Citation Nr: 21073149 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-11 918 DATE: December 7, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for painful right foot scars is denied. Entitlement to an initial compensable rating for right foot scars, associated with bunionectomy, is denied. For the appeal period prior to May 30, 2017, entitlement to a total disability rating based on individual unemployability (TDIU) is granted subject to the laws and regulations governing payment of monetary benefits. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran had, at most, three painful scars on his right foot. His right foot scars were not unstable, deep, nonlinear or associated with underlying soft tissue damage, did not cover an area of 144 square (sq.) inches (in.) (929 sq. cm.) or more, and did not cause functional impairment. 2. Resolving all reasonable doubt in the Veteran's favor, for the appeal period prior to May 30, 2017, the Veteran was unable to secure and follow a substantially gainful employment as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for painful right foot scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code (DCs) 7804, 7805. 2. The criteria for an initial compensable rating for service-connected right foot scars, residuals of bunionectomy, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7805. 3. For the appeal period prior to May 30, 2017, the criteria for entitlement to TDIU have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1979 to January 1983. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran's claim for entitlement to an initial compensable rating for right foot scars, associated with bunionectomy, was previously before the Board in August 2019, when it was remanded for additional development. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an initial rating in excess of 20 percent for painful right foot scars is denied. 2. Entitlement to an initial compensable rating for right foot scars, associated with bunionectomy, is denied. As an initial matter, the Veteran filed his claim for entitlement to an increased rating for a service-connected foot disability in May 2013, and in a May 2014 rating decision, the RO granted entitlement to service connection for scar, right foot, residuals of bunionectomy, and assigned a non-compensable rating, effective May 2, 2013, the date of the Veteran's increased rating claim. See May 2014 Rating Decision Narrative. Thereafter, a January 2017 rating decision granted entitlement to service connection for painful scars, right foot, and assigned a separate 20 percent evaluation, effective May 2, 2013. To this end, the RO found that the separate 20 percent evaluation was warranted after a December 2016 VA examination documented five total scars, including three painful scars, on the Veteran's service-connected right foot from a bunionectomy and hammertoes repair. The RO also explained that the Veteran's claim for entitlement to an initial compensable rating for his right foot scar would be addressed in a separate decision. See January 2017 Rating Decision Narrative. Here, the Veteran contends that he is entitled to a higher initial rating for his service-connected right foot scars. As noted above, the Veteran's service-connected painful right foot scars have been assigned a 20 percent disability rating under DC 7804. In addition, the Veteran's service-connected right foot scars, residuals of bunionectomy, have been assigned a separate non-compensable rating, pursuant to DC 7805, throughout the period on appeal. See March 2019 Rating Decision Codesheet. The Board notes that the applicable rating criteria for skin disorders under 38 C.F.R. § 4.118 were also amended in August 2018. However, the 2018 revisions did not substantively change the Codes applicable to the Veteran's scars, and as such, will not be discussed further herein. DC 7805 provides that any disabling effects of other scars and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 that are not considered in a rating provided under the aforementioned codes should be evaluated under an appropriate one. See 38 C.F.R. § 4.118. To this end, DC 7800 provides a 10 percent rating for burn scars of the head, face, or neck; or scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck - when the skin disability has one characteristic of disfigurement. Id. Under DC 7801, a 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear, at least 39 sq. centimeters (cm.) in area, but less than 77 sq. cm. (or between 6 sq. in. and 12 sq. in.). Id. Pursuant to DC 7802, a maximum 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are superficial (not associated with soft tissue damage) and nonlinear, affecting an area or areas of 144 sq. in. (929 sq. cm.) or greater. Id. DC 7804 provides a 10 percent rating for one or two scars that are unstable or painful, and a 20 percent rating for three or four scars that are unstable or painful. Under DC 7804, maximum 30 percent rating is warranted for five or more scars that are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. See 38 C.F.R. § 