Citation Nr: 21023176 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-24 601A DATE: April 20, 2021 ORDER Entitlement to a rating of 60 percent for a neck disability is granted. Entitlement to a rating in excess of 40 percent for a back disability is denied. Entitlement to an initial rating of 50 percent prior to November 28, 2016, and 40 percent thereafter, for right upper extremity radiculopathy is granted. Entitlement to an initial rating of 40 percent prior to November 28, 2016, and 30 percent thereafter, for left upper extremity radiculopathy is granted. Entitlement to an initial rating of 40 percent prior to April 3, 2015, and 20 percent thereafter, for right lower extremity sciatic nerve radiculopathy is granted. Entitlement to an initial rating of 40 percent prior to April 3, 2015, and 20 percent thereafter, for left lower extremity sciatic nerve radiculopathy is granted. Entitlement to an increased 20 percent rating from January 6, 2021 for right lower extremity femoral nerve radiculopathy is granted. Entitlement to an increased 20 percent rating from January 6, 2021 for left lower extremity femoral nerve radiculopathy is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The Veteran’s neck disability is manifested by incapacitating episodes having a total duration of at least six weeks during the past 12 months. 2. The Veteran’s back disability is not manifested by unfavorable ankylosis of any part of his spine or by incapacitating episodes having a total duration of at least six weeks during the past 12 months. 3. Prior to November 28, 2016, the Veteran’s right upper extremity radiculopathy was manifested by severe symptoms. 4. From November 28, 2016, the Veteran’s right upper extremity radiculopathy was manifested by moderate symptoms. 5. Prior to November 28, 2016, the Veteran’s left upper extremity radiculopathy was manifested by severe symptoms. 6. From November 28, 2016, the Veteran’s left upper extremity radiculopathy was manifested by moderate symptoms. 7. Prior to April 3, 2015, the Veteran’s right lower extremity sciatic nerve radiculopathy was manifested by moderately severe symptoms 8. From April 3, 2015, the Veteran’s right lower extremity sciatic nerve radiculopathy was manifested by moderate symptoms. 9. Prior to April 3, 2015, the Veteran’s left lower extremity sciatic nerve radiculopathy was manifested by moderately severe symptoms. 10. From April 3, 2015, the Veteran’s left lower extremity sciatic nerve radiculopathy was manifested by moderate symptoms. 11. From January 6, 2021, the Veteran’s bilateral lower extremity femoral nerve radiculopathy was manifested by moderate symptoms. 12. The Veteran’s service-connected disabilities render him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating of 60 percent from April 11, 2012 for a neck disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code (DC) 5243. 2. The criteria for a rating in excess of 40 percent for a back disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 5243. 3. The criteria for a rating of 50 percent from April 11, 2012 to November 28, 2016 and 40 percent thereafter for right upper extremity radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8510. 4. The criteria for a rating of 40 percent from April 11, 2012 to November 28, 2016 and 30 percent thereafter for left upper extremity radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8510. 5. The criteria for a rating of 40 percent from April 11, 2012 to April 3, 2015 and 20 percent thereafter for bilateral lower extremity sciatic nerve radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8520. 6. The criteria for a rating of 20 percent from January 6, 2021 for right lower extremity femoral nerve radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8526. 7. The criteria for a rating of 20 percent from January 6, 2021 for left lower extremity femoral nerve radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8526. 8. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1993 to April 2002. These matters were previously before the Board and were remanded for further development in an October 2020 decision. The development has been completed and the matters are again before the Board. Regarding a claim of service connection for bilateral thrombophlebitis that was before the Board in its previous remand, the claim was granted by the RO in a January 2021 rating decision. As the full benefit sought was granted – i.e., an award of service connection – further appellate review is moot, and the claim is no longer on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. Increased Rating Claims Disability evaluations (ratings) 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 the 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. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Back and Neck Claims The Veteran contends his back and neck disabilities are worse than indicated by his current ratings. In this regard, the General Rating Formula for Disease and Injuries of the Spine provides that with or without such symptoms as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, provides a 10 percent rating if forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or forward flexion the cervical spine greater than 30 degrees but not greater than 40 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, if the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or guarding severe enough to result in an abnormal gait, or abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis; a 40 percent rating if forward flexion of the thoracolumbar spine being 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine; a 50 percent rating if there is unfavorable ankylosis of the entire thoracolumbar spine; and 100 percent rating if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code 5235-5242. Note (1) also articulates that neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be evaluated separately, under an appropriate diagnostic code. Id. Normal back motion is flexion to 90 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees, and right and left rotation to 30 degrees. 38 C.F.R. § 4.71a, Plate V. The Formula for Rating Intervertebral Disc Syndrome provides a 20 percent rating if the adverse symptomatology includes incapacitating episodes having a total duration of at least 2 weeks during the past 12 months, a 40 percent rating if the adverse symptomatology includes incapacitating episodes having a total duration of at least 4 weeks during the past 12 months, and a 60 percent rating if the adverse symptomatology includes incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Diagnostic Code 5243 defines an incapacitating episode as one where the Veteran has physician prescribed bed rest. The Veteran’s neck disability is currently rated as 20 percent disabling prior to April 11, 2012 and 30 percent thereafter and his back disability is rated as 40 percent disabling. The Board notes that, as these claims are non-initial increased rating claims, the period on appeal is one year prior to the date the Veteran filed his present claim. The Veteran had an examination for his neck in October 2012. The Veteran’s forward flexion ended at 30 degrees with painful motion at 30 degrees. After repetitive use testing, there was no additional loss of range of motion. The Veteran had functional loss from less movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. The Veteran also had guarding that did not result in abnormal gait. The Veteran had IVDS with at least six weeks of bed rest prescribed by a physician. The Veteran had an examination for his back in October 2012. The Veteran’s forward flexion was to 15 degrees with no additional loss of range of motion after repetitive use testing. The Veteran did have functional loss due to his back and did have guarding or muscle spasm that resulted in abnormal gait. The Veteran had IVDS in his back which resulted in at least four weeks, but less than six weeks, of bed rest prescribed by a physician over the past 12 months. The Veteran had an examination for his back in November 2012. The examiner found the Veteran’s forward flexion was to 10 degrees with no additional loss of range of motion after repetitive use testing. The Veteran had functional loss due to pain on movement. The examiner did not find the Veteran had guarding or muscle spasm. The Veteran had an examination for his neck in November 2012 and the examiner found the Veteran’s forward flexion was to 45 degrees or greater with no additional loss of range of motion after repetitive use testing. However, the Veteran did have pain on movement but no guarding or muscle spasms. The Veteran did not have IVDS but did regularly use braces and a cane. The Veteran had an examination for his back and neck in October 2013. The Veteran’s neck forward flexion was to 15 degrees with no additional loss of range of motion after repetitive use testing. The Veteran had functional loss with less movement than normal, pain on movement, disturbances of locomotion, and interference with sitting, standing, and weight-bearing. The Veteran had guarding or muscle spasm that resulted in abnormal gait. The Veteran had IVDS in his neck with incapacitating episodes over the past 12 months that lasted at least six weeks. The Veteran’s back forward flexion was to 10 degrees with no additional loss of range of motion and functional loss resulting from less movement than normal, pain on movement, disturbances of locomotion, and interference with sitting, standing, and weight-bearing. The Veteran had IVDS with incapacitating episodes lasting at least six weeks in the past 12 months. The Veteran had an examination for his back in April 2015 in which the Veteran said he had continued back pain and had spinal injections in 2012. The examiner found the Veteran’s forward flexion was to 30 