Citation Nr: 21015024 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 07-35 981 DATE: March 16, 2021 ORDER Beginning October 19, 2011 an initial rating of 100 percent for posttraumatic stress disorder (PTSD) with alcohol use disorder is granted. Beginning February 28, 2005, an initial rating of 50 percent for bilateral pes planus is granted. An initial rating in excess of 10 percent for limitation of flexion in the left knee is denied. Beginning February 28, 2005, an initial separate rating of 20 percent for medial meniscal tear of the left knee is granted. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Beginning October 19, 2011 and throughout the entire period on appeal, the service-connected PTSD with alcohol use disorder is manifested by total occupational and social impairment. 2. Beginning February 28, 2005 and throughout the time period on appeal, the service-connected bilateral pes planus with right foot hallux valgus is manifested by pronounced symptoms including pain and swelling; pain on manipulation, movement and weight bearing productive of disturbed locomotion and interfering with the ability to stand; increased functional impairment on daily flare-ups and repetitive use; moderate bilateral pes cavus and right hallux valgus, and x ray findings of degenerative joint disease bilaterally. 3. Throughout the period on appeal, the service connected left knee disability characterized by limited flexion is manifested by range of flexion motion limited to zero to 90 degrees at its most limited with consideration for pain, pain on motion, and functional impairment during flare-ups and on repetitive motion without findings of ankylosis, lateral instability, residuals of removed cartilage, impairment of the tibia and fibula, or genu recurvatum. 4. Beginning February 28, 2005 and throughout the period on appeal, the service-connected left knee medial meniscal tear is manifested by persistent swelling, effusion and dislocated semilunar cartilage. 5. The Veteran’s service-connected PTSD is, by this decision, assigned an evaluation of 100 percent for PTSD with alcohol use disorder for the entire period on appeal. The evidence does not show the Veteran’s other service-connected disabilities rendered him unable to obtain and retain substantially gainful employment. CONCLUSIONS OF LAW 1. Beginning October 19, 2011, the criteria for an initial 100 percent rating for service-connected PTSD with alcohol use disorder are met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.1 through 4.7, 4.21, 4.130, Diagnostic Code (Code) 9411 (2020). 2. Beginning February 28, 2005, the criteria for an initial rating of 50 percent for bilateral pes planus are met. 38 U.S.C. § 1155, 5107 (2018); 38 C.F.R. §§ 3.159, 4.1 through 4.7, 4.10, 4.21, 4.71a, Code 5276 (2020). 3. The criteria for an initial rating in excess of 10 percent for left knee limitation of flexion are not met. 38 U.S.C. § 1155, 5107 (2018); 38 C.F.R. §§ 3.159, 4.1 through 4.7, 4.10, 4.21, 4.40, 4.45, 4.59 4.71a, Code 5003-5260 (2020). 4. Beginning February 28, 2005, the criteria for a separate initial rating of 20 percent for medial meniscal tear left knee are met. 38 U.S.C. § 1155, 5107 (2018); 38 C.F.R. §§ 3.159, 4.1 through 4.7, 4.10, 4.21, 4.40, 4.45, 4.59 4.71a, Code 5258 (2020). 5. The criteria for TDIU are not met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Marine Corps on active service from May 1975 to May 1978 and from September 1980 to June 1983. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of May 2006, October 2012, January 2014, June 2016 rating decisions by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). Unfortunately, the Veteran died in February 2020. The appellant is his surviving spouse, whose application for substitution was accepted in May 2020. The Board offers its profound condolences. In November 2009, the Veteran testified at a November 2009 hearing before the undersigned acting Veterans Law Judge at the Muskogee, Oklahoma Regional Office. A transcript of the hearing is associated with the record. In a July 2010 decision, the Board denied service connection for a right foot disorder and a left foot disorder. The Veteran appealed these issues to the United States Court of Appeals for Veterans Claims (Court). In April 2011, the Court granted a joint motion for remand (JMR) which vacated the Board’s denial of these claims for entitlement to service connection. In December 2011, the Board remanded the service connection claims for additional development. The Board remanded the issues again in September 2017. The Board’s September 2017 decision also denied a rating in excess of 30 percent for PTSD. In May 2018, the issues of entitlement to an initial rating in excess of 10 percent for left knee medial meniscus tear, entitlement to an initial rating in excess of 30 percent for bilateral pes planus and entitlement to TDIU were remanded for additional development, including VA examinations. The Veteran appealed the Board’s September 2017 denial of a rating in excess of 30 percent for PTSD to the Court. In August 2018, the Court granted a JMR which vacated the Board’s denial and remanded the issue for further proceedings consistent with the JMR. In November 2019, the issue was remanded for additional development including a VA PTSD examination. In June 2020, the RO granted an increased evaluation of 50 percent for PTSD effective December 13, 2019. As this is not the highest evaluation afforded by the rating schedule and it was not awarded for the entire period on appeal, this issue remains before the Board. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Duty to Notify and Assist VA has not met its duty to notify and assist the Veteran in substantiating his claim for VA benefits, as prescribed in 38 U.S.C. §§ 5100, 5102, 5103, 5109A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). All identified and relevant records have been obtained or appropriate efforts to secure them have been undertaken. However, the VA examinations afforded the Veteran were not adequate, and the Board directed remands for additional VA examinations in 2018 and 2019. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). However, the examinations were not conducted before the Veteran passed away. The Board will therefore resolve all reasonable doubt in the Veteran’s favor. 38 C.F.R. §§ 3.102, 4.7. Increased Ratings Disability ratings are assigned in accordance with the VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. § 3.321(a), 4.1. Separate Codes identify the various disabilities. See 38 U.S.C. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. The evaluation of the same disability under several Codes, known as pyramiding, must be avoided. 38 C.F.R. § 4.14. “Staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). When evaluating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant’s capacity for adjustment during periods of remission. VA shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, and 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. If feasible, these determinations are to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995). Moreover, joint testing is to be conducted on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 170 (2016). Effective February 7, 2021, the evaluations pertaining to the evaluation of musculoskeletal disabilities were revised. See 85 Fed. Reg. 76460 (November 30, 2020). However, to the extent these changes impact the evaluations assigned the service-connected bilateral feet and left knee disabilities, the regulations in place prior to February 7, 2021 are more favorable to the Veteran, and are thus applied in the present case. See VAOPGCPREC 7-2003 ; Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003). I. PTSD The appellant argues that the Veteran’s PTSD was worse than originally evaluated. The evidence supports her contentions. Service connection was granted for PTSD with alcohol use disorder in an October 2012 rating decision and evaluated as 30 percent disabling, effective in October 2011. The Veteran appealed the evaluation initially assigned. In a June 2020 rating decision, a 50 percent evaluation was assigned, effective December 13, 2019. After review of the evidence, the Board finds that a 100 percent evaluation for PTSD is warranted effective October 19, 2011 and throughout the entire period on appeal. PTSD is evaluated under Code 9411, which applies the general rating formula for mental disorders under 38 C.F.R. § 4.130. This affords a 100 percent rating where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. See 38 C.F.R. § 4.130, Code 9411. VA examination reports and VA treatment records reveal the Veteran’s PTSD was manifested by persistent audio and visual hallucinations, persistent suicidal ideation, chronic sleep impairment with nightly violent nightmares, intrusive thoughts and reliving of the incident, persistent depression and anxiety, panic attacks, isolation and an inability to tolerate other people. This meets the criteria for a 100 percent evaluation. The Board is cognizant that VA examiners in 2012, 2016, and 2019 generally assessed the Veteran to be less that totally occasionally and socially impaired. However, close review of the evidence shows the Veteran was more impaired by his symptoms in his everyday life than he reported to VA examiners. There are several instances where this is apparent, including the degree of his self-isolation and difficulty interacting with others (see January 2018 letter from his lay witness and spouse, RC), to the severe degree of sleep disturbance, depression and anxiety he experienced as the result of nightmares, intrusive thoughts and reliving the experiences of his stressor. The Board will focus on his hallucinations, suicidal ideation, and alcohol use. Despite the Veteran’s efforts to minimize his reports of hallucinations and suicidal ideation, VA treatment records document that these symptoms remained current and persisted throughout the time period on appeal. In 2012, VA treatment records show the Veteran reported hearing music and seeing