Citation Nr: 21067829 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 15-16 890 DATE: November 5, 2021 ORDER 1. Entitlement to a rating in excess of 10 percent for vitiligo is denied. 2. Entitlement to a rating in excess of 30 percent for degenerative disc disease of the lumbar spine is denied. 3. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right lower extremity prior to December 1, 2020, and in excess of 20 percent beginning December 1, 2020, is denied. 4. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity prior to December 1, 2020, and in excess of 20 percent beginning December 1, 2020, is denied. 5. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran's vitiligo is already assigned the maximum 10 percent schedular rating. 2. Throughout the period on appeal, the Veteran's thoracolumbar spine flexion has been limited to no less than 45 degrees objectively documented, and no less than 35 degrees estimated during a flare-up. 3. Prior to December 1, 2020, the Veteran's radiculopathy of the right lower extremity did not manifest in greater than mild incomplete paralysis of the sciatic nerve. 4. Beginning December 1, 2020, the Veteran's radiculopathy of the right lower extremity did not manifest in greater than mild incomplete paralysis of the sciatic nerve. 5. Prior to December 1, 2020, the Veteran's radiculopathy of the left lower extremity did not manifest in greater than moderate incomplete paralysis of the sciatic nerve. 6. Beginning December 1, 2020, the Veteran's radiculopathy of the left lower extremity did not manifest in greater than moderate incomplete paralysis of the sciatic nerve. 7. The preponderance of the evidence is against finding that the Veteran's service-connected disabilities preclude him from securing and following any substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria are not met for a rating higher than 10 percent for the vitiligo. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.1, 4.2, 4.7, 4.118, Diagnostic Code 7823. 2. Throughout the appeal period, the criteria for a disability rating in excess of 30 percent for the low back disability have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243-5242. 3. The criteria for an initial rating in excess of 10 percent for radiculopathy of the right lower extremity prior to December 1, 2020, and in excess of 20 percent beginning that date, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.123, 4.124a, Diagnostic Code 8520. 4. The criteria for an initial rating in excess of 10 percent for radiculopathy of the left lower extremity prior to December 1, 2020, and in excess of 20 percent beginning that date, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.123, 4.124a, Diagnostic Code 8520. 5. The criteria for TDIU have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1970 to June 1990. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision. The Veteran's appeal was previously remanded in May 2020 and again in May 2021. In the May 2020 remand, the Board determined that the Veteran's option for a hearing had been waived. Additionally, in the May 2020 remand, the Board determined that the issue of entitlement to a TDIU has been raised by the record and was within the jurisdiction of the Board. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In May 2021, the Board remanded the appeal for further development. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating 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. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Where a claimant appeals the denial of a claim of an increased disability rating for a disability for which service connection was in effect before the claim for increase is filed, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 50 (2007). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 1. Entitlement to a rating in excess of 10 percent for vitiligo is denied. The Veteran's service-connected vitiligo is currently rated at 10 percent under the criteria of Diagnostic Code 7823, which is specifically for vitiligo. Under 38 C.F.R. § 4.118, Diagnostic Code 7823, the currently-assigned 10 percent rating is the maximum schedular rating available. The Board has also considered whether another applicable rating code is more appropriate or favorable in evaluating the service-connected vitiligo. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Notably, the Veteran reported at the January 2014 VA examination that there had been an increase in the areas of vitiligo and that they worsened with sun exposure. At the December 2020 VA examination, he further described the affected areas as dry, itchy, red, and blotchy. However, the evidence does not show that the Veteran's vitiligo results in any additional symptomatology that would warrant a rating under a different code. Indeed, the VA examiners of record had the option to identify dermatitis or eczema, infectious skin conditions, psoriasis, exfoliative dermatitis, amongst other skin conditions, but no other diagnosis was identified upon examination in January 2014 and December 2020. In any event, the objective medical evidence of record does not show that he has any other skin condition, visible or otherwise. Therefore, a rating under a different Diagnostic Code would be inappropriate. See Butts v. Brown, 5 Vet. App. 532, 539 (1993) (holding that the Board's choice of Diagnostic Code should be upheld if supported by explanation and evidence); Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992) (indicating that any change in Diagnostic Code must be specifically explained). For these reasons and bases, a higher schedular rating for the service-connected vitiligo in excess of 10 percent is denied. 