Citation Nr: 21073428 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 18-03 902 DATE: December 8, 2021 ORDER An effective date earlier than July 30, 2009 for the grant of service connection for right lower extremity radiculopathy is denied. An effective date earlier than November 29, 2010 for the grant of service connection for left lower extremity radiculopathy is denied. An initial disability rating greater than 10 percent prior to August 19, 2014, greater than 20 percent from August 19, 2014 to March 15, 2016, and greater than 40 percent beginning March 15, 2016 for right lower extremity radiculopathy is denied. An initial disability rating greater than 10 percent for left lower extremity radiculopathy prior to July 16, 2020 is denied. A disability rating of 20 percent, and no higher, for left lower extremity radiculopathy beginning July 16, 2020 is granted. A total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted. FINDINGS OF FACT 1. In a February 1993 rating decision, the RO denied service connection for numbness of the hips/knees. 2. On May 21, 1993, the Veteran submitted a claim to reopen the previously denied claim of entitlement to service connection for numbness of the right lower extremity and, in a March 2016 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) granted service connection for right lower extremity radiculopathy, assigning a 10 percent disability rating effective July 30, 2009, the date of receipt of a subsequent claim for service connection for right lower extremity radiculopathy. The Veteran submitted a timely notice of disagreement as to the effective date assigned in this decision. 3. On December 15, 1995, the Veteran submitted a claim to reopen the previously denied claim of entitlement to service connection for numbness of the left lower extremity and, in a March 2016 rating decision, the RO granted service connection for left lower extremity radiculopathy, assigning a 10 percent disability rating effective November 29, 2010, the date of a VA peripheral nerves examination showing possible lumbar radiculopathy. The Veteran submitted a timely notice of disagreement as to the effective date assigned in this decision. 4. The earliest definitive medical evidence of lower extremity radiculopathy of either side is a September 11, 2014 VA treatment record. 5. Prior to August 19, 2014, the Veteran's right lower extremity radiculopathy was manifested by no more than mild incomplete paralysis of the sciatic nerve. 6. From August 19, 2014 to March 15, 2016, the Veteran's right lower extremity radiculopathy was manifested by no more than moderate incomplete paralysis of the sciatic nerve. 7. Beginning March 15, 2016, the Veteran's right lower extremity radiculopathy has been manifested by no more than moderately severe incomplete paralysis of the sciatic nerve. 8. Prior to July 16, 2020, the Veteran's left lower extremity radiculopathy was manifested by no more than mild incomplete paralysis of the sciatic nerve. 9. Beginning July 16, 2020, the Veteran's left lower extremity lumbar radiculopathy has been manifested by no more than moderate incomplete paralysis of the sciatic nerve. 10. Resolving all reasonable doubt in the Veteran's favor, the Board finds that she is unable to secure and follow a substantially gainful occupation by reason of her service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to July 30, 2009, for the award of service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 5101, 5110, 5111; 38 C.F.R. §§ 3.151, 3.155, 3.400. 2. The criteria for an effective date prior to November 29, 2010, for the award of service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 5101, 5110, 5111; 38 C.F.R. §§ 3.151, 3.155, 3.400. 3. Prior to August 19, 2014, the criteria for a disability rating greater than 10 percent for right lower extremity radiculopathy were not met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8520. 4. From August 19, 2014 to March 15, 2016, the criteria for a disability rating greater than 20 percent for right lower extremity radiculopathy were not met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.124a, DC 8520. 5. Beginning March 15, 2016, the criteria for a disability rating greater than 40 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.124a, DC 8520. 6. Prior to July 16, 2020, the criteria for a disability rating greater than 10 percent for left lower extremity radiculopathy were not met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.124a, DC 8520. 7. Beginning July 16, 2020, the criteria for a disability rating of 20 percent, and no higher, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.124a, DC 8520. 