Citation Nr: 21068444 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 99-13 825 DATE: November 10, 2021 ORDER A 20 percent initial rating, but no higher, prior to January 15, 2014, for peripheral neuropathy of the right upper extremity is granted, subject to the laws and regulations governing payment of monetary benefits. A 20 percent initial rating, but no higher, prior to January 15, 2014, for peripheral neuropathy of the left upper extremity is granted, subject to the laws and regulations governing payment of monetary benefits. A rating greater than 40 percent from January 15, 2014, for peripheral neuropathy of the right upper extremity is denied. A rating greater than 30 percent from January 15, 2014, for peripheral neuropathy of the left upper extremity is denied. A total disability rating due to individual unemployability (TDIU) from August 19, 2004 to August 16, 2010, is granted, subject to the laws and regulations governing payment of monetary benefits. FINDINGS OF FACT 1. Prior to January 15, 2014, the Veteran's diabetes mellitus disability was productive of no more than mild right upper extremity neuropathy of the median and ulnar nerves. 2. Prior to January 15, 2014, the Veteran's diabetes mellitus disability was productive of no more than mild left upper extremity neuropathy of the median, and ulnar nerves. 3. From January 15, 2014, the Veteran's diabetes mellitus disability was productive of no more than moderate right upper extremity neuropathy of the radial, median, and ulnar nerves. 4. From January 15, 2014, the Veteran's diabetes mellitus disability was productive of no more than moderate left upper extremity neuropathy of the radial, median, and ulnar nerves. 5. Resolving doubt in favor of the Veteran, the combination of his service-connected disabilities rendered him unemployable from August 19, 2004 to August 16, 2010, the entire period on appeal. CONCLUSIONS OF LAW 1. The criteria for a 20 percent initial disability rating prior to January 15, 2014, for right upper extremity neuropathy, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8513. 2. The criteria for a 20 percent initial disability rating prior to January 15, 2014, for left upper extremity neuropathy, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8513. 3. The criteria for a disability rating greater than 40 percent from January 15, 2014, for peripheral neuropathy of the right upper extremity, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8513. 4. The criteria for a disability rating greater than 30 percent from January 15, 2014, for peripheral neuropathy of the left upper extremity, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8513. 5. The criteria for a TDIU from August 19, 2004 to August 16, 2010, are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1969 to January 1971. In July 2007, the Veteran testified before a Veterans Law Judge via videoconference; a transcript of the hearing has been associated with the record. In February 2021, the Veteran was informed that the Veterans Law Judge who held the July 2007 hearing was no longer employed by the Board, and the Veteran was given an opportunity to appear at another hearing. 38 C.F.R. § 20.604 (2020). The letter informed the Veteran that, if no response was received in 30 days, the Board would assume he did not want another hearing. The Veteran has not responded to the letter; therefore, no further action concerning a Board hearing in necessary. The Veteran's appeal was previously before the Board in June 2019, at which time an increased rating of 40 percent was awarded to the Veteran's service-connected peripheral neuropathy, right upper extremity, effective January 15, 2014; and an increased rating of 30 percent was awarded to the Veteran's service-connected peripheral neuropathy, left upper extremity, effective January 15, 2014. In doing so, the Board denied initial ratings in excess of 10 percent prior to January 15, 2014, for both upper extremities, as well as ratings in excess of the 40 percent and 30 percent assigned to both upper extremities. Insofar as the Board denied initial ratings in excess of 10 percent prior to January 15, 2014, for both upper extremities, as well as ratings in excess of 40 percent and 30 percent for both upper extremities from January 15, 2014, the Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). Subsequently, the parties to the action submitted a Joint Motion for Partial Remand (JMPR) which was adopted by the Court in an Order issued in August 2020. In the JMPR, the parties agreed that the Board's decision to award increased ratings of 40 percent and 30 percent to the Veteran's bilateral upper extremities, effective January 15, 2014, should not be disturbed. The appeal was remanded by the Board in May 2021 in compliance with the JMPR and the appeal is now ready for further disposition. 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. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Thus, although the Board has thoroughly reviewed all evidence of record, the more critical evidence consists of the evidence generated during the appeal period. Further, the Board must evaluate the medical evidence of record since the filing of the claim for increased rating and consider the appropriateness of a "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007). Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations do provide that ratings for peripheral neuropathy are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for a 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. Although the rating schedule contains criteria for rating each nerve of the upper extremity individually, a note accompanying the criteria specifically directs that combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. 38 C.F.R. § 4.124a, Note. Additionally, VA regulations make clear that pyramiding the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes is to be avoided. 38 C.F.R. § 4.14. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). In this case, in a November 2005 Rating Decision, the agency of original jurisdiction (AOJ) granted service connection for right and left upper extremity peripheral neuropathy (10 percent each), effective August 19, 2004. The present appeal arises from the Veteran's disagreement with the initial rating. During the pendency of the appeal, the right upper extremity disability rating was increased to 40 percent and the left upper extremity disability rating was increased to 30 percent, both from January 15, 2014, the date of a VA examination. Prior to January 15, 2014, the Veteran's service-connected right and left peripheral neuropathy of the upper extremities was rated under 38 C.F.R. § 4.124a, Diagnostic Code 8515. From January 15, 2014, the disabilities were rated under Diagnostic Code 8513. The Board notes that the Veteran is right-hand dominant (major hand). See, e.g., October 2019 VA examination report. VA treatment records dated in March 2000 noted the Veteran's complaints of numbness in the left hand. A March 2000 VA EMG report noted abnormal findings in the median and ulnar nerves, bilaterally. In a July 2006 statement, the Veteran described increased pain in the upper and lower extremities such that he had to double his pain medication. During the July 2007 Board hearing, the Veteran reported that his upper extremity symptoms were above the elbow, moving upwards from the wrist. He reported that he experienced tingling and numbness to the point where he could not feel things that he saw himself pick up and that these symptoms occurred daily. The Veteran was provided with VA examinations in May 2009, August 2010, January 2014, and December 2016. During the May 2009 VA examination, the Veteran complained of having pain in his hands all the time. The Veteran also reported experiencing occasional numbness in his hands and denied any parasthesia or sensation problems. On objective evaluation, the examiner noted that he was unable to identify any specific nerve affected. The examiner noted that the Veteran's peripheral neuropathy seemed to be clinically insignificant. The examiner indicated that an EMG would be ordered. Thereafter, the Veteran's representative submitted a statement that although an EMG appeared to have been ordered, the results of the same were not in the file. As a result, in March 2010, the Board remanded the appeal for outstanding records as well as a VA examination. During the August 2010 VA examination, the Veteran reported numbness and tingling in the bilateral arms and hands and reported difficulty gripping objects. The examiner also reviewed the EMG study and noted that it showed mild bilateral carpal tunnel syndrome with no evidence of neuropathy. The examiner diagnosed mild bilateral upper extremity carpal tunnel syndrome. During the January 2014 VA examination, the Veteran reported that he had not worked since 1991 due to pain in the bilateral hands and feet. He reported constant pain in the bilateral hands daily. He described the pain as throbbing, radiating to the elbows and rated as a 6 out of 10 on the pain scale, at worst. He reported that trying to carry things made his pain worse (rated as a 6 out of 10 on the pain scale), that he experienced pins and needles two to three times per week which lasted for a half an hour at a time, numbness four to five times per week, which lasted for an hour at most. The Veteran also reported having moderate, constant pain in both upper extremities. He also reported having mild paresthesias and/or dysesthesias and mild numbness in the bilateral upper extremities. The examiner noted that the Veteran had mild incomplete paralysis of the median nerve, bilaterally. The examiner found that the ulnar nerve was normal. The examiner also noted that although the Veteran subjectively reported having no sensation to light touch in both hands, the Veteran was observed being able to open his phone, touch the screen to talk, and that the Veteran was able to drive. During the December 2016 VA examination, the Veteran denied constant pain but reported experiencing severe, intermittent pain, moderate paresthesias/dysesthesias, and mild numbness. Following objective testing, the examiner noted that the Veteran had full muscle strength, normal reflexes, and normal light touch, in the upper extremities. The examiner noted, however decreased vibration testing and decreased cold sensation in the upper extremities. The examiner determined that the Veteran had moderate, incomplete paralysis of the radial, median, and ulnar nerves. The examiner determined that the overall severity of the upper extremity sensory neuropathy in both upper extremities was moderate. Private treatment records dated in March 2016 include the Veteran's report of constant pain rated 6 out of 10 on the pain scale, in both arms. A December 2015 private treatment record noted the Veteran's report of constant pain rated 6 out of 10 from the elbows down, due to diabetic neuropathy. 