Citation Nr: 21076323 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-03 686 DATE: December 23, 2021 ORDER Entitlement to a 10 percent rating, but no higher, for right medial epicondylitis prior to September 6, 2016, is granted. Entitlement to a 10 percent rating, but no higher, for left medial epicondylitis prior to September 6, 2016, is granted. Entitlement to a rating in excess of 10 percent for right medial epicondylitis since September 6, 2016 is denied. Entitlement to a rating in excess of 20 percent for left medial epicondylitis since September 6, 2016 is denied. Entitlement to an initial compensable rating for right elbow limitation of flexion prior to September 2, 2020, is denied. Entitlement to an initial compensable rating for left elbow disability limitation of flexion prior to September 2, 2020, is denied. Entitlement to a rating in excess of 20 percent for right elbow limitation of flexion since September 2, 2020, is denied. Entitlement to a rating in excess of 20 percent for left elbow limitation of flexion since September 2, 2020, is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. Prior to September 6, 2016, the Veteran's right medial epicondylitis was manifested by painful motion but not manifested by extension limited to 75 degrees. 2. Prior to September 6, 2016, the Veteran's left medial epicondylitis was manifested by painful motion but not manifested by extension limited to 75 degrees. 3. Since September 6, 2016, at its worst, the Veteran's right medial epicondylitis was manifested by extension limited to 60 degrees; it has not been manifested by extension limited to 75 degrees. 4. Since September 6, 2016, at its worst, the Veteran's left medial epicondylitis was manifested by extension limited to 80 degrees; it has not been manifested by extension limited to 100 degrees. 5. Prior to September 2, 2020, at worst, the Veteran's right elbow flexion was limited to 120 degrees; it was not limited to 100 degrees. 6. Prior to September 2, 2020, at worst, the Veteran's left elbow flexion was limited to 1150 degrees; it was not limited to 100 degrees. 7. Since September 2, 2020, at worst, the Veteran's right elbow flexion was limited to 75 degrees; it was not limited to 70 degrees. 8. Since September 2, 2020, at worst, the Veteran's left elbow flexion was limited to 90 degrees; it was not limited to 55 degrees. CONCLUSIONS OF LAW 1. Prior to September 6, 2016, the criteria for a rating of 10 percent, but no higher, for right medial epicondylitis were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 2. Prior to September 6, 2016, the criteria for a rating of 10 percent, but no higher, for left medial epicondylitis were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 3. Since September 6, 2016, the criteria for a rating in excess of 10 percent for right medial epicondylitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 4. Since September 6, 2016, the criteria for a rating in excess of 20 percent for left medial epicondylitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 5. Prior to September 2, 2020, the criteria for a compensable rating for right elbow limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 6. Prior to September 2, 2020, the criteria for a compensable rating for left elbow limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 7. Since September 2, 2020, the criteria for rating in excess of 20 percent for right elbow limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. 8. Since September 2, 2020, the criteria for rating in excess of 20 percent for right elbow limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5024-5207. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from July 1980 to July 2000. This matter comes back before the Board of Veterans' Appeals (Board) on Remand from the United States Court of Appeals for Veterans Claims regarding Board decisions rendered in January 2019 and July 2019. This matter was originally on appeal from rating decisions of the Department of Veterans Affairs (VA), Regional Office (RO). Increased Rating The Veteran contends that he is entitled to higher ratings for his service-connected bilateral elbow disabilities. Disability ratings are determined by applying the criteria set forth in the 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. If two evaluations are potentially applicable, 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. The Veteran is appealing the original assignments of disability ratings following awards of service connection for bilateral medial epicondylitis. As such, it is not the present level of disability, which is of primary importance, but rather the entire period is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). Initially, the Board notes that the Veteran filed his claim for bilateral arm medial epicondylitis in February 2010. By rating decision dated in October 2020, separate 20 percent ratings were assigned for right and left elbow limitation of flexion effective from September 2, 2020. As the Veteran has expressed disagreement with the 20 percent ratings and effective dates assigned for right and left elbow limitation of flexion as well as the 20 percent ratings, the Board finds that these issues are on appeal pursuant to AB v. Brown, 6 Vet. App. 35, 38 (1993) as part of the underlying increased rating claim for right and left elbow medial epicondylitis. The Veteran's service-connected elbow medial epicondylitis is rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5024-5207. The Veteran's service-connected elbow limitation of flexion is rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5003-5206. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned; the additional code is shown after a hyphen. 38 C.F.R. § 4.27. The schedular criteria for rating musculoskeletal disabilities, including those pertaining to tenosynovitis (Diagnostic Code 5024) and degenerative arthritis (Diagnostic Code 5003), were amended effective February 7, 2021. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). Prior to the revision, tenosynovitis was to be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout; the revised version of Diagnostic Code 5024 indicates that tenosynovitis is to be evaluated as degenerative arthritis, based on limitation of motion of affected parts. In addition, Diagnostic Code 5003 was updated to specify that it pertains to degenerative arthritis, other than post-traumatic; however, the rating criteria did not change. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion of the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted for X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating is warranted for X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Only portions of the Rating Schedule addressing the musculoskeletal system were revised effective February 7, 2021; diagnostic codes pertaining to the elbow and forearm were not changed. Disabilities of the elbow and forearm are contemplated by Diagnostic Codes 5205 through 5213. The terms "major" and "minor" are used in the rating criteria to refer to the dominant or non-dominant upper extremity. 38 C.F.R. § 4.69. As the evidence of record reflects the Veteran is right-hand dominant, ratings for the major side will be considered. Limitation of extension of the forearm is rated under Diagnostic Code 5207. A 10 percent rating is warranted where extension of either elbow is limited to 60 degrees. A 20 percent rating is warranted where extension of either elbow is limited to 75 degrees, or where extension of the minor elbow is limited to 90 degrees. A 30 percent rating is warranted where extension of the major elbow is limited to 90 degrees, or where extension of the minor elbow is limited to 100 degrees. A 40 percent rating is warranted where extension of the major elbow is limited to 100 degrees, or where extension of the minor elbow is limited to 110 degrees. A maximum 50 percent rating is warranted where extension of the major elbow is limited to 110 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5207. Pursuant to Diagnostic Code 5206, a 10 percent rating is warranted where flexion of either elbow is limited to 100 degrees. A 20 percent rating is warranted where flexion of either elbow is limited to 90 degrees, or where flexion of the minor elbow is limited to 70 degrees. A 30 percent rating is warranted where flexion of the major elbow is limited to 70 degrees, or where flexion of the minor elbow is limited to 55 degrees. A 40 percent rating is warranted where flexion of the major elbow is limited to 55 degrees, or where flexion of the minor elbow is limited to 45 degrees. A maximum 50 percent rating is warranted where flexion of the major elbow is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5206. Additionally, Diagnostic Code 5208 provides a 20 percent rating for flexion of the major forearm limited to 100 degrees with extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5208. Normal ranges of elbow motion are zero degrees extension and 145 degrees flexion; and forearm pronation and supination are 80 and 85 degrees, respectively. 38 C.F.R. § 4.71 Plate I. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). VA treatment records indicates that the Veteran reported elbow pain and tenderness with flexion in the right elbow from March to December 2009. Physical examinations in March 2009 showed full range of motion at the right elbow. Private treatment records indicate that in January 2010, the Veteran reported that right elbow injection was partially helpful but that his left elbow was bothering him a bit more than the right elbow. The Veteran underwent VA examination in April 2010 at which time he described dull, mild pain located in the medial aspect of the elbows, weakness, stiffness, lack of endurance with lifting, and pain with lifting heavy objects. On physical examination, there was slight tenderness to medial and lateral joint lines but no pain with motion. Range of motion was full bilaterally in flexion, supination, and pronation after repetitive use testing. In a May 2011 statement, the Veteran stated, "I do have on-going chronic pain and limitation of use to both my (R) and (L) Elbows. Please note that I have received shots in both of these elbows. ..." The Veteran underwent VA examination in September 2016 at which time he reported constant elbow pain. On physical examination, right elbow flexion was from 60 to 120 degrees, extension was from 120 to 60 degrees, supination and pronation were full. Left elbow flexion was from 80 to 115 degrees, extension was from 115 to 80 degrees, and supination and pronation were full. Pain was noted with all motion, there was evidence of pain with weightbearing, and there was moderate tenderness on palpation. Muscle strength was normal, and there was no muscle atrophy or ankylosis. The examiner noted that she was unable to provide