2. Entitlement to a rating in excess of 30 percent for the low back disability is denied. For disabilities evaluated based on limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59 (2020). In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id. (quoting 38 C.F.R. § 4.40). When 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Painful motion without functional limitation, however, cannot serve as the basis for a rating in excess of the minimum. Mitchell, supra. The Veteran service-connected low back disability has been rated 10 percent disabling since July 19, 2002. This rating was assigned under former Diagnostic Code 5010-5292, based on moderate limitation of motion combined with pain on motion. The rating criteria for diseases and injuries of the spine have changed since the Veteran's back disability was last rated. Because the Veteran filed his increased rating claim in October 2013, only the current schedular criteria effective beginning 2003 are applicable. As such, consideration will only be given to whether greater than a 30 percent rating is warranted. Disabilities of the spine are currently rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a, Diagnostic Code 5237 and Note. The General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent rating 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 assigned where forward flexion of the thoracolumbar spine is to 30 degrees or less, or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, while a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. Additionally, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under the appropriate diagnostic codes. Id. at Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. See 38 C.F.R. § 4.71a, General Rating Formula Note (2); Plate V. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Intervertebral disc syndrome (preoperatively or postoperatively) may be evaluated 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 evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). The Formula for Rating IVDS Based on Incapacitating Episodes provides for a 60 percent rating when there are incapacitating episodes of IVDS having a total duration of at least six weeks during the past 12 months. A 40 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least four weeks, but less than six weeks during the past 12 months. A 20 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least two weeks, but less than four weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. The evidence of record does not show that the Veteran has experienced IVDS requiring bed rest during any period on appeal. As required bed rest is a fundamental element for an evaluation under this section of the rating schedule, the absence of any prescribed bed rest precludes a rating under these criteria. As such, a rating based on IVDS is not appropriate, and it is therefore more beneficial to evaluate the Veteran's spine disability under the General Rating Formula for Diseases and Injuries of the Spine. In October 2013, the Veteran was afforded a VA examination for his low back disability. He reported experiencing daily lower back pain and denied any flare-ups. Flexion was to 90 degrees or greater, with objective evidence of pain at 70 degrees. The Veteran was able to perform repetitive use testing with three repetitions during which flexion was limited to 70 degrees. The examiner noted less movement than normal, weakened movement, and pain on movement during such testing. The Veteran demonstrated guarding and/or muscle spasms, which did not result in abnormal gait or spinal contour. Muscle strength testing was normal, with no evidence of muscle atrophy. Reflex and sensory testing were also normal. The Veteran denied any additional neurological abnormalities related to his low back disability. Although he had IVDS, such had not resulted in any incapacitating episodes. The Veteran did not use an assistive device for locomotion. In September 2015, the Veteran underwent another VA examination. He reported experiencing sharp lower back pain. He described flare-ups due to spasms, which lasted for 20 minutes after walking. Flexion was to 90 degrees. There was no evidence of pain with weight-bearing or localized tenderness. The Veteran was able to perform repetitive use testing with three repetitions and no additional loss of range of motion. The Veteran did not demonstrate guarding and/or muscle spasms. Muscle strength testing was normal, with no evidence of muscle atrophy. Reflex and sensory testing were also normal. There was no evidence of ankylosis or IVDS. The Veteran denied any additional neurological abnormalities related to his low back disability. He did not use an assistive device for locomotion. Most recently, in December 2020, the Veteran attended a third VA examination for his lower back. He reported experiencing throbbing pain and stiffness. He described mild flare-ups, which occurred between two and three times weekly and lasted for less than one day. The flare-ups were precipitated by exercise and alleviated by rest. The Veteran further report functional loss involving difficulty lifting, climbing stairs, and walking for prolonged periods of time. Flexion was to 50 degrees, with objective evidence of pain. There was no evidence of pain with weight-bearing or localized tenderness. The Veteran was able to perform repetitive use testing with three repetitions with flexion to 45 degrees. The examiner noted pain and lack of endurance resulting in functional loss following such testing. Although the Veteran was not examined following repetitive use over time or during a flare-up, the examiner estimated that flexion would be limited to 40 degrees and 35 degrees in such situations, respectively. Guarding and/or muscle spasms were not observed. Muscle strength and reflex testing were normal, with no evidence of muscle atrophy. There was no evidence of ankylosis or IVDS. The Veteran denied any additional neurological abnormalities related to his low back disability. He regularly used a cane to assist with locomotion. The Veteran's treatment records contain findings consistent with these VA examinations reports. Based on the clinical findings