Citation Nr: 21013024 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 16-46 156 DATE: March 8, 2021 ORDER For the entire rating period on appeal, an increased disability rating of 30 percent, but no higher, for disc herniation at C6-7 and degenerative disc disease of the cervical spine, is granted. For the entire rating period on appeal, a rating in excess of 20 percent for right upper extremity radiculopathy is denied. For the rating period prior to July 22, 2020, a rating of 20 percent, but no higher, for left upper extremity radiculopathy is granted. For the rating period beginning July 22, 2020, a rating in excess of 20 percent for left upper extremity radiculopathy is denied. For the appeal period beginning August 29, 2015, a total disability rating based on individual unemployability due to service-connected disorders (TDIU) is granted. FINDINGS OF FACT 1. For the entire rating period on appeal, the evidence is at least in equipoise as to whether, after taking into account pain, functional loss, and the limited ability of the cervical spine to perform the normal working movements, the symptoms of the Veteran’s cervical spine disability most closely approximated forward flexion of 15 degrees or less; however the Veteran’s disability has not caused ankylosis of the cervical spine or incapacitating episodes requiring physician-prescribed bed rest. 2. For the entire rating period on appeal, the Veteran’s cervical spine disability has resulted in bilateral upper extremity radiculopathy manifested by “mild” incomplete paralysis of the middle radicular group. 3. The Veteran last worked on August 28, 2015; for the appeal period beginning August 29, 2015, the Veteran’s service-connected disabilities render him unemployable. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating of 30 percent, but no higher, for disc herniation and degenerative disc disease of the cervical spine, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5242, 5243. 2. For the entire rating period on appeal, the criteria for a rating in excess of 20 percent for right upper extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.119, 4.124a, DC 8511 (2020). 3. For the rating period prior to July 22, 2020, the criteria for a rating of 20 percent, but no higher, for left upper extremity radiculopathy are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.119, 4.124a, DC 8511 (2020). 4. For the rating period beginning July 22, 2020, the criteria for a rating in excess of 20 percent for left upper extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.119, 4.124a, DC 8511 (2020). 5. For the appeal period beginning August 29, 2015, the criteria for entitlement to a TDIU rating are met. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 3.341, 4.16, 4.19 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1983 to April 2003. This matter initially came to the Board from a May 2015 decision of the Agency of Original Jurisdiction (AOJ). In January 2019, the Board denied disability ratings higher than 20 percent for the Veteran’s service-connected cervical spine disability and for radiculitis of the right upper extremity (now diagnosed as cervical radiculopathy of the bilateral upper extremities). After further proceedings before the United States Court of Appeals for Veterans Claims (Court), both parties filed a Joint Motion for Partial Remand (JMR), in which they agreed that, in the January 2019 decision, the Board failed to give an adequate explanation of its reasons for denying higher ratings for the cervical spine and right upper extremity disabilities. They also agreed that the Board erred in deciding that the issue of a TDIU was not part of this appeal. By granting the JMR the Court vacated the January 2019 Board decision’s rulings on these issues and returned them to the Board. The Board remanded this case for further development in May 2020. Based on the medical evidence obtained since then, the AOJ granted service connection for cervical radiculopathy of the left upper extremity in September 2020. This issue was not part of the May 2015 decision, but it is considered part of the cervical spine increased rating claim because the Veteran’s radiculopathy is a neurological abnormality associated with the service-connected cervical spine disability. See Note (1) to the General Rating Formula for Diseases and Injuries of the Spine, 38 C.F.R. § 4.71a. 1. Entitlement to an increased disability rating for disc herniation at C6-7 and degenerative disc disease of the cervical spine Rating Criteria Disability ratings are determined by applying VA’s Schedule for Rating Disabilities (Rating Schedule), 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 their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Board may consider whether separate ratings may be assigned for separate periods of time – a practice known as “staged ratings,” – whether or not the claim concerns an initial rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s disability ratings for degenerative disc disease and intervertebral disc syndrome have been assigned pursuant to 38 C.F.R. § 4.71a. The General Formula for Diseases and Injuries of the Spine (General Formula) applies to this disability, unless it is appropriate to evaluate the disability under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board will apply whichever method results in the higher rating. See 38 C.F.R. § 4.71(a). Under the General Formula, a cervical spine injury is rated as follows: a 10 percent disability rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees or combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 height. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees or combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for forward flexion of the cervical spine of 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. Under 38 C.F.R. § 4.40, DeLuca v. Brown, 8 Vet. App. 202, 206 (1995) and Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011), when evaluating the severity of certain disabilities, including disabilities of the spine, VA is generally required to consider whether the disability resulted in a level of functional loss greater than that already contemplated by the assigned rating. Relevant factors include weakness, fatigability, lack of coordination, restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. Whenever possible, VA examiners assessing the nature of additional functional loss should describe any additional functional limitations in terms of additional degrees of range of motion loss. See Mitchell, 25 Vet. App. at 33. Under 38 C.F.R. § 4.71a, an intervertebral disc syndrome may be rated under either the General Formula or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Under the Formula for Rating Intervertebral Disc Syndrome (IVDS), incapacitating episodes having a total duration of least 2 weeks but less than 4 weeks during the past 12 months warrant a rating of 20 percent. Incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months warrant a 40 percent rating. Incapacitating episodes having a total duration of at least 6 weeks during the past 12 months warrant a 60 percent rating. Note (1) to this Formula defines an incapacitating episode as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Effective February 7, 2021, VA’s Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a). When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021.  Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied.   For applications filed on or after the effective date, only the new criteria will be applied.  As the Veteran’s claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the updated regulations from February 7, 2021 forward, applying the most favorable criteria for the Veteran. The changes effective February 7, 2021 under 38 C.F.R. § 4.71a, DC 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under DC 5243 and all other intervertebral disc disabilities under 5242. As such, DC 5242 now reflects “Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)”; DC 5243 now reflects “Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses.” As such, the changes do not impact the general rating formula and evaluation of the disability under the pre-and post-February 7, 2021 regulations is not required. Factual Background The 20 percent rating currently assigned to the cervical spine disability was granted in April 2003. According to a March 2014 letter, the Veteran stated that “My upper back and neck have now also deteriorated to the point where as just mentioned, they combine to form an extremely continuously uncomfortable and at times very painful upper right quadrant OA condition. There is increasingly noticeable grinding and popping from my vertebrae in that region. I experience acute localized pain when looking down at a workbench or laptop computer for more than a few minutes. [Range of motion] turning the head in either direction is diminished and painful.” The comment added in red type to the April 2015 version of the letter reads as follows: “Now a year later, the [range of motion] for unimpeded neck movement is down to about zero. It hurts all the time. Turning the head goes a total of 45 degrees total right to left. Lateral flexion is not at all possible without pain.” To help decide the claim, the AOJ arranged a cervical spine examination in April 2015. According to the examiner’s report, the diagnosis was intervertebral disc syndrome. The report’s medical history section indicates that, since his previous examination in January 2013, “he has binding up, strange noises and has constant pain. Denies any additional injuries, states it is getting worse.” The Veteran reported flare-ups of pain in his cervical spine. According to the report, he described flare-ups as follows: “fast turning of neck, ‘any movement’ of [the] neck will increase pain.” During initial range of motion testing, flexion of the cervical spine was from zero to 40 degrees (45 degrees of flexion is normal), extension was from zero to 35 degrees (45 is normal), right lateral flexion was from zero to 15 degrees (45 is normal), left lateral flexion was from zero to 25 degrees (45 is normal), right lateral rotation was from zero to 40 degrees (80 is normal) and left lateral rotation was from zero to 30 degrees (80 is normal). According to the examiner, there was pain during all of these movements, but there was no pain on weight-bearing. The cervical spine was capable of repetitive use and did not experience any further loss of range of motion after three repetitions. According to the examiner, the Veteran had IVDS, but he had no incapacitating episodes requiring bed rest prescribed by a physician in the previous 12 months. Asked to comment on the effect of the cervical spine disorder on the ability to work, the examiner wrote that the Veteran needed an ergonomic work station. A May 2015 neurosurgery consultation note described the muscles around the Veteran’s neck as stiff and sore. According to the note “turning the head to the left or the right” aggravated stiffness, soreness, and radiating pain from the cervical spine. There was tenderness to palpation throughout the cervical paraspinal and interscapular regions. The note describes range of motion as “reduced range with pain” during flexion, extension, and rotation, but did not indicate the precise amount of reduced motion, in degrees. In a statement he submitted in January 2016, the Veteran wrote that he “cannot