Citation Nr: 21014252 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-00 270 DATE: March 11, 2021 ORDER For the entire period on appeal, entitlement to a disability rating of 40 percent, but no higher, for a left shoulder disability is granted. For the entire period on appeal, entitlement to a total disability rating based upon individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. For the entire period on appeal, the evidence is in equipoise as to whether the Veteran’s left shoulder disability has been manifested by limitation of motion of the arm to 25 degrees from the side, but there was no ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. 2. For the entire period on appeal, the evidence is in equipoise as to whether the Veteran has been rendered unable to maintain gainful employment due to his service-connected disabilities. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran’s favor, the criteria for a disability rating of 40 percent, but no higher, for a left shoulder disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5201. 2. Resolving all reasonable doubt in the Veteran’s favor, the criteria for an award of a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.400, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from May 1983 to May 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2009 rating decision which, in pertinent part, denied entitlement to a disability rating in excess of 20 percent for a left shoulder disability. By way of procedural background, this matter was previously before the Board in August 2015, October 2017, and September 2019. In its August 2015 and October 2017 decisions, the Board remanded the matter for further development. In its September 2019 decision, the Board denied entitlement to a rating in excess of 20 percent for a left shoulder disability and entitlement to a TDIU. The Veteran then appealed to the United States Court of Appeals for Veterans Claims (Court) which, by way of a September 2020 Order, granted the parties’ September 2020 Joint Motion for Partial Remand (JMPR), vacated the Board’s September 2019 decision insofar as it denied entitlement to a rating in excess of 20 percent for a left shoulder disability and entitlement to a TDIU, and remanded the matter to the Board for readjudication consistent with the JMPR. After the issuance of the Board’s September 2019 decision, the Veteran’s representative properly withdrew his representation in accordance with 38 C.F.R. § 14.631(c). See February 2020 Third Party Correspondence. Correspondence received October 2020, which contains argument and lay evidence in support of the instant appeal, indicates that it was “submitted with the assistance of counsel at CAVC,” and includes the name of an attorney and law firm. As there is no VA Form 21-22a of record appointing a new representative, in January 2021, the Veteran was sent a letter to give him an opportunity to clarify his representation. To date, the Veteran has not responded to the letter or appointed another representative. Therefore, as noted in the letter, the Board will assume the Veteran wishes to represent himself and will resume its review of the appeal. The Board observes that the Veteran submitted additional lay evidence since the RO’s adjudication in a June 2019 Supplemental Statement of the Case (SSOC), without a waiver of initial RO consideration. See October 2020 Correspondence; see also Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law No. 112-154, 126 Stat. 1165 (amending 38 U.S.C. § 7105 to provide that if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests agency of original jurisdiction (AOJ) consideration). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 1. Entitlement to a disability rating in excess of 20 percent for a left shoulder disability Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. 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 disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine on a case-by-case basis whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In evaluating disabilities of the musculoskeletal system, painful motion is an important factor of disability. See 38 C.F.R. § 4.59. The intent of the schedule is to recognize painful motion with joint or particular pathology as productive of disability. Id. Joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id.; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that section 4.59 applies to all forms of painful motion of joints, and not just to arthritis). Moreover, when evaluating disabilities of the musculoskeletal system, consideration must be given to functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. 38 C.F.R. § 4.40. Consideration must also be given to weakened movement, premature or excess fatigability and incoordination. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995) (holding that the criteria discussed in sections 4.40 and 4.45 are not subsumed by the Diagnostic Codes applicable to the affected joint). The Court of Appeals for Veterans Claims (Court) clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. During the pendency of the instant appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If 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. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran’s claim under the former criteria prior to February 7, 2021 and both the former and revised rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In terms of the pertinent rating criteria, DCs 5200 through 5203 address disability ratings for the shoulder and arm, and DC 5003 addresses disability ratings for degenerative arthritis. Prior to the regulatory change, the relevant rating criteria were as follows. DC 5200 provides for the evaluation of a shoulder or arm disability if there is ankylosis of the scapulohumeral articulation. For the major extremity, a 30 percent rating is warranted for favorable ankylosis with abduction to 60 degrees and the ability to reach the mouth and head, a 40 rating is warranted for intermediate between favorable and unfavorable ankylosis, and a 50 percent rating is warranted for unfavorable ankylosis with abduction limited to 25 degrees from the side. 38 C.F.R. § 4.71a, DC 5200 (as in effect prior to February 7, 2021). Under DC 5201, for the major extremity, a 20 percent rating is warranted when the range of motion of the arm is limited to shoulder level. A 30 percent rating is assigned when range of motion of the shoulder is limited midway between the side and shoulder level. A maximum 40 percent rating is assigned when the range of motion of the arm is limited to 25 degrees from the side. 38 C.F.R. § 4.71a, DC 5201 (as in effect prior to February 7, 2021). Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 to 180 degrees, abduction from 0 to 180 degrees, and both internal and external rotation from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. In determining whether the Veteran has limitation of motion to shoulder level, it is necessary to consider forward flexion and abduction. See Mariano v. Principi, 17 Vet. App. 305, 314-16 (2003). DC 5202 is applicable to impairment of the humerus. A 20 percent rating is warranted for the major extremity if there are infrequent recurrent episodes of dislocation of the scapulohumeral joint with guarding of movement only at the shoulder level, or malunion of the humeral head with moderate deformity. A 30 percent rating is warranted for frequent recurrent episodes of dislocation of the scapulohumeral joint with guarding of all arm movements, or malunion of the humeral head with marked deformity. A 50 percent rating is warranted for the major extremity if there is fibrous union of the humerus. A 60 percent rating is warranted for the major extremity for nonunion of the humerus, or false flail joint. A maximum 80 percent rating is warranted for the major extremity for loss of head of humerus, or flail shoulder. 38 C.F.R. § 4.71a, DC 5202 (as in effect prior to February 7, 2021). DC 5203 provides for a 10 percent rating for malunion of the clavicle or scapula or nonunion of the clavicle or scapula without loose movement. A 20 percent rating is warranted for nonunion of the clavicle or scapula with loose movement or dislocation of the clavicle or scapula. DC 5203 also provides that the shoulder disability may alternatively be rated on impairment of function of the contiguous joint. 38 C.F.R. § 4.71a, DC 5203 (as in effect prior to February 7, 2021). Under DC 5003, degenerative arthritis established by radiographic imaging/X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint involved. Limitation of motion must be objectively confirmed by clinical findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Where there is X-ray evidence of arthritis and limitation of motion, but not to a compensable degree under the diagnostic code, a 10 percent rating is for assignment for each major joint affected. A rating in excess of 10 percent is not available absent X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, DC 5003 (as in effect prior to February 7, 2021). As of February 7, 2021, the changes to the DCs are as follows. Unless noted below, no changes were made to the relevant rating criteria. Under DC 5201, the criteria were changed to clarify that limitation of motion of the arm was to be considered based on flexion and/or abduction. As such, for the major extremity, a 20 percent rating is warranted when the range of motion of the arm is limited to shoulder level, with flexion and/or abduction limited to 90 degrees. A 30 percent rating is assigned when range of motion of the shoulder is limited midway between the side and shoulder level, with flexion and/or abduction limited to 45 degrees. A maximum 40 percent rating is assigned when flexion and/or abduction of the arm is limited to 25 degrees from the side. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, DC 5201). Under DC 5202, the criteria for a 20 percent rating for recurrent dislocation of the humerus at the scapulohumeral joint were changed to clarify that guarding of movement only at shoulder level meant flexion and/or abduction at 90 degrees. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, DC 5202). The rating criteria under DC 5003 did not change on February 7, 2021; however, the DC was changed to clarify that it only applied to degenerative arthritis, other than post-traumatic. Post-traumatic arthritis is separately rated under DC 5010. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, DCs 5003, 5010). Relevant here, ratings based on functional impairment of the upper extremities are predicated upon which extremity is the major extremity, with only one extremity being considered major. 