Citation Nr: 21024325 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-46 042 DATE: April 22, 2021 ORDER Entitlement to an initial compensable rating for old avulsion fracture fragment in the region of the medial malleus, right ankle, prior to December 28, 2015, is denied. Entitlement to an initial 10 percent rating, and no higher, for old avulsion fracture fragment in the region of the medial malleus, right ankle, from December 28, 2015, is granted. Entitlement to an initial compensable rating for thigh, impairment of the right knee (DC 5253), is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to September 5, 2018, is denied. FINDINGS OF FACT 1. Prior to December 28, 2015, the appellant’s old avulsion fracture fragment in the region of the medial malleus, right ankle, was not manifested by at least moderate limitation of motion. There was no X-ray evidence of arthritis. 2. Since December 28, 2015, the appellant’s old avulsion fracture fragment in the region of the medial malleus, right ankle, has been manifested by limitation of plantar flexion to 14 degrees at worst, and limitation of dorsiflexion to 11 degrees at worst. Such was manifested by no more than moderate limitation of motion. There has been no X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating episodes. 3. Throughout the period on appeal, the appellant did not experience limitation of the right thigh such that he could not toe-out more than 15 degrees, he did not experience limitation of adduction such that he could not cross his legs, and he did not experience limitation of abduction with most lost beyond 10 degrees. 4. Prior to September 5, 2018, there is not sufficient evidence to substantiate a reasonable possibility that the appellant was unemployable by reason of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial compensable rating for old avulsion fracture fragment in the region of the medial malleus, right ankle, prior to December 28, 2015, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5003-5271. 2. The criteria for entitlement to an initial 10 percent rating, and no higher, for old avulsion fracture fragment in the region of the medial malleus, right ankle, from December 28, 2015, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5003-5271. 3. The criteria for entitlement to an initial compensable rating for thigh, impairment of the right knee (DC 5253), have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5253. 4. The criteria for entitlement to a TDIU prior to September 5, 2018, have not 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 appellant served on active duty in the U.S. Army from August 1972 to August 1976. He had an additional period of active duty while a member of the U.S. Air Force Reserve from February 1991 to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). An August 2015 rating decision, inter alia, awarded service connection for punctate old avulsion fracture fragment in region of medial malleolus right ankle (right ankle disability) and assigned an initial noncompensable rating, effective November 24, 2014. Such rating decision also denied entitlement to a TDIU. An April 2016 rating decision, in pertinent part, awarded service connection for thigh, impairment of right knee (DC 5253), and assigned an initial noncompensable rating, effective December 5, 2015. The appellant was afforded a video hearing before the undersigned in October 2019. A transcript is of record. The Board remanded the matter in December 2019. A November 2020 rating decision, in pertinent part, increased the evaluation of old avulsion fracture fragment in the region of the medial malleus, right ankle, to 10 percent, effective May 2, 2019, and awarded entitlement to a TDIU, effective September 5, 2018. Although higher ratings were granted, the issues remain in appellate status, as the maximum schedular ratings were not assigned for the entire period on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board has recharacterized the issues to reflect these partial grants on the cover page of this decision. A Supplemental Statement of the Case (SSOC) was most recently issued in November 2020. In accordance with the Board’s remand directives, a Statement of the Case (SOC) addressing the issues of entitlement to initial ratings in excess of 10 percent for (a) degenerative arthritis and right knee meniscal tear with scar (DC 5003-5260), and (b) trochanteric pain syndrome, right hip (DC 5251), was issued on September 18, 2020. See Manlincon v. West, 12 Vet. App. 238 (1999). Received on October 16, 2020, was a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), upon which the appellant elected to participate in the modernized appeals system with respect to these claims. The appellant has requested a hearing before a Veterans Law Judge in connection with this appeal. These issues will be the subject of a future decision, if otherwise in order. The Board also notes that entitlement to service connection for right thigh impairment with decreased flexion (DC 5252), as secondary to service-connected punctate old avulsion fracture fragment in region of medial malleolus right ankle (right ankle disability), was granted in an October 2020 rating decision. The RO assigned an initial noncompensable evaluation, effective August 25, 2020. The appellant was notified in an October 27, 2020, letter, which explained his appellate rights in the modernized appeals system. In response, the appellant submitted a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) in December 2020. On this form, the appellant appealed the evaluation and effective date assigned for right thigh impairment with decreased flexion (DC 5252) in the October 2020 decision. The appellant has requested a hearing before a Veterans Law Judge in connection with this appeal. These issues will be the subject of a future decision, if otherwise in order. Initial Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if that disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous. . . .” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Id. Rating Criteria Effective February 7, 2021, VA amended its Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, including Diagnostic Code 5271 and the diagnostic codes for arthritis. In cases where rating criteria are amended during the course of the appeal, the Board must consider both the former and current schedular criteria. Should an increased rating be warranted under new, revised criteria, the award may not be made effective before the effective date of change. See Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003). Under both versions of Diagnostic Code (DC) 5271, which pertains to limited motion of the ankle, a 10 percent evaluation is assigned for moderate limitation of the ankle, and a maximum 20 percent evaluation is assigned for marked limitation of motion. 