8. The criteria for a TDIU have been 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 1978 to April 1988 and again from February 1991 to March 1991. These matters come before the Board of Veterans' Appeals (Board) from a March 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran testified before the undersigned Veterans Law Judge at a Board virtual hearing in July 2021. A transcript of this proceeding has been associated with the claims file. With regard to the TDIU issue, this such issue was raised by the Veteran's representative during the July 2021 Board hearing pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) as part and parcel to her increased rating claims. Factual Background By way of history, the Veteran submitted an initial claim for service connection for a lumbar spine disability as well as numbness of the hips/knees in February 1992. By rating decision dated in February 1993, the RO denied service connection for a lumbar spine disability and numbness of the hips/knees, finding that there was no evidence of a current diagnosis of either a lumbar spine disability and/or a disability manifested by numbness of the hips/knees. The Veteran did not perfect an appeal of this decision and it became final. The Veteran submitted a second claim for service connection for a lumbar spine disability with associated right lower extremity numbness, on May 21, 1993. In connection with this claim, the RO obtained updated VA treatment records showing continuous treatment for low back pain with no complaints of numbness. By rating decision dated in June 1993, the RO granted service connection for mechanical low back pain, assigning a 10 percent disability rating effective March 12, 1991, the date of the Veteran's discharge from service. Significantly, the June 1993 rating decision did not address the Veteran's May 1993 claim regarding right lower extremity numbness. On December 15, 1995, the Veteran submitted a claim for an increased rating for her lumbar spine disability as well as a claim for service connection for left lower extremity numbness. In connection with this claim, the RO obtained updated VA treatment records showing continuous treatment for low back pain with no complaints of numbness. By rating decision dated in May 1996, the RO increased the Veteran's disability rating for mechanical low back pain from 10 to 20 percent disabling effective May 11, 1995, the date of a VA treatment record showing increased lumbar spine symptomatology. Significantly, the May 1996 rating decision did not address the Veteran's claim regarding left lower extremity numbness. Following the May 1996 rating decision, the Veteran continued to submit periodic claims for an increased rating for her lumbar spine disability but did not specifically claim that she was experiencing radiculopathy of the lower extremities in any of these claims. Furthermore, VA spine examinations dated in February 1999, April 2000, and May 2006 show normal neurological examinations of the lower extremities. Also, a June 2009 VA treatment record shows normal neurological examination of the lower extremities with no complaints regarding numbness. On July 30, 2009, the Veteran a claim for service connection for a right knee disability. The RO construed this claim as a claim to reopen the previously denied claim of numbness of the bilateral hips/knees and, by rating decision dated in September 2009, the RO found that the Veteran had failed to submit new and material evidence to reopen the previously denied claim of entitlement to service connection for numbness of the bilateral hips/knees. The Veteran disagreed with this decision and perfected an appeal. In connection with this appeal, the Veteran was afforded several VA examinations. Significantly, a November 29, 2010 VA peripheral nerves examination shows a diagnosis of possible lumbar radiculopathy of the right lower extremity, only, but also shows decreased vibratory sense of the left lower extremity. However, a December 2012 VA peripheral nerves examination shows no current objective or subjective evidence of radiculopathy, noting that the Veteran's lower extremity symptoms are atypical for radiculopathy and likely due to bilateral knee disabilities. In November 2015, the Board reopened the previously denied claim of entitlement to service connection for numbness of the bilateral hips/knees, granted service connection for right lower extremity radiculopathy, and remanded the claim of entitlement to service connection for left lower extremity radiculopathy for further development. Pursuant to the November 2015 Board remand, the Veteran was afforded a VA peripheral nerves examination in March 2016. Significantly, this examination report shows a history of sudden onset of weakness and inability to stand on August 19, 2014 with a diagnosis of radiculopathy of the bilateral lower extremities, lateral confirmed via imaging showing positionally dependent spondylolisthesis capable of acute symptoms. This examination report also noted a September 11, 2014 showing a diagnosis of bilateral lower extremity radiculopathy. By rating decision dated in March 2016, the RO effectuated the November 2015 grant of service connection for right lower extremity radiculopathy, assigning a 10 percent disability rating effective July 30, 2009 (the date of the Veteran's claim for a "right knee