Citation Nr: 21064047 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 13-16 433 DATE: October 18, 2021 ORDER For the entire appeal period, entitlement to a 40 percent rating for service-connected degenerative disc disease of the lumbar spine (lumbar spine disability or DDD) is granted. Entitlement to a rating in excess of 20 percent for service-connected left lower extremity radiculopathy with nerve impingement (LLE radiculopathy) is denied. Entitlement to a rating in excess of 30 percent prior to May 26, 2021 for service-connected sinusitis is denied. Entitlement to a rating in excess of 50 percent on and after May 26, 2021 for service-connected sinusitis is denied. Entitlement to a rating in excess of 10 percent for service-connected right knee, chondromalacia, oblique tear of the medial meniscus (right knee instability) prior to February 7, 2021 is denied. On and after February 7, 2021, a rating of 20 percent for service-connected right knee instability is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to April 1, 2021 is granted. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's service-connected lumbar spine DDD manifests in 30 degrees of flexion when considering additional functional loss, but does not manifest more nearly in unfavorable ankylosis or incapacitating episodes. 2. The Veteran's service-connected LLE radiculopathy is more nearly manifested by moderate incomplete paralysis. 3. Prior to May 26, 2021, the Veteran's service-connected sinusitis is not more nearly manifested by near-constant sinusitis or a history of chronic osteomyelitis. 4. On and after May 26, 2021, there is no higher evaluation contemplated for the Veteran's service-connected sinusitis. 5. Prior to February 7, 2021, right knee instability is more nearly manifested by mild instability. 6. On and after February 7, 2021, right knee instability more nearly approximates a sprained ligament with a prescription for a brace. 7. The Veteran's service-connected disabilities cause him to be unemployable prior to April 1, 2021. CONCLUSIONS OF LAW 1. The criteria for a rating of 40 percent, but no higher, for service-connected lumbar spine DDD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5243. 2. The criteria for a disability rating in excess of 20 percent for service-connected LLE radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 3. Prior to May 26, 2021, the criteria for a rating in excess of 30 percent service-connected sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6514. 4. On and after May 26, 2021, the criteria for a rating in excess of 50 percent service-connected sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6514. 5. Prior to February 7, 2021, the criteria for a rating in excess of 10 percent for right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 6. Effective February 7, 2021, the criteria for a rating in excess of 20 percent, but no higher, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 7. Prior to April 1, 2021, the criteria for entitlement to TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1983 to February 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. The issues on appeal were remanded in May 2019 and in January 2021. See BVA Decision (May 2019); BVA Decision (January 2021). The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In May 2019, the Board remanded the issues to obtain current VA examinations, current VA treatment records, and authorizations for a private provider. See BVA Decision (May 2019). VA records were obtained. See CAPRI (August 2019); CAPRI (September 2019). Current examinations were obtained. See C&P Exam (December 2019). Authorizations were requested from the Veteran; he notified VA there were no such records. See Subsequent Development Letter (January 2020); VA 27-0820 Report of General Information (February 2020). The remand directives were thus substantially met. Dyment v. West, 13 Vet. App. 141 (1999). In January 2021, the Board remanded for current VA treatment records, authorizations for private treatment providers, a current lumbar spine examination, and retroactive opinions regarding the lumbar spine. See BVA Decision (January 2021). A current VA examination and retroactive opinions were obtained. See C&P Exam (April 2021); C&P Exam (April 2021). More recent VA treatment record were obtained. See CAPRI (April 2021). The RO sent a request for authorizations for private providers. See Subsequent Development Letter (February 2021). No response from the Veteran was received. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that VA's duty to assist is a two-way street, and the Veteran cannot wait passively in those situations where his assistance to VA is necessary). The Board thus finds that the remand directives have been substantially met. Dyment, 13 Vet. App. 141 (1999). During remand status, TDIU was granted, effective April 1, 2021. See Rating Decision (July 2021). It was not, however, granted for the entire appeal period. It remains on appeal for the period prior to April 1, 2021 as the award does not represent a full grant of the benefit sought on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). See also Harper v. Wilkie, 30 Vet. App. 345 (2018) (where the RO grants a TDIU that does not span the entire period on appeal, the issue of entitlement to a TDIU for an earlier period is still on appeal and should be addressed by the Board). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. Although the Veteran's representative asserted entitlement to extraschedular evaluations, this was a general statement without asserting any specific symptoms regarding a specific disability. The evidence does not, however, suggest such consideration is necessary. 