, a rating in excess of 20 percent for a left ankle disability is denied. From August 1, 2012, to August 3, 2019, a higher 40 percent rating for the left ankle disability, though no greater, is granted. Since August 3, 2019, a rating in excess of 40 percent for the left ankle disability is denied. A rating in excess of 10 percent for a right ankle disability is denied. Prior to August 3, 2019, a 10 percent rating, though no greater, is granted for a lumbar spine disability. Since August 3, 2019, a rating in excess of 10 percent for the lumbar spine disability is denied. Prior to August 3, 2019, a 10 percent rating, though no greater, is granted for radiculopathy of the right lower extremity. Since August 3, 2019, a rating in excess of 10 percent for the radiculopathy of the right lower extremity is denied. A 10 percent rating for left lower extremity radiculopathy is granted. Since August 1, 2012, a total disability rating based on individual unemployability (TDIU) is granted. An extension of a temporary total rating beyond August 1, 2012, based on the need for convalescence following left ankle surgery is moot and, therefore, dismissed. REMANDED Entitlement to a TDIU prior to January 17, 2012, is remanded. FINDINGS OF FACT 1. Prior to January 17, 2012, the Veteran’s left ankle disability was manifested by marked limitation of motion of this ankle. 2. Since August 1, 2012, the Veteran’s left ankle disability has been manifested by ankylosis that occurs in plantar flexion at more than 40 degrees or in dorsiflexion at more than 10 degrees. 3. Throughout the appeal period, the Veteran’s right ankle disability has been manifested by moderate limitation of motion. 4. Throughout the appeal period, the Veteran’s lumbar spine disability has been manifested by arthritis and consequent painful motion; forward flexion of his thoracolumbar spine is to greater than 60 degrees but not to greater than 85 degrees or the combined range of motion of his thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees. 5. Throughout the appeal period, the radiculopathy affecting the Veteran’s right and left lower extremities has caused what amounts to “mild” incomplete paralysis of the sciatic nerve. 6. Since August 1, 2012, his service-connected disabilities have prevented him from obtaining and maintaining substantially gainful employment. 7. Since, for all intents and purposes, he has been totally disabled effectively since August 1, 2012, based primarily on his left ankle disability, the issue of his entitlement to a temporary total convalescent rating beyond that date for this same disability is now moot. CONCLUSIONS OF LAW 1. Prior to January 17, 2012, the criteria for a rating in excess of 20 percent for the Veteran’s left ankle disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code (DC) 5271. 2. From August 1, 2012, to August 3, 2019, the criteria for an increased 40 percent rating for the Veteran’s left ankle disability, though no greater, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, DC 5270. 3. Since August 3, 2019, the criteria for a rating in excess of 40 percent for the Veteran’s left ankle disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, DC 5270. 4. The criteria for a rating in excess of 10 percent for the Veteran’s right ankle disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, DC 5271. 5. Prior to August 3, 2019, the criteria for an increased 10 percent rating for the lumbar spine disability, though no greater, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.71a, DC 5242. 6. Since August 3, 2019, the criteria for a rating higher than 10 percent for the lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.71a, DC 5242. 7. Prior to August 3, 2019, the criteria for a 10 percent rating, though no greater, for the associated radiculopathy of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.124a, DC 8520. 8. Since August 3, 2019, the criteria for a rating in excess of 10 percent for the associated radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.124a, DC 8520. 9. The criteria for a 10 percent rating, though no greater, for the associated radiculopathy of the left lower extremity have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.124a, DC 8520. 10. Since August 1, 2012, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.19. 11. The claim for an extension of the temporary total rating beyond August 1, 2012, based on the need for convalescence following left ankle surgery, is dismissed as moot. 38 U.S.C. § 1155; 38 C.F.R. § 4.30.   REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from November 1971 to November 1973. Increased Ratings 1. Prior to January 17, 2012, a rating in excess of 20 percent rating for the left ankle disability is denied. 2. From August 1, 2012, to August 3, 2019, an increased 40 percent rating, though no greater, for the left ankle disability is granted. 3. Since August 3, 2019, a rating in excess of 40 percent for the left ankle disability is denied. Disability ratings are determined by comparing the Veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based, as far as practically can be determined, on average impairment in earning capacity. Separate codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. All reasonable doubt material to the determination is resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The Board will consider entitlement to “staged” ratings to compensate for times when the disability may have been more severe than at others. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 exertion, strength, speed, coordination and endurance. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the 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. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40. Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss, taking into account any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions regarding the avoidance of pyramiding do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare ups. 38 C.F.R. § 4.14. The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45, however, should only be considered in conjunction with the Codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The intent of the rating 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. 38 C.F.R. § 4.59. With respect to the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: (a) less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); (b) more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); (c) weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); (d) excess fatigability; (e) incoordination, impaired ability to execute skilled movements smoothly; and (f) pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. 38 C.F.R. § 4.45. Pursuant to DC 5270, ankylosis of the ankle is rated as follows: 20 percent for ankylosis in plantar flexion of less than 30 degrees; 30 percent for ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between zero and 10 degrees; and 40 percent for ankylosis in plantar flexion at more than 40 degrees, in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion or eversion deformity. Diagnostic Code 5271 provides a 10 percent disability rating for moderate limitation of motion of the ankle and a 20 percent disability rating for marked limitation of motion of the ankle. The Board finds that, from December 9, 2008, the beginning of the appeal period, until January 17, 2012, when the Veteran underwent surgery for left ankle fusion, a disability rating exceeding 20 percent is not warranted. The two VA examinations completed during this time period, in August 2010 and January 2011, as well as the treatment records dated during this time period, indicate he did not have ankylosis of this ankle. Rather, he had plantar flexion and dorsiflexion of this ankle, although both were markedly limited. Even when motion is markedly limited is not tantamount to ankylosis since ankylosis requires no ankle motion at all. Ankylosis is stiffening or fixation of the joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999); Lewis v. Derwinski, 3 Vet. App. 259 (1992) [citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)]. The complete elimination of the Veteran’s left ankle motion (i.e., the fixation of this ankle in a certain position) did not occur until his left ankle “fusion”. Absent indication of ankylosis, a higher rating is not warranted. In this regard, the Veteran was able to walk, drive, and attend to his activities of daily living. The record does not show a disability that would be considered similar or akin to ankylosis. The 20 percent rating assigned for this period of time accounts for his symptoms of pain, feeling of giving way, and other impairment, to include limitation of movement and limitation of physical activity. Since August 1, 2012, following his left ankle fusion and period of convalescence following that surgery, the Veteran has had ankylosis of this ankle as shown on April 2012 and June 2012 VA examinations. At the April 2012 VA examination, it was noted he had ankylosis of his left ankle in plantar flexion at less than 30 degrees and in dorsiflexion at more than 10 degrees. At the June 2012 VA examination, it was noted that his ankle was still healing from the fusion surgery. It again was confirmed, however, that he had ankylosis, though whether that ankylosis was of the ankle, itself, or of the subastragalar or tarsal joint was not differentiated. Nonetheless, range of motion testing was not done. On August 2019 VA examination, however, he had ankylosis of this ankle with plantar flexion limited to 10 degrees and dorsiflexion limited to 30 degrees. Thus, when resolving all reasonable doubt in his favor, because the criteria for a higher 40 percent rating as likely as not were met for this entire time period at issue, a higher 40 percent rating is also warranted from August 1, 2012, to August 3, 2019. But, consideration of whether a rating in excess of 40 percent is not warranted since this rating considers the Veteran’s severe limitation of motion of this ankle, as well as his symptoms of functional loss on motion. The evidence does not show other symptoms unaccounted for by this rating. 4. A rating in excess of 10 percent for the right ankle disability is denied. The Board finds that a rating in excess of 10 percent for the Veteran’s right ankle disability is not warranted at any time during the appeal period. On August 2010 VA examination, there was evidence of instability, weakness, tenderness, and guarding of movement of the right ankle. Range of motion testing showed dorsiflexion to be 15 out of 20 degrees, and plantar flexion to be 35 out of 45 degrees. There was no evidence of additional functional loss on repetitive testing. On January 2011 VA examination, there were signs of instability, weakness, and tenderness. Range of motion testing showed dorsiflexion to 15 degrees, and plantar flexion to 30 degrees. There was no indication of additional functional loss on repetitive movement. On April 2012 VA examination, dorsiflexion was to 15 degrees and plantar flexion was to 15 degrees. There was evidence of functional loss on repetitive movement, to include less movement than normal, excess fatigability, incoordination, pain on movement, disturbance of locomotion, and interference with sitting and standing. There was evidence of localized tenderness. Os calcis or talus astragalus was not found on examination. On June 2012 VA examination, right ankle plantar flexion was to 35 degrees, and dorsiflexion