disability," a 20 percent disability effective August 19, 2014 (the date of a treatment record showing worsening of the right lower extremity), and a 40 percent disability rating effective March 15, 2016 (the date of the VA peripheral nerves examination). The RO also granted service connection for left lower extremity radiculopathy, assigning a 10 percent disability rating for the left lower extremity beginning November 29, 2010 (the date of the VA peripheral nerves examination showing "decreased vibratory sense of the left lower extremity"). The Veteran disagreed with the disability ratings and effective dates assigned regarding these disabilities and perfected this appeal. More recently, the Veteran was afforded a VA spine examination on July 16, 2020. Significantly, this examination shows that the Veteran experiences moderate radiculopathy of both the right and left lower extremities. Also, during the July 2021 Board hearing, the Veteran testified that her bilateral lower extremity radiculopathy has been really bad since 2009 and had difficulty walking due to the pain. In fact, the Veteran testified that she began using a walker and/or scooter in approximately 2002 and had relied on these assistive devices since 2015 to aid with ambulation. In connection with this claim, the Veteran's representative submitted a private vocational assessment in September 2021 wherein S.M.H., a vocational expert, noted review of the Veteran's pertinent medical records and opined that it was at least as likely as not that the Veteran had been unable to secure and follow substantially gainful employment since at least July 2013 to the present due to her service-connected spinal canal stenosis, bilateral lower extremity radiculopathy, and bilateral knee conditions. EFFECTIVE DATE Generally, the effective date for an award of service connection and disability compensation is the day following separation from active service, or the date entitlement arose if the claim is received within one year after separation from service; otherwise, for an award based on an original claim, a claim reopened after a final allowance, or a claim for an increase, the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. An application for VA compensation must generally be a specific claim in the form prescribed by the VA Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). However, prior to March 24, 2015, a claim could be either a formal or informal written communication "requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit." See 38 C.F.R. § 3.1(p) (2014). But see 38 C.F.R. § 3.1(p) (2015) (now providing that a "claim" must be submitted on an application form prescribed by the Secretary); 79 Fed. Reg. 57,696 (Sept. 25, 2014) (eliminating informal claims by requiring that, effective March 24, 2015, claims be filed on standard forms). 1. An effective date earlier than July 30, 2009 for the grant of service connection for right lower extremity radiculopathy is denied. With regard to the right lower extremity, as previously noted, the appropriate effective date of reopened claims shall be the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (r). Here, while the Veteran's claim for service connection for radiculopathy of the right lower extremity has been pending since February 1992, there is no definitive evidence of radiculopathy of the right lower extremity until September 11, 2014. As above, VA spine examinations dated in February 1999 and May 2006 show a normal neurological examination and in a June 2009 VA treatment record, the Veteran specifically denied numbness of the extremities. Thus, the Board finds no evidence on which to base an effective date prior to the date entitlement arose, which was in 2014. However, the RO has assigned an even earlier effective date of July 30, 2009, and the Board does not disturb this finding. It does find, however, no entitlement to an effective date earlier than July 30, 2009. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. An effective date earlier than November 29, 2010 for the grant of service connection for left lower extremity radiculopathy is denied. With regard to the left lower extremity, as above, by rating decision dated in February 1993, the RO denied service connection for numbness of the hips/knees. Because the Veteran did not appeal, nor submit new and material evidence regarding the left lower extremity within one year of this decision, it became final. See 38 U.S.C. § 7104. Based on the foregoing, any effective date awarded in the present case must be later than February 1993. Here, while the Veteran did submit a claim to reopen the previously denied claim regarding left lower extremity numbness on December 15, 1995, this claim was never adjudicated. Thus, the Veteran's claim for service connection for radiculopathy of the left lower extremity has been pending since December 15, 1995. However, there is no definitive evidence of radiculopathy of the right lower extremity until September 11, 2014. As above, VA spine examinations dated in February 1999 and May 2006 show a normal neurological examination and in a June 2009 VA treatment record, the Veteran specifically denied numbness of the extremities. As with the right lower extremity findings above, the RO has assigned an even earlier effective date of November 29, 2010 based on the November 2010 VA examination report showing decreased vibratory sense of the left lower extremity. The Board does not disturb this finding, but finds there is no entitlement to an effective date earlier than November 29, 2010. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 54-56. INCREASED RATING Disability ratings are determined by the application of the facts presented to VA's Schedule for Rating Disabilities. 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 service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In rating 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 ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's radiculopathy of the lower extremities is rated under the provisions of 38 C.F.R. § 4.124a, DC 8520. DC 8520 assigns 10, 20, 40, and 60 percent ratings for incomplete paralysis of the sciatic nerve that is mild, moderate, moderately severe, and severe with marked muscular atrophy, respectively. 38 C.F.R. § 4.124a, DC 8520. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis for a particular nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Peripheral neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. As above, evidence relevant to the level of severity of the Veteran's radiculopathy of the lower extremities during the appeal period includes November 2010, December 2012, and March 2016 VA peripheral nerve examination reports as well as September 2015 and July 2020 VA spine examinations. Also of record are private treatment records dated through June 2018 and VA treatment records dated through March 2020. During the November 2010 VA peripheral nerve examination, the Veteran reported that she began experiencing "more than normal numbness" in her hips/knees approximately five years earlier. On physical examination, the Veteran displayed normal reflex examination of 2+ for the bilateral lower extremities. Sensory examination was normal with the exception of the left lower median, ulnar, and radial nerves which showed decreased vibration. Motor examination was also normal, bilaterally. Muscle tone was normal and there was no muscle atrophy. There was slight antalgic gait, bilaterally, but no imbalance, tremor, and/or fasciculations and the examiner indicated that there was no joint affected by a nerve disorder. Neither electromyography nor nerve conduction testing was performed but X-rays of the spine and knees showed some arthritis. It was noted that the Veteran was employed, part-time, as a school bus driver and had been in this position for the past 5 to 10 years but had lost 13 weeks or work in the last year due to her back/hip problems. Prior to working as a bus driver, she worked as a child care provider for approximately five years. The examiner diagnosed bilateral hip/knee numbness, noting left sided deficit to vibration, and indicated that this possibly represented lumbar radiculopathy. There was nerve dysfunction but there was no paralysis, neuritis, nor neuralgia. There were no effects on the Veteran's occupation due to this condition. The examiner noted that the Veteran's primary complaints regarding the knees/hips were pain rather than numbness and found that the majority of the Veteran's symptoms were related to her arthritis of knees and back pain radiating to the hips. During the December 2012 VA peripheral nerves examination, the examiner noted that the Veteran had a peripheral nerve condition and/or peripheral neuropathy, described as degenerative disc disease of the thoracolumbar spine. The Veteran reported experiencing numbness in her legs intermittently, only four times per year, which lasts one to two days, without tingling, prior to sensation returning to normal. It can occur in either leg but does not occur in both legs at the same time. The numbness is from mid-thigh to mid-calf on the lateral aspect of the thighs and posterior/lateral aspects of the lower legs. When she experiences this numbness, her knees will give out. She was told that this numbness was rom her back. She denied any current symptoms regarding her lower extremities with the exception of bilateral knee pain due to arthritis. The examiner noted that there was mild paresthesias and/or dysesthesias as well as numbness of the bilateral lower extremities. Muscle strength testing was normal and there was no muscle atrophy. Reflex and sensory examination were also normal and there were no trophic changes. The Veteran did have an antalgic gait and used a cane due to her bilateral knee and hip disabilities. Significantly, the examiner found no current objective or subjective evidence of radiculopathy noted on examination, noting that the symptoms she experienced in the past (numbness from mid-thigh to