Citation Nr: 21077002 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 11-20 658 DATE: December 28, 2021 ORDER Entitlement to a disability rating greater than 10 percent prior to June 19, 2012, and greater than 20 percent thereafter, for a low back disability is denied. Entitlement to an initial 10 percent rating from August 22, 2019 to August 28, 2020, for right lower extremity radiculopathy is granted. Entitlement to an initial rating greater than 10 percent for left lower extremity radiculopathy is denied. Entitlement to total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The record evidence shows that, prior to June 19, 2012, the Veteran's low back disability was manifested by pain and forward flexion limited to no worse than 65 degrees, a combined range of motion greater than 120 degrees, and no guarding, spasms, or ankylosis. 2. The record evidence shows that, beginning June 19, 2012, the Veteran's low back disability was manifested by pain and forward flexion limited to no worse than 35 degrees without favorable ankylosis of the entire thoracolumbar spine. 3. The record evidence shows that, beginning August 22, 2019, the Veteran's right lower extremity radiculopathy was no worse than mild. 4. The record evidence shows that, beginning August 28, 2020, the Veteran's left lower extremity radiculopathy was no worse than mild. 5. The record evidence shows that the Veteran's service-connected disabilities do not meet the schedular requirements for a TDIU and do not warrant referral to the Director of Compensation and Pension for extraschedular consideration since they do not render him unemployable. CONCLUSIONS OF LAW 1. The criteria for a disability rating greater than 10 percent prior to June 19, 2012, and greater than 20 percent thereafter, for a low back disability have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5237. 2. The criteria for an initial 10 percent rating from August 22, 2019 to August 28, 2020, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.10, 4.14, 4.124a, DC 8526. 3. The criteria for entitlement to an initial rating greater than 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.10, 4.14, 4.124a, DC 8526. 4. The criteria for a TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1992 to June 1996. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2013, the Veteran testified at a Travel Board hearing and a transcript of the hearing is associated with the claims file. In January 2021 correspondence, the Board notified the Veteran that the Veterans Law Judge who conducted the June 2013 hearing was no longer available and he was offered another opportunity for a hearing before a different Veterans Law Judge. He did not respond. Therefore, his Board hearing request is deemed satisfied. See 38 C.F.R. § 20.704. In March 2015, January 2018, February 2019, January 2020, and April 2021, the Board remanded the appeal to the RO for additional development. The Board finally notes that portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, but Diagnostic Codes 5242 and 5237 were not changed. INCREASED RATING Factual Background On November 2009 VA examination, the Veteran reported having back pain that was 5/10 in severity. During flare-ups, his pain increased to 8/10, which occurred with walking longer than 30 minutes, leaning forward to pick something up, bending, or stooping. His most recent flare-up was one month earlier when he picked up his daughter. The examination revealed forward flexion to 70 degrees with discomfort; extension to 20 degrees with discomfort; and bilateral lateral rotation and flexion to 30 degrees. There was no additional limitation of motion or joint function due to pain after repetitions nor was there fatigue, weakness, lack of endurance, or incoordination. The Veteran did not have any muscle spasms or guarding. His gait was normal, the straight leg raise test was negative, and the Veteran's strength, sensation, and deep tendon reflexes in his lower extremities were intact and equal without neurologic deficit. On May 2010 VA examination, the Veteran reported having flare-ups of back pain that were 8/10 in severity with radiation to the left and right anterior and posterior thighs without neuropathy. The last flare-up had been in December 2009 when he lifted up his three year old daughter; he had to hold on to the stroller to leave the store. The flare-up lasted two days during which time he had additional limitation of motion and functional impairment. He had two days of lost work and one incapacitating episode during the past 12 months. Due to pain, his standing was limited to 30 minutes, walking was limited to one mile, and he did not use any assistive device. His back disability affected his work and carrying weapons. Daily activities such as doing chores, shopping, and exercising were also affected. The examination revealed forward flexion was to 65 degrees with pain, and extension, bilateral lateral flexion and rotation were to 30 degrees. There was no addition reduction in range of motion or joint function after three repetitions due to pain, fatigue, incoordination, weakness, or lack of endurance. The Veteran could do a normal heel and toe walk. The straight leg raise test was negative bilaterally and there was no decrease in sensation in either leg. X-rays revealed minimal early degenerative changes. A March 2011 VA treatment record noted there was no progressive weakness in the legs and no new numbness or tingling in the legs. The Veteran's