38 C.F.R. § 4.71a, DC 5271. Under the version of the diagnostic code in effect prior to February 7, 2021, marked and moderate were undefined. Under the amended version of DC 5271, moderate was defined to mean less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, and marked was defined to mean less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. Normal range of motion of the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71a, Plate II. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992). Under the version of the diagnostic code in effect prior to February 7, 2021, DC Code 5010 (traumatic arthritis) provides that traumatic arthritis should be rated as arthritis, degenerative. DC 5003 (arthritis, degenerative) indicated that arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, DC 5003 provides a 20 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on x-ray findings, above, will not be utilized in rating conditions listed under DCs 5013 to 5024, inclusive. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Effective February 7, 2021, DC 5003 was renamed from “arthritis, degenerative (hypertrophic or osteoarthritis)” to “degenerative arthritis, other than post-traumatic.” DC 5010 had been “arthritis, due to trauma, substantiated by X-ray findings,” and such was to be rated as arthritis, degenerative. Following the changes, DC 5010 now pertains to post-traumatic arthritis and is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. DC 5253 pertains to impairment of the thigh, the only thigh/hip rating currently before the Board, as discussed above. A 10 percent rating is assigned for (a) limitation of rotation, such that one cannot toe-out more than 15 degrees, or (b) limitation of adduction such that one cannot cross legs. A maximum 20 percent rating is assigned for limitation of abduction such that motion is lost beyond 10 degrees. DC 5253 has not been changed. As noted below, because there is no indication or contention that the appellant experienced impairment of the femur, the changes to Diagnostic Code (DC) 5255 are not relevant. Factual Background The appellant was afforded a contracted ankle examination in July 2015. The claims file was reviewed. The appellant reported that he experiences flare-ups of the right ankle “every now and then,” characterized by aching and stiffness. Functional impairment was present in the form of pain and stiffness with overuse. Range of motion testing revealed full right dorsiflexion to 20 degrees and full right plantar flexion to 45 degrees. No pain was noted on examination. There was no objective evidence of localized tenderness or pain on palpation. There was no crepitus. There was no additional limitation of motion following repetitive-use testing. Examination was conducted immediately after repeated use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time. The examination was not conducted during a flare-up. However, pain, weakness, fatigability, or incoordination did not significantly limit functional ability during a flare-up, according to the examiner. Additional factors contributing to disability were swelling and interference with standing. Muscle strength was full and there was no atrophy. There was no ankylosis. Instability or dislocation of the right ankle was not suspected. The appellant did not have, nor had he ever had, shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus, or talectomy. No assistive devices were used. Amputation with prosthesis would not equally serve the appellant. There was no functional impact. July 2015 imaging studies of the appellant’s right ankle were conducted in connection with his contracted compensation and pension examination due to suspected arthritis. These imaging studies revealed punctate old avulsion fracture fragment in region of medial malleolus. The imaging studies were otherwise unremarkable. There was no evidence of arthritis. The contracted physician reported that a goniometer was used for all joint range of motion measurements. In his December 2015 NOD, the appellant expressed displeasure with the contract examination because no examination or testing was performed. Rather, he sat on the table and the clinician asked him a few questions. The appellant reported very limited motion, particularly with weight-bearing. A December 28, 2015, report of the Orthopaedic Center states that the appellant reported right hip, knee, and ankle pain and walking with a limp. Examination revealed unrestricted range of motion of the right hip. There was no evidence of instability, although there was mild discomfort with palpation over the greater trochanteric bursal region as well as some minimal discomfort with resisted abduction of the adducted hip. There was no gross deformity of the right ankle. Range of motion was full on both dorsiflexion and plantar flexion. There was no evidence of instability. There was mild discomfort with palpation over the medial joint line. The ankle was stable to anterior drawer and talar tilt. Capillary refill was brisk and neurovascular status was intact. Imaging studies of the right hip demonstrated no fracture, subluxation, or advanced degenerative change. There were no significant findings of the hip, but physical examination findings were suggestive of some mild trochanteric bursitis. Imaging studies of the right ankle revealed mild degenerative changes over the medial malleolus. The assessment was very mild posttraumatic arthritis of the ankle. In January 2016, the appellant contended that his right ankle joint was fairly weak and immobile. The appellant was afforded a contracted hip and thigh examination in April 2016. The claims file was reviewed. The appellant reported that he experiences flare-ups in the form of pain on the side of the hip which limits running, or walking more than 20 minutes. Functional loss or impairment was endorsed in the form of an inability to run and limitations regarding walking distances. Range of motion testing revealed right flexion to 50 degrees, right extension to 30 degrees, right abduction to 25 degrees, right adduction to 25 degrees, right external rotation to 25 degrees, and right internal rotation to 15 degrees. Adduction was not limited such that the appellant could not cross his legs. Pain was noted on all ranges and caused functional loss. There was no crepitus. It was noted that lateral pain limited walking distances. There was no additional limitation of motion following repetitive-use testing. Regarding repeated use over time, pain, fatigue, and lack of endurance significantly limited functional ability, but the examination was not conducted immediately after repeated use over time. The examiner was not able to describe such in terms of range of motion, but explained that there was no change upon examination, although lateral pain limited walking distances. Regarding flare-ups, pain, fatigue, and lack of endurance significantly limited functional ability, but the examination was not conducted during a flare-up. The examiner was not able to describe such in terms of range of motion, but explained that there was no change upon examination, although