Citation Nr: 21067891 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 17-39 750A DATE: November 5, 2021 ORDER Entitlement to a rating greater than 10 percent disabling for chondromalacia patella, left knee, is denied. Entitlement to a rating greater than 10 percent disabling for left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. A preponderance of the evidence is against a finding that the Veteran has flexion of the left leg limited to 60 degrees, 45 degrees, 30 degrees, or 15 degrees. 2. A preponderance of the evidence is against a finding that the Veteran has extension of the left leg limited to 5 degrees, 10 degrees, 15 degrees, 20 degrees, 30 degrees, or 45 degrees. 3. The Veteran met the requirements for a 10 percent rating for degenerative arthritis of the left knee between April 4, 2014, and October 20, 2019, but at no point on appeal met the requirement for a rating greater than 10 percent disabling. 4. A 10 percent rating for painful motion of the knee more nearly approximates the criteria for the Veteran's symptoms of a left knee disability and adequately compensates the Veteran for the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in his civil occupation. 5. A preponderance of the evidence is against a finding that the Veteran has forearm flexion limited to 110 degrees, 100 degrees, 90 degrees, 70 degrees, 55 degrees, or 45 degrees. 6. A preponderance of the evidence is against a finding that the Veteran has forearm extension limited to 45 degrees, 60 degrees, 75 degrees, 90 degrees, 100 degrees, or 110 degrees. 7. A preponderance of the evidence is against a finding that the Veteran has both forearm flexion limited to 100 degrees and forearm extension limited to 45 degrees. 8. A preponderance of the evidence is against a finding that the Veteran has malunion of, with bad alignment, nonunion in the upper half, nonunion in the lower half, with false movement, without loss of bone substance or deformity, or nonunion in the lower half, with false movement, with loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity. 9. The Veteran met the requirements for a 10 percent rating for degenerative arthritis of the left elbow between April 4, 2014, and October 20, 2019, but at no point on appeal met the requirement for a rating greater than 10 percent disabling. 10. A 10 percent rating for painful motion of the elbow more nearly approximates the criteria for the Veteran's symptoms of a left elbow disability and adequately compensates the Veteran for the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in his civil occupation. 11. Prior to October 2, 2014, the Veteran's service-connected disabilities do not meet the minimum percentage requirements for an award of a TDIU, and the average impairment in earning capacity due to the Veteran's service-connected disability symptoms are adequately compensated and accounted for in the Veteran's schedular ratings. 12. From October 2, 2014, the preponderance of the evidence favors the conclusion that the Veteran's service-connected disabilities have not rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating greater than 10 percent disabling for chondromalacia patella, left knee, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.41, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5003, 5260, 5261. 2. The criteria for entitlement to a rating greater than 10 percent disabling for radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.41, 4.45, 4.59, 4.71a, DC 5010, 5206, 5207, 5208, 5212. 3. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from December 1998 to December 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In his August 2017 substantive appeal, the Veteran indicated, "I do not want an optional Board hearing." See August 2017 VA Form 9, Appeal to Board of Veterans' Appeals. The matters were remanded in August 2019 for further development, to include additional VA Elbow and Forearm Conditions and Knee and Lower Leg Conditions examinations. See August 2019 BVA Decision. The matters are returned to the Board for further consideration. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2016). Proper VCAA notice must inform the claimant of any information and evidence not of record: (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). In Dingess-Hartman v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. With respect to the Veteran's claim, no notice or duty to assist deficiencies have been alleged by the Veteran. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.") Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Nevertheless, VA has satisfied its duties to inform and assist the Veteran in this case. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 21.1032(a). Further development or assistance by VA is not warranted. The RO provided a custom VA 5103 / DTA Letter in March 2014 informing the Veteran of the legal requirements needed to substantiate the claim and how VA would obtain any evidence needed to support the claim. See March 2014 VA 5103 / DTA Letter. Further efforts to inform and assist the Veteran include VA examinations in March 2014 and October 2019, September 2014 VA Rating Decision Narrative, July 2017 Statement of the Case, October 2019 VA Subsequent Development Letter, May 2020 Supplemental Statement of the Case (SSOC), May 2020 VA Rating Decision Narrative, June 2020 SSOC, and July 2020 SSOC. A remand for further development of this claim would serve no useful purpose. Further, the RO's efforts have substantially complied with the instructions contained in the August 2019 remand. See Stegall v. West, 11 Vet. App. 268 (1998). Service medical records and VA and private treatment records were obtained, and the Veteran was provided with the opportunity to provide employer information, work history, specific periods of unemployment, and clarification regarding unemployability. See August 2019 BVA Decision and October 2019 VA Subsequent Development Letter. Any deficiencies identified in the April 2014 VA examinations were cured by the October 2019 VA examinations. See October 2019 VA Knee and Lower Leg Conditions and Elbow and Forearm Conditions examination reports. The Board finds that VA has done everything reasonably possible under 38 C.F.R. § 21.1032(a) and in keeping with principles of basic fairness, in the spirit of the non-adversarial nature of VA benefits adjudication, to assist the Veteran. See Gambill v. Shinseki, 576 F.3d 1307 (Fed. Cir. 2009) (quoting Prickett v. Nicholson, 20 Vet. App. 370, 382 (2006) ("[C]reating a procedural right in the name of fair process principles [for applicants for VA disability benefits] is primarily based on the underlying concept of the VA adjudicatory scheme, not the U.S. Constitution."). The Veteran has not identified any available, outstanding records that are relevant to the claim decided herein, nor is there an indication that any outstanding evidence, relevant to the claim, needs to be obtained. See April 2014 Veteran VCAA Notice Acknowledgement ("I have enclosed all the remaining information or evidence that will support my claim, or I have no other information or evidence to give VA to support my claim. Please decide my claim as soon as possible.") and March 2019 Veteran Correspondence ("This is our final submission in support of the appeal, and we waive any remaining time to send additional evidence or arguments. Please forward the case to the Board for a decision."). Accordingly, the Board finds that no prejudice to the Veteran will result from the adjudication of his claim in this Board decision. Increased Ratings Disability evaluations are determined by the application of facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) in 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred in or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate, staged ratings are appropriate in adjudicating increased ratings when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 506 (2007). The period of consideration begins one year prior to the claim for increase and extends to the present. Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993) (holding that a claim for an original or increased rating remains in controversy when less than the maximum available benefit is awarded). Any reasonable doubt as to the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. 1. Entitlement to a rating greater than 10 percent disabling for chondromalacia patella, left knee. The Veteran contends that he is entitled to an evaluation of 30 percent disabling for his left knee condition. See October 2014 VA Form 21-0958, Notice of Disagreement. Potentially applicable diagnostic codes for the Veteran's left knee disability include 38 C.F.R. § 4.71a, DC 5003, DC 5260, and DC 5261. Diagnostic Code 5003 states: "Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, 10 percent; [w]ith X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, 20 percent." See 38 C.F.R. § 4.71a, DC 5003. According to 38 C.F.R. § 4.71a, DC 5260, Leg, limitation of flexion of, a 0 percent rating is assigned for flexion of the leg limited to 60 degrees, a 10 percent rating is assigned for flexion of the leg limited to 45 degrees, a 20 percent rating is assigned for flexion of the leg limited to 30 degrees, and a 30 percent rating is assigned for flexion of the leg limited to 15 degrees. Under DC 5260, a 30 percent rating is the maximum schedular evaluation. See 38 C.F.R. § 4.71a, DC 5260. Pursuant to 38 C.F.R. § 4.71a, DC 5261, Leg, limitation of extension of, a 0 percent rating is assigned for extension of the leg limited to 5 degrees, a 10 percent rating is assigned for extension of the leg limited to 10 degrees, a 20 percent rating is assigned for extension of the leg limited to 15 degrees, a 30 percent rating is assigned for extension of the leg limited to 20 degrees, a 40 percent rating is assigned for extension of the leg limited to 30 degrees, and a 50 percent rating is assigned for extension of the leg limited to 45 degrees. According to DC 5261, a 50 percent rating is the maximum schedular evaluation. See 38 C.F.R. § 4.71a, DC 5261. Factual Background The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the entire body of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Pursuant to a duty to assist, the Veteran was provided with a VA medical examination in April 2014. The examining physician reviewed the claims file and evidence of record in preparation for the report. The Veteran was examined in person, and his statements were considered, including a report of pain at the end of each day. No flare-ups were reported by the Veteran. The Veteran was diagnosed with a left knee injury and minimal patellofemoral osteoarthritis. Range of motion testing revealed flexion at 130 degrees and extension at 0 degrees or any degree of range of motion, with pain. Repetitive testing produced the same results, without any functional loss or impairment reported as due to pain. Muscle strength and stability were normal. There was no evidence of subluxation, dislocation, meniscal conditions, assistive devices, or other pertinent physical findings, complications, conditions, signs, or symptoms. X-rays taken in conjunction with the examination found "[m]inimal patellofemoral osteoarthritis." The Veteran reported no functional impact on his ability to work due to a knee condition. See April 2014 VA Knee and Lower Leg Conditions examination report. Pursuant to the August 2019 Board remand, the Veteran was provided with a medical examination in October 2019. The claims file and evidence of record was reviewed in preparation for the examiner's report. The Veteran was examined in person, and his statements were considered, including a report of pain and occasional locking of the left knee. Flare-ups were reported as locking of the knee, occurring once a month, lasting for 2 hours. Any functional loss was attributed to limited range of motion, limited standing, running, bending, and squatting. The Veteran was diagnosed with chondromalacia patella of the left knee, status post arthroscopy. Active, passive, weight-bearing, and non-weight bearing range of motion testing was normal, with the same results after repetitive testing. Muscle strength was normal. There was no evidence of atrophy, ankylosis, recurrent subluxation, lateral instability, recurrent effusion, recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome, tibial or fibular impairment, meniscal conditions, assistive devices, or other pertinent physical findings, complications, conditions, signs, or symptoms. Imaging studies, completed on the same date, revealed "no fracture or other significant bone, joint, or soft tissue abnormality" and were "[n]egative for arthritis." The Veteran reported no functional impact on his ability to work due to a knee condition. See October 2019 VA Knee and Lower Leg Conditions examination report. Analysis To the extent that the VA Compensation and Pension examinations and other physical examinations discussed herein failed to record passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that the examinations nevertheless are adequate for VA rating purposes. Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual's ability to produce motion at a joint (active range of motion). CYNTHIA NORKIN & D. JOYCE WHITE, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 8-9 (2016). Testing the joint under weight-bearing conditions involves movement of the body against gravity. J. Randy Jinkins, et al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005). When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present. Id. at 1823. Because there is no indication that the structural integrity of the Veteran's left knee is compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to record limitation of motion on passive range of motion and in non-weight-bearing is harmless error and not prejudicial to the Veteran. In addition to the October 2019 VA examination report, the Board will evaluate the Veteran's range of motion using the available measurements on active range of motion using the April 2014 VA examination report. Under 38 C.F.R. § 4.7, the Veteran is entitled to the benefit of the rating criteria that will result in the higher evaluation of his disability. The Veteran reports "pain" in his left knee. See April 2014 and October 2019 VA Knee and Lower Leg Conditions examination reports. Because the Veteran does not meet the minimum evaluation criteria for a compensable rating under any of the potentially applicable diagnostic codes under 38 C.F.R. § 4.71a, he is provided with the "minimum compensable rating for the joint," as prescribed by 38 C.F.R. § 4.59, "Painful motion." Left knee X-rays taken at the April 2014 VA examination revealed "[m]inimal patellofemoral