Citation Nr: 21076368 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 16-60 624 DATE: December 23, 2021 ORDER 1. Entitlement to an initial rating in excess of 10 percent prior to May 10, 2021 and in excess of 20 percent thereafter for degenerative joint disease of the lumbar spine (lumbar spine disability) is denied. 2. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity is denied. 3. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right lower extremity is denied. 4. Entitlement to an initial rating in excess of 10 percent for left knee degenerative arthritis (left knee disability) is denied. 5. Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Prior to May 10, 2021, the lumbar spine disability was not manifested by flexion limited to greater than 30 degrees but not greater than 60 degrees, a combined range of motion of the thoracolumbar of 120 degrees or less, or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. From May 10, 2021, the lumbar spine disability was not manifested by forward flexion of the thoracolumbar spine limited to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. 3. Radiculopathy of the left lower extremity is not manifested by moderate incomplete paralysis of the sciatic nerve. 4. Radiculopathy of the right lower extremity is not manifested by moderate incomplete paralysis of the sciatic nerve. 5. Left knee disability has not been manifested by limitation of flexion of the knee to 30 degrees or less, limitation of extension, a meniscus disability, or instability or subluxation. 6. The preponderance of the evidence is against a finding that the Veteran's service-connected disabilities prevent him from securing or following substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating in excess of 10 percent prior to May 10, 2021 an in excess of 20 percent thereafter for the lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242 (2020). 2. The criteria for an initial disability rating in excess of 10 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 3. The criteria for an initial disability rating in excess of 10 percent for radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 4. The criteria for an initial rating in excess of 10 percent for left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, DC 5003-5260, 5257. 5. The criteria for entitlement to a TDIU rating have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1985 to April 1988. These matters other than the claim for TDIU are before the Board of Veterans' Appeals (Board) on appeal from May 2011 and March 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing in front of the undersigned Veterans Law Judge in January 2021. In March 2021, the Board remanded the claims to obtain updated VA examinations. The Board is satisfied there was substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The RO issued a supplemental statement of the case and a rating decision in June 2021, and the claims now return to the Board for further deliberation. The issue of entitlement to a TDIU rating is based on the Veteran's claims for increased ratings for degenerative joint disease of the lumbar spine and left knee disability. The Veteran has submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, where he claims he is unable to secure and follow a substantially gainful employment due his service-connected depression, lumbar spine, and knee disabilities. Where a veteran, or the record, raises the question of unemployability due to the disability for which an increased rating is sought, then part of the increased rating claim is an implied claim for TDIU. Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Ratings VA has adopted a Schedule for Rating Disabilities (Schedule) to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. Disability evaluations assess the ability of the body as a whole, the psyche, or a body system or organ to function under the ordinary conditions of daily life, to include employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Id. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as "staged ratings." When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. 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 it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. The provisions of 38 C.F.R. § 4.40 allow for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. Under 38 C.F.R. § 4.45, functional loss due to weakened movement, excess fatigability, and incoordination must also be considered. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id.; see Burton v. Shinseki, 25 Vet. App. 1 (2011). Pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. The final sentence provides that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." The Court found that, "to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59." Correia, 28 Vet. App. at 169-70. Furthermore, in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that examiners have to offer opinions with respect to the additional limitation of motion during flare-ups based on estimates derived from information procured from relevant sources, including a veteran's lay statements. The Court explained that an examiner must do all that reasonably could be done in order to become informed before concluding that a requested opinion cannot be provided without resorting to speculation. The Court held in that case that the VA examination was inadequate because the examiner, although acknowledging that the veteran in that case was not suffering from a flare-up at the time of the examination, failed to ascertain adequate information such as frequency, duration, characteristics, severity, or functional loss regarding flare-ups in order to provide the requested opinion. Sharp, 29 Vet. App. at 26. 1. Entitlement to an initial rating in excess of 10 percent prior to May 10, 2021 and in excess of 20 percent thereafter for lumbar spine disability The Veteran was initially granted a 10 percent rating under Diagnostic Code 5242, which provides ratings for degenerative arthritis of the spine, based on the diagnoses of degenerative arthritis without compensable limitation of range of motion. In a June 2021 rating decision, a 20 percent rating was granted for the thoracolumbar spine disability from May 10, 2021 based on the worsening of the disability. Lumbosacral strain is to be evaluated under the General Rating Formula for rating diseases and injuries of the spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237. Intervertebral disc syndrome (IVDS) will be evaluated under the general formula for rating diseases and injuries of the spine or under the formula for rating IVDS based on incapacitating episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5242. Under the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply to lumbar spine disabilities. An evaluation of 20 percent is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a, Diagnostic Codes 5242. A 40 percent evaluation is warranted if forward flexion of the thoracolumbar spine is limited to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5242. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5242. A 100 percent evaluation is warranted if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5242. Unfavorable ankylosis is a condition in which the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, n. 5. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, General Rating Formula, note 1. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the musculoskeletal system and muscle injuries. 85 Fed. Reg. 76453 (November 30, 2020). The final rule went into effect on February 7, 2021. However, the February 2021 revision did not change the rating criteria for Diagnostic Code 5243. However, it clarified for what conditions this Diagnostic Code applies. Namely, Diagnostic Code 5243 prior to February 2021 applies to intervertebral disc syndrome (IVDS). 38 C.F.R. § 4.71a (2020). However, under the revised regulation effective February 2021, Diagnostic Code 5243 applies to IVDS when there is disc herniation with compression and/or irritation of the adjacent nerve root. As the Veteran is not service connected for intervertebral disc syndrome, and the 2021 VA examination report shows the examiner did not find that the Veteran had the diagnosis, the facts of this care are not impacted by the change. (a) Prior to May 10, 2021 The Veteran was provided a VA examination in February 2013. The Veteran was noted to have diagnoses of lumbago and degenerative joint disease of the lumbar spine. The Veteran reported to the VA examiner that he managed his back pain with over-the-counter pain relief medication and heat. He said these measures manage his pain enough such that he has not had to complain at primary care provider visits. The Veteran was not documented to have an abnormal gait. The examiner documented that the Veteran had radiating pain, but had no muscle spasms, tenderness or guarding of movement, weakness, ankylosis, or muscle atrophy. The examiner documented positive straight leg raising testing. Range of motion testing, both initial and repetitive use, was mostly normal with forward flexion (including painful motion) ending at 85 degrees, and extension (including painful motion) ending at 25 degrees. The Veteran was noted to have functional loss of excess fatiguability and pain on movement. At the Veteran's January 2021 hearing, he testified that he had variable back pain that ranged from a 7 to a 7.5 out of 10. He said that pain shoots down his hamstring a couple of times per week, and the left side is worse than the right. Under Diagnostic Code 5242, a rating in excess of 10 percent is not warranted unless forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or muscle spasms or guarding are severe enough to result in abnormal gait or abnormal spinal contour. Initially, the Board notes that the February 2013 VA examiner documented that the Veteran had some pain with forward flexion and extension of the thoracolumbar spine, but that pain was descried as mild. The VA examiner documented that the Veteran's pain limited his forward flexion to end at 85 degrees, and extension to end at 25 degrees. This is evidence against a finding that the Veteran had flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasms or guarding are severe enough to result in abnormal gait or abnormal spinal contour. The preponderance of the evidence is against a finding that flexion is limited to greater than 30 but less than 60 degrees or that the combined range of motion of the thoracolumbar spine is 120 degrees or less. Rather, the February 2013 VA examiner documented that the Veteran had forward flexion ending at 85 degrees, and extension ending at 25 degrees. The Board acknowledges the Veteran's testimony that his spinal pain varies and his pain impacts his spinal range of motion. However, the Board finds that the Veteran would have required significantly worse range of motion during an initial testing or repetitive motion testing to warrant a 20 percent rating. Given that the Veteran testified that his symptoms had worsened, the Board finds it is not at least as likely as not that the flexion, even during a flare-up, was limited to 60 degrees in February 2013, and there is no objective evidence to show it had worsened to that extent prior to May 10, 2021. Additionally, pain is specifically contemplated by the rating criteria. The Board finds the same analysis applies to the combined range of motion of the thoracolumbar spine. The Veteran would have to lose 110 degrees of combined range of motion during a flare-up to meet the criteria for a 20 percent rating. Even after assessing the impact of pain, weakness, fatigability, and/or incoordination the combined range of motion at the February 2013 VA examination was 230 degrees. Again, the Veteran testified in January 2021 hearing that his disability had worsened since the February 2013 VA examination, and thus, the Board finds it highly probative that even eight years after the February 2013 VA examination, the combined range of motion was not limited to 120 degrees or less. Thus, the Board finds it not at least as likely as not that the combined range of motion was limited to 120 degrees or less during a flare-up prior to May 10, 2021. Given the aforementioned, the preponderance of the evidence is against an initial rating in excess of 10 percent prior to May 10, 2021 for the thoracolumbar spine disability. (b) From May 10, 2021 The Veteran was provided a VA examination in May 2021. The Veteran denied experiencing flare-ups of the thoracolumbar spine at this examination. He reported constant pain with radiation to both legs. He stated he does not utilize any treatment or assistive device. He stated there is an impact to his functioning including difficulty exercising. The examiner documented worsening symptomatology on a regular basis, specifically on range of motion testing. Forward flexion was measured to 40 degrees, extension was limited to 10 degrees, right lateral flexion was limited to 18 degrees, left lateral flexion was limited to 20 degrees, right lateral rotation was limited to 25 degrees, and left lateral rotation was limited to 25 degrees. Passive range of motion testing revealed the same findings. There was also no additional reduction in range of motion after repetitive use. The VA examiner found pain, weakness, fatigability, and/or incoordination did not limit functional ability and in terms of range of motion. The examiner documented that the Veteran did not have localized tenderness, guarding, or muscle spasm of the thoracolumbar spine. Muscle strength testing showed 4/5 for hip flexion, 4/5 for knee extension, 5/5 for ankle planar flexion, 5/5 for ankle dorsiflexion, and 5/5 for great toe extension. The examiner documented there was no muscle atrophy. A straight leg raising test was negative, and though the examiner documented that the Veteran had radiculopathy into the lower extremities, the Board notes that this has already been separately compensated for in the January 2016 rating decision. Finally, the examiner documented that the Veteran had a diagnosis of degenerative arthritis. As noted above, Diagnostic Code 5242 requires favorable ankylosis of the entire thoracolumbar spine or forward flexion of the lumbar spine limited to 30 degrees or less to warrant a rating in excess of 20 percent. Since January 15, 2020, the evidence of record specifically documents that forward flexion was limited to 60 degrees, and the Veteran did not have ankylosis of the thoracolumbar