described above, the Board finds that a rating in excess of 30 percent is not warranted for the service-connected low back disability at any point during the appeal period. The pertinent evidence does not reflect that the Veteran demonstrated flexion to 30 degrees or less, to include as a result of pain, weakness, or other similar factors. Rather, the evidence shows the Veteran's flexion was limited to 45 degrees during the appeal period. There is no indication that pain resulted in objectively-documented limited motion beyond 45 degrees during the examinations of record. Additionally, there is no evidence of any form of ankylosis affecting the spine throughout the period on appeal. In evaluating the Veteran's increased rating claim under DeLuca and Mitchell, supra, the Board notes that there has been objective evidence of painful motion on examination, as well as reports of functional impairment. Although the Veteran was not observed after repetitive use over time or during a flare-up during the examinations, the December 2020 examiner provided range of motion estimates that did not reflect flexion to 30 degrees or less. Any additional functional limitation caused by his back pain was considered by the examination reports of record and is contemplated by the 30 percent rating. Indeed, the pertinent evidence has not revealed that his motion was limited to 30 degrees or less as a result of pain, weakness, fatigability, incoordination, lack of endurance, or repetitive motion to warrant a higher rating. Nor does the evidence reflect that his additional functional limitation has resulted in ankyloses affecting the lumbar spine throughout the period on appeal. Therefore, the Board finds that a rating higher than 30 percent is not warranted even when the provisions of 38 C.F.R. §§ 4.40 and 4.45 are considered. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. The Board finds the examinations of record are adequate for rating purposes and that a higher disability rating is not warranted, even when considering the functional effects of pain, to include during flare-ups and after repetitive use. Initially, the Veteran denied experiencing flare-ups during the October 2013 examination. In September 2015, the Veteran described flare-ups lasting for 20 minutes following periods of walking. Notably, the December 2020 examiner elicited detailed information from the Veteran regarding the flare-ups and provided estimates regarding additional loss of range of motion resulting in the case of flare-ups, which demonstrated that flexion would not be limited to 30 degrees or less under such circumstances. Based on the VA examination reports and lay statements, the evidence does not reflect symptomatology, including flexion to 30 degrees or ankylosis of the lumbar spine, due to flare-ups that would warrant a higher rating during the appeal period. As noted above, when evaluating the disability rating assignable to a spinal disability, the Board must consider any neurologic abnormalities associated with the spinal disability. The Veteran has consistently denied any bladder or bowel impairment resulting from his back disability. The Board finds the preponderance of the evidence does not reflect that the Veteran experiences bladder, bowel, or other objective neurologic abnormalities as a result of his service-connected low back disability, aside from the bilateral lower extremity sciatic nerve impairment addressed elsewhere in this decision; thus, a separate compensable rating is not warranted at any point during the appeal period for those considerations. In summary, the Board finds the preponderance of the evidence is against the assignment of a disability rating in excess of 30 percent for the service-connected low back disability for the entire period on appeal. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. 3. Entitlement to an initial rating in excess of 10 percent prior to December 1, 2020, and in excess of 20 percent beginning that date, for radiculopathy of the bilateral lower extremities is denied. The Veteran's service-connected radiculopathy of the bilateral lower extremities is rated as 10 percent disabling for each leg, prior to December 1, 2020, and as 20 percent disabling beginning December 1, 2020, under 38 C.F.R. § 4.124a, Diagnostic Code 8520. Incomplete paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under DCs 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. 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 DCs 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). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. At the October 2013 VA back examination, the examiner noted mild intermittent pain and numbness of the bilateral lower extremities. She concluded that the overall severity of the radiculopathy of both lower extremities was no more than mild. At the September 2015 VA back examination, the Veteran reported sharp pain radiating from his lower back into his legs. The examiner did not observe any radicular pain or related symptomatology upon examination. At the December 2020 VA back and peripheral nerve examinations, the Veteran reported throbbing pain, numbness, and tingling of the lower extremities. The examiner noted moderate constant pain, paresthesias and/or dysesthesias, and numbness of the bilateral lower extremities. Muscle strength and reflex testing were normal, with no evidence of muscle atrophy. There was decreased sensation in both lower extremities. The Veteran's gait was normal. The examiner concluded that the Veteran had incomplete paralysis of the sciatic nerve in both lower extremities, which was moderate in severity. The Veteran's VA treatment records contain findings consistent with the VA examinations reports. Based on the above, the Board finds that the disabilities are primarily manifest by sensory disturbance and pain. In applying the above law to the facts of the case, the Board finds that the Veteran is not