shadows, animals and images of people. In 2013, his VA health care provider diagnosed depression with psychosis. The 2016 VA examination documents that these visual and audio hallucinations, termed “unusual perceptual experiences,” continued, notwithstanding the VA examiner’s notation that the Veteran did not seem to find them distressing. VA treatment records in 2012 and 2013 noted a history of past suicidal ideation and remote violence. In 2014, he was observed to exhibit fleeting suicidal thoughts, despite his report to the contrary. In 2016, he placed a call to the crisis hotline, expressing constant feelings of hopelessness, uselessness, and sadness. He fired a gun during the call and asserted he had many guns. Yet, he also tried to assure the responder he had a safety plan. When another responder called to check in on him, he stated the event was just a personal matter and there was no danger. He declined mental health care services. In 2019 he was placed on a 72 hour hold due to concern for suicidality and admitted for medical detox. On interview he reported a previous suicidal gesture six months prior, but denied current suicidal/homicidal ideation. Concerning the Veteran’s alcohol use, it is noted that alcohol use disorder is part of the service-connected PTSD. VA treatment records show the Veteran reported in 2012 he was a heavy alcoholic but was then drinking one half a bottle of wine over the weekend. It 2013, he reported drinking three to six beers daily when working outside. In 2016, he reported drinking every other day, two to three drinks at a time. Sometimes he would drink himself to sleep. In 2019, during medical detoxification, he admitted he had been binging alcohol monthly until spring of that year. The Veteran’s wife voiced her concerns about his drinking at the same time. VA admission records show she reported she did not feel the Veteran had been truthful about how much he drank or his motivation for sobriety. In 2020, he admitted he drank to cope. In January 2020, VA treatment records show the Veteran’s wife brought him for emergency treatment with severe ascites. She reported he had failed to get out of bed and was confused, belligerent and unable to sit up due to the size of his abdomen when she tried to wake him. She further stated he was not compliant with his prescribed medications and was very resistant to going to the doctor. He was assessed with hepatic encephalopathy and subsequently admitted to palliative care with diagnoses of hepatic encephalopathy, acute alcoholic hepatitis with chronic cirrhosis, and diabetes mellitus. In February 2020, the Veteran passed away. His death certificate listed his cause of death as acute alcoholic hepatitis which was due to alcoholism which was due to PTSD. In April 2020, the AOJ granted service connection for the cause of the Veteran’s death. When comparing the Veteran’s assertions to VA examiners that he was not suicidal, was not bothered by auditory and visual hallucinations, and did not drink as frequently or heavily to the observations of his health care providers and lay witness, and to his own actions, it is clear that the Veteran was factually and persistently suicidal and hallucinatory, and abused alcohol gravely in an attempt to cope throughout the period on appeal. Given his persistent hallucinations, suicidal ideation and use of alcohol to sleep and cope, and his other PTSD symptoms as described and discussed above, the medical and lay evidence supports the assignment of an initial 100 percent rating throughout the period of time on appeal. Accordingly, an initial evaluation of 100 percent from October 19, 2011 for service-connected PTSD with alcohol use disorder is warranted. II. Bilateral Pes Planus The Appellant argues that the Veteran’s bilateral pes planus was more disabling than originally evaluated. The medical evidence supports her assertions. Service connection was granted for bilateral pes planus with hallux valgus, right foot, was granted in a June 2016 rating decision, and evaluated as 30 percent disabling, effective in February 2005. The evidence supports a 50 percent evaluation for bilateral pes planus with right hallux valgus throughout the entire period on appeal. Pes planus is evaluated under 38 C.F.R. § 4.71a, Code 5276, which contemplates a 50 percent evaluation is warranted for pronounced symptoms of marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo-achillis on manipulation, not improved by orthopedic shoes or appliances. VA examinations in 2014 and 2016 show the Veteran reported pain in both feet increasing with standing and activity, and of daily flare-ups and swelling which impacted functional impairment. VA examiners observed manifestations of pain and swelling; and pain on manipulation, movement and weight bearing productive of disturbed locomotion and interfering with the ability to stand. Repetitive use increased the degree of functional impairment. In addition, VA examiners observed right foot hallux valgus and bilateral pes cavus, both moderate at worse in severity. Degenerative