an opinion beyond the documented information regarding increased limitation of functionality when the joint was used repeatedly over a period of time and explained that such an opinion would require her to observe the Veteran over a period longer than the examination or for repetitions beyond three. The examiner also noted that she could not estimate the additional loss of functionality during flare-ups objectively as she would have to observe and measure range of motion/functionality for the Veteran both at baseline and during flares in the same visit in order to obtain the information. The examiner noted that the Veteran would have to be both at a baseline level of limitation and have the range of motion/functionality be measured in that state; then sometime in the same encounter he would also have to be in a flared state and then have that range of motion and other functionality measured. The Veteran underwent VA examination in September 2020 at which time he reported a constant dull pain and stiffness. Physical examination demonstration right elbow flexion was from zero to 80 degrees, extension was from 80 to zero degrees, supination was from zero to 35 degrees, and pronation was from zero to 65 degrees with pain on all motion causing functional loss; left elbow flexion was from zero to 95 degrees, extension was from 95 to zero degrees, supination was from zero to 40 degrees, and pronation was from zero to 30 degrees with pain on all motion causing functional loss; and tenderness to the medial epicondyle area and the elbow capsule. There was no additional loss of function or range of motion on repetitive use testing; and the examiner opined that pain, fatigue, weakness, and lack of endurance would significantly limit functional ability with repeated use over a period of time but without additional loss of range of motion. The examiner noted that pain, fatigue, weakness, and lack of endurance would significantly limit functional ability with flare ups such an additional 5 degrees would be lost in all motions. Muscle strength was slightly diminished, there was no muscle atrophy, and no ankylosis. X-rays of the elbows showed no fractures but minimal capitellar osteoarthritis in the left elbow. About the VA examinations of record, the Board notes that the September 2019 JMPR noted that the April 2010 and September 2016 VA examination reports were inadequate for rating purposes. The Board has reviewed the available medical and lay evidence of record and finds that retrospective medical opinions are not necessary in this case as there is no reasonable possibility that such assistance would aid in substantiating the claim. The 2010 VA examination was conducted approximately eleven years ago, and the 2016 VA examination was conducted approximately five years ago. It is not reasonable to assume that a medical provider can estimate the extent of limitation of motion caused by flare-ups or during active and passive motion that occurred nine years or five years earlier based on a review of medical and lay evidence. 1. Entitlement to a compensable rating for right medial epicondylitis prior to September 6, 2016 2. Entitlement to an initial compensable rating for left medial epicondylitis prior to September 6, 2016 The Board finds that initial ratings of 10 percent for right and left elbow medial epicondylitis with painful motion is warranted prior to September 6, 2016. Although the VA examination in April 2010, the examiner noted no pain with motion, the Veteran has reported experiencing pain in both elbows with lifting. The Veteran is competent to report elbow pain, and the Board finds his reports credible. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Thus, the Board finds that a rating of 10 percent is warranted for the Veteran's right and left elbow medial epicondylitis prior to September 6, 2016. The Board, however, finds that the preponderance of the evidence is against a rating in excess of 10 percent for right and left medial epicondylitis prior to September 6, 2016. The Board acknowledges the Veteran's lay reports of pain, weakness, and lack of endurance with lifting. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in right or left elbow extension limited to 75 degrees or more. As noted above, the September 2019 JMPR found the April 2010 VA examination inadequate for rating purposes. Specifically, the JMPR noted, inter alia, that the examiner failed to provide range of motion results for extension. As noted above, the Veteran demonstrated full range of motion bilaterally in flexion, supination, and pronation at the April 2010 VA examination; and although there is not a specific measurement for elbow extension, the examiner noted that there was no pain with motion, no evidence of weakness, and no decreased strength with range of motion. The Board finds that it is reasonable to assume that because all other range of elbow motions were normal, if the Veteran had shown limited extension at the April 2010 VA examination, the examiner would have noted such limited extension. In addition, the JMPR noted that the examiner failed to provide range of motion measurements due to pain or flareups. Although the Veteran described dull, mild pain located in the medial aspect of the elbows, weakness, stiffness, lack of endurance with lifting, and pain with lifting heavy objects; on physical examination, there was no pain with motion, no evidence of weakness, and no decreased strength with range of motion. In addition, the Veteran specifically denied flare-ups. In conclusion, the Board finds that the preponderance of the evidence supports 10 percent ratings but no higher for right and left medial epicondylitis prior to September 6, 2016. In denying ratings in excess of 10 percent prior to September 6, 2016, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a rating in excess of 10 percent for right medial epicondylitis since September 6, 2016 4. Entitlement to a rating in excess of 20 percent for left medial epicondylitis since September 6, 2016 The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for right medial epicondylitis from September 6, 2016. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due during repetitive use over time and flareups. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in right elbow extension limited to 75 degrees. As noted above, on VA examination in September 2016, right elbow extension was to 60 degrees; and on VA examination in September 2020, right elbow extension was full at zero degrees. The Board also finds that the preponderance of the evidence is against a rating in excess of 20 percent for left medial epicondylitis from September 6, 2016. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due during repetitive use over time and flareups. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in right elbow extension limited to 100 degrees. As noted above, on VA examination in September 2016, left elbow extension was to 80 degrees; and on VA examination in September 2020, right elbow extension was full at zero degrees. As noted above, the September 2019 JMPR found the April 2010 VA examination inadequate for rating purposes. Specifically, the JMPR noted, inter alia, the examiner failed to provide range of motion measurements due to pain or flareups. Although the Veteran reported flare-ups, he reported only cramping in his arms with no mention that such made elbow motion more difficult or that it caused loss of elbow motion. In addition, the examiner noted that on examination, all motion exhibited pain. The Board finds that it is reasonable to assume that the range of motion findings took into consideration the Veteran's pain. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a rating in excess of 10 percent for right medial epicondylitis and in excess of 20 percent for left medial epicondylitis since September 6, 2016. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to an initial compensable rating for right elbow limitation of flexion prior to September 2, 2020 6. Entitlement to an initial compensable rating for left elbow disability limitation of flexion prior to September 2, 2020 Initially, the Board notes that although the Veteran reported experiencing pain in both elbows prior to September 2, 2020, 10 percent ratings have been assigned for his painful right and left elbow extension. Separate ratings may be, and have been, awarded under Diagnostic Codes 5206 and 5207 based on limitation of flexion and limitation of extension of the same joint. See VAOPGCPREC 9-2004. Providing separate ratings under those diagnostic codes based on painful motion pursuant to 38 C.F.R. § 4.59 and Burton, however, would constitute impermissible pyramiding because doing so would be compensating the same symptomatology under different diagnostic codes. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). As the Board has herein determined that the Veteran is entitled to initial ratings of 10 percent for right and left medial epicondylitis on the basis of painful elbow motion and not based on limited elbow motion, the Veteran is not entitled to separate 10 percent ratings for painful flexion prior to September 6, 2016. The Board finds that the preponderance of the evidence is against compensable ratings for right and left elbow limitation of flexion prior to September 2, 2020. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due during repetitive use over time and flareups. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in right or left elbow flexion limited to 100 degrees or less. As noted above, the Veteran demonstrated full flexion in both elbows at the April 2010 VA examination and right elbow flexion limited to 120 degrees and left elbow flexion limited to 115 degrees at the September 2016 VA examination. As noted above, the April 2010 VA examiner failed to provide range of motion measurements due to pain or flareups. Although the Veteran reported flare-ups, he reported only cramping in his arms with no mention that such made elbow motion more difficult or that it caused loss of elbow motion. In addition, the examiner noted that on examination, all motion exhibited pain. The Board finds that it is reasonable to assume that the range of motion findings took into consideration the Veteran's pain. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for compensable ratings for right and left limitation of flexion prior to September 2, 2020. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to a rating in excess of 20 percent for right elbow limitation of flexion since September 2, 2020 8. Entitlement to an initial rating in excess of 20 percent for left elbow disability on the basis of limitation of flexion since September 2, 2020 The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for right and left limitation of flexion since September 2, 2020. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due during repetitive use over time and flareups. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in right elbow flexion limited to 70 degrees or left elbow flexion limited to 55 degrees. As noted above, the Veteran demonstrated right elbow flexion limited to 80 degrees and left elbow flexion limited to 95 degrees at the September 2020 VA examination. The examiner noted that there was no additional loss of function or range of motion on repetitive use testing and that although pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over of a period of time, right elbow flexion would still be to 80 degrees and left elbow flexion would still be to 95 degrees. The examiner, however, noted that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare ups such that right elbow flexion would be additionally limited to 75 degrees and left elbow flexion would be additionally to 90 degrees. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for ratings in excess of 20 percent for right and left limitation of flexion since September 2, 2020. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 9. Entitlement to a TDIU is remanded. The Veteran contends that he is employable due to his service-connected disabilities. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. §§ 3.340 (a)(1), 4.15. A total disability rating for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, 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, this disability shall be ratable at 60 percent or more. If there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16 (a). Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system such as orthopedic disabilities, will be considered as one disability for TDIU purposes. Id. The Veteran meets the schedular threshold percentage criteria for consideration of a total rating based on individual unemployability due to service-connected disabilities. See 38 C.F.R. § 4.16 (a). In fact, the Veteran has had a combined schedular rating of 100 percent. There could be a situation where a Veteran has a schedular total rating for a particular service-connected disability, and nonetheless could establish entitlement to a TDIU for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) by having an "additional" disability of 60 percent or more ("housebound" rate). Bradley v. Peake, 22 Vet. App. 280, 293 (2008); see also 38 U.S.C. § 1114 (s). Essentially, the Veteran might still be entitled to TDIU if one service-connected disability alone could constitute the basis for a grant of TDIU at any point during the appeal period. Thus, it is possible to be awarded a TDIU on the basis of a single disability, notwithstanding the combined 100 percent rating. Bradley v. Peake, 22 Vet. App. at 293-94. The question in this case is whether the Veteran is unemployable due to a single service-connected disability. In this case, the Veteran's right shoulder, right upper extremity peripheral neuropathy, right and left elbow disabilities, and bilateral thumb disabilities are considered one disability; as such, they have had a combined schedular rating of at least 70 percent from August 2014, 80 percent since September 6, 2016, and 90 percent since September 2, 2020. In addition, the Veteran's lumbar degenerative disc disease and right and left sciatica are considered one disability; as such, they have a combined schedular rating of at least 60 percent since August 2014. In September 2021, the Veteran submitted a VA 21-8940, Veterans Application for Increased Compensation Based on Unemployability, which noted that he last worked full time in August 2014. Remand is necessary to obtain complete employment information from the Veteran's former employers. The matter is REMANDED for the following action: 1. Contact all employers listed on the Veteran's TDIU application and ask that they complete a Request for Employment Information in Connection with Claim for Disability Benefits. 2. Schedule the Veteran for an orthopedic examination by an appropriate clinician. The claims folder must be made available for the examiner to review. The VA examiner should provide an opinion as to the functional impairment caused solely by each of the Veteran's service-connected disabilities (noted below) given his education and occupational experience, which could impact either daily living or industrial capacity. bilateral upper extremity disability (right trapezius strain/rotator cuff tear/AC joint arthritis, peripheral neuropathy right upper extremity, right and left medial epicondylitis, right and left elbow limitation of flexion, right and left elbow supination and pronation impairment, residuals of bilateral thumb injuries with chronic paronychia) lumbar spine disability (lumbar degenerative disc disease, right and left sciatica) cervical spine disability (cervical degenerative disc disease) The examiner should not consider the Veteran's age or any nonservice-connected disabilities. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. 3. Thereafter, adjudicate the issue of entitlement to a TDIU. The AOJ should also consider whether a TDIU is warranted for any particular service-connected disability even though a schedular 100-percent combined rating is already in effect in order to determine the Veteran's eligibility for SMC under section 1114(s). Garrett Morales Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Olson, Patricia 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.