mid-calf) are atypical for a radiculopathy and may be related to her knee conditions. During the September 2015 VA spine examination, the Veteran was noted to experience moderate radiculopathy of the right lower extremity with no radiculopathy of the left lower extremity. During the March 2016 VA peripheral nerves examination, the examiner noted review of pertinent medical records pertaining to the Veteran's peripheral nerve condition, noting a history of sudden onset of weakness and inability to stand on August 19, 2014 with a diagnosis of radiculopathy of the bilateral lower extremities, lateral confirmed via imaging showing positionally dependent spondylolisthesis capable of acute symptoms. The Veteran reportedly experienced severe and constant pain as well as severe paresthesias and/or dysesthesias of the right lower extremity as well as mild pain of the left lower extremity. Muscle strength testing was normal except for right knee extension which was noted to be 3/5 (active movement against gravity). There was no muscle atrophy. Reflex examination was slightly abnormal, bilaterally, noted to be 1+ (hypoactive). Sensory examination was normal and there were no trophic changes. The Veteran's gait was slow and, mainly, due to right knee pain. Nerve testing was not done as it was not indicated. With regard to assistive devices, the examiner noted that the Veteran regularly used both a brace and a cane and occasionally used a walker. There was no functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. The examiner opined that the Veteran's peripheral nerve condition impacted her ability to work as it limited her to sedentary work and would require an accommodation to be able to rise from a seated posture and move around to relieve discomfort. During the July 2020 VA spine examination, the Veteran was noted to experience moderate radiculopathy of both the right lower and left lower extremities. Notably, a September 11, 2014 VA treatment record shows a diagnosis of bilateral lower extremity radiculopathy. Significantly, it was noted that, on August 19, 2014, the Veteran jumped up from the sofa and immediately experienced severe pain radiating down to her right leg causing loss of strength in the right leg and she collapsed. It was also noted that the Veteran had experienced numbness in her right foot about two years prior to this acute episode. More recently, in a September 2021 vocational assessment, S.M.H. (a vocational expert) noted that, based on her review of the Veteran's medical records and a telephonic interview with the Veteran, it was at least as likely as not that the Veteran had been unable to secure and follow substantially gainful employment since at least July 2013 to the present due to her service-connected spinal canal stenosis, bilateral lower extremity radiculopathy, and bilateral knee conditions. 1. An initial disability rating greater than 10 percent prior to August 19, 2014, greater than 20 percent from August 19, 2014 to March 15, 2016, and greater than 40 percent beginning March 15, 2016 for right lower extremity radiculopathy is denied. With regard to the right lower extremity for the time period prior to August 19, 2014, the Board finds that a disability rating greater than 10 percent is not warranted. The medical evidence of record reflects that, prior to August 19, 2014, the Veteran's right lower extremity radiculopathy was comparable to no more than mild incomplete paralysis of the sciatic nerve, wholly sensory in nature. Significantly, both the November 2010 and December 2012 VA peripheral nerve examination report are negative for radiculopathy. The earliest indication of increased symptomatology is the August 19, 2014 private treatment record showing a history of sudden onset of weakness and inability to stand on August 19, 2014 with a diagnosis of radiculopathy of the bilateral lower extremities, lateral confirmed via imaging showing positionally dependent spondylolisthesis capable of acute symptoms. As such, affording the Veteran the benefit of the doubt, the Board will presume that the Veteran did have radiculopathy prior to August 19, 2014 and, despite the negative findings in November 2010 and December 2012, will characterize the Veteran's right lower extremity radiculopathy as no more than mild prior to August 19, 2014. With regard to the right lower extremity for the time period from August 19, 2014 to March 15, 2016, the Board finds that a disability rating greater than 20 percent is not warranted. The most probative evidence of record is the September 2015 VA spine examination which objectively documented moderate right lower extremity peripheral neuropathy. As such, the Board will characterize the Veteran's right lower extremity radiculopathy as no more than moderate from August 19, 2014 to March 15, 2016. With regard to the right lower extremity for the time period beginning March 15, 2016, the Board finds that a disability rating greater than 40 percent is not warranted. While the March 2016 VA peripheral nerves examination noted severe and constant pain as well as severe paresthesias and/or dysesthesias of the right lower extremity, the examiner did not perform any specialized nerve testing and even wrote that the Veteran's bilateral lower extremity nerves were "normal." Furthermore, the July 2020 VA spine examiner described the Veteran's right lower peripheral neuropathy as a moderate level of severity. 