4.118, DC 7804, Note (1). If one or more scars are both unstable and painful, 10 percent is to be added to the evaluation based on the total number of unstable or painful scars. See 38 C.F.R. § 4.118, DC 7804, Note (2). Scars can receive separate evaluations under DCs 7800, 7801, 7802, and 7805, despite also be rated under DC 7804. See 38 C.F.R. § 4.118, DC 7804, Note (3). Turning to the evidence of record, the Veteran underwent a VA flatfoot examination in June 2012. The examiner determined that the Veteran's diagnosed bilateral pes planus resulted in pain on use and manipulation of the feet, pain accentuated on use and manipulation, swelling on use, and extreme tenderness of plantar surface of one or both feet. The examiner further noted that the Veteran had scars related to his diagnosed pes planus, but found that the scars were not painful or unstable and that they did not cover an area greater than 39 in. See June 2012 VA examination. In July 2013, the Veteran underwent VA examinations for miscellaneous foot conditions and flatfoot. During the examinations, the Veteran reported that his service-connected hammer toes, hallux valgus, and bilateral pes planus were manifested by chronic pain in both of his feet and impaired his ability to walk. In this regard, the examiner determined that the Veteran's diagnosed bilateral pes planus resulted in pain on use and manipulation of the feet, pain accentuated on use and manipulation, and extreme tenderness of plantar surface of one or both feet. The examiner indicated that the Veteran had scars related to his service-connected hammer toes and hallux valgus, but found that the scars were not painful or unstable and that they did not cover an area greater than 39 in. After performing the examinations, the examiner determined that the Veteran constantly required crutches due to his feet and would likely have difficulty with work that entailed standing or frequent ambulation. The Veteran was also afforded a VA examination for scars/disfigurement in July 2013. The examiner reported that the Veteran had one linear scar on the dorsum of his right metatarsal and great toe, which measured six cm. The examiner indicated that the scar was not painful, unstable, or caused by burns. Following the examination, the examiner stated that the Veteran's right foot scar did not impact his ability to work. See July 2013 CAPRI. In an August 2014 statement, the Veteran endorsed severe pain and inflammation associated with his right foot scars that interfered with his ability to perform daily activities, to include walking and standing. He further indicated that his right foot scars became agitated when his shoes or socks rubbed against them. See August 2014 VA Form 21-4138 Statement in Support of Claim. The Veteran next underwent a VA examination for scars/disfigurement in December 2016. During the examination, the Veteran reported pain and swelling at the surgical scars on his second and third toes, as well as on the scar overlying his first metatarsophalangeal (MTP) joint. He further reported that his pain was aggravated by standing and walking and indicated that it was worst in his second toe. On examination, the examiner noted that the Veteran had five scars on his right lower extremity, to include a vertical scar across his dorsal first MPT joint, which measured four cm. in length and was mildly tender to palpation, a vertical scar on his proximal dorsal second phalanx, which measured two cm. in length and was tender to palpation, and a vertical scar on his proximal dorsal third phalanx, which measured two cm. in length and was mildly tender to palpation. The examiner also indicated that the Veteran had vertical scars on his dorsal fourth and fifth phalanxes, which respectively measured three cm. and one cm. in length and were non-tender to palpation. As such, the examiner found that the Veteran experienced pain, described as tenderness and soreness with weightbearing, in three of his right foot scars. However, the examiner also found that the Veteran's right foot scars were not unstable or caused by burns and determined that they did not cover an area greater than 39 in. In addition, the examiner determined that the Veteran's right foot scars did not impact his ability to work. See January 2017 CAPRI. In his February 2017 substantive appeal, the Veteran stated that his service-connected right foot scars caused severe pain and tenderness that prevented him from walking or standing for long periods of time. To this end, he stated that his toes constantly swelled and became inflamed when he put weight on his foot and indicated that he was not able to wear shoes because they irritated his scars and caused severe pain. The Veteran further reported that he used a rollator to perform activities of daily living but continued to experience difficulty maneuvering around his house. He also indicated that, with the exception of leaving to attend medical appointments, he was not able to travel outside of his home due to fear of pain and swelling from walking and of falling. See February 2017 VA Form 9. The Veteran was