degrees with painful motion beginning at 30 degrees. After repetitive use testing, there was no additional loss of range of motion. The Veteran had functional loss in the form of less movement than normal, weakened movement, excess fatigability, and main on movement. The Veteran also had trouble walking and had guarding and muscle spasm enough to result in abnormal gait. The Veteran had IVDS and had incapacitating episodes in the past 12 months that lasted at least four weeks but less than six weeks. The Veteran had another examination for his back in November 2016. The examiner reviewed the Veteran’s file and highlighted certain relevant records. The Veteran’s forward flexion was found to be to 80 degrees with the examiner reporting he was sure the Veteran did have some pain, however he felt that there was a large somatic component. The Veteran did not have guarding or muscle spasms in his back and did not have ankylosis in his back. The examiner stated the Veteran did not have IVDS but did regularly use braces and canes. The Veteran also had an examination for his neck in November 2016. The examiner reported the Veteran’s forward flexion was to 45 degrees with no guarding or muscle spasm and no ankylosis. The Veteran was again examined for his back in January 2021 in which the examiner saw the Veteran in person, reviewed his file, and noted his back diagnoses. The Veteran reported constant aching and intermittent radiating into the legs and worse pain with bending and lifting. The Veteran reported flare ups of his condition and using medication. The Veteran had functional loss, being unable to sit or stand for long periods of time. The Veteran’s forward flexion was to 25 degrees with pain noted on examination. After repetitive use testing, the Veteran’s forward flexion was found to be to 20 degrees. The Veteran did have muscle spasm that did not result in abnormal gait or abnormal spinal contour. The Veteran did not have ankylosis in his back but did have IVDS. However, the Veteran’s IVDS did not lead to periods of bed rest prescribed by a physician or treated by a physician in the past 12 months. The Veteran stated he regularly used a brace and a cane for his disability. The Veteran had an examination for his neck in January 2021. The examiner saw the Veteran in person, reviewed his file, and noted his neck disability diagnoses along with the Veteran’s bilateral upper extremity radiculopathy. The Veteran said his current symptoms included sharp, constant pain, intermittent pain, and that repetitive movement caused increase pain. The Veteran is right-handed and reported flare ups of his neck condition and functional loss having difficulty washing hair, brushing teeth, driving, and eating. The Veteran’s neck forward flexion was to 20 degrees with abnormal range of motion leading to functional loss. After repetitive use testing, there was no additional loss of range of motion but with pain leading to functional loss but no additional loss of range of motion. During a flare up, the Veteran’s range of motion was completely limited. The Veteran had guarding and muscle spasm not resulting in abnormal gait or spinal contour. The Veteran did not have ankylosis in his neck but did have IVDS with no episodes that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. In addition to his examinations, the Veteran’s records so he has been treated for his back and neck conditions. Imaging results from September 2012 show the Veteran had degenerative disc disease in his neck but that his limited lumbar series showed no definite abnormalities. In June 2016, the Veteran still had chronic neck pain and chronic back pain. In a Feb 2017 treatment note, the Veteran said in general his back and neck pain were stable, though he has good and bad days, but that he still got sharp intermittent sharp pain and in June 2017, the Veteran still reported chronic neck pain. Pertaining to the Veteran’s neck disability, the Board finds a rating of 60 percent is warranted based on the Veteran’s IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months. While one examiner in January 2021 said the Veteran did not have any incapacitating episodes, the Board finds that most of the evidence shows the Veteran’s neck disability leads to several incapacitating episodes. Therefore, a 60 percent rating is warranted from April 11, 2012. However, the Board does not find evidence that the Veteran’s neck led to such episodes or that the Veteran had ankylosis in his neck prior to April 11, 2012 as the Veteran’s medical records and examinations do not show this. Therefore, a higher rating prior to that date is not warranted. The Board finds a higher rating is not warranted for the Veteran’s back disability. None of the medical evidence of record indicates the Veteran has unfavorable ankylosis of his entire thoracolumbar spine or of his entire spine. Additionally, most of the medical evidence does not indicate