spine. Thus, a rating in excess of 20 percent is not warranted under Diagnostic Code 5242. The Board has considered the effects of the Veteran's symptoms, including pain and functional loss. Pain is specifically contemplated by the rating criteria for the spine. The Board finds that the 10 and 20 percent ratings already assigned contemplate the Veteran's symptoms of pain, to include pain on weightbearing, non-weightbearing, and on active and passive range of motion. The Veteran's muscle strength was documented to be mostly normal, and to the extent that he had 4/5 muscle strength with some motions, that level of weakness is contemplated by the 20 percent rating. There was no muscle atrophy, and the evidence does not support that the Veteran experiences guarding or muscle spasms. Furthermore, the symptoms of radiculopathy have been assigned separate, compensable ratings. These clinical findings are evidence against a thoracolumbar spine that is more than mildly disabling. Thus, an initial rating higher than 10 percent prior to May 10, 2021 and 20 percent thereafter under the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria is not approximated in the Veteran's disability picture for the period on appeal. 2. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity 3. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right lower extremity Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8520. Under this criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various DCs are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against an award of an initial increased rating of 10 percent for radiculopathy of the left and right lower extremities. The reasons follow. The evidence shows that the Veteran's radiculopathy of the left lower extremity is manifested with mild incomplete paralysis of the left and right lower extremities. For instance, during the February 2013 VA examination, the VA examiner specifically noted that the severity of the Veteran's left and right radiculopathy was mild. The Veteran was noted to have mild radiculopathy pain in the right and left lower extremities. The Veteran had no constant pain, paresthesias and/or dysesthesias, numbness, or any other signs of radiculopathy. The Veteran had no muscle atrophy in the bilateral lower extremity. The muscle strength testing was normal at hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. Deep tendon reflexes were noted to be normal at the bilateral knee and ankle. Sensation to light touch testing of the bilateral upper anterior thigh, bilateral thigh/knee, right lower leg/ankle, and bilateral foot/toes were all normal. The Veteran demonstrated decreased sensation of the left lower leg/ankle, and positive straight leg raise testing bilaterally, which the Board finds is indicative of no more than mild incomplete paralysis. The Veteran was provided another VA examination in May 2021. At that time, the examiner found the Veteran had no constant pain, mild paresthesias and/or dysesthesias, and mild numbness. The Veteran had no muscle atrophy in the bilateral lower extremity. Muscle strength testing was 4/5 at hip flexion, 4/5 at knee extension, 5/5 at ankle plantar flexion, 5/5 at ankle dorsiflexion, and 5/5 at great toe extension. The Veteran's deep tendon reflexes were normal in the bilateral ankles and knees. Sensation to light touch testing of the upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes were all normal. The Veteran also had negative straight leg raises bilaterally. The Veteran's reports of radiating pain have been considered in evaluating the Veteran's neurological manifestations. See 38 C.F.R. § 4.6 (Board must evaluate all of the evidence, to the end that its decisions are "equitable and just"). Although the Veteran reported pain when seen at his VA examinations, and stated he has pain that shoots down his hamstrings a couple of times per week at the January 2021 hearing, the Veteran was found to have no more than mild findings at the February 2013 and May 2021 VA examinations. This notably included negative straight leg testing bilaterally at the May 2021 VA examination resulting in normal sensory findings bilaterally. The Veteran had positive straight leg raise testing bilaterally and decreased sensation of the left lower leg/ankle at the February 2013 VA examination. However, he also showed normal muscle strength and normal reflexes. At the May 2021 VA examination, the Veteran had mild paresthesias and/or dysesthesias, and mild numbness, but also showed no more than mildly reduced muscle strength and normal reflexes. The Board affords the clinical findings documented in the February 2013 and May 2021 VA examination reports more probative value than the Veteran's statements, as the examiners utilized medical testing, such as the straight leg test and sensory testing that covered from L2 to S1 of the lumbar spine and objective medical criteria to assess the Veteran's symptoms and found that the Veteran had mild symptoms of radiculopathy. The Veteran is in receipt of a 10 percent rating during, which contemplates mild incomplete paralysis of the sciatic nerve. Although the Veteran also reported pain on other occasions, these reports of pain do not constitute evidence of moderate incomplete paralysis of the Veteran's left or right lower extremity sciatic nerve for the appeal period. In sum, the preponderance of the evidence is against entitlement to a disability rating in excess of 10 percent for Veteran's sciatic radiculopathy of the left and right lower extremities. As the preponderance of the evidence is against the claims for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran's claims for increased ratings are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 4. Entitlement to an initial rating in excess of 10 percent for left knee disability The Veteran contends that the disability rating for his service-connected left knee arthritis symptoms should be rated higher than the currently-assigned disability rating of 10 percent. At the January 2021 hearing, the Veteran testified his knee pain fluctuates between aching and sharp pain, and it is exacerbated by weather. He stated his left knee swells and is bigger than right knee. He also testified he has a brace given to him by the VA. The Veteran stated his left knee is unstable. He said it has buckled under pressure, and the last time it buckled was six months prior to the hearing, but he also said it has never gotten to the point where he could not put pressure on it. The Veteran testified he has lost movement going forwards or backwards and cannot bring his knee all the way in. The Veteran's left knee arthritis symptoms are rated under DC 5003-5260 as 10 percent disabling. DC 5003 provides that if degenerative arthritis is established by x-rays, then the disability is rated under the appropriate DC for the specific joint limitation of motion. When the rating of a specific joint is noncompensable under the codes pertaining to limitation of motion, a rating of 10 percent is for application for each major joint affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. If x-ray evidence shows that the arthritis involves 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations, a rating of 20 percent is assigned. See 38 C.F.R. § 4.71a, DC 