Citation Nr: 21011579 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-23 299A DATE: March 2, 2021 ORDER Entitlement to an initial evaluation in excess of 20 percent for left lower extremity radiculopathy is denied. Entitlement to an initial evaluation in excess of 20 percent for right lower extremity radiculopathy is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), from October 31, 2008 to February 25, 2017, is granted. FINDINGS OF FACT 1. The Veteran’s left lower extremity radiculopathy was manifested by no more than moderate neuralgia of the sciatic nerve. 2. The Veteran’s right lower extremity radiculopathy was manifested by no more than moderate neuralgia of the sciatic nerve. 3. From October 31, 2008 to February 25, 2017, the Veteran’s service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 20 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124a, Diagnostic Code 8520. 2. The criteria for an initial evaluation in excess of 20 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to a TDIU, from October 31, 2008 to February 25, 2017, are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 1976 to January 1981. The Veteran died in March 2018, and the appellant is his surviving spouse. The appellant requested to be substituted for the Veteran in this appeal and her motion for substitution was granted by the Agency of Original Jurisdiction (AOJ) in June 2018. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Board issued a decision which, in pertinent part, granted an increased initial evaluation of 20 percent for the Veteran’s left lower extremity radiculopathy, effective October 31, 2008; granted an increased initial evaluation of 20 percent for the Veteran’s right lower extremity radiculopathy, effective October 31, 2008; and granted entitlement to TDIU. In March 2019, the RO issued a rating decision which effectuated the Board’s September 2018 decision, including the award of entitlement to TDIU, effective February 25, 2017. The appellant timely appealed the portion of the Board’s September 2018 decision relating to his left and right lower extremity radiculopathy to the United States Court of Appeals for Veterans Claims (Court). In September 2019, the Court granted a Joint Motion for Remand, which set aside the portion of the Board’s September 2018 decision to the extent it denied initial evaluations in excess of 20 percent for the Veteran’s left and right lower extremity radiculopathy, and remanded the matter for further adjudication consistent with the Joint Motion. In June 2020, the Board remanded this matter for additional development. The RO subsequently obtained the medical records requested by the Board, as well as the requested medical opinion. The Board finds these actions to be in substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that substantial, rather than strict, compliance with remand directives is required). Although the RO granted entitlement to a TDIU, effective February 25, 2017, the issue of entitlement to a TDIU, prior to February 25, 2017, remains in appellate status. Payne v. Wilkie, 31 Vet. App. 373 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018). Increased Ratings The Veteran’s right and left lower extremity radiculopathy are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520, used in evaluating paralysis of the sciatic nerve. Under 38 C.F.R. § 4.124a, Diagnostic Code 8520, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. 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 is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. 1. Entitlement to an initial evaluation in excess of 20 percent for left lower extremity radiculopathy. 2. Entitlement to an initial evaluation in excess of 20 percent for right lower extremity radiculopathy. Based upon a longitudinal review of the evidence of record, the Board finds that the Veteran’s left and right lower extremity radiculopathy manifested no more than moderate neuralgia of the sciatic nerve. Thus, an evaluation in excess of 20 percent is not warranted any time throughout this appeal period. A November 2007 VA MRI of the lumbar spine noted the Veteran’s complaints of back pain radiating down into the legs and causing him to stumble. A January 2009 podiatry report noted his complaints of foot pain, numbness, coldness, and occasional swelling. The report listed an assessment of radiculopathy, secondary to chronic spinal stenosis; and chronic foot pain. A June 2009 VA treatment report noted the Veteran’s history of chronic low back pain which radiates down into his legs. Physical examination revealed normal muscle tone and bulk, and 5/5 strength throughout the lower extremities. He was hyporeflexic with reflexes 1+ throughout. Sensation was intact to light touch, pin, temperature, and vibration testing, and his gait was antalgic with a cane. During his March 2012 VA back examination, the Veteran reported back discomfort, with flare ups of pain occurring with prolonged sitting. Physical examination revealed a range of motion of the