Citation Nr: 21062446 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 14-17 222 DATE: October 7, 2021 ORDER Entitlement to a 30 percent rating, but no higher, for residuals of a right knee strain from June 1, 2008 to September 1, 2009 is granted. Entitlement to a 60 percent rating, but no higher, for total right knee replacement with degenerative joint disease from November 1, 2010 to March 3, 2013 is granted. Entitlement to a rating of total disability due to individual unemployability based upon service-connected disorders (TDIU) effective November 1, 2010, but no earlier and subject to controlling laws and regulations governing monetary awards, is granted. FINDINGS OF FACT 1. For the appeal period from June 1, 2008 to September 1, 2009, the Veteran's residuals of a right knee strain manifested as severe instability without flexion limited to 45 degrees or extension limited to 10 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, ankylosis, subluxation, malunion or nonunion of the tibia and fibula or genu recurvatum. 2. For the appeal period from November 1, 2010 to March 3, 2013, the Veteran's total right knee replacement with degenerative joint disease has manifested in chronic residuals consisting of severe painful motion or weakness in the affected extremity; this is the maximum schedular rating available. 3. The Veteran has been unable to obtain and maintain gainful employment since November 1, 2010. CONCLUSIONS OF LAW 1. The criteria for a 30 percent rating, but no higher, for residuals of a right knee strain from June 1, 2008 to September 1, 2009 have been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.14.14, 4.71a, Diagnostic Code 5257. 2. The criteria for a 60 percent rating, but no higher, for total right knee replacement with degenerative joint disease from November 1, 2010 to March 3, 2013 have been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.14.14, 4.68, 4.71a, Diagnostic Code 5055. 3. The criteria for entitlement to a TDIU, effective November 1, 2010 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1977 to June 1980 and from February 1981 to April 1990. The Veteran also has additional service with the Army Reserves. These matters are before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran's claims were previously before the Board on March 24, 2016 and October 15, 2018at both times, the claims were remanded for further development. As of March 24, 2016, the Veteran's right knee (for which he has continuously prosecuted claims for higher ratings) was rated as 10 percent disabling from June 1, 2008 to September 1, 2009, and 30 percent thereafter. The Veteran had already been granted a temporary total disability rating from March 31, 2008 until May 31, 2008. On October 15, 2018, the Board granted the Veteran a third temporary total rating from March 4, 2013 to April 30, 2014. 38 C.F.R. § 4.30. The Veteran was also previously awarded a temporary total rating from September 2, 2009 to October 31, 2010. Subsequent to the last remand, the Veteran was awarded a 60 percent rating for his right knee status post-replacement effective May 1, 2014. See Rating Decision (Apr. 24, 2020). This is a maximum grant of the benefit on appeal from that date, and there is no alternative diagnostic code that better approximates the Veteran's right knee post-replacement and that could afford a more advantageous rating. 38 C.F.R. § 4.71a, Diagnostic Code 5055. The Board concludes that because the 60 percent rating since June 10, 2017 represents a full grant of the benefit sought, that portion of the appeal is no longer in appellate status. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); See 38 C.F.R. § 4.68. Additionally, the April 24, 2020 rating decision granted TDIU effective May 1, 2014, but also specifically denied TDIU on an extraschedular basis prior to that date. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board asserts jurisdiction of TDIU for the appeal period prior to May 1, 2014 and the previous denial of TDIU on an extraschedular basis in this rating decision confirms that the Board would not be adjudicating this claim in the first instance. The issue of entitlement to higher ratings for the right knee also raises the issue of derivative entitlement to special monthly compensation under 38 U.S.C. § 1114(s). VA has a duty to maximize benefits and policy to consider entitlement to special monthly compensation where applicable. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); AB, 6 Vet. App. 35 at 38; Bradley v. Peake, 22 Vet. App. 280 (2008). See also 38 C.F.R. § 3.103(a) (noting VA's obligation to "render a decision which grants every benefit that can be supported in law"). In this case, there is no competent or credible evidence of record suggesting entitlement to special monthly compensation, and the Veteran has made no such argument. Aside from the right knee disorder, the rest of the Veteran's disability picture is only 20 percent10 percent each for a right hip and right ulna nerve entrapment, and other noncompensable service-connected disorders. There is no evidence or argument that the Veteran requires the aid and attendance of another, nor that he is permanently housebound due to service-connected disorders. As higher ratings are available from June 1, 2008 to September 1, 2009 (for the right knee prior to replacement) and from November 1, 2010 to March 3, 2013 (post-replacement), and to the extent that TDIU may be awarded effective an earlier date, see Rice, supra, these issues remain on appeal, for the Veteran is presumed to seek the maximum available benefits. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Pursuant to these issues, the Veteran was issued a Supplemental Statement of the Case (SSOC) on April 24, 2020. The Board concludes that the Veteran has been afforded substantial compliance with all previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Finally, the Board notes that the Veteran's representative requested the status of the Veteran's appeal and indicated that they had not received any correspondence from the Board regarding the appeals in a June 2021 letter. In July 2021, the Board provided an update regarding the status of the Veteran's appeals as well as a copy of the Board docketing letter to the Veteran's representative. For reasons to be more thoroughly explained below, the Board grants increased ratings for the Veteran's knee to 30 percent pre-replacement (from June 1, 2009 to September 1, 2009) and 60 percent post-replacement (from November 1, 2010 to March 3, 2013). As explained previously, for all other appellate periods, the Veteran is either in receipt of a maximum rating under Diagnostic Code 5055 (which is only applicable after knee replacement), or else he has already been awarded a temporary total rating recovering from a right knee surgery, 38 C.F.R. § 4.30as has already been awarded from (1) March 31, 2008 until May 31, 2008; (2) September 2, 2009 until October 31, 2010; and (3) March 4, 2013 to April 30, 2014. The Board's awarding of a 60 percent rating for the Veteran's right knee post-replacement effective November 1, 2010 is a full grant under Diagnostic Code 5055. This yields the Veteran's schedular eligibility effective that date, and the Board further grants TDIU effective that date as well, but no earlier. The Board has jurisdiction over TDIU on an extraschedular basis, but as the preponderance of the evidence precludes such an entitlement, that portion of the claim is denied. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable Diagnostic Code, any additional functional loss the veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). 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. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims. The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran's case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Prior to February 7, 2021, under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg. The amended Diagnostic Code 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability. For recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A maximum 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) provides that, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) provides hat a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as a surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. The Board notes that this rating criteria was not changed under the revised rating criteria effective February 7, 2021. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Board notes that this rating criteria was not changed under the revised rating criteria effective February 7, 2021. For comparison, normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. See 38 C.F.R. § 4.71, Plate II. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Separate ratings can be assigned for the above knee disabilities (Diagnostic Codes 5257, 5258, 5259, 5260, and 5261) when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology. See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). Ratings can also be assigned for impairment of the tibia or fibula, removal of semilunar cartilage, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5259, 5262, 5263. As an initial matter, the Board notes that the evidence in this case does not reflect and the Veteran does not allege that he has tibia or fibula impairment, genu recurvatum, or ankylosis. As such, those diagnostic codes are not for application. Diagnostic Code 5055 contemplates a 100 percent rating for one year following the implantation of the prosthesis (i.e., the knee replacement surgery), and a 60 percent rating for chronic residuals consisting of severe painful motion or weakness in the affected extremity. A minimum rating of 30 percent is provided post knee replacement, and for intermediate degrees of residual weakness, pain, or limitation of motion, warranting a rating greater than 30 percent, but less than 60 percent, the code calls for rating by analogy to Diagnostic Code 5256, 5261, 5262. 