afforded another VA examination for foot conditions in June 2017. The examiner noted that the Veteran's right foot scars measured 4 cm. in length by 0.2 cm. in width, and indicated that they were not painful or unstable, and that they did not cover an area greater than 39 in. The examiner also noted identical findings regarding location, size, and associated pain with the Veteran's service-connected right foot scars to those shown on the December 2016 VA scars/disfigurement examination report. After performing an examination and reviewing the evidence of record, the examiner opined that the Veteran's bilateral foot disability resulted in impaired balance, increased pain and swelling with weight-bearing activities, while his bilateral foot callosities were noted to cause bilateral foot pain an additional tenderness affecting weight-bearing activities. However, the examiner also opined that the Veteran's foot disabilities did not prevent him from participating in occupational activities that did not require use of his feet or weight-bearing activities. See June 2017 C&P examination. In support of his claim, the Veteran submitted a letter from his daughter, dated in June 2017. In the letter, the Veteran's daughter stated that the Veteran's physical disabilities prevented him from being employed. To this end, she noted, in pertinent part, that the Veteran's toes swelled and throbbed and indicated that the Veteran used a rollator to sit down when he tried to maneuver around their home because he could not stand or walk for extended periods of time without assistance. See June 2017 Buddy/Lay Statement. The Veteran underwent a VA examination for scars/disfigurement in October 2018 in connection with his claim for entitlement to service connection for a lip burn. However, the examiner did not make any findings or otherwise address the severity of the Veteran's service-connected right foot scars. See October 2018 C&P examination. Lastly, an October 2019 podiatry note shows that the Veteran endorsed painful scars on his right toes two through four, right distal interphalangeal (DIP) joint, and left hallux. The assessment included painful right foot scars and DIP joint. See November 2019 CAPRI. After a review of the evidence of record, the Board finds that an initial rating in excess of 20 percent for the Veteran's service-connected painful right foot scars is not warranted. In this regard, the Board finds that there is nothing in the record to suggest that the Veteran had more than three painful right for scars at any time during the period on appeal. Moreover, the preponderance of the evidence shows that the Veteran's right foot scars were not unstable, deep, nonlinear, or associated with underlying soft tissue damage, and did not cover an area of at least 39 sq. cm. but less than 77 sq. cm. Thus, the Board finds that a separate compensable rating for right foot scars, associated with bunionectomy, is also not warranted at any time during the relevant period. The Board recognizes the Veteran's reports that severe pain and tenderness associated with his service-connected right foot scars interfered with his ability to perform daily activities, to include walking and standing, and caused him to remain at home when he was not attending medical appointments. See August 2014 VA Form 21-4138 Statement in Support of Claim; February 2017 VA Form 9. In this regard, the Board notes that a Veteran is competent to report purported symptoms such as pain or whether he has received a diagnosis from a medical professional. 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303 (2007). However, to the extent that the Veteran suggests that his right foot scars cause functional impairment, he has not been shown to be competent to offer such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376, 1377 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). To this end, the Board finds that the Veteran's lay statements are at odds with the medical evidence of record. Specifically, the Board notes that the July 2013, December 2016, and June 2017 VA examiners found that the Veteran's right foot scars did not impact his ability to work. The June 2017 VA examiner opined that the Veteran's bilateral foot disabilities resulted in functional impairment, to include impaired balance and increased pain and swelling with weight-bearing activities, while the Veteran's bilateral foot callosities were found to cause foot pain and additional tenderness affecting weight-bearing activities. Notably, the examiner did not ascribe any functional impairment to the Veteran's right foot scars. See June 2017 C&P examination; see also July 2013 CAPRI examination; January 2017 CAPRI. Thus, the Board finds that the Veteran's service-connected right foot scars have not caused disabling effects not considered under DCs 7800-7804 or functional impairment, and as a result, that a separate compensable rating under DC 7805 is not warranted. In reaching this conclusion, the Board has considered the representative's contention that the December 2016 and June 2017 VA examinations are