joint disease was shown in both feet by x ray. In addition, the Veteran testified in 2009 as to persistent aching and pain in his feet, increasing in severity and functional impairment with activity. In her January 2018 statement RC attested to her observations of the Veteran’s pain and its impact on his mobility and function. She reported the pain made it difficult for him to sleep, and that he could not stand for more than 20 minutes. In addition, because of pain, he needed to rest frequently when doing any activity requiring standing or walking due to the pain. Resolving all doubt in the Veteran’s favor, and noting that the service-connected bilateral pes planus and pes cavus, and his right hallux valgus, have been grouped together under Code 5276, the Board finds that the medical evidence meets the criteria for a 50 percent evaluation under the Code. This is the highest evaluation afforded by Code 5276. Separate compensable evaluations could be warranted for bilateral weak foot under Code 5277, bilateral pes cavus under Code 5278, or hallux valgus under Code 5280 but the required manifestations are not present. 38 C.F.R. § 4.71, Codes 5277, 5278 and 5280. Code 5277 contemplates symptomatic bilateral week foot secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness. Rating is directed for the underlying condition, with a minimum rating of 10 percent. However, there are no findings of atrophy of the musculature or disturbed circulation resulting from the service-connected bilateral foot disorder or any other service-connected disorder. In addition, the medical evidence shows no finding of weakness in either foot that is not already contemplated in the 50 percent evaluation awarded by this decision under Code 5276. To assign an additional evaluation for this symptom under Code 5277 is thus impermissible under 38 C.F.R. § 4.14. Code 5278 contemplates acquired claw foot (pes cavus). Slight symptoms warrant zero percent. A 10 percent evaluation is afforded for either unilateral or bilateral symptoms of dorsiflexed great toe, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads. An evaluation is afforded of 20 percent for unilateral and of 30 percent for bilateral symptoms of all toes tending to dorsiflexion, limitation of dorsiflexion at the ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. An evaluation is warranted of 30 percent for unilateral and of 50 percent for bilateral symptoms of marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity. However, 2012 and 2016 VA examiners specifically observed that the pes cavus did not affect the Veteran’s toes. Therefore, symptoms of moderate pes cavus are contemplated in the 50 percent evaluation awarded by this decision. To assign separate compensation under Code 5278, like that for Code 5277 is also impermissible under 38 C.F.R. § 4.14. Code 5280 contemplates unilateral hallux valgus and affords a 10 percent evaluation for severe symptoms if equivalent to amputation of the great toe or post-operative with resection of metatarsal head. However, the medical evidence does not show the Veteran underwent surgery for hallux valgus, or that his great toe is symptomatic to the degree equivalent to amputation. As the medical evidence shows reports and observations throughout the period of time under appeal of pronounced symptoms including pain and swelling; pain on manipulation, movement and weight bearing productive of disturbed locomotion and interfering with the ability to stand; increased functional impairment on daily flare-ups and repetitive use; of moderate bilateral pes cavus and right hallux valgus, and x ray findings of degenerative joint disease, an initial 50 percent evaluation for bilateral pes planus is appropriate. Accordingly, beginning February 28, 2005, an initial 50 percent evaluation for bilateral pes planus is warranted. III. Left Knee The Appellant argues that the Veteran’s left knee disability was more disabling than originally evaluated. The medical evidence supports her assertions in part. Service connection was granted for left knee medial meniscus tear in a January 2014 rating decision and evaluated as 10 percent disabling effective in February 2005. The evidence does not support an initial evaluation greater than 10 percent for limitation of flexion motion. However, it does support the assignment throughout the entire period on appeal of a separate 20 percent evaluation under Code 5258 for frequent episodes of pain and effusion into the left knee joint with medial meniscal tear and frequent episodes of locking and or collapse. The left knee disorder has been evaluated under Code 5260, which contemplates limitation of flexion. Code 5260 provides a 20 percent rating for flexion limited to 30 degrees. A 30 percent rating is afforded for flexion of the leg limited to 15 degrees. 