1. Entitlement to an initial rating greater than 10 percent for peripheral neuropathy of the right upper extremity prior to January 15, 2014. 2. Entitlement to an initial rating greater than 10 percent for peripheral neuropathy of the left upper extremity prior to January 15, 2014. In this case, it is clear that multiple upper extremity nerves have been affected by the Veteran's diabetic neuropathy for the entire period on appeal. See e.g. March 2000 VA EMG report. However, no medical evidence separates out the symptomatology from each nerve injury. As discussed above, during the period prior to January 15, 2014, the Veteran's service-connected upper extremity disability was productive of numbness and pain during the period prior to January 14, 2015. The Board concludes, based on a review of the record as a whole, and the note following the rating criteria and VA's general policy against pyramiding, that separate ratings for the individual affected nerves are not warranted. Further, as the evidence supports a finding that the Veteran's disability involves multiple nerves prior to January 15, 2014, and the upper extremities are already rated by reference to all radicular groups from January 15, 2014, the Board finds that rating under DC 8513 for all radicular groups is the appropriate rating for both upper extremities for the period prior to January 15, 2014. Paralysis of all radicular groups is rated in accordance with criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8513. Under Diagnostic Code 8513, mild incomplete paralysis of all radicular groups warrants a 20 percent rating for the major or minor arm; moderate incomplete paralysis of all radicular groups warrants a 40 percent rating for the major arm and a 30 percent rating for the minor arm; severe incomplete paralysis of all radicular groups warrants a 70 percent rating for the major arm and 60 percent for the minor arm. When there is complete paralysis, DC 8513 provides for a 90 percent rating for the major arm and an 80 percent rating for the minor arm. After review of the record, the Board finds that for both upper extremities prior to January 15, 2014, the Veteran's diabetic neuropathy manifested in mild incomplete paralysis of the upper radicular groups. In reaching this conclusion, the Board places a high probative value on the March 2000 VA EMG report which identified abnormalities in the median and ulnar nerves, as well as the Veteran's subjective complaints of mild numbness, pain, and tingling above the elbow, moving upwards from the wrist in both upper extremities, throughout the entire period on appeal. As noted above, because multiple nerves were affected during the period prior to January 14, 2015, the Board finds that the Veteran's mild peripheral neuropathy is more accurately rated under DC 8513 for all radicular groups. This is consistent with the manner in which the disabilities were treated for the period after January 15, 2014. The Board accordingly finds that the Veteran's disability ratings for right and left upper extremity neuropathy under DC 8515 (median nerve) should be rated under DC 8513 (all radicular groups), and that a 20 percent rating is warranted for mild peripheral neuropathy in each upper extremity from August 19, 2004, the date of the claim. However, a rating higher than 20 percent at any time prior to January 15, 2014, for right or left upper extremity neuropathy, is not warranted. There is no indication that the upper extremity disabilities were more than mild prior to January 14, 2015. In this regard, the May 2009 VA examiner found the Veteran's peripheral neuropathy to be clinically insignificant. Further, the Board the March 2000 VA EMG report noted that the impairment in the median and ulnar nerves was mild. Subsequent VA treatment records and examination reports, and lay statements did not indicate that the upper extremity symptoms were more than mild prior to January 15, 2014. Based on the foregoing, the Board resolves doubt and finds that mild impairment of the median and ulnar nerves in both upper extremities was present for the entire period prior to January 15, 2014, but the preponderance of the evidence is against a finding of more than mild impairment prior to January 15, 2014. 3. Entitlement to a rating greater than 40 percent for peripheral neuropathy of the right upper extremity from January 15, 2014. 4. Entitlement to a rating greater than 30 percent for peripheral neuropathy of the left upper extremity from January 15, 2014. For the reasons explained below, the Board finds that ratings greater than 40 percent for the right upper extremity and greater than 30 percent for the left upper extremity, from January 15, 2014, are not warranted. In reaching these conclusions, the Board has considered the Veteran's subjective complaints during the January 2014 VA examination that he experienced upper extremity symptoms including moderate constant pain, mild paresthesias and/or dysesthesias, and mild numbness of the bilateral upper extremities. The Board also notes the January 2014 objective findings that the Veteran showed decreased sensation in the inner/outer forearm and moderate incomplete paralysis of the median nerves (albeit