Citation Nr: 21073974 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 13-21 671 DATE: December 13, 2021 ORDER Entitlement to a rating in excess of 10 percent for a right wrist disability is denied. Prior to October 31, 2014, entitlement to a rating in excess of 10 percent for a left knee disability is denied. From February 1, 2015, entitlement to a rating in excess of 10 percent for a left knee disability is denied. Entitlement to service connection for a left thumb disability is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran is right-hand dominant; therefore, his right wrist is his major wrist. 2. Throughout the period on appeal, the Veteran's right wrist disability was not manifested by ankylosis. 3. Throughout the period on appeal, the Veteran's left knee disability was not manifested by ankylosis, flexion limited to 60 degrees or less, extension limited to 10 degrees or less, a meniscal condition with frequent episodes of joint locking pain and effusion, or instability. 4. The Veteran does not have a current left thumb disability. 5. The evidence of record does not reflect that the Veteran was unable to secure or follow substantially gainful employment as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for a right wrist disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5010-5215. 2. Throughout the period on appeal, the criteria for a rating in excess of 10 percent for a left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, DCs 5256-5263. 3. The criteria for service connection for a left thumb disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 4. The criteria for entitlement to a TDIU have not 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 October 2001 to February 2004. He also served on active duty for training (ACDUTRA) from May 1980 to August 1980, with additional service in the Army National Guard. These matters come before the Board of Veterans' Appeals (Board) on appeal from September 2012 and January 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2017, the Veteran testified at a Board hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. By way of background, these matters were previously before the Board in February 2018, when they were remanded for additional development. During the pendency of the appeal, a January 2015 rating decision awarded a temporary 100 percent rating, effective October 31, 2014, for the Veteran's service-connected left knee disability based on surgical or other treatment requiring convalescence. A 10 percent evaluation was assigned from February 1, 2015. See January 2015 Rating Decision Narrative. As the temporary 100 percent rating represents a full grant of the benefits sought on appeal, that period is no longer before the Board. Lastly, the Board recognizes that the Veteran has also perfected appeals for the issues of entitlement to service connection for sleep apnea and lumbosacral strain. See March 2021 VA Form 10182 Notice of Disagreement; June 2021 VA Form 10182 Notice of Disagreement. However, in the March 2021 and June 2021 VA Forms 10182, Decision Review Requests, the Veteran elected Evidence Submission Review. 38 C.F.R. § 20.202(b)(3). Thus, those issues will be addressed in separate decisions under other docket numbers. Increased Rating 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). When rating musculoskeletal disabilities on the basis of limited motion of a joint, VA must consider functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered only in conjunction with diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). 1. Entitlement to a rating in excess of 10 percent for a right wrist disability is denied. As an initial matter, the Veteran filed his claim for entitlement to a rating in excess of 10 percent for his service-connected right wrist disability on March 9, 2010. See March 2010 Correspondence. The Veteran contends that he is entitled to a disability rating in excess of 10 percent for his service-connected right wrist disability throughout the period on appeal. See, e.g., October 2012 NOD. The Veteran's service-connected right wrist disability is rated pursuant to 38 C.F.R. § 4.71a, DC 5010-5215. Hyphenated diagnostic codes are utilized when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic code indicates that the Veteran's service-connected right wrist disability is manifested by traumatic arthritis under DC 5010, to be rated as limitation of motion of the right wrist pursuant to DC 5215. Specifically, a review of the September 2012 rating decision shows that the assigned 10 percent rating was based on painful motion of the wrist. See September 2012 Rating Decision Narrative. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 30, 2020). Prior to February 7, 2021, the Board will consider the old version of the diagnostic code only; however, for the period beginning February 7, 2021 the Board will consider both the old and amended version of the diagnostic code and rate based on whichever is most favorable to the Veteran. Prior to the regulatory change, DC 5010 provides that arthritis, due to trauma and substantiated by x-ray findings, is rated as degenerative arthritis. See 38 C.F.R. § 4.71a. Degenerative arthritis is rated under DC 5003, which provides that degenerative arthritis, established by x-ray findings, is rated according to limitation of motion for the joint or joints involved. Id. The Board notes the only change to DC 5003 is a change in the title to the code, indicating that the criteria apply to all types of degenerative arthritis other than post-traumatic. DCs 5214 and 5215 assign disability ratings based on limitation of motion of the wrist. The Board notes that the rating criteria applicable to musculoskeletal wrist disorders were unchanged by the February 7, 2021 revisions. Pursuant to DC 5214, a 20 percent disability rating is assigned for favorable ankylosis of the minor wrist in 20 degrees to 30 degrees of dorsiflexion, and a 30 percent disability rating is warranted for ankylosis causing any other position except favorable. Under DC 5214, a maximum 40 percent disability rating is assigned for unfavorable ankylosis of the minor wrist in any degree of palmar flexion, or with ulnar or radial deviation. A note following DC 5214 states that extremely unfavorable ankylosis will be rated as loss of use of hands under DC 5125. 38 C.F.R. § 4.71a. Pursuant to DC 5215, a 10 percent rating is warranted for palmar flexion limited in line with the forearm or dorsiflexion less than 15 degrees. The Board notes that DC 5215 does not provide for a rating in excess of 10 percent. Id. Normal range of motion (ROM) of the wrist includes dorsiflexion (extension) from zero to 70 degrees, palmar flexion from zero to 80 degrees, ulnar deviation from zero to 45 degrees, and radial deviation from zero to 20 degrees. 38 C.F.R. § 4.71a, Plate I. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. As demonstrated by the medical evidence of record, the Veteran is right-handed, and as such, a disability rating for his major, right wrist is applicable here. See 38 C.F.R. § 4.69. Turning to the evidence of record, the Veteran received a wrist splint in March 2009. See June 2009 Medical Treatment Record Government Facility. The Veteran underwent a VA joints examination in April 2009. During the examination, the Veteran reported swelling and daily pain in his right wrist and indicated that he was right-hand dominant. ROM testing revealed dorsiflexion and plantar flexion to 60 degrees, ulnar deviation to 40 degrees and radial deviation to 15 degrees; pain was noted on all ROM testing, but the examiner found no diminution with repetitive use testing. Motor strength testing, and sensation were normal, and no atrophy in the Veteran's hands or extremities was noted. See April 2009 VA examination. In a March 2010 letter, the Veteran endorsed increased pain with strenuous activity, which affected his ability to perform jobs that required him to use his wrist. See March 2010 Correspondence. The Veteran was afforded a VA examination for wrist conditions in December 2012. The examiner noted that the Veteran had been diagnosed with right wrist tendonitis status-post surgical tendon repair. During the examination, the Veteran endorsed decreased strength and intermittent swelling, which was aggravated by everyday usage and by performing activities like sweeping, lifting, and carrying more than 25 pounds. He also endorsed flare-ups, which occurred approximately 12 times per month. ROM testing revealed dorsiflexion to 40 degrees, palmar flexion to 60 degrees, radial deviation to 15 degrees, and left ulnar deviation to 25 degrees. No additional loss of motion was noted on repetitive use testing. The examiner noted additional contributing factors of disability, to include less movement than normal, weakened movement, and pain on movement. Muscle strength testing revealed active movement against some resistance on flexion and extension of the Veteran's right wrist. However, there was no evidence of ankylosis. See December 2012 VA examination. During his November 2017 Board hearing, the Veteran testified that his right wrist disability had worsened over time. Specifically, the Veteran stated that he was unable to bend, lift, carry over five pounds, or perform routine household tasks while wearing his wrist brace. He also indicated that his ROM was limited to the point that he could not bend his wrist to scratch his back. See November 2017 Hearing Transcript, pages 18-21. The Veteran was next afforded a VA examination for wrist conditions in August 2019. The examiner noted that the Veteran had been diagnosed with traumatic arthritis of the right wrist status-post tendon repair. During the examination, the Veteran endorsed pain on the ulnar side of his wrist that occasionally spread up his forearm and stated that he used a brace and occasionally took Tylenol with codeine to manage his symptoms. He also reported that his right wrist disability made it difficult for him to open jars, carry objects without dropping them, use tools, and type on a keyboard. Notably, however, the examiner found that the Veteran did not have "true" flare-ups as he reported constant pain that increased with use. ROM testing revealed dorsiflexion to 20 degrees, palmar flexion to 25 degrees, radial deviation to 5 degrees, and left ulnar deviation to 10 degrees. However, the examiner noted that the Veteran's effort on ROM testing was very limited. Pain causing functional loss was noted on all ROM measurements and with weight bearing, but no additional loss of motion was found on repetitive use testing. Muscle strength testing revealed active movement against some resistance on flexion and extension of the Veteran's right wrist. However, there was no evidence of muscle atrophy or ankylosis. See September 2019 C&P examination. The Veteran also underwent a VA examination for wrist conditions in October 2019. The examiner noted that the Veteran had been diagnosed with osteoarthritis of the right wrist and status-post tendon repair of the right wrist. During the examination, the Veteran denied flare-ups and functional impairment. ROM testing revealed dorsiflexion to 50 degrees, palmar flexion to 60 degrees, radial deviation to 10 degrees, and left ulnar deviation to 35 degrees. Pain was noted on dorsiflexion and palmar flexion, but ROM itself was not found to contribute to functional loss. No additional loss of motion was noted on repetitive use testing. Muscle strength testing was normal, and the examiner found no evidence of muscle atrophy or ankylosis. See November 2019 CAPRI. Lastly, in a December 2020 statement, the Veteran indicated that his right wrist disability caused him to experience pain and stiffness, which impacted his ability to write, open jars, type on a keyboard, and to perform activities that required twisting. He also stated that he experienced increased aches with cold weather. See January 2021 Correspondence. Following a review of the evidence of record, the Board finds that a disability rating in excess of 10 percent for the Veteran's service-connected right wrist disability is not warranted. As noted above, under DC 5215, a maximum 10 percent rating is warranted for limitation of motion of the wrist with palmar flexion limited in line with the forearm or dorsiflexion less than 15 degrees. The Veteran is already in receipt of the maximum rating pursuant to DC 5215, and as a result, he cannot receive a higher disability rating under that diagnostic code. The Board has considered whether the Veteran may be entitled to a higher rating pursuant to DC 5214 for ankylosis of the wrist. However, the evidence of record indicates that the Veteran can move his right wrist, and all VA examiners have found that the Veteran's service-connected right wrist disability is not manifested by ankylosis. See April 2009 VA examination; December 2012 VA examination; September 2019 C&P examination; November 2019 CAPRI. Therefore, an increased rating pursuant to Diagnostic Code 5214 is not warranted. Additionally, a rating in excess of 10 percent is not warranted under DC 5010 as the involvement of the Veteran's right wrist is a single joint, and DC 5010 requires involvement of two or more joints, either major or minor, with occasional incapacitating exacerbations, for a 20 percent rating. Moreover, DC 5010 explicitly notes that the Veteran should be rated under the limitation of motion code for the joint unless the limitation of motion of that joint is noncompensable under the applicable code. Thus, as the Veteran has been rated for the appropriate limitation of motion for his right wrist, any further contemplation of that disability under DC 5010 would be impermissible pyramiding. Accordingly, the Board finds no basis on which to assign a rating in excess of 10 percent for the Veteran's service-connected right wrist disability. 38 C.F.R. § 4.71, DCs 5010, 5214, 5215. The Board notes that 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). However, as the Veteran has been assigned the maximum rating for limitation of motion, the provisions of 38 C.F.R. §§ 4.40 and 4.45 are not for application. In sum, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for the Veteran's service-connected right wrist disability. The claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.71a, DCs 5010-5215; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Prior to October 31, 2014, entitlement to a rating in excess of 10 percent for a left knee disability is denied. 3. From February 1, 2015, entitlement to a rating in excess of 10 percent for a left knee disability is denied. As an initial matter, the Veteran filed his claim for entitlement to a rating in excess of 10 percent for his service-connected left knee disability on March 9, 2010. See March 2010 Correspondence. The Veteran has appealed the 10 percent rating. The Board further notes that the Veteran is in receipt of a total 100 percent disability rating from October 31, 2014 to January 31, 2015. See January 2015 Rating Decision Narrative. The temporary total 100 percent rating is not on appeal. Throughout the periods on appeal, the Veteran's service-connected left knee disability has been rated pursuant to 38 C.F.R. § 4.71a, DC 5260, based on painful motion of the knee. Turning to the evidence of record, the Veteran submitted a statement, dated in June 2009, to report that his knees tended to give out on him when he climbed stairs. See June 2009 VA Form 21-4138 Statement in Support of Claim. The Veteran underwent a VA joints examination in July 2009. During the examination, the Veteran endorsed intermittent daily knee pain and buckling, which was exacerbated by cold, rainy weather. However, he denied swelling, locking, popping, grinding, and flare-ups and indicated that he did not use a brace, cane, or crutch. In addition, the Veteran indicated that he was unable to walk more than two to three hours and had trouble