2. An initial disability rating greater than 10 percent for left lower extremity radiculopathy prior to July 16, 2020 is denied. With regard to the left lower extremity for the time period prior to July 16, 2020, the Board finds that a disability rating greater than 10 percent is not warranted. The medical evidence of record reflects that, prior to July 16, 2020, the Veteran's right lower extremity radiculopathy was comparable to no more than mild incomplete paralysis of the sciatic nerve. Significantly, both the November 2010 and December 2012 VA peripheral nerve examination reports are negative for radiculopathy. The first indication of left lower extremity radiculopathy is the September 11, 2014 VA treatment record. As such, affording the Veteran the benefit of the doubt, the Board will presume that the Veteran did have radiculopathy prior to September 11, 2014 and, despite the negative findings in November 2010 and December 2012, will characterize the Veteran's left lower extremity radiculopathy as no more than mild prior to July 16, 2020. 3. A disability rating of 20 percent, and no higher, for left lower extremity radiculopathy beginning July 16, 2020 is granted. With regard to the left lower extremity for the time period beginning July 16, 2020, the Board finds that a disability rating of 20 percent, and no higher, is warranted. Significantly, the July 2020 VA spine examination characterized the Veteran's left lower extremity radiculopathy as moderate in severity. As above, a 20 percent rating under DC 8520 is warranted for moderate incomplete paralysis of the sciatic nerve. As such, a 20 percent disability rating, and no higher, is warranted for left lower extremity radiculopathy beginning July 16, 2020. 4. A TDIU is granted. A total disability rating may be assigned when the schedular rating is less than 100 percent where a Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, that disability is rated 60 percent or more, or if there are two or more disabilities, there shall be at least one disability rated 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran has established service connection for right lower extremity radiculopathy, rated 40 percent disabling; spinal canal stenosis, rated 40 percent disabling; left knee instability, rated 20 percent disabling; right knee instability, rated 20 percent disabling; hypertension, rated 10 percent disabling; left lower extremity radiculopathy, rated 10 percent disabling; right knee degenerative joint disease, rated 10 percent disabling; left knee degenerative joint disease, rated 10 percent disabling; and scars of the trunk, rated noncompensably disabling. Pertinent to the appeal period beginning July 30, 2009, the Veteran's combined rating for compensation purposes was 40 percent effective July 30, 2009; 60 percent effective July 3, 2013 (irrespective of temporary total ratings); 70 percent effective March 15, 2016; and 90 percent effective September 13, 2019. 38 C.F.R. § 4.25. Therefore, she has met the threshold criteria for a TDIU since March 15, 2016. 38 C.F.R. § 4.16(a). The remaining inquiry is whether she is unable to secure or follow substantially gainful occupation due solely to service-connected disabilities. In determining whether a veteran is unemployable for VA purposes, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. A review of the record shows that the Veteran last worked in 2010 as a school bus driver and records from the Social Security Administration show that the Veteran has been in receipt of disability benefits due, at least in part, to her service-connected lumbar spine and knee disabilities since June 2013. As above, in a September 2021 vocational assessment, S.M.H. (a vocational expert) noted that, based on her review of the Veteran's medical records and a telephonic interview with the Veteran, it was at least as likely as not that the Veteran had been unable to secure and follow substantially gainful employment since at least July 2013 to the present due to her service-connected spinal canal stenosis, bilateral lower extremity radiculopathy, and bilateral knee conditions. Based on the foregoing, the Board finds that the medical evidence supports a finding that the Veteran's service-connected disabilities make her unemployable. As above, the September 2021 vocational assessment shows that the combined effects of the Veteran's service-connected disabilities prevent her from maintaining gainful employment. Therefore, a TDIU is warranted. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board April Maddox, 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.