thoracolumbar spine consisting of flexion to 70 degrees, with pain at 70 degrees; extension to 25 degrees, with pain at 25 degrees; right lateral flexion to 20 degrees, with pain at 20 degrees; left lateral flexion to 25 degrees, with pain at 25 degrees; and right and left lateral rotation both to 30 degrees or greater with no objective evidence of painful motion. Range of motion of the thoracolumbar spine remained the same following repetitive motion testing, with the exception of left lateral flexion which was reduced to 20 degrees. There was functional loss/functional impairment of the thoracolumbar spine in terms of less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and/or weight-bearing. There was right sciatic notch tenderness to deep palpation and the Veteran experienced guarding and/or muscle spasm, but these symptoms did not result in an abnormal gait or abnormal spinal contour. Moreover, right lower extremity muscle strength associated with hip flexion, knee extension, ankle plantar flexion and dorsiflexion, and great toe extension was impaired (4/5), and left lower extremity muscle strength was normal (5/5). There was no muscle atrophy, lower extremity reflexes were normal (2+) bilaterally, lower extremity sensation was normal bilaterally, straight leg raise testing was normal bilaterally, there was no radicular pain or any other signs or symptoms due to radiculopathy, and there were no other neurologic abnormalities or findings related to the Veteran’s back disability. He had intervertebral disc syndrome of the thoracolumbar spine, but he had not experienced any incapacitating episodes over the previous 12 months. He constantly used a brace and cane, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There were no scars associated with the Veteran’s back disability and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. Diagnoses of degenerative disc disease L3-4, L4-5 and lumbar stenosis were provided. This disability did not impact the Veteran’s ability to work. The examiner who conducted the March 2012 examination noted that the Veteran’s right ankle weakness associated with ankle dorsiflexion and plantar flexion was due to an Achilles tendon injury and was not related to his back disability. There was no further explanation or rationale provided for this opinion. A June 2012 VA treatment report noted the Veteran’s complaints of pain and numbness in his feet, and intermittent muscle cramping and spasms to the feet. Physical examination revealed intact protective threshold sensation, 4/5 muscle strength bilaterally, and pain in the heel and sinus tarsi. In a March 2013 notice of disagreement, the Veteran’s representative contended that in light of the Veteran’s reports of flare ups, the spinal range of motion findings recorded during the March 2012 examination were “elevated compared to reality.” While it was not disputed that “the 70 degrees of attained flexion [was] the extreme ability,” it was disputed that “the point of pain intrusion [was] at some point before the 70-degree mark, and, when evaluated during flare-up, considerably before the 70-degree mark.” This was further evidenced by the examiner’s findings of less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, or weight-bearing.” Moreover, the Veteran’s representative disputed the findings of no radicular complaints during the March 2012 examination, especially in light of the fact that the Veteran reported radicular symptoms in 2009, had not undergone any surgical intervention, and had experienced continued deterioration of his spine as a whole. VA treatment records dated in September 2013 and May 2016 document reports of back pain which radiated to the lower extremities bilaterally and a burning sensation in the feet. The pain increased with activity. An examination revealed mild tenderness at the lumbosacral junction, positive straight leg raise testing bilaterally, and moderately limited flexion of the lumbar spine. X-rays revealed moderate facet arthropathy and degenerative disc disease. The Veteran was diagnosed as having chronic low back and leg pain (left greater than right, likely multifactorial from degenerative joint disease, facet arthropathy, and lumbar radiculitis), moderate lumbar facet arthropathy, and multilevel degenerative disc disease of the lumbar spine. In February 2017, a VA examination of the back was conducted. The VA examiner noted that the Veteran’s claims file had been reviewed, and the Veteran’s contentions as to the severity of this condition were noted. The VA examiner physically examined the Veteran and also supported opinions provided with a sufficient rationale. The report listed diagnoses of degenerative joint disease of the lumbar spine with spinal stenosis, and bilateral lower extremity radiculopathy. The Veteran reported that 3 years prior to the examination, his back pain was 6/10 at rest and 7/10 with activity, and that he was able to walk 2 blocks, stand for 30 minutes at a time, sit for 45 minutes, and occasionally lift 20 