5003. Under DC 5260, limitation of flexion of the knee to 60 degrees warrants a noncompensable rating. Limitation of flexion of the knee to 45 degrees warrants a 10 percent rating. Limitation of flexion of the knee to 30 degrees warrants a 20 percent rating. Limitation of flexion of the knee to 15 degrees warrants a 30 percent rating. See 38 C.F.R. § 4.71a, DC 5260. The Veteran's representative filed a submission in December 2010 that was taken as his claim for service connection for left knee degenerative arthritis. A May 2010 VA treatment record noted the Veteran was status post left knee ACL repair surgery in 1998. Diagnostic imaging showed evidence of the previous ACL tear, degenerative changes, and no fracture or dislocation. The Veteran demonstrated full 5/5 left knee strength, normal left knee sensation, and normal left knee reflexes, and normal 5/5 left knee extension in a physical examination from a February 2013 VA treatment record. In May 2015, the Veteran reported his left knee gave out causing him to fall, which resulted in "slight" knee pain of 2/10. The Veteran denied any swelling or difficulty ambulating and stated the same thing had happened a few months prior. He stated he had shooting pain three to four times per day that lasted several seconds and he complained of left knee pain. He was also diagnosed with left knee pain. The next day he reported left knee pain at a 3-4/10. A left knee x-ray from May 2015 showed postoperative changes and osteoarthritis. The Veteran underwent a left knee VA examination in February 2016 where he stated he had flare-ups of up to 7/10 pain and he stated he had functional loss of pain when it is cold outside. The VA examiner found the Veteran had some reduced range of motion with flexion from 0 to 110 degrees. Further, the Veteran showed pain with functional loss on both flexion and extension, evidence of pain with weightbearing, and crepitus. In November 2017, the Veteran presented for treatment following a left knee twisting injury and he reported pain and limping. VA treatment records noted the Veteran showed normal heel toe gait mechanics, normal clinical contour of the left thigh, no swelling or ecchymosis, no effusion, negative drawer testing, and range of motion from 0 to 130 degrees. Left knee x-rays showed status post probable old ACL revision with advancing moderate to severe tricompartmental degenerative changes, mild joint effusion on the left, and mild degenerative changes within the medial compartment on the right. The Veteran was prescribed a custom left knee brace. In May 2021, the Veteran underwent a VA examination of the left knee. He reported he had worsening pain in his left knee and his left knee causes him to have difficulty walking up stairs. He was noted to use a left knee brace. The VA examiner found left knee flexion 0 to 95 degrees with no pain exhibited. Given this evidence, the Board finds that the Veteran's left knee arthritis has not manifested by limitation of flexion to 30 degrees or less during the appeal. The Board notes that the Veteran's left knee arthritis is currently rated as 10 percent disabling due to painful motion and the presence of arthritis in the joint pursuant to 38 C.F.R. § 4.71a, DC 5003-5260. Testing in the medical record showed the Veteran's left knee range of motion limited to 110 degrees, 130 degrees, and 95 degrees as detailed above, which shows that the Veteran's left knee range of motion symptoms manifested as a noncompensable disability rating under DC 5260. Thus, while the record shows that the Veteran has had some limitation of flexion of this knee, as well as painful motion, for the entire period, the record does not show that flexion was limited to 30 degrees or less. Nonetheless, the Board has considered the applicability of other diagnostic codes pertaining to the left knee arthritis. Range of motion testing performed during the February 2016 VA examination and the May 2021 VA examination showed that the Veteran was fully able to extend the left knee. Though the 2016 VA examiner reported the Veteran showed pain on extension with functional loss, in a November 2017 VA treatment record, the Veteran demonstrated full knee extension that did not reproduce posterior compartment pain. The May 2021 VA examiner also did not find pain on knee testing. The Board finds the November 2017 and May 2021 findings that the Veteran had no pain on full extension to be more probative than the February 2016 VA examiner's findings of pain because the November 2017 testing was done near the time the Veteran had suffered a twisting injury and he was noted to have heightened symptoms at that time. Additionally, the November 2017 record specifically noted the Veteran did not demonstrate pain on extension, which shows that the medical provider specifically tested for such pain. The Veteran was also examined in person in May 2021 and, despite reporting pain, none was found in objective diagnostic testing. Thus, a separate disability rating based on limitation of extension is not warranted. See 38 C.F.R. § 4.71a, DC 5261. Within both the February 2016 and May 2021 VA examination reports, the examiners documented that the Veteran did not have a meniscus condition. Thus, the application of DCs 5258 and 5259 are not warranted. During the appeal, the Veteran has made allegations that he felt his left knee would buckle. The Veteran as a layperson is competent to describe factual matters of which he has first-hand knowledge such as experiencing pain, perceiving instability in a joint, or witnessing actually observed symptoms such as swelling. See Washington v. Nicholson, 19 Vet. App. 362, 368 (discussing competence to report experienced or witnessed symptoms versus incompetent to offer render a medical diagnosis or identify the etiology of disease or injury that require medical knowledge). With respect to lateral instability, the Board has considered the Veteran's statements describing left knee instability and buckling. When considering whether lay evidence is competent the Board must determine on a case-by-case basis whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Here, the Board finds the Veteran is competent to describe symptoms of his left knee disability, such as perceived instability and pain. See Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). However, his statements regarding perceived left knee instability are not entirely credible as they were inconsistent at the time he gave the statements at the January 2021 hearing. The Veteran testified both that his knee had never gotten to the point where he could not put pressure on it, and that it had buckled under pressure. Further, the Veteran did not report instability to medical professionals in the various medical records other than the one instance in November 2017 that was immediately following a left knee twisting injury. Additionally, to the extent that the February 2016 VA medical examiner used specific clinical tests to assess the stability of the Veteran's left knee, the Board finds the objective medical evidence is more probative than the lay evidence on the issue of instability because the clinical assessment of knee instability made by performing particular joint stability tests falls outside the realm of common