osteoarthritis." See April 2014 VA Knee and Lower Leg Conditions examination report. Left elbow X-rays taken in December 2013 private treatment showed "[n]o significant degenerative changes." See December 2013 East Ridge Internal Medicine X-ray Report. In January 2014 private treatment, left elbow X-rays found "some degree of radiocapitellar degenerative change." See January 2014 Chattanooga Bone & Joint Surgeons Clinical Encounter Summary. Imaging at the October 2019 VA examination were "[n]egative for arthritis." See October 2019 VA Knee and Lower Leg Conditions examination report. While the Veteran appears to have met the criteria under DC 5003 for a 10 percent rating between April 4, 2014 and October 20, 2019, there is no evidence of "incapacitating exacerbations" at any point to satisfy the criteria for a 20 percent rating for degenerative arthritis. See 38 C.F.R. § 4.71a, DC 5003. Range of motion at the April 2014 VA examination was recorded as 130 degrees of flexion and 0 degrees of extension. See April 2014 VA Knee and Lower Leg Conditions examination report. VA treatment in July 2015 charted "full range of motion" and "excellent range of motion." See July 2015 VA Orthopedic Surgery Consult. At the October 2019 VA examination, range of motion testing was "normal." See October 2019 VA Knee and Lower Leg Conditions examination report. At no point during the period on appeal did the Veteran meet the criteria for a compensable rating under either DC 5260, Leg, limitation of flexion of, or DC 5261, Leg, limitation of extension of. See 38 C.F.R. § 4.71a, DC 5260, DC 5261. Assuming arguendo that the Veteran met the criteria for a compensable evaluation under 38 C.F.R. § 4.71a, the prohibition against pyramiding of claims prevents compensation for the same manifestation of symptoms, i.e., pain, weakness, and limitation of range of motion, under multiple diagnostic codes in 38 C.F.R. § 4.71a. See 38 C.F.R. § 4.14; see also Brady v. Brown, 4 Vet. App. 206 (1993) (holding that 38 U.S.C. § 1155 means, "the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity."). The Board has considered the provisions of 38 C.F.R. § 4.40, Functional loss, and 4.45, The joints. While the Veteran complained of painful movement (See April 2014 and October 2019 VA Knee and Lower Leg Conditions examination reports), there is no "swelling, deformity or atrophy of disuse, [i]nstability of station, disturbance of locomotion (See April 2014 VA Knee and Lower Leg Conditions examination report, July 2015 VA Orthopedic Surgery Consult, and October 2019 VA Knee and Lower Leg Conditions examination report)." While there is evidence of locking (See October 2019 VA Knee and Lower Leg Conditions examination report)," there is no evidence of ankylosis (See April 2014 and October 2019 VA Knee and Lower Leg Conditions examination reports) or weakened movement (See April 2014 and October 2019 VA Knee and Lower Leg Conditions examination reports). The "minimum compensable rating," required under 38 C.F.R. § 4.59, is 10 percent under DC 5003, DC 5260, and DC 5261. See 38 C.F.R. § 4.71a, DC 5003, DC 5260, DC 5261. There is no "question as to which of two evaluations shall be applied." See 38 C.F.R. § 4.7. Aside from the Veteran's 2001 left knee fragment removal surgery in 2001, the record does not contain evidence of "frequent periods of hospitalization" for the Veteran's left knee. See April 2014 VA Knee and Lower Leg Conditions examination report. Because it is not reasonably raised from the record or from the appeal, referral for extraschedular consideration under 38 C.F.R. § 3.321 is not warranted. See 38 C.F.R. § 3.321(b)(1). Conclusion In summary, the evidence of record indicates the Veteran met the relevant diagnostic criteria under 38 C.F.R. § 4.71a, DC 5003, for a 10 percent rating between April 4, 2014 and October 20, 2019. At no point during the period on appeal did the Veteran meet the relevant diagnostic criteria for a rating greater than 10 percent disabling. Based on the evidence of record, the Veteran does not currently meet the relevant diagnostic criteria for entitlement to a compensable rating. In the alternative, the Veteran is rated for his "pain" and "locking" under 38 C.F.R. § 4.59, Painful motion, at the highest possible "minimum compensable rating." The minimum compensable rating is 10 percent in all potential rating criteria, so there is no "question as to which of two evaluations shall be applied" under 38 C.F.R. § 4.7. The provisions of 38 C.F.R. § 4.40 and § 4.45 have been considered. The Veteran does not meet the requirements for a disability rating greater than 10 percent for chondromalacia patella, left knee, for the relevant appeal period. The Veteran's disability does not present such an exceptional or unusual picture as to render the Rating Schedule impractical. Therefore, consideration for extraschedular evaluation is not for application. The Veteran is adequately compensated for the average impairment in earning capacity resulting from diseases or injuries incurred in or aggravated by his active service in his civilian occupation. The Board has carefully reviewed and considered the Veteran's statements regarding the severity of his left knee disability. To that end, the Board acknowledges that the Veteran, in advancing this appeal, believes that the residuals of his left knee disability are more severe than is reflected in the assigned evaluation rating. The Board is likewise aware of the Veteran's contentions that his residuals of a left knee disability impact his daily activities. Moreover, the Board notes that the Veteran is competent to report observable symptoms such as pain and locking. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, however, the competent medical evidence offering detailed, specific, and specialized determinations pertinent to the rating criteria, namely, determinations of limitation of motion, degree of motion, and X-ray evidence of degenerative arthritis, is the most probative evidence regarding the evaluation of pertinent symptoms for the disability on appeal. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The evidence also contemplates the Veteran's descriptions of his symptoms both at VA examinations and in treatment, private and VA-based, including his reports of impairment with respect to pain and locking. The lay testimony has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The April 2014 and October 2019 VA examination reports are the most probative evidence of record on the question of entitlement to an increased rating. The opinions were based on an extensive review of all the evidence, including lay statements from the Veteran, were supported by a detailed rationale, provided data to support any conclusions, and each provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the April 2014 and October 2019 VA examiner reports are consistent with the evidence of record, including the Veteran's reports of no swelling and full range of motion. The VA examiner opinions provide compelling evidence against the Veteran's claim for increase. There is no competent, credible evidence to refute the April 2014 and October 2019 VA examiner reports. The weight of the probative evidence of record is against a finding that the Veteran is entitled to a disability rating greater than 10 percent for chondromalacia patella, left knee, for the period on