pain from his back sometimes radiated to his buttocks. A June 2012 VA examination showed that the Veteran reported having back pain three to four times a week that lasted three or four hours. When asked about flare-ups he described the incident that had occurred in December 2009 when he picked up his daughter. On examination, forward flexion was to 60 degrees, extension and bilateral lateral flexion were to 20 degrees, and bilateral rotation was to 30 degrees. There was pain with range of motion but there was no worsening in the range of motion after repetitive use testing. There was also no guarding or muscle spasms. The examiner indicted the straight leg test was positive on the right, but also noted there was no evidence of radicular pain or any other signs or symptoms of radiculopathy. At the June 2013 Travel Board hearing, the Veteran stated his back worsened after he stopped working and that he recalled an incident when his back made a sound after he picked up his daughter and he had to rely on the stroller to walk. He had to walk gingerly for two days after the incident. He also stated that he had so much pain after the May 2010 VA examination that he had to sit and rest in the lobby after the examination. The Veteran stated that his back often gave him problems even with light jobs such as bending down to lift up things. A November 2015 treatment record showed the Veteran had been in a car accident and had mild tenderness in the right mid and left mid lumbar areas. The range of motion was normal, and X-rays were negative. A February 2016 VA examination showed the Veteran reported current symptoms of constant pain and stiffness. He did not get treatment for his back, but he wore an over-the-counter brace when working under a sink or when bending down. His symptoms were precipitated by bending or walking too much. The Veteran denied having flare-ups. On examination, forward flexion was to 60 degrees, extension was to 20 degrees, and bilateral lateral bending and bilateral rotation were to 30 degrees. There was pain on motion but no change in his range of motion after repetitive use testing. Pain, weakness, fatigability, or incoordination did not significantly limit his functional ability with repeated use over time and there was no guarding or muscle spasm. The Veteran had normal muscle strength, reflexes, and sensation. He occasionally wore a brace but was not currently wearing one. The straight leg test was negative for both lower extremities and there was no radicular pain or signs or symptoms of radiculopathy. The Veteran also had normal muscle strength, reflexes, and sensation. On June 2018 VA examination, the Veteran reported having flare-ups that involved extreme strain, difficulty walking, and loss of movement. His overall functional impairment was limited bending, no prolonged standing, and an inability to lift objects. Range of motion testing revealed forward flexion to 75 degrees, extension to 25 degrees, and bilateral lateral flexion and bilateral rotation to 30 degrees. Pain avoidance prevented full range of motion and an inability to use the joint in a prolonged or repetitive manner. There was no pain with weight bearing but there was pain with motion. There was no addition loss of function or range of motion after three repetitions or evidence of ankylosis and the Veteran did not have intervertebral disc syndrome. There was objective evidence of pain on passive range of motion testing of the back and on non-weight bearing testing of the back. The examiner stated he did not comment on whether pain, weakness, fatigability, or incoordination significantly limited his functional ability with repeated use over time or during flare-ups because the initial range of motion on the current exam was such that as to make an estimate of any additional degree of range of motion loss would be nothing more than conjecture. There was no guarding or muscle spasm. The straight leg test was negative for both lower extremities and there was no radicular pain or signs or symptoms of radiculopathy. The Veteran also had normal muscle strength, reflexes, and sensation. On August 2019 VA examination, the Veteran reported that he had flare-ups of pain in his back three to four times a week that were 8/10 in severity and included tightness. Regarding functional loss or impairment, he had difficulty bending down, standing upright, and walking, and he was unable to lift. The Veteran's evaluation was during a flare-up and range of motion testing revealed forward flexion to 35 degrees, extension to 5 degrees, bilateral lateral flexion to 10 degrees and bilateral rotation to 50 degrees. There was pain with forward flexion and evidence of pain with weight bearing, non-weight bearing, and passive range of motion. Three repetitions did not produce any additional loss in his range of motion. The testing was not performed immediately after repetitive use over time, but pain, weakness, fatigability, or incoordination significantly limited his functional ability with repeated use over time. The examiner estimated such loss to be the same as during the Veteran's flare-ups. The straight leg raising test was positive for each lower extremity, but the examiner indicated the Veteran did not have radicular pain or any other signs or symptoms of radiculopathy. Strength and sensation testing was normal, but reflexes were 1+ in the right knee and ankle. On August 2020 VA examination, the Veteran reported symptoms of lower back strain, stiffness, and