Citation Nr: 21006983 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-13 941 DATE: February 8, 2021 ORDER A rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the left upper extremity is denied. A rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the right upper extremity is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Prior to August 28, 2020, the Veteran’s peripheral neuropathy of the bilateral upper extremities resulted in no more than mild incomplete paralysis of the median nerves. 2. As of August 28, 2020, the Veteran’s peripheral neuropathy of the bilateral upper extremities results in no more than mild incomplete paralysis of the musculospiral (radial) nerves. 3. Resolving all doubt in the Veteran’s favor, his service-connected disabilities render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.120, 4.124a, Diagnostic Codes (DCs) 8515, 8514. 2. The criteria for a rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.120, 4.124a, DCs 8515, 8514. 3. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to May 1969, September 1990 to July 1991, and February 2003 to February 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2016, the Veteran testified before a Decision Review Officer (DRO) at the RO and, in June 2019, he testified at a Board hearing before the undersigned Veterans Law Judge. Transcripts of both hearings are associated with the record. In September 2019, the Board remanded the case for additional development. While on remand, a September 2020 rating decision increased the ratings assigned for the Veteran’s peripheral neuropathy of the bilateral upper extremities 20 percent, effective August 28, 2020. However, as he is presumed to be seeking the maximum available benefit for a disability, and higher ratings for such disabilities are available, such claims remains on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The claims have also been characterized to reflect that staged ratings are in effect. Hart v. Mansfield, 21 Vet. App. 505 (2007). The case now returns for further appellate review. 1. Entitlement to a rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the left upper extremity. 2. Entitlement to a rating in excess of 10 percent prior to August 28, 2020, and in excess of 20 percent thereafter for peripheral neuropathy of the right upper extremity. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found—a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart, supra. Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261–62 (1994). The appeal period before the Board begins on June 23, 2015, the date of receipt of the Veteran’s claim for increased ratings, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the appeal period prior to August 28, 2020, the Veteran’s peripheral neuropathy of the bilateral upper extremities has been rated as 10 percent disabling pursuant to DC 8515, which pertains to the median nerve. As of August 28, 2020, such disabilities have been rated as 20 percent disabling pursuant to DC 8514, which pertains to the musculospiral (radial nerve). In this regard, DC 8515 provides the rating criteria for paralysis of the median nerve. Disability ratings of 10 percent, 30 percent, and 50 percent are assignable for incomplete paralysis that is mild, moderate, or severe in degree, for the major arm, respectively. Disability ratings of 10 percent, 20 percent, and 40 percent are assignable for incomplete paralysis that is mild, moderate, or severe in degree, for the minor arm, respectively. Complete paralysis of such nerve, which is rated as 70 disabling for the major side and 60 percent disabling for the minor side, contemplates the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand), pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended, cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm, flexion of wrist weakened, and pain with trophic disturbances. DC 8515 provides the rating criteria for paralysis of the musculospiral (radial) nerve. Disability ratings of 20 percent, 30 percent, and 50 percent are assignable for incomplete paralysis that is mild, moderate, or severe in degree, for the major arm, respectively. Disability ratings of 20 percent, 20 percent, and 40 percent are assignable for incomplete paralysis that is mild, moderate, or severe in degree, for the minor arm, respectively. Complete paralysis of such nerve, which is rated as 70 disabling for the major side and 60 percent disabling for the minor side, contemplates drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of the wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, a disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. Turning to the evidence of record, at an August 2015 VA examination, the Veteran reported that tingling, numbness, and mild paresthesia of the bilateral upper extremities that became slightly more progressive over the prior six months. Upon examination, it was noted that the Veteran is right hand dominant, and reported mild paresthesias and/or dysesthesias and numbness, but denied constant and intermittent pain. Muscle strength and reflexes were normal at 5/5 and 2+, respectively, throughout the bilateral upper extremities. Upon sensory testing, the Veteran had decreased sensation in the bilateral inner/outer forearm and hands/fingers, but normal sensation in the shoulders. He had normal position sense, but decreased vibratory sensation in