Citation Nr: 21065328 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 18-45 076 DATE: October 25, 2021 ORDER Entitlement to a rating in excess of 10 percent for service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome, is denied. Entitlement to an initial compensable rating for service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome and limitation of flexion, is denied. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome, was manifested by pain, weakened movement, and fatigue, with mild flare-ups and slightly decreased muscle strength; there is no evidence of ankylosis, limitation of extension, impairment of the thigh, or flail joint. 2. Throughout the appeal period, the Veteran's service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome and limitation of flexion, was manifested by flexion limited to no less than 115 degrees, including as due to pain and weakness, after repetitive use, and during flare-ups. 3. The Veteran's service-connected disabilities do not prevent him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5299-5252. 2. The criteria for an initial compensable rating for service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome and limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5255. 3. The criteria for entitlement to TDIU have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This appeal arises from a May 2018 rating decision that continued a 10 percent rating for service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome, and granted a separate noncompensable (zero percent) rating for fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome and limitation of flexion, effective January 11, 2018. In July 2019, the Board denied both increased rating claims. The Veteran appealed the July 2019 decision to the United States Court of Appeals for Veterans Claims (Court). In May 2020, the Court granted a Joint Motion for Remand (JMR) wherein the parties agreed that the denial of both increased rating claims in the July 2019 decision should be vacated and the issues remanded for further development. In November 2020, the Board remanded the increased rating claims pursuant to the JMR and requested the Veteran be afforded an adequate VA examination. Review of the record reveals there has been substantial compliance with the November 2020 remand and, as a result, the claims have been returned to the Board for further consideration. Increased Rating 1. Entitlement to a rating in excess of 10 percent for service-connected fracture of right superior ischiopubic ramus and both inferior ischial rami with myofascial pain syndrome 2. Entitlement to an initial compensable rating for service-connected fracture of right superior ischiopubic ramus and both inferior ischial rami with myofascial pain syndrome and limitation of flexion In January 2018, the Veteran filed a claim seeking a total disability rating based upon individual unemployability due to his service-connected fracture of right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome disability (hereinafter referred to as service-connected right pelvis/hip disability"). See also February 2018 VA Form 21526EZ. The Veteran's TDIU claim was accepted to include a claim for an increased rating for the service-connected right pelvis/hip disability. As noted, in the May 2018 rating decision on appeal, the AOJ continued the 10 percent rating assigned for the service-connected right pelvis/hip disability under DC 5299-5255 and granted a separate noncompensable (zero percent) rating for fracture, right superior ischiopubic ramus and both inferior ischial rami with myofascial pain syndrome and limitation of flexion under DC 5252, effective January 11, 2018. This disability will hereinafter be referred to as service-connected right pelvis/hip limitation of flexion disability. In this context, the Board notes that, while the service-connected disability on appeal includes fracture of both inferior ischial rami, the AOJ also granted separate ratings for the symptoms and manifestations associated with the left hip disability, including painful, limited motion in the left pelvis/hip. The Veteran has not appealed the ratings assigned to the left hip disability. As such, this decision will only discuss the ratings warranted for the symptoms and manifestations associated with the right pelvis/hip disability. Therefore, the Board will consider whether a rating in excess of 10 percent is warranted for the service-connected right pelvis/hip disability from January 11, 2017, which includes the one-year look back period prior to the date of receipt of the TDIU claim and whether a compensable rating is warranted for the service-connected right pelvis/hip limitation of flexion disability from January 11, 2018, the date from which service connection is granted for that disability. As a final initial matter, the Board notes that portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, including DC 5255, under which the service-connected right pelvis/hip disability is currently evaluated. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021, and the criteria that is more favorable to the Veteran will be applied. Diagnostic Code 5255 evaluates impairment of the femur. Under the criteria in effect prior to February 7, 2021, for malunion of the femur, slight knee or hip disability warrants a 10 percent rating, moderate knee or hip disability warrants a 20 percent rating, and marked knee or hip disability warrants a 30 percent rating. A 60 percent rating is warranted for fracture of surgical neck of the femur with false joint. A 60 percent rating is also warranted for fracture of shaft or anatomical neck of the femur with nonunion, without loose motion, weightbearing preserved with aid of brace. A maximum 80 percent rating is warranted for fracture of the shaft or anatomical neck of the femur with nonunion, with loose motion (spiral or oblique fracture). 