normal functioning of radial nerves). The Board finds it significant that the January 2014 VA examiner noted that the Veteran's peripheral neuropathy in the upper extremities was clinically insignificant. The Board finds that the Veteran's complaints and objective findings are no more than moderate in severity. The Board also acknowledges that during the December 2016 VA examination, the Veteran reported experiencing severe, intermittent pain, moderate paresthesias/dysesthesias, and mild numbness. However, the Board finds that these symptoms were no more than moderate because objective testing revealed that the Veteran had full muscle strength, normal reflexes, and normal light touch, in the upper extremities. The Board has also considered the December 2016 VA examiner's findings of decreased vibration testing and decreased cold sensation in the upper extremities. The Board places a high probative value on the VA examiner's determination that based on the Veteran's subjective complaints and objective testing, the Veteran had moderate, incomplete paralysis of the radial, median, and ulnar nerves. The examiner determined that the overall severity of the upper extremity sensory neuropathy in both upper extremities was moderate. The Board finds that VA and private treatment records do not indicate worse findings than those reported and noted during the December 2016 VA examination. The Board finds that severe incomplete paralysis has not been shown in either upper extremity during the period on appeal. In this regard, the December 2016 VA examiner noted normal muscle strength, normal response to light touch, and no muscle atrophy in the bilateral upper extremities. One would expect to see some decreased muscle strength or atrophy in the upper extremities if the disorder was severe. Further, in December 2016, the VA examiner considered the Veteran's subjective reports of severe, intermittent pain but determined that the Veteran's overall severity of both extremities was moderate. The Board places a high probative value on the examiner's conclusion as the examiner considered the Veteran's subjective reports in addition to the objective findings which indicated normal findings for muscle strength, reflexes, light touch and only decreased vibration testing and decreased cold sensation. The Board acknowledges that private treatment records dated in December 2015 and March 2016 indicate that the Veteran experienced constant pain in the upper extremities, but the Board finds it significant that during the December 2016 VA examination, the Veteran denied constant pain and rather, described the pain as severe but intermittent. The findings of mild and moderate symptoms during the period since January 15, 2014, are more consistent with the currently-assigned moderate incomplete paralysis under Diagnostic Code 8513. The Board acknowledges the Veteran's belief that his symptoms are of such severity as to warrant higher ratings; however, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability is evaluated, more probative than the Veteran's assessment of the severity of his disabilities. The Board has considered whether additional staged ratings are appropriate for the Veteran's service-connected upper extremity disabilities; however, the Board finds that his symptomatology has been stable throughout the currently assigned appeal periods. Therefore, additional staged ratings for the upper extremity disabilities are not warranted. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. Indeed, the Board has afforded the Veteran the benefit of the doubt in finding that he is entitled to 20 percent disability ratings for each upper extremity prior to January 15, 2014. However, the preponderance of the evidence is against the claim of entitlement to ratings higher than 20 percent in each upper extremity prior to January 15, 2014, or greater than 40 percent for the right upper extremity and 30 percent for the left upper extremity, thereafter. To this extent, the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. TDIU The Veteran filed an informal claim for TDIU in November 2009 and thereafter, the Board remanded the appeal for further development. The Veteran submitted a formal claim in September 2013. On the September 2013 formal claim, the Veteran reported that he was no longer able to work due to his upper extremity peripheral neuropathy disabilities in addition to service-connected PTSD and lower extremity peripheral neuropathy disabilities. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." See 38 C.F.R. §§ 3.340 (a)(1), 4.15. A TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of 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. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In this case, the Veteran was granted a TDIU from August 16, 2010 to December 5, 2016. See April 2017 Rating Decision. However, as discussed in the January 2019 Remand, because the claim for a TDIU arose during the pendency of the claim for increase, the claim for TDIU extends back to the date of the claim for the underlying claim for increase (in this case, upper extremity peripheral neuropathy). Here, based on the awards outlined above, the Veteran is now in receipt of a 70 percent total schedular rating, effective the date of his claim for service connection for peripheral neuropathy, August 19, 2004. See 38 C.F.R. §§ 4.25, 4.26. Importantly, for the time period from August 19, 2004 to August 16, 2010, the Veteran was, in pertinent part, service-connected for the following: PTSD at 10 percent prior to September 21, 2009, and 30 percent thereafter; diabetes mellitus at 20 percent; right arm peripheral neuropathy at 20 percent and left arm peripheral neuropathy at 20 percent; left lower extremity peripheral neuropathy at 10 percent and right lower extremity peripheral neuropathy at 10 percent; which amounts to a combined rating of 70 percent after applying the appropriate bilateral factors for the upper and lower extremity disabilities. As such, the Veteran is eligible for a TDIU under the provisions of 38 C.F.R. § 4.16 (a) for the entire period prior to August 16, 2010. The Veteran last worked in 1991. The type of work was identified as boiler maker. The Veteran reported that his highest level of education was four years of high school. He reported that he has not had any other education or training before or since he became too disabled to work. VA treatment records and examination reports indicate functional impairment with numbness in the upper and lower extremities for the entire period on appeal. See e.g. May 2009 VA examination report. The Veteran reported interference with his daily activities as requiring another person to clean his house. He also reported that he was only able to walk a few steps before having to stop. Additionally, he reported that he was able to drive but had to stop at times due to wrist pain. He consistently reported significant pain throughout the entire period on appeal. See e.g. July 2006 Substantive Appeal Form 9 (he reported he had doubled his pain medication). A January 2005 VA PTSD examination noted the Veteran's report that he was unemployable and had no skills to get a job. The Veteran reported at that time that he had worked as a carpenter on and off for two years and did a couple of jobs as a boiler maker. He also reported that he worked in a paper mill for three months. During the January 2005 VA examination, the Veteran also reported that he enjoyed a hobby of working with beads and that it calmed him, but that he could not do it for long periods of time due to problems with concentration, as a result of service-connected PTSD. He reported that likewise, he could work on a computer for three to four hours on and off but could not work continuously for hours due ot his concentration. He reported that when he did things on the computer, he would do a task on the computer for an hour, take a break, and then come back again later. After review of the evidence, the Board finds that the Veteran's service-connected disabilities, in combination, prevented the Veteran from securing and following gainful employment for the entire period on appeal prior to August 16, 2010. The Board notes that in the April 2017 rating decision, the AOJ found the Veteran unemployable due to the combination of the Veteran's PTSD and peripheral neuropathy. The AOJ assigned an effective date of August 16, 2010 because at that time, that was the date that the Veteran met the schedular criteria for a TDIU. Importantly, the evidence does not indicate that the Veteran was employable prior to August 16, 2010. The AOJ also determined that the Veteran was only entitled to a TDIU until December 5, 2016 because that is the date that the Veteran's combined disability rating reached 100 percent. The Board acknowledges that it is possible to be awarded a separate TDIU in addition to a 100 percent schedular rating but in this case, the Veteran's combined disabilities rendered him unemployable, not a specific disability. The Veteran does not assert otherwise. In reaching this conclusion, the Board acknowledges that the May 2009 VA examiner indicated that the Veteran was unemployable due to his lower extremity peripheral neuropathy. However, the decision of whether a veteran is employable is a legal determination, rather than a medical determination. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (holding that "applicable regulations place responsibility for the ultimate TDIU determination on the VA [adjudicator], not a medical examiner.") The Board finds that the mild, peripheral neuropathy in the lower extremities alone did not preclude the Veteran from working. Rather, even if the Veteran was not able to do strenuous work activities due to his lower extremity disabilities, he would have been able to work in another capacity, but for his service-connected PTSD which significantly affected his concentration such that he could not work on hobbies for more than an hour or so at a time. See e.g. January 2005 VA PTSD examination. Further, the Veteran's service-connected upper extremity peripheral neuropathy also affected his ability to work given symptoms of pain and numbness and difficulty gripping. As the Board finds the Veteran's disabilities were substantially the same for the entire period prior to August 16, 2010, the Board resolves all doubt in the Veteran's favor and finds the combination of the Veteran's physical limitations and PTSD symptoms severely impacted the Veteran's ability to work, and due to his service-connected conditions, he is entitled to a TDIU award for the entire period from August 19, 2004 to August 16, 2010. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Donna D. Ebaugh, 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.