turn my head at all without discomfort. My cervical spine frequently becomes excruciatingly painful after standing at a workbench looking down, skipping too many therapy exercise sessions or forgetting to take medication.” A VA physician’s note, dated April 2016, indicates neck stiffness and complaints of “‘worsening cervical symptoms’ for the past month.” In September 2016, he submitted another statement together with his substantive appeal (VA Form 9). He wrote that, “Cervical movement with bending and stretching or just being seated” caused pain, loss of feeling in the hands, and numbness. He suggested that the range of motion test results were skewed by his use of pain medication. According to the Veteran, did not “drive much any more because of an inability to turn my head without pain . . .” In November 2017, the AOJ arranged another cervical spine examination. According to the report’s medical history section, the Veteran told the examiner he had experienced “ongoing neck pain for many years. He reports difficulty with rotation and with radiculopathy.” During initial range of motion testing, cervical flexion and extension were normal. Right lateral flexion was reduced to 20 degrees (45 is normal). Left lateral flexion was 35 degrees (45 is normal). Right lateral rotation was from zero to 65 degrees (80 is normal), while left lateral rotation was from zero to 30 degrees (80 is normal). There was pain during all of these movements. Asked to identify any contribution to functional loss due to range of motion limits, the examiner wrote, “Veteran has difficulty driving due to pain.” There was no evidence of pain with weight-bearing. But there was objective evidence of mild tenderness over the cervical musculature. Range of motion remained the same after three repetitions. The Veteran exhibited guarding due to pain, but it did not cause abnormal gait or abnormal spinal contour. Unlike the previous examiner, the November 2017 examiner indicated that the Veteran did not have IVDS and did not experience flare-ups. When the examination report form asked whether the cervical spine condition affected the ability to work, the examiner indicated “yes” and explained that, “Veteran cannot perform duties that require regular driving.” In the January 2019 decision, the Board denied the Veteran’s request for a rating higher than 20 percent for his cervical spine disability because all of the previously noted information about range of motion testing indicated that his spine was capable of more than 15 degrees of flexion. In their November 2019 JMR, the parties criticized the adequacy of the November 2017 examination report because “range of motion findings [in that report], did not contain any specifications as to where pain began nor did the examiner approximate functional limitations in terms of additional range of motion lost.” The JMR required the Board “to afford Appellant a new VA examination that provides range of motion findings compliant with Mitchell.” Pursuant to the JMR, the Board remanded the case for new examinations in May 2020. The Board ordered the post-remand examiner, for all range of motion test results, to “state where in the range of motion the Veteran reports that he begins to experience pain. The examiner should not include the ameliorative effects of medication in providing this assessment.” The Board also instructed the examiner to provide an opinion describing functional impairment of the cervical spine due to additional factors of disability, including pain, incoordination, weakened movement, and excess fatigability on use. The requested examination report, dated July 2020, included these range of motion test results: zero to 30 degrees flexion, zero to 20 degrees extension, zero to 20 degrees of both right and left lateral flexion, zero to 40 degrees right lateral rotation and 0 to 30 degrees left lateral rotation. Pain was present during all of the range of motion tests. Unfortunately, the examiner did not identify the point in each range of motion test where the Veteran reported that he began to experience pain. It is also unclear whether the examiner considered the effects of medication. The examiner wrote that there was pain with weightbearing. But there was no additional range of motion loss after three repetitions. The examiner did provide the requested estimate of range of motion loss after repeated use over time. According to this estimate, flexion would be reduced to 25 degrees, extension would be reduced to 15 degrees, right and left lateral flexion would both be reduced to 15 degrees, right lateral rotation would be reduced to 35 degrees and left lateral rotation would be reduced to 25 degrees. The examiner did not attempt to estimate range of motion during flare-ups because, according to her note, “No flare-ups [were] reported.” On the portion of the questionnaire asking the examiner to provide information about range of motion testing using the methods required by 38 C.F.R. § 4.59, the examiner indicated that there was objective evidence of pain in non-weightbearing. According to the examiner, passive range of motion testing could not be performed because it was not medically appropriate. The Veteran did have IVDS. But there had been no episodes requiring bed rest prescribed by a physician during the previous 12 months. As requested, the July 2020 examiner provided an opinion describing impairment due to functional loss due to additional factors of disability such as pain, incoordination, weakened movement, and excess fatigability. According to the examiner, the Veteran was “unable to perform strenuous activities.” He was also “unable to perform gross motor movements that require him to turn his head more than a minimally [sic] amount