1. Entitlement to a 30 percent rating, but no higher, for residuals of a right knee strain from June 1, 2008 to September 1, 2009 is granted. As indicated in the January 2014 examination, the Veteran claims that his right knee symptoms never improved. The evidence of record is at least evenly balanced to suggest that this is true. As a result, the Board resolves all reasonable doubt in the Veteran's favor and awards a 30 percent rating under Diagnostic Code 5257 from June 1, 2008 until September 1, 2009. This is the maximum schedular rating available for instability. With regards to limitation of flexion under Diagnostic Code 5260, the Board finds that a separate rating is not warranted at any time during the appeal period. In this regard, the Board notes that flexion measured 135 degrees, at worst, during the appeal period. Specifically, during the July 2008 VA examination, while the Veteran's observed initial range of motion testing showed 135 degrees of flexion and to 90 degrees on repetitive motion testing. The Veteran denied flare-ups in the July 2008 VA examination. To qualify for a compensable rating, the Veteran's flexion requires limitation to at least 45 degrees, which was not seen during the entire appeal period and there is simply no competent or credible evidence to suggest that this applies to the Veteran. Therefore, Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 45 degrees in the knee. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. With regards to limitation of extension under Diagnostic Code 5261, the Board notes that during the July 2008 VA examination, the Veteran's left knee extension was to zero degrees with no additional limitation of motion on repetitive use testing. The Veteran denied flare-ups in the July 2008 VA examination. To qualify for a compensable rating, the Veteran's extension requires limitation to at least zero degrees, which was not seen during the entire appeal period and there is simply no competent or credible evidence to suggest that this applies to the Veteran. Therefore, Board finds that such factors do not result in functional loss more nearly approximating extension limited to zero degrees in the knee. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. The Board has also considered whether the Veteran is entitled to any additional separate ratings for his residuals of a right knee strain status pre-replacement. The clinical evidence does not establish, and the Veteran has not alleged, ankylosis, impairment of the tibia or fibula, or genu recurvatum. Therefore, Diagnostic Codes 5256, 5258, 5259, 5262, and 5263 are not for application. To the extent that Diagnostic Codes 5258 or 5259 may otherwise apply for the Veteran meniscectomy, the Board concludes that the Veteran's knee is already rated under Diagnostic Code 5257. This is more advantageous to the Veteran, and awarding a separate rating for the same meniscal disability under Diagnostic Code 5258 or 5259 would constitute impermissible pyramiding. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court's holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. In this case, the July 2008 VA examination occurred before these holdings and hence contains partial information. The July 2008 VA examination measured active range of motion. Further, while such examination did not reflect passive range of motion testing, the evidence does not suggest, and the Veteran has not argued, that his range of motion in the right knee would be further limited in such capacity. In fact, as a general matter of course, active range of motion testing usually results in further limitation than passive range of motion testing. See Massie v. Shinseki, 25 Vet. App. 123, 131 (2011). Regarding repeated use over time and flare-ups, the Board notes that July 2008 VA examiner conducted repetitive-use testing and concluded that there was no additional limitation in range of motion that would push the Veteran's rating to a higher rating. In addition, the Veteran denied flare-ups in the July 2008 VA examination. There is no other indication from the record, to include the Veteran's own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. As the Veteran has not endorsed those symptoms, the Board finds the examination of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. To the extent that the Veteran and contends that his right knee disorder is more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his knee disability is of sufficient severity to warrant a higher evaluation under VA's rating schedule because such an opinion requires medical expertise (training in evaluating musculoskeletal impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board has considered whether a further staged rating under Hart, supra is appropriate; however, the Board finds that the remainder of his symptomatology has been stable throughout each period on appeal. Therefore, assigning a staged rating is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Ultimately, while the Veteran claims that his right knee disability never improved despite surgeries, the Board must ultimately decide whether his right knee instability prior to replacement manifested in severe, moderate, or mild recurrent subluxation or lateral instability. Resolving all reasonable doubt in the Veteran's favor, the Board concludes that a 30 percent is warranted for severe instability from June 1, 2008 to September 1, 2009. To this extent only, this portion of the claim is granted. To the extent that higher ratings may exist in excess of 30 percent prior to September 2, 2009, the Board concludes that as the preponderance of the evidence is against such an additional finding, that portion of the claim is denied. Prior to right knee replacement, there is no further doubt to resolve. 