38 C.F.R. § 4.71a, DC 5255. According to MERRIAM WEBSTER, "slight" means "small of its kind or in amount". See www.merriam-webster.com/dictionary/slight. "Moderate" means "tending toward the mean or average amount or dimension." See www.merriam-webster.com/dictionary/moderate. "Marked" means "having a distinctive or emphasized character." See www.merriam-webster.com/dictionary/marked. Under the revised criteria effective February 7, 2021, malunion of the femur is to be evaluated under Diagnostic Codes 5256, 5257, 5260, or 5261 for the knee, or Diagnostic Codes 5250-5254 for the hip, whichever results in the highest evaluation. The new criteria did not change how fractures of the surgical neck of the femur or fractures of the shaft or anatomical neck of the femur are rated. Diagnostic Code 5252 provides the rating criteria for limitation of flexion of the thigh. Under that code, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252. 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). 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). Parenthetically, the Board notes that the 10 percent rating currently assigned for the service-connected right pelvis/hip disability was initially granted based upon objective evidence of tenderness in the right medial superior and inferior pubic ramus. See October 2005 VA examination. Indeed, based upon this evidence, the AOJ evaluated the right pelvis/hip disability by analogy under DC 5299-5255 and 38 C.F.R. § 4.27. See November 2005 rating decision. The noncompensable rating currently assigned for the service-connected right pelvis/hip limitation of flexion disability was granted based upon evidence showing the Veteran's right hip flexion was limited, but not to a degree to warrant a compensable rating under DC 5252, i.e., to 45 degrees or less. See May 2018 rating decision. Due to the similar evidence related to these claims, the Board will address them in common discussion. At this juncture, the Board notes that the claims file includes VA treatment records dated from February 2017 to May 2021 that generally note the Veteran's service-connected disabilities, but the records do not contain any specific information regarding the severity of his service-connected right pelvis/hip disability, to include limitation of flexion or motion and, thus, will not be discussed any further. The preponderance of the evidence reflects that the Veteran has consistently endorsed experiencing pain and discomfort in his right hip and lower groin area throughout the appeal period. See e.g., September 2018 VA Form 9; VA examinations dated April 2018 and March 2021. During the April 2018 VA examination, the Veteran denied having flare-ups but reported that his pain increased with prolonged standing and walking. He also endorsed weakness in the hip. During the March 2021 VA hip examination, he reported that his pain occurred while standing, lying on his back, and getting up, and he also described burning pain and numbness in the right hip, back, and lower region. In this regard, the Veteran endorsed having mild flare-ups on a daily basis that were manifested by burning and pain with standing and sitting and alleviated with medication. The March 2018 VA examiner noted the Veteran's right hip disability was manifested by weakened movement with loss of motion, pain, and fatigue. See also March 2021 VA muscles examination. During the April 2018 VA examination, the Veteran's right hip flexion was limited to 120 degrees, including after repetitive use testing and during passive range of motion testing. While the examiner noted there was objective evidence of pain while testing flexion, adduction, and rotation of the hip and stated that the pain caused functional loss, the examiner did not identify the point or degree at which the Veteran experienced pain or functional loss or attempt to quantify the degree of loss due to pain. As a result, the April 2018 VA examination is deemed inadequate with respect to the degree of functional loss the Veteran experienced at that time. See e.g., May 2020 JMR. During the March 2021 VA examination, the Veteran's right hip flexion was, again, limited to 120 degrees with objective evidence of pain while testing flexion, adduction, and rotation of the hip. However, the examiner noted that the pain did not cause any functional loss and noted there was change of the Veteran's range of motion due to pain during active or passive range of motion or repetitive use testing. The examiner also opined that the evidence, including statements from the Veteran, did not suggest that pain, weakness, and other factors significantly limited the Veteran's functional ability during repetitive use over time. However, in an May 2021 addendum, the VA examiner noted that the Veteran's flare-ups would result in flexion limited to 115 degrees and limit his walking ability. Based upon the foregoing evidence, the Board finds the preponderance of the evidence is against the grant of an increased rating for the Veteran's service-connected right pelvis/hip and limitation of