climbing into his work truck but denied missing days of work due to his service-connected left knee disability. ROM testing for the knee revealed forward flexion to 80 degrees and extension to 0 degrees. The examiner noted pain on both flexion and extension, but no additional limitation of motion was noted on repetitive use testing. The examiner did not note any pain or tenderness to palpation or instability, and an anterior drawer test was negative. The impression was status-post left knee arthroscopy with patellar spur formation. See July 2009 VA examination. In letters dated in March 2010, November 2010, and April 2012, the Veteran endorsed left knee pain and swelling. He also reported that his left knee occasionally gave out when he climbed stairs, got in and out of vehicles, or stood for an extended period of time. The Veteran further indicated that his service-connected left knee disability made it difficult for him to stand, bend, and climb stairs. See March 2010 Correspondence; November 2010 Correspondence; April 2012 VA Form 21-4138 Statement in Support of Claim. The Veteran underwent a VA examination for knee and lower leg conditions in December 2012. The examiner noted that the Veteran had been diagnosed with left knee strain status-post arthroscopic surgery. During the examination, the Veteran endorsed progressive knee pain and intermittent swelling. He also reported flare-ups that occurred 12 times per month, which impacted the function of the knee and lower leg and required rest for relief. ROM testing of the left knee revealed flexion to 120 degrees and extension to 0 degrees. The examiner noted pain on flexion and found objective evidence of localized tenderness or pain on palpation of the joint. However, repetitive-use testing did not result in additional loss of function or ROM, muscle strength testing was normal, and no joint instability was found. Additionally, the examiner noted no history of recurrent subluxation, lateral instability, or recurrent effusion. No ankylosis was found. See December 2012 VA examination. In October 2014, the Veteran stated that he had been experiencing left knee pain with occasional locking and catching for two to three months. On examination, the examiner noted that the Veteran's knee felt stable to anterior and posterior drawer and varus and valgus stress, though the examiner found some pain with varus stretching. ROM testing revealed flexion to 110 degrees and full extension. The assessment was left knee medial meniscus tear. The Veteran subsequently underwent a left knee arthroscopy. See November 2014 CAPRI: June 2015 CAPRI. A March 2015 orthopedic surgery outpatient note shows that the Veteran endorsed occasional pain to the medial aspect of his left knee. On examination, the examiner noted very mild effusion, but the Veteran's knee was found to be stable to varus and valgus stresses. ROM testing revealed flexion to 120 degrees and full extension. See June 2015 CAPRI. A December 2015 private treatment record noted pain with movement of the left knee and on instability testing. ROM testing revealed flexion to 90 degrees and full extension. See November 2019 Medical Treatment Records Furnished by SSA. During his November 2017 Board hearing, the Veteran testified that the severity of his left knee disability had increased since his 2014 surgery. To this end, he reported that his left knee buckled and lacked strength. See November 2017 Hearing Transcript, pages 21-25. The Veteran underwent a VA examination for knee and lower leg conditions in August 2019. The examiner noted that the Veteran had been diagnosed with left knee injury status-post knee arthroscopy. During the examination, the Veteran endorsed ongoing pain and limitation of motion. He also endorsed functional impairment, to include difficulty going up and down stairs, difficulty sitting or standing for extended periods of time, and pain with prolonged walking. However, the examiner found that, because the Veteran reported that he experienced left knee pain every day, he did not have any "true flare[s]." ROM testing of the left knee revealed flexion to 80 degrees and extension to 0 degrees with pain noted on flexion, which caused functional loss. However, the examiner noted that the testing was not necessarily reliable, as the Veteran resisted testing and anticipated pain. Repetitive-use testing did not result in additional loss of function or ROM, and although the examiner noted evidence of pain on passive ROM testing, no evidence of pain was noted on weight-bearing or non-weight bearing. Muscle strength and joint stability testing of the left knee were normal, and the examiner found no evidence of ankylosis or of a history of recurrent subluxation, lateral instability, or recurrent effusion. The Veteran also reported that he used a left knee brace when he was not in bed, and the examiner noted that the Veteran's diagnosed left knee disability impacted the Veteran's ability to perform occupational tasks that involved squatting, kneeling, crawling, and climbing ladders. See September 2019 C&P examination. The Veteran was also afforded a VA examination for knee and lower leg conditions in October 2019. The examiner noted that the Veteran had been diagnosed with left knee meniscal tear. The Veteran denied flare-ups of the knee and/or lower leg and functional loss or impairment, to include as due to repeated use over time. ROM testing of the left knee revealed flexion to 110 degrees and extension to 0 degrees with no pain noted on examination. Repetitive-use testing did not result in additional loss of function or ROM, and although the examiner noted evidence of pain on passive ROM testing, no evidence of pain was noted on weight-bearing or non-weight bearing. Muscle strength and joint stability testing of the left knee was normal, and the examiner found no evidence of ankylosis or of a history of recurrent subluxation, lateral instability, or recurrent effusion. See November 2019 CAPRI. Lastly, in a December 2020 statement, the Veteran indicated that his left knee disability caused pain and stiffness, which impacted his ability to work. He endorsed left knee swelling following prolonged periods of walking and standing and stated that he experienced increased aches with cold weather. See January 2021 Correspondence. As noted above, the Veteran's right knee disability has been rated as 10 percent disabling pursuant to 38 C.F.R. § 4.71a, DC 5260, throughout the periods on appeal. Included within 38 C.F.R. § 4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or instability, and patellar instability), DC 5258 (cartilage, semilunar, dislocated with frequent episodes of "locking" pain, and effusion into the joint), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). Initially, the Board notes that the Veteran's left knee disability has not been manifested by ankylosis, episodes of "locking" pain, symptomatic cartilage removal, impairment of the tibia and fibula, or genu recurvatum at any time during the periods on appeal; therefore, DCs 5256, 5258, 5259, 5262 and 5263 are not for application. Additionally, as noted above, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov 30, 2020). With regard to ratings concerning the knee, the revisions revised DC 5257 and 5262. As noted above, DC 5262 is not for application. DC 5257 is addressed below. Under DC 5260, limitation of flexion to 60 degrees warrants a non-compensable evaluation, and limitation of flexion to 45 degrees warrants a 10 percent evaluation. Limitation of flexion to 30 degrees warrants a 20 percent evaluation, and limitation of flexion to 15 degrees warrants a 30 percent evaluation. 38 C.F.R. § 4.71a. DC 5261 provides the rating criteria for limitation of extension of the leg. Under this diagnostic code, extension that is limited to 5 degrees is noncompensable; extension that is limited to 10 degrees warrants a 10 percent disability rating; and extension limited to 15 degrees warrants a 20 percent disability rating. Extension limited to 20 degrees warrants a 30 percent disability rating; extension limited to 30 degrees warrants a 40 percent disability rating; and extension limited to 45 degrees warrants a 50 percent disability rating. 