Citation Nr: 21075528 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 16-58 763 DATE: December 20, 2021 ORDER 1. Prior to March 1, 2017, a separate 10 percent rating for left knee instability is granted. 2. Prior to November 9, 2017, a rating in excess of 30 percent for left knee post arthroplasty is denied. 3. Since November 9, 2017, a 60 percent rating for left knee post arthroplasty is granted. 4. A total disability rating based on individual unemployability (TDIU) prior to November 25, 2018 is denied. FINDINGS OF FACT 1. Prior to March 1, 2017, the Veteran's left knee post arthroplasty manifested in slight instability. 2. Prior to November 9, 2017, the Veteran's left knee post arthroplasty manifested in no worse than intermediate residual weakness, pain, or limitation of motion. 3. Since November 9, 2017, the Veteran's left knee post arthroplasty manifested in severe residual weakness, pain, or limitation of motion. 4. Prior to January 28, 2018, the Veteran's service-connected disabilities did not preclude substantially gainful employment consistent with his educational and occupational background. CONCLUSIONS OF LAW 1. Prior to March 1, 2017, the criteria for a separate 10 percent rating for left knee instability were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5257. 2. Prior to November 9, 2017, the criteria for a rating in excess of 30 percent for Veteran's left knee post arthroplasty were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055. 3. Since November 9, 2017, the criteria for 60 percent rating for left knee post arthroplasty are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055. 4. Prior to January 28, 2018, the criteria for a TDIU were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1970 to August 1974. The case is on appeal from November 2015 and July 2017 rating decisions. In February 2021, the Veteran testified at a Board hearing. In a May 2021 decision, the Board denied a rating in excess of 30 percent for a right foot disability and remanded claims for service connection for a right knee disorder, an increased rating for a left knee disorder, and a TDIU prior to January 28, 2018. Thereafter, in an August 2021 rating decision, the RO granted service connection for a right knee disability effective August 19, 2015. The rating decision also granted a 60 percent rating for left knee post arthroplasty effective June 18, 2021. As the right knee claim has been granted in full, it is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). However, the staged ratings assigned for the left knee disability do not represent the maximum disability rating assignable and the Veteran has not indicated that the current staged ratings are the maximum benefit sought. As higher ratings are available and a claimant is presumed to be seeking the maximum available rating for disabilities, the left knee rating claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In October 2021, the Veteran's representative submitted additional evidence. Waiver of RO consideration of the additional evidence is presumed given the date of the substantive appeal. See 38 U.S.C. § 7105(e). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. A rating in excess of 30 percent prior to June 18, 2021, exclusive of the temporary total rating period from March 1, 2017 to May 31, 2017, and in excess of 60 percent thereafter for left knee post arthroplasty. Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Disabilities of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Veteran's left knee post arthroplasty is evaluated under 38 C.F.R. § 4.71a, DC 5055. Under DC 5055, a 100 percent evaluation is assigned for prosthetic replacement of the knee joint following implantation of prosthesis. After the period of a 100 percent evaluation, the minimum rating for this disability is 30 percent based on intermediate degrees of residual weakness, pain or limitation of motion, rated by analogy to DCs 5256, 5261, or 5262. Outside periods of temporary total ratings, the maximum rating under DC 5055 is 60 percent based on chronic residuals consisting of severe painful motion or weakness in the extremity. In addition, under DC 5257, a 10 percent rating is warranted for either slight recurrent subluxation or slight lateral instability; a 20 percent rating is warranted for moderate recurrent subluxation or moderate lateral instability; and a 30 percent rating is warranted for severe recurrent subluxation or severe lateral instability. 38 C.F.R. § 4.71a, DC 5257. Effective February 7, 2021, the criteria to knee instability were amended. See 82 Fed. Reg. 76453 (Nov. 30, 2020); 38 C.F.R. § 4.71a, DC 5257. Under the new criteria for DC 5257, a 10 percent rating is assigned for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane, crutch, walker) or bracing for ambulation; a 20 percent rating is assigned for sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace or assistive device (e.g., cane, crutch), walker) for ambulation, or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane, crutch, walker) or bracing for ambulation; and a 30 percent rating is assigned for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane, crutch, walker) and bracing for ambulation. Furthermore, under the new criteria separate ratings may also be assigned for patellar instability. For patellar instability a 10 percent rating assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker; a 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker; and a 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Id. NOTE 1 following the criteria provides, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. NOTE 2 following the criteria provides a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). The Board also notes that, as the February 7, 2021 rating criteria change did not specify that it was to have a retroactive effect, the prior criteria and the new criteria will both be considered for the later rating period and the rating assigned based on the criteria most favorable to the Veteran. However, an award warranted under the revised criteria cannot be effective prior to February 7, 2021. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). In regard to DCs 5055 and 5257, Merriam-Webster dictionary defines "moderate" as tending toward the mean or average amount or dimension and "severe" is "of a great degree." See https://www.merriam-webster.com/dictionary/moderate; www.merriam-webster.com/dictionary/severe. An effective date for an increased rating should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that the disability first manifested. Accordingly, the effective date for an increased rating, as well as for an initial rating or for staged ratings, is predicated on when the increase in the level of disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); DeLisio v. Shinseki, 25 Vet. App. 45, 56 (2011). In determining when an increase is "factually ascertainable," all of the evidence must be looked to, including testimonial evidence and expert medical opinions, and an effective date must be assigned based on that evidence. See McGrath v. Gober, 14 Vet. App. 28, 35-36 (2000); VAOPGCPREC 12-98. Thus, "it is the information in a medical opinion, and not the date the medical opinion [that] was provided that is relevant when assigning an effective date." Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010); see also Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Analysis The Veteran filed a claim for a higher rating for a left knee disability in August 2015. During the February 2021 Board hearing, he reported that his left knee symptoms have worsened since the most recent VA examination for this disability due to falling off a latter while putting up Christmas lights in 2017. He also reported that his left knee range of motion is limited to 90 degrees and he has to use a cane. He further reported that he has experienced right knee pain due to compensating for his left knee disability. In an October 2021 correspondence, the Veteran's representative stated that the Veteran experienced increased knee pain and was visibly limping in 2016. The representative also stated that the Veteran was regularly using a cane and sometimes a walker during this time period. The representative further stated that he underwent revision surgery in 2017 due to particle disease around a screw in the left knee. The Veteran's VA records include treatment for the left knee in July 2015. The Veteran reported constant left knee aching. He also reported falling multiple times, but was unable to say if it was due to a knee condition. He further reported being unable to use the treadmill at the gym and difficulty climbing stairs. During VA treatment in August 2015, the Veteran reported falling at night and some instability in his bilateral knees. He also reported swimming regularly. The treatment provider reported left knee range of motion from zero degrees to 111 degrees and the presence of slight left knee laxity. Pursuant to this claim, the Veteran was afforded a VA left knee examination in October 2015. The Veteran reported the left knee was getting worse with pain, giving out frequently, and periods of instability. He also reported pain on walking, use of stairs, and standing for prolonged periods of time. He denied experiencing flareups. The examiner reported left knee range of motion from zero to 110 degrees with mild, wincing pain on flexion and extension, and the presence of pain with weight-bearing. The examiner also reported normal stability testing with the exception of "1+" for zero to 5 millimeters (mms) of anterior instability. The examiner further reported that a July 2015 radiology report showed left knee arthroplasty without signs of hardware complication and unchanged heterotopic ossification in the posterior compartment. The examiner denied additional loss of range of motion on 3 repetitions of testing, crepitus, loss of muscle strength, meniscal conditions, use of assistive devices, ankylosis, and history of recurrent subluxation, lateral instability, and recurrent effusion. The examiner found that the left knee disability results in less movement than normal, disturbance of locomotion, and interference with standing, but not weakened movement, swelling, deformity, atrophy of disuse, instability of station, or interference with sitting. The examiner concluded that the left knee disability results in intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran's VA records include treatment for left knee pain in December 2015. The Veteran reported his left knee pain had worsened over the past 3 years and was told that the screws in his left knee had loosened, but the hardware was still intact. He also reported changing his walking gait due to left knee pain that resulted in right knee symptoms. He was treated again for knee pain in July 2016. The VA physician reported left knee range of motion from 5 degrees to 120 degrees with 5 degrees contracture on flexion. The physician also reported stable testing on varus and valgus stress testing and anterior and posterior drawer testing. The physician noted imaging showed well positioned components with some evidence of loosening