flexion disabilities. As shown above, while the lay and medical evidence documents the Veteran's pain, discomfort, weakness, and fatigue in the right pelvis/hip area, the evidence reflects that the Veteran's right hip flexion has been limited to no more than 115 degrees, even when considering the functional loss experienced due to pain, weakness, and other factors. Indeed, the evidence does not reflect that the Veteran's right hip flexion has been limited to or more nearly approximated 45 degrees or less to warrant a higher, compensable rating under DC 5252. Therefore, a compensable rating is not warranted for limitation of flexion in the right pelvis/hip under DC 5252 at any point during the appeal period. In this context, the Board acknowledges that the evidence shows the Veteran experiences painful motion in his right hip and that his pain, weakened movement, and fatigue result in functional loss, including with prolonged standing and walking; however, the Board finds that this functional loss is contemplated by the 10 percent rating assigned under DC 5299-5255. Indeed, assigning an additional 10 percent rating for painful, limited flexion under DC 5252 would violate the pyramiding prohibition contained in 38 C.F.R. § 4.14, as any functional impairment caused by the Veteran's painful, limited flexion is contemplated by the 10 percent rating assigned under DC 5299-5255. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also 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). Even considering the Veteran's pain, weakened movement, fatigue, and pain during flare-ups, the Board notes that the functional limitation caused by these symptoms, including any additional limitation during the Veteran's mild flare-ups, are not shown to result in symptoms that more nearly approximate a moderate or marked knee or hip disability, fracture of the surgical neck of the femur, or fracture of shaft or anatomical neck of the femur to warrant a rating higher than 10 percent under the pre-February 7, 2021 criteria for DC 5255. In this regard, the preponderance of the evidence reflects that, despite his pain and weakness in his right hip, the Veteran's range of motion has been only slightly limited in flexion and other planes of excursion throughout the appeal period and, in April 2018, resulted in no more than slightly decreased muscle strength (4/5) in right hip flexion. Cf. March 2021 VA muscles examination. Further, as noted, the Veteran has described his flare-ups as mild and stated that they are alleviated by medication and rest, and the objective evidence does not reflect any significant, i.e., moderate or marked, functional impairment caused thereby. Instead, the preponderance of the evidence supports a finding that the pain and slightly decreased and weakened movement and muscle strength more nearly approximate a slight hip disability. As such, the Board finds a rating in excess of 10 percent is not warranted for the service-connected right pelvis/hip disability under the rating criteria of DC 5255 in effect prior to February 7, 2021. In evaluating the Veteran's service-connected right pelvis/hip disability under the revised criteria of DC 5255 in effect from February 7, 2021, the Board must consider the Veteran's disability under Diagnostic Codes 5250-5254 for the hip, whichever results in the highest evaluation. The preponderance of the evidence shows that, while the Veteran's range of motion has been slightly limited in flexion, adduction, and rotation, he has retained movement in all planes of excursion in his right hip throughout the appeal period. Indeed, both VA examinations of record reflect that there was no ankylosis in the right hip and the Veteran has not described symptoms or identified evidence that would show his right hip has been manifested by symptoms that more nearly approximate favorable or unfavorable ankylosis in the right hip as contemplated by DC 5250. Therefore, a compensable rating is not warranted under DC 5250. The preponderance of the evidence also shows the Veteran has demonstrated normal extension to 30 degrees in the right hip throughout the appeal period, and there is no lay or medical evidence of record that suggests his extension would be limited to 5 degrees or less due to pain and weakness, after repetitive use, or during flare-ups. Therefore, a compensable or separate rating is not warranted under DC 5251. Under DC 5253, a 10 percent rating is warranted for limitation of rotation of affected leg, cannot toe out more than 15 degrees. A 10 percent rating is also warranted for limitation of adduction, cannot cross legs. A maximum 20 percent rating is warranted for limitation of abduction, motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. In this case, the preponderance of the evidence reflects that the Veteran's right hip rotation was decreased by 5 degrees, with external rotation limited to 55 out of 60 degrees and internal rotation limited to 35 out of 40 degrees. See VA examinations dated April 2018 and March 2021. The evidence does not reflect that the Veteran could not toe-out more than 15 degrees in the right leg or that pain, weakness, fatigue, repetitive use, or flare-ups would result in symptoms that more nearly approximate that level of impairment. Similarly, the evidence shows the Veteran's right hip adduction was consistently limited to 20 degrees, including as due to pain, but both VA examiners noted that the Veteran's limited adduction did not prevent crossing his