38 C.F.R. § 4.71, Code 5260. For VA purposes, normal range of knee is from 0 degrees of extension to 140 degrees of flexion. Id., Plate II. VA examinations in 2010, 2012, 2014, 2016 and 2017 document range of motion in the left knee joint at zero to 90 degrees at its most limited, with consideration for painful motion, and additional limitation of motion on flare-ups and after repetitive motion. This does not meet the criteria for an evaluation greater than 20 percent under Code 5260. Notwithstanding, higher and/or separate evaluations could also be warranted under Codes 5258, 5261, 5256, 5257, 5259, 5262 and 5263. See 38 C.F.R. § 4.71, Codes 5256 through 5260, and 5261 through 5263. Code 5258 contemplates dislocated semilunar cartilage and affords a 20 percent evaluation for frequent episodes of locking, pain, and effusion into the joint. Throughout the period on appeal, the Veteran reported episodes of collapse. In 2017, he reported episodes of buckling and locking. Corroborating his report, his witness, RC, attested to the Veteran’s left knee giving way and causing him to fall if there was nothing to grab on to. She reported his left knee was frequently so inflamed and painful that it prevented his sleep. In addition, she attested he frequently required a cane for walking. VA examinations in 2010, 2012, 2014, 2016, 2017 concur. VA examiners reported findings of frequent joint pain and joint effusion in the left knee attributed to his torn meniscus. In addition, VA treatment records throughout the time period under appeal document the Veterans use of assistive devices for ambulation throughout the time period under appeal, including a cane and, more recently, a walker. Thus, a 20 percent evaluation for frequent locking (buckling and/or collapsing), pain and effusion in the left knee joint attributable to the meniscal disorder is appropriate throughout the entire time on appeal. This is the highest evaluation afforded by the Code. Code 5261 contemplates limitation of extension. A zero percent rating is afforded for extension limited to 5 degrees. Higher evaluations are afforded for greater limitation of extension. However, the medical evidence does not show that the left knee was manifested by limitation of extension motion at any time during the period on appeal. Rather, the evidence establishes range of motion from zero degrees extension to 90 degrees flexion at its most limited. Code 5256 contemplates ankylosis of the knee joint. Thirty, 40, 50 and 60 percent evaluations are afforded for ankylosis in favorable and unfavorable positions of the knee with minimal or no range of motion. However, the medical evidence does not demonstrate that the left knee is ankylosed. Rather, the evidence establishes range of motion from zero degrees extension to 90 degrees flexion at its most limited. Code 5257 contemplates recurrent subluxation or lateral instability and affords 10, 20, and 30 percent ratings, in turn, for slight, moderate, and severe recurrent subluxation or lateral instability of the knee. However, the medical evidence does not establish lateral instability or recurrent subluxation attributed to the service-connected left knee. Rather, although the Veteran reported instability in the left knee, such was not diagnosed or found to be manifested by VA examiners throughout the time period on appeal. Notwithstanding, by this decision, the Board is awarding a compensable evaluation under Code 5258, as discussed above, for his and his witness’ reported episodes of left knee collapse. The Board Code 5258 rather than Code 5257 to be more appropriate Code because the medical evidence documents the Veteran as having symptomatic meniscal tear with pain and effusion in the joint. In addition, manifestations of swelling have been both reported, and objectively observed throughout the period on appeal. Accordingly, the Board find Code 5258 to the more precise code under which to assign additional compensation. Other Codes, 5259, 5262, and 5263, contemplate symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum, but none of the required manifestations are present in this case. Thus, none of these Codes are here for application. Absent findings of limited flexion at 45 degrees or less, an evaluation greater than 10 percent cannot be appropriate under Code 5260. In addition, while the evidence supports an evaluation of 20 percent under Code 5258, absent limited extension at 10 degrees or more, ankylosis, lateral instability, residuals of surgically removed cartilage, impairment of the tibia and fibula, or genu recurvatum, other separate compensable evaluations cannot be granted under Codes 5256, 5257, 5259, 5262 and 5263 cannot be appropriate. Accordingly, an initial evaluation higher than 10 percent under Code 5260 is not warranted at any time throughout the period on appeal. In addition, an additional evaluation of 20 percent under Code 5258 is warranted beginning February 28, 2005 and throughout the entire period on appeal. TDIU The appellant argues that Veteran has not been able to work as a result of his service-connected disabilities and thus, TDIU is warranted. Unfortunately, as below explained, TDIU cannot be granted in the present case. This decision has assigned a 100 percent evaluation for PTSD effective October 19, 2011. Throughout the period on appeal, the Veteran asserted his service-connected disabilities prevented him from securing or following any substantially gainful occupation. TDIU is typically awarded where the schedular rating is less than total and it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is a sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340 , 3.341, 4.16(a). If a total rating is present, then it must be at least as likely as not that the Veteran is unable to secure or follow a substantially gainful occupation as a result of that disease. See 38 C.F.R. § 4.16 (a). 