the Veteran’s back IVDS leads to incapacitating episodes having a total duration of at least six weeks during the past 12 months. Therefore, the claim must be denied. Radiculopathy Claims The Veteran’s left upper extremity radiculopathy is rated as 30 percent disabling and his right (major) upper extremity radiculopathy is rated as 20 percent disabling under DC 8510. DC 8510 provides ratings for paralysis of the upper radicular group of nerves (fifth and sixth cervicals). DC 8510 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the upper radicular group, with all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected, is rated 70 percent disabling on the major side and 60 percent on the minor side. In October 2012, an examiner found the Veteran had severe symptoms of radiculopathy in his upper extremities which was severe in both extremities. In October 2013, the Veteran’s bilateral upper extremity radiculopathy was again found to be severe. In a November 2016 examination, the Veteran was found to not have upper extremity radiculopathy with the examiner reporting the Veteran’s MRIs did not indicate neural involvement at the time. In a VA peripheral nerves examination in January 2021, the examiner noted the Veteran was right-handed and did not have any symptoms attributable to any peripheral nerve condition. The examiner did not note any incomplete or complete paralysis in the Veteran’s upper or lower extremities. The examiner stated that while the Veteran had radiculopathy, that condition is not a peripheral nerve condition as it involves nerve roots impingement rather than in the periphery. The examiner noted the Veteran had symptoms of radiculopathy with moderate radiculopathy found in both extremities. The Board finds a higher, 50 percent rating is warranted for the Veteran’s right, dominant upper extremity radiculopathy manifesting severe incomplete paralysis from April 11, 2012 to November 28, 2016. After that, the evidence shows the Veteran’s right upper extremity radiculopathy was either asymptomatic (see November 2016 examination) or was moderate in severity. Therefore, a 40 percent rating is warranted from November 28, 2016. The Board finds a 40 percent rating is warranted for the Veteran’s left, non-dominant upper extremity radiculopathy from April 11, 2012 to November 28, 2016, and 30 percent thereafter based on the evidence discussed above. As to his lower extremities, the Veteran’s left and right sciatic nerve radiculopathy are each rated as 10 percent disabling under DC 8520. His bilateral femoral nerve radiculopathy is rated as 10 percent disabling under DC 8526. Under DC 8520, complete paralysis of the sciatic nerve, manifested by symptoms including that the foot dangles and drops, no active movement of the muscles below the knee, flexion of the knee weakened or lost, is rated as 80 percent disabling. Incomplete paralysis of the sciatic nerve, which is severe, with marked muscular atrophy, is rated as 60 percent disabling. Moderately severe incomplete paralysis of the sciatic nerve is rated as 40 percent disabling. Moderate incomplete paralysis of the sciatic nerve is rated as 20 percent disabling. Mild incomplete paralysis of the sciatic nerve is rated as 10 percent disabling. The Veteran’s left and right femoral nerve radiculopathy are each rated as 10 percent disabling. Under DC 8526, mild incomplete paralysis of the crural (femoral) nerve is rated as 10 percent disabling, moderate incomplete paralysis is rated as 20 percent disabling, severe incomplete paralysis is rated as 30 percent disabling, and complete paralysis is rated as 40 percent disabling. Words such as “severe,” “moderate,” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree of impairment. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings are combined with application of the bilateral factor. 38 C.F.R. § 4.124a. In an October 2012 examination, the Veteran was found to have severe symptoms of radiculopathy in both of his lower extremities, but a November 2012 examiner did not find the Veteran had lower extremity radiculopathy. In October 2013, an examiner opined the Veteran had severe radiculopathy in his bilateral lower extremities. In April 2015, an examiner found the Veteran had bilateral sciatic radiculopathy that was mild in both extremities, but in a November 2016 examination, the Veteran was not found to have any lower extremity radiculopathy. The examiner reported the Veteran’s MRIs did not indicate neural involvement at the time. In a VA peripheral nerves examination in January 2021, the examiner noted the involvement of not only the sciatic, but also the femoral nerve. The examiner opined the Veteran’s radiculopathy was moderate in both extremities with no other neurological abnormalities. The Board finds that the Veteran’s sciatic nerve radiculopathy was manifested by moderately severe symptoms from April 11, 2012 to April 3, 2015. While some