the bilateral upper extremities. There was no muscle atrophy or tropic changes. Upon review of the Veteran’s subjective symptoms and objective examination, the examiner found that the Veteran had peripheral neuropathy of the bilateral upper extremities, which was mild in nature, but determine that his musculospiral (radial), median, and ulnar nerves were normal, without incomplete or complete paralysis. At the October 2016 DRO hearing, the Veteran testified that his peripheral neuropathy of the bilateral upper extremities resulted in difficulty driving, working around the house, and cutting the lawn. A December 2016 Disability Benefits Questionnaire (DBQ) completed by the Veteran’s private physician, Dr. G.F., reflects that the Veteran is right hand dominant, and reported severe intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness. Muscle strength testing was normal at 5/5 throughout the bilateral upper extremities, with the exception of pinch (thumb to index finger) on the right, which was reduced at 4/5. Reflex were normal in the biceps and brachioradialis on the right, but were reduced at 1+ on the left. Such were also absent at the triceps bilaterally. Sensory testing was normal in the bilateral shoulders and inner/outer forearms, and decreased in the hands/fingers. Position sense and vibration sensation were normal in the bilateral upper extremities. There was no muscle atrophy or trophic changes. Upon review of the Veteran’s subjective symptoms and objective examination, Dr. G.F. found that the Veteran had peripheral neuropathy of the bilateral upper extremities that resulted in mild incomplete paralysis of the median nerve. The musculospiral (radial) and ulnar nerves were noted to be unaffected. At the June 2019 Board hearing, the Veteran testified that he has difficulty doing chores around the house and picking up his grandchildren. He also indicated that he has constant burning, tingling, pain, and loss of sensation in his upper extremities, and a deformity of the last two fingers on his right hand as he cannot fully open such hand. In July 2019, Dr. G.F. reported that the Veteran’s peripheral neuropathy of the bilateral upper extremities resulted in a moderate degree of severity; however, he did not provide any clinical findings in support of such conclusion. Accordingly, the Board remanded the claims in order to obtain a new examination evaluating the severity of the Veteran’s peripheral neuropathy of the bilateral upper extremities. In November 2019, an EMG/nerve conduction study (NCS) revealed a superimposed mild to moderate median neuropathy at both wrists, slight worse on the left, and a suggestion for compressive ulnar neuropathy at both elbows, mild on the right and moderate on the left, but there was no evidence of muscle denervation. At a VA examination conducted on August 28, 2020, the Veteran reported that his peripheral neuropathy of the bilateral upper extremities had progressed/worsened, and he currently experienced constant numbness, tingling, and pain in both hands. Upon examination, it was noted that the Veteran is right hand dominant, and reported mild constant pain and numbness, but denied intermittent pain and paresthesias and/or dysesthesias. Muscle strength testing was normal at 5/5 at the bilateral elbow extension, wrist flexion and extension, grip, and pinch, but was reduced at 4/5 at the bilateral elbow flexion. Reflex and sensory testing were normal throughout the bilateral upper extremities. There was no muscle atrophy or trophic changes. Phalen’s sign and Tinel’s sign were negative bilaterally, thus indicating no median nerve involvement. Upon review of the Veteran’s subjective symptoms and objective examination, the examiner found that the Veteran had peripheral neuropathy of the bilateral upper extremities that resulted in mild incomplete paralysis of the musculospiral (radial) nerve. All other nerves of the bilateral upper extremities were noted to be unaffected. Based on the foregoing, the Board finds that, prior to August 28, 2020, the Veteran’s peripheral neuropathy of the bilateral upper extremities resulted in no more than mild incomplete paralysis of the median nerves. In this regard, the record reflects the Veteran’s subjective complaints of pain, tingling, numbness, paresthesia, and objective findings of decreased, but not absent, sensation, with normal muscle strength, except for a slight reduction of pinch on the right in December 2016 and normal reflexes, with the exception of hypoactive reflexes of the left biceps and brachioradialis and absent reflexes at the bilateral triceps in December 2016. Moreover, upon consideration of the Veteran’s subjective symptoms and objective examination, the August 2015 VA examiner found that his peripheral neuropathy of the bilateral upper extremities was mild in nature without incomplete or complete paralysis of any nerve. Furthermore, even in consideration of additional objective findings showing that muscle strength, reflexes, and sensation were affected by the Veteran’s peripheral neuropathy of the bilateral upper extremities, his private physician, Dr. G.F. found that such disabilities resulted in no more than mild incomplete paralysis of the median nerves, without involvement of the musculospiral (radial) and ulnar nerves. The Board has also considered Dr. G.F.’s July 2019 report that the Veteran’s peripheral neuropathy of the