entitled to initial disability ratings in excess of 10 percent prior to December 1, 2020. In determining the degree of neurologic impairment, the Board has considered the guidance contained in 38 C.F.R. §§ 4.120, 4.123, 4.124, and 4.124(a). As instructed in 38 C.F.R. § 4.120, there is an obligation to rate by comparison. Here, the nerve has been identified and there is lay and medical evidence of pain and sensory disturbance. However, prior to the December 2020 VA examination, there is no evidence of moderate incomplete paralysis of the sciatic nerve in either extremity. Indeed, the symptoms reported at the October 2013 and September 2015 VA examinations were normal or mild in severity. The Veteran had full muscle strength and normal reflexes. His sensory examinations were normal. Based upon these lay and clinical findings, the bilateral lower extremity radiculopathy was manifest primarily by decreased sensation and pain prior to December 1, 2020; however, other neurologic function remained intact. Thus, for this period, the Board finds that the bilateral sciatica was no more than mild in degree and ratings in excess of 10 percent are not warranted for the Veteran's mild incomplete paralysis of the sciatic nerves of his left and right lower extremities prior to December 1, 2020. See 38 C.F.R. § 4.124, Diagnostic Code 8520. Furthermore, the Veteran is not entitled to disability ratings in excess of 20 percent beginning December 1, 2020. At the December 2020 VA examination, the examiner concluded that the level of radiculopathy in the sciatic nerve of the bilateral lower extremities was indicative of moderate incomplete paralysis. The Veteran has not demonstrated symptoms of moderately severe or severe incomplete paralysis since December 1, 2020. Indeed, at the December 2020 VA examination, muscle strength testing was normal with no evidence of muscle atrophy. Reflex was normal and sensory testing revealed decreased, but not absent, sensation in the lower extremities. His gait was normal and tropic changes were not documented. The Board finds that the most probative evidence of record is against a finding that the bilateral lower extremity radiculopathy is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis to warrant disability ratings in excess of 20 percent for this period. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis, which warrants 20 percent disability ratings for both lower extremities, since December 1, 2020. The Board acknowledges that the Veteran is competent to give evidence about what he observes or experiences. For example, he is competent to report that he experiences certain symptoms, such as pain and numbness, and he is credible in this regard. See Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran's competent and credible belief that his disabilities are worse than the assigned ratings is outweighed by the competent and credible medical examinations that evaluated the true extent of impairment based on objective data coupled with the lay complaints. The VA examiners have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the physical examination findings. The Board has considered all other potentially applicable Diagnostic Codes, but the evidence does not establish that 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. 38 C.F.R. § 4.124. In summary, the Board finds that ratings in excess of 10 percent prior to December 1, 2020, and in excess of 20 percent beginning that date, are not warranted for radiculopathy of the bilateral lower extremities. See 38 C.F.R. § 4.124, Diagnostic Code 8520. In denying higher ratings, 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. 4. Entitlement to TDIU is denied. In order to establish service connection for TDIU, there must be impairment so severe that it is impossible for the average person to follow a substantially-gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. When a claimant's combined schedular rating is less than total, a total rating based upon unemployability may nonetheless be assigned. If there is only one service-connected disability, it must be rated at 60 percent or more. If there are two or more service-connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be at least 70 percent. See 38 C.F.R. § 4.16(a). Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system such as orthopedic disabilities, will be considered as one disability for TDIU purposes. Id. A total disability rating also may be assigned on an extraschedular basis, pursuant to the procedures set forth in 38 C.F.R. § 4.16(b), for veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in section 4.16(a). For a veteran to prevail on a claim for a TDIU, the sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361 (1993). Marginal employment cannot be considered substantially-gainful employment. Generally, marginal employment exists when a veteran's earned annual income does not exceed the Federal poverty threshold for one person. 38 C.F.R. § 4.16(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert, supra. Here, the Veteran's service-connected disabilities currently include his low back disability rated as 30 percent disabling, sciatic radiculopathy of the bilateral lower extremities associated with the low back disability each rated as 10 or 20 percent disabling (prior to and beginning December 1, 2020), tinnitus rated as 10 percent disabling, vitiligo rated as 10 percent disabling, left lingual nerve paresthesia rated as 10 percent disabling, and bilateral hearing loss and headaches each rated as noncompensable. Because the Veteran's sciatic nerve impairment is secondary to his back disability, the Veteran's low back disability and sciatic radiculopathy of the bilateral lower extremities are considered to have a common etiology, and thus combine as one disability for TDIU purposes. When combined, the percentage of these disabilities is 40 percent prior to December 1, 2020, and 60 percent beginning that date, with a total overall rating of 70 percent beginning that date. Thus, the schedular criteria for TDIU are met effective December 1, 2020. See 38 C.F.R. § 4.25. However, the remaining question concerns whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. 