1. Entitlement to a 40 percent rating, but no higher, for service-connected lumbar spine disability, is granted. The Veteran contends that he is entitled to a higher rating because he has constant back pain, including radiating pain. See Hearing Transcript (October 2018). He describes that it is difficult to get moving in the morning, and he is unable to do many activities as it hurts to sit or stand too long, and it hurts to bend. See Hearing Transcript (October 2018); VA 21-4138 Statement in Support of Claim (August 2019); NOD (April 2011). The Veteran reported muscle spasms, excess fatigability, and that he wears a back brace and utilizes a cane. See Hearing Transcript (October 2018). Additionally, he asserts he has bladder problems due to his service-connected lumbar spine disability. See Hearing Transcript (October 2018). The Board finds that the preponderance of the evidence indicates that the lumbar spine disability is manifested by 30 degrees of flexion when considering additional functional impairment, and thus a 40 percent evaluation is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.71, General Rating Formula. The criteria for evaluating spine disabilities were amended effective September 23, 2002, September 26, 2003, and February 7, 2021. Only the 2021 amendment is applicable herein. The Veteran's lumbar spine DDD is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, for intervertebral disc syndrome (IVDS). Diagnostic Code 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. Effective February 7, 2021, Diagnostic Code 5243 was amended to read: "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses." The substance of the applicable DCs did not change. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note 1. Under the General Rating Formula for Diseases and Injuries of the Spine, 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 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. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Unfavorable ankylosis is a condition in which the entire thoracolumbar spine is fixed in flexion or extension and the ankylosis results in one or more of the following: difficulty walking due to a limited line of vision, restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurological symptoms due to nerve root stretching. Fixation of spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See General Rating Formula, Note 5. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. See General Rating Formula, Note 1. Notably, the Veteran is separately service-connected for left lower extremity nerve impingement, beginning in September 2010. See Rating Decision (April 2011). The Veteran did not appeal the 10 percent evaluation assigned after the 2011 rating decision; rather, he filed a claim for an increased evaluation in March 2014. See VA 21-526EZ, Fully Developed Claim (March 2014). This was later denied, and the Veteran appealed. See Rating Decision (July 2014); NOD (October 2014). Eventually, a 20 percent evaluation was assigned. See Rating Decision (August 2016); SOC (August 2016); Form 9 (September 2016). Thus, the issue of an increased evaluation for the left lower extremity is separately on appeal and is addressed later within this decision. The Veteran is also separately service-connected for right lower extremity radiculopathy as part of the service-connected lumbar spine DDD, effective in October 2019. See Rating Decision (December 2019). The Veteran has not appealed the evaluation of that service-connected disability; that issue is thus not on appeal. However, whether a right lower extremity neurological disability as due to the lumbar spine DDD was present during the appeal period prior to October 2019 is part and parcel of the increased rating claim and is addressed below. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.] The Board finds that the preponderance of the evidence supports a 40 percent evaluation for the entire appeal period. The preponderance of the evidence shows forward flexion of the thoracolumbar spine to 30 degrees when considering additional functional loss. In the November 2010, June 2014, October 2019 VA examination reports, flexion was noted to be 100 degrees or 90 degrees due to pain, 65 degrees, and 70 degrees, or 60 degrees with repetitive use or flare-ups, respectively. See VA Examination (November 2010); CAPRI (September 2019); C&P Exam (December 2019). In April 2021, a VA examination report noted flexion to 40 degrees and 30 degrees due to repeated use over time or flare-ups. See C&P Exam (April 2021). The April 2021 VA examiner provided an estimate that upon review of the 2014 and 2019 VA examinations, and considering repetitive use and flare-ups, flexion would be limited to 30 degrees. See C&P Exam (April 2021). Based on this, flexion is limited to 30 degrees at least as early as the 2014 VA examination. Resolving all doubt in favor of the Veteran, the Board finds that this applies prior to the 2014 VA examination. The 2010 VA examiner found flexion to 90 degrees due to pain, without additional limitation of motion upon repetition. See VA Examination (November 2010). The examiner noted, however, that further activities could exacerbate the Veteran's pain, but it was not feasible to discuss this in terms of limitation of motion, as this cannot be accurately assessed during a single medical examination. See VA Examination (November 2010). VA medical records during this time period, however, indicate that in June 2011, the Veteran went to the emergency room for back pain and received pain medication. Another 2011 VA record noted that the Veteran was unable to walk more than a mile, and his pain was aggravated by standing or sitting more than 30 minutes. See CAPRI (April 2013). 