to the right or left, or up and down.” The baseline level of the Veteran’s pain was only 1 or 2 out of 10, but with movement, he “has an increase in pain, which he describes as sharp pain.” The examiner wrote, “He needs to turn his entire body to see behind him when backing out, but he is still able to drive.” Analysis As a preliminary matter, the Board must assess the implications of the failure of the July 2020 examiner to identify the point, during range of motion testing, when the Veteran began to experience pain and the failure to indicate whether the effects of medication had been considered. As noted, the parties’ JMR specifically complained about the lack of similar information in the November 2017 report and, in its most recent remand orders, the Board ordered the examiner to provide this information. The Board has therefore considered whether it is necessary to remand the cervical spine increased rating claim for yet another VA examination. Fortunately, the July 2020 examiner’s opinion describing additional functional loss due to weakness, fatigability or pain on movement justifies a decision to grant an increased 30 percent disability rating under the General Rating Formula. The criteria for a 30 percent rating contemplate favorable ankylosis of the cervical spine or cervical flexion limited to 15 degrees or less. 38 C.F.R. § 4.71a. Although the examination reports consistently indicated that the Veteran’s cervical spine has been capable of greater range of motion, 38 C.F.R. §§ 4.40, 4.45, 4.59 authorize the Board, under certain conditions, to award a higher rating than that already contemplated by the rating assigned based on limited motion. See DeLuca, 8 Vet. App. at 206. In her July 2020 opinion, the examiner indicated that, because of pain, stiffness, tenderness, and painful movement of his cervical spine, “He is unable to perform gross movements which require him to turn his head more than a minimally [sic] amount to the left and right, or up and down.” The inability to turn one’s head more than minimally “left and right, or up and down” describes a level of disability highly similar to flexion limited to 15 degrees or less. See 38 C.F.R. § 4.71a, Plate V (“Range of Motion of Cervical and Thoracolumbar Spine”). As a result of the Board’s decision to increase the cervical spine rating to 30 percent, the July 2020 examiner’s failure to identify the point in range of motion where pain begins, to clarify the effects of medication, and the failure of earlier examiners to strictly comply with 38 C.F.R. § 4.59, Correia v. McDonald, 28 Vet. App. 158, 170 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) is harmless error. A 40 percent rating under the General Rating Formula requires unfavorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. The DeLuca line of cases does not apply to the analysis for rating disabilities beyond the highest schedular evaluation based on limited motion when a higher evaluation requires ankylosis. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The purpose of testing range of motion for pain in the ways described in 38 C.F.R. § 4.59 is to apply rating criteria which consider the extent of limited motion in the relevant joint. Thus, the reasoning of Johnston applies when a Veteran is in receipt of the highest schedular rating based on limited motion and an examination fails to provide precise information about the extent of range of motion where pain begins. Moreover, there is no evidence from any source, and nothing in the Veteran’s detailed statements, which indicate that, when he is not using his pain medication, that his cervical spine has ever reached a state of unfavorable ankylosis. Resolving reasonable doubt in the Veteran’s favor, the Board finds that, after considering additional functional loss due to stiffness, tenderness, fatigability, and pain on movement, the symptoms of his cervical spine disability have most closely approximated the criteria for a 30 percent rating for the entire rating period on appeal. To the extent that he seeks a rating higher than 30 percent for his cervical spine disability, the Veteran’s claim is denied. Under the General Rating Formula, a higher 40 percent rating requires unfavorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. All three VA examiners indicated that the Veteran did not have cervical ankylosis. A higher rating for IVDS based on incapacitating episodes is also inappropriate. Although there is evidence that the Veteran was diagnosed with IVDS, there is no information from any source suggesting that this condition ever required periods of bed rest required by a physician. Once again, it is significant that none of the Veteran’s written statements, in which he has described his symptoms in detail, indicate unfavorable ankylosis or physician-prescribed periods of bed rest. In his notice of disagreement, the Veteran described the percentage rating sought in this appeal as a 30 percent rating. For these reasons, the Board will grant an increased 30 percent rating for the Veteran’s cervical spine disability for the entire rating period on appeal. A rating higher than 30 percent for this disability is denied. Neurological Abnormalities As for neurological abnormalities associated with the cervical spine disability, the Veteran has already been granted a 20 percent rating for right upper extremity radiculopathy under DC 8511 for the rating period on appeal, applicable to paralysis of the middle radicular nerve group nerve. The Veteran has also been awarded a 20 percent rating for left upper extremity radiculopathy, but only for the period beginning July 22, 2020. Under DC 8511, contemplating paralysis of the middle radicular group nerves, a 20 percent rating is