Citation Nr: 21063145 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 16-21 396 DATE: October 13, 2021 ORDER Entitlement to an increased disability rating greater than 20 percent for lumbar spine arthritis with degenerative disc disease (DDD) prior to December 21, 2015 is denied. Entitlement to an increased disability rating of 20 percent, but no higher, for lumbar spine arthritis from December 21, 2015 is granted. Entitlement to an increased initial disability rating of 20 percent, but no higher, for left lower extremity radiculopathy is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. During the entire appeal period, the Veteran's lumbar spine arthritis was manifested by additional functional loss more closely approximating forward flexion to greater than 30 degrees but not greater than 60 degrees. It was not manifested by functional loss more closely approximating forward flexion limited to 30 degrees or less, ankylosis, or incapacitating episodes requiring bed rest prescribed by a physician. 2. The Veteran's left lower extremity radiculopathy was manifested by moderate incomplete paralysis. It was not manifested by moderately severe incomplete paralysis. 3. The preponderance of the competent and probative evidence of record does not demonstrate that the Veteran was unable to obtain or maintain employment solely due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating greater than 20 percent for lumbar spine arthritis prior to December 21, 2015 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2019); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243 (2020). 2. The criteria for an increased disability rating of 20 percent, but no higher, for lumbar spine arthritis from December 21, 2015 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2019); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243 (2020). 3. The criteria for an initial disability rating of 20 percent, but no higher, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2019); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2020). 4. The criteria for entitlement to TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2019); 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1981 to August 1997. He appeals an August 2014 rating decision denying entitlement to ratings greater than 10 percent for both lumbar spine arthritis and left lower extremity radiculopathy. During the appeal, the AOJ increased the Veteran's lumbar spine arthritis rating to 20 percent, prior to December 21, 2015 and decreased it to 10 percent thereafter. See March 2016 rating decision. Also before the Board of Veterans' Appeals (Board) is the Veteran's appeal of the September 2014 rating decision denying entitlement to TDIU. A Board hearing was held in January 2021. A transcript is of record. In March 2021, the Board remanded these claims for further development. They are now back before the Board. As a preliminary matter, the Board remanded in March 2021, in part, to obtain private medical treatment records identified by the Veteran at the January 2021 Board hearing. In April and May 2021, the AOJ sent development letters to the Veteran specifically asking for the contact information of Dr. S. and Dr. D. and requested the Veteran submit the appropriate forms so the AOJ could request these pertinent records. The Veteran did not respond to these letters; thus, the AOJ was unable to request these private treatment records. The Board finds the AOJ complied with its duty to assist the Veteran in obtaining his private treatment records with the two subsequent development letters. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (the duty to assist is not a one-way street). As such, there has been substantial compliance with the Board's remand directives, and the Veteran's claims can be adjudicated. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Increased Rating Disability ratings are determined by applying a schedule of ratings based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. When considering the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Also, when there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Lumbar Spine Arthritis with DDD The Veteran claims his lumbar spine condition is more severe than his disability rating under Diagnostic Code (DC) 5243 would indicate. See 38 C.F.R. § 4.71a, DC 5243. For the appeal period, the Veteran is currently rated under DC 5243 at 20 percent prior to December 21, 2015 and 10 percent thereafter. As a preliminary matter, the regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. Generally, claims pending prior to the effective date will be considered under both old and new rating criteria from that date, and whatever criteria is more favorable to the Veteran will be applied from the effective date of the change. Here, however, the Veteran's lumbar spine arthritis is rated under DC 5243 and the General Rating Formula for Diseases and Injuries of the Spine (General Formula) did not change under the revised regulations. As such, the rating criteria for the Veteran's lumbar spine arthritis is unchanged and the Board will proceed with adjudication. Under 38 C.F.R. § 4.71a, all spinal disabilities are evaluated under the General Formula. If the Veteran has Intervertebral Disc Syndrome (IVDS), he may also be evaluated under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Here, although the record reflects the Veteran has IVDS, any compensable rating under the IVDS Formula requires physician prescribed bedrest, for which there is no medical evidence in the record. Therefore, as the Veteran is not entitled to a compensable rating under the IVDS Formula, he will be rated solely under the General Formula. The pertinent criteria under the General Formula are as follows: A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, a combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. See 38 C.F.R. § 4.71a General Formula. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Id. at note (5) (defining ankylosis as fixation of a joint in a particular position). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, or flare-ups is demonstrated, and those factors are not contemplated in the relevant rating criteria See DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. This includes any functional loss resulting in the equivalent of ankylosis during flareups or with repeated use over time. See Chavis v. McDonough, 34 Vet. App. 1 (2021). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors such as decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement. Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Of record are five VA examinations conducted during the appeal period. At the April 2014, December 2015, September 2019, and August 2021 VA examinations, the Veteran had full movement of his lumbar spine with the only exception being minimal decreases in lateral flexion and rotation at the April 2014 VA examination. Full range of motion for forward flexion is 90 degrees. The March 2017 VA examination was the only instance where the Veteran's forward flexion was limited, to 85 degrees, and his combined range of motion was 205 degrees. The Veteran exhibited pain on most movement and had no loss of motion after repetitive testing on all examinations. Thus, based solely on the Veteran's range of motion, he would not be entitled to an increased rating. However, the Board must also consider whether any functional loss due to pain, weakness, fatigability, incoordination during flare-ups or with repeated use over time warrants a higher rating. See DeLuca, 8 Vet. App. at 204-07; see also 38 C.F.R. §§ 4.40, 4.45, 4.59. The Veteran noted he suffers from flareups where he has severe, incapacitating pain. See, e.g., May 2016 VA Form 9. He stated flareups occur one to two times a week and last several hours to a full day. See March 2017 and August 2021 VA examination reports. Generally, he contends flareups occur with any activity, such as lifting, bending, sitting, and standing and walking for long periods. See December 2015, March 2017, and August 2021 VA examination reports. The April 2014 VA examiner estimated the Veteran's functional loss due to flareups and with repeated use over time resulted in a decrease of 40 degrees of flexion; this would manifest in forward flexion limited to 50 degrees during flareups and with repeated use over time. This estimation is the most restricted movement estimated by any physician. For example, the December 2015 and August 2021 VA examiner estimated the Veteran's functional loss during flareups and with repeated use due to pain caused an estimated decrease in all movement by 5 degrees. The March 2017 VA examiner noted the Veteran was suffering from a flareup at the examination and his forward flexion was only reduced to 85 degrees. The September 2019 VA examiner stated the Veteran had no additional functional loss during flareups or with repeated use over time; thus, this examination is not probative in this regard as it contradicts the Veteran's competent statements and prior VA examination reports. See Sharp, 29 Vet. App. at 35. Additionally, the Veteran's private treatment records do not reflect the Veteran's functional loss during flareups or with repeated use. See August 2014 NeoSpine treatment records (normal range of motion); January 2015 Urgent Care Treatment Records (full range of motion). As such, the Veteran's most restricted estimated movement during flareups and with repeated use over time is forward flexion limited to 50 degrees. This more closely reflects the rating criteria for a 20 percent rating as his forward flexion was greater than 30 percent but not greater than 60 percent. Additionally, the Veteran complained of muscle spasms and MRI reports reflect the Veteran suffers from lumbar scoliosis. See, e.g. January 2015 Urgent Care Treatment Records (thoracic muscle spasms); March 2017 VA examination report ("low back spasms level five out of ten"); December 2016 VA treatment records ("slightly increased scoliosis"); June 2019 VA treatment records ("scoliosis of the lumbar spine"). For instance, a September 2015 letter from the Veteran's treating physician noted the Veteran's "sciatica, left leg numbness, and muscle spasms [are] so severe he has been forced to seek emergency room care" and the record reflects the Veteran walks with an antalgic gait. See, e.g., June 2014 WestSound Orthopaedics. Thus, the record reflects the Veteran also meets the criteria for a 20 percent rating during the appeal period with muscle spasms severe enough to result in an abnormal gait or scoliosis. However, the record does not suggest the Veteran is entitled to a rating greater than 20 percent at any point in the appeal period as the next highest rating, 40 percent, requires forward flexion limited to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. As stated above, ankylosis would require the Veteran's lumbar spine to be immobile and completely fixated in a particular position. Even during flareups and