38 C.F.R. § 4.71a. VA's General Counsel (GC) has interpreted that a veteran who has arthritis and instability of the knee could receive separate ratings under DCs 5003 and 5257. VAOPGCPREC 23-97. In VAOPGCPREC 9-98, the VA GC explained that, when a veteran has a knee disability evaluated under DC 5257, to warrant a separate rating for arthritis based on X-ray findings, the limitation of motion need not be compensable under DC 5260 or DC 5261; rather, such limited motion must at least meet the criteria for a zero-percent rating. In VAOPGCPREC 9-2004, the VA GC held that, when considering DCs 5260 and 5261 together with 38 C.F.R. § 4.71, a veteran may receive a rating for limitation in flexion only, limitation of extension only, or separate ratings for limitations in both flexion and extension under DC 5260 and DC 5261. After a review of the evidence of record, the Board finds that a rating in excess of 10 percent disabling based on limitation of motion is not warranted for the Veteran's service-connected left knee disability. In this regard, the Board finds that the evidence of record does not demonstrate that the Veteran's left knee disability was manifested by forward flexion limited to 30 degrees or less at any time during the periods on appeal. To the contrary, the Board notes that, at worst, the Veteran's left knee flexion was found to be limited to 80 degrees. See September 2019 C&P examination. Thus, a rating in excess of 10 percent under DC 5260 is not for application. Additionally, throughout the periods on appeal, the Veteran's left knee disability extension was consistently found to be normal, and he did not demonstrate extension limited to 10 degrees or less at any time during the relevant period. Accordingly, a compensable rating under DC 5261 is not for application. The Board has also considered assigning a rating pursuant to DC 5257, which, as noted above, was recently revised effective February 7, 2021. Under the rating criteria in effect prior to February 7, 2021, under DC 5257, ratings were provided for subluxation or lateral instability. Effective February 7, 2021, DC 5257 provides ratings for recurrent subluxation or instability, and patellar instability. In this regard, the Board recognizes that the Veteran has reported symptoms, to include giving out and buckling, related to his service-connected left knee disability. See, e.g., June 2009 VA Form 21-4138 Statement in Support of Claim; March 2010 Correspondence; November 2010 Correspondence; April 2012 VA Form 21-4138 Statement in Support of Claim; November 2017 Hearing Transcript, page 23. While the Veteran is competent to report observed symptoms such as giving way, he is not competent to provide a medical finding as to joint instability as such is a complicated medical issue. 38 C.F.R. § 3.159(a)(1)-(2); Jandreau v. Nicholson, 492 F.3d 1372 (2007). In any event, the Board finds the cumulative VA medical records and examination reports dated during the periods on appeal to be the most probative evidence of record; all of which found that the Veteran's service-connected left knee disability was not manifested by instability. With regard to the June 2009, December 2012, August 2019, and October 2019 VA examinations, those examinations specifically included diagnostic testing to determine whether the Veteran's service connected left knee disability was manifested by instability. However, all such diagnostic tests were consistently negative. Thus, the Board concludes that if the Veteran had instability that more nearly approximated the criteria for a compensable rating under either the old or new rating criteria, such would have been shown upon objective testing at some point during the periods on appeal. Therefore, the Board finds that assignment of a separate rating for the Veteran's service-connected left knee disability based on reported symptoms of giving way is not warranted under either the old or new rating criteria. The Board further finds no basis for assigning any higher rating based on consideration of functional loss of the left knee during the periods on appeal. 38 C.F.R. §§ 4.40, 4.45, 4.59; Deluca, 8 Vet. App. at 204-06; Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011); Correia, 28 Vet. App. at 158. Here, the Veteran's left knee disability has been assigned a compensable rating based on painful motion. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In this regard, limitation of flexion has been shown to be, at worst, 80 degrees. See September 2019 C&P examination. Accordingly, as limitation of motion does not warrant a rating in excess of 10 percent, the criteria for a higher rating based on functional loss have not been met. 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5260. In sum, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for the Veteran's service-connected left knee disability during the periods on appeal. The claims are denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.71a, DCs 5256-5263; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. See Gilbert, supra. 4. Entitlement to service connection for a left thumb disability is denied. During his November 2017 Board hearing, the Veteran testified that he has a current left thumb disability that was caused by a crush injury he sustained while he was serving on active duty. Specifically, he reported that the hatch of a 113 personnel carrier fell and slammed down onto his left thumb while he was participating in a maintenance check during service. The Veteran further testified that he has continued to experience pain and stiffness in his left thumb since the initial injury and indicated that he takes prescription medication, to include Tylenol III, for his symptoms and continues to use the brace he received following the in-service injury. See November 2017 Hearing Transcript, pages 3-8. A review of the service treatment records (STRs) shows that the Veteran received treatment for a jammed left thumb in June 1999. A subsequent medical record, also dated in June 1999, shows that the Veteran sustained a crush injury after a hatch fell across his left thumb. The examiner noted that an x-ray obtained the previous day did not show any evidence of fracture, dislocation, or arthritic changes. The assessment was left thumb contusion. Thereafter, during a July 1999 physical therapy initial consultation, the Veteran was noted to have pain, edema, decreased active range of motion, decreased pinch grip, and decreased functional use in his left thumb. A medical record dated in August 1999 shows that the Veteran reported that his symptoms had been improving slowly but indicated that he continued to have discomfort when he moved his left thumb. Th examiner noted that the Veteran had been treated with a thumb spica splint with activity modifications and occupational therapy for modalities of treatment. On physical examination, the examiner noted tenderness in the region of the proximal phalanx, and the Veteran had difficulty bringing his left thumb into opposition with his small finger with pain on the distal aspect of the proximal phalanx of the thumb. The impression was resolving contusion of the left thumb. On an April 2000 annual medical review certificate, the Veteran reported that his left thumb was crushed in a hatch in or around June or July 1999. He stated that he received some therapy following the injury but indicated that he was still "having problems" with his thumb and that he may need surgery. Despite the injury, the Veteran was found fully fit. A June 2000 physical report of medical examination shows the Veteran's upper extremities to be normal. However, on his June 2000 physical report of medical history, the Veteran endorsed swollen or painful