38 C.F.R. § 4.16(a). After careful review of the lay and medical evidence of record, the Board finds that the preponderance of the evidence is against the award of a TDIU for any portion of the period on appeal as explained below. With respect to the Veteran's education and work experience, the Board notes that the Veteran did not return the VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability, which was provided to him in June 2020. Nevertheless, the record indicates that the Veteran retired from his job as a security officer in March 2006. Records from the Social Security Administration (SSA) records further indicate that he obtained his high school diploma and received specialized training for his security job. The VA examination reports of record consistently documented findings that the Veteran's service-connected disabilities, including his low back disability, radiculopathy, and vitiligo, did not rise to the level of impairment so severe that it would be impossible for the average person to follow a substantially-gainful occupation. The October 2013 VA examiner noted that the Veteran's back condition "slows him down, problem with lifting and carrying" but did not conclude that the Veteran could not perform sedentary employment. Similarly, the December 2020 VA spine examiner indicated that the Veteran's low back disability and radiculopathy would limit his ability to complete physical labor, that examiner did not find that the Veteran was precluded from sedentary employment. The December 2020 VA peripheral nerves examiner indicated that the Veteran would have "[d]ifficulty with prolonged standing more than 10 minutes and walking more than 10 minutes"; again, a limitation on sedentary employment is not noted. Additionally, in an August 2008 decision, the SSA determined that the Veteran had the residual functional capacity to perform sedentary labor. While SSA decisions are not binding on the Board, they are indeed probative information, especially in considering the impairment of a service-connected disability or disabilities on a claimant's capacity for employment. The Board acknowledges that the Veteran has claimed to have been unemployed since he retired in March 2006. The Board also acknowledges the Veteran's assertions that he is unemployable due to his service-connected low back disability and associated medication. The Veteran is competent to describe the symptoms he experiences. However, the competent medical evidence offering detailed specific findings pertinent to the criteria governing the award of a TDIU is the most probative evidence in evaluating the functional impact of the Veteran's service-connected disabilities on his employability. As such, while the Board accepts the Veteran's statements regarding the matters he is competent to address, the Board relies upon the unbiased competent medical evidence related to the specialized evaluation of functional impairment, symptom severity, and the impact of the service-connected disabilities on the Veteran's employability. However, as indicated above, unemployed does not mean unemployable. The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Van Hoose, supra. The Veteran has not submitted any additional information related to his claim for entitlement to a TDIU, to include a current VA Form 21-8940. Thus, based on the above, the Board finds that the evidence does not persuasively show the Veteran to be incapable of performing the tasks that comport with his education and occupational experience due to his service-connected disabilities. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran is unemployable due to his service-connected disabilities. The Board reiterates that the sole fact that the Veteran is unemployed or has difficulty obtaining or following employment is not enough to warrant entitlement to a TDIU. The ratings for the Veteran's service-connected disabilities consider the limitations and difficulties he has due to these disabilities. 38 C.F.R. § 4.1. The ultimate question is whether the Veteran can perform the physical and mental acts required by employment, not whether he can find employment. The evidence shows that the Veteran has a high school diploma and worked for a significant amount of time after separation from service. He can communicate fully, and while he does have some physical limitations related to his low back disability and radiculopathy, he has not been shown to be precluded from performing the tasks required in sedentary employment. Indeed, the August 2008 SSA decision reflects that his conditions would not prevent sedentary employment. The evidence of record indicates that it is likely that he could work in a position that did not require manual labor, and that his physical limitations would not impact his ability to perform occupational functions required of a sedentary job. After considering the limitations related to the service-connected disabilities as shown by the credible lay and medical evidence, the Board finds that Veteran can perform work considering the symptomatology and functional impairment of service-connected disability alone, without regard to age or nonservice-connected disabilities. As such, the Board finds that, for the entire appeal period, the Veteran's service-connected disabilities have not rendered him unable to secure and follow a substantially gainful occupation and the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim for a TDIU, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-7 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). J. M. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Erin J. Trojanowski, 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.