38 C.F.R. § 4.69. The injured extremity, or the most severely injured extremity, of an ambidextrous individual will be considered the dominant extremity for rating purposes. Id. In this matter, the weight of the evidence reflects that the Veteran is ambidextrous. See VA examination reports dated August 2006, June 2009, October 2015; December 2003 VA orthopedic note; but see January 2018 VA examination report. The most recent VA examination in January 2018 reveals that limitation of motion and functional impairment of the left shoulder is more severe than that of the right shoulder. Therefore, the left extremity will be considered the Veteran’s major or dominant extremity for rating purposes. The Veteran is currently in receipt of a 20 percent disability rating for his left shoulder disability for the entire period on appeal. He asserts that a higher rating is warranted. On review of the evidence, both lay and medical, and after resolution of all reasonable doubt in favor of the Veteran, the Board finds that the manifestations of his left shoulder disability more nearly approximate the criteria for a disability rating of 40 percent under DC 5201, as in effect both prior to and beginning February 7, 2021. Specifically, the evidence is in equipoise as to whether the Veteran’s left shoulder disability has been manifested by limitation of motion of the arm to 25 degrees from the side, in flexion or abduction, for the entire period on appeal. During the June 2009 VA examination, the Veteran reported extreme pain in his left shoulder while sleeping, driving, or doing any activities that required the use of left shoulder lifting. In a December 2009 private treatment record, the Veteran reported constant pain in his left shoulder, and on physical examination, the provider noted diminished abduction and severe pain with resistance to abduction of the left shoulder. In an August 2010 Notice of Disagreement (NOD), the Veteran reported that after he does work around the house (i.e., vacuuming) or yardwork (i.e., “light tree trimming”) his left shoulder is in severe pain and he is unable to use it for three to four days, and he is sometimes unable to hold his baby. Notably, the October 2015 VA examiner indicated that the Veteran was not able to perform three repeated attempts for abduction of his left shoulder due to pain. During the January 2018 VA examination, the Veteran reported experiencing flare-ups and functional impairment of the left shoulder described as shoulder pain, stiffness, limited range of motion, and difficulty with heavy lifting. The Board acknowledges that VA examinations have shown that the Veteran is capable of flexion and abduction of the left arm to greater than 25 degrees. See VA examinations dated June 2009, October 2015, and January 2018. However, with consideration of the additional functional limitations caused by pain and weightbearing, the evidence demonstrates that, at worst, the Veteran experiences limitation of motion of the left arm to 25 degrees from the side, in either flexion or abduction. This level of impairment is consistent with a 40 percent disability rating under both the former and revised DC 5201. As 40 percent is the highest schedular rating for limitation of motion, consideration of whether the Veteran is entitled to a higher disability rating because of functional loss under §§ 4.40 and 4.45 is not for application. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In Johnston, the Court indicated that where the veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, the cited regulations are not for application. Id. at 84-85 (although the Secretary suggested remand because of the Board’s failure to consider functional loss due to pain, remand was not appropriate because higher schedular rating required ankylosis). For the same reasons, as the Veteran here is currently in receipt of the highest schedular rating for limitation of motion, the Court’s holding in Correia v. McDonald, 28 Vet. App. 158 (2016) is not applicable here. See also Sharp, 29 Vet. App. at 33 (finding orthopedic examination inadequate with regard to flare-ups where the examination was the basis for a denial of a higher disability rating and the veteran was not receiving the maximum schedular rating based on limitation of motion). A higher rating is available under DC 5200 for unfavorable ankylosis of the scapulohumeral articulation with abduction limited to 25 degrees from the side. While the Veteran has reported that he is sometimes unable to use his left shoulder due to pain, the evidence nonetheless reflects that he still retains some degree of motion in all ranges, and no medical professional has determined that the Veteran has ankylosis of the scapulohumeral articulation. Thus, the Board finds that the weight of the evidence is against a higher rating under DC 5200. Separate ratings are available under DC 5202 for impairment of the humerus, to include fibrous union of the humerus, nonunion of the humerus (false flail joint), loss of head of the humerus (flail shoulder), malunion of the humerus, and recurrent dislocation of the humerus. However, the record does not contain any lay or medical evidence of these conditions. Thus, a separate rating pursuant to DC 5202 is not warranted, under either the former or revised rating criteria. Separate ratings are also available under DC 5203 for dislocation, nonunion, or malunion of the clavicle or scapula. However, the record does not contain any lay or medical evidence of these conditions. Accordingly, a separate rating under DC 5203 is not warranted. For these reasons, the Board finds that the Veteran is entitled to a 40 percent disability rating for his left shoulder disability for the entire period on appeal. 