lateral pain limited walking distances. Additional factors contributing to disability included less movement than usual and disturbance of locomotion. Muscle strength testing was 4/5 on right flexion, but full on extension and abduction, but was not entirely due to the service-connected disability. The examiner was unable to determine why there was weakness on flexion as there was no evidence of muscle loss. There was no atrophy. There was no ankylosis. There was no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. No assistive devices were used and amputation with prosthesis would not equally serve the appellant. Regarding functional impact, the appellant would be limited from walking long distances. The contracted physician noted that a goniometer was used for all joint range of motion measurements. In June 2016, the appellant again claimed that range of motion measurements were not taken during his contracted ankle examination. He stated that he never stood for load-bearing on moving or checked for pain. The appellant also contended that the examiner should have picked up on him having posttraumatic arthritis. He also reported that, after the contracted ankle examination, the appellant saw a different physician who referred him to the Orthopaedic Center due to the appellant exhibiting symptoms of arthritis: pain with motion, pain that flares up with activity, tenderness on palpation, joint swelling and warmth, and increased pain and swelling in the morning and after sitting and resting. A May 2016 VA clinical note states that the appellant called and asked if he could get cortisone injections for his right ankle and knee pain. The appellant was afforded a contracted hip examination in June 2016. The claims file was reviewed. The appellant reported that his right hip pain was worse with activity. Flare-ups were described as pain from walking a lot or sitting in a car for a long time. Functional loss was reported in an inability to run or use a treadmill. Range of motion testing revealed right flexion to 115 degrees, right extension to 25 degrees, right abduction to 45 degrees, right adduction to 25 degrees, right external rotation to 60 degrees, and right internal rotation to 40 degrees. Adduction was not so limited that the appellant could not cross his legs. The appellant’s flexion was limited by thigh girth which was bilaterally symmetrical. Range of motion itself did not contribute to a functional loss. There was pain on adduction and external rotation but did not cause functional loss. There was mild tenderness to palpation of the right posterior to acetabulum. There was no evidence of pain with weight-bearing and there was no crepitus. There was no additional limitation of motion following repetitive-use testing. The examiner was unable to determine whether there was additional functional loss following repeated use over time or during flare-ups, or to describe such in terms of range of motion because there was no basis to do so unless observing the appellant during those conditions. There were no additional contributing factors to disability. Muscle strength was 4/5 for right flexion but full for extension and abduction. There was no atrophy. There was no ankylosis. The appellant did not have malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. No assistive devices were used and amputation with prosthesis would not equally serve the appellant. Imaging studies were negative for degenerative or traumatic arthritis. Regarding functional impact, the appellant would lose zero to one week’s worth of work time per year and would be precluded from prolonged sitting. However, it was noted that he was retired. A May 2019 examination report from the Ellis Clinic is of record. Dr. Ellis stated that a right hip X-ray revealed degenerative joint disease. The appellant reported right hip pain as a dull, constant ache, 3/10 in severity. It goes to 7/10 with prolonged walking, standing, sitting, using stairs, and squatting. He had difficulty crossing his thighs when sitting. Pain was better with medical marijuana, rest, and NSAIDs. Regarding the right ankle, Dr. Ellis stated that the most recent X-rays revealed punctate old avulsion fracture fragment in the area of the medial malleolus. The appellant reported pain as a dull, constant ache, 4/10 in severity. It goes up to 7/10 with prolonged walking, standing on uneven and hard surfaces, using stairs, and pressing on the gas pedal. Pain was better with rest, NSAIDs, and intra-articular injections. The right ankle rolls outwards and causes repeated sprains, at least four per year, which lead to pain and swelling. Dr. Ellis reported that right hip range of motion testing revealed flexion to 71 degrees, extension to 14 degrees, abduction to 17 degrees, adduction to 8 degrees, internal rotation to 4 degrees, and external rotation to 28 degrees. The appellant was unable to cross his legs and there was mild discomfort in the right groin. Right ankle examination revealed laxity of the ligaments on the inferior aspect of the lateral malleolus. Range of motion testing revealed plantar flexion to 14 degrees, dorsiflexion to 11 degrees, inversion to 6 degrees, and eversion to 0 degrees. In May 2019, the appellant reported that his right ankle pain keeps him awake at night and limits his activities. It is always painful to do yard work, walk, run, or play with grandchildren. Later, he reported that he has pain, weakness, stiffness, swelling, fatigability, and lack of endurance, and that he has been unable to run since separation from active service. The appellant also made reference to physical therapy for his right ankle in this statement. While he did not identify or provide any records from M.C., his physical therapist, the appellant stated that objective findings of right ankle range of motion were dorsiflexion to -6 degrees and plantar flexion to 12 degrees. The appellant was afforded a contracted ankle examination in June 2019. The claims file was reviewed. The appellant reported current symptoms of right ankle pain. He receives injections in the bilateral ankles four times per year, the most recent occurred two weeks ago. Such takes sharp pain out. Flare-ups were denied. The appellant did not report having any functional loss or impairment. Range of motion testing revealed right dorsiflexion to 20 degrees and right plantar flexion to 45 degrees. No pain was noted on examination and there was no localized tenderness or pain to palpation. There was no evidence of pain with weight-bearing and there was no crepitus. There was no additional limitation of motion following repetitive-use testing. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time. There were no additional factors contributing to disability. Muscle strength was full and there was no atrophy. There was no ankylosis. Instability or dislocation of the right ankle was not suspected. The appellant did not have, nor had he ever had, shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus, or talectomy. No assistive devices were used. Amputation with prosthesis would not equally serve the appellant. There was no functional impact. In July 2019, the appellant reported that he had limited motion in the ankle joint and flare-ups manifested by pain, swelling, and fatigue. He repeated his contentions of pain, weakness, stiffness, swelling, fatigability, and lack of endurance. The appellant contacted his VA primary care clinician in July 2019 to inquire whether pain patches were available for his hip as he did not wish to take pain pills due to problems with pills in the past. In an August 2019 addendum, with respect to a claim of service connection for a left ankle disability as secondary to the right ankle disability, the June 2019 contracted clinician explained that there was no evidence of record to suggest that the appellant’s old avulsion fracture of the right ankle was anything but well-healed and that there was no evidence to support significant residuals which would result in impairment significant to cause altered gait. The appellant testified during his October 2019 hearing before the undersigned Veterans Law Judge that he experiences cramps and blood clots in the legs which preclude him from walking. Regarding his thigh, he testified that he could not cross his legs, even if he picks his leg up to place it over the other one. He also noted difficulty putting shoes on but attributed those limitations to other leg disabilities. He also reported that he was taking medication for arthritis. The appellant reported that he must sit in an odd position, which requires him to lean over to the left, when sitting at home or in a car due to his right hip pain. Regarding the right ankle, the appellant noted that he receives shots on a four-month cycle. He is able to be seen more often if his pain returns more quickly. These shots generally give him relief from the sharp pains for a couple of months, but they do not fully relieve the pain. Future surgery has been discussed. The appellant reported that he sprains his ankle often. Swelling occurs with the sprains, about three times per year. Received in October 2019 was an ankle conditions Disability Benefits Questionnaire (DBQ). However, such only addressed the left ankle and not the right. An October 2019 VA primary care note states that the appellant received periodic steroid shots every four to six months in both of his ankles. A March 2020 VA physical therapy note states that the appellant described his right hip pain level as “very little.” The appellant was afforded a contracted hip and thigh examination in August 2020. The claims file was reviewed. The appellant reported that his pain had been worsening and that it was difficulty to walk. Pain was 8/10 with prolonged sitting, walking, standing, squatting, and using stairs. Flare-ups of the right hip were endorsed which occur four to five times per week. They were moderate to severe and last two hours. The flare-ups are precipitated by walking and alleviated by medication. The appellant did not report any functional loss or impairment of the right hip. Range of motion testing revealed right flexion to 90 degrees, extension to 20 degrees, abduction to 30 degrees, adduction to 20 degrees, external rotation to 40 degrees, and internal rotation to 20 degrees. Adduction was not so limited such that the appellant could not cross his legs. Range of motion itself did not contribute to a functional loss. Pain was noted on all ranges of motion but did not cause functional loss. There was moderate localized tenderness or pain on palpation of the right hip. There was no pain with weight-bearing or crepitus. There was no additional limitation of motion following repetitive-use testing. The appellant was examined immediately after repeated use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time or during flare-ups. There were no additional factors contributing to disability. Muscle strength was full bilaterally and there was no atrophy. There was no ankylosis. There was no malunion or nonunion of femur, flail hip joint, or leg length discrepancy. No assistive devices were used and amputation with prosthesis would not equally serve the appellant. Regarding functional impact, the appellant would be able to walk and stand for two out of eight hours and sit for six of eight hours. He would not be able to use ladders. He could climb stairs, bend, stop, and kneel occasionally. He could lift or carry 10 pounds frequently and 20 pounds occasionally. There was no evidence of pain on passive range of motion or on non-weightbearing. A goniometer was used for range of motion measurements. Received in November 2020 were statements from the appellant in which he expressed displeasure with how his contracted compensation and pension examinations appeared to be less than thorough. The appellant contended that he should be assigned, inter alia, a 20 percent evaluation for degenerative arthritis and two 10 percent ratings under DC 5010 for traumatic arthritis of the right knee and right hip, respectively. He also argued that the range of motion testing in the June 2016 contracted hip examination was inaccurate because it reports that the appellant’s hip range of motion was the same for the left hip as it was for the right. The appellant also argued that he should be afforded a higher rating due to pain, fatigue, weakness, lack of endurance, incoordination, and flare-ups of the right hip and right ankle. The appellant also argued that he should be awarded higher ratings for degenerative arthritis of the right ankle and traumatic arthritis of the right hip, and a separate rating for instability of the right ankle. 1. Entitlement to an initial compensable rating for old avulsion fracture fragment in the region of the medial malleus, right ankle, prior to December 28, 2015, is denied. 2. Entitlement to an initial 10 percent rating, and no higher, for old avulsion fracture fragment in the region of the medial malleus, right ankle, from December 28, 2015, is granted. The issue currently before the Board is entitlement to an initial compensable rating for old avulsion fracture fragment in the region of the medial malleus, right ankle, prior to May 2, 2019, and a rating in excess of 10 percent thereafter. For the reasons that follow, the Board finds that the preponderance of the evidence is against the award of an initial compensable rating prior to December 28, 2015, but the evidence is in relative equipoise as to whether an initial 10 percent rating, but no higher, is warranted from December 28, 2015. Prior to December 28, 2015, the appellant’s right ankle disability was not manifested by moderate limitation of motion. Indeed, the appellant had full range of motion without pain in the right ankle at the time of the July 2015 contracted examination, although the appellant has competently reported pain and stiffness. July 2015 imaging studies were negative for arthritis. 