inadequate. Specifically, the representative asserts that the examinations are inadequate because the examiners did not adequately consider the Veteran's complaints or assess the effects of pain on functional ability and resultant functional limitation. See August 2019 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief); see also July 2021 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief). However, after reviewing the December 2016 and June 2017 VA examination reports, the Board finds that they are adequate. In this regard, the Board finds that the examiners conducted a thorough examination of the Veteran's right foot scars, noted the location, size, and level of tenderness to palpation associated with each scar, and found that they did not result in pain or instability or cover an area greater than 39 cm. Moreover, the examiners explicitly noted the Veteran's reports regarding pain and functional limitations in their examination reports. See January 2017 CAPRI; June 2017 C&P examination. Thus, the Board finds that there is no evidence the December 2016 or June 2017 examinations were not thorough; as such, the Board finds the representative's arguments challenging the adequacy of the examinations to be unpersuasive. The Board has also considered the representative's assertion that the December 2016 VA examination report includes a pivotal inconsistency with respect to the severity of the Veteran's service-connected right foot scars, and that any ambiguity created thereby should be resolved in the Veteran's favor. Specifically, the representative argued that the December 2016 VA examiner's finding that the Veteran's service-connected right foot scars did not cause functional impairment was contradicted by the examiner's recitation of the symptoms and functional limitations described by the Veteran. To this end, the representative indicated that the examiner presented the Veteran's statements as though they accepted the veracity thereof. See July 2021 Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief). However, contrary to the representative's argument, the Board finds that by specifically including the symptoms and functional limitations reported by the Veteran, the examiner directly considered such contentions but found that they were outweighed by the other evidence of record, to include objective evidence elicited during the examination and a review of the evidence of record. The Board further notes that the findings recorded by the December 2016 VA examiner regarding functional impairment are consistent with the previous VA examinations of record, to include the July 2013 and June 2017 VA examinations, which also found that the Veteran's diagnosed right foot scars did not result in functional impairment. See July 2013 CAPRI; January 2017 CAPRI; June 2017 C&P examination. Thus, the Board also finds the representative's assertion that the December 2016 VA examination is inconsistent and ambiguous lacks merit. The Board has also considered the applicability of other potentially applicable diagnostic criteria for rating the Veteran's scars but finds that no higher rating is assignable under any other diagnostic code. To this end, the Board notes that the Veteran's service-connected right foot scars are located on his right lower extremity. Therefore, DC 7800 is not for application. 38 C.F.R. § 4.118, DC 7800. In addition, as documented in the above-noted VA examination reports, there is no evidence that the Veteran's scars are deep or nonlinear or that they cover a surface area of 144 sq. in. or greater. Thus, a compensable rating is also not available under DC 7801 or DC 7802. 38 C.F.R. § 4.118, DCs 7801, 7802. In addition, the Board finds that the Veteran's right foot scars were manifested by, at worst, three painful, but not unstable scars, and by two scars that were neither painful nor unstable. As such, the evidence of record does not support a rating in excess of 20 percent under DC 7804, at any time during the period on appeal. 38 C.F.R. § 4.118, DC 7804. Based on the foregoing, the Board finds that an initial rating in excess of 20 percent for the Veteran's painful right foot scars is not warranted. Moreover, the Board finds that an initial compensable rating for right foot scars is not warranted as the evidence does not show that such scars are unstable, of a size to warrant a compensable rating, or result in any other disabling effects. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the Veteran's claims. The claims are denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.118, DCs 7800-7805; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 3. Prior to May 30, 2017, entitlement to TDIU is granted subject to the laws and regulations governing payment of monetary benefits. In his February 2017 substantive appeal, the Veteran reported that, with the exception of leaving to attend medical appointments, he was not able to travel outside of his home due to fear of pain and swelling from walking and of falling. He also indicated that he could not perform activities of daily living without the assistance of his primary caregiver and stated that he was unable to wear shoes because they irritated his scars and caused atrocious pain. See February 2017 VA Form 9. Thus, as the Veteran has indicated he cannot leave his house, independently perform activities of daily living, or wear shoes due to his service-connected scar disabilities, the Board finds that the issue of entitlement to TDIU is part and parcel of the Veteran's claim for an increased disability rating. See Rice v Shinseki, 22 Vet. App. 447, 454-455 (2009). In this regard, the Board notes that the Veteran's claim for entitlement to TDIU was initially denied in a May 2014 rating decision. See May 2014 Rating Decision Narrative. Thereafter, a September 2017 rating decision found that the claim for entitlement to TDIU was moot because the Veteran submitted his formal claim for TDIU on May 30, 2017, which was also the date that his service-connected disabilities were evaluated as 100 percent disabling. See September 2017 Rating Decision Narrative. However, as discussed above, the Veteran's claim for entitlement to TDIU has been raised by the record and is part and parcel to his claims for increased disability ratings for his service-connected right foot scars, which were received in May 2013. Thus, the Bord finds that, prior to May 30, 2017, the issue of entitlement to TDIU has not been rendered moot and, as such, remains on appeal during that period. A TDIU 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). TDIU will be granted when the evidence shows that the veteran, due to service-connected disabilities, is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. In the present case, the Veteran is service connected for the following disabilities: posttraumatic stress disorder (PTSD) with major depressive disorder and cocaine and cannabis use disorder rated as 50 percent disabling from September 7, 2011, to May 30, 2017, and as 100 percent disabling thereafter; bilateral pes planus rated as 30 percent disabling from October 1, 2009, to May 30, 2017, and as 50 percent disabling thereafter; lip burn rated as 30 percent disabling as of September 27, 2018; painful right foot scars rated as 20 percent disabling as of May 2, 2013; right hallux valgus status-post bunionectomy with hammer toe repair rated as 10 percent disabling as of October 1, 2009; left foot hammer toes rated as 10 percent disabling as of October 1, 2009; and right foot scars, residuals of bunionectomy, rated as non-compensable from May 2, 2013. Thus, pursuant to the combined rating table in 38 C.F.R. § 4.25, the Veteran's combined disability rating was 80 percent from May 2, 2013 to May 30, 2017. See March 2019 Rating Decision Codesheet. As such, the Board finds that the Veteran meets the schedular rating criteria for entitlement to TDIU throughout the relevant period. Turning to the evidence of record, the Veteran underwent VA examinations for flatfoot and miscellaneous foot conditions in June 2012. The examiner indicated that the Veteran's foot disabilities, to include bilateral pes planus, metatarsalgia, hammer toes, a healed right foot fracture and bilateral foot osteoarthritis and first metatarsophalangeal (MTP) joint bunions, impacted his ability to work. In this regard, the examiner noted that the Veteran had not worked since 2000 because of his feet. Specifically, the examiner explained that the Veteran previously worked as a truck driver but indicated that he had problems standing and driving with a clutch. See June 2012 VA examination. In an August 2012 rating decision, the Veteran was found not competent to handle disbursement of funds. In this regard, the RO noted that a November 2011 VA examination showed that the Veteran was unable to make appropriate decisions due to his memory problems and impaired insight and judgment based on his continued alcohol and drug use. See August 2012 Rating Decision Narrative. In April 2013, the Veteran reported that his service-connected PTSD and bilateral foot disabilities prevented him from securing or following any substantially gainful employment. In this regard, the Veteran reported that his disabilities began affecting his ability to work in 2000 and indicated that he last worked as a truck driver in 2002; however, he reported that he did not become too disabled to work until 2005. In addition, the Veteran stated that he left his last job because of his service-connected disabilities and indicated that he did not receive disability retirement or workers compensation benefits. He further reported that he completed high school and attained a truck driver certification in 1986. In addition, the Veteran stated that he used crutches, wore ankle and knee braces, and had been assigned a fiduciary by VA. See May 2013 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Veteran underwent a VA examination for PTSD in July 2013. The examiner found that the Veteran's PTSD and cocaine and cannabis dependence disorders were manifested by occupational and social impairment with reduced reliability and productivity. The Veteran's symptoms, in pertinent part, were noted to