legs. Therefore, a separate or higher rating is not warranted under DC 5253, for impairment of the thigh. Finally, the Board notes that the evidence does not reflect that the Veteran's service-connected right pelvis/hip disability has been manifest by flail joint during the period on appeal. Therefore, DC 5254 is not for application in this case. In conclusion, the Board finds that the preponderance of the evidence is against the grant of a rating in excess of 10 percent for the service-connected right pelvis/hip disability and a compensable rating for the service-connected right pelvis/hip limitation of flexion disability. In denying these ratings, the Board finds the benefit of the doubt doctrine is not applicable and the Veteran's claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome As noted, this appeal arises from a January 2018 claim for TDIU due to the service-connected right hip/pelvis disability. In the May 2018 rating decision on appeal, the AOJ denied the Veteran's TDIU claim, and the Veteran did not submit a timely notice of disagreement (NOD) as to this claim. Instead, the Veteran limited his appeal to the increased rating claims for his service-connected right hip/pelvis disability. See July 2018 NOD. However, in statements submitted in August 2021, the Veteran indicated that he is unable to look for and hold steady employment. See Veteran statements dated August 2021. Given these statements, the Board finds the Veteran has, again, raised the issue of entitlement to TDIU in conjunction with the increased rating claims on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the Board must consider whether entitlement to a TDIU is warranted from January 11, 2018, the date of receipt of his TDIU and increased rating claims. TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In this case, the Veteran's service-connected fracture, right superior ischiopubic ramus and both inferior ischial rami, with myofascial pain syndrome, i.e., right hip/pelvis disability, is rated 10 percent disabling. A separate noncompensable rating is also assigned for limitation of flexion caused by the right hip/pelvis disability. Service connection has also been established for left hip limitation of extension, rated 10 percent disabling effective January 11, 2018, and left hip limitation of adduction and limitation of flexion, both rated noncompensable (zero percent disabling) from the same date. See August 2018 rating decision. Given the foregoing, the Veteran's combined rating for the service-connected right hip/pelvis disability is 20 percent throughout the appeal period. 38 C.F.R. § 4.25. As such, the Veteran does not meet the schedular criteria for TDIU. See 38 C.F.R. § 4.16(a). Nevertheless, the Board must consider whether his service-connected disabilities render him unable to obtain and maintain substantially gainful employment, as it is VA policy is to grant a TDIU in all cases in which service-connected disabilities prevent the Veteran from engaging in substantially gainful employment. 38 C.F.R. § 4.16(b). However, the Board is precluded from granting a TDIU on an extraschedular basis in the first instance if the Veteran does not meet the TDIU percentage requirements. Bowling v. Principi, 15 Vet. App. 1 (2001). Instead, the Board is required to remand the claim so that it can be referred to the Director of Compensation Service for adjudication under 38 C.F.R. § 4.16(b). VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). In arriving at a conclusion, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The Court has held that the term unable to secure and follow a substantially gainful occupation in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual Veteran's ability to follow and secure employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the Veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58 (2019). As sedentary is defined as "doing or requiring much sitting" the Board finds that sedentary employment is a job where the worker primarily sits down. MERRIAM-WEBSTER'S COLLEGEIATE DICTIONARY 1123 (2003). After review of the lay and medical evidence of record, the Board finds the preponderance of the evidence is against a finding that the Veteran's service-connected right and left hip disabilities prevented him from securing or following gainful employment at any point during the appeal period. The Board has considered the Veteran's educational and employment background. The evidence reflects that the Veteran completed four years of high school and has not obtained any additional educational or training. The evidence of record also reflects that the Veteran's previous work history consisted of various physical and skilled labor positions, such as a mechanic, truck driver, and warehouse supervisor. See e.g., April 2006 Board hearing; VA examinations dated May 2010 and October 2011. His most recent work history includes performing janitorial work for a staffing company from September 2014 to February 2015, in addition to various janitorial and industrial duties with a temporary agency for a one-month assignment in January 2014. See VA Form 21-8940 dated January 2018. On his January 2018 TDIU claim, the Veteran reported that he did not lose any time from work because of his disability, as he noted that he did not work all the time. He did not indicate if he left his last job because of his disability, and the evidence of record does not contain any information as to whether the Veteran has worked