2012 VA records indicate that the Veteran loses sleep at night due to pain. See CAPRI (April 2013). A 2013 VA record noted moderate DDD. See CAPRI (December 2014). The Board finds that the evidence thus supports that upon repetitive use over time, flexion would be limited to 30 degrees. Accordingly, a 40 percent is assigned for the entire period on appeal. The Board also finds that the preponderance of the evidence is against a rating in excess of 40 percent. First, the evidence of record does not show unfavorable ankylosis, which requires not only spine fixation, but other additional effects. See General Rating Formula, Note (5). Here, each of the VA examinations notes either some range of motion or that there is no ankylosis. See VA Examination (November 2010); CAPRI (July 2014); C&P Exam (December 2019); C&P Exam (April 2021). The Board acknowledges the Veteran's lay reports of functional impairment due to pain and other lumbar spine symptoms, such as that he was limited in walking, and prolonged sitting and standing was not possible. See NOD 9 (April 2011); Medical Treatment Record Government Facility (October 2012); CAPRI (April 2013); CAPRI (September 2014); CAPRI (May 2017); CAPRI (August 2019); CAPRI (September 2019); CAPRI (August 2020). At the Board hearing, he reported functional impairment with less movement than normal, weakened movement, pain on movement, disturbance of locomotion, and interference with sitting, standing, and weightbearing. See Hearing Transcript (October 2018). However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating unfavorable ankylosis of the lumbar spine, which is evidenced by the examiner's estimate of how that functional loss would affect his range of motion. See C&P Exam (April 2021). Accordingly, the General Rating Criteria does not provide for an evaluation in excess of 40 percent. Second, the preponderance of the evidence is also against a rating in excess of 40 percent based on incapacitating episodes. In the 2019 and 2021 VA examinations, the Veteran reported treatment, but no physician-ordered bed rest. The examiners noted there was no physician-ordered bed rest. See C&P Exam (April 2021); C&P Exam (October 2019). Medical records dated from 2009 to the present do not indicate physician-ordered bed rest. See e.g., CAPRI (April 2013); CAPRI (July 2014); CAPRI (May 2017); CAPRI (August 2019); CAPRI (September 2019); CAPRI (August 2020). Although the Veteran alleged incapacitating episodes at the Board hearing, he did not note any physician-ordered bed rest, or otherwise describe what he meant by this statement. See Hearing Transcript (October 2018). Accordingly, no higher evaluation is warranted under these criteria. Regarding the revised criteria effective February 7, 2021, the Board finds that this does not change the analysis. The disability is assessed under both the General Rating Criteria and the Formula for Rating IVDS, and the substance of both has not changed. See 38 C.F.R. § 4.71a. Regarding neurological impairment, as noted above, any symptoms of the left lower extremity are considered separately. Regarding the right lower extremity, the Board will consider evidence prior to October 21, 2019. In the November 2010 VA examination, the Veteran did not report right lower extremity symptoms. There was 5/5 strength of the lower extremity and normal reflexes. See VA Examination (November 2010). In the 2014 VA examination, the Veteran did not report right lower extremity radiculopathy signs or symptoms. There were hypoactive reflexes but normal sensation throughout. Straight leg raising test was negative. The examiner concluded that there was no right-side radiculopathy. See CAPRI (July 2014). VA and private treatment records dated prior to October 2019 show complaints of occasional right foot numbness or right leg pain in 2011, 2015, and 2018. See CAPRI (August 2019); Medical Treatment Record Non-Government Facility (November 2018); CAPRI (April 2013). Despite occasional complaints related to the right lower extremity, the Veteran did not consistently report leg symptoms such as he did for the left extremity. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Additionally, the objective evidence, including testing and medical opinions, show that there was no right lower extremity radiculopathy. Accordingly, no separate evaluation for right lower extremity neurological impairment is warranted. In October 2018, the Veteran asserted that he had possible bladder impairment. See Hearing Transcript (October 2018). However, in VA treatment records dated in 2011, 2014, 2015, 2018, and 2019, and 2021, the Veteran denied all bowel and bladder impairment. See CAPRI (April 2013); CAPRI (August 2019); CAPRI (September 2019); CAPRI (April 2021). Although the Veteran is competent to report such symptoms, the Board finds that the consistent nature of his statements in the medical treatment records both prior to the 2018 hearing and after, are more credible, and thus, are assigned more probative value. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge); Caluza, 7 Vet. App. at 511. The Board therefore finds that the evidence of record supports a finding that there are no bowel or bladder neurological symptoms related to the service-connected lumbar spine DDD. No separate evaluation on this basis is warranted. A 40 percent rating for the entire appeal period is assigned herein and for the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 40 percent for a lumbar spine disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a rating in excess of 20 percent for service-connected left lower extremity radiculopathy is denied. The Veteran contends that he is entitled to a higher rating based on pain radiating into his left lower extremity and left foot drop. See Hearing Transcript (October 2018); NOD (April 2011). The Board finds that the preponderance of the evidence demonstrates moderate incomplete paralysis, but not moderately severe incomplete paralysis of the sciatic nerve. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). In 2014 VA records, the Veteran reported low back pain that radiated to the left side. See CAPRI (December 2014). At the June 2014 VA examination, the Veteran reported pain that radiated down the left leg. See CAPRI (September 2019). There was 5/5 muscle strength without atrophy. There were reduced reflexes, but normal sensation and a negative straight leg raise test. The examiner found mild paresthesias and/or dysesthesias and numbness, but no intermittent pain or constant pain. The examiner found there was mild radiculopathy. See CAPRI (September 2019). In November 2016, the Veteran reported numbness and tingling in his hips and the LLE due to nerve impingement. See CAPRI (August 2019). In October and December 2017, he reported pain radiating into his left leg. He also reported numbness in the lateral aspect of his left lower extremity all the way to his toes, left foot drop while walking, and weakness. See CAPRI (August 2019). In February, March, May, and July 2018, the Veteran reported pain that radiated down his left leg to his foot. See CAPRI (August 2019). He also reported the pain was burning and sharp, and there was numbness and tingling. See CAPRI (August 2019). In a November 2018 private record, the Veteran reported left leg pain. See Medical Treatment Record Non-Government Facility (November 2018). In a March 2019 VA record, the Veteran reported pain that radiated down his left leg to his foot. See CAPRI (August 2019). At the October 2019 VA examination, the Veteran reported shooting pain to the legs and toes and tingling at night on the left side. See C&P Exam (October 2019). There was full strength and no muscle atrophy, but reduced reflexes and a positive straight leg raise test. There was normal sensation. The examiner found mild constant pain, moderate intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness with no other signs or symptoms of the radiculopathy. See C&P Exam (October 2019). In a November 2020 VA record, the Veteran reported pain that radiated down his left leg to the toes. There was a positive straight leg raise test. See CAPRI (April 2021). In December 2020, there was low back pain and numbness and tingling. See CAPRI (April 2021). In March 2021, a VA clinician noted poor endurance, and weakness in the hip flexors and extensors. See CAPRI (April 2021). In April 2021, the Veteran reported pain that radiated into the left leg. See CAPRI (April 2021). At the April 2021 VA examination, the examiner found reduced reflexes of the left ankle, but normal reflexes at the knee. There was normal sensation at the upper anterior thigh and thigh/knee, but decreased sensation at the lower leg/ankle, and foot/toes. There was full muscle strength of the entire left lower extremity without muscle atrophy. The examiner found moderate intermittent pain, moderate paresthesias and/or dysthesias, and moderate numbness. See C&P Exam (April 2021). Based on the above, the Board finds that the disability is more accurately characterized as moderate, rather than moderately severe. The evidence of record demonstrates lay and medical evidence of pain in the left lower extremity, and reduced reflexes, moderate numbness, and tingling. The evidence also shows, however, full muscle strength and normal sensation. Although the Veteran reported foot drop, the evidence of record did not support such a finding, and although he is competent to report feelings of foot weakness, the examiners found full strength throughout the period on appeal. See Washington, 19 Vet. App. at 368; Caluza, 7 Vet. App. at 511. Lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The etiology of a foot drop, however, is not susceptible to lay observation and requires medical knowledge as to disease processes and their likely causes, which the Veteran is not shown to possess. See Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 20 percent for left lower extremity radiculopathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an evaluation in excess of 30 percent prior to April 1, 2021, for service-connected sinusitis is denied. The Veteran contends he is entitled to a higher evaluation for his sinusitis as he has constant symptoms and infections about 2 to 3 times per year. See NOD (April 2011). The Board finds that the preponderance of the evidence does not support a finding of chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, DC 6514. The Veteran's sinusitis is evaluated under the General Rating Formula for Sinusitis. See 38 C.F.R. § 4.97, DC 6514. A 30 percent evaluation contemplates three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. See 38 C.F.R. § 4.97, DC 6514. A 50 percent evaluation is assigned following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. See 38 C.F.R. § 4.97, DC 6514. An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. See 38 C.F.R. § 4.97, General Rating Formula for Sinusitis, Note. In a May 2010 VA treatment record, the Veteran reported a history of chronic sinusitis. See Medical Treatment Record Government Facility (October 2010). In a January 2011 VA examination, the Veteran reported that his current treatment