2. Entitlement to a 60 percent rating, but no higher, for a total right knee replacement with degenerative joint disease from November 1, 2010 to March 3, 2013 is granted. The Veteran generally contends that his right knee disabilities (pre- and post-replacement) have been more severe than for which he has previously been compensated. The Board is in receipt of previous VA examinations dated July 17, 2008, March 9, 2012, and January 25, 2014. The Veteran had a third surgery, revising the arthroplasty. See VA Exam (Jan. 25, 2014), at Question no. 2 ("Veteran underwent 3 surgeries (1st knee scope, 2nd knee arthroplasty, 3rd revision knee arthroplasty) Symptoms did not improve with this treatment."). The Board concludes that the Veteran is competent to testify that his right knee symptomatology did not improve, and that a revision to the arthroplasty was required. Ultimately, prior to this Board decision, the Veteran's right knee status post-replacement was rated as 60 percent disabling effective May 1, 2014 onlyin other words, after the revision to his arthroplasty, and third documented knee surgery as pertaining to his claims on appeal. Resolving all reasonable doubt in the Veteran's favor, the Board accepts the Veteran's statements that if the first arthroplasty did not improve his symptoms, the revision was required because his symptoms were consistently severe since the first knee replacement. As indicated previously, the Veteran receives a maximum grant of the benefit sought effective May 1, 2014. The Board now awards the same 60 percent rating from November 1, 2010 until March 3, 2013. This represents a maximum grant of the benefit sought, 38 C.F.R. § 4.71a, Diagnostic Code 5055, Grantham, 114 F.3d at 1156. In addition, the amputation rule would preclude a rating in excess of 60 percent. 38 C.F.R. § 4.68. 3. Entitlement to a TDIU effective November 1, 2010, but no earlier and subject to controlling laws and regulations governing monetary awards, is granted. The Veteran generally contends that TDIU is warranted specifically due to his total knee replacement. By way of background, this benefit has been granted by the AOJ in an April 2020 rating decision for this exact reason effective May 1, 2014. See VA Form 21-8940 (rec'd Jan. 17, 2012; Dec. 9, 2013). As delineated above, as the Board grants a 60 percent rating since November 1, 2010, the Veteran satisfies the schedular criteria for a TDIU for this period of time as well. As such, the Board has jurisdiction to grant entitlement to a TDIU in the first instance on a schedular basis. See Rice v. Shinseki, 22 Vet. App. 447 (2009); 38 C.F.R. § 4.16; Rating Decision (Apr. 24, 2020), supra. The Board once again notes that from March 31, 2008 until May 31, 2008; from September 2, 2009 until October 31, 2010; and from March 4, 2013 until April 30, 2014, the Veteran's right knee is rated as 100 percent disabling (a higher benefit than TDIU); therefore, these portions of the claim for a TDIU are dismissed as moot. 38 U.S.C. § 7105(d)(5); 38 C.F.R. §§ 20.202, 20.204. Also, there is no competent or credible evidence or argument that the Veteran is entitled to special monthly compensation at any time on appeal. In short, the Veteran now satisfies the schedular criteria for a TDIU effective November 1, 2010, for the same reason as detailed in the April 2020 rating decision, but now earlier than May 1, 2014. The Board therefore grants TDIU effective November 1, 2010, but no earlier and subject to controlling laws and regulations governing monetary awards. However, the preponderance of the evidence of record precludes the Board from finding that TDIU is warranted on an extraschedular basis; therefore, that portion of the claim for a TDIU is denied prior to September 2, 2009. 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. 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). Individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). As noted in Bradley v. Peake, 22 Vet. App. 280 (2008), VA must consider a TDIU claim despite the existence of a schedular total rating, and award special monthly compensation under 38 U.S.C. § 1114(s) if VA finds the separate disability supports a TDIU independent of the other 100 percent rating. This does not apply to this Veteran's case, because aside from his right knee disability, the remainder of his service-connected disability picture is only 20 percent disabling. 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. It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Id. at § 4.16(b). In this case, the Veteran has been entitled to schedular consideration throughout the appeal period. Id. at § 4.16(a). The key question at issue is whether the Veteran's service-connected disabilities, in and of themselves, have rendered him unable to secure or follow gainful employment at any time during the period under review. It is not in serious dispute that the Veteran was alternately employed as a laborer or cook until April 2008, and that his unemployability is attributed to his knee replacement. The Board resolves all doubt in the Veteran's favor and determines that his right knee disorder alone renders the Veteran unemployable, and that he is entitled to a TDIU effective November 1, 2010. This TDIU award now coincides with the Veteran's 60 percent rating for his total right knee replacement with degenerative joint disease, 38 C.F.R. § 4.71a, Diagnostic Code 5055. Both of these awards are effective upon expiration of a temporary total disability rating from the first arthroplasty conducted September 2, 2009. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board now shifts its focus to whether the Veteran is entitled to TDIU on an extraschedular basis prior to September 2, 2009. Before the Veteran underwent a total knee replacement of the right knee, and excluding periods of temporary total disability (in other words, from June 1, 2008 to September 1, 2009 only), his service-connected disability picture was as follows: right knee lateral instability, 30 percent; a secondary right hip disorder, 10 percent; a right ulna nerve impingement, 10 percent. This yields a total rating of 40 percent. 38 C.F.R. § 4.25. During this time, the Veteran had neither (a) one disorder 60 percent disabling, or (b) one disorder 40 percent disabling with a total disability picture of 70 percent. 38 C.F.R. § 4.16(a). Accordingly, entitlement to a schedular TDIU could not have been granted prior to September 2, 2009. However, TDIU may also be considered on an extraschedular basis. If a veteran does not meet the applicable percentage standards set forth in 38 C.F.R. § 4.16(a), the issue of entitlement to a TDIU may be submitted to the Director of the Compensation Service for extraschedular consideration where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b); Fanning v. Brown, 4 Vet. App. 225 (1993). The Board does not have the authority to assign an extraschedular TDIU rating in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). An extraschedular rating is requested by the RO and approved by the Director of the Compensation Service. 38 C.F.R. § 4.16(b). For the reasons below, the Board accordingly concludes that the evidence of record is simply not at least evenly balanced to grant the sought benefit. Even though the Board may remand a potential claim for extraschedular TDIU for submission to the Director of Compensation Service, the Board declines to do so in this instance, because further development would unnecessarily impose additional burdens upon the Board with no reasonable possibility of any benefit flowing to the Veteran. Soyini v. Derwinski, 1 Vet. App. 540 (1991). The Board acknowledges a vocational assessment by P.C., submitted on the Veteran's behalf and received on August 29, 2016. See Vocation Assessment (rec'd Aug. 29, 2016 ). The report suggests that the replaced right knee and nerve entrapment alone cause service-connected unemployability. However, the replaced knee is now 60 percent disabling throughout the period on appeal; therefore, the report is silent as to whether any combination of the Veteran's right knee pre-replacement, right hip, and nerve entrapment disorders (but excluding all other disorders) alone cause unemployability any earlier than September 2, 2009. The Board has reviewed the remainder of the Veteran's claims file, and evidence of record confirms that he was enrolled in vocational rehabilitation at a local community college from May 2009 until August 2009, in pursuit of new employment as a radiographic technician. See VR&E (rec'd June 7, 2017 ). The Board notes in passing that less than one month later, the Veteran would undergo knee replacement. Vocational Rehabilitation Counselor (VRC) "A's" notes confirm that the Veteran dropped out of school and his file was placed in "interrupted status" on December 29, 2010shortly after one of his convalescent ratings expired. See id. A's notes further confirm that fellow VRC "M" discussed with the Veteran a plan to resume vocational rehabilitation; however, "on May 17, 2012[, the Veteran] advised on that date that his physical disabilities had worsened and he did not feel emotionally or physically stable enough to participate in services." See id. The Board does not intend to in any way diminish the severity of the Veteran's disabilities, nor the impact they have on him and his family. Instead, the Board simply notes that the Veteran appears to be adequately compensated by his disabilities prior to September 2, 2009. The Board interprets the Veteran's contemporaneous account as memorialized by VRC's to mean that before the Veteran required a knee replacement, he was able to follow vocational rehabilitation curriculum, but only after his knee replacement did he become truly unemployable due to service-connected disabilities (albeit on a schedular basis that has already been granted). Indeed, effective November 1, 2010 (but not earlier, due to an intervening period of temporary total disability), the Veteran is in receipt of a TDIU as the Board has already determined that then, and not earlier than then, the Veteran's service-connected disorders (without considering the effects of non-service-connected disorders) render him unemployable. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. The Board grants entitlement to a TDIU on a schedular basis, effective September 2, 2009 and the appeal is granted to that extent. However, the preponderance of the evidence is against the Veteran's claim of entitlement to TDIU on an extraschedular basis prior to September 2, 2009. To that extent, the appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael B. Engle, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.