Citation Nr: 21008471 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 16-47 891 DATE: February 17, 2021 ORDER A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) throughout the appeal period is granted. FINDING OF FACT 1. The Veteran reports unemployability due to her service-connected hysterectomy residuals with abdominal adhesions (causing abdominal pain and vomiting) and various orthopedic issues. 2. During the period on appeal (i.e., extending one year before the May 29, 2013 report of contact that initiated this claim), she has been service connected for hysterectomy residuals with bilateral ovary removal, previously rated as polycystic ovaries with adhesions (rated 50 percent), bilateral pes planus with plantar fasciitis and bilateral heel spurs (rated 30 percent), right shoulder degenerative joint disease (DJD) and bursitis (rated 20 percent), left lower extremity radiculopathy (rated 10 percent), right hip DJD (rated 10 percent), left hip DJD (rated 10 percent), thoracolumbar spine degenerative arthritis (rated 10 percent), bilateral carpal tunnel syndrome (rated 10 percent), and right wrist ganglion cyst, scalp cyst, right and left foot hallux valgus, hysterectomy scar, and right foot bunionectomy scar (each rated 0 percent). Her combined rating during the period on appeal is 80 percent prior to June 28, 2017 and 90 percent thereafter, clearly satisfying the schedular criteria under 38 C.F.R. § 4.16(a). 3. The evidence shows the Veteran has primarily worked as a cook, caterer and caregiver (i.e., physical jobs) with some experience in clerical, sedentary jobs. 4. Medical evidence of record shows that her low back, right hip, bilateral foot, and right shoulder disabilities have severely limited her ability to walk, stand, sit, run, climb stairs, reach overhead, squat, or perform other similar functions for prolonged periods in the year preceding this claim (e.g., July 2012 complaints of increased back pain with prolonged standing, bending, stooping, or lifting and multiple October 2012 VA examination reports noting limited right shoulder motion and pain “slows her down” and precludes frequent overhead reaching or lifting of patients as a caregiver; right hip flare-ups interfering with climbing stairs and an inability to do repetitive motion testing due to pain in flexion (which occurs when sitting as well as standing or walking), extension, and internal and external rotation; plantar fasciitis and pes planus that precluded standing for longer than 60 minutes at a time and already caused job loss in her usual occupation as a cook). 5. Subsequent medical records in June 2013 (noting back disability interfered with sitting, standing, or weight-bearing and involved incapacitating episodes of intervertebral disc syndrome totaling two to four weeks over the prior year and right hip disability that limited prolonged squatting, climbing, running, walking, and standing), August 2016 (noting bilateral foot symptoms continued to limit walking, shoulder impairment continued to limit overhead lifting, and hip symptoms continued to limit prolonged standing, walking, kneeling, or crawling), August 2017 (noting shoulder impairment precluding repetitive motion or lifting, lifting over five pounds at chest level, or continuous work or long overhead reaching; hip impairment limiting squatting “to a minimum” and “time spent walking and standing”; and foot disability limiting her to sedentary work “with a limited amount of walking and standing”), October 2017 (noting back impairment that left her limited to work in “a sedentary work environment if she is able to stand frequently and stretch, or light duty with occasional light lifting and very limited bending/twisting at the waist and upper back”), and January 2019 (indicating that a sedentary position with allowances to stretch her back and hips and not involving any lifting or motion above the shoulder “would be advised”) do not suggest her condition has materially improved at any time. 6. On the contrary, the added service connection of bilateral carpal tunnel syndrome (with competent reports of tingling and numbness in the hands since the 1980s on October 2017 VA examination) suggests additional impairment of more fine motor skills typically required in precisely the sort of sedentary positions recommended by other VA examiners during the appeal period. 7. Furthermore, clinical records and VA examinations show the Veteran has a long history of unpredictable abdominal issues involving intense abdominal pain, nausea, and vomiting that can detain her for long periods of time and have required recurrent hospital admissions since the year preceding this claim, and it would be reasonable to state that such pathology would certainly make working in any job consistently and reliably difficult, particularly considering both the practical effects of active “episodes” and the general anxiety associated with constantly anticipating such “episodes.” 8. Notably, a response from a former employer indicates that she most recently worked as a cook from September 2014 to October 15, 2018, presumably in extremely limited, part-time shifts (as she earned only $8,462.90 over four years), because she “couldn’t do the job without help.” Indeed, a contemporaneous statement indicates she had tried to work the job seasonally but it became progressively harder, and she required more frequent rest due to frequent and intense pain from her back, hips, and feet as well as locking of the hips and weak, painful shoulders. She reportedly needed help every day, which her employer could not provide. 9. Accordingly, even considering her experience in sedentary work, the evidence is at least in relative equipoise as to whether the Veteran’s service connected disabilities caused impairment that would be inconsistent with obtaining or following substantially gainful physical or sedentary employment in an unprotected environment throughout the appeal period. In so finding, the Board is particularly mindful of her limitations in both sitting and standing as well as additional fine motor impairment from her bilateral carpal tunnel syndrome. Consequently, the Board resolves all remaining reasonable doubt in her favor and grants this appeal. CONCLUSION OF LAW The criteria for TDIU are met. 38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19, 4.25 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from April 1979 to June 1980 and March 1981 to March 1990. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision appealed in a timely March 2015 notice of disagreement (NOD) and perfected by a timely September 2016 substantive appeal in response to an August 2016 statement of the case (SOC). In January 2021, a hearing was held before the undersigned; a transcript of the hearing is associated with the record. For the reasons outlined above, the Board grants the appeal throughout the relevant review period, obviating any need for further discussion thereof at this time. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yuan, 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.