was to 15 degrees. There was evidence of less movement than normal, excess fatigability, incoordination, pain on movement and instability of station following repetitive testing. There was evidence of a moderate deformity of the right ankle. On August 2019 VA examination, the Veteran reported constant pain in the right ankle. Dorsiflexion was to 15 degrees, and plantar flexion was to 35 degrees. The Veteran’s right ankle disability made it difficult for him to walk or stand. He reported significant instability and falls due to his right ankle. There was tenderness at the anterior joint line. There was five degrees less motion on repetitive testing with plantar flexion. The Veteran was limited by functional loss. Os calcis or talus astragalus was not found on examination. From the above evidence, the Board finds that the evidence overall shows a moderate disability of the right ankle. The Veteran showed less plantar flexion on April 2012 VA examination, however in June 2012, his plantar flexion had increased and was in line with the remaining examinations of record, both prior to and following that examination. The April 2012 VA examination otherwise summarized a similar disability picture as that shown with the other VA examinations, namely moderate symptoms that affected the Veteran’s ability walk, but not severe or marked symptoms. Throughout the appeal period, the Veteran has shown symptoms of pain, a feeling of instability, and demonstrated limitation of motion and functional loss. These symptoms impacted his ability for prolonged walking but did not prevent the ability to walk. Generally, he was able to walk unassisted and his limitation of flexion was not severely, or markedly, limited. Significantly, his muscle strength testing and testing to instability did not show more than mild impairment. Accordingly, the Board finds that a rating higher than 10 percent for moderate limitation of motion of the right ankle is not warranted. This rating considers the Veteran’s loss of ankle function on movement. Lastly, although os calcis or talus astragalus was found on June 2012 examination, no such deformity was found on any other VA examination, to include in April 2012. Considering such, the Board finds that the evidence does not generally support a separate rating for this condition, as the majority of the evidence does not support a finding that the condition exists. 5. Prior to August 3, 2019, a 10 percent rating, though no greater, for the lumbar spine disability is granted. 6. Since August 3, 2019, a rating in excess of 10 percent for the lumbar spine disability is denied. The Veteran’s lumbar spine disability is evaluated under the General Rating Formula for Diseases and Injuries of the Spine. Under these criteria, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, or, 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 rating is warranted for forward flexion of the lumbar spine greater than 30 degrees but not greater than 60 degrees, or the combined range of motion of spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait pattern or spine contour such as scoliosis, reverse lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the lumbar spine 30 degrees or less, or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted when there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted when there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is from zero to 90 degrees, extension is from zero to 30 degrees, left and right lateral flexion (side bending) are from zero to 30 degrees, and left and right lateral rotation (twisting) are from zero to 30 degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2). The Board finds that, prior to August 3, 2019, a 10 percent rating for this lumbar spine disability is warranted. Although the Veteran did not show evidence of compensable limitation of motion of his spine on VA examination during this period of time, he did show evidence of painful motion and arthritis. Given such, pursuant to 38 C.F.R. §§ 4.40, 4.45 and 4.59, as well as the regulations pertaining to degenerative and traumatic arthritis (namely, DCs 5003 and 5010), a 10 percent rating is warranted for such symptoms. DC 5010 refers the rater to DC 5003, which in turn stipulates that a 10 percent rating is assigned, even absent a compensable level of limitation of motion, when there is arthritis. See also Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In Mitchell, the Court held that the evaluation of painful motion as limited motion only applies when limitation of motion is noncompensable (meaning 0-percent disabling) under the applicable DC. The Court further explained that, although painful motion is entitled to a minimum 10 percent rating under Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991), when read together with DC 5003 concerning arthritis, it does not follow that the maximum rating is warranted under the applicable DC pertaining to range of motion simply because pain is present throughout the range of motion. See id. The Board resultantly finds that a rating greater than 10 percent for the Veteran’s lumbar spine disability is not warranted at any time during the appeal period. The VA examinations of record, as well as the VA treatment records, do not show limitation of motion that would warrant any higher rating. He has described painful motion of his low back, but as explained, this is contemplated by his 10 percent rating. Additionally, there is no evidence of incapacitating episodes – meaning resulting in bed rest prescribed by a physician, certainly not of the required frequency and direction, which would alternatively warrant assigning a higher rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. 