appeal. Consequently, an increase is not warranted, and the claimed increase must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 2. Entitlement to a rating greater than 10 percent disabling for radial head and condyle fracture, status post open reduction internal fixation, now with arthritis. In support of a claim for increase to 30 percent disabling, the Veteran contends, "I have lost strength in my left elbow, which does not allow me to lift over 50 lbs. without being in pain." See October 2014 VA Form 21-0958, Notice of Disagreement. Potentially applicable diagnostic codes for the Veteran's left elbow disability include 38 C.F.R. § 4.71a, DC 5010, DC 5206, DC 5207, DC 5208, and DC 5212. According to 38 C.F.R. § 4.71a, DC 5010, Arthritis due to trauma, criteria required: "Rate as arthritis, degenerative." See 38 C.F.R. § 4.71a, DC 5010. Changes to DC 5010, effective February 7, 2021, require: "Rate as limitation of motion, dislocation, or other specified instability under the affected joint." See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5010). Pursuant to 38 C.F.R. § 4.71a, DC 5206, Forearm, limitation of flexion of, a 0 percent rating is assigned for flexion of the forearm limited to 110 degrees, major and minor, a 10 percent rating is assigned for flexion of the forearm limited to 100 degrees, major and minor, a 20 percent rating is assigned for flexion of the forearm limited to 90 degrees, major and minor, and for flexion of the forearm limited to 70 degrees, minor, a 30 percent rating is assigned for flexion of the forearm limited to 70 degrees, major, and for flexion of the forearm limited to 55 degrees, minor, a 40 percent rating is assigned for flexion of the forearm limited to 55 degrees, major, and for flexion of the forearm limited to 45 degrees, minor, and a 50 percent rating is assigned for flexion of the forearm limited to 45 degrees, major. Pursuant to DC 5206, a 50 percent rating is the maximum schedular rating. See 38 C.F.R. § 4.71a, DC 5206. Under 38 C.F.R. § 4.71a, DC 5207, Forearm, limitation of extension of, a 10 precent rating is assigned for extension of the forearm limited to 45 degrees, major and minor, and for extension of the forearm limited to 60 degrees, major and minor, a 20 percent rating is assigned for extension of the forearm limited to 75 degrees, major and minor, and for extension of the forearm limited to 90 degrees, minor, a 30 percent rating is assigned for extension of the forearm limited to 90 degrees, major, and for extension of the forearm limited to 100 degrees, minor, a 40 percent rating is assigned for extension of the forearm limited to 100 degrees, major, and for extension of the forearm limited to 110 degrees, minor, and a 50 percent rating is assigned for extension of the forearm limited to 110 degrees, major. Pursuant to DC 5207, a 50 percent rating is the maximum schedular rating. See 38 C.F.R. § 4.71a, DC 5207. According to 38 C.F.R. § 4.71a, DC 5208, Forearm, flexion limited to 100 degrees and extension to 45 degrees, a 20 percent rating is assigned for major and minor. A 20 percent rating is the only available schedular evaluation under DC 5208. See 38 C.F.R. § 4.71a, DC 5208. Pursuant to 38 C.F.R. § 4.71a, DC 5212, Radius, impairment of, a 10 percent rating is assigned for malunion of, with bad alignment, major and minor, a 20 percent rating is assigned for nonunion in upper half, major and minor, and for nonunion in lower half, with false movement, without loss of bone substance or deformity, minor, a 30 percent rating is assigned for nonunion in lower half, with false movement, without loss of bone substance or deformity, major, and for nonunion in lower half, with false movement, with loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity, minor, and a 40 percent rating is assigned for nonunion in lower half, with false movement, with loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity, major. A 40 percent rating is the maximum schedular evaluation under DC 5212. See 38 C.F.R. § 4.71a, DC 5212. Factual Background The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the entire body of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Pursuant to a duty to assist, the Veteran was provided with a VA medical examination in April 2014. The examining physician reviewed the claims file and evidence of record in preparation for the report. The Veteran was examined in person, and his statements were considered, including a report of pain on complete extension. The Veteran was diagnosed with a left elbow injury and post traumatic arthritis of the left elbow. Range of motion was measured as 145 degrees or greater flexion and 10 to 145 degrees extension, without evidence of painful motion. The same results were achieved after repetitive testing. Muscle strength was normal. There was no evidence of ankylosis. Any functional loss or impairment was recorded as due to pain on movement and deformity. Residuals of 2003 surgery were documented as intermediate degrees of residual weakness, pain, and / or limitation of motion. Functional impact on the ability to work was reported by the Veteran as pain with lifting and on full extension. See April 2014 VA Elbow and Forearm Conditions examination report. Pursuant to the August 2019 Board remand, the Veteran was provided with a medical examination in October 2019. The claims file and evidence of record was reviewed in preparation for the examiner's report. The Veteran was examined in person, and his statements were considered, including a report of weakness, pain, and decreased range of motion. Flare-ups were reported as sharp pain in the elbow, occurring daily, lasting for one hour. Any functional loss or impairment was recorded as due to limited range of motion. The Veteran was diagnosed with status post open reduction internal fixation left elbow fracture. Muscle strength was normal. Range of motion testing measured flexion from 125 to 10 degrees and extension from 10 to 125 degrees, with no additional loss of function or range of motion after repetitive testing and no objective evidence of pain on passive range of motion or in non-weight bearing movement. There was no evidence of atrophy, flail joint, joint fracture, ununited fracture, malaligned fracture, impairment of supination or pronation, assistive devices, or other pertinent physical findings, complications, conditions, signs, or symptoms. Imaging studies, completed on the same date, showed "internal fixation hardware securing a remote and healed fracture" with "[n]o acute abnormality" and "[n]egative for arthritis." Functional impact on ability to work was reported by the Veteran as decreased range of motion and pain limiting carrying of heavy loads for prolonged periods. See October 2019 VA Elbow and Forearm Conditions examination report. Analysis To the extent that the VA Compensation and Pension examinations and other physical examinations discussed herein failed to record passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that the examinations nevertheless are adequate for VA rating purposes. Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual's ability to produce motion at a joint (active range of motion). CYNTHIA NORKIN & D. JOYCE WHITE, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 8-9 (2016). Testing the joint under weight-bearing conditions involves movement of the body against gravity. J. Randy Jinkins, et al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005). When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present. Id. at 1823. Because there is no indication that the structural integrity of the Veteran's left elbow is compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to record limitation of motion on passive range of motion and in non-weight-bearing is harmless error and not prejudicial to the Veteran. In addition to the October 2019 VA examination report, the Board will evaluate the Veteran's range of motion using the available measurements on active range of motion using the April 2014 VA examination report. Under 38 C.F.R. § 4.7, the Veteran is entitled to the benefit of the rating criteria that will result in the higher evaluation of his disability. The Veteran reports "pain" in his left elbow. See December 2013 East Ridge Internal Medicine Treatment Note, October 2014 VA Form 21-0958, Notice of Disagreement, April 2014 VA Elbow and Forearm Conditions examination report, October 2019 VA Elbow and Forearm Conditions examination report, January 2020 Raleigh Radiology CT Report, and January 2020 Cary Orthopaedics Treatment Note. Because the Veteran does not meet the minimum evaluation criteria for a compensable rating under any of the potentially applicable diagnostic codes under 38 C.F.R. § 4.71a, he was provided with the "minimum compensable rating for the joint," as prescribed by 38 C.F.R. § 4.59, "Painful motion." Left elbow X-rays taken in December 2013 private treatment showed "[n]o significant degenerative changes." See December 2013 East Ridge Internal Medicine X-ray Report. In January 2014 private treatment, left elbow X-rays found "some degree of radiocapitellar degenerative change." See January 2014 Chattanooga Bone & Joint Surgeons Clinical Encounter Summary. Left knee X-rays taken at the April 2014 VA examination revealed "[m]inimal patellofemoral osteoarthritis." See April 2014 VA Knee and Lower Leg Conditions examination report. Imaging at the October 2019 VA examination were "[n]egative for arthritis." See October 2019 VA Knee and Lower Leg Conditions examination report. While the Veteran appears to have met the criteria under DC 5003 for a 10 percent rating between April 4, 2014 and October 20, 2019, there is no evidence of "incapacitating exacerbations" at any point prior to October 20, 2019, to satisfy the criteria for a 20 percent rating for degenerative arthritis. See 38 C.F.R. § 4.71a, DC 5003. Rating criteria under DC 5010 after February 7, 2021, requires "limitation of motion, dislocation, or other specified instability." Range of motion at the April 2014 VA examination measured 145 degrees or greater of flexion and 10 to 145 degrees of extension. See April 2014 VA Elbow and Forearm Conditions examination report. July 2015 VA treatment cited "[e]xcellent range of motion and strength of left upper extremity. See July 2015 VA Orthopedic Consult. At the October 2019 VA examination, range of motion was detailed as 125 to 10 degrees flexion and 10 to 125 degrees extension. See October 2019 VA Elbow and Forearm Conditions examination report. January 2020 private treatment reported "[range of] motion is excellent." See January 2020 Cary Orthopaedics Treatment Note. At no point during the period on appeal has the Veteran met the requirements for a compensable rating under DC 5206, DC 5207, or DC 5208. See 38 C.F.R. § 4.71a, DC 5206, 5207, DC 5208. December 2013 private treatment noted "malalignment due to 2 previous surgeries." See December 2013 East Ridge Internal Medicine Treatment Note. However, an X-ray report at the same visit documented "evidence of cannulated screws stabilizing the left radial head and capitellum" and "[n]o evidence of acute fracture or dislocation." See December 2013 East Ridge Internal Medicine X-ray Report. Examination in January 2014 private treatment described "no strong mechanical symptom[s]...no clear evidence of lateral collateral ligament instability...no posterolateral elbow instability." See January 2014 Chattanooga Bone & Joint Surgeons Clinical Encounter. July 2015 VA treatment revealed "no evidence of loosening of the hardware." See July 2015 VA Orthopedic Surgery Consult. The October 2019 VA examination found no evidence of atrophy, flail joint, joint fracture, ununited fracture, or malaligned fracture. See October 2019 VA Elbow and Forearm Conditions examination report. Imaging taken in January 2020 found "[t]rabecular pattern otherwise maintained about the elbow without clear features of frank osteonecrosis." See January 2020 Raleigh Radiology CT Report. A VA X-ray report from January 2020 indicated "[s]table hardware." See January 2020 VA Primary Care Letters. At no point during the period on appeal has the Veteran met the requirements for a compensable rating under DC 5212. See 38 C.F.R. § 4.71a, DC 5212. Assuming arguendo that the Veteran met the criteria for a compensable evaluation under 38 C.F.R. § 4.71a, the prohibition against pyramiding of claims prevents compensation for the same manifestation of symptoms, i.e., pain, weakness, and limitation of range of motion, under multiple diagnostic codes in either 38 C.F.R. § 4.71a or § 4.73. See 38 C.F.R. § 4.14; see also Brady v. Brown, 4 Vet. App. 206 (1993) (holding that 38 U.S.C. § 1155 means, "the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity."). The Board notes that the Veteran is evaluated under DC 5307, Group VII, Function: Flexion of wrist and fingers, with a rating of 10 percent disabling, and 38 C.F.R. § 4.71a, DC 5213, Supination and pronation, impairment of, with a rating of 10 percent disabling. See May 2020 VA Rating Decision Codesheet. The Board has considered the provisions of 38 C.F.R. § 4.40, Functional loss, and 4.45, The joints. While the Veteran complained of weakened movement (See October 2014 VA Form 21-0958, Notice of Disagreement and October 2019 VA Elbow and Forearm Conditions examination report), there is no "evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like (See July 2015 VA Orthopedic Surgery Consult and October 2019 VA Elbow and Forearm Conditions examination report)." While there is evidence of "less movement than normal (See April 2014 and October 2019 VA Elbow and Forearm Conditions examination reports)," there is no evidence of ankylosis (See April 2014 and October 2019 VA Elbow and Forearm Conditions examination reports) or instability (See December 2013 East Ridge Internal Medicine X-ray Report, January 2014 Chattanooga Bone & Joint Surgeons Clinical Encounter Summary, October 2019 VA Elbow and Forearm Conditions examination report, and January 2020 VA Primary Care Letters). The minimum compensable evaluation under DC 5003, as required by DC 5010 pre-February 7, 2021, DC 5206, DC 5207, and DC 5212 is 10 percent. See 38 C.F.R. § 4.71a, DC 5003, DC 5206, DC 5207, DC 5212. The higher evaluation of 20 percent under DC 5208, Forearm, flexion limited to 100 degrees and extension to 45 degrees, does not more nearly approximate the Veteran's symptoms, given the range of motion measurements in the record, so the "lower rating will be assigned." See 38 C.F.R. § 4.7. Aside from the Veteran's 2003 open reduction internal fixation left radius, the record does not contain evidence of "frequent periods of hospitalization" for the Veteran's left elbow. See April 2014 VA Elbow and Forearm Conditions