difficulty standing and walking; he had difficulty lifting over 20 pounds and had pain with repeated bending, standing, climbing, or prolonged walking. Flare-ups occurred two to three times a week, and the intensity was from moderate to severe. These episodes lasted from days to weeks and were precipitated by lifting, bending, or standing. The Veteran described his functional loss or impairment as pain that was 8/10 in severity, trouble getting out of bed due to pain, and trouble with lifting more than 20 pounds, repeated bending, standing, climbing, prolonged walking, and standing. Range of motion tests revealed forward flexion to 70 degrees, extension to 20 degrees, bilateral lateral flexion to 10 degrees, and bilateral rotation to 15 degrees. The range of motion contributed to functional loss because it limited range of motion activities and affected bending, standing, sitting, walking, and climbing. Pain was the only factor that caused functional loss. There was objective evidence of pain with weight bearing, non-weight bearing, and passive range of motion. There was no change in functional loss or range of motion after three repetitions of motion testing. With repeated use over time or during flare-ups, the examiner indicated the Veteran had forward flexion to 65 degrees, extension to 15 degrees, and bilateral lateral flexion and bilateral rotation to 10 degrees. The clinician noted the Veteran had difficulty lying down and he needed assistance getting up from the table, which also contributed to his disability in addition to musculoskeletal pain and radiculopathy. Muscle strength was 4/5 bilaterally and reflexes were normal. Sensation in the upper thighs, knee/thigh, lower leg/ankle, and foot/toes was decreased bilaterally; the Veteran did not sense any difference in sensation to light touch. The straight leg raise test was positive for each leg and the Veteran had radicular pain or other signs or symptoms of radiculopathy. He had mild intermittent pain but no constant pain or numbness, paresthesias, or dysesthesias. The radiculopathy involved the femoral nerve of both legs and the overall severity of the Veteran's radiculopathy was mild. In a September 2020 addendum, the clinician wrote that the Veteran's back pain began with movement and that he moved his back even though there was pain to points noted when he could no longer tolerate the pain. In July 2021, a VA physician reviewed the Veteran's medical records and claims file to address the Veteran's radiculopathy. His review of medical records noted evaluations that documented complaints of pain down both legs starting in 2004; however, he was unable to state the severity at that time since there was not enough information to rate the severity. In 2005, the Veteran also reported shooting left leg pain when he walked too much. Further review of multiple VA examinations noted normal neurological exams until the August 28, 2020 VA examination that revealed 4/5 muscle strength bilaterally, normal reflexes, positive straight leg raising, radiculopathy to bilateral lower extremities with intermittent pain involving the femoral nerve bilaterally. Despite the absence of other studies such as MRI of the lumbar spine, the reported history of pain down both legs are consistent with radiculopathy. Review of medical literature notes that radiculopathy refers to a set of conditions in which one or more nerves are affected and do not work properly, with the location of the injury is at the level of the nerve root and can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles, and caused by a mechanical compression of a nerve root usually at the exit foramen or lateral recess and can be secondary to degenerative disc disease, osteoarthritis, facet joint degeneration/hypertrophy, ligamentous hypertrophy, spondylolisthesis, or a combination of these factors. Entitlement to a disability rating greater than 10 percent prior to June 19, 2012, and greater than 20 percent thereafter, for a low back disability The Board finds that, for the period prior to June 19, 2012, the symptomatology attributable to the Veteran's low back disability did not more closely approximate the criteria for a higher rating. VA examinations in November 2009 and May 2010 showed his forward flexion was to 65 degrees or greater and repetitive use testing did not further decrease the range of motion. The combined range of motion was also greater than 120 degrees and there were no lumbar muscle spasms or guarding. Repetitive use testing did not result in any additional decrease in range of motion or functional impairment. He had flare-ups and even though he reported they produced additional limitation of motion, they were infrequent based on the May 2010 VA examination when he reported only having had one in the past year. No other factors were shown to produce additional functional impairment that resulted in additional loss of range of motion. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an increased rating prior to June 19, 2012, for his service-connected low back disability. For these reasons, the Board finds that a preponderance of the evidence is against a assigning a disability rating greater than 10 percent prior to June 19, 2012, for a low back disability. The Board next finds that, beginning June 19, 2012, the symptomatology attributable to the Veteran's low back disability did not more nearly approximate the criteria for a higher rating. During this period, forward flexion under normal conditions was no worse than to 60 degrees as noted on June 2012 and February 2016 VA examinations. In June 2018, the Veteran reported having loss of movement during flare-ups. Even though the examiner stated he could not estimate the range of motion during a flare-up or after use over time, the August 2019 VA examination was conducted during a flare-up at which time forward flexion was to 35 degrees. The August 2019 VA examiner estimated the Veteran had same range of motion after use over time. More recently, the August 2020 VA examiner estimated forward flexion during flare-ups and after use over time was to 65 degrees, so both the findings during flare-ups and the estimated loss during flare-ups were consistent with the criteria for the current 20 percent rating. The August 2020 VA examiner also noted that there was pain with passive and active range of motion and in non-weight bearing and weight bearing. The Veteran reported that his pain began with motion and continued until the point he could no longer tolerate pain. Thus, it is evident that range of motion in all the various ways tested yielded the same results and were not consistent with the criteria for a higher rating. None of the VA examiners found evidence of ankylosis. The evidence shows that, even considering the presence of other factors such as stiffness and range of motion during flare-ups or after use over time, the service-connected low back disability did not demonstration functional loss equivalent to favorable ankylosis of the thoracolumbar spine. The Veteran reported on multiple VA examinations that he had difficulty bending and difficulty standing upright. In June 2018, he indicated that functional impairment included limited bending. Despite the reports of pain during flare-ups and limited bending, the August 2019 VA examination (which was conducted during a flare-up) contained no evidence of functional ankylosis since forward flexion was from 0 to 35 degrees and extension was from 0 to 5 degrees. The August 2020 VA examination indicated the Veteran had even greater motion during flare-ups or after use over time with forward flexion from 0 to 65 degrees and extension from 0 to 15 degrees. To be equivalent to ankylosis, both the Veteran's forward flexion and extension would have to be severely limited to a degree that was close to the neutral position. That is not the case here. Thus, the Veteran did not have functional loss equivalent to favorable ankylosis of the thoracolumbar spine. He otherwise has not identified or submitted any evidence demonstrating his entitlement to a disability rating greater than 20 percent effective June 19, 2012, for his service-connected low back disability. In summary, the Board finds that the criteria for a disability rating greater than 20 percent effective June 19, 2012, for a low back disability have not been met. RADICULOPATHY During the appeal, the RO granted separate compensable ratings for bilateral lower extremity radiculopathy. The Board finds that it has jurisdiction of these issues as part of the Veteran's appeal for a higher rating for his low back disability. Chavis v. McDonough, 34 Vet. App. 1 (2021). The Veteran's bilateral lower extremity radiculopathy was identified as impairment involving the femoral nerve. When the RO granted separate 10 percent ratings for bilateral lower extremity radiculopathy associated with the Veteran's lumbar disability, the effective date for each extremity was August 28, 2020. Since the increased rating claim for the low back was received in September 2009, the Board may consider whether a compensable rating is appropriate prior to this date and whether higher ratings can be assigned beginning September 20, 2020. Entitlement to an initial rating greater than 10 percent prior to August 28, 2020 for right lower extremity radiculopathy The Board finds that a separate compensable rating is warranted effective August 22, 2019, for right lower extremity radiculopathy. This finding is based on the results of the VA examination conducted on that date. At that examination, the Veteran's straight leg raise test was positive for the right lower extremity and he had decreased reflexes. The Board notes in this regard that, prior to the August 2019 examination, the June 2012 VA examination also had a positive straight leg raise test. There were inconsistencies in the overall findings at the June 2012 examination. The examiner found no evidence of radicular pain or any other signs or symptoms of radiculopathy. Since that test is used to assess whether there is radiculopathy and the test is positive when there is pain radiating below the knee, the fact that it was positive conflicts with the finding that there was no radicular pain. Because the Veteran did not report having radicular symptoms on the February 2016 and June 2018 VA examinations and the examination findings were negative, to include the straight leg raise tests, the Board finds the evidence does not support assigning an initial 10 percent rating prior to August 22, 2019, for right lower extremity radiculopathy. The Board next notes that, throughout the appeal period, the Veteran's disability did not more closely approximate moderate incomplete paralysis; thus, a higher rating cannot be assigned (except where noted above). The July 2021 VA physician indicated radiculopathy as nerve impairment that that was manifested by radicular pain, weakness, numbness, or difficulty controlling specific muscles. Based on the