Citation Nr: 21005812 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 09-15 207 DATE: February 2, 2021 ORDER Entitlement to an initial rating in excess of 10 percent before June 29, 2011, and in excess of 20 percent, thereafter, for service-connected arthritic/degenerative facet changes and degenerative disc disease at L2-L3, L3-4, and L4-5 of the thoracolumbar spine (hereinafter, service-connected low back disability) is denied. Entitlement to a total disability rating based on individual unemployability by reason of service-connected disabilities (TDIU) prior to June 29, 2011, is denied. FINDINGS OF FACT 1. Prior to June 29, 2011, the Veteran’s service-connected low back disability did not result in limitation of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. 2. From June 29, 2011, the Veteran’s service-connected low back disability did not result in limitation of forward flexion of the thoracolumbar spine to 30 degrees, or less or favorable ankylosis of the entire thoracolumbar spine. 3. The most probative evidence reflects that the Veteran’s service-connected disabilities did not render him unable to secure or maintain substantially gainful employment before June 29, 2011. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for service-connected arthritic/degenerative facet changes and degenerative disc disease at L2-L3, L3-4, and L4-5 of the thoracolumbar spine before June 29, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242 (2019). 2. The criteria for a rating in excess of 20 percent for service-connected arthritic/degenerative facet changes and degenerative disc disease at L2-L3, L3-4, and L4-5 of the thoracolumbar spine from June 29, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242 (2019). 3. The schedular criteria for TDIU have not been met; referral for extraschedular consideration is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19, 4.25 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army for over 21 years, from June 1987 to March 2008, including service in Bosnia. He also had a period of active duty for training (ACDUTRA) from May 1986 to October 1986. The Veteran’s appealed issues were previously remanded by the Board in May 2013 and June 2019. Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a “staged” rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court since has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Court in Mitchell explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45 (2019). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. 1. Entitlement to an initial rating in excess of 10 percent before June 29, 2011, and in excess of 20 percent, thereafter, for arthritic/degenerative facet changes and degenerative disc disease at L2-L3, L3-4, and L4-5 of the thoracolumbar spine is denied. The Veteran separated from service in March 2008. Before he separated, he filed for service connection for lower back foraminal disc protrusion L3-L4, and was service connected for the condition in a May 2008 rating decision. The claim continued to remain pending, and in June 2011, the Veteran filed for an increase to his back condition. While the original claim remained pending, in an April 2019 rating decision the rating was increased to 20 percent, effective June 29, 2011. The Veteran’s service-connected low back diability is currently rated under diagnostic code 5242. Under DC 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved. If the limitation of motion is noncompensable, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 20 percent evaluation is merited for X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. A 10 percent evaluation is merited for X-ray evidence of involvement of two or more major joints or two or more minor joint groups. 38 C.F.R. § 4.71a, Diagnostic Code 5003. As the Veteran is rated at 10 percent and above for his lumbar spine condition during the period on appeal, a higher rating is not permitted under this code. The General Rating Formula for Diseases and Injuries of the Spine 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 evaluated 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. Facts Prior to discharge, a February 2008 VA examination reports that the Veteran was diagnosed with lower back pain. His condition existed for many years. He reported the following symptoms: stiffness with sitting or standing too long and weakness with bending over or lifting. Due to his back condition, he had pain located in his lower back for years. His pain was occurring constantly. The pain would travel to his right leg; and the pain was described as burning, aching, and sharp. On a scale from 1 to 10, his pain was described as an 8. His pain was elicited by physical activities and his day to day activities. It was relieved by nothing. At the time of pain, he could function without medication. It hurt him to stand or sit too long; but he was not receiving treatment for the condition. He said that the condition has not resulted in any incapacitation. On physical examination, it was reported that there was no evidence or radiating pain on movement. Muscle spasms were absent. There was tenderness in the lower lumbar spine and para lumbar muscle. Straight leg testing was negative, and ankylosis was not present. Range of motion (ROM) testing revealed forward flexion to 80 degrees with painful motion beginning at 80 degrees, extension to 30 degrees with painful motion beginning at 30 degrees, right lateral flexion to 30 degrees with painful motion beginning at 30 degrees, left lateral flexion to 30 degrees with painful motion beginning at 30 degrees, right lateral rotation to 30 degrees with painful motion beginning at 30 degrees, and left lateral rotation to 30 degrees with painful motion beginning at 30 degrees. His joint function of the spine was additionally limited by repetitive use due to pain and lack of endurance. Yet it was not additionally limited by fatigue weakness, and incoordination. Additional lost in joint function in degrees was not shown. There were no signs of intervertebral disc syndrome. In July 2008, on a notice of disagreement (NOD), the Veteran reported that his back pain caused him pain every day; and that it limited his lifting and bending ability. In April 2009, on a VA