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 issue is not whether the Veteran can find employment generally, but whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose, 4 Vet. App. at 363. The receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. See Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of a TDIU rating for another service-connected disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). Id. In addition to PTSD rated at 100 percent disabling, the Veteran is service connected for bilateral pes planus with right foot hallux valgus evaluated as 50 percent disabling from February 28, 2005; left knee degenerative joint disease evaluated as 10 percent disabling from February 28, 2005; left knee medial meniscus tear evaluated as 20 percent disabling from February 28, 2005; (these last three also awarded by this decision); tinnitus evaluated as 10 percent disabling from October 19, 2011, right knee degenerative joint disease evaluated as 10 percent disabling from March 4, 2014; and bilateral hearing loss evaluated as noncompensable from October 19, 2011. As a 100 percent rating has been assigned for PTSD, that disability will not be considered in determining TDIU. The Veteran’s remaining disabilities meet the threshold eligibility requirements for a TDIU. Pes planus is evaluated at 50 percent, from February 28, 2005; and the combined knee and feet disabilities which derive from the same inservice injury total 70 percent from February 28, 2005. See 38 C.F.R. §§ 3.340 , 3.341, 4.16(a). Concerning factual unemployability, the Board looks to the medical evidence. At his August 2012 VA initial PTSD examination, the Veteran asserted he was unemployable as a result of his service-connected bone and joint injuries. The evidence reflects he graduated from high school and had three years of college, studying art history. Prior to entering the military service, he worked in construction for three months. After his discharge from service, he worked as a housing cost coordinator for one and one-half years; as a staff writer for a newspaper for one and one-half years; in construction for four years; installing cable for two years; and carving wood and remodeling houses for eight years. He stated that he last worked in 2010 and stopped working due to physical problems. VA examinations in 2012, 2016, and 2017 show that the VA examiners did not find the service-connected knee and bilateral foot disabilities to render him unemployable. Rather, they found no indication that the Veteran had any limitations on his ability to perform clerical work, or any type of work performed at a desk. Rather, the medical and lay evidence established that the Veteran had the intellectual and educational aptitude necessary to adapt to other types of employment. He had worked as a staff news writer, studied art history and had substantial knowledge of construction, woodworking and home remodeling. This indicates to the Board that he could have maintained substantially gainful employment in a desk job, whether in sales or providing information or guidance, related to his past occupations, or could have shifted into another line of work. The record does not suggest that the Veteran’s service-connected disabilities, other than PTSD, caused the level of functional impact contemplated by TDIU. He manifested chronic bilateral foot and bilateral knee pain and symptoms for which he had taken prescribed and over-the-counter pain medications, and he used a cane and a walker. The Board does not doubt that he had severe pain caused by his service-connected joint disabilities However, the medical evidence does not support a finding that bilateral pes planus, bilateral knee and bilateral hearing disabilities alone prevented him from securing or following any substantially gainful occupation at any time during the period on appeal. Rather, it is only when the PTSD is considered that the evidence shows the Veteran had been precluded from manual and sedentary labor. Absent medical evidence showing that the Veteran was unable to obtain and retain substantially gainful employment on basis of his service-connected bilateral foot, knee, and hearing disabilities, alone, a finding of TDIU on this basis excluding PTSD is not appropriate. Accordingly, the claim for TDIU is denied. LILA J. BAKKE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Lunger, 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.