severity, frequency, and nature of the symptomatology in the record, the Board finds that the July 2021 VA examiner's assessment that the Veteran has mild radiculopathy is consistent with the record. VA examinations showed positive straight leg tests in August 2019 and August 2020 which was indicative of pain. The only deficit noted in 2019 was decreased reflexes and in 2020 he had decreased strength and sensation, normal reflexes, and intermittent pain. These records indicated the Veteran's symptoms varied and were not constant. He has not reported any functional difficulties or expressed any complaints specific to these lower extremity symptoms during his examinations. Nor has he sought outpatient treatment for any symptoms. This persuasively suggests that his symptoms were not sufficiently problematic to warrant an increased rating. Taken together, the Board finds that the record evidence supports finding that the severity of the Veteran's radiculopathy has been no worse than mild throughout the appeal period. Entitlement to an initial rating greater than 10 percent for left lower extremity radiculopathy Prior to August 20, 2020, the evidence does not support assigning a separate initial compensable rating for the Veteran's service-connected left lower extremity radiculopathy. Aside from an incident in December 2009 when the Veteran had left lower extremity pain that radiated to the left thigh, there are no complaints or findings of left lower extremity radiculopathy in the record evidence until August 2020. VA examinations in November 2009, May 2010, June 2012, February 2016, and June 2018 showed negative straight leg raise tests and there were no signs or symptoms of radiculopathy. Beginning August 20, 2020, the findings for the left lower extremity were identical to those for the right lower extremity. In other words, the straight leg test was positive in the left lower extremity. He had mild intermittent pain of the left lower extremity. There was decreased sensation of the left lower extremity. And strength was decreased to 4/5 in the left lower extremity. Outside of these examination findings, the Veteran did not report any left lower extremity symptoms or functional impairment. There also is no evidence the Veteran sought treatment for any left lower extremity symptoms. Although he is not required to seek treatment to establish the severity of the disability, the absence of treatment, the absence of complaints during the examination, and the lack of more than mild findings on examination tend to show the overall severity of the disability is no more than mild. The fact that the only episode of left lower extremity radiculopathy the Veteran reported was in December 2009 further supports the Board's finding that he would have reported any significant episodes of radiculopathy had they existed. Therefore, the August 2020 VA examiner's assessment that the radiculopathy has been no worse than mild is consistent with the record. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent for his service-connected left lower extremity radiculopathy. In summary, the Board finds that the criteria for an initial rating greater than 10 percent for left lower extremity radiculopathy have not been met. Entitlement to a TDIU In October 2009, the Veteran stated he was unable to find employment due to his disabilities. In August 2011, he reported that he had difficulty picking up and lifting things at same time with his right hand and that it was difficult to drive especially when he made turns. It took 2 arms and a strong back for lifting or moving at a fast pace in his work environment. He was constantly watched at last job because he could not perform like his coworkers. The Veteran's service-connected disabilities consist of a right shoulder disability rated 30 percent disabling since September 16, 2009 a low back disability rated 10 percent disabling since April 17, 2003, and 20 percent disabling since June 19, 2012, right lower extremity radiculopathy rated 10 percent disabling since August 22, 2019, left lower extremity radiculopathy rated 10 percent disabling since August 28, 2020, and a left cheek cyst which has a noncompensable rating. The combined ratings for these disabilities have been no greater than 60 percent. Since he has more than one service-connected disability the combined disability rating is below the schedular requirement for a TDIU. Consequently, the Board only may consider whether this claim should be referred to the Director, Compensation Service, on an extraschedular basis. The record shows the Veteran completed high school and had two years of college but no additional education or training. A vocational rehabilitation (voc rehab) application showed he had an associate's degree in information technology. He primarily worked in a warehouse from May 2001 to February 2009 and then as a weapon handler from February through July 2009. Voc rehab records in December 2004 noted that the Veteran's back, shoulder, wrist, and knee affected his ability to do heavy lifting, carrying, pushing, or pulling. He had difficulty walking or standing when the disorders were aggravated. He had physical jobs since service working in warehouse, as a dishwasher/bussing tables, and in multiple temporary jobs. A functional capacity evaluation indicated a warehouse job was not physically suitable for him. The counselor stated that the Veteran had definite vocational impairment based on his education level and disabilities. He also