Form 9 the Veteran reported that bending was still painful; and he experienced sharp pain and stiffness. He had to hold onto things until some of the feeling returned. In July 2011, the Veteran denied back pain. An August 2011 VA medical record reports the Veteran had chronic lower back pain that was not relieved with naproxen. He was started on diclofenac 50 mg daily with his food, as needed, for the lower back pain. He was also given cyclobenzaprine 10 mg to be taken at bedtime as needed for any spasms. Weight loss was encouraged to place less stress on his lower back. He was referred to physical therapy. In September 2011, the Veteran was seen at physical therapy to evaluate and treat lower back pain. The pain was on the right side of his lower back and did not change locations. The pain increased with bending, stooping, and carrying heavy loads. He reported that his diclofenac and cyclobenzaprine dulled the pain a little. He was working as a manager for office supply at Camp Atteberry, and he said his job doesn’t affect his back pain as much. In October 2011, the Veteran tried lumbar traction at physical therapy. He reported that he was feeling looser after the session. He also noted that his back pain had improved slightly with exercises. Later in the month, he reported that he got 40-50% reduction in his low back pain for approximately 2 hours after the traction. Yet, radiating pain with sitting remained the same. In January 2013, the Veteran was seen for physical therapy again. His lower back pain was worsening. The pain continued to be worse with lifting, getting up and down, but it improved with traction and medication. Later in the month, he was issued a back brace to help with heavy lifting or prolonged stopping at work. VA medical records in April 2013 report the Veteran had problems with recurrent numbness in his legs with prolonged sitting or when he got up after laying on his back all night. This pain was also in his right leg when he walked for prolonged periods. He was using a cane for ambulatory assistance. He could no longer use diclofenac due to erosive esophagitis. Tramadol was tried. A March 2016 chiropractor consultation reported the Veteran presented with complaints of lower back pain. His pain, beginning around 10 years ago, had become progressively worse. He described the pain as a 9-10 pain that was constant, sharp, and “pressure like.” It was worse with driving. He said he tried physical therapy in 2008, but he told the chiropractor it did not help. He reported that his traction unit temporarily helped. Range of motion was reported. Flexion was to 60 degrees. Extension was to 20 degrees. Right rotation was to 10 degrees. Left rotation was to 5 degrees. Right lateral flexion was 10 degrees, and left lateral flexion was to 5 degrees. Pain was noted with every measurement. VA chiropractic notes from July 2016 report the Veteran presented for treatment of chronic back pain. He reported losing weight and was feeling better. His cane was hurting his arms when he walked and inquired about a walker or other aid so he could remain active. His gait and posture were generally within normal limits. His lower back pain was assessed to be from lumbar scoliosis, retrolisthesis L2 on L3, mild to moderate central canal stenosis at L4-5 and L3-4 disc protrusion. The Veteran was evaluated for a walker later in July 2016. He was using a single point cane at the time, but it made his right arm hurt. He rated his pain as an 8 out of 10 at this point. He had a history of two falls in the past couple of weeks due to his lower extremity numbness that caused instability when proceeding to stand. In August 2016, the Veteran reportedly still had back pain, and was approved for aquatic therapy. In September 2017, he reported that the aquatherapy helped a lot. At a March 2018 physical therapy consultation, the Veteran was issued a tens unit to help control his chronic lower back pain. In February 2019, a VA back conditions examination was conducted. The Veteran reported that he still had low back pain with constant throbbing rated at an 8-9/10 on average. At worst, it was a 10 out of 10. Functional loss was reported. His mobility was limited along with his range of motion. He could not sit or stand for prolonged periods and now he used his cane or rollator walker constantly. Difficulty with self-cleaning was also reported. He was using ibuprofen, heat, and a tens unit with minimal relief. Initial ROM testing revealed flexion to 60 degrees, extension to 15 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. Pain during forward flexion and extension were noted during the examination. There was evidence of pain with weight bearing and objective evidence of localized tenderness on palpation in the right lower back with a severity of 5 out of 10. With observed repetitive use testing, the Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or ROM after three repetitions. The examiner reported that he was unable to reach objects on the floor or lower than his knee from standing position; and he was unable to lift weights. The examiner indicated that it was unable to say without speculation that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. It was explained that there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions. Additionally, there was a lack supporting objective documentation in the file. Flare-ups were denied. No guarding or muscle spasms were noted. Disturbance of locomotion, interference with sitting, and interference with standing were all contributing factors. He had difficulty with walking, prolonged sitting, and prolonged standing. No muscle atrophy was noted. Radiculopathy was reported. No ankylosis or IVDS were noted. Use of a cane and walker were reported. The examiner indicated that the functional impact of the back condition resulted in the Veteran “quit trying to be employed” due to the inability to stand long in the office. A few months later, the Veteran underwent an additional VA back examination in August 2019. He told the examiner that his last medical encounter for his back was a couple of years ago. He stated that his average daily pain is rated at 8 out of 10. He denied flares of back pain. He stated that he has to consistently change positions to