or sought employment since February 2015. As noted, the Veteran has asserted that he has recently been unable to look for and hold steady employment, presumably due to his service-connected disabilities; however, he has not provided any further information as to how his service-connected right hip/pelvis and left hip disabilities impact his ability to function. Nevertheless, the medical evidence of record shows that he has consistently reported that the pain in his hips increases with prolonged walking, standing, and sitting. See VA examinations dated April 2018 and March 2021. In this regard, the April 2018 VA examiner noted that the information provided by the Veteran suggests that the pain and weakness in his hips would affect his functional capacity and further opined that his right hip/pelvis disability would impact his ability to work, as it reduces his ability to walk and stand for prolonged periods. Similarly, the March 2021 VA examiner noted the Veteran experienced weakened and less movement than normal in both hips, in addition to fatigue and pain. See March 2021 VA hip and muscles examination reports. The March 2021 VA examiner also opined that the Veteran's hip disabilities would impact his ability to work, as long periods of standing and ambulating may result in breaks from his tasks, including as due to pain and fatigue with ongoing standing and ambulation. The foregoing evidence clearly shows that the Veteran experiences a functional impairment as a result of his service-connected right and left hip disabilities. Indeed, the Board finds that the Veteran's pain, weakness, fatigue, and limited range of motion in his hips would likely result in difficulties performing the various physical and skilled labor positions consistent with his previous employment. However, the preponderance of the evidence does not reflect that the Veteran's right and left hip disabilities are manifested by symptoms or result in functional impairment that would preclude him from obtaining or maintaining any gainful employment consistent with his education and occupational experience. In this regard, the Board notes that the evidence shows that the Veteran's right and left hip disabilities reduce his ability to walk or stand for extended periods of time; however, the evidence also suggests that he would be able to walk, stand, and sit if he is given breaks. See e.g., March 2021 VA examination. There is no indication that the right and left hip disabilities would prevent him from performing limited amounts of lifting, bending, sitting, standing, or walking. Nor is there any indication that the Veteran does not possess the basic visual, physical, and mental skills that are likely needed to work in an environment where he could sit for the majority of the day, such as a supervisory or clerical position. In this regard, the Board notes that, during the March 2021 examination, the Veteran reported that his flare-ups were manifested by burning pain with standing and sitting; however, he also reported that his flare-ups were mild in nature, which suggests that they would not prevent him from sitting for extended periods of time. The Board also acknowledges that the Veteran's limitations in standing for long periods would require that he sit and vice versa; however, the evidence does not show that the severity of his disabilities, education, and/or work history would prevent him from obtaining a job that would allow him to take a break to sit or stand, as needed. The Board also notes the Veteran does not have any work experience in an office setting and that his education and work history is limited, as he completed high school and has primarily performed physical and skilled labor position but, given that the Veteran's previous job as a warehouse supervisor likely required some form of administrative and supervisory skills, the Board finds these skills would likely transfer to a job that required basic skills. Therefore, despite the functional impairment caused by his right and left hip disabilities, the Board finds that the preponderance of the evidence shows the Veteran remains capable of performing the visual, physical, and mental ability required for some form of gainful employment, including employment in a setting that requires limited to minimal walking or standing and allowed him to take breaks, as needed. Further, the Board finds that the functional impairment experienced by the Veteran due to his service-connected right and left hip disabilities is adequately reflected and contemplated in the individual disability ratings assigned for each disability throughout the appeal period. In this regard, the Board notes that the 10 percent and noncompensable ratings assigned for the various right and left hip disabilities is recognition of the functional impairment caused by the disabilities. Indeed, the evidence shows the Veteran's painful, limited motion in both hips creates difficulty performing some tasks, such as walking and standing for prolonged periods, but does not make render him unable to obtain and keep employment. Therefore, while the Veteran would likely have difficulty in some employment settings, the evidence does not reflect that he is unable to obtain and retain some form of substantially gainful employment that is consistent with his educational and vocational experience. Accordingly, the preponderance of the evidence is against the grant of entitlement to TDIU, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.