had the potential for success in suitable employment. The counselor noted that although he had an associate's degree in computer technology, working in this area often required certifications, which he did not have, and his grades showed that he had struggled academically. Service-connected disabilities materially contributed to impairment to employment. A June 2006 record showed the Veteran's voc rehab file was closed because he no longer wanted to continue. Regarding his service-connected disabilities, the Veteran's left cheek cyst has a noncompensable rating and caused no impairment in performing the physical and mental tasks of employment. As shown on VA examinations and treatment records, the Veteran's right shoulder (non-dominant), lumbar, and bilateral lower extremity disabilities were manifested primarily by pain and, in the case of his shoulder and back, limitation of motion. They were shown to interfere with his ability to perform certain physical activities such as overhead work, lifting, bending, carrying, pushing, and pulling. The May 2010 VA examination indicated that he was limited to standing 30 minutes and walking one mile. He reported losing 2 days from work in the past year due to his disabilities. The June 2018 VA examination indicated the disabilities impacted the Veteran's ability to work in that he was unable to bend, lift, push, pull, walk, run, squat, or crawl in a prolonged or repetitive manner. Regarding employability, the June 2018 clinician stated that Veteran was not able to do job duties requiring heavy or repetitive or prolonged lifting, overhead work, running, walking, standing, bending, or squatting. The August 2019 VA examiner noted that the Veteran's pain avoidance was another factor that impacted his ability to work. The August 2020 VA examiner noted that the Veteran's limited range of motion limited his ability to perform activities of the right arm (e.g., lifting carrying, etc.). He had trouble lifting over 20 pounds and difficulty with repeated bending, standing, climbing, prolonged walking, and standing. At the August 2013, hearing, the Veteran testified that at his last job he had a hard time walking, lifting things, and carrying things from one place to another due to his right shoulder and back. He sat or took a break when it started to pinch. At his last job he carried weapons, which involved a lot of lifting, bending, and walking. Prior to that job, he worked in a medical warehouse and that was when his disabilities worsened. He lifted a lot of boxes and put them on shelves. His employer became mad at him because he worked slower than the others, which was due to his shoulder and back. He left because he knew he would not be able to keep up with new requirements the company were implementing. He had looked for work but has not been hired and he indicated that this was because he noted his bad shoulder and back on applications. The Veteran added that all of his work was essentially warehouse work, even in service. He currently did side work off and on when he felt he could do them. His back gave him problems even with light jobs when he bent down to lift things. He also had problems driving a truck due to problems with his shoulder. See August 2013 Hearing Transcript. The Board notes that, while a December 2004 functional capacity evaluation indicated the physical demands of a warehouse job were not suitable for the Veteran, he worked continuously in that capacity from 2001 to 2009. Although he reported having difficulty carrying weapons in his next job which only lasted five months, he left that position for reasons unrelated to his disabilities. The record further showed that even though he was not able to find outside employment since 2009, he has worked continuously by becoming self-employed. In December 2015, the Veteran stated he was self-employed and working in renovations. In November 2015 and August 2016, he reported that he owned his own cleaning business and that he still was working full-time. In February 2016, he reported that since leaving his job in 2009 he did odd jobs and repaired things. When his symptoms prevented him from working, he either rescheduled the job or hired a friend to help him with the work. In October 2019, he reported that he was self-employed and did odd jobs. In March 2021, he requested information on establishing his business as a Small Disabled Veteran Owned Business. The record evidence shows that the Veteran's service-connected disabilities had no impact on his ability to perform the mental tasks associated with working. He did not leave his last job in 2009 due to his service-connected disabilities. And there is no evidence that he could not return to a similar type of work. Even though he was unable to obtain outside employment and his disabilities impacted his ability to work and made certain tasks or activities difficult, his service-connected disabilities did not render him unable to maintain substantial gainful employment. He has been self-employed since 2009. And the record shows he was also able to hire additional help as needed. In light of this evidence, the Board finds no basis for referring the TDIU claim to the Director, Compensation Service, for extraschedular consideration. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to a TDIU. Thus, the Board finds that the criteria for a TDIU have not been met. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Bredehorst, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.