include irritability or outbursts of anger, difficulty concentrating, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships, and the examiner explained that the Veteran experienced moderate occupational and social impairment due to his diagnosed psychiatric disorders. Following the examination, the examiner found that the Veteran's PTSD alone did not render him unable to secure or maintain substantially gainful employment but did cause reduced reliability and productivity. See July 2013 VA examination. The Veteran was also afforded VA examinations for miscellaneous foot conditions, flat feet, and scars and disfigurement in July 2013. During the VA examinations for miscellaneous foot conditions and flat feet, the Veteran endorsed chronic bilateral foot pain. In this regard, the examiner determined that the Veteran's diagnosed foot disabilities impacted his ability to work and noted that he constantly used crutches. In addition, the examiner noted that the Veteran would likely have difficulty performing work that required standing or frequent ambulation. As such, the examiner stated that sedentary employment would be more appropriate for the Veteran. However, the July 2013 scars and disfigurement VA examination shows that the Veteran's right bunionectomy scar did not result in limitation of function. See July 2013 CAPRI. A January 2014 VA Form 21-4192 shows that the Veteran worked as a tractor trailer driver for the United States Postal Service from May 2000 to December 2001. The Veteran was noted to work at least eight hours per day for a total of at least 40 hours per week. The Veteran's employer indicated that it was unknown whether the Veteran had any concessions due to his disabilities and reported that he had been removed from the job for an unknown reason. See February 2014 VA Form 21-4192 Request for Employment Information in Connection with Claim for Disability. In addition, a February 2014 VA Form 21-4192 shows that the Veteran worked as a tractor trailer driver for the United States Postal Service from May 2000 to December 2001. The Veteran's employer indicated that it was unknown whether the Veteran had any concessions due to his disabilities and reported that he was removed from his work for a condition arising and indicated that a form had been sent to personnel for labor. See March 2014 VA Form 21-4192 Request for Employment Information in Connection with Claim for Disability. The Veteran also submitted a VA Form 21-4192 dated in April 2014. There, the veteran's employer continued to show that the Veteran worked as a tractor trailer driver for the United States Postal Service from May 2000 to December 2001. The employer further indicated that they did not have information regarding whether the Veteran was afforded any concessions for his disabilities and noted that he was removed for unspecified conditions arising after entrance on duty. The employer further noted that the Veteran did not receive and was not entitled to receive sick, retirement, or other benefits. See April 2014 VA Form 21-4192 Request for Employment Information in Connection with Claim for Disability. In an August 2014 statement, the Veteran endorsed severe pain and inflammation associated with his right foot scars that interfered with his ability to perform daily activities, to include walking and standing. He further indicated that his right foot scars became agitated when his shoes or socks rubbed against them. See August 2014 VA Form 21-4138 Statement in Support of Claim. In September 2014, the Veteran reported that he was not able to work and that his income was comprised of VA benefits. He further indicated that he dropped out of high school in eleventh grade and noted that his past interests included active tennis, bible study, and working in his yard. See December 2015 CAPRI. The Veteran underwent a VA examination for scars/disfigurement in December 2016. The examiner found that the Veteran's right foot scars did not impact his ability to work. See January 2017 CAPRI. As noted above, in his February 2017 substantive appeal, the Veteran reported that, with the exception of leaving to attend medical appointments, he was not able to travel outside of his home due to fear of pain and swelling from walking and of falling. He further stated that he was unable to wear shoes because they irritated his scars and caused atrocious pain and indicated that he would not be able to perform activities of daily living without the assistance of his primary caregiver. See February 2017 VA Form 9. In May 2017, the Veteran reported that his service-connected PTSD and bilateral foot disabilities prevented him from securing or following any substantially gainful employment. In this regard, the Veteran reported that he was last employed as a truck driver and stated that he left his job because of his service-connected disabilities. He further reported that he completed high school and noted that he had attained a CDL license. See May 2017 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Veteran was also afforded a VA examination for foot conditions in June 