joints but denied loss of finger and bone, joint, or other deformity. In this regard, an examiner noted that the Veteran injured his left thumb in May 1999 and continued to experience left joint pain with decreased mobility. Thereafter, the Veteran's upper extremities were also noted to be normal on a September 2003 medical board report of medical examination, and the Veteran denied impaired use of arms, legs, hands, or feet on the corresponding report of medical history. See April 2004 STR Medical; January 2009 STR Medical; August 2009 Medical Treatment Record Government Facility; January 2015 STR Medical Photocopy. The Veteran underwent a VA general medical examination in April 2004. During the examination, the Veteran endorsed right wrist pain and intermittent decreased grip strength in his right hand, especially with an expanded palm. To this end, the Veteran explained that he performed tasks, such as opening large-mouthed jars of pickles, with his left hand. The examiner did not note any other findings pertaining to the Veteran's left hand or thumb. See April 2004 VA examination. Thereafter, the Veteran underwent VA joints examinations in April 2009 and July 2009. The Veteran did not report any symptoms related to his claimed left thumb disability, and the examiner did not note any other findings pertaining to the Veteran's left hand or thumb during either examination. See April 2009 VA examination; July 2009 VA examination. The Veteran was afforded a VA examination for hand and finger conditions in August 2019. During the examination, the Veteran indicated that a hatch fell on his left thumb while he was cleaning the contacts for an antenna on top of a 113 personnel carrier. In this regard, he indicated that he did not seek treatment for his left thumb injury immediately after he was discharged from service because he gave up after he was told that nothing could be done for the injury. The Veteran also endorsed functional loss associated with his claimed left thumb disorder, to include difficulty picking things up, holding plates, and using tools. ROM testing of the Veteran's left hand was noted to be normal, but the examiner also indicated that pain on finger flexion, finger extension, and opposition of the thumb caused functional loss. In addition, muscle strength testing revealed active movement against some resistance, but the examiner noted that the Veteran exhibited very little effort bilaterally. In this regard, the examiner explained that the Veteran anticipated pain during testing, which made a good examination difficult, and noted that he did not report any symptoms specific to his thumb. Rather, the examiner noted that the Veteran endorsed pain and stiffness throughout both of his hands. Following the examination, the examiner found that the Veteran did not have a current diagnosis associated with his claimed left thumb disorder but indicated that his presentation on examination called into question whether he may have a chronic pain syndrome as opposed to a focal diagnosis. After performing an examination and reviewing the evidence of record, the examiner opined that it was less likely than not that the Veteran's claimed left thumb disability was incurred in or caused by the claimed in-service injury, event, or illness. In support of her opinion, the examiner noted that a good examination was not possible because the Veteran anticipated pain and was resistant to pushing through the rigors of good joint testing on all aspects of the examination. In this regard, the examiner noted no focal issues associated with the Veteran's thumbs as he had resistance to moving any of the joints in his hands and would flinch and pull back before he was touched on both his right and left hands. As such, the examiner indicated that she was not giving a diagnosis specific to the thumb. In spite of this finding, the examiner acknowledged that the Veteran's STRs indicated that he sustained a crush injury to his left thumb in June 1999 but found that there were no subsequent residual complaints or treatment related to his left thumb following treatment with occupational therapy. As such, the examiner opined that it was less likely than not that the Veteran had a left thumb disability that was a residual of his 1999 crush injury. See September 2019 C&P examination. Following a review of the evidence of record, the Board finds that entitlement to service connection for a left thumb disability is not warranted. As noted above, service connection requires evidence that establishes that the Veteran currently has the claimed disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, the Veteran reported that he has a current left thumb disability during his November 2017 Board hearing. See November 2017 Hearing Transcript, pages 3-8. However, the Veteran's post-service medical records are absent for any complaints or diagnoses related to his left thumb, and the August 2019 VA examiner found that he did not have a current diagnosis associated with his claimed left thumb disorder. See September 2019 C&P examination. In this regard, the Veteran is considered competent to report the observable manifestations of his claimed disability, to include pain and swelling. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (lay testimony iterating knowledge and personal observations of witness are competent to prove that claimant exhibited certain symptoms at particular time following service). However, while a Veteran can competently report the onset and continuity of subjective symptoms, he is not competent to diagnose himself with a left thumb disability. 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). The Board has considered the Veteran's report that he takes prescription pain medication, to include Tylenol III, to treat pain and stiffness in his left thumb. See November 2017 Hearing Transcript, page 7. To this end, although the Veteran's medical records confirm that he has been prescribed pain medications, to include Tylenol and acetaminophen, throughout the relevant period, there is no indication that they were prescribed to treat his claimed left thumb disability. Rather, as noted above, the Veteran's post-service medical records are absent for any complaints or treatment related to a current left thumb injury prior to the August 2019 VA examination report. See, e.g., June 2015 CAPRI; June 2019 CAPRI; March 2020 CAPRI. Thus, the Board concludes that any lay assertions by the Veteran in the present case are outweighed by the medical evidence of record, including the August 2019 VA examination report and medical opinion. The examiner has training, knowledge, and expertise on which she relied to form her opinion and she provided a persuasive rationale. Accordingly, the first element of service connection has not been met. To this end, the Board acknowledges that the August 2019 VA examiner found that the Veteran anticipated pain and showed limited effort on ROM testing of the right hand, but notes that she did not report any such findings with regard to the Veteran's left hand on the examination report. Moreover, despite this limited effort, the examiner was still able to perform an examination and to provide objective medical testing results. See September 2019 C&P examination. The duty to assist in developing the facts and evidence pertinent to a veteran's claim is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, it is a veteran's responsibility to cooperate with VA, including with any efforts to provide an adequate medical examination. See Caffrey v. Brown, 6 Vet. App. 377, 383 (1994); Olson v. Principi, 3 Vet. App. 480, 483 (1992). In light of the fact that the Veteran was found unwilling to fully participate with the August 2019 VA examination and as that examination was obtained in order to further develop his claim, the Board finds that remanding this matter for the sole purpose of obtaining another VA examination would service no useful purpose. The Board further finds that VA has satisfied the duty to assist provisions of law with regard to the claim on appeal, and, therefore, finds there was substantial compliance with the requested development. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). Moreover, to the extent that the August 2019 VA examiner indicated that the Veteran may have a global pain issue, the Board emphasizes that she did not find, and the cumulative medical evidence of record does not show, that any global pain issue may be related to the Veteran's service. See September 2019 C&P examination. As such, the Board finds that a remand to obtain a medical opinion to address the etiology of a possible global pain syndrome is also not warranted as the claim does not meet the low threshold requirements of McLendon, and therefore VA's duty to provide an examination has not been triggered. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (explaining that something more than conclusory, generalized statements is needed to trigger the VA's duty to assist); Duenas v. Principi, 18 Vet. App. 512, 517 (2004). Thus, absent a diagnosis of a left thumb disability, the Board finds that the first Shedden requirement has not been met, and the probative evidence is against the Veteran's claim. Accordingly, the claim is denied. 5. Entitlement to a TDIU is denied. By way of background, in a February 2018 decision, the Board found that the issue of entitlement to a TDIU had been raised by the record. As such, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), the claim for entitlement to a TDIU was considered part and parcel to the Veteran's claims for increased ratings for his service-connected right wrist and left knee disabilities, which were filed on March 9, 2010. See March 2010 Correspondence. 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 their education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. It is the established policy of the Department of Veterans Affairs 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. Therefore, rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) above. The Board notes that the Veteran is service connected for the following disabilities: glaucoma rated as 10 percent disabling from February 21, 2004 to October 16, 2007, as 20 percent disabling from October 17, 2007 to April 6, 2009, as 30 percent disabling from April 7, 2009 to March 8, 2010, and as 60 percent disabling thereafter; right wrist traumatic arthritis status-post tendon repair rated as 10 percent disabling from February 21, 2004; painful right wrist post-operative scar rated as 10 percent disabling from April 7, 2009; left knee injury status-post knee arthroscopy rated as 10 percent disabling from February 21, 2004 to October 30, 2014, as 100 percent disabling from October 31, 2014 to January 31, 2015, and as 10 percent disabling thereafter; and right wrist post-operative scar rated as non-compensable from March 9, 2010. See March 2021 Rating Decision Codesheet. Thus, the Board notes that the Veteran's combined disability rating is 70 percent from March 9, 2010 to October 30, 2014 and after February 1, 2015. As such, he meets the schedular rating criteria throughout the relevant periods. Turning to the evidence of record, the Veteran submitted a letter from a co-worker, J.Y. Brown, dated in May 2009. In the letter, Brown states that he noticed that the Veteran had difficulty lifting heavy objects due to his wrist and back disabilities. Brown further reported that the Veteran's fingers occasionally swelled and that his eye disability prevented him from reading certain diagrams and from standing in bright sunlight for long periods of time. To this end, Brown stated that, although the Veteran's illnesses occasionally kept him home from work, he continued to work hard despite his disabilities. See June 2009 Buddy/Lay Statement. In support of his claim, the Veteran submitted a letter, dated in March 2010, which states that swelling and pain caused by his service-connected right wrist and left knee disabilities made it difficult for him to perform his job. Specifically, the Veteran reported that he had trouble lifting more than 25 pounds, using tools, climbing, jumping, kneeling, squatting, and standing for long periods of time. He further reported that his knee tended to give out when he climbed into his truck and indicated that his eyes were painful. See March 2010 Correspondence. The Veteran endorsed difficulty seeing electronic schematics at work during an April 2010 VA eye examination. However, he also indicated that he was employed and had never missed a day of work because of his eye problems. See April 2010 VA examination. In a letter, received in November 2010, the Veteran reported that he could not maintain a job or find work that did not cause him physical pain. He further reported that his service-connected glaucoma made it difficult for him to work in technical positions because he could not read components or diagrams required to make equipment work. See November 2010 Correspondence. A March 2012 letter from one of the Veteran's former employers, S.A.I.C., shows that the task to which the Veteran had been assigned was scheduled to end on or about April 20, 2012. To this end, the letter states that the Veteran would be transitioned to an involuntary leave without pay status for four weeks after the task ended and that his employment would end if he had not identified and secured an internal transfer at the end of that period. See April 2012 Third Party Correspondence. In an April 2012 statement, the Veteran indicated that he was going to lose his job because his service-connected disabilities caused him to be frequently absent from work. In this regard, he endorsed blurred vision and stated that he had difficulty using tools, to include wrenches, and standing, bending, and walking for long periods of time. However, the Veteran also reported that he was unable to lift more than thirty pounds or bend for long periods of time due to a nonservice-connected back disability and noted that he had also missed work due to his nonservice-connected gout. See April 2012 VA Form 21-4138 Statement in Support of Claim; see also April 2012 Correspondence. The Veteran underwent VA examinations for knee and lower leg conditions and wrist conditions in December 2012. During the examinations, the Veteran endorsed progressive, daily knee pain aggravated by work activities, to include standing for longer than 40 minutes, decreased strength in his right wrist, decreased ability to open jars, and intermittent pain and swelling. He also reported that his right wrist disability was aggravated by everyday usage, to include performing activities like sweeping and lifting and carrying more than 25 pounds. Following the examinations, the examiner found that the Veteran's service-connected disabilities impacted his ability to work. In this regard, the examiner noted that the Veteran was unemployed at the time of the examinations, had last worked in April 2012, and that he missed three days of work between January and April 2012. In this regard, the examiner noted that the Veteran reported that his previous job required him to bend over and walk for more than one mile, but determined that he could tolerate lifting up to approximately 25 pounds. Notably, however, the examiner also indicated that she did not have access to the Veteran's claims folder at the time of either examination. See December 2012 VA examination. A disability determination and transmittal form, dated in July 2016, shows that the Social Security Administration (SSA) found the Veteran to be disabled from August 2015 and reported his primary diagnosis as discogenic and degenerative disorders of the back. Other and unspecified arthropathies were noted as secondary diagnoses. SSA records also indicate that the Veteran was last employed part-time as a floor technician from May 2015 to January 2016. He also worked as a janitorial supervisor from December 2012 