of the tibial component and some osteolysis. The physician reported that the left knee had been very stable over several years of imaging and the significance of the loosing with osteolysis was unknown. The Veteran was seen by another VA physician in December 2016 for left knee symptoms. The Veteran reported increasing left knee pain made worse with using stairs. The physician reported tenderness to palpation and pain on motion and with compression testing of the patella. The physician also reported left knee range of motion from 5 degrees to 120 degrees. The physician further reported the left knee was stable to varus and valgus stress testing and to anterior and posterior drawer testing. The physician found that left knee imaging showed evidence of particle disease around a screw and concluded that he was a candidate for screw removal, bone grafting, and patella resurfacing. In March 2017, the Veteran underwent a left knee revision of the total knee arthroplasty. An October 2017 VA treatment record shows that he was doing well, back to all activities, and overall happy with the left knee progress since surgery. The Veteran denied experiencing left knee instability symptoms and the treatment provider denied the presence of mid-flexion instability. The Veteran was afforded another VA left knee examination in June 2017. The Veteran reported the presence of chronic, achy pain resulting in decreased range of motion. He denied experiencing flareups. The examiner reported left knee range of motion from zero to 95 degrees. The examiner also reported reduced left knee strength and regular use of a cane. The examiner denied additional loss of range of motion on 3 repetitions of testing or on passive range of motion testing. The examiner also denied pain on palpation, pain on weight-bearing, pain on nonweight-bearing, crepitus, meniscal conditions, ankylosis, and history of recurrent subluxation, lateral instability, and recurrent effusion. The examiner also reported that the left knee disability results in less movement than normal, swelling, disturbance of locomotion, interference with sitting and standing. The examiner found that the left knee disability makes it difficult for Vet to sit, stand for prolonged periods of time. The examiner concluded that the left knee disability results in intermediate degrees of residual weakness, pain, or limitation of motion. On November 9, 2017, the Veteran was treated by VA after falling from a ladder due to his right knee giving way and landing on his left knee. He reported severe left knee pain. Pursuant to the May 2021 Board remand, the Veteran was afforded another examination for this claim in August 2021. The Veteran reported the left knee did well after his initial surgery, which was performed in 2002, but later built of too much scar tissue to the point that he could not walk on the left knee and required another surgery. He also reported that the left knee was injured when he fell and landed on it putting up Christmas lights one year with current symptoms of constant pain, very limited range of motion, and bruising with prolonged use. The Veteran further reported experiencing moderate left knee flareups occurring a few days a week and lasting 1 to 2 days. The examiner reported active and passive left knee range of motion from 5 degrees to 85 degrees with pain on extension at 15 degrees and flexion at 40 degrees. The examiner also reported left knee range of motion on 3 repetitions of testing from 10 degrees to 80 degrees with pain, fatigability, weakness, and lack of endurance. The examiner estimated left knee range of motion on repeated use over time from 15 degrees to 70 degrees and during flareups from 30 degrees to 50 degrees with symptoms of pain, fatigability, lack of endurance, weakened movement, swelling, and interference with standing, sitting, and walking. The examiner further reported the presence of muscle atrophy, regular use of a knee brace, and pain on weight-bearing and nonweight-bearing. The examiner denied the presence of recurrent subluxation, persistent instability, recurrent patellar instability, ankylosis, and crepitus. The examiner found that the left knee disability results in functional impairment of lack of endurance, inability to jump or kneel, and difficulty jogging, walking more than 100 feet, standing for 10 minutes, using stairs, and sitting or lying down for long periods of time due to stiffness. The examiner concluded that the left knee disability is manifested by chronic residuals consisting of severe painful motion or weakness. The Board find that prior to November 9, 2017, exclusive of the temporary total rating period, the Veteran's left knee manifested in no worse than intermediate residual weakness, pain, or limitation of motion. In this regard, the October 2015 and June 2017 examiners reported less movement than normal, disturbance of locomotion, and interference with standing. However, examiners denied the presence of additional loss of range of motion on 3 repetitions of testing, crepitus, meniscal conditions, ankylosis, history of recurrent subluxation, recurrent effusion, weakened movement, swelling, and deformity. The examiners concluded that the condition results in intermediate degrees of residual weakness, pain, or limitation of motion rather than severe residuals. The VA treatment records prior to this examination and prior to the Veteran's March 2017 left knee surgery reflect similar symptomatology. During left knee treatment in December 2016, a VA physician reported left knee range of motion from 5 degrees to 120 degrees with tenderness