2017. During the examination, the Veteran reported that his diagnosed foot disabilities, to include hammer toes, right foot injuries, bilateral plantar fasciitis, right foot degenerative arthritis, bilateral dystrophic toenails, painful right foot callosities to right foot one through five metatarsal heads and to distal right great toe and second toe, and left foot primus varus, caused constant bilateral foot pain that worsened when he stood or walked. To this end, the Veteran indicated that his right foot swelled after he walked approximately 100 yards. The examiner noted that the Veteran was wearing a right foot slide due to his inability to wear a shoe because of pain and showed the examiner a photo that depicted moderated to severe swelling and redness effecting all of the toes on his right foot. The examiner also found that the Veteran's foot disabilities impacted his ability to perform any type of occupational tasks without further elaboration. VA obtained an addendum medical opinion in June 2017. The examiner found that the Veteran's bilateral foot disabilities impaired balance and noted that weight-bearing caused increased pain and swelling of the feet. In addition, the Veteran's bilateral foot callosities caused bilateral foot pain and tenderness, which further impacted weight-bearing activities. In this regard, the examiner found that the Veteran could participate in occupational activities that did not require use of his feet or weight bearing activities. However, the examiner further noted that the Veteran last worked in 2000 as a full-time truck driver for Sarah Lee and indicated that he had no other occupational skills other than truck driving. The Veteran also underwent a VA examination for PTSD in June 2017. The examiner found that the Veteran's service-connected PTSD, major depressive disorder, cocaine use disorder, and cannabis use disorder were manifested by total social and occupational impairment. The Veteran's symptoms, in pertinent part, were noted to include irritability or outbursts of anger typically expressed as verbal or physical aggression toward persons or objects, reckless or self-destructive behavior, problems with concentrating, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or in a worklike setting, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. See June 2017 C&P examination. After a review of the evidence of record, and resolving all reasonable doubt in the Veteran's favor, the Board finds that the totality of the record indicates the functional impairments caused by the Veteran's service-connected disabilities likely rendered him unable to secure or follow a substantially gainful occupation throughout the period on appeal. In this regard, the Board finds that the Veteran's bilateral foot disabilities precluded him from performing work that required standing or frequent ambulation during the period on appeal. To this end, the Board notes that the Veteran ambulates with crutches and has indicated that he finds it difficult to wear shoes. In addition, the June 2012 VA examiner found that the Veteran's bilateral foot disabilities impaired his ability to drive automobiles with manual transmissions. See June 2012 VA examination; July 2013 CAPRI; June 2017 C&P examination. In addition, the Board finds that the Veteran's service-connected PTSD with major depressive disorder and cocaine and cannabis use disorder was manifested by irritability or outbursts of anger typically expressed as verbal or physical aggression toward persons or objects, reckless or self-destructive behavior, problems with concentrating, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or in a worklike setting, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. See July 2013 VA examination; June 2017 C&P examination. To this end, the Board acknowledges that the July 2013 VA examiner found that the Veteran's PTSD alone caused reduced reliability and productivity but did not render him unable to secure or maintain substantially gainful employment. See July 2013 VA examination. However, the Board finds it significant that, when considered in conjunction with his service-connected major depressive disorder and cocaine and cannabis use disorder, the Veteran's psychiatric disorders were found to be manifested by total social and occupational impairment. See June 2017 C&P examination. Thus, the Board finds that the combined persistent functional effects of the Veteran's service-connected disabilities likely prevented him from maintaining the attention and concentration necessary to complete a full, productive work schedule in a substantially gainful occupation throughout the relevant period. Accordingly, the Board finds that the functional effects of the Veteran's service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation throughout the period on appeal. Therefore, after resolving reasonable doubt in the Veteran's favor, entitlement to TDIU is warranted for the appeal period prior to May 30, 2017. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, Associate 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.