with repeated use, the Veteran's testimony reflects he has at least some movement of his spine. Additionally, the Veteran contends the "multitude of emergency room visits...are sufficient evidence of the severity of" his lumbar spine condition, but these records and others do not reflect his forward flexion was limited to 30 degrees or less. See May 2016 VA Form 9; see also January 2015 Urgent Care treatment records. Overall, the record does not reflect the Veteran's forward flexion was limited to 30 degrees or less at any point in the appeal period, even by estimation of functional loss during flareups or with repeated use over time. Thus, the Board finds the Veteran is not entitled to an increased rating greater than 20 percent for his service-connected lumbar spine arthritis prior to December 21, 2015. His lumbar spine arthritis is, however, entitled to a 20 percent rating, but no higher, from December 21, 2015. Left Lower Extremity Radiculopathy Pursuant to Note (1) of the General Formula, VA is to evaluate any associated objective neurologic abnormalities separately under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, DC 5242, Note (1). The Veteran does not report any bowel or bladder problems. See, e.g., April 2014 and August 2021 VA examination reports. Additionally, the Veteran has continuously pursued his claim for entitlement to an increased initial rating greater than 10 percent for his service-connected left lower extremity radiculopathy rated under 38 C.F.R. § 4.124a, DC 8520. The Board notes the Veteran is also service connected for right lower extremity radiculopathy, but he has made no contention regarding the initial rating; therefore, the Board will only discuss the left lower extremity rating. See, e.g., May 2016 VA Form 9 ("sciatica left leg/lower spine"); March 2021 Board Hearing Tr. (no mention of right lower extremity radiculopathy). Under DC 8520, mild incomplete paralysis of the sciatic nerve warrants a 10 percent disability rating, moderate incomplete paralysis warrants a 20 percent disability rating, moderately severe incomplete paralysis warrants a 40 percent rating, and severe incomplete paralysis with marked muscle atrophy warrants a 60 percent disability rating. See 38 C.F.R. § 4.124a, DC 8520. An 80 percent disability rating is warranted for complete paralysis, where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. Id. Descriptive words such as "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all the evidence for "equitable and just decisions." See 38 C.F.R. § 4.6. However, when the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" in 38 C.F.R. § 4.124(a). For the left lower extremity, the Veteran testified he has constant tingling and numbness in his left lower extremity with an occasional "sharp shooting pain" that causes him to "lose all strength" and "drop to [his] knees." See January 2021 Board Hearing Tr. at 6. At the April 2014 VA examination, the VA examiner noted the Veteran had severe intermittent pain, but had full muscle strength with normal reflexes and sensation testing. As the April 2014 VA examiner found no other radicular symptoms, he concluded the Veteran's radiculopathy was moderate in severity. After review of the record, the Board agrees, the Veteran's radicular symptoms more closely approximate moderate incomplete paralysis and not moderately severe incomplete paralysis. For example, June 2014 WestSound Orthopaedics records reflect the Veteran was treated for intermittent, not constant, pain that was "stabbing and sharp." Upon examination, his physician noted intact muscle strength, reflexes, and "sensation except for diminished sensation...to proprioception and vibration." Additionally, all VA examinations of record note the Veteran has full muscle strength despite his testimony noting a loss of muscle tone. Id. at 7; see also August 2021 VA examination report. The March 2017 VA examiner noted hyperactive knee reflexes and decreased sensory testing in the lower leg, ankle, foot, and toes. The September 2019 VA examiner noted hypoactive ankle reflexes and decreased sensation in only the foot and toes. Finally, the August 2021 VA examiner noted hypoactive reflexes of the knees and ankles, but the left lower extremity had normal sensation in the entire leg. Importantly, no VA examiner noted the Veteran suffered from moderately severe or severe incomplete paralysis. Overall, the Veteran reports paresthesiases and numbness which VA examiners have noted is mild in severity along with intermittent severe pain; this more closely reflects moderate incomplete paralysis. Accordingly, the Board grants entitlement to an increased initial disability rating of 20 percent, but no higher, for left lower extremity radiculopathy. See Gilbert, 1 Vet. App. at 55-57; 38 C.F.R. § 3.102. TDIU The issue of entitlement to TDIU has been raised in this case and will be considered by the Board for the entire appeal period. See Rice v. Shinseki, 22 Vet. App. 447, 453-55 (2009); see also Harper v. Wilkie, 30 Vet. App. 356, 361 (2018). Total disability will be considered to exist where there presently is any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. See 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. Specifically, if there is only one such disability, this disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the stated purpose of one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system, such as orthopedic, or stemming from the same common etiology are considered one disability for TDIU purposes. 