bilateral upper extremities resulted in a moderate degree of severity; however, he did not provide any clinical findings in support of such conclusion. Accordingly, the Board affords such assessment no probative weight. Furthermore, while a November 2019 EMG/NCS revealed a superimposed mild to moderate median neuropathy at both wrists, slight worse on the left, and a suggestion for compressive ulnar neuropathy at both elbows, mild on the right and moderate on the left, such testing is performed for diagnostic purposes and there are no additional examination findings so as to assess the overall severity of the Veteran’s peripheral neuropathy of the bilateral upper extremities. Thus, the Board likewise affords such EMG/NCS limited probative value. Therefore, based on the foregoing, the Board finds that, prior to August 28, 2020, as the Veteran’s peripheral neuropathy of the bilateral upper extremities resulted in no more than mild incomplete paralysis of the median nerves, a rating in excess of 10 percent under DC 8515 is not warranted. Furthermore, as of such date, the Board finds that the Veteran’s peripheral neuropathy of the bilateral upper extremities results in no more than mild incomplete paralysis of the musculospiral (radial) nerves. In this regard, the August 2020 VA examination reflects the Veteran’s subjective reports of constant numbness, tingling, and pain in both hands with normal muscle strength testing, except for a slight reduction at the bilateral elbow flexion, and normal reflex and sensory testing. Furthermore, upon review of the Veteran’s subjective symptoms and objective examination, the examiner found that the Veteran had peripheral neuropathy of the bilateral upper extremities that resulted in mild incomplete paralysis of the musculospiral (radial) nerve. Consequently, the Board finds that, as of August 28, 2020, a rating in excess of 20 percent for such disability is not warranted. In reaching such determinations, the Board observes that, prior to August 28, 2020, the Veteran’s median and ulnar nerves were noted to be affected by his peripheral neuropathy; however, as such date, such were found to be normal and his musculospiral (radial) nerve was found to be affected. In this regard, such nerves stem from the same branch and affect similar functions of the upper extremities. Therefore, assigning separate ratings for such affected nerves would be tantamount to pyramiding and is precluded by law. 38 C.F.R. § 4.14; Esteban, supra. Moreover, while evaluating the Veteran’s peripheral neuropathy of the bilateral upper extremities pursuant to DC 8514 pertinent to the musculospiral (radial) nerve is more beneficial to the Veteran, there is no indication that such nerve was affected prior to August 28, 2020. Thus, an earlier effective date for the award of a 20 percent rating based on such DC is not warranted. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his peripheral neuropathy of the bilateral upper extremities is more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether additional staged ratings under Hart, supra, are appropriate for the Veteran’s peripheral neuropathy of the bilateral upper extremities; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Thus, assigning additional staged ratings for such disabilities is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Therefore, the Board finds that increased ratings for the Veteran’s peripheral neuropathy of the bilateral upper extremities is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's increased rating claim. Consequently, that doctrine is not applicable in the instant appeal, and such claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a TDIU. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall 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). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant 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. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the United States Court of Appeals for Veterans Claims (Court) held defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. As an initial matter, the Board notes that the Veteran meets the schedular requirements for a TDIU for the entire appeal period stemming from his June 23, 2015, claim. Specifically, during such period, he is service-connected for right shoulder osteoarthritis with total shoulder arthroplasty, diabetes mellitus type II, peripheral neuropathy of the bilateral upper and lower extremities, posttraumatic stress disorder (PTSD), post-operative residuals of pilonidal cystectomy, bilateral hearing loss, and a right shoulder scar. Furthermore, for such period, he is in receipt of a combined disability rating of 70 percent prior to March 13, 2018, and 80 percent thereafter, with one disability, i.e., diabetes mellitus type II and peripheral neuropathy of the four extremities, rated as more than 40 percent disabling. Thus, the remaining inquiry is whether the Veteran’s service-connected disabilities render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. In this regard, in his Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940), the Veteran reported that he last worked full time on January 1, 2007, as a heavy equipment operator for Berkeley Township, a position that he held since January 1, 1979. He further indicated that he had a high school education without further training. In August 