pounds. At the time of the February 2017 examination, however, the Veteran reported increased functional loss/functional impairment of the thoracolumbar spine in that he was only able to walk ½ block at a time with a walker and back brace, was limited to standing 5 minutes at a time and sitting 15 minutes at a time, and was only able to occasionally lift 5 pounds. There were no reported flare ups of his back symptoms. He treated his back symptoms with medications. Physical examination revealed the range of motion of the thoracolumbar spine consisting of flexion to 35 degrees, extension to 5 degrees, right and left lateral flexion to 5 degrees, and right and left lateral rotation to 10 degrees. There was pain associated with all ranges of spinal motion other than left lateral rotation, the pain caused functional loss, and the Veteran experienced difficulty putting on shoes and picking up objects off the floor due to his back symptoms. There was pain on palpation of the lower back which was 8/10 in severity and evidence of pain with weight-bearing. The Veteran was unable to perform repetitive use testing of the spine due to pain. The Veteran was not examined immediately after repetitive use over time, but the examination was medically consistent with his statements describing functional loss with repetitive use over time. Pain, fatigue, weakness, lack of endurance, and incoordination significantly limited the Veteran’s functional ability with repeated use over time, but the examiner noted that the ranges of spinal motion would remain the same with repeated use over time despite these factors. Also, the examination was not being conducted during a flare up and the Veteran had not reported any flare ups of his back disability. Muscle spasms, localized tenderness, and guarding of the thoracolumbar spine caused kyphosis of the lumbar curve and the Veteran had to lean forward to walk. There was also less movement than normal, weakened movement, instability of station, disturbance of locomotion, interference with sitting, and interference with standing. Lower extremity muscle strength was normal (5/5) bilaterally, there was no muscle atrophy, and lower extremity reflexes were normal (2+) bilaterally. Sensation at the upper anterior thighs and thighs/knees was normal bilaterally, but sensation was decreased at the lower legs/ankles and feet/toes bilaterally. Straight leg raise testing was positive bilaterally, there was severe intermittent pain of the lower extremities bilaterally, and there was moderate constant pain, paresthesias/dysesthesias, and numbness of the lower extremities bilaterally. Overall, the examiner concluded that the radiculopathy of the Veteran’s lower extremities was moderate in severity. There was no ankylosis of the spine and the Veteran did not have intervertebral disc syndrome. He constantly used a walker and brace due to his back disability, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There were no scars associated with the Veteran’s back disability and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran was diagnosed as having degenerative joint disease of the lumbar spine with spinal stenosis and bilateral lower extremity radiculopathy. This disability impacted his ability to work in that he was limited to walking ½ block at a time, standing 5 minutes at a time, sitting 15 minutes at a time, and lifting 5 pounds occasionally. In addition, the physician who conducted the February 2017 examination noted that there was pain with non weight-bearing (8/10) and pain with passive range of motion. In September 2020, the VA examiner opined that it was not possible to distinguish between the lower extremity symptoms attributable to Veteran’s service-connected radiculopathy of the bilateral lower extremities and those attributable to his nonservice-connected diabetic neuropathy involving the lower extremities. In support of this opinion, the VA examiner noted that the symptoms clinically overlap. Under these circumstances, the Board accepts the overall symptomatology of his lower extremities to be due to his service-connected bilateral lower extremity radiculopathy. Regarding impairment of motor functions, the Veteran’s right lower extremity muscle weakness was noted as 4/5 in the March 2012 examination, and 5/5 in the February 2017 VA examination. His left lower extremity muscle strength was noted as 5/5 during both examinations, and only 4/5 muscle strength in June 2012. Regarding muscle atrophy, no muscle atrophy was found during this period of time. Regarding sensory disturbance, the February 2017 VA examination of the back noted decreased sensory examination findings in his lower leg/ankle and foot/toes, bilaterally. Findings for his upper anterior thigh and thigh/knee were normal, bilaterally. Straight leg raising were positive. The March 2012 VA examination of the back noted normal findings upon sensory examinations of the right and left lower extremities, and his straight leg raising tests were negative at this time. Regarding