consisted of nasal spray and medication. The Veteran reported a medical history of incapacitating episodes that did not require 4 to 6 weeks of antibiotic treatment. The Veteran reported a history of non-incapacitating episodes, to include headache, fever, purulent drainage, and sinus pain. He has at least four episodes per year that lasted 5 or 6 days. His current rhinitis symptoms included nasal congestion, excess nasal mucus, watery eyes. He also gets headaches and sinus pain several times per year, but less than monthly. He had missed work due to the sinusitis. The examiner noted there was no history of osteomyelitis. Upon examination, there was tenderness and evidence of active disease. There was 60% left nasal obstruction and 60% right nasal obstruction without nasal polyps. There was septal deviation due to trauma, permanent hypertrophy of turbinates from bacterial rhinitis. There were significant effects on his usual occupation due to lack of stamina, weakness or fatigue, and pain. See VA Examination (January 2011). In an October 2011 VA record, the Veteran reported headache related to sinusitis. See CAPRI (April 2013). In February 2012, the Veteran reported daily sinus problems. In April 2012 record, the Veteran reported sinus drainage of 3 days. See CAPRI (April 2013). In a June 2012 VA record, the Veteran reported congestion, but denied sinus tenderness and pressure. There was no radiographic evidence of sinusitis but there was turbinate mucosal thickening/edema. See CAPRI (April 2013). In December 2013 VA record, this was noted that the Veteran had chronic sinusitis. There was tenderness of the maxillary sinus. See CAPRI (April 2013). In a June 2014 VA examination, the Veteran stated his sinusitis had worsened. He reported he had sinusitis 3 to 4 times per year and usually gets antibiotics each time. He reported tenderness and pressure in the maxillary sinuses, postnasal drip and cough, but denied fever and discharge. The Veteran reported non-incapacitating episodes characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. The examiner noted there was episodes of sinusitis, but not near-constant sinusitis. The examiner noted there was tenderness of the affected sinus, but reported there was no discharge, although there was postnasal drip. See CAPRI (September 2019). In a February 2015 VA record, the Veteran reported left side face pain due to sinus infection. See CAPRI (September 2019). In an October 2019 VA examination report, the Veteran noted his nose was dry and it bleeds at times. The examiner found there was no sinusitis, but there was allergic rhinitis. The examiner found there was no greater than 50% obstruction of the nasal passage on both sides, no complete obstruction on the right or left side, no permanent hypertrophy of the nasal turbinates, nasal polyps, or granulomatous conditions. See C&P Exam (December 2019). The Board finds that an evaluation in excess of 30 percent is not warranted. The evidence does not demonstrate chronic osteomyelitis or near-constant sinusitis, as noted by the 2011 and 2014 VA examiners. The Veteran has reported a history of non-incapacitating episodes, to include headache and sinus pain. The Veteran, however, has not reported near-constant sinusitis; rather, he has multiple episodes per year which were reported as 3 or 4 episodes per year. Accordingly, the criteria for a 50 percent evaluation are not warranted. All potentially applicable diagnostic codes have been considered. Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991) (holding that the Board must consider all potentially applicable regulatory provisions). Here, however, rhinitis is not service-connected. Even if it were, the evidence does not show rhinoscleroma or Wegener's granulomatous. See 38 C.F.R. § 4.97, Diagnostic Code 6523, 6524. Additionally, allergic rhinitis does not provide for an evaluation in excess of 30 percent. See 38 C.F.R. § 4.97, Diagnostic Code 6522. Accordingly, no higher evaluation is warranted. The claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). 4. Entitlement to an evaluation in excess of 50 percent, on and after April 1, 2021, for service-connected sinusitis is denied. The Veteran asserts that his sinusitis is worse than the evaluation assigned as he has constant symptoms. See NOD (April 2011). The Board finds that an evaluation in excess of 50 percent is not for assignment, as no such evaluation is provided for under the rating criteria. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, DC 6514. Here, the General Rating Formula for Sinusitis does not provide for an evaluation in excess of 50 percent. See 38 C.F.R. § 4.97, DC 6514. Accordingly, no higher evaluation is warranted. All potentially applicable diagnostic codes have been considered. Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991) (holding that the Board must consider all potentially applicable regulatory provisions). Here, however, rhinitis is not service-connected. Even if it were, the evidence does not show rhinoscleroma. See 38 C.F.R. § 4.97, Diagnostic Code 6524. Additionally, the diagnostic codes for bacterial rhinitis and allergic rhinitis do not provide for an evaluation in excess of 50 percent. See 38 C.F.R. § 4.97, Diagnostic Codes 6522, 6523. Accordingly, no higher evaluation is warranted. 5. Entitlement to a rating in excess of 10 percent for service-connected right knee instability prior to February 7, 2021 is denied; a 20 percent evaluation is granted on and after February 7, 2021. The Veteran contends that he is entitled to a higher rating because he experiences right knee instability and give-way. See Hearing Transcript (October 2018). The Board finds that the preponderance of the evidence demonstrates that prior to February 7, 2021, there is right knee slight, but not moderate, instability. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5257. On and after February 7, 2021, there is right knee instability that more nearly approximates a sprained ligament with a prescription for a brace. See 38 C.F.R. § 4.71a, DC 5257. Initially, the Board notes that the Veteran is in receipt of three separate evaluations for her service-connected right knee disability. In a May 1999 rating decision, the RO granted service connection for right knee chondromalacia, and assigned a zero percent evaluation under Diagnostic Code 5299-5259, effective November 7, 1998. See Rating Decision (May 1999). In a January 2003 rating decision, that evaluation was increased to 10 percent, effective July 26, 2001. See Rating Decision (January 2003). In a February 2009 rating decision, the RO denied an increased evaluation for right knee chondromalacia. The RO also granted service connection for right knee instability, and assigned a 10 percent evaluation under DC 5257, effective November 6, 2008. See Rating Decision (February 2009). In a July 2014 rating decision, the RO denied an increased evaluation for right knee instability. See Rating Decision (July 2014). The Veteran appealed. See NOD (October 2014); SOC (August 2016); Form 9 (September 2016). In a March 2015 rating decision, the RO noted that it had committed error in the February 2009 rating decision, stating that it could not assign separate evaluations under DCs 5257 and 5259, but because a 10 percent evaluation was warranted under DC 5260 for pain on flexion, DC 5299-5259 was changed to 5259-5260 to avoid pyramiding with the evaluation under 5257 for instability. See Rating Decision Codesheet (March 2015). In a July 2021 rating decision, as part of the issue on appeal, the RO granted service connection for right knee limitation of extension under DC 5261, and assigned a zero percent rating, effective May 26, 2001. See Rating Decision (July 2021). Thus, there are three evaluations. Only the evaluation for instability is on appeal. The percentage assigned to the separate evaluation for limitation of extension has not been separately appealed; because it was granted during the processing of this appeal, whether an evaluation on this basis is warranted prior to May 26, 2021 is on appeal. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991) (holding that the Board must consider all potentially applicable regulatory provisions). No evaluation under Diagnostic Code 5260 will be considered herein, as it is not on appeal. The Veteran's right knee instability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5257, for other impairment of the knee. 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 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 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 that 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).] The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for right knee instability. The Board has carefully considered the Veteran's reports about instability. English, 30 Vet. App. 347, 352-53. The Veteran reported grinding, instability, and give-way, but not locking. See Hearing Transcript (October 2018). He stated he normally walked with a cane due to the instability. See Hearing Transcript (October 2018). The Veteran has reported popping when he walks. See CAPRI (September 2019). He has also reported aching, pain, and swelling. The Veteran stated his right knee is unstable at times and he felt like he could fall. See C&P Exam (May 2021). VA treatment records show complaints of pain, instability, subluxation, and give-way in 2015 and 2016. See CAPRI (September 2019); CAPRI (August 2016). However, overall, the lay and medical evidence indicates that the symptoms have varied and do not suggest the presence of symptoms more nearly approximating moderate severity. Here, a 2014 VA examiner found there was no objective evidence of instability; anterior, posterior, lateral, or medial. See CAPRI (September 2019). The examiner noted there was no evidence or history of recurrent patellar subluxation/dislocation. See CAPRI (September 2019). In April 2015, a VA clinician diagnosed right patellar instability and patellar subluxation, based on objective testing. See CAPRI (September 2019). The October 2019 VA examiner found there was no history of recurrent subluxation or lateral instability. There was also no current instability of the knee; anterior, posterior, medial, or lateral. See C&P Exam (October 2019). The 2021 VA examiner found there was no recurrent patellar instability, but there was slight recurrent subluxation. The examiner also found there was normal anterior and posterior instability, but medial instability of 1+ and lateral instability was 1+, or zero to 5 millimeters. See C&P Exam (May 2021). Thus, at points during the appeal period, there was instability and subluxation, while at times objective testing often showed no instability. This more nearly approximates mild instability. Accordingly, an evaluation in excess of 10 percent is not for assignment. Effective February 7, 2021, the Board finds that the preponderance of the evidence supports a rating of 20 percent for right knee instability. The Board has carefully considered the Veteran's reports of instability. See English, 30 Vet. App. 347, 352-53. In a 2008 VA examination report, it was noted that a 2005 MRI of the knee showed a tear of the posterior horn of the medial meniscus. The VA examiner diagnosed a mild ACL strain and meniscus derangement. See VA Examination (November 2008). In 2015, the Veteran requested a new knee brace. See CAPRI (August 2016). In October 2015, a hinged knee brace to increase stability was issued to the Veteran by VA. See CAPRI (May 2017). The Board finds that under the amended rating criteria, the preponderance of the evidence demonstrates that the right knee instability more nearly approximately a sprained ligament with a prescription for a brace. A 20 percent evaluation is thus for assignment. No higher evaluation was warranted because the evidence did not show a complete ligament tear. See 38 C.F.R. § 4.71a, DC 5257. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). As noted above, a separate or higher evaluation under Diagnostic Code 5260 will not be addressed. As for a separate or higher evaluation under DC 5261, prior to May 26, 2021, the Board finds that the evidence of record does not support such an evaluation. At the June 2014 and 2019 VA examinations, right knee extension was to zero degrees, or full extension. See C&P Exam (December 2019); CAPRI (September 2019). There was no additional limitation of motion upon repetitive use or flare-ups. See C&P Exam (December 2019); CAPRI (September 2019). The Veteran denied flare-ups at the 2014 VA examination. See CAPRI (September 2019). Although the Veteran reported significant knee pain, this element is part of the 10 percent evaluation assigned for right knee limitation of flexion under DC 5260, and thus is not considered herein. See Rating Decision Codesheet (March 2015); 38 C.F.R. § 4.14. Accordingly, the Board finds that a higher or separate evaluation is not for assignment for limitation of extension. The Board finds that higher or separate evaluations were not for assignment under DCs 5258 or 5259 as there was not removal of the semilunar cartilage or frequent episodes of locking. See 38 C.F.R. § 4.71a, DCs 5258, 5259. Finally, the evidence of record has not demonstrated any right knee ankylosis, genu recurvatum, impairment of the tibia and fibula. See 38 C.F.R. § 4.71a, DCs 5256, 5262, 5263. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for instability prior to February 7, 2021. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Thereafter, a 20 percent evaluation, but no higher, is warranted. TDIU VA will grant TDIU when the evidence shows that a veteran is precluded, by reason of service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. TDIU is granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. If there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. 38 C.F.R. § 4.16(a). If there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Being unable to secure and follow a substantially gainful occupation has two components: One economic and one noneconomic. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16. The claimant is not required to show 100 percent unemployability; the question is whether he or she is unable to pursue a substantially gainful occupation. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). Whether the veteran can actually find employment is not determinative, as the focus of the inquiry is on "whether the veteran is capable of performing the physical and mental acts required by employment." Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (emphasis in original). For VA purposes, the term unemployability is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2,317 (Jan. 21, 1992). Consideration may be given to the veteran's education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose, 4 Vet. App. at 363. The ability to work sporadically or obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16(a). 6. Entitlement to TDIU prior to April 1, 2021 is granted. The Veteran asserted that he last worked in March 2012 and resigned due to his service-connected disabilities. See VA 21-4192 Request for Employment Information in Connection with Claim for Disability (October 2016). In 2011, he noted that in his job he had to sit and walk a lot, which he could no longer do. See NOD (April 2011). In various records in 2011, 2012, 2015, and 2018, the Veteran reported worsening pain with activity and with sitting. See CAPRI (August 2019); CAPRI (May 2017); CAPRI (April 2013). The Board finds that TDIU is warranted prior to April 2021, as the preponderance of the evidence demonstrates that the Veteran is unemployable due to his service-connected disabilities. As a result of this decision, service connection is in effect for the following disabilities since 2010 when the Veteran filed a claim for increased evaluations for his service-connected lumbar spine disability and sinusitis: lumbar spine DDD at 40%; sinusitis at 30%; left lower extremity radiculopathy at 10%, effective September 28, 2010, and 20%, effective March 28, 2014; right knee chondromalacia at 10%; right knee instability at 10% and 20% effective February 7, 2021; and several noncompensable evaluations for residuals of a nasal fracture, right knee surgical scars, and right knee limitation of extension. See Rating Decision Codesheet (July 2021). For the time period on appeal, the Veteran's combined disability evaluation is 70%. Thus, the percentage requirements for a TDIU are met because the Veteran has two or more service-connected disabilities, one of which is rated as 40 percent disabling, and his combined disability evaluation is at least 70 percent. 