through May 2015, an electronics technician from March 2007 through May 2012, a janitorial area manager from January 2004 to March 2007, and as a combat communications officer from January 1980 to January 2004. The Veteran submitted a private medical assessment from Dr. W. F. Maguire, Jr., dated in December 2015, in connection with his claim for entitlement to SSA disability benefits. Dr. Maguire found that the Veteran's long-standing fairly severe low back pain would limit him from carrying out a lot of physical activities, to include activities that required carrying, lifting, squatting, bending, crawling, and any other activities that would put strain on his lower back. Dr. Maguire also indicated that the Veteran's left knee, bilateral shoulders, and right wrist symptoms would limit his physical ability to carry out prolonged activity such as gripping, carrying, lifting especially overhead, and kneeling. To this end, Dr. Maguire found that the Veteran would find squatting and spending prolonged time on his feet very difficult and that he would find standing or walking uncomfortable. See November 2019 Medical Treatment Records Furnished by SSA. During his November 2017 Board hearing, the Veteran testified that he last worked in or around May 2015 and indicated that his service-connected disabilities impeded his ability to work. To this end, the Veteran reported that he had been employed as a janitor and indicated that he found it difficult to use his hands and to lift, bend and move around heavy objects. Notably, the Veteran also attributed his inability to work, at least in part, to a nonservice-connected back disability. See November 2017 Hearing Transcript, pages 6, 14, 25-26. In August 2019, the Veteran reported that all of his service-connected disabilities prevented him from securing or following any substantially gainful employment. In this regard, the Veteran reported that he last worked as a floor supervisor performing custodial work for WFF Services from November 2012 through October 2014. He further reported that he performed custodial work for Q.T.J. from June 2005 through November 2011 and indicated that he completed two years of college. See August 2019 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Veteran underwent a VA examination for knee and lower leg conditions in August 2019. During the examination, the Veteran endorsed ongoing pain and limitation of motion and indicated that he experienced pain when he attempted to sit or stand for long periods of time. The examiner found that the Veteran's service-connected left knee disability impacted his ability work and indicated that he should avoid squatting, kneeling, crawling, and climbing ladders. The Veteran was also afforded VA examinations for wrist and skin conditions in August 2019. During the former, the Veteran endorsed constant pain on the ulnar side of his wrist that occasionally radiated up his forearm, and the examiner found that the Veteran's service-connected right wrist disability impacted his ability to work. Specifically, the examiner indicated that the Veteran should avoid repetitive twisting, turning, pushing, and pulling with his wrists. However, although the Veteran endorsed ongoing pain associated with his right wrist scar, the examiner who performed the skin conditions examination found that it did not impact his ability to work. See September 2019 C&P examination. The Veteran was next afforded a VA examination for knee and lower leg conditions in October 2019. Following the examination, the examiner found that, although the Veteran's service-connected left knee disability prevented him from engaging in physical types of employment, he would still be able to work in light physical and sedentary types of employment. In this regard, the examiner noted that the Veteran's left knee disability was manifested by a mild to moderate reduction in ROM without pain or functional loss. In support of his opinion, the examiner noted that there was no evidence of instability or flare-ups, muscle strength was normal, and that the Veteran was able to do repetitive motions without further loss of function or ROM. As a result, the examiner found that the Veteran would be able to do light physical and sedentary types of jobs but indicated that his left knee disability precluded him from performing heavy physical employment. The Veteran also underwent a VA examination for wrist conditions in October 2019. Following the examination, the examiner opined that the Veteran's service-connected right wrist disability did not render him unable to seek and maintain substantially gainful sedentary employment but would preclude him from engaging in physical types of employment. In addition, the Veteran underwent VA examinations for scars and eye conditions in October 2019. Following the examination for scars, the examiner found that the Veteran's right wrist scar did not render him unable to seek and maintain substantially gainful physical or sedentary types of employment. In support of his opinion, the examiner noted that the scar on the dorsum of the Veteran's right wrist was superficial, stable, and not elevated with no pain, tenderness, or keloid formations. The examiner further indicated that the Veteran's work history showed that he was last employed in 2015 doing janitorial work and that he had stopped working because of his back and knee disabilities. As such, the examiner found that the Veteran's scar was a non-factor on any type of employment that he may undertake. Similarly, following the eye conditions examination, the examiner opined that the Veteran's service-connected glaucoma did not impose any restrictions on his job activities. See October 2019 C&P examination. In a May 2020 email, the Veteran reported that he was not able to hold a job due to pain and discomfort associated with his service-connected left knee and right wrist disabilities. In this regard, the Veteran indicated that he found it very hard to stand or sit for more than 15 to 20 minutes at a time. He also reported that medications he took to manage pain associated with his service-connected disabilities caused sleepiness, dizziness, mild confusion, and frequent trips to the bathroom. In addition, the Veteran endorsed constant back pain and noted that he woke up exhausted due to his severe sleep apnea. See May 2020 Email Correspondence. In support of his claim, the Veteran submitted a private medical opinion from Dr. M. Blevins, dated in January 2021. After reviewing the evidence of record and consulting with the Veteran, Dr. Blevins opined that it was as likely as not that the combination of pain and limitations caused by his service-connected disabilities prevented him from being able to work fulltime. In support of her opinion, Dr. Blevins reported that the Veteran's service-connected left knee and right wrist disabilities prevented him from being able to walk, stand, or sit for more than 20 minutes, impaired his ability to lift or use his upper extremities for repetitive motions, and resulted in poor sleep and distraction due to pain causing excessive daytime sleepiness, fatigue, and irritability. In addition, Dr. Blevins found that the Veteran's service-connected glaucoma caused poor vision. See January 2021 Medical Treatment Record Non-Government Facility. In a January 2021 letter, the Veteran indicated that his service-connected vision, wrist, and knee disabilities impeded his ability to work and to complete daily tasks in a timely manner. In this regard, the Veteran endorsed daily knee and back pain, which occasionally caused him to stay awake until three or four o'clock in the morning. He further noted that his service-connected wrist disability impaired his ability to complete everyday tasks, to include typing on a computer, and reported that he experienced pain in his knee, wrist, and back when he trimmed trees, pushed his lawn mower, and performed household tasks like washing dishes. He further indicated that