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). Here, however, prior to December 28, 2015, there is no objective evidence of painful motion or arthritis. Although the appellant is certainly competent to report ankle pain, the Board affords greater probative weight to the report of the July 2015 contracted examination which specifically notes that there was no evidence of painful motion and there was no localized tenderness or pain on palpation. Even during a flare-up or after repeated use over time, pain, weakness, fatigability, or incoordination did not significantly limit functional ability. In essence, despite the appellant’s competently-reported symptoms, there was no functional impact from his right ankle disability which produced loss of motion necessary for a compensable degree. As such, an initial compensable rating prior to December 28, 2015, for the appellant’s reported pain and stiffness, without competent evidence of functional impairment from such, is not warranted. The Board also notes that, although the appellant contends that his July 2015 examination did not include the measuring of range of motion, the July 2015 clinician reported that a goniometer was used for all joint range of motion measurements. In this regard, there is a presumption of regularity in the administrative process whereby it is assumed that government officials “have properly discharged their official duties.” United States v. Chemical Foundation, Inc., 272 U.S. 1, 14-15 (1926); Romero v. Tran, 2021 U.S. App. Vet. Claims LEXIS 78 (No. 19-3687). The presumption may only be rebutted by “clear evidence to the contrary.” Schoolman v. West, 12 Vet. App. 307 (1999). Questions of credibility notwithstanding, the Board finds that the appellant’s conclusory lay statements do not rebut the presumption of regularity. Since December 28, 2015, the appellant’s right ankle disability was manifested by no more than moderate limitation of motion. The December 28, 2015, report of the Orthopaedic Center reveals that, although the appellant had full range of motion of the right ankle, there was mild discomfort with palpation over the medial joint line. Further, imaging studies revealed very mild arthritis of the right ankle. While the appellant described his right ankle joint as immobile in January 2016, again, he had full range of motion of the right ankle on objective testing on December 28, 2015. The Board affords greater probative weight to the contracted examination reports which describe the appellant’s right ankle range of motion than to the appellant’s statements that he cannot move his ankle because these reports are based upon clinical examinations of the appellant and the examiners noted that measurements of range of motion were taken with a goniometer. The appellant’s statements that he cannot move his ankle are unsupported by the clinical evidence of record. Notwithstanding the discussion below of his report being an outlier, even the May 2019 report of Dr. Ellis indicates that the appellant retained range of motion of the ankle. The May 2019 report of Dr. Ellis states that right ankle range of motion testing revealed plantar flexion to 14 degrees and dorsiflexion to 11 degrees. Full plantar flexion of the ankle is 45 degrees and full dorsiflexion of the ankle is 20 degrees. 38 C.F.R. § 4.71a, Plate II. In June 2019, the appellant’s right dorsiflexion was measured to 20 degrees and right plantar flexion was to 45 degrees. No pain was noted on examination and there was no localized tenderness or pain to palpation. Approximately one month after the examination by Dr. Ellis, he again had full range of motion. The results of the range of motion testing performed by Dr. Ellis are outliers compared to the majority of the medical evidence of record. However, even assuming arguendo that the appellant experienced marked limitation of motion in May 2019, he regained full motion by June 2019. As such, to assign a higher rating for this discrete period would violate the rule regarding stabilization of ratings. 38 C.F.R. § 3.344. Notably, these measurements would not meet the criteria for a 20 percent rating under the revised DC 5271, even if these measurements had been taken after February 7, 2021. For the period beginning February 7, 2021, the Board finds that the new version of DC 5271 is no more or less favorable than the previous version in this matter. For the reasons discussed above, the appellant experienced no more than moderate limitation of motion for any portion of the period on appeal since December 28, 2015, under the old version of DC 5271. Whether or not the May 2019 range of motion measurements of Dr. Ellis (11 degrees of right dorsiflexion and 14 degrees of right plantar flexion) are of greater probative value than the June 2019 contracted examination report (20 degrees of right dorsiflexion and 45 degrees of right plantar flexion), an initial rating in excess of 10 percent would not be warranted under the new version of DC 5271. The Board notes that the appellant has argued that he experiences right ankle instability and that such warrants a higher rating. However, the Board assigns more probative weight to the VA clinical evidence which affirmatively shows no right ankle instability. The July 2015 and June 2019 contracted examiners noted that, following examinations and reviews of the claims file, instability of the right ankle was not suspected. The December 28, 2015, report of the Orthopaedic Center states that there was no evidence of instability and that the right ankle was stable to anterior drawer and talal tilt. The Board has considered Dr. Ellis’ notations of right ankle laxity of the ligaments on the inferior aspect of the lateral malleolus but finds that absent any finding of functional loss as a result of that noted laxity, a higher rating would not be warranted. Even considering the appellant’s subjective reports of instability as accurate, the subjective instability described would not more nearly approximate a higher evaluation for any portion of the period on appeal. Rather, the appellant’s overall functional impairment of the right ankle has been considered in the determination that an initial compensable rating prior to December 28, 2015, is not warranted, and that an initial rating in excess of 10 percent thereafter is not warranted. The Board has considered the appellant’s May 2019 statement in which he reported that M.C., his physical therapist, measured his right ankle range of motion as dorsiflexion to -6 degrees and plantar flexion to 12 degrees. However, the appellant has not submitted records from his physical therapist, nor has he provided authorization and information in order for VA to attempt to obtain these records. An August 2019 Report of General Information states that the appellant was contacted by VA regarding private medical records which he had identified in recent correspondence. The appellant stated that he had submitted all records and that VA did not need to request any other medical records. In any