examination report. Because it is not reasonably raised from the record or from the appeal, referral for extraschedular consideration under 38 C.F.R. § 3.321 is not warranted. See 38 C.F.R. § 3.321(b)(1). Conclusion In summary, the evidence of record indicates the Veteran met the relevant diagnostic criteria under 38 C.F.R. § 4.71a, DC 5010, for a 10 percent rating for degenerative arthritis between April 4, 2014 and October 20, 2019. At no point during the period on appeal did the Veteran meet the relevant diagnostic criteria for a rating greater than 10 percent disabling. Based on the evidence of record, the Veteran does not currently meet the relevant diagnostic criteria for entitlement to a compensable rating. In the alternative, the Veteran is rated for his "pain" and "weakness" under 38 C.F.R. § 4.59, Painful motion, at the highest possible "minimum compensable rating." The higher evaluation of 20 percent under DC 5208 does not more nearly approximate the Veteran's symptoms, so the "lower rating will be assigned" under 38 C.F.R. § 4.7. The provisions of 38 C.F.R. § 4.40 and § 4.45 have been considered. The Veteran does not meet the requirements for a disability rating greater than 10 percent for left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, for the relevant appeal period. The Veteran's disability does not present such an exceptional or unusual picture as to render the Rating Schedule impractical. Therefore, consideration for extraschedular evaluation is not for application. The Veteran is adequately compensated for the average impairment in earning capacity resulting from diseases or injuries incurred in or aggravated by his active service in his civilian occupation. The Board has carefully reviewed and considered the Veteran's statements regarding the severity of his left elbow disability. To that end, the Board acknowledges that the Veteran, in advancing this appeal, believes that the residuals of his left elbow disability are more severe than is reflected in the assigned evaluation rating. The Board is likewise aware of the Veteran's contentions that his residuals of a left elbow disability impact his daily activities. Moreover, the Board notes that the Veteran is competent to report observable symptoms such as pain and weakness. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, however, the competent medical evidence offering detailed, specific, and specialized determinations pertinent to the rating criteria, namely, determinations of limitation of motion, degree of motion, malunion, nonunion, loss of bone substance, false movement, and marked deformity, is the most probative evidence regarding the evaluation of pertinent symptoms for the disability on appeal. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The evidence also contemplates the Veteran's descriptions of his symptoms both at VA examinations and in treatment, private and VA-based, including his reports of impairment with respect to pain and weakness. The lay testimony has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The April 2014 and October 2019 VA examination reports are the most probative evidence of record on the question of entitlement to an increased rating. The opinions were based on an extensive review of all the evidence, including lay statements from the Veteran, were supported by a detailed rationale, provided data to support any conclusions, and each provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the April 2014 and October 2019 VA examiner reports are consistent with the evidence of record, including the Veteran's reports of pain on full extension and pain related to "overuse and strenuous use at work." The VA examiner opinions provide compelling evidence against the Veteran's claim for increase. There is no competent, credible evidence to refute the April 2014 and October 2019 VA examiner reports. The weight of the probative evidence of record is against a finding that the Veteran is entitled to a disability rating in excess of 10 percent for left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, for the period on appeal. Consequently, an increase is not warranted, and the claimed increase must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 3. Entitlement to a total disability rating based on individual unemployability (TDIU). The Veteran contends, "I'm unable to hold a decent job due to pain and the restrictions of weight limit." See October 2014 VA Form 21-0958, Notice of Disagreement. The Veteran's argument for increase of his service-connected disabilities raises the possibility that his service-connected disabilities preclude him from obtaining and maintaining substantially gainful employment. See October 2014 VA Form 21-0958, Notice of Disagreement. VA will grant a TDIU when the evidence shows that a veteran is precluded, by reason of his service-connected disabilities, from securing and following "substantially gainful employment" consistent with his education and occupational experience. 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). In determining unemployability for VA purposes, consideration may be given to a veteran's level of education, special training, and previous work experience but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992); Faust v. West, 13 Vet. App. 342 (2000). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough, as a high disability rating is in and of itself a recognition that the impairment makes it difficult to obtain and keep employment. The 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 v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). Medical evaluations are probative to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Recently, in Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the United States Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the Veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. The Board recognizes the Court's findings in Cantrell v. Shulkin, 28 Vet. App. 382 (2000) concerning the meaning of the term "in a protected environment" under 38 C.F.R. § 4.16(a). In Cantrell, the Court held that the meaning of "employment in a protected environment" is not clear from the regulation's plain language and noted that the list of examples in the regulation "suggests that VA may have intended employment 'in a protected environment' to be a term of art that differs from the ordinary, accommodation-based dictionary definition proffered by the [V]eteran." Id. The Board takes note of the examples of "protected environment" used in the text of 38 C.F.R. § 4.16(a), "family business or sheltered workshop." In the case of a family business, it is common for an employer to hire a relative to fill a position, not because the relative is necessarily the most capable or efficient prospective employee, but for reasons of affection or obligation. The term "sheltered workshop" is not defined in Title 38 of the Code of Federal Regulations. Several state codes across the U.S. define "sheltered work shop" in the following ways: "a facility designed to provide gainful employment for individuals with severe disabilities who cannot be absorbed into the competitive labor market or to provide interim employment for such individuals when employment opportunities for them in the competitive labor market do not exist" (Louisiana); "a facility, or any portion thereof, operated by a