Citation Nr: 21005735 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 11-12 425 DATE: February 2, 2021 ORDER An increased disability rating in excess of 40 percent for left sided lumbar disc herniation and degenerative joint disease (lumbar spine disability) is denied. A higher initial disability rating in excess of 10 percent for right lower extremity radiculopathy is denied. An increased disability rating in excess of 20 percent for left lower extremity radiculopathy is denied. An increased disability rating in excess of 20 percent for gynecomastia, status post mastectomy (impairment of the left shoulder muscle group III) is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. For the entire rating period on appeal from April 12, 2016, the lumbar disability has not been manifested by ankylosis of the thoracolumbar spine and/or incapacitating episodes requiring physician ordered bed rest having a total duration of at least six weeks during a 12-month period. 2. For the initial rating period on appeal from April 12, 2016, the right lower extremity radiculopathy has not manifested in moderate incomplete paralysis of the sciatic nerve. 3. For the entire rating period on appeal from April 12, 2016, the left lower extremity radiculopathy has manifested in moderately severe incomplete paralysis of the sciatic nerve without symptoms of severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. 4. For the entire rating period on appeal from April 12, 2016, impairment of the left shoulder muscle group III has not been manifested by a severe muscle injury. 5. For the entire relevant rating period on appeal from April 12, 2016, the Veteran has been in receipt of a 100 percent combined schedular rating for a combination of service-connected disabilities. CONCLUSIONS OF LAW 1. For the entire rating period from April 12, 2016, the criteria for an increased disability rating in excess of 40 percent for the lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. For the initial rating period on appeal from April 12, 2016, the criteria for a higher initial disability rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 3. For the entire rating period on appeal from April 12, 2016, the criteria for an increased disability rating in excess of 20 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 4. For the entire rating period on appeal from April 12, 2016, the criteria for an increased disability rating in excess of 20 percent for impairment of the left shoulder muscle group III have not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.73, Diagnostic Code 5303. 5. For the entire relevant rating period on appeal from April 12, 2016, the issue of entitlement to a TDIU has been rendered moot by a 100 percent combined schedular disability rating. 38 U.S.C. §§ 1155, 7104, 7105; 38 C.F.R. § 4.16; Bradley v. Peake, 22 Vet. App. 280 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from August 1970 to August 1973. The issue of service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety, and depression, was previously denied in a September 2017 Board decision, which the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In April 2018, the Court vacated the Board’s September 2017 Board decision pursuant to a March 2018 Joint Motion for Remand (JMR). In a November 2018 decision, the Board remanded the matter to the Regional Office (RO) for further development. In an August 2020 rating decision, the RO granted service connection for an acquired psychiatric disorder; thus, the issue has been removed from the Board’s instant decision. Disability Rating Legal Criteria Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 9-98. 1. Rating the lumbar spine disability For the entire rating period on appeal from April 12, 2016, the Veteran is in receipt of a 40 percent disability rating for the lumbar spine disability under the General Rating Formula. See 38 C.F.R. § 4.71a, Diagnostic Code 5242. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243, unless 5243 is rated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (IVDS Rating Formula). Ratings under the General Rating Formula are made 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 General Rating Formula provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range-of-motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is provided for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range-of-motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is provided for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately rated under an appropriate diagnostic code. Note (2) (See also Plate V) provides that, for VA compensation purposes, normal forward flexion of the lumbar 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 lumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range-of-motion. Note (3) provides that, in exceptional cases, an examiner may state, that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range-of-motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range-of-motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range-of-motion is normal for that individual will be accepted. Note (4) instructs to round each range-of-motion measurement to the nearest five degrees. Note (5) provides that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire lumbar 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. Under Diagnostic Code 5243 (Intervertebral Disc Syndrome), a 10 percent disability rating is assigned with incapacitating episodes having a total duration of at least 1 weeks but less than 2 weeks during the past 12 months; a 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent disability rating is assigned with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2) provides that if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment should be evaluated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher rating for that segment. After a review of all the lay and medical evidence of record, the Board finds that, for the entire rating period on appeal from April 12, 2016, the criteria for an increased disability rating in excess of 40 percent for the lumbar spine disability have not been met or more nearly approximated. The Veteran has not described complete ankylosis of the entire thoracolumbar spine or indicated that there were incapacitating episodes requiring physician ordered bedrest over a 12-month period. May 2017 and August 2020 VA examination reports reflect negative findings for ankylosis in the thoracolumbar spine or incapacitating episodes requiring physician ordered bedrest over a 12-month period. Additionally, VA and private treatment records throughout the rating period on appeal also do not indicate unfavorable ankylosis of the entire thoracolumbar spine (criteria for a 50 percent rating), or that the Veteran has experienced incapacitating episodes requiring physician ordered best rest with a total duration of at least 6 weeks during a 12 month period (criteria for a 60 percent rating). Based on the foregoing, the Board finds that the preponderance of the evidence is against the assignment of an increased disability rating for the lumbar spine disability in excess of 40 percent for the entire rating period from April 12, 2016. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a. 2. Rating the right lower extremity radiculopathy For the entire initial rating period on appeal from April 12, 2016, the Veteran is in receipt of an initial 10 percent disability rating for the right lower extremity radiculopathy under Diagnostic Code 8520. 38 C.F.R. § 4.124a. Diagnostic Code 8520 provides the rating criteria for paralysis of the sciatic nerve. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124(a). Words such as “severe,” “moderate,” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding assignment of a disability rating. 38 U.S.C. § 7104; 38 C.F.R. § § 4.2, 4.6. In rating diseases of the peripheral nerves, the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture 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 should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. After review of the lay and medical evidence of record, the Board finds the weight of the evidence is against finding that the right lower extremity radiculopathy more nearly approximated moderate incomplete paralysis of the sciatic nerve so as to warrant a higher 20 percent rating for the initial rating period from April 12, 2016. For the initial rating period from April 12, 2016, the right lower extremity radiculopathy has been manifested by symptoms more nearly approximating mild incomplete paralysis of the sciatic nerve. The Veteran underwent a VA examination for the lumbar spine disability in May 2017, the examination report for which reflects the VA examiner assessed the right lower extremity radiculopathy has manifested in symptoms of mild intermittent pain, mild paresthesias/dysesthesias, and mild numbness involving the sciatic nerve. Neurologic examination of the lower extremities revealed active movement against some resistance in right hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and normal strength in great toe extension. The May 2017 VA examiner noted negative findings for muscle atrophy, and reflexes were normal in the right knee and ankle. A light touch sensory examination found decreased responses in the right lower leg/ankle and foot/toes. No other signs or symptoms of radiculopathy were found. The VA examiner assessed mild incomplete paralysis of the sciatic nerve in the right lower extremity. October 2017 VA treatment records reflect the Veteran complained of radiating right leg pain that had worsened over the last two years, but examination of the Veteran revealed he still had full use of the right lower extremity. Other VA and private treatment records revealed the Veteran had a normal gait, full strength in the right lower extremity, and that sensory tests were intact in the right lower extremity. See February 2017 private treatment record; February 2018 private treatment record; February 2019 VA treatment record. An August 2020 VA examination report also reflects findings that the right lower extremity radiculopathy has been manifested by symptoms of mild constant pain, mild paresthesias/dysesthesias, and mild numbness involving the sciatic nerve. Neurologic examination of the lower extremities revealed normal strength in right hip flexion and right knee extension, and active movement against some resistance in right ankle plantar flexion, ankle dorsiflexion, and normal strength in great toe extension. The August 2020 VA examiner noted negative findings for muscle atrophy, and reflexes were normal in the right knee and were hypoactive in the right ankle. A light touch sensory examination found decreased responses in the right lower leg/ankle and foot/toes. No other signs or symptoms of radiculopathy were found. The VA examiner assessed mild incomplete paralysis of the sciatic nerve in the right lower extremity. Based on the foregoing, the Board finds that the weight of the lay and medical evidence of record demonstrates that the Veteran’s right lower extremity radiculopathy had not more nearly approximated the criteria for a 20 percent rating under Diagnostic Code 8520 for symptoms of moderate incomplete paralysis of the sciatic nerve for any part of the initial rating period from April 12, 2016; therefore, a higher initial disability rating in excess of 10 percent is not warranted under Diagnostic Code 8520 for the right lower extremity radiculopathy. 38 C.F.R. §§ 4.3, 4.7. 