38 C.F.R. § 4.16 (a). In a November 2010 VA spine examination, the Veteran reported his spine and left lower extremity radiculopathy affected his ability to perform his job as a revenue officer. See VA Examination (November 2010). In a January 2011 VA sinus examination, the Veteran reported he worked for the IRS in the Collections Department for the last 1 to 2 years. He reported he had lost 4 days of work due to sinusitis during the previous year. The examiner concluded that sinusitis has significant effects (increased absenteeism) on occupation due to lack of stamina, weakness or fatigue, and pain. See VA Examination (January 2011). In 2011, the Veteran reported that he was currently unable to perform activities of his job description including prolonged sitting, standing, and walking, due to back pain. See CAPRI (September 2019). In 2012, the Veteran stated he was not able to work due to the inability to stand or sit for extended periods of time and that he could not lift more than 25 pounds. See CAPRI (April 2013). In an April 2013 VA Vocational Rehabilitation (VR) document, the Veteran reported working as a police officer from 1999-2008 but that he left that employment as it aggravated his disabilities. He then worked in the field as a revenue officer from 2009 to 2012 for the IRS, which was also quite active and required carrying heavy case files. See VA Form 28-1902b, Counseling Record-Narrative Report (April 2013). He was currently working on an associate degree in Criminal Justice. See VA Form 28-1902b, Counseling Record-Narrative Report (April 2013). The report noted that the Veteran had extensive work history in corrections, but with his physical limitations due to service-connected disabilities, that field would not be available to him. The VR counselor noted limitations in work tolerance and work skills, and a lack of education. See VA Form 28-1902b, Counseling Record-Narrative Report (April 2013). Another VR document noted that the Veteran was not able to work in the area in which he had training and experience, and without a degree, the Veteran was not competitive in many other areas. See VR&E-General (April 2013). In a June 2014 VA examination, the Veteran reported he had difficulty while working at the IRS due to his back. See CAPRI (September 2019). At June 2014 VA knee and sinus examinations, the examiners found that the knee instability and sinusitis did not impact the Veteran's ability to work. See CAPRI (September 2019). In a January 2018 medical record, a private physician stated that they did not anticipate the Veteran being able to do law enforcement work again due to his service-connected lumbar spine and left leg disabilities. See Medical Treatment Record Non-Government Facility (November 2018). In a March 2018 VA record, the Veteran reported he was currently unemployed but was actively seeking employment that did not require hard labor, noting that he was a formerly trained law-enforcement officer. See CAPRI (August 2019). In an October 2019 VA spine examination, the examiner opined that the Veteran was suitable only for a sedentary job or a light physical job and that strenuous and moderate activity would be limited. The examiner noted that the Veteran could not stand or walk more than 10 minutes and could not bend over without pain. See C&P Exam (December 2019). In an October 2019 VA knee examination, the examiner found that the knee disability impacted the Veteran's occupational abilities as he could run or stand for more than 15 minutes without pain. See C&P Exam (December 2019). An October 2019 VA sinus examiner found that this disability did not have any impact on the Veteran's ability to work. See C&P Exam (December 2019). In a July 2021 VA peripheral nerve examination, the examiner opined that the Veteran would not perform well with a manual labor job nor a sedentary job because he cannot sit for long periods of time due to the back pain and radiculopathy. See C&P Exam (July 2021). The 2021 VA knee examination report concluded much the same. See C&P Exam (July 2021). The Board finds that TDIU is warranted. The Veteran has consistently reported that his lumbar spine pain, left lower extremity pain, and knee pain cause him to be unable to work. The Board finds these statements competent and credible as they are capable of lay observation and are supported by a finding of significant functional impairment as demonstrated by the evaluations assigned to the service-connected disabilities. See Washington, 19 Vet. App. at 368; Caluza, 7 Vet. App. at 511. Additionally, the Veteran's relevant work history includes mostly active jobs or manual labor, such as a police officer or IRS collections department field officer. The Veteran does not have a college degree. Thus, he is most likely qualified for jobs that would require some level of activity. A private physician in 2018 determined that the Veteran could not obtain a job in his field of experience due to his back and lower extremity disabilities. See Medical Treatment Record Non-Government Facility (November 2018). The July 2021 VA examiner is the first examiner who opined that the Veteran would not be able to work in a sedentary job or a manual labor. See C&P Exam (July 2021). The Board notes, however, that throughout the period on appeal, the Veteran's disabilities are rated at the same level as they are in July 2021. In 2011, a VA examiner noted that sinusitis had significant effects, including absenteeism, on employment due to a lack of stamina, weakness, fatigue, and pain. See VA Examination (January 2011). The Board finds that the combination of the significant functional impairment due to the Veteran's lumbar spine disability, left lower extremity radiculopathy, right knee disabilities, and the sinusitis, the Veteran is not able to obtain or maintain the type of employment consistent with his education and work history. Accordingly, the claim is granted. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.