to palpation and pain on motion and with compression testing of the patella. After termination of the Veteran's temporary total rating period following surgery, an October 2017 VA treatment record shows that he was back to all activities and happy overall with the left knee progress since surgery. The Veteran denied experiencing left knee instability type of symptoms and the treatment provider denied the presence of mid-flexion instability. In addition, the Veteran did not report and the medical evidence does not show the presence of severe pain prior to the November 9, 2017 VA treatment record. The Board notes that the Veteran stated during the August 2021 examination that he was unable to walk prior to the March 2017 left knee surgery. In addition, the Veteran's representative reported that the Veteran sometimes used a walker. However, the October 2015 and June 2017 examination reports and contemporaneous treatment records do not indicate that the condition resulted more than intermediate symptoms prior to the Veteran's fall in November 2017. In this regard, the Veteran retained left knee range of motion from at least 5 degrees to at least 95 degrees, did not report being unable to walk, and the evidence does not indicate regular use of a walker due to the left knee disability. To the extent that the Veteran experienced left knee instability prior to the March 2017 surgery, such symptomatology is addressed below. However, since November 9, 2017, the left knee has manifested in severe residual weakness, pain, or limitation of motion. In this regard, the August 2021 examiner found that the Veteran's left knee results in severe residual symptomatology. In addition, the Veteran reported that the condition became worse after falling from a ladder putting up Christmas lights. His treatment records show that he was treated by VA for severe left knee pain on November 9, 2017 after falling off a ladder and landing on his left leg. Therefore, the evidence indicates that the Veteran experienced severe left knee impairment as of such date. See Swain, 27 Vet. App. at 219. In addition, prior to March 1, 2017, the Board finds that the evidence is at least in equipoise regarding whether a separate a 10 percent rating for slight left knee instability is warranted under DC 5257. 38 C.F.R. §§ 4.71a, DC 5257. Prior to March 2017, the Veteran reported experiencing falls due to left knee instability. The October 2015 examiner found the presence of zero to 5 mms of anterior instability. While a compensable rating is warranted prior to such date, a rating in excess of 10 percent is not warranted as the examinations of record do not indicate the presence of moderate or severe instability. The October 2015 examiner denied the presence of lateral instability, recurrent subluxation, or any stability on posterior, medial, and lateral testing. Furthermore, a separate rating is not warranted since the temporary total rating period starting on March 1, 2017. Following this period, the Veteran denied experiencing left knee instability during treatment in October 2017 and the August 2021 examiner denied the presence of recurrent subluxation, persistent instability, and recurrent patellar instability. Thus, a rating in excess of 10 percent or a separate rating since March 1, 2017 for left knee instability is not warranted. The Board has considered whether it may be appropriate to grant additional separate ratings for the Veteran's left knee disability under other DCs. However, the provisions of 38 C.F.R. § 4.14 prohibit the evaluation of the same disability under various diagnoses, and provide that the evaluation of the same manifestations under different diagnoses is to be avoided. Separate evaluations are, however, available when none of the manifestations of the disabilities at issue overlap. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). However, as the evidence does not show ankylosis, extension limited to 30 degrees or worse, even with painful motion, repetitive use over time, flareups and other factors, or nonunion of the tibia and fibula, additional separate ratings are not warranted. In sum, the preponderance of the evidence shows that, prior to March 1, 2017, the Veteran's left knee disability manifested in slight instability; prior to November 9, 2017, exclusive of the temporary total rating period, the left knee disability manifested in no worse than intermediate residual weakness, pain, or limitation of motion; and since November 9, 2017, the left knee disability manifested in severe residual weakness, pain, or limitation of motion As there is no reasonable doubt to be resolved, a separate 10 percent rating for instability prior to March 1, 2017 and a 60 percent rating since November 9, 2017 for the left knee disability are warranted, but higher ratings or additional separate ratings are not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 2. A TDIU prior to January 28, 2018. Legal Criteria Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when 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, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the purpose of meeting these schedular criteria, disabilities affecting a single body system, e.g. orthopedic, will be considered as one disability. Id. In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to: The veteran's history, education, skill, and training; Whether the veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. Factors that may be relevant include, but are not limited to, the veteran's limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and Whether the