nonprofit organization, corporation, partnership, limited liability company or association whose purpose is to provide meaningful work or training activities to individuals with developmental disabilities" (Oklahoma); "an occupation-oriented facility operated by a not-for-profit corporation, which, except for its staff, employs only persons with disabilities" (Missouri); "an occupation-oriented facility operated by a nonprofit agency, public or private, which except for its staff, employs only handicapped persons" (New Jersey). La. R.S. § 39:1604.4 ; 63 Okl. St. § 1-865.2 ; § 178.900 R.S.Mo.; N.J. Stat. § 34:16-40. Title 20 of the Code of Federal Regulations, 20 C.F.R. § 404.1574 (a)(3), which the Code describes as an evaluation guide for (Social Security Administration) employees for determining whether a worker is involved in substantially gainful activity, states: "If you are working in a sheltered workshop, you may or may not be earning the amounts you are being paid. The fact that the sheltered workshop or similar facility is operating at a loss or is receiving some charitable contributions or government aid does not establish that you are not earning all you are being paid." The Board recognizes that the Secretary, as of this decision, has not defined "protected environment." Therefore, said determinations must be made on a case-by-case basis, evaluating the information and evidence in the record. TDIU may be assigned where the schedular rating is less than total and it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If the Veteran does not meet the required percentage standards set forth in 38 C.F.R. § 4.16(a), he still may receive a TDIU on an extraschedular basis if it is determined that he is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities. See 38 C.F.R. § 4.16(b). In cases where extraschedular consideration is warranted, referral to the Director of Compensation Service is necessary prior to a determination on eligibility. In Thun v. Peake, 22 Vet. App. 111 (2008), the Court held that the determination of whether a claimant is entitled to an extraschedular rating under 38 C.F.R. § 3.321(b) is a three-step inquiry. First, there must be a finding that the evidence of record presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Id. This first element is a threshold element and requires the Board to compare the severity and symptomatology of the claimant's service-connected disability with the rating-schedule for that disability. See Id. If the rating criteria reasonably describe the claimant's disability level and symptomatology, the assigned schedular evaluation is adequate and no referral is required. Id. Second, if the schedular criteria are found to be inadequate to evaluate the claimant's disability, the Board must determine whether the exceptional disability exhibits other related factors such as marked interference with employment or frequent periods of hospitalization. Id. If so, then under the third step of the inquiry the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination of whether the claimant's disability picture requires the assignment of an extra-schedular rating. Id. When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of doubt shall be given to the claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Factual Background Service-connected conditions for the Veteran include: 1) Major Depressive Disorder Associated with Anxiety (MDD) [rated as 50 percent disabling from October 2, 2014]; 2) Left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis (claimed as left elbow condition and left elbow surgery), painful and limited flexion [rated as 10 percent disabling from January 1, 2005]; 3) Chondromalacia patella, left knee (claimed as pain and swelling, left knee, Baker's Cyst and slight lateral tilt of the left patella) [rated as 10 percent disabling from January 1, 2005]; 4) Residuals of muscle injury to left forearm, muscle group VII (minor) associated with left radial head and condyle fracture, status post open reduction interna fixation, now with arthritis (claimed as left elbow condition and left elbow surgery), painful and limited flexion [rated as 10 percent disabling from February 20, 2008]; 5) Scar, left elbow associated with left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis (claimed as left elbow condition and left elbow surgery) [rated as 0 percent disabling from January 1, 2005 and 10 percent disabling from February 20, 2008]; 6) Left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis (claimed as left elbow condition and left elbow surgery), painful and limited supination [rated as 10 percent disabling from October 21, 2019]; and 7) Left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis (claimed as left elbow condition and left elbow surgery), limited flexion [rated as 0 percent disabling from October 21, 2019]. See May 2020 VA Rating Decision Codesheet. Combined overall ratings for the Veteran, including consideration of the bilateral factor, excluding periods of temporary total ratings and special monthly compensation, are: 1) 20 percent from January 1, 2005; 2) 30 percent from February 20, 2008; and 3) 70 percent from October 2, 2014. See May 2020 VA Rating Decision Codesheet. The Veteran graduated from high school and has a bachelor's degree in Business Administration. See June 2015 VA Primary Care Note, July 2015 VA Psychiatry Consult, July 2015 VA Orthopedic Surgery Consult, and June 2017 VA Mental Disorders examination report. Service records indicate that the Veteran was trained as a "Cryogenics Equipment Operator" and achieved the rank of Sergeant. See December 2004 Certificate of Release or Discharge from Active Duty. Employment history for the Veteran includes: "Cargill, Terminal Operator...2 to 5 years (See February 2008 VA C & P Examination Note), plant operator (See June 2015 VA Primary Care Note), filling [metal] cylinders with gas or liquid (See July 2015 VA Orthopedic Surgery Consult), pull[ing] hoses out of trailers (See June 2017 VA Mental Disorders examination report), mechanic at the airport (See June 2017 VA Mental Disorders examination report and April 2018 Veteran-provided Mental Disorders DBQ), and Gregory Poole...as a mechanic (See October 2019 VA Mental Health Consult)." As indicated previously, the Veteran has not claimed TDIU per se. Pursuant to the August 2019 Board remand and October 2019 VA correspondence, the Veteran was asked to complete VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, and VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefit. See August 2019 BVA Decision and October 2019 VA Subsequent Development Letter. To date, the Veteran has not supplied this information to VA. As a result, information such as whether the Veteran's income is above the poverty threshold is not part of the record before the Board. Period from September 10, 2013, to October 2, 2014 Prior to October 2, 2014, the Veteran was in receipt of a combined evaluation of 30 percent. See May 2020 VA Rating Decision Codesheet. The percentage standards criteria for schedular TDIU are set aside only when the evidence clearly and factually shows the veteran has been rendered unemployable solely due to service-connected disabilities regardless of their individual and combined percentages. Such cases are submitted to the Director of the Compensation and Pension Service for extra-schedular