alleviate his pain. The pain was concentrated to right side of his back. He slept through the night, and his sleep did not disturb his sleep pattern. He continued to cut the grass, but used a power mower because he could not tolerate the vibration of the riding mower. He also stated he had to use his cane when he walked. He only used his walker for moderate to long distance walking. Flares were not reported. Functional loss or functional impairment was reported. He could not go jogging or running. He could not use a ladder because it hurt him to go up and down the ladder. He could not bend over and tie his shoes. Initial ROM testing revealed flexion to 35 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 20 degrees. Pain was noted with every measurement, and it caused functional loss. There was no evidence of pain with weight bearing and no objective evidence of localized tenderness on palpation. With observed repetitive use testing, the Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or ROM after three repetitions. There was no reported pain, weakness, fatigability or incoordination that significantly limited functional ability with repeated use over a period of time. Flare-ups were denied. No muscle atrophy was noted. Radiculopathy was reported. No ankylosis or IVDS were noted. Use of a cane and walker were reported. The examiner reported that prior to 2008, the Veteran reported minimal disability due to back pain. His episodes of pain were described as infrequent flares. He continued to jog. The Veteran reported he stopped jogging sometime in 2010 due to the vibration exacerbating his back pain. He began walking for exercise and tolerated this well, initially, but found a gradual increase in his back pain. During this time, he denied changes in range of motion. He said that his condition did progress; and then, in 2017, he was unable to continue walking due to back pain; and he also had difficulty lifting heavy objects. This is when he began to experience limitation in range of motion. Yet, due to the time lapse, he was unable to state or demonstrate any specific range of motion with any accuracy at the time of the examination. The examiner reported that his first record of evaluation for back pain was in August 2011; and that his December 2007 progress note from Dr. Wiseman notes subjective reported of right sided lower back pain intermittently for a few years. At that time, he denied loss of strength and numbness. The examiner noted that those statements were based on the Veteran’s subjective report and that empirical evidence was present in his treatment records. Yet, it was not possible to speculate or estimate the Veteran’s limited range of motion, as requested in the Board’s June 2019 remand. Analysis Prior to June 29, 2011, the Veteran’s service-connected low back disability is rated 10 percent disabling based on 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. To warrant a higher rating of 20 percent, the Veteran would need to display 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. The Board finds the symptomology associated with the service-connected lower back condition most nearly approximates the criteria for a 10 percent rating currently assigned under the applicable rating criteria. The evidence of record during the rating period on appeal is limited. At his February 2008 VA examination, his flexion extended to 80 degrees. Later, a review of symptoms in July 2011, reported the Veteran denied back pain. This was a month after June 2011 but is relevant as the period on appeal ended a few days before July 2011. Additionally, the Veteran specifically reported at his most recent August 2019 VA examination that his range of motion did not change during this period on appeal. While the record indicates the Veteran was experiencing back pain during this period on appeal the Veteran is already being compensated for his pain with his 10 percent rating. After June 29, 2011, the Veteran is currently rated at 20 percent based on forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined ROM of the thoracolumbar spine not greater than 120 degrees. In order for the Veteran to warrant the next higher rating of 40 percent, there must be evidence of forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The Board finds the symptomology associated with the service-connected lower back condition most nearly approximates the criteria for a 20 percent rating currently assigned under the applicable rating criteria after June 29, 2011. The Veteran’s forward flexion was limited to, at most, 35 degrees as noted at his most recent VA examination in August 2019; and ankylosis has continuously been denied during this period on appeal. The Board finds the clinicians observations as to the Veteran’s range of motion during the period on appeal to be worthy of probative weight. The VA examiners are competent to report on what they observe in the Veteran’s movements. The Board acknowledges that the Veteran is competent to describe symptoms that he is able to perceive through the use of his senses and to give evidence about what he has experienced. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, he is not shown to possess any medical expertise; thus, any opinion as to the severity of his low back disability is not competent medical evidence. The Board has considered whether a higher disability rating is warranted based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also Mitchell, Burton, and DeLuca, supra. Pursuant to 38 C.F.R. § 4.59, at least the minimum compensable rating for painful motion with joint or periarticular pathology is authorized. However, pain by itself throughout a joint’s range of motion does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). As discussed, the Veteran’s 10 percent rating before June 29, 2011, considers his complaints of pain. Further, there is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness, or incoordination. See 38 C.F.R. §§ 4.40 and 4.45 and DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). There is no finding that the Veteran’s low back was limited due to these factors to warrant the next higher criteria. Even when considering pain, fatigue, weakness, lack of endurance, incoordination or flare-ups, functional ability described in terms of ROM showed, at worst, flexion was limited to 80 degrees before June 29, 2011 and limited to 35 degrees thereafter. See 38 C.F.R. § 4.45, 4.71a; DeLuca, 8 Vet. App. at 202; Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In addition, the Veteran did not report flare-ups at any of his VA examinations. Thus, the Board finds that the current 10 percent rating before June 29, 2011, and the 20 percent rating thereafter for the lower back condition contemplates functional loss due to pain, excess fatigability, and less movement. There is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness or incoordination at any point during the period of appeal. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 206-07. To the extent radiculopathy was reported, the Veteran is already separately service-connected for those symptoms; and their ratings are not on appeal. In sum, the preponderance of the evidence indicates a rating in excess of 10 percent before June 29, 2011 and in excess of 20 percent thereafter, is not warranted for the Veteran’s lower back disability. 2. Entitlement to a TDIU prior to June 29, 2011, is denied. A TDIU may be granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining or obtaining of substantially gainful employment. Substantially gainful employment is 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(a). If there is only one service-connected disability, it must be ratable at 60 percent or more to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there must be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). During the period on appeal, the Veteran is service-connected for arthritic/degenerative facet changes and degenerative disc disease at L2-3, L3-4, and L4-5 of the thoracolumbar spine, at a 10 percent rating, degenerative arthritic changes at the right thumb carpometacarpal joint, with a 10 percent rating, degenerative arthritis of the right knee, with a 10 percent rating, right and left second toes Morton’s metatarsalgia status post osteotomy plantar fascitis, inferior calcaneal spur and first metatarsal phalangeal joint arthritis, both at a 10 percent rating, tinnitus, at a 10 percent rating, left atrial enlargement and left ventricular hypertrophy, at a 10 percent rating, scar status post wrist melanoma excision, at a 10 percent rating, bilateral ocular histoplasmosis and macular degeneration, at a noncompensable rating, right ear hearing loss, at a noncompensable rating, scar at the bottom of the left foot status post bunionectomy, at a noncompensable rating, scar status post right ulnar nerve transposition, at a noncompensable rating, scars status post laceration of the right index and long finger with residual sensory dysfunction of the finger tips, at a noncompensable rating, scar at the dorsal aspect of left foot at the first metatarsophalangeal joint status post bunionectomy, at a noncompensable rating, right cubital tunnel syndrome, at a noncompensable rating, and left ankle scar, medical aspect of left medial distal to the medical malleolus associated with left second toe Mortons metatarsalgia status post bunionectomy, plantar fascitis, inferior calcaneal spur and first metatarsal phalangeal joint arthritis, with a noncompensable rating. He had a combined total rating for the period of 60 percent, and the ratings for these disabilities may not be combined to be considered a single disability. 38 C.F.R. § 4.16(a). As such, the Veteran did not meet the threshold requirements for a schedular TDIU. Where a veteran does not meet the schedular TDIU criteria, a total rating may be assigned on an extraschedular basis upon a showing that s/he is unable to obtain or retain substantially gainful employment due solely to service-connected disabilities. 38 C.F.R. § 4.16(b) (2019). The Board is unable to award an extraschedular TDIU in the first instance, and instead must first determine whether referral to VA’s Director of Compensation Services is warranted. See Bowling v. Principi, 15 Vet. App. 1, 10 (2001). The determination of a referral is dependent on “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993) VA medical records report the Veteran was working in full time employment at Camp Attebury in July 2011, a month after this period on appeal ended. Subsequent VA medical records report he continued to work full time, even as a manager, as recent as August 2014. The salary for this position is not in the record, but there is no allegation from the Veteran or any evidence of record which suggests this employment is not gainful. Therefore, the record has demonstrated that he was able to secure and follow a substantially gainful occupation despite his service-connected disabilities during this period. In short, the evidence does not indicate that service-connected disability precluded him from gainful employment prior to June 29, 2011. The Board acknowledges that the Veteran experienced loss of industrial capacity due to his service-connected disabilities during this period on appeal. As noted in his June 2008 notice of disagreement and his February 2009 Form 9, he experienced pain, limits with bending and lifting, limits with walking, standing, and performing weight bearing activities; cold sensitivity; and limits with grasping things. Loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321 (a), 4.1. Specifically, 38 C.F.R. § 4.1 states: “[g]enerally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.” See also Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992). A disability rating itself is recognition that the impairment makes it difficult to obtain or keep employment. By the schedular ratings assigned during the appeal period, the Veteran has already been compensated for interference with occupational functioning due to his service-connected disabilities. Accordingly, the preponderance of the evidence indicates the Veteran was still able to perform the mental and/or physical acts of employment, as corroborated by his full-time employment for 3 subsequent years after the appeal period ended. Therefore, referral for TDIU for extraschedular consideration is not warranted. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert, 1 Vet. App. at 55-57. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.