event, the Board has considered the range of motion measurements that the appellant provided and, questions of competency notwithstanding, such would not warrant a higher rating for any portion of the period on appeal. Plantar flexion to 12 degrees is close to the 14 degrees measured by Dr. Ellis in May 2019, but is an outlier compared to the June 2019 finding of 45 degrees of plantar flexion. Assuming that it was indeed -6 degrees and not 6 degrees, dorsiflexion to -6 degrees is inconsistent with the evidence of record, as there is no other indication or contention that the appellant’s dorsiflexion was limited to being outside normal range of motion, or was immobile. If dorsiflexion was limited to 6 degrees, such is approximately half of the dorsiflexion to 11 degrees measured by Dr. Ellis in May 2019 and it is an outlier compared to the 20 degrees of dorsiflexion measured on other occasions, including in December 2015 and June 2019. Thus, questions of competency and accuracy notwithstanding, to assign a higher rating for this one measurement of dorsiflexion to 6 degrees would violate the rule regarding stabilization of ratings. 38 C.F.R. § 3.344. See also Warren v. Brown, 6 Vet. App. 4 (1993) (holding that a claimant’s lay statements relating what a medical professional told him, filtered as they are through a layperson’s sensibilities, are too attenuated and inherently unreliable to constitute competent evidence to support a claim). To the extent that the appellant’s right ankle arthritis has been described as both degenerative and traumatic in nature, including in the December 28, 2015, report of the Orthopaedic Center which states that mild degenerative changes were observed while the assessment was very mild posttraumatic arthritis, he would not be entitled to an initial rating in excess of 10 percent for any portion of the period on appeal since December 28, 2015, or under the old or new regulations from February 7, 2021, to the present. Regarding the versions of DCs 5003 (degenerative arthritis) and 5010 (traumatic arthritis) in effect prior to February 7, 2021, and the version of DC 5003 (degenerative arthritis other than post-traumatic), an initial rating in excess of 10 percent would not be warranted because there was no X-ray evidence of involvement of two or more major joints, or two or more minor joint groups, with occasional incapacitating exacerbations. It is not contended otherwise. Regarding the version of DC 5010 effective February 7, 2021, the Board finds that it is no more or less favorable than the prior version because the new version of DC 5010 directs that the disability is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. As discussed above, an initial rating in excess of 10 percent for right ankle disability is not warranted under the diagnostic codes pertaining to the affected joint, the right ankle. In sum, the Board finds that (a) the preponderance of the evidence is against the award of an initial compensable rating for right ankle disability prior to December 28, 2015; (b) the evidence is in relative equipoise as to whether an initial rating of 10 percent, and no higher, is warranted effective December 28, 2015; and (c) the preponderance of the evidence is against the award of an initial rating in excess of 10 percent for any portion of the period on appeal since December 28, 2015. As the evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to an initial compensable rating for thigh, impairment of the right knee (DC 5253), is denied. The Board finds that the most probative evidence establishes that entitlement to an initial compensable rating for thigh, impairment of the right knee (DC 5253) is not warranted. As delineated above, at no point during the period on appeal did the appellant have limitation of rotation of the thigh such that he could not toe-out more than 15 degrees. Indeed, external rotation was never less than 25 degrees. The Board finds that the most probative evidence shows that at no point during the period on appeal was the appellant’s right thigh adduction limited such that he could not cross his legs. While the appellant is competent to report that he is unable to cross his legs, questions of credibility notwithstanding, the Board finds his reports, made in the context of a claim for monetary benefits, of minimal probative value because such are contradicted by the most probative medical evidence of record. Indeed, during numerous clinical examinations throughout the appeals period, the appellant was able to adduct such that he could cross his legs. Although the May 2019 report of Dr. Ellis states that the appellant had difficulty crossing his thighs and could not cross his legs, the Board assigns greater probative weight to the findings recorded at the VA examination conducted both before and after Dr. Ellis’ examination. At no point during the period on appeal was abduction of the right thigh limited such that motion was lost beyond 10 degrees. Indeed, abduction was not measured as less than 17 degrees. Thus, the appellant does not meet the schedular criteria for an initial compensable rating under DC 5253 at any point during the period on appeal. To the extent that the appellant contends that higher or additional ratings for the right hip are warranted, the appellant’s functional impairment has already taken into account in the compensable evaluation assigned for trochanteric pain syndrome, right hip (DC 5251). Notably, the appellant is also in receipt of a noncompensable rating for right thigh impairment with decreased flexion (DC 5252). As such, to assign a higher rating for DC 5253 based on these same symptoms would constitute impermissible pyramiding. 38 C.F.R. § 4.14. Regarding the appellant’s contentions that the June 2016 hip and thigh examination was inadequate because reported range of motion testing results were the same for the right and left hips for each range of motion, the Board has reviewed the report and observes that right and left abduction, right and left adduction, right and left external rotation, and right and left internal rotation were all measured as full. Right and left flexion were each measured to 115 degrees while full flexion is 125 degrees, and right and left extension were each measured to 25 degrees while full extension is 30 degrees. The contracted clinician explained that range of motion was normal for the appellant for reasons other than a hip condition. Indeed, it was noted that flexion was limited by thigh girth and that such was bilaterally symmetrical. The Board has considered the appellant’s lay history of symptomatology related to his claimed disorder throughout the appeal period. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through an individual’s senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The appellant in this case is not competent to determine the cause of his symptoms because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the appellant in this case, who has not been shown by the evidence of record to have medical training or skills. As such, his contention that the June 2016 hip examination was inadequate due to both hips having the same range of motion is entitled to no weight. Questions of competency and credibility notwithstanding, the Board finds that the appellant’s conclusory lay statements do not rebut the presumption of regularity. See also United States v. Chemical Foundation, Inc., supra; Romero v. Tran, supra; Schoolman v. West, supra. The Board emphasizes that the appeals with respect to the appellant’s claims for increased evaluations for trochanterica pain syndrome, right hip, and right thigh impairment with decreased flexion under the other hip disability codes, 5251 and 5252, respectively, are not currently before the Board and will be the subject of future decisions, if otherwise in order. As the evidence preponderates against the award of entitlement to an initial compensable evaluation under DC 5253 for the appellant’s service-connected thigh, impairment of the right knee, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). TDIU VA disability ratings are based, as far as practicable, on the average impairment of earning capacity attributable to disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Id. Where the schedular rating is less than total, a total disability rating may nonetheless be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disability; provided that, in pertinent part, if there is only one such disability, the disability shall be rated at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability rated 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341(a), 4.16(a). For the above 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 extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from 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. Id. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Thus, in any case where the veteran is unemployable by reason of service-connected disabilities but has failed to meet the percentage standards discussed above, rating boards will submit the case to the Director, Compensation and Pension Service, for extra-schedular consideration under 38 C.F.R. § 4.16(b). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. 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). For VA purposes, the term “unemployability” is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed. Reg. 2317 (1992). Consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion. Individual unemployability, however, must be determined without regard to any nonservice-connected disabilities or advancing age. 38 C.F.R. §§ 3.341 (a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or maintain employment, but the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. 1. Entitlement to a TDIU prior to September 5, 2018, is denied. As an initial matter, the Board observes that the appellant is currently in receipt of a TDIU, effective September 5, 2018. However, the grant of a total disability rating does not always render the issue of TDIU moot. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). The November 2020 rating decision which awarded entitlement to a TDIU did so based on the evidence showing that the appellant was unable to secure or follow a substantially gainful occupation due to his service-connected right hip, right knee, and right ankle disabilities. The effective date of September 5, 2018, was assigned based on the appellant meeting the schedular criteria for a TDIU beginning on that date. The appellant contends that his service-connected right hip, right knee, and right ankle disabilities render him unable to secure or follow a substantially gainful occupation. Here, the issue of entitlement to a TDIU from September 5, 2018, is indeed moot because the evidence contains no indication, nor does the appellant contend, that service-connected unspecified depressive disorder with alcohol use disorder, tinnitus, and/or bilateral hearing loss, in and of themselves, form a sole basis for an award of a TDIU. It is not contended otherwise. For the period prior to December 5, 2015, service connection was in effect for (1) tinnitus, rated as 10 percent disabling; (2) punctate old avulsion fracture fragment in region of medial malleolus right ankle, rated as noncompensable; and (3) bilateral hearing loss, rated as noncompensable. The appellant’s combined evaluation for compensation was 10 percent. For the period December 5, 2015, to December 27, 2015, service connection was in effect for (1) tinnitus, rated as 10 percent disabling; (2) degenerative arthritis and right knee meniscal tear with scar, rated as 10 percent disabling; (3) trochanteris pain syndrome, right hip (DC 5251), rated as 10 percent disabling; (4) punctate old avulsion fracture fragment in region of medial malleolus right ankle, rated as noncompensable; (5) bilateral hearing loss, rated as noncompensable; (6) thigh, impairment of right knee (DC 5253), rated as noncompensable, and (7) right thigh impairment with decreased flexion (DC 5252), rated as noncompensable. The appellant’s combined evaluation for compensation was 30 percent. For the period December 28, 2015, to September 4, 2018, service connection was in effect for (1) tinnitus, rated as 10 percent disabling; (2) degenerative arthritis and right knee meniscal tear with scar, rated as 10 percent disabling; (3) trochanteris pain syndrome, right hip (DC 5251), rated as 10 percent disabling; (4) punctate old avulsion fracture fragment in region of medial malleolus right ankle, rated as 10 percent disabling; (5) bilateral hearing loss, rated as noncompensable; (6) thigh, impairment of right knee (DC 5253), rated as noncompensable, and (7) right thigh impairment with decreased flexion (DC 5252), rated as noncompensable. The appellant’s combined evaluation for compensation was 30 percent. Thus, the appellant does not meet the schedular criteria for a TDIU under 38 C.F.R. § 4.16(a) for any portion of the period prior to September 5, 2018. However, the Board must consider whether his service-connected disabilities affect his employability to the extent that a remand to the Director of Compensation to consider a TDIU on an extraschedular basis is warranted, as the Board cannot award an extraschedular TDIU in the first instance. Bowling v. Principi, 15 Vet. App. 1, 10 (2001); see also 38 C.F.R. § 4.16(b). In the case at hand, however, referral for extraschedular consideration is not warranted because there is not sufficient evidence to substantiate a reasonable possibility that the appellant was unemployable by reason of his or her service-connected disabilities prior to September 5, 2018. Ray v. Wilkie, 31 Vet. App. 58, 66 (2019). In a statement received in February 2015, the appellant stated that he had worked for a company for 25 years which had just let him go and that he was now unemployed. During his July 2015 contracted audiological examination, the appellant reported that