veteran has the mental ability to perform the activities required by the occupation at issue. Factors that may be relevant include, but are not limited to, the veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). As noted above, Merriam-Webster dictionary defines "moderate" as tending toward the mean or average amount or dimension and "severe" is "of a great degree." In addition, sedentary employment is the common meaning in society of non-physical, white collar, office-type work. Analysis In a May 2017 TDIU application, the Veteran claimed to be unable to work due to right foot and left knee disabilities. He stated that he became too disabled to work in November 2002, last worked fulltime in November 2003, and that he could no longer perform construction work after his left knee arthroplasty. However, he denied trying to obtain employment since November 2003. In a December 2018 notice of disagreement (NOD), the Veteran's representative claimed that a TDIU was raised by an April 2005 letter from a VA physician, which he also submitted. In the April 2005 letter, the VA physician stated that the Veteran is unable to be employed due to lumbar radiculopathy and his underlying other problems including severe depression. The physician noted that his history of knee problems prevent him from any activities that require climbing, bending, twisting, or walking distances. During the February 2021 Board hearing, the Veteran reported being able to walk for about 10 minutes at a time. In an October 2021 correspondence, the Veteran's representative speculated that all Social Security Administration (SSA) records were not in the file. He also stated that the Veteran's foot symptoms date back to 2002 and that he had not worked since that time. The representative also submitted additional medical evidence. This included an October 2001 from a VA treatment provider. The October 2001 provider stated that the Veteran had extensive surgery on his right foot in December 2000 and that he had been unable to perform a "regular job" since the surgery. She stated that the foot would make it difficult to perform any standing job. The representative also submitted a February 2005 VA treatment record where the Veteran reported being unemployed and experiencing back and psychiatric symptoms. The Veteran is assigned a TDIU effective January 25, 2018. The Veteran is service connected for a right foot disability rated 10 percent disabling from June 17, 1991 to December 11, 2000, temporary total rating from December 12, 2000 to February 28, 2001, and 30 percent disabling thereafter; a left knee disability rated as 30 percent disabling from December 12, 2000 to November 24, 2002, temporary total rating from November 25, 2002 to February 29, 2004, 30 percent disabling from March 1, 2004 to February 28, 2017, temporary total rating from March 1, 2017 to May 31, 20017, 30 percent disabling from June 1, 2017 to November 8, 2017, and 60 percent disabling thereafter; a left knee scar rated noncompensable since November 25, 2002; a right knee disability rated as 10 percent disabling from August 19, 2015 to June 17, 2021, and 40 percent disabling thereafter; and major depressive disorder rated 70 percent disabling since January 25, 2018. As the Veteran's right foot and left knee disabilities affect a single body system, the schedular criteria have been met since December 12, 2000. See 38 C.F.R. § 4.16(a)(2). The Veteran's complete SSA file was added to the record in December 2016. It shows he filed a disability claim in June 2005 based on mental illness, back, neck, headache, and bilateral knee disabilities. The Veteran reported completing high school and specialized training as a jet mechanic in the Navy and working construction from 1979 to 2003 as a lead worker supervising 6 people on the job. He also reported being able to drive a car and swimming regularly. He further reported experiencing insomnia and having issues with lifting over 20 pounds, walking, using stairs, short term memory loss, and lack of concentration. The SSA examiner reported that the Veteran had a history of working in construction as a semi-skilled worker. The SSA examiner found that prior to reaching advanced age, defined by SSA as 55 years old, in December 2006, the Veteran was capable of working as a routing clerk or office helper. The SSA examiner explained that the Veteran had no problem with personal care, preparing meals, doing household chores, driving a car, counting change, or handling a savings account. The examiner noted a primary condition of a back disability, a secondary condition of a left knee disability, and additional conditions of psychiatric disabilities. The Veteran was afforded a VA examination in March 2005. The Veteran reported experiencing constant, dull right foot pain 2 out of 10 in severity that increases to 7 out of 10 in severity with weight-bearing. He also reported that he can walk one-half of one block before he cannot put weight on the foot. The Veteran also reported his left knee had improved since surgery in November 2002, but that it aches 3 times per week 6 out of 10 in severity. The Veteran was afforded a right knee examination in October 2015. The Veteran reported experiencing right knee instability. The examiner reported right knee range of motion from zero degrees to 120 degrees with mild, wincing pain on flexion and extension. The examiner denied the presence of recurrent subluxation, persistent instability, recurrent patellar instability, ankylosis, loss of muscle strength, and crepitus. The examiner found that the condition results in less