knowledge of laypersons. Here, the February 2016 VA examination constitutes competent medical evidence that the Veteran's left knee joint was stable to anterior testing (Lachman test), posterior testing (posterior drawer test), medial testing (valgus stress testing), and to lateral testing (varus stress testing). Further, the findings of the February 2016 VA examiner are consistent with the findings of the May 2021 VA examiner that the Veteran had no recurrent subluxation or persistent instability, and no recurrent patellar instability. The Board acknowledges the November 2017 objective findings showing the Veteran had 2+ collateral instability at that time. However, this finding was after an incident in which the Veteran twisted his knee. The Veteran was prescribed a custom knee brace at that time, which he was noted to use at the May 2021 VA examination. However, there are no consistent findings of instability in the record. Prior to the November 2017 findings of instability, the February 2016 VA examiner noted the Veteran had no history of left knee recurrent subluxation or lateral instability. After the November 2017 findings of instability, the May 2021 VA examiner found that the Veteran had no recurrent subluxation or persistent instability, and no recurrent patellar instability. The Veteran also reported no history of instability or recurrent subluxation of the knee at the May 2021 VA examination. Additionally, the Veteran did not consistently complain about left knee instability being an issue when treated by VA. Further, when the Veteran reported left knee instability at the January 2021 hearing, the Veteran stated the last time his knee buckled on him was six months prior. This is suggestive the Veteran does not have persistent left knee instability. Thus, the single instance of instability in VA treatment records from November 2017 and the Veteran's use of a knee brace are outweighed by the more probative evidence from the VA examiners finding the Veteran did not have left knee instability, the Veteran's own statements that he did not have subluxation or instability in his left knee, and the Veteran's statement from the hearing that his last instance of left knee instability was six months prior. The VA examiners' findings of no left knee instability came both before and after the November 2017 finding of instability and issuance of a knee brace. While the Veteran showed use of his knee brace at the May 2021 VA examination, he also reported no left knee subluxation or instability at that time, which is consistent with the May 2021 VA examiner's findings. Further, while the Veteran reported occasional instability at the January 2021 hearing, this is insufficient for a finding of "persistent instability" as required to receive a compensable rating under DC 5257. In Jandreau, the United States Court of Appeals for the Federal Circuit held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when...lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau, 492 F.3d at 1977. The issue of whether the Veteran's perceived symptom of left knee instability is competent and sufficient to establish that he has actual instability of the knee sufficient to warrant a separate disability rating under DC 5257 is analogous to the situation described in Jandreau. In this case, the Veteran has described his perception of left knee instability by describing that this left knee sometimes buckles. However, as detailed above, the February 2016 VA examiner tested his left knee for instability during the pendency of his appeal and did not find even slight instability on anterior, posterior, medial, or lateral stability testing. Additionally, while November 2017 objective findings showed the Veteran had 2+ collateral instability at that time, those findings were shortly after the Veteran had suffered a specific left knee twisting injury. Further, as also mentioned above, the Veteran testified at the January 2021 hearing that the last time his knee buckled on him was six months prior. Additionally, at the May 2021 VA examination, the Veteran reported no left knee instability or subluxation and the VA examiner found no recurrent subluxation or persistent instability, and no recurrent patellar instability in the left knee. The objective medical evidence findings, circumstances surrounding the objective findings of left knee instability, and lay statements contradicting the claim that his left knee is consistently unstable are insufficient to establish the presence of anterior, posterior, medial, or lateral instability sufficient to warrant separate disability rating. In English v. Wilkie, 30 Vet. App. 347 (2018), the Court held that the Board cannot find objective medical evidence categorically more probative than lay evidence without explaining why that is the case. To be clear, the Board finds the objective medical evidence more probative than the Veteran's reports of perceived left knee instability for four reasons. First, the clinical findings by the February 2016 VA examiner involved four forms of stability testing. Second, these findings of no instability are consistent with the findings of the May 2021 VA examiner that the Veteran had no left knee instability findings. Third, while the November 2017 VA treatment records contain objective evidence of knee instability and issuance of a left knee brace, those findings came right after an injury to the knee, and subsequent VA examination findings showed no left knee instability. Finally, the Veteran issued contradictory statements to his claims of persistent left knee instability by saying (1) that the most recent bout of left knee instability that he suffered was six months prior at the January 2021 hearing, and (2) that he had no left knee instability or subluxation at the May 2021 VA examination. For all of these reasons, the Board concludes that a separate rating under DC 5257 for left knee instability is not warranted. The Board has considered whether higher ratings should be assigned pursuant to 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria but determines that higher ratings are not warranted for the Veteran's disability picture. The Veteran reported having flare-ups of his symptoms during the February 2016 VA examination, and that VA examination report showed the presence of additional functional impairment due to such symptoms as pain. See Sharp, 29 Vet. App. at 26. However, even though there is evidence of flare-ups, limited range of motion, and the presence of arthritis in the left knee, and even after considering the effects of pain and functional loss, the evidence does not show that the Veteran's left knee manifested by limitation of flexion to 30 degrees or less. A February 2013 VA examination for the spine shows the Veteran demonstrated 5/5 muscle strength in left knee extension. The February 2016 VA examiner documented that the Veteran had 4/5 muscle strength. The Board finds that this is evidence against the Veteran having more than mild weakness in the left knee. Further, at the May 2021 VA examination, the Veteran did not report flare-ups of the left knee and he was found to have no muscle atrophy. Thus, a higher rating under these provisions is not approximated in the Veteran's left knee disability picture. Accordingly, the