Citation Nr: 21014996 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 08-08 166 DATE: March 16, 2021 ORDER Entitlement to rating in excess of 20 percent for service-connected degenerative disease of the cervical spine is denied prior to July 21, 2014. A disability rating of 30 percent, but no higher, is granted for service-connected degenerative disease of the cervical spine for the period from July 21, 2014 to February 14, 2020. A disability rating in excess of 30 percent for service-connected degenerative disease of the cervical spine is denied beginning February 14, 2020. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted effective March 31, 2016. FINDINGS OF FACT 1. Prior to July 21, 2014, the Veteran’s degenerative disease of the cervical spine did not result in forward flexion of 15 degrees or less or favorable ankylosis of the entire cervical spine. 2. Beginning July 21, 2014, the Veteran’s degenerative disease of the cervical spine resulted in forward flexion of less than 15 degrees; unfavorable ankylosis of the entire cervical spine was not shown or approximated. 3. Beginning March 31, 2016, the Veteran’s service-connected disabilities precluded him from securing and following “substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for degenerative disease of the cervical spine were not met prior to July 21, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for a rating in 30 percent for degenerative disease of the cervical spine were met from July 21, 2014 to February 14, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242. 3. The criteria for a rating in excess of 30 percent for degenerative disease of the cervical spine have not been met since July 21, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242. 4. Since March 31, 2016, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1982 to August 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Board remanded this matter for further development in an August 2011 remand, and issued a decision in April 2013, denying entitlement to a rating in excess of 20 percent. The Veteran appealed that decision to the (Court), which granted a Joint Motion for Remand (JMR) in November 2013, vacating the April 2013 decision. The Board remanded the claim in May 2014. In March 2015, the Board again denied an evaluation in excess of 20 percent for cervical spine disease. The Veteran appealed this decision to the Court, which granted a March 2016 Joint Motion for Partial Remand (JMR). Increased disability ratings pertaining to the Veteran’s left and right upper extremity radiculopathy in the Board decision were not disturbed. The Board remanded the case in July 2016 and January 2020 for additional development consistent the findings in the JMR. It is again before the Board for additional appellate review. Increased Ratings – Cervical Spine The Veteran contends that he is entitled to a higher rating for his cervical spine disability because he experiences significant pain in his neck. Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. The Veteran’s disability is currently rated under Diagnostic Code 5242 at a 20 percent disability rating for the period from February 14, 2007 to February 14, 2020, and at a 30 percent disability rating beginning February 14, 2020. 38 C.F.R. § 4.71a. During the pendency of the 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); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 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; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In this case, the actual rating criteria for spine disabilities was not changed in this amendment. However, the new regulations direct that degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome is to be rated under Diagnostic Code 5242 and that Diagnostic Code 5243, pertaining to IVDS and allowing for rating on the basis of incapacitating episodes, is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. For all other disc diagnoses Diagnostic Code 5242 is to be assigned. The Veteran in this case is rated under Diagnostic Code 5242, in effect prior to the change on February 7, 2021. The examiners in this case have determined that the Veteran does not have IVDS of the cervical spine. As such, the Board will not change the Diagnostic Code under which the disability is rated. As will be explained in the decision below, the Veteran has not had any incapacitating episodes during the appeals period, therefore there is no prejudice to the Veteran in leaving his rating under Diagnostic Code 5242. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the 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 to 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. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Rating Period Prior to July 21, 2014 The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for the Veteran’s cervical spine disability for the period prior to July 21, 2014. The Veteran was provided with a VA examination in June 2007. The Veteran reported ongoing sharp moderate pain. Upon examination forward flexion was to 25 degrees. There was objective evidence of pain but no additional limitations after repetitive motion. Functional limitations were due to fatigue, decreased motion, stiffness, and weakness. The Veteran did not have incapacitating episodes. The Veteran was provided with a VA examination in June 2008. He continued to report ongoing pain, which was sharp and at a 7-8/10 with flares to 10/10. Forward flexion was to 30 degrees. There was objective pain following repetitive movement but no additional limitations after such movement. Functional impairment was due to decreased motion, stiffness, weakness, and pain and was significant during flare-ups. The Veteran was provided with a VA examination in April 2012. He reported flare-ups during cold weather and on movements of his back. Forward flexion was to 25 degrees with pain at 15 degrees. After repetitive movements, forward flexion was to 20 degrees with pain. Functional loss was due to less movement than normal, weakened movement, and pain on movement. The examiner noted that the Veteran had no incapacitating episodes in the prior year. The Veteran was provided with a VA examination in July 2014. The Veteran reported progressive pain and stiffness and flare-ups which limit twisting, lifting and carrying. Forward flexion to 35 degrees with pain at 35 degrees. After repetitive movement, range of motion was not further limited. There were no incapacitating episodes and no ankylosis. VA medical records show ongoing treatment for neck pain. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to decreased motion, stiffness, weakness, and pain. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he had ongoing neck pain and flare-ups would not result in limitation of motion more nearly approximating forward flexion of the cervical spine to 15 degrees or less or favorable ankylosis of the entire cervical spine over the appeals period prior to July 21, 2014. The Veteran’s forward flexion of his cervical spine was consistently more than 15 degrees, even with functional loss due to his reported symptoms, including pain. While the Veteran has reported flare-ups, the evidence of record does not show that impairment during flare-ups approximates the criteria for a higher rating. Significantly, the Veteran’s range of flexion after repetitive movement was not limited to 15 degrees or less such that a higher rating would be warranted. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. VA examiners have specifically indicated that the Veteran did not have incapacitating episodes over the appeals period prior to July 21, 2014. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the upper extremities and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for his cervical spine disability prior to July 21, 2014. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Rating as of July 21, 2014 The Board finds that the evidence of record supports a disability rating of 30 percent beginning July 21, 2014. A July 21, 2014 VA medical record shows that the Veteran reported a flare in his cervical spine disability. Upon examination, forward flexion of neck was to 10 degrees. The Veteran was unable to laterally bend or rotate his neck or to posteriorly move his head. VA medical records show that, since that time, the Veteran has experienced significant cervical spine pain. The Board finds that a 30 percent rating is warranted beginning July 21, 2014, when the evidence reflects that the Veteran’s forward flexion was limited to 10 degrees, meeting the criteria for the 30 percent rating. The Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for the Veteran’s cervical spine disability since July 21, 2014. The Veteran was provided with a VA examination in February 2020. The Veteran reported flare ups, constant pain, and stiffness. The Veteran reported that he was unable to get out of bed at times and had limited movement of his neck. The Veteran was unable to complete range of motion movements because he was in too much pain. The examiner noted that functional limitation was due to pain, fatigue, weakness, lack of endurance and incoordination. Disturbance of locomotion also contributed to his impairment. The examiner found that the Veteran did not have IVDS. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, fatigue, weakness, lack of endurance and incoordination. However, even considering the Veteran’s lay reports of symptoms and significant functional loss, the degree of additional limitation reflected by the Veteran’s symptoms and flare-ups during the period since July 21, 2014 would not result in symptoms more nearly approximating unfavorable ankylosis of the entire cervical spine. As noted above, unfavorable ankylosis is a condition in which the entire cervical spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. In this case, while it is clear that the Veteran is significantly impaired due to his service-connected cervical spine disability, his current disability does not approximate the level of disability contemplated by the criteria for a 40 percent rating. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the upper extremities and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. For the foregoing reasons, the preponderance of the evidence is against the veteran’s claim for a rating in excess of 30 percent for his service-connected cervical spine disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Extraschedular Consideration The Board also acknowledges that the Veteran's representative has requested consideration of an extraschedular evaluation. In exceptional cases, an extraschedular rating may be provided. 38 C.F.R. § 3.321. The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for the service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disabilities with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). If the criteria reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the rating schedule and no referral is required. In this case, the evidence fails to show symptomatology regarding the Veteran’s service-connected cervical spine disability that would render the schedular criteria inadequate. The Veteran’s service-connected cervical spine disability is manifested by signs and symptoms such as pain, stiffness, locking, fatigability, and lack of endurance. These signs and symptoms, and their resulting impairment, are contemplated by the rating schedule. The diagnostic codes in the rating schedule corresponding to disabilities of the spine provide disability ratings on the basis of limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5242 (providing ratings on the basis of ankylosis and limited flexion and extension). For all musculoskeletal disabilities, the rating schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). For disabilities of the joints in particular, the rating schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. Given the variety of ways in which the rating schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran’s disability picture, which is manifested by impairment in movement of his neck and arms. In short, there is nothing exceptional or unusual about the Veteran’s cervical spine disability because the rating criteria reasonably describe his disability level and symptomatology. Thun, 22 Vet.App. at 115. The Veteran did not have any symptoms from his service-connected cervical spine disability that are unusual or different from those contemplated by the schedular criteria. Accordingly, the Board finds that referral for consideration of extraschedular ratings is not warranted, as the manifestations of the Veteran's disability are considered by the schedular rating assigned. 38 C.F.R. § 3.321; Thun, 22 Vet. App. 111. TDIU Entitlement The Veteran has contended that his service-connected disabilities have precluded him from substantially gainful employment since March 31, 2016. VA will grant entitlement to TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing and following “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16; VAOPGCPREC 75-91; 57 Fed. Reg. 2317 (1992). The central inquiry is, “whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The sole fact that the Veteran was unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran was capable of performing the physical and mental acts required by employment, not whether he can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Board must evaluate whether there are circumstances in the Veteran's case, apart from any non-service-connected condition and advancing age, which would justify a total rating based on individual unemployability due solely to the service-connected conditions. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993); see also Blackburn v. Brown, 5 Vet. App. 375 (1993). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). The regulations provide that if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the above purposes of one 60 percent disability or one 40 percent disability. 38 C.F.R. § 4.16(a). For the 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 or lower or one or both lower extremities, including the bilateral factor if applicable; (2) disabilities resulting from a 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). In this case, the Veteran has contended that he stopped working on March 31, 2016 and that TDIU is warranted from that date. The Veteran has been service-connected for his cervical spine disability at a 30 percent disability rating (now since July 21, 2014) and for associated radiculopathy of the right and left upper extremities. His right upper extremity is at 20 percent prior to February 14, 2020 and 40 percent since February 14, 2020. His left upper extremity is rated at 30 percent. The combined rating for these disabilities is at least 60 percent since July 2014. As these disabilities are from the same etiology, they are considered as one disability when determining if the percentage criteria under § 4.16 (a) are met. Therefore, the Veteran has met the percentage requirements for a TDIU under § 4.16 (a) have been met since the Veteran stopped working. The second aspect of TDIU to be addressed is whether the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The term unable to secure and follow a substantially gainful occupation in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates 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. In this case, the Veteran has contended that he has not worked since March 31, 2016 and has therefore not earned an income since that time. As such, the first component is met since March 31, 2016. Second, there is a non-economic component dealing with the individual veteran's ability to follow and secure employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58 (2019). As sedentary is defined as doing or requiring much sitting the Board finds that sedentary employment is a job where the worker primarily sits down. MERRIAM-WEBSTER'S COLLEGEIATE DICTIONARY 1123 (2003). The Veteran reported that he had a high school education and completed one year of college. He had been employed by the United States Postal Service (USPS) as an electronic technician performing maintenance but retired in March 2016. He has reported that he worked in a management role mainly at a desk. A December 2015 letter from VA physician noted that the Veteran’s cervical spine disability caused significant limitations in his ability to life any weight over his head and that it was advised for him not to lift more than 15 pounds above his waist level. He indicated that the Veteran should not bend, stretch, reach, or squat more than five minutes of each hour and not more than a total of 30 minutes per day. Records from the Social Security Administration include a form sent from the USPS to the Veteran’s physician, requesting documentation to confirm that the Veteran needed to be placed in a work environment with temporary restrictions. In March 2016, the Veteran’s physician completed the form, noting that the Veteran had cervical spondylosis with cord compression at C6-7 and chronic low back pain. The examiner opined that limited, if any, improvement was expected in the near term. She noted that this was a chronic condition, and that with avoidance of stress on the cervical spine, the progression would occur at a slower rate. The Veteran’s ongoing treatment records show that he has consistently reported pain and symptoms in his neck and upper extremities. A February 2020 VA examination report reflects that the Veteran experienced flare ups, constant pain, stiffness and shooting pain to the arms. He wore a neck brace. At his examination the Veteran’s pain was severe enough to prevent him from performing any range of motion for examination. The Veteran wore a neck brace constantly. The examiner found that he had severe pain, paresthesias, and numbness in his upper extremities. She opined that the Veteran would have difficulty if work tasks required frequent movement of head and neck. Given the Veteran's physical deficits from his service-connected cervical spine disability and associated radiculopathy of the upper extremities, securing his past relevant employment would be very difficult, if not impossible. While the Veteran was working at a desk in a supervisory role, the evidence reflects that his neck and upper extremity disabilities significantly restricted his ability to work in such a capacity. The December 2015 and March 2016 records reflect that the Veteran’s ability to perform his job functions was limited to the extent that he could not bend, stretch, reach, or squat more than five minutes of each hour and not more than a total of 30 minutes per day and that his condition was chronic with limited immediate improvement. VA medical records show continued reports of pain in his neck and upper extremities. Most recently, at his February 2020 examination, the Veteran’s pain prevented him from completing range of motion movements. The examiner noted severe pain, paresthesias, and numbness in his upper extremities. These impairments would prevent the Veteran from employment in an occupation even in a supervisory capacity. Further, given his education, he does not have the transferrable skills to obtain and maintain other employment in light of limitations from his service-connected disabilities. Accordingly, based on the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds that his service-connected disabilities have rendered him unable to secure and follow substantially gainful employment since March 31, 2016, the date the Veteran has reported that he stopped working. Thus, based on the foregoing and resolving all doubt in the Veteran's favor, the Board finds that his service-connected disabilities prevented him from securing or following a substantially gainful employment from March 31, 2016. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.16 (a). Therefore, entitlement to a TDIU as of such date is warranted. A.M. CLARK Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Harrigan Smith 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.