consideration. See 38 C.F.R. § 4.16(b). Referral for extraschedular consideration is not warranted for the Veteran's service-connected left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, chondromalacia patella, left knee, or scar, left elbow, associated with left radial head and condyle fracture, status post open reduction internal fixation, now with arthritis, symptoms. The symptoms did not show "such an exceptional or unusual disability picture... as to render impractical the application of the regular schedular standards." See 38 C.F.R. § 3.321(b) (2016). For instance, he was examined privately in April 2013 for complaints of left elbow pain that had begun 4 months earlier (also verified in an earlier private treatment). It was noted that his occupation was that of a mechanic and was right hand dominant and worked regular duty. When examined by a private provider in December 2013, it was noted that he was employed full time even though decreased hand grip strength on the left was noted. There is no indication in the medical record, nor does the Veteran claim that he was unable to obtain and maintain substantially gainful employment due to his service-connected disabilities during this time. The average impairment in earning capacity due to the Veteran's service-connected disability symptoms was adequately compensated and accounted for in the Veteran's schedular ratings. See Thun v. Peake, 22 Vet. App. at 115 (2008). Period After October 2, 2014 From October 2, 2014, the Veteran's combined overall disability rating was 70 percent, including a 50 percent rating for Major Depressive Disorder Associated with Anxiety. See May 2020 VA Rating Decision Codesheet. The Board finds that the Veteran meets the rating requirements for consideration of a schedular TDIU from October 2, 2014, which coincides with the date on which the Veteran stated, "I'm unable to hold a decent job due to pain the restrictions of weight limit." See October 2014 VA Form 21-0958, Notice of Disagreement. However, there is no evidence from the Veteran or the record that he is unemployable due to a service-connected disability. While the Veteran argues that his service-connected disabilities preclude him from obtaining and maintaining substantially gainful employment (See October 2014 VA Form 21-0958, Notice of Disagreement), the Veteran was employed during this period (See October 2019 VA Mental Health Consult, "was previously in one stable [job] for 9 years."). As such, the Board finds that the Veteran's employment cannot be considered marginal. There is no evidence in the record that the Veteran was employed in a sheltered or protected work environment during this period. See June 2017 VA Mental Disorders examination report, April 2018 Veteran-provided Mental Disorders DBQ, and October 2019 VA Mental Disorders examination report. Moreover, to consider entitlement to individual unemployability, the law requires the Veteran provide a substantially complete application. The Agency of Original Jurisdiction (AOJ) contacted the Veteran to request a completed VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, and VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits. See August 2019 BVA Decision and October 2019 VA Subsequent Development Letter. As of this date, the requested Form has not been received. The Board cannot verify the Veteran's work history, job skills history, job training history, or employment income history. Based on the available evidence in the record, the Veteran cannot be found unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. See February 2008 VA C & P Examination Note, June 2015 VA Primary Care Note, July 2015 VA Orthopedic Surgery Consult, June 2017 VA Mental Disorders examination report, June 2017 VA Mental Disorders examination report, April 2018 Veteran-provided Mental Disorders DBQ, and October 2019 VA Mental Health Consult. In addition, VA examinations concluded that occupational and social impairment for the Veteran was: "occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation." See June 2017 and October 2019 VA Mental Disorders examination reports. The April 2018 Disability Benefits Questionnaire, provided by the Veteran, indicated occupational and social impairment as: "deficiencies in most areas, such as work, school, family relations, judgment, thinking and / or mood." See April 2018 Veteran-provided Mental Disorders DBQ. As reported by the Veteran in the October 2019 VA examination, "his lawyer recommended he schedule an (April 2018) appointment with Dr. R.W." After the reviewing the April 2018 report from Dr. R.W., the October 2019 examining psychologist concluded, "The [Veteran] did not report breadth or level of functional impairment noted in the 4/30/18 report completed by Dr. W." See October 2019 VA Mental Disorders examination report. The April 2018 report completed by Dr. R.W., who has never treated the Veteran, did not include a review of the Veteran's claims file and evidence of record as a basis for its conclusions. See April 2018 Veteran-provided Mental Disorders DBQ ("My current examination and relevant mental and medical records regarding occupational history reported (emphasis added) by Veteran."). For these reasons, the Board affords more weight and probative value to the VA examination reports that did review the claims file and evidence of record in preparation for their respective reports. See June 2017 and October 2019 VA Mental Disorders examination reports; see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). Conclusion As previously noted, the standard in awarding a TDIU 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 v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). 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). In summary, the Board concludes that the Veteran's service-connected conditions do not prevent him from securing or following a substantially gainful occupation, consistent with his history, education, including a bachelor's degree in Business Administration, skill, and training. While the Veteran's service-connected conditions have the potential to functionally impact his employment, as suggested by his current 50 percent evaluation for Major Depressive Disorder with Anxiety, the standard under 38 C.F.R. § 4.16(a) is whether the disabled person is unable to secure or follow a substantially gainful occupation. The record reflects that the Veteran continues to maintain full-time employment, and despite complaints regarding the inability to perform heavy lifting, he has remained capable of working full-time. The Board finds that the Veteran's employment cannot be considered marginal. According to the record, the Veteran has never had any post-service legal issues, been disciplined, nor has he experienced interpersonal problems during his work history. There is no evidence that his service-connected conditions limited his work to the degree required for a TDIU, including that the Veteran was employed in a sheltered or protected work environment during the appeal period. VA examinations, afforded more weight and probative value, found occupational and social impairment to be "occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation." Accordingly, the Veteran's claim for a TDIU is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Small, Attorney Advisor 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.