warranted for mild incomplete paralysis, in the major or minor extremity. A 40 percent rating is warranted for moderate incomplete paralysis of the major extremity and a 30 percent rating is warranted for the same in the minor extremity. A 50 percent rating is warranted for severe incomplete paralysis of the major extremity and a 40 percent rating is warranted for the same in the minor extremity. Complete paralysis of the middle radicular group nerves is rated as 70 percent disabling for the major extremity and 60 percent disabling in the minor extremity and contemplates the loss or severe limitation of adduction, abduction, and rotation of arm, flexion of elbow, and extension of wrist. The term “incomplete paralysis,” with these and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as “mild,” “moderate,” “moderately severe,” and “severe.” Sellers v. Wilkie, 30 Vet. App. 157 (2018) (“DC 8520 does not define ‘mild,’ ‘moderate,’ ‘moderately severe,’ or ‘severe,’ or generally associate those terms with specific symptoms”). It should also be noted that use of terminology such as “mild” and “moderate” by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Upon review of the evidence of record, the Board finds that the Veteran’s right and left upper extremity radiculopathy disabilities warrant a 20 percent, but no higher, for the entire rating period on appeal. In this regard, the July 2020 VA examiner specifically indicated that the Veteran had chronic neck pain and bilateral upper extremity radicular symptoms since his in-service injury. A diagnosis of bilateral radiculopathy was also noted to have an onset date of 2003. It was specifically indicated that the Veteran had “mild” incomplete paralysis of the middle radical group nerves in both upper extremities. Further, previous VA examination reports show consistent complaints by the Veteran of upper extremity symptoms, including numbness and pain in the arms. See e. g., April 2015 and November 2017 VA examination reports. For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds that, for the rating period prior to July 22, 2020, a rating of 20 percent, but no higher, for left upper extremity radiculopathy is granted. The Board further finds that a rating in excess of 20 percent is not warranted for either extremity throughout the rating period on appeal. The Veteran has been specifically diagnosed with mild, bilateral radiculopathy. See July 2020 VA examination report. None of the examination reports or treatment records have described the Veteran’s radiculopathy as more than mild. As such, for the entire rating period on appeal, a rating in excess of 20 percent for right upper extremity radiculopathy is denied. For the rating period beginning July 22, 2020, a rating in excess of 20 percent for left upper extremity radiculopathy is denied. TDIU—Laws and Analysis VA regulations allow for the assignment of TDIU when a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities, and the Veteran has certain combinations of ratings for service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more 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). Disabilities of one or both upper or extremities or one or both lower extremities (to include the bilateral factor), disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system (such as orthopedic disabilities) are considered as one disability for TDIU purposes. Id. The central inquiry is “whether a Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). Pursuant to an October 2016 VA Form 21-4192 (employment information), the Veteran last worked on August 28, 2015. As such, consideration for a TDIU begins as of this date. For the appeal period beginning August 29, 2015, the Veteran’s service-connected disabilities, which include a lumbar spine disability, cervical spine disability, bilateral upper extremity radiculopathy, a right shoulder disability, and bilateral knee disabilities combine to at least 70 percent (with consideration of the bilateral factor). The Veteran has indicated that he last worked as a systems engineer. He maintains that he is unable to work due to his service-connected orthopedic disabilities. The relevant evidence of record includes a November 2017 VA spine examination indicated that the Veteran could not perform duties that required regular driving. During a July 2020 VA cervical spine examination, the examiner indicated that the Veteran was unable to perform strenuous activities and was unable to perform gross motor movements that required him to turn his head more than a minimally amount to the right and left, or up and down. The Veteran was also unable to perform repetitive gross motor movements with his hands. In a November 2020 spine examination, the Veteran’s lumbar spine was found to impact the Veteran’s ability to work in that he would be limited in motion, which interfered with ambulation, sitting, and standing, and thus performing occupational tasks. For these reasons, the Board finds that a TDIU is warranted as the evidence suggests that the Veteran is unable to secure or maintain a substantially gainful occupation due to his service-connected disabilities. The Veteran has been found to have difficulties with driving, ambulation, sitting, and standing, in addition to an inability to perform strenuous activities and gross motor movements that required him to turn his head more than a minimally. The Board finds that these restrictions would significantly limit the Veteran’s ability to perform any occupational task. As such, and resolving reasonable doubt in his favor, the Veteran’s TDIU claim is granted. 38 C.F.R. § 4.16. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Nye, 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.