38 C.F.R. § 4.71a, DC 5243, including Note (1). Even if the Veteran has felt the need, however often, to remain in bed or rest in bed because of this disability is not equivalent or tantamount to an incapacitating episode given the express requirement in the VA regulation of this having to be on prescription of a doctor, not instead at the Veteran’s election.   7. Prior to August 3, 2019, a 10 percent rating, though no greater, for radiculopathy of the right lower extremity is granted. 8. Since August 3, 2019, a rating in excess of 10 percent for the radiculopathy of the right lower extremity is denied. 9. A 10 percent rating, though no greater, for left lower extremity radiculopathy is granted. 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. 38 C.F.R. § 4.120. 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, 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. 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. DC 8520 provides the rating criteria for paralysis of the sciatic nerve, and therefore neuritis and neuralgia of that nerve. Complete paralysis of the sciatic nerve, which is rated as 80-percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Disability ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis that is mild, moderate or moderately severe in degree, respectively. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. 38 C.F.R. § 4.124a, DC 8520. DC 8620 refers to neuritis of the sciatic nerve, and DC 8720 refers to neuralgia of the sciatic nerve. The Board finds that the Veteran’s right and left lower extremities have shown what amounts to mild impairment (incomplete paralysis) of his sciatic nerve, warranting a 10 percent rating for each lower extremity throughout the appeal period. He has reported feeling tingling and numbness in his right and left lower extremities in statements since 2008. The VA examinations and VA treatment records show these continued reports. Clinically, radiculopathy of the left lower extremity has not been diagnosed, as evidence by the 2012 and 2019 VA examinations. However, as stated, he has reported neurological symptoms in both legs and feet and was later diagnosed with disc disease – based, in part, on these reported symptoms. The 2019 VA examination confirmed there are mild radicular symptoms in the right lower extremity. Thus, 10 percent ratings, but no higher, are warranted. The Veteran has not shown clinical signs of neurological deficits on motor examination, muscle strength testing, or sensation testing that would be considered to be moderate or severe in degree (as opposed to mild). 10. Since August 1, 2012, a TDIU is granted. Total disability ratings for compensation may be assigned where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of a service-connected disability(ies) – provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the purpose of determining whether these rating requirements are met, disabilities affecting both upper extremities or both lower extremities, disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, or those resulting from a single accident or common etiology are considered as one, collective, disability. Id. Substantially gainful employment is defined as work that is more than marginal and that permits the individual to earn a living wage. See Moore v. Derwinski, 1 Vet. App. 356 (1991). In a precedent case, the Court held that "substantially gainful employment," in the TDIU context, contains economic and noneconomic components; the economic component means "an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person," while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. The Court also provided guidance as to the meaning of a Veteran's ability to "secure and follow" such employment, noting that attention must be given to: the Veteran's occupational history, education, skill and training; whether the Veteran has the physical ability to perform occupational activities; and whether the Veteran has the mental ability to perform occupational activities. See Ray v. Wilkie, 31 Vet. App. 58 (2019). To establish entitlement to a TDIU, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. In making this determination, the central inquiry is whether the Veteran’s service-connected disabilities, alone, are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In this case at hand, when considering the additional and higher ratings that have been granted earlier in this decision, since August 1, 2012, the Veteran has had the required 60 percent rating. This 60 percent rating is based on disabilities affecting a single body system – namely, orthopedic with a related neurological residual, and therefore they are considered in combination and for all intents and purposes as one disability ratable at 60 percent. Thus, his disabilities meet the schedular criteria for consideration of a TDIU since August 1, 2012 according to 38 C.F.R. § 4.16(a).   The Board also finds that a TDIU is warranted since August 1, 2012. The evidence reflects that the Veteran worked as a car mechanic for his career and, most recently, from 2000 to 2005 at one automobile repair shop. He has testified that his service-connected ankle disabilities began to become severe in the degree of pain around this time period, eventually leading to the need for the left ankle fusion in 2012. He has reported that, since the termination of his employment in 2005, he has not been able to work as a mechanic owing to the severity of his ankle disabilities, but especially his left ankle disability. His left ankle disability has resulted in falls and very limited mobility. He has reported that, briefly in 2012, he drove a car for his spouse’s employer. While the Veteran appears to be able to drive his personal car, there is no indication he is employable in the