Board concludes that the Veteran's left knee arthritis does not warrant a disability rating in excess of 10 percent. As the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply, and the claim for a higher rating is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.71a, DC 5003-5260; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to a TDIU rating Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the schedular requirements. Specifically, if there is only one such disability, the disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and enough additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran is service-connected for an acquired psychiatric disorder of major depressive disorder with melancholic features, somatic symptom disorder associated with left knee arthritis status post ACL tear, rated as 70 percent disabling from December 30, 2010; esophagus stricture of associated with gastroesophageal reflux disease (GERD), rated as 30 percent disabling from December 30, 2010; GERD associated with left knee degenerative arthritis status post ACL tear, rated as 30 percent disabling from December 30, 2010; degenerative joint disease of the lumbar spine, rated as 10 percent disabling from January 10, 2013 and 20 percent disabling from May 10, 2021; left knee degenerative arthritis status post ACL tear, rated as 10 percent disabling from December 30, 2010; tinnitus, rated as 10 percent disabling from January 10, 2013; painful scar, residuals of appendectomy, rated as 10 percent disabling from January 10, 2013; radiculopathy of the right lower extremity associated with degenerative joint disease of the lumbar spine, rated as 10 percent disabling from January 10, 2013; radiculopathy of the left lower extremity associated with degenerative joint disease of the lumbar spine, rated as 10 percent disabling from January 10, 2013; hearing loss of the right ear, rated as 0 percent disabling from January 10, 1997; and scar, residuals of appendectomy, rated as 0 percent disabling from January 10, 1997. Based upon the above, the Veteran's combined disability rating during the relevant appeal period is 90 percent from December 30, 2010. As such, the service-connected disabilities meet the schedular criteria for a TDIU rating for the entire period on appeal. "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16. In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts he personally observed or described; this includes recalling what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure or follow substantially gainful employment. The reasons follow. In the May 2021 VA Form 21-8940, Application for Increased Compensation Based on Individual Unemployability, the Veteran reported that he was entitled to TDIU based upon his depression, back, and knee disabilities. The Veteran reported last working as a telecom technician from 1998 to December 2008. He said he has not had any other education or training. The Veteran reported education at the freshman college level. He also reported that he was awarded Social Security Disability Insurance benefits in 2008. A February 2014 VA treatment record noted the Veteran's work history, which included working as a laborer for 2 years following his military service, and also included traffic signal maintenance, construction, environmental hazardous waste, and fiber optics. In a February 2016 VA examination report, the examiner had documented the Veteran detailed that he graduated high school and went to college for one year. VA examinations throughout the relevant period showed some of the Veteran's service-connected disabilities had an impact on his work abilities. In the February 2013 VA examination for the lumbar spine, the examiner wrote the Veteran's lumbar spine disability impacts his ability to work. The examiner noted the Veteran worked in telecommunications at the time in a more or less sedentary position where he worked on computers for the previous 10 years. The Veteran's prior job was noted to be more physical, and he had to do more lifting of equipment and move furniture around. In a February 2016 audio VA examination report, the examiner stated tinnitus impacted the Veteran's ordinary conditions of daily life including his ability to work as the Veteran reported tinnitus could interfere with his sleep. A February 2016 VA examiner found the Veteran's left knee impacts his ability to perform the occupational task of walking up and down steps as the Veteran reported pain with this activity. In July 2020, a psychological VA examiner found the Veteran had the occupational and social impairment of reduced reliability and productivity due to his psychological disability. The Veteran's scars were noted to impact the Veteran's ability to work because they limited activities such as bending in an October 2020 VA examination. Additionally, a May 2021 VA examiner found the Veteran's left knee disability impacted his occupational abilities by causing difficulty climbing stairs. However, VA examinations of other service-connected disabilities revealed no impact on the Veteran's occupational abilities. The February 2016 audio VA examiner stated the Veteran's right ear hearing loss did not impact his ability to work. In an October 2020 esophageal VA examination, a VA examiner stated the Veteran's gastroesophageal reflux disease (GERD) did not impact his ability to work. Also, a May 2021 lumbar spine VA examiner found the Veteran's lumbar spine disability and radiculopathy do not impact his work ability. Beginning in October 2012, VA treatment records frequently detailed that the Veteran was performing some part-time work and looking for other employment. October 2012 VA treatment records stated the Veteran was doing some part-time work while feeling better able to handle stress that accompanies work/relationships much better. He stated he needed a part-time job to keep busy. He continued to express a desire to find employment in January and February 2013. April 2013 VA treatment records stated the Veteran coached his son's baseball team. In May 2013, the Veteran reported completing some minor carpentry work. A September 2013 VA treatment record documented how the Veteran set up a time to take delivery of a mattress, but indicated he might be out on a job at the time of the delivery. The Veteran also stated in October 2013 that he kept busy by doing work around the house and performing odd jobs when they were available. In March 2013, the Veteran expressed that he continued to work side jobs whenever he got a chance. The Veteran continued to report performing odd or side jobs in April, May, and July 2014. In May 2014, the Veteran again informed medical professionals that he coached his son's baseball team. The Veteran reported he enjoyed working on his house and working jobs in October 2014. Also, in October 2014, the Veteran entered into the VA Transitional Work Experience (TWE) program. TWE participants received at least 30 hours per week of structured vocational rehabilitation activities and were assigned to therapeutic work placements for six months to one year. See https://pathwaystowork.acf.hhs.gov/intervention-detail/477. A Vocational Rehabilitation Specialist noted the Veteran did not have a resume, and had limited computer skills for job