the constant pain associated with his service-connected disabilities wore on his mental state and caused him to become irritable, easily distracted, and to dislike being around people. In addition, the Veteran indicated that his service-connected glaucoma impaired his vision. To this end, he explained that he struggled or was unable to read prescription labels, street signs, paperwork, phone numbers, instructions, and any small print text. However, the Veteran also indicated that his inability to work was due, at least in part, to his nonservice-connected sleep apnea and back disabilities. See January 2021 Correspondence. Lastly, the Veteran reported that all of his service-connected disabilities prevented him from securing or following any substantially gainful employment in January 2021. In this regard, the Veteran reported that he last worked part-time as a floor technician and janitor from May 2015 through January 2016. He further stated that he had been employed as a floor supervisor from November 2012 through May 2015 and as an area supervisor from June 2005 to August 2012. He also indicated that he completed two years of college. See January 2021 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. Following a review of the evidence of record, the Board finds that entitlement to a TDIU is not warranted. In this regard, the Board recognizes that the Veteran's service-connected left knee and right wrist disabilities result in daily pain and stiffness and impede his ability to stand for more than 15 to 20 minutes, climb, jump, kneel, squat, and perform repetitive twisting, turning, pushing, and pulling with his wrists. See, e.g., March 2010 Correspondence; November 2017 Hearing Transcript, pages 6, 14, 25-26; September 2019 C&P examination; October 2019 C&P examination. Nevertheless, the Board finds that the Veteran's service-connected left knee and right wrist disabilities do not impose restrictions that preclude the Veteran from obtaining or maintaining employment. Specifically, the Board finds that the Veteran's service-connected left knee disability and right wrist disabilities do not preclude substantial gainful employment that involves fewer physical demands. See October 2019 C&P examination. The Board recognizes that the Veteran has reported that his service-connected glaucoma causes visual impairment, to include difficulty reading and blurry vision. In this regard, the Board notes that the Veteran stated that he could not read components or diagrams in a November 2010 statement and explained that he struggled or was unable to read prescription labels, street signs, paperwork, phone numbers, instructions, and any small print text in a January 2021 statement. See November 2010 Correspondence; January 2021 Correspondence. The Board also notes that he is rated at 60 percent for his glaucoma. However, the Board also notes that, with the exception of the January 2021 medical opinion from Dr. Blevins, the medical evidence of record consistently indicates that the Veteran's service-connected glaucoma does not preclude him from securing and maintaining substantially gainful employment. In this regard, the Veteran indicated that he had never missed a day of work due to his service-connected glaucoma during the April 2010 VA eye examination. Although the Veteran's glaucoma might affect his ability to read small print text or other detailed information, his glaucoma did not prevent employment that did not require such precision. In reaching these conclusions, the Board has considered the January 2021 private medical opinion from Dr. Blevins. In this regard, after performing a review of the evidence of record and consulting with the Veteran, Dr. Blevins opined that it was as likely as not that the combination of pain and limitations caused by his service-connected disabilities prevented him from being able to work fulltime. However, as noted above, the Veteran's medical treatment records consistently show that his service-connected disabilities did not preclude him from performing less physical employment. In this regard, the Board notes that Dr. Blevins appears to have based her findings on the Veteran's statements rather than on the objective evidence of record. Moreover, she did not explain how the Veteran's disabilities prevented him from performing employment requiring fewer physical demands. See Gardin v. Shinseki, 613 F.3d 1374, 1379 (Fed. Cir. 2010) (stating that the Board acted appropriately in its fact-finding role in its determination that lay statements of record were not credible because they are in direct contradiction to the medical evidence of record). Contemporaneous evidence may have greater probative value than history as reported by the Veteran at a later date. Curry v. Brown, 7 Vet. App. 59, 68 (1994). In any event, the Board notes that the question of employability is ultimately a legal one. Thus, the Board finds that Dr. Blevins private medical opinion is outweighed by the more probative evidence of record, to include the August 2019 and October 2019 VA examination reports, and the cumulative medical evidence of record, which shows that the Veteran's service-connected disabilities do not prevent him from securing and maintaining substantially gainful employment with fewer physical demands. The Board further notes that the Veteran has intermittently attributed his inability to obtain or maintain substantially gainful employment, at least in part, to nonservice-connected disabilities, to include gout, a back disability, and sleep apnea. See, e.g., April 2012 VA Form 21-4138 Statement in Support of Claim; April 2012 Correspondence; November 2017 Hearing Transcript, pages 6, 14, 25-26; May 2020 Email Correspondence. In addition, a disability determination and transmittal form, dated in July 2016, shows that SSA found the Veteran to be disabled due primarily to discogenic and degenerative disorders of the back. See November 2019 Medical Treatment Records Furnished by SSA. To this end, the Board notes that the Veteran's nonservice-connected disabilities cannot be considered for determining entitlement to a TDIU. Thus, while it is clear that the Veteran has some occupational and functional impairment as a result of his service-connected disabilities, the evidence does not support that the Veteran's service-connected disabilities alone preclude him from securing and maintaining substantially gainful employment. Here, the Board notes the evidence shows that the Veteran last worked fulltime as a janitorial supervisor from December 2012 to May 2015. Moreover, the Veteran also reported that he worked as an area supervisor for a janitorial services company from June 2005 to August 2012 and indicated that he completed high school and two years of college. See August 2019 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability; November 2019 Medical Treatment Records Furnished by SSA; January 2021 VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Board finds that the Veteran's experience as a supervisor and education level would help qualify him for a less physical job. (Continued on the next page) Based on the foregoing, the Board finds that the most probative evidence of record reflects that the Veteran is not unemployable due solely to his service-connected disabilities. Rather, while the evidence of record indicates that the Veteran's service-connected disabilities prevent him from performing physically demanding work and work that requires reading small print or other detailed information, they do not prevent him from obtaining sedentary and less physically demanding employment, or work that does not require 20/20 vision, or the ability to frequently read small print. Accordingly, the Board finds that the preponderance of the evidence is against entitlement to a TDIU. The claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.130; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS 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.