38 C.F.R. § 4.16(a)(2). When the percentage requirements are not met, entitlement to TDIU may be considered on an extraschedular basis. 38 C.F.R. § 4.16(b). However, the Board does not have the authority to assign extra-schedular TDIU in the first instance, but it may determine whether the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disabilities and then refer the issue to the Director of the Compensation Service, for a determination in the first instance as to whether the Veteran is entitled to TDIU on an extra-schedular basis under 38 C.F.R. § 4.16(b). See Bowling v. Principi, 15 Vet. App. 1 (2001). Prior to August 12, 2015, the Veteran did not meet the 38 C.F.R. § 4.16(a) threshold requirement for entitlement to TDIU on a schedular basis as his combined disability rating was rated at 60 percent, pursuant to the Order above. During this time, he was service connected for the following: (1) right shoulder condition rated at 10 percent prior to July 24, 2015 and 20 percent thereafter; (2) lumbar spine condition rated at 20 percent disabling; (3) left lower extremity radiculopathy rated at 20 percent disabling; (4) right lower extremity radiculopathy rated at 10 percent disabling; and, (5) hypertension rated at 10 percent, along with numerous other noncompensable service-connected disabilities. See October 2019 rating decision codesheet. The Veteran did not meet the schedular requirement for TDIU and the Board finds a referral for extra-schedular consideration by the Director of the Compensation Service is not warranted as the record reflects the Veteran was working for most of the appeal period prior to August 12, 2015 and the record does not reflect his service-connected disabilities rendered him unable to obtain or maintain substantial employment. For example, the Veteran submitted a September 2015 VA Form 21-8940 noting he was still working fulltime for Lockheed Martin. A second VA Form 21-8940 submitted on November 2015 reflects the Veteran stopped working in June 2015. Additionally, the record reflects the Veteran sought an initial claim for disability with the Social Security Administration (SSA) in September 2015 noting he last worked fulltime in June 2015. That month, the Veteran also applied for VA Vocational Rehabilitation and Employment (VR&E) services. Finally, in September 2015, the Veteran's manager submitted a letter to VA on behalf of the Veteran noting the Veteran was still working, despite his absenteeism due to his shoulder and back conditions. See September 2015 M.D. correspondence. Based on the analysis below, and the fact that the Veteran was substantially employed, referral for extra-schedular consideration of TDIU prior to August 12, 2015 is not warranted. From August 12, 2015, the Veteran was provided an initial rating of 20 percent for a left shoulder condition, increasing the Veteran's combined rating to 70 percent, with a combined rating for orthopedic conditions at least 40 percent. Thus, the Veteran meets the schedular requirement from August 12, 2015 and the narrow issue before the Board is whether the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities from August 12, 2015. In determining whether a veteran can secure, follow, and maintain a substantially gainful occupation, the Board must consider: (1) the Veteran's occupational history, education, skill, and training; (2) whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the Veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). To determine whether TDIU is warranted, the Board must conduct a holistic and individualized assessment of the veteran. See Withers v. Wilkie, 30 Vet. App. 139, 142 (2018). Ultimately, the responsibility for making a TDIU determination is placed on the adjudicator and not a medical clinician. See Geib v. Shinseki, 733 F.3d 1350, 1354 (2013). The record reflects the Veteran's career in the Air Force was with a military occupational specialty (MOS) of aircraft communication and navigation system craftsman. During service, the Veteran received associate degrees in electronic technology and avionics systems technology, and a bachelor's degree in business administration and management, finishing his education in 1997. See SSA records (resume). After service, the record reflects the Veteran held two managerial positions, and two electrician and maintenance positions before working as a missile electronics technician as a military contractor with Lockheed Martin. Id. (work history report). The Veteran worked at this position from June 2004 until his retirement in 2015. Id. He also testified to having "a whole bunch of post military training in hazardous waste separation [and] management," "a lot of advanced training," and noted he taught on issues surrounding hazardous waste at the University of Alaska. See January 2021 Board Hearing Tr. at 14. Thus, the record reflects the Veteran has the education, background, and experience to work in numerous skilled positions, in addition to any labor or customer service position. The Veteran, himself, testified he was employable and, in September 2015, noted he was able to return to his previous employer "in a different capacity." See January 2021 Board Hearing Tr. at 14; see also September 2015 VA Form 28-1902w. The Veteran's symptoms regarding his lumbar spine and radiculopathy symptoms are noted in detail above and prohibit any manual labor or position that required prolonged standing, walking, lifting, or running. See Marcy 2017 and