seeking. She stated the Veteran had not worked in "years," and stated his last attempt at employment was in 2011 when the hours conflicted with his schedule. The Vocational Rehabilitation Specialist also noted that barriers to the Veteran's employment at that time included gaps in work history, maintaining sobriety, and legal issues. He was noted to have a trial date set in November 2014 for an assault and battery charge, and he had other past charges as well. The Veteran reported wanting a "government job" and looking on the USA jobs website. However, it was noted he had not applied to any jobs since he left the last one. The Veteran also inquired about starting his own business. The Veteran reported his last attempt at employment was 2011, but, as detailed above, the Veteran reported working various jobs between 2011 and his October 2014 TWE intake meeting. Additionally, the Veteran reported that the reason he did not take the reported job in 2011 was not because he was unable to work, but because the hours conflicted with his schedule. The Vocational Rehabilitation Expert stated the Veteran's barriers to employment at that time included gaps in work history, maintaining sobriety, and legal issues. Notably absent from that list of barriers are any of the Veteran's service-connected disabilities. The Veteran stated he had not applied to any jobs since his reported last job, which is indicative that the reason the Veteran did not obtain any full-time employment had more to do with him not attempting to obtain employment and less to do with any limitations from service-connected disabilities. Further, the Veteran inquired about starting his own business, which is indicative that he is capable of performing some gainful activity. The Veteran continued to express an interest in finding a job in December 2014 and February 2015. April 2015 VA treatment records detailed how the Veteran was working on his resume and he was noted to be alert, able to remain on task, and demonstrated a full understanding of the material presented. He was described as hopeful that he would get a job soon in May 2015, and he was also noted to not have an excuse for not looking for work despite still wanting a job. He also expressed a desire to find a job in June 2015 and said he would make it a priority since he admitted to being busy with working around his house doing projects that took all of his time. A June 2015 VA treatment record noted the Veteran often reported his goal was to find a job, but he did not follow through with actions related to that. Later June 2015 treatment records documented the Veteran had applied to jobs, and he was noted to be attending a class regarding starting his own business. In a late June 2015 VA treatment record the Veteran discussed an incident where his neighbor whom he does odd jobs for refused to pay him a pre-agreed upon amount for work he had already done. By the end of June 2015, the Veteran reported he would pursue starting his own business as opposed to getting a job. VA treatment records documented that the Veteran's participation in TWE was supposed to end at the end of July 2015 due to his decision to pursue self-employment rather than look for a job, but he injured himself and did not get medical clearance to return to the work program. Despite the Veteran previously reporting he would pursue self-employment, the Veteran reported he was considering working a full-time job in October 2015 and he was working with a friend at that time completing side jobs. He also stated he did occasional side jobs sometimes reported as "minor construction jobs" and often noted to be performed with a friend in November 2015, December 2015, January 2016, February 2016, April 2016, and December 2016. The Veteran continued to report he wanted to work or was actively looking for work in February 2016. The Veteran also stated in February 2016 that he enjoyed watching his son play basketball, interacting with friends, and working on his residence. He expressed a desire to be employed in May 2016 and 2017, and he stated he wanted to get into a work therapy program in September 2018. July 2019 VA treatment records noted the Veteran has started to work for a "couple" of days per week at that time. The Veteran stated in an April 2013 VA treatment record that he believes historically work pressures contributed to destabilization of his depression. In August 2014, the Veteran expressed that he was not sure he was ready to hold down a job. A September 2014 VA treatment record documented the Veteran's history of having several jobs, doing well, and then backsliding into depression. The Veteran was noted to have lost two jobs due to losing a license for drinking. In March 2015, the Veteran reported he had last worked in 2000 as a union laborer and left due to issues with alcohol and depression. In November 2015, the Veteran stated he self-medicated over the years with alcohol and drugs, got into fights, and lost jobs and his family. He stated this was especially true when he started gambling. The Veteran reported in August 2017 that substance use caused issues with employment. However, it is noted that the alcohol abuse, drug abuse, and gambling are not service-connected disabilities. Therefore, it's impact does not factor into this TDIU analysis. A June 2015 VA treatment record noted the Veteran mentioned possibly not being able to work due to his knee. However, the same treatment record noted that the previous time this issue was discussed the Veteran reported his knee was fine and his doctor approved his continuation in the TWE program. As previously noted, a February 2016 VA examiner found the Veteran's left knee impacts his ability to perform the occupational task of walking up and down steps as the Veteran reported pain with this activity. However, this is not indicative of an impact to the Veteran's work abilities to a level severe enough to prevent him from being able to perform any substantial gainful activity. The Board has considered the opinions of the medical professionals; however, the ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator. See 38 C.F.R. § 4.16(a). Notably, an October 2008 doctor who performed an examination in connection with an application for Social Security disability benefits states the Veteran's mental disabilities caused moderate limitation in restriction of activities of daily living, marked difficulties in maintaining social functioning, and marked difficulties in maintaining concentration, persistence, or pace. Additionally, an August 2017 VA treatment record stated the Veteran was unemployed due to his disability of depression. The Veteran has a service-connected psychiatric disorder. However, this April 2017 statement is inconsistent with other medical records that documented the Veteran reported he was performing some work which he often referred to as "side jobs." He also reported working on his own home and coaching his son's baseball team. At his October 2014 TWE intake meeting, the Veteran reported that the reason he did not take a job in 2011 was not because of depression, but because the hours conflicted with his schedule. Additionally, the Veteran's barriers to employment were described at that time as gaps in work history, maintaining sobriety, and legal issues. Depression was not listed as a barrier to employment. Thus, more weight is afforded to the various other service treatment records that indicate the Veteran's unemployment was due to factors other than his service-connected depression disability. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges that the Veteran experiences lumbar pain and radiculopathy, left knee pain, lack of sleep, and an impact to his physical abilities from his abdominal scar. The Board acknowledges the Veteran's disabilities cause the impacts to his work ability of fatigue, reduced ability to walk up and down stairs, and reduced bending. However, the record indicates that the Veteran has remained capable of performing a wide array of physical activities and has remained independent in activities of daily living. He is capable of ambulating with no gait or balance problem without the use of an assistive device. The Veteran received only sporadic treatment for his physical disabilities without significant exacerbations requiring inpatient or urgent care during the relevant period. The Veteran also recorded full strength and normal reflexes in the lumbar spine and left knee 2021. Thus, as suggested by the 2013 VA examiner, the Veteran's lumbar spine, radiculopathy, left knee, and abdominal scar disabilities can be accommodated by restricting the Veteran from occupations in which he would be required to spend the majority of his time standing or walking. Despite the Veteran's tinnitus, he has demonstrated the ability to converse without difficulty and to socialize appropriately as demonstrated at the January 2021 hearing. Therefore, the Veteran's hearing loss and tinnitus can be accommodated by restricting the Veteran from work in crowded public spaces with high noise exposure. Accordingly, the evidence shows that the Veteran was physically capable of performing substantially gainful employment during the relevant period. The Department of Labor's Dictionary of Occupational Titles (DOT) defines light work as exerting up to 20 pounds of force occasionally (i.e., up to one-third of the time), and/or 10 pounds of force frequently (i.e., from one-third to two-thirds of the time), and/or a negligible amount of force constantly to lift, carry, push, pull, or otherwise move objects. According to the DOT's definition, when walking or standing are involved to a significant degree, the job is classified as light even when the weight lifted is negligible. A job is also classified as light when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls, or when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. The Board finds no prejudice to the Veteran in considering the definition for purposes of deciding this claim. The treatment record does not indicate the Veteran's service-connected disabilities to limit him beyond restrictions of light work, with additional limitations associated with prolonged walking and acute hearing. This finding is supported by the Veteran's independence in activities of daily living and the clinical findings documented within VA examination reports. The weight of the evidence shows that the Veteran is physically capable of performing substantially gainful employment. As to the Veteran's ability to perform the mental requirements of substantially gainful employment, the Board acknowledges the Veteran's history of depressive symptoms associated with his acquired psychiatric disorder of major depressive disorder with melancholic features, somatic symptom disorder associated with left knee arthritis status post ACL tear. However, the longitudinal evidence does not indicate that his symptoms have resulted in significant functional impairments. During the relevant period, the Veteran's treatment records reflect generally unremarkable findings on mental status examination, including that the Veteran is alert and oriented, cooperative attitude, appropriate affect, euthymic mood, motor activity within normal limits, speech within normal limits, linear thought process, logical thought processes, concentration within normal limits, adequate insight, adequate judgment, no delusions, no hallucinations, and no suicidal ideation. Although the Veteran reported in a July 2020 VA examination that he was depressed and had difficulties concentrating and maintaining attention, he has engaged in a vocational rehabilitation program and he frequently reported doing some work. and he graduated from massage therapy school in 2013. He has also reported regular social engagement in activities such as attending his son's baseball games, golfing, and attending a professional football game. Thus, he is able to interact appropriately in social situations. The Board finds that the Veteran's major depressive disorder can be accommodated by restricting the Veteran from occupations that would require advanced training or additional education. The evidence shows that the Veteran's service-connected psychiatric disorder does not preclude him from performing the mental requirements of substantially gainful employment. Based on the above assessment of the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the Board finds that the Veteran is capable of work that would result in income at the level of substantially gainful employment. Although the Veteran stated that he was unable to continue with his past job as a telecom technician, there are other jobs the Veteran would be capable of performing, which could primarily be performed while sitting. There are a wide range of occupations that the Veteran could perform despite his service-connected disabilities. For example, the Veteran could perform jobs involving data entry. With data entry, the Veteran would be primarily responsible for entering data into a system. These jobs can often be done from home, would not require significant training or expertise, and could be performed while seated. In fact, the Veteran's past work on computers would allow him to perform this job. The Veteran could also perform an occupation such as telemarketer, where the employee makes calls and reads a script, which does not require extensive training or experience, would require minimal exertional activity, and could be performed while seated. Additionally, the Veteran would be capable of performing certain cashier or assembly line positions, or work as a library or museum attendant in some settings, entry-level positions that would allow the Veteran to spend most of his time seated without excessive noise exposure. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran could perform. This is evidence against a finding that the Veteran is precluded from all forms of substantially gainful employment due to his service-connected disabilities during the relevant period. For all these reasons, the Board finds the preponderance of the evidence is against a finding that the Veteran has been precluded from securing or following a substantially gainful occupation due to his service-connected disabilities for the period on appeal. As the probative evidence of record weighs against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim of entitlement to a TDIU rating is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Patton 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.