loss of reflexes, the VA examinations of the back in March 2012 and February 2017 both noted normal findings for reflexes at the knee and ankle level, bilaterally. A June 2009 VA treatment report noted that he was hyporeflexic with reflexes of 1+ throughout. Regarding pain and radiculopathy, the February 2017 VA examination of the back noted the Veteran’s radiculopathy in the bilateral lower extremities exhibited constant pain that was moderate, intermittent pain that was severe, paresthesias and/or dysesthesias that was moderate, and numbness that was moderate. The report noted that there was no other signs or symptoms of radiculopathy or other neurologic abnormalities. The examiner noted that this condition involved the sciatic nerve, bilaterally, and opined that the severity of the radiculopathy overall was moderate in the left and right lower extremity. The March 2012 VA examination noted that there were no signs of radicular pain and or any other signs or symptoms due to radiculopathy in the left and right lower extremity. The examiner noted that overall, the Veteran’s radiculopathy did not affect his left and right lower extremity. From October 31, 2008 through the date of the Veteran’s death, his right and left lower extremity radiculopathy was manifested by radiating pain, bilateral muscle strength no lower than 4/5, bilateral foot numbness and muscle spasms, a burning sensation in the lower extremities, decreased sensation, occasional swelling, and reflexes ranging from hyporeflexic 1+ to normal. The right lower extremity muscle weakness caused the Veteran to stumble at times and required the use of assistive devices for ambulation. The examiner who conducted the February 2017 VA examination opined that overall, the Veteran had moderate bilateral lower extremity radiculopathy. In light of the Veteran’s reported lower extremity neurological symptoms and the clinical findings of impaired sensation, decreased muscle strength, and reduced reflex response, the Board finds the symptoms of the service-connected right and left lower extremity radiculopathy most closely approximated the criteria for a 20 percent rating for incomplete paralysis of the sciatic nerve (i.e., moderate incomplete paralysis) under DC 8520 during the entire period of appeal, from the October 31, 2008 through the date of his death. A higher rating is not warranted at any time during the claim period. In particular, the Veteran’s left and right lower extremity muscle strength was no lower than 4/5, there was no lower extremity muscle atrophy, lower extremity reflexes were no worse than 1+, and the examiner who conducted the February 2017 VA examination reported that that the Veteran’s right and left lower radiculopathy was manifested by moderate incomplete paralysis of the right and left lower extremities. The Board thus finds that the level of impairment of the Veteran’s radiculopathy in the left and right lower extremities to be most analogous to and no more than moderate incomplete paralysis. The Board acknowledges that the Veteran used assistive device brace and walker due to his bilateral radiculopathy of the lower extremities. However, 38 C.F.R. § 4.120 “contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker.” Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. Accordingly, the preponderance of the evidence is against the Veteran's claims for increased initial evaluations in excess of 20 percent for left and right lower extremity radiculopathy, from October 31, 2008 through the date of the Veteran’s death. See 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. § 4.7, 4.124a, DC 8520. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a TDIU, from October 31, 2008 to February 25, 2017. A TDIU rating may be granted 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. 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). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). Where the percentage requirements for TDIU are not met, a total disability rating may nevertheless be assigned on an extraschedular basis when the veteran is unable to secure or follow a substantially gainful occupation as a result of his or her service-connected disability or disabilities. 38 C.F.R. § § 4.16(b). The Board is precluded from assigning a TDIU rating on an extraschedular basis in the first instance. Instead, a claim that meets the criteria for referral for consideration of entitlement to a TDIU rating on an extraschedular basis must be referred to the Director of Compensation Service for consideration. See Bowling v. Principi, 15 Vet. App. 1, 10 (2001). For a veteran to prevail on a claim for a TDIU rating, the record must reflect some factor which takes the case outside the norm. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). Initially, the Board concludes that the Veteran has met the schedular criteria for a TDIU rating throughout this period of appeal. During this time frame, he was service connected for: an acquired psychiatric disorder, including posttraumatic stress disorder, evaluated as 30 percent disabling; degenerative disc disease of the lumbar spine with spinal stenosis, evaluated as 20 percent disabling; left lower extremity radiculopathy associated with degenerative disc disease of the lumbar spine with spinal stenosis, evaluated as 20 percent disabling; and right lower extremity radiculopathy associated with degenerative disc disease of the lumbar spine with spinal stenosis, evaluated as 20 percent disabling. The combined disability evaluation for these disabilities was 70 percent from October 31, 2008 through February 25, 2017. His back and radicular symptoms may be considered one disability for purposes of determining schedular eligibility. The remaining issue is whether the Veteran is able to secure or follow substantially gainful employment as a result of his service-connected disabilities. Based upon a longitudinal review of the record, the Board concludes that from October 31, 2008 through February 25, 2017, the Veteran’s service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation. A June 1982 statement from the Veteran (VA Form 21-4138), a February 1983 “Veteran’s Application for Compensation or Pension” form (VA Form 21-526), the report of an August 1983 VA examination, a June 2007 statement from R.S.K, VA treatment records dated in August and October 2007, and an undated statement from Bishop M.S. indicate that the Veteran had an associate degree in criminal justice and that he had employment experience as a security officer/supervisor, child care worker, salesman, and construction worker. He experienced difficulty dealing with other people, had frequent job changes and moves, lost several job-related contracts because of emotional outbursts, and was unable to have successful business ventures due to limitations caused by his psychiatric disability. Also, he experienced chronic low back pain which radiated down the legs and was associated with paresthesia. He walked with a cane and had started to stumble. He stopped working in April 2007 due to back pain and depression and filed for Social Security Administration (SSA) disability benefits in July 2007. The Veteran was diagnosed as having “low back pain with radiculopathy.” In an October 2007 statement, the Veteran’s former employer reported that the Veteran’s job was terminated in January 2005 due to his inability or unwillingness to maintain a professional relationship with his assigned employees. He was counseled on numerous occasions regarding his maltreatment of his assigned employees, which included cursing at the employees and threatening them with bodily harm. His employment was terminated in light of his inability to develop a positive working relationship with his superiors and subordinates. An October 2007 psychiatric examination report from Psychological Consulting Services indicates that the Veteran had experienced a marked increase in his PTSD and depressive symptoms, which included depression, sleep impairment, hypervigilance, hyperirritability, nightmares, social isolation, outbursts of anger, suicidal and homicidal ideation, and impaired memory and concentration. The Veteran was diagnosed as having chronic and severe PTSD and recurrent major depressive disorder. The medical professional who conducted the October 2007 examination concluded that the Veteran’s PTSD and depressive symptoms markedly impacted the occupational, social, and personal aspects of his life. His problems with memory and concentration negatively affected his ability to be responsible or productive at any job and limited him from learning new tasks. Also, his hyperirritability, hypervigilance, and mood swings negatively impacted his ability to initiate or sustain work relationships. His prognosis for recovery was poor due to the longevity and chronicity of his symptoms, and he was highly likely to experience marked worsening of his PTSD and depressive symptoms due to stressors inherent in any work environment. Thus, he was considered to be permanently and totally disabled and unemployable. A second former employer reported in a November 2007 statement that the Veteran’s employment was terminated in February 2004 due to his unwillingness to maintain a high expectation and professionalism on the job and with his peers. His attitude towards those that he supervised was unacceptable with the company’s policy and he was reprimanded on several occasions. In the end, it was in the company’s best interest to release the Veteran from employment before someone got hurt. VA treatment records dated from November 2007 to April 2009, the report of an October 2008 VA psychiatric examination, and the Veteran’s SSA disability records indicate that he experienced lower back pain which radiated to the buttocks and lower extremities, right leg weakness which caused him to stumble and required him to use a cane for ambulation, bilateral foot pain, numbness, and muscle spasms, a burning sensation in his legs and feet, depression, social isolation, intrusive thoughts