examiners reported the Veteran’s symptoms were severe, there was no indication that his symptoms led to marked muscular atrophy. Additionally, one examiner in this time period said the Veteran did not have any radiculopathy. Based on this evidence, the Board finds a moderately severe rating most accurately reflects the Veteran’s disability picture during this time period. From April 3, 2015, the Board finds the weight of the evidence shows the Veteran’s sciatic nerve bilateral lower extremity radiculopathy was manifested by moderate symptoms, and therefore, a 20 percent rating is warranted from that time. Finally, as to the Veteran’s bilateral femoral nerve radiculopathy, no medical examiner prior to the examination in January 2021 indicated involvement of any lower extremity nerve other than the sciatic. However, as the January 2021 examiner opined that lower extremity radiculopathy was moderate in severity, a higher 20 percent rating is warranted from that date for the femoral nerve. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Regarding all the above, the Board acknowledges the Veteran’s statements that he believes his disabilities are worse than indicated by his current ratings. The Board has considered the Veteran’s statements of his symptoms in making the determinations above. However, while the Veteran is competent to report his symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as the severity of his medically complex disabilities. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board attaches more probative weight to the medical records and clinical findings from the medical professionals who conducted the medical assessments of these conditions. In this case, the most probative evidence of record shows that the Veteran’s disabilities are indeed worse than indicated by his previous ratings and therefore, the Board has granted higher ratings. However, in the case of the Veteran’s back disability, the Board finds the most probative evidence does not support a higher rating. This does not mean the Board believes the Veteran’s back does not cause him problems. Indeed, in part because of his back disability, the Board has granted a TDIU as discussed below. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). TDIU Claim The Court has held that a request for a total disability rating based on individual unemployability (TDIU), whether expressly raised by the Veteran or reasonably raised by the record, is not a separate “claim” for benefits, but rather, can be part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such a determination, 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 fact that a veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361. The law provides that a total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). The Veteran’s combined disability rating is now at 100 percent and was at 90 percent as of April 11, 2012, with his mental health disability rated as 50 percent disabling. In addition to his mental health disability, the Veteran is also service connected for the following disabilities: • A back disability, rated as 40 percent disabling, • A neck disability, currently rated as 30 percent disabling, • Left upper extremity radiculopathy, rated as 30 percent disabling, • Right upper extremity radiculopathy, rated as 30 percent disabling, • A scar, rated as 10 percent disabling, • Thrombophlebitis, right lower extremity, rated as 10 percent disabling, • Thrombophlebitis, left lower extremity, rated as 10 percent disabling, • Left lower extremity sciatic nerve radiculopathy, rated as 10 percent disabling, • Right lower extremity sciatic nerve radiculopathy, rated as 10 percent disabling, • Left lower extremity femoral nerve radiculopathy, rated as 10 percent disabling, • Right lower extremity femoral nerve radiculopathy, rated as 10 percent disabling, and • A skin disability rated as noncompensable (zero percent). The Veteran completed high school has a B.A. degree. The Veteran last worked in 2009 and has previous experience working at home doing flooring, painting, and sanding work. (See November 2012 examination.) The Veteran also had experience as a computer technician. (See January 2021 examination.) The evidence indicates that when combined, the Veteran’s mental and physical service-connected disabilities render him unable to secure and maintain gainful employment. The Veteran’s back and neck disabilities have routinely been shown to interfere with his ability to work at a computer, stand, walk, or sit for prolonged periods of time. These disabilities also limit his ability to work machinery or lift heavy objects. (See e.g. October, November 2012, October 2013, April 2015 examinations.) Therefore, based on the Veteran’s cumulative disability picture, a TDIU is granted. Robert N. Scarduzio Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Snoparsky 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.