3. Rating the left lower extremity radiculopathy For the entire rating period on appeal from April 12, 2016, the Veteran is in receipt of a 20 percent rating for the left lower extremity radiculopathy under Diagnostic Code 8520. 38 C.F.R. § 4.124a. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that the left lower extremity radiculopathy more nearly approximates moderately severe incomplete paralysis of the sciatic nerve, so as to warrant an increased 40 percent rating for the rating period from April 12, 2016. Throughout the rating period from April 12, 2016, the left lower extremity radiculopathy has manifested in symptoms or findings of moderate constant pain, moderate intermittent pain, moderate paresthesias/dysesthesias, and moderate numbness in the left lower extremity involving the sciatic nerve, more nearly approximating moderate incomplete paralysis of the sciatic nerve. The Veteran underwent a VA examination for the lumbar spine disability in May 2017, the examination report for which reflects the VA examiner assessed the left lower extremity radiculopathy has manifested in symptoms of moderate intermittent pain, moderate paresthesias/dysesthesias, and moderate numbness involving the sciatic nerve. Neurologic examination of the lower extremities revealed active movement against some resistance in left hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and normal strength in great toe extension. The May 2017 VA examiner noted negative findings for muscle atrophy, and reflexes were normal in the left knee and ankle. A light touch sensory examination found decreased responses in the left lower leg/ankle and foot/toes. No other signs or symptoms of radiculopathy were found. The VA examiner assessed moderate incomplete paralysis of the sciatic nerve in the left lower extremity. The Veteran underwent another VA examination for the lumbar spine disability in August 2020, the examination report for which reflects the VA examiner assessed the left lower extremity radiculopathy has manifested in symptoms of moderate constant pain, moderate paresthesias/dysesthesias, and moderate numbness involving the sciatic nerve. Neurologic examination of the lower extremities revealed normal strength in left hip flexion and left knee extension, and active movement against some resistance in left ankle plantar flexion, ankle dorsiflexion, and normal strength in great toe extension. The August 2020 VA examiner noted negative findings for muscle atrophy, and reflexes were normal in the left knee and were hypoactive in the left ankle. A light touch sensory examination found decreased responses in the left lower leg/ankle and foot/toes. No other signs or symptoms of radiculopathy were found. The VA examiner assessed moderate incomplete paralysis of the sciatic nerve in the left lower extremity. VA and private treatment records throughout the rating period from April 12, 2016 reflect complaints of left leg pain, numbness, tingling, and weakness, without evidence of moderately severe incomplete paralysis of the sciatic nerve. See e.g. February 2017 private treatment record; October 2017 VA treatment record; February 2019 VA treatment record; September 2020 VA treatment record. Based on the foregoing, the Board finds that the weight of the lay and medical evidence of record demonstrates that the Veteran’s left lower extremity radiculopathy has not more nearly approximated the criteria for a 40 percent rating under Diagnostic Code 8520 for symptoms of moderately severe incomplete paralysis of the sciatic nerve for the rating period from April 12, 2016; therefore, an increased disability rating in excess of 20 percent is not warranted under Diagnostic Code 8520 for the left lower extremity radiculopathy. 38 C.F.R. §§ 4.3, 4.7. 4. Rating impairment of the left shoulder muscle group III For the entire rating period on appeal from April 12, 2016, the Veteran is in receipt of a 20 percent rating for impairment of the left shoulder muscle group III under Diagnostic Code 5303. 38 C.F.R. § 4.73. The Veteran's left shoulder is his non-dominant, or minor, extremity. See August 2020 VA examination report. Under Diagnostic Code 5303, applicable to Muscle Group III, includes the intrinsic muscles of the shoulder girdle, including the pectoralis major I (clavicular) and deltoid. Under this Diagnostic Code, a 20 percent rating is warranted for moderate or moderately severe disability of the non-dominant extremity, and a 30 percent rating is warranted for severe disability of the non-dominant extremity. 38 C.F.R. § 4.73, Diagnostic Code 5303. The cardinal signs and symptoms of muscle disability are loss of power, leg weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56. A moderate muscle disability results from a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. The veteran manifests consistent complaints of one or more of the cardinal signs and symptoms of a muscle disability, particularly a lowered fatigue threshold. Some loss of deep fascia or muscle substance or impairment to muscle tonus and loss of power or lowered threshold of fatigue is expected. Objective findings are entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue, and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2). A moderately severe muscle disability results from a through-and-through or deep penetrating wound with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. Records should indicate hospitalization for a prolonged period for treatment of the wound and consistent complaints of cardinal signs and symptoms of muscle disability with evidence of an inability to keep up with work requirements. A moderately severe disability also requires indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side; and tests of strength and endurance compared with the sound side demonstrating positive evidence of impairment. 