and dreams, impaired sleep, and hypervigilance. He was employed in construction until 2004, at which time his job was terminated because he could not get along with his bosses. He was self-employed until 2007 as a handyman (e.g., made mortar mix, set up scaffolding, laid blocks and bricks), but he stopped working in April 2007 due his PTSD and back disability. He was awarded SSA disability benefits on the basis of affective and mood disorders and anxiety related disorder. He also contended that hypertension and vision problems contributed to his inability to work. The Veteran was diagnosed as having, among other things, chronic low back pain, radiculopathy of both lower extremities “secondary to chronic spinal stenosis,” and muscle cramping of the feet. The Veteran reported during a March 2012 VA back examination that he experienced back discomfort and that flare ups of pain occurred with prolonged sitting. There was functional loss/functional impairment of the thoracolumbar spine in terms of less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and/or weight-bearing. The report also noted that he constantly used a brace and cane to ambulate. VA treatment records dated in September 2013 and May 2016 document reports of back pain which radiated to the lower extremities bilaterally and a burning sensation in the feet. The pain increased with activity. The report of a VA back examination dated on February 25, 2017 reflects that the Veteran reported that 3 years prior to the examination, his back pain was 6/10 at rest and 7/10 with activity and he was able to walk 2 blocks, stand for 30 minutes at a time, sit for 45 minutes, and occasionally lift 20 pounds. At the time of the February 2017 examination, however, he reported increased functional loss/functional impairment of the thoracolumbar spine in that he was only able to walk ½ block at a time with a walker and back brace, was limited to standing 5 minutes at a time and sitting 15 minutes at a time, and was only able to occasionally lift 5 pounds. The Veteran was diagnosed as having degenerative joint disease of the lumbar spine with spinal stenosis and bilateral lower extremity radiculopathy. This disability impacted his ability to work in that he was limited to walking ½ block at a time, standing 5 minutes at a time, sitting 15 minutes at a time, and lifting 5 pounds occasionally. In addition, the physician noted that there was pain with non weight-bearing (8/10) and pain with passive range of motion. The evidence reflects that the Veteran had an associate degree in criminal justice and that he had employment experience as a security officer/supervisor, childcare worker, salesman, and handyman/construction worker. He stopped working in April 2007 due to symptoms associated with his service-connected back and psychiatric disabilities and was awarded SSA disability benefits on the basis of psychiatric disability. While employed, he experienced significant occupational disruptions due to mood and behavioral problems associated with his psychiatric disability and he had lost jobs due to such problems. Moreover, he experienced significant functional impairments due to his service-connected back disability (e.g. limitations with sitting, walking, standing, and lifting) which would have limited his ability to perform physical employment, and impairments from his psychiatric disability (e.g., impaired memory and concentration) that would have interfered with his ability to perform sedentary employment. Also, the medical professional who conducted the October 2007 private psychiatric examination indicated that he was unable to work as a result of his service-connected psychiatric disability. While the examiner who conducted the March 2012 VA back examination indicated that the Veteran’s back disability did not impact his ability to work, medical examiners are only responsible for providing a full description of the effects of disability upon a veteran’s ordinary activity. See 38 C.F.R. § 4.10; Floore v. Shinseki, 26 Vet. App. 376, 381 (2013)). The ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one, but is rather a determination for the adjudicator. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). The above discussion of the severity of the symptoms of the Veteran’s service-connected disabilities and his educational and occupational experience, to include the medical opinions, reflects that the preponderance of the evidence is in favor of a conclusion that the Veteran was unable to secure and follow substantially gainful employment as a result of his service-connected disabilities from October 31, 2008. Resolving all doubt in favor of the Veteran, when the effects of the Veteran’s service-connected disabilities are combined, the Board concludes substantially gainful employment cannot be retained, and entitlement to a TDIU rating, from October 31, 2008 to February 25, 2017, is warranted. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Yates, 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.