2. Entitlement to a TDIU It is the established policy of VA that all veterans who are unable to secure and maintain substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” 38 C.F.R. § 3.340(a)(1). Controlling laws provide that a TDIU may be assigned when a veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities where at least one disability is rated at 40 percent or more and the combined rating is at least 70 percent. 38 C.F.R. § 4.16(a). The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or maintaining a substantially gainful occupation. Id. See 38 U.S.C. § 1155. Here, during the timeframe relevant to the period on appeal, the Veteran is in receipt of the following ratings for his service-connected disabilities: 40 percent for a left shoulder disability (as granted herein), 20 percent for a lumbar spine disability, 10 percent for tinnitus, 10 percent for right knee gout and degenerative arthritis, 10 percent for left knee gout and degenerative arthritis, and 10 percent for gout of the right 4th toe. As such, the Veteran has a combined disability rating of 70 percent with one disability rated at 40 percent. Therefore, the Veteran has meet the schedular requirement for a TDIU under 38 C.F.R. § 4.16(a) for the entire period on appeal. The remaining question is whether the Veteran’s service-connected disabilities preclude the Veteran from securing and following a substantially gainful occupation. See 38 C.F.R. § 4.16(a). The fact that a veteran is unemployed or has difficulty finding employment does not alone warrant assignment of a TDIU, as a high rating itself establishes that his disability makes it difficult for him to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he is incapable “of performing the physical and mental acts required” to be employed. Id. at 363. Thus, the central question is whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability, and not whether a veteran could find employment. Id. Consideration may be given to a veteran’s education, training, and special work experience, but not to his age or to impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. To determine whether a TDIU is warranted, the Board must consider all evidence of record to determine the earliest date as of which, within the one year prior to the filing of an informal or formal claim for TDIU, an increase in disability is ascertainable. See Servello v. Derwinski, 3 Vet. App. 196, 198-200 (1992). After careful consideration of the record and resolution of all reasonable doubt in favor of the Veteran, the Board finds that the Veteran is unemployable by reason of his service-connected disabilities. Specifically, the Board finds that the Veteran would not have been able to maintain any type of employment that was relevant to his educational background and work experience. In this regard, the Board notes that in Ray v. Wilkie, the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to have 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. See Ray v. Wilkie, 31 Vet. App. 58 (2019). As to the economic component of a substantially gainful occupation, the Board finds that the Veteran has been unemployed since 2004. See March 2006 VA 119 Report of Contact; VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability dated April 2006 and October 2015. Thus, the Board finds that the Veteran did not work in a gainful capacity at any point during the period on appeal. As to the non-economic component of a substantially gainful occupation, the Veteran’s work history was as a marine inspector in the Coast Guard until his retirement in 2003, five months at a shipyard as a project officer, and seven months as an environmental officer. See March 2006 VA 119 Report of Contact; VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability dated April 2006 and October 2015; October 2020 Correspondence. The Veteran’s duties as a marine inspector required the physical ability to climb, crawl, and kneel, and the record indicates that the Veteran had to quit his jobs as a project officer and environmental officer due to experiencing pain and fatigue because of his service-connected orthopedic disabilities. See June 2009 VA examination report; July 2009 Capitol City Rehabilitation Group, Counseling Record-Narrative Report. Notably, multiple VA examiners have opined that the Veteran’s service-connected disabilities impact his ability to perform the physical activities of employment, such as bending, prolonged standing, walking, or climbing stairs, lifting and overhead activities, pushing, and pulling. See VA examination reports dated October 2015; VA medical opinions dated January 2018. The Board acknowledges that VA examiners have opined that the Veteran’s service-connected disabilities would not impact his ability to participate in sedentary employment. See id. However, the Board finds that sedentary employment would also be negatively impacted by the Veteran’s service-connected disabilities, as the Veteran has competently and credibly reported that his low back pain makes him extremely fatigued and renders him unable to sit or stand for prolonged periods of time. See August 2010 NOD. Based on the foregoing, the Board finds that a TDIU predicated on unemployability stemming from the Veteran’s service-connected disabilities is warranted for entire period on appeal. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. M. Gill, 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.