38 C.F.R. § 4.56 (d)(3). A severe muscle disability results from through-and-through or deep penetrating wound with extensive debridement, prolonged infection, sloughing of soft parts, and intermuscular scarring and binding. It requires ragged, depressed and adherent scars; loss of deep fascia or muscle substance or soft flabby muscles in the wound area; and severe impairment on tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side. 38 C.F.R. § 4.56 (d)(4). After a review of all the lay and medical evidence of record, the Board finds that impairment of the left shoulder muscle group III has not been manifested by a severe muscle disability to warrant an increased 30 percent disability rating under Diagnostic Code 5303. The Veteran has not shown a loss of deep fascia, a loss of muscle substance, or soft flabby muscles in the left shoulder muscle group III area. Instead, May 2017 and August 2020 VA examination reports show the Veteran was found to have normal muscle testing on shoulder abduction. Muscle atrophy was also not shown. The May 2017 VA examiner noted findings of consistent lowered threshold of fatigue and fatigue-pain at a more severe level in the left shoulder muscle group III. Both the May 2017 and August 2020 VA examiners noted that the Veteran's muscle impairment did not result in functional impairment of an extremity such that no effective function remained other than that which would be equally well served by amputation with prosthesis. Other VA and private treatment records throughout the rating period on appeal from April 12, 2016 also do not reflect a severe muscle disability in the left shoulder muscle group III. Based on the foregoing, the Board finds that the weight of the lay and medical evidence of record demonstrates that the Veteran’s left shoulder muscle group III impairment has not more nearly approximated the criteria for a 30 percent rating under Diagnostic Code 5303 for symptoms of a severe muscle disability in the left shoulder muscle group III for the rating period from April 12, 2016; therefore, an increased disability rating in excess of 20 percent is not warranted under Diagnostic Code 5303 for impairment of the left shoulder muscle group III. 38 C.F.R. §§ 4.3, 4.7. 5. TDIU A claim for a TDIU is part of a rating issue when such claim is raised by the record or the Veteran during the rating period. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran contends that a TDIU is warranted due to the service-connected lumbar spine disability and right and left lower extremity radiculopathies, impairment of the left shoulder muscle group III. See March 2018 Notice of Disagreement. A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a), (b). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In evaluating a veteran’s employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. If a veteran’s disabilities do not meet the objective combined rating percentage criteria of 38 C.F.R. § 4.16(a), it then becomes necessary to consider whether the criteria for referral for extraschedular consideration are met under § 4.16(b) criteria. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Submission to the Director of Compensation and Pension Service, for extraschedular consideration is warranted in all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16(a). 38 C.F.R. § 4.16(b). Individual unemployability must be determined without regard to any non service connected disabilities or a veteran’s advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran’s favor. 38 C.F.R. § 4.3. For the rating period on appeal from April 12, 2016, the Veteran is service-connected for an acquired psychiatric disorder (70 percent disabling), dislocation of the metacarpophalangeal joint of the right thumb (20 percent disabling), impairment of the left shoulder muscle group III (20 percent disabling), scar on the right palmer thumb (20 percent disabling), a lumbar spine disability (40 percent disabling), gynecomastia status post mastectomy (10 percent disabling), tinnitus (10 percent disabling), right carpal tunnel syndrome (10 percent disabling), bilateral hearing loss (10 percent disabling), scar on the right dorsal thumb (10 percent disabling), right lower extremity radiculopathy (10 percent disabling), and left lower extremity radiculopathy (20 percent disabling), for a combined schedular disability rating of 100 percent. As the Veteran is already in receipt of a combined 100 percent (“total”) combined schedular disability rating, entitlement to a TDIU is rendered moot for the entire rating period on appeal from April 12, 2016. The Court has recognized that a 100 percent rating under the Schedule for Rating Disabilities indicates that a veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Locklear v. Shinseki, 24 Vet. App. 311, 314 n.2 (2011) (finding entitlement to TDIU mooted from the effective date of a 100% schedular disability rating); see also Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). A grant of a 100 percent disability rating does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether the disabilities establish entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); see also Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if a veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated at 100 percent. See Bradley, 22 Vet. App. at 294 (analyzing 38 U.S.C. § 1114); see also 75 Fed. Reg. 11,229-04 (Mar. 10, 2010) (withdrawing VAOPGCPREC 6-99). In this case, the Veteran does not have a single disability rated 100 percent disabling, but rather a 100 percent (“total”) combined disability rating based on multiple disabilities; thus, there is no basis for assignment of SMC per 38 U.S.C. § 1114. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Choi, 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.