August 2021 VA examination reports. The March 2017 VA examiner noted the Veteran could not work in manual labor, "but he could perform supervisory work" in such a field for which he is trained. Additionally, the September 2019 VA examiner noted the Veteran was limited to "light duty or sedentary work with no heaving lifting... [and he] must be permitted to change position as needed for comfort." The Veteran's education and work history reflects the ability to work in a typical office position, especially in an electronics technician, military contractor, or aviation-specific field. The Veteran's symptoms regarding his bilateral shoulder conditions include pain, muscle spasms, and significantly limited range of motion. See, e.g., August 2015 Bremerton Naval Hospital (BNH) records; September 2019 VA examination report. During flareups, the record reflects the Veteran cannot lift his left shoulder above 90 degrees, or shoulder level, due to pain and weakness. See December 2017 VA examination report. Both the December 2017 and September 2019 VA examiners noted the Veteran was limited to light duty and office-type work that precluded heavy lifting and any overhead work or repetitive motion with his shoulders. The December 2017 VA examiner additionally noted the Veteran had "trouble with prolonged writing" and was "limited with gripping or grasping." Importantly, the Veteran did not mention either of his shoulder conditions impaired his ability to work at the January 2021 Board hearing or during his September 2015 VA VR&E counseling session. Thus, while the Veteran's shoulder conditions would prevent him from any physical labor work, the record does not suggest his physical conditions prevent him from maintaining any managerial or office position in a field for which he is amply qualified. The Veteran also contends he cannot work due to the medication he is required to take for his shoulder and back pain. See August 2014 and September 2015 Veteran correspondence. Specifically, the Veteran stated he missed more than one third of his work schedule towards the end of his employment with Lockheed Martin due to his inability to perform his duties while on pain medication. Id. In September 2015, a treating physician stated the Veteran was prescribed oxycodone and muscle relaxants for his bilateral rotator cuff surgeries in 2008, which he was still prescribed and "prevented him from going to work as he should not drive nor operate heavy or complex machinery under their influence." See September 2015 Dr. A.M.L. letter. However, the record reflects the Veteran did, in fact, drive and work full time after his rotator cuff surgeries from 2008 until his retirement in 2015, despite him missing significant work towards the end of his employment. Additionally, the Veteran entered the VA VR&E program to obtain educational assistance for the "Troops to Teachers" program with the goal of becoming a high school teacher and no restrictions were noted regarding pain medication. See September 2015 VA Form 28-1902w. Finally, in September 2015, the Veteran's treating physician stated there was no medical reason the Veteran should not be employed or pursue his desire to teach, he was "currently capable of working full time," and he was not prescribed any medication that would prohibit work. See September 2015 Dr. J.A. medical assessment. Thus, the record overall does not reflect the Veteran is unable to work due to the medication required to manage his lumbar and shoulder pain. Further, the Veteran testified that half of the reason he cannot work is his service-connected back condition while "the other half is [his] ankles." See January 2021 Board Hearing Tr. at 15. During the Board hearing, the Veteran continuously noted his bilateral ankle condition was a primary source of his pain. See, e.g., January 2021 Board Hearing Tr. at 7 ("I can barely get up the hill to my driveway to my truck...it is just hard to do because of my ankles"); p.8 (cannot walk with his wife "because of the foot pain [that] transfers up to my back"); p.10 ("I have not asked [my treating physician] for any help on my back because I have always blamed it on my feet"); p.12 ("feet and lower extremities affect [the] back"); p.15. The Veteran's ankle conditions cannot be considered for entitlement to TDIU as he is not service connected for any ankle condition. Finally, SSA's December 2015 functional capacity assessment noted the Veteran could stand for a total of four hours and sit for a total of six hours a day with normal breaks. The Veteran noted he was unable to continue work at his most recent employment due to required tasks involving more lifting and carrying than his shoulders and back disabilities could handle. See December 2015 SSA functional capacity assessment. While the Veteran could not lift, carry, or perform manual labor tasks in any profession, the preponderance of the evidence reflects he has the education, training, and background to substantially work in any office-based position for which he is qualified. This includes positions in aviation technology, communications and navigation systems, and numerous other managerial positions. As such, the Board finds a referral for extra-schedular consideration by the Director of the Compensation Service is not warranted for the period prior to August 12, 2015 and the Veteran is also not entitled to TDIU from August 12, 2015. Thus, the Veteran's claim for entitlement to TDIU is denied. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.