position as a driver in light of his ankle disabilities, certain not in the work he did previously as a mechanic. Moreover, on August 2019 VA examination, the examiner concluded the Veteran’s ankle disabilities significantly affected his ability to function in an occupational environment. His participation in sedentary work was also affected because of his trouble with standing from a seated position and ability to walk without assistance. To that extent, the record reflects that he has walked with the assistance of both a cane and walker at various points during the appeal period. Further in this regard, on June 2012 VA examination, the examiner also concluded that the Veteran’s ankle disabilities impacted his ability to work in that he could not do prolonged standing or walking, he could not squat or run, he has difficulty going up and down stairs, could not climb ladders, and had a severe falls risk, primarily due to his left ankle disability. The evidence also shows the Veteran’s report of considerable back pain stemming from his service-connected lumbar spine disability. When considering the extent of his ankle disabilities and lumbar spine disability, in light of his level of eduction, prior training and work experience, the Board finds that the criteria for a TDIU have been met since August 1, 2012.   11. An extension of the temporary total rating beyond August 1, 2012, based on the need for convalescence following the left ankle surgery, is now moot. Given that the Veteran is now in receipt of a 100 percent (i.e., total) rating for the entire appeal period – in light of the grant of a TDIU, and the fact that the grant of a TDIU was based in large part on his left ankle disability, the issue of his entitlement to a temporary total rating for this same disability beyond August 1, 2012, is moot. The Court has recognized that a 100 percent schedular disability rating means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a Veteran to be totally disabled due to a particular service-connected disability or combination of disabilities pursuant to the Rating Schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for a TDIU moot where 100 percent schedular rating was awarded for the same period). The Veteran's award of a total schedular rating is assigned based on the combination of all his service-connected conditions – albeit some more so than others, and no single disability is rated as 100-percent disabling. The Board is mindful of the Court's decision in Bradley v. Peake, 22 Vet. App. 280, 294 (2008), but as the issue before the Board does not include eligibility for special monthly compensation (SMC) or TDIU based exclusively on a single disability, this case is distinguishable from Bradley. Therefore, this 38 C.F.R. § 4.30 extension claim is moot as of August 1, 2012, when the TDIU takes effect.   REASONS FOR REMAND 1. Entitlement to a TDIU prior to January 17, 2012, is remanded. As already alluded to, from January 17, 2012 to August 1, 2012, the Veteran had temporary 100 percent convalescent rating under 38 C.F.R. § 4.30 as he recovered from his left ankle fusion surgery, and, as a result of this decision, he now has had a TDIU (so a de facto 100 percent rating) effectively since August 1, 2012. For the preceding period from December 9, 2008, to January 17, 2012, however, the Veteran’s service-connected disabilities do not meet the criteria for a TDIU on a schedular basis – meaning under § 4.16(a). However, the evidence suggests that his service-connected disabilities rendered him unemployable even during this earlier period, so this claim must be referred to the Director of the Compensation Service for extra-schedular TDIU consideration during this earlier period under the special provisions of § 4.16(b). Although the Board cannot grant a TDIU on an extra-schedular basis in the first instance, the Board must determine whether this referral for extra-schedular consideration is warranted to have the Director of the Compensation Service, instead, make this initial determination. See Barringer v. Peake, 22 Vet. App. 242 (2008). See also Bagwell v. Brown, 9 Vet. App. 237, 238-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995); and VAOPGCPREC 6-96 (August 16, 1996). But, by the same token, consider also that the Director's eventual decision is not evidence, but, rather, the de facto decision of the Agency of Original Jurisdiction (AOJ0, and if unfavorable the Board must conduct de novo review of this decision. See Wages v. McDonald, 27 Vet. App. 233, 238-39 (2015) (holding that the Board conducts de novo review of the Director's decision denying extra-schedular consideration). The Court since has reaffirmed that the Board has jurisdiction to review the entirety of the Director's decision denying or granting an extra-schedular rating and elaborated that the Board is authorized to assign an extra-schedular rating when appropriate. Kuppamala v. McDonald, 27 Vet. App. 447 (2015). Although the Board is required to obtain the Compensation Service Director's decision before awarding extra-schedular TDIU benefits, the Board is not bound by the Director's decision or otherwise limited in its scope of review of that determination. Wages, 27 Vet. App. at 236-38 (2015) (citing 38 U.S.C. §§ 511(a), 7104(a); 38 C.F.R. § 4.16(b)). Accordingly, this TDIU claim (to this extent) is REMANDED for the following action: Refer the Veteran’s claim for a TDIU from December 9, 2008, to January 17, 2012, to the Director of the Compensation Service pursuant to the provisions of § 4.16(b) for consideration of whether this benefit is warranted alternatively on an extra-schedular basis. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Erdheim 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.