movement than normal, disturbance of locomotion, and interference with standing. The Veteran was afforded another right knee examination in June 2017. The examiner reported right knee range of motion from zero degrees to 140 degrees. The examiner denied the presence of recurrent subluxation, persistent instability, recurrent patellar instability, ankylosis, loss of muscle strength, and crepitus. The Veteran was afforded another right foot examination in June 2017. The Veteran reported experiencing aching right foot pain if he stands for too long. The examiner reported symptoms of pain on movement and weight-bearing, and disturbance of locomotion and standing. The examiner noted regular use of a cane. The examiner found functional impairment of difficulty standing or walking for prolonged periods of time. The examiner concluded that the disability is moderate in severity. The Veteran's left knee symptoms are addressed in adjudicating the rating claim above. The Board finds that the Veteran was not prevented from working due to his service-connected disabilities prior to January 25, 2018. The evidence shows that the Veteran completed high school, was trained as an aircraft mechanic during service, and worked in construction, including supervising coworkers after service until 2003. As explained above, prior to January 2018 the Veteran was service-connected for right foot and bilateral knee disabilities. While the lower body disabilities greatly affected his ability to perform jobs requiring him to stand, walk, or lift heavy objects, including construction work, they would not have prevented him from performing sedentary employment prior to January 2018. In this regard, the Veteran had sufficient education and work experience, including supervisory experience, to obtain and maintain gainful sedentary employment at entry level positions such as in a call center or an office environment. The Board notes that the evidence indicates that the Veteran had some difficulty with sitting for prolonged periods of time, but most sedentary jobs would allow for intermittent breaks to get up and stretch. The Veteran also had difficulty with prolonged standing and walking, but sedentary positions generally involve sitting to complete most work tasks. Otherwise, the evidence indicates that the Veteran was able to maintain the minimum standards to appear routinely and on schedule for a job, make himself presentable, interact socially with coworkers, supervisors, and customers, and follow directions while performing the job functions. There is no indication that he could not work in an unskilled or semi-skilled sedentary position that allow him to train on-the-job, while adapting his limitations to the position, including with reasonable accommodations. See Cantrell v. Shulkin, 28 Vet. App. 382, 396 (2017). To the extent that the SSA administration found that the Veteran could not perform such work after 2006, this conclusion was based on all of the Veteran's disabilities rather than just his service-connected disabilities. Specifically, the SSA considered the Veteran's back disability as a main cause and his psychiatric conditions contributing causes his of his inability to work. While the Veteran's psychiatric disabilities may have prevented him from successfully performing sedentary employment during the appeal period, he was not service-connected for a psychiatric disability prior to January 25, 2018. To the extent that the present TDIU claim can be construed as pending at such time, in October 2001 a VA treatment provider indicated that the Veteran could not perform a "regular job" after right foot surgery. However, the Veteran reported to the SSA and VA that he continued to work fulltime in construction until 2003. In addition, as explained above, the Veteran was capable of sedentary employment at such time. The Board also notes that a VA physician reported in April 2005 that the Veteran is unable to be employed due to lumbar radiculopathy and his underlying other problems including severe depression. However, he has never been service-connected for a back disability and was not service-connected for a psychiatric disability prior to January 25, 2018. Furthermore, the Board does not find the Veteran's reports of being unable to work after November 2003 due to his service-connected disabilities credible as he denied attempting to find other employment after discontinuing working in the construction field. The Board is sympathetic to the Veteran's assertions regarding the impact the disabilities have on him, both professionally and personally. However, the limitations caused by the service-connected disabilities prior to January 25, 2018 were compensated by the schedular ratings for such disabilities. Van Hoose v. Brown, 4 Vet. App. 361 (1993). Moreover, while the relevant disabilities caused some economic impairment, the assigned disability ratings contemplated the level of occupational impairment for the conditions. A TDIU claim is not a purely medical question. Here, the Board has considered both the relevant medical evidence as well as the non-medical evidence, including work history and lay statements. In sum, the preponderance of the evidence shows that the Veteran was not prevented from securing and following substantially gainful employment as a result of the service-connected disabilities prior to January 25, 2018. Therefore, the benefit-of-the-doubt rule is not applicable, and a TDIU prior to January 25, 2018 is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jimerfield, David 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.