2015, Berkeley Township indicated that the Veteran worked as a heavy equipment operator from June 1981 through December 2007 when he retired. In his June 2015 VA Form 21-8940, the Veteran reported that, due to his diabetes mellitus type II with peripheral neuropathy of all four extremities and right shoulder disability, he had retired from his position as a heavy equipment operator at Berkeley Township as he had problems dropping or opening things due to his peripheral neuropathy in his bilateral upper extremities and could not feel his feet when operating the equipment. Further, at his June 2019 Board hearing, the Veteran testified that he retired from his long-term job operating heavy machinery because his bilateral upper and lower extremity peripheral neuropathy prevent him from safely operating the hand controls and pedals of such machinery. Specifically, the Veteran explained that he has trouble keeping his right hand open, with his last two fingers on that hand unable to straighten or grip appropriately. He further stated that things could fall out of his hand, to include the operating controls for the bulldozers, cranes, and front-end loaders, without his feeling the movement. He stated that, when factoring in some interpersonal challenges resulting from his PTSD, his service-connected disabilities prevented him from working. In regard to the functional impairment associated with the Veteran’s service-connected disabilities, a January 2011 VA examination indicated that his bilateral hearing loss resulted in an increased challenge in hearing when in the presence of background noise and/or when more than one person is speaking at a time. However, at a January 2011 VA examination, an examiner found that the Veteran’s PTSD symptoms were mild in nature, and his occupational and social functioning had not been adversely impacted. Similarly, August 2015 and March 2018 VA examination revealed that his diabetes mellitus type II and right shoulder disability, respectively, did not impact his ability to perform physical or sedentary activities. However, at an August 2015 VA peripheral neuropathy examination, the Veteran reported tingling, numbness, and mild paresthesias in both the upper and lower extremities, and examination revealed hypoactive reflexes at the bilateral ankles, and decreased sensation in the inner/outer forearm, hand/fingers, ankle/lower leg, and foot/toes. Furthermore, he had decreased position sense in the bilateral lower extremities, and decreased vibration sense in all four extremities. Nonetheless, the examiner found that such disabilities did not impact the Veteran’s ability to work. At the October 2016 DRO hearing, the Veteran reported that his peripheral neuropathy resulted in difficulty driving, working around the house, cutting the lawn. He also indicated that the medications he takes for such disabilities made him sleepy. In the December 2016 DBQ, Dr. G.F. noted severe constant pain and paresthesias and/or dysesthesias, and moderate numbness in the bilateral lower extremities and severe intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness in the bilateral upper extremities. Further, the Veteran had reduced muscle strength with pinch (thumb to index finger) in the right upper extremity, reduced or absent reflexes in the left bicep, bilateral triceps, left brachioradialis, and bilateral ankles. There was also decreased sensation in the hands/fingers, ankle/lower leg, and foot/toes bilaterally, and absent position sense, vibration sensation, and cold sensation in the bilateral lower extremities. Dr. G.F. indicated that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities affect his ability to work as such resulted in severe pain, side effects from medication, and balance and gait disturbances. In July 2019, Dr. G.F. opined that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities was moderate in severity, but resulted in permanent neurologic disability that precluded any gainful employment. At an August 2020 VA examination, such service-connected disabilities were noted to result in mild constant pain and numbness with reduced muscle strength in bilateral elbow flexion, and the examiner found that, due to the Veteran’s peripheral neuropathy of the bilateral upper extremities, he would have difficulty with repetitive mobility of both hands. Based on the foregoing, the Board resolves all doubt in the Veteran’s favor and finds that his service-connected disabilities render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. In this regard, the record shows that the Veteran worked for his entire career as a heavy equipment operator and only has a high school education. Furthermore, due primarily to his peripheral neuropathy of the bilateral upper and lower extremities, he is unable to perform the physical duties associated with such position. Specifically, due to impairment in muscle strength, reflexes, and sensation in all four extremities, the Veteran is not able to safely perform his duties operating heavy equipment as such requires manipulating hand controls and utilizing pedals. Moreover, due to his limited education and work experience, he does not have skills that are transferable to other positions or lines of work. Therefore, the Board finds that a TDIU is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Breckenridge, Associate 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.