the functional impairment from his hearing loss was in the form of difficulty understanding speech in noise. Regarding tinnitus, the appellant endorsed difficulty concentrating and irritability. During his June 2016 contracted audiological examination, the appellant reported that the functional impairment from his hearing loss was that he had trouble understanding his wife and children. There was no functional impact due to tinnitus. An October 2018 outpatient note from Saint Francis Health System states that the appellant’s observed cognitive abilities did not appear to match with his reported history of international business negotiations. Notably, he spoke agrammatically often and used double negatives frequently. The assessment was depression, alcohol abuse, and alcohol-induced cognitive dysfunction. Received in January 2019 was a statement from the appellant that he was forced to quit work because he could not travel on airplanes around the world anymore, which was a requirement of his job. Rather, it had become too painful for him to travel. The appellant could not hear his customers and could not stand, sit, or walk due to pain in his right lower extremity, which caused him to develop depression. The appellant stated that he had not worked in the past four years. He also reported that, due to his psychiatric symptoms, he had to turn over the operation of his business to his son. During a January 2019 contracted psychiatric examination, the appellant reported that he provided maintenance services as part of his Air Guard and Air Reserves service when Air Force personnel were deployed, at which time he would take a leave of absence from his civilian position. The appellant had last worked in 2014 or 2015 as Director of Program Management at an aerospace company, where he had worked for 25 years. The appellant also had an Aviation Mechanic Certificate which included both Airframe and Powerplant (A and P) ratings. See also https://www.faa.gov/mechanics/become/test_requirements/ (last accessed 13 April 2021). Received in January 2019 was a statement from the appellant’s spouse. She stated that, when the appellant was working, he traveled all over the world to deal with companies to get work for his company. However, he told her that he stopped traveling due to the pain in his leg and hip. The appellant’s spouse had been told by her husband’s coworkers that the appellant was depressed, not getting along with management, offered illogical arguments, and could not function with other employees anymore. As such, the company worked out a separation package for the appellant in 2015 and the appellant had not worked since. The appellant’s spouse also noted that the appellant had to turn over the operation of their business to their son because the appellant was having problems getting up and going to the business. During his October 2019 hearing before the undersigned, the appellant testified that he had not worked since September 2014. He had been the director of program management and would travel to different countries and work out contracts, deals, and programs. The appellant stated that he had problems walking at airports and getting to the customers due to his right lower extremity disabilities. He was given pain pills while in New Zealand but ended up having to be hospitalized and has not used pain pills since. The appellant stated that walking, standing, and sitting were his three main problems. The appellant testified that he had a stock interest in a company and that they have let him come in a few times and sit around. However, he stated that he did not contribute anything and they did not really want him around. A July 2020 VA psychiatric consult note states that the appellant reported having graduated high school and that he had two years of college which resulted in an Associate’s degree in business. He reported that he had not worked since 2014 and that he had worked most of his life as a program manager. Received in October 2020 was a VA Form 21-8940 upon which the appellant reported that he believed himself to be unemployable due to his right hip, right knee, and right ankle disabilities. He reported that his disability affected full-time employment in September 2014 and that he last worked full-time in September 2014, although he had become too disabled to work in June 2013. Notably, he stated that the most money he earned in one year was 2014 when he earned more than $200,000 as director of program management. The appellant also reported that he worked at an express oil change company from August 2012 to June 2020 for an average of 10 hours per week. He had lost 10 months due to illness. He reported that he had two years of high school education and two years of college education. He had not had any other education or training before or after he became too disabled to work. A completed VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, was provided to VA in October 2020 from the oil change (quick lube) company where the appellant had worked. The appellant had worked as a cashier from August 2012 to June 2020 for approximately 12 hours per week. He had lost 10 months of work due to disability in the past 12 months. They could not let the appellant work downstairs because he was too unstable to go up and down the stairs 100 times per day as is required in the oil change business. It was noted that the appellant did not have a set schedule, but would generally provide support during lunch hours. The employer who completed the form, J.M. stated that it was apparent that the appellant was in major pain and could not work a full day. A medical opinion from Dr. Ellis of the Ellis Clinic was received in November 2020. Following examination of the appellant and review of records, Dr. Ellis opined that the appellant had been individually unemployable since June 2020 and that his unemployability was permanent and progressive and that the appellant would be unable to return to any type of gainful employment. Dr. Ellis noted that the appellant had severe pain in the right hip, right knee, right ankle, left knee, and bilateral feet from traumatic arthritis and plantar fasciitis. Such affected his ability to walk, stand for a prolonged time, climb stairs, bend, kneel, stoop, lift, and carry. It was noted that the appellant began working at the oil change (quick lube) company for two hours a day in 2014. He last worked there in June 2020. He had to quit working because of pain in his bilateral ankles, bilateral knees, and hips. Applying the facts set forth above, in addition to those delineated supra with respect to the initial rating claims on appeal, the Board finds that referral for extraschedular consideration is not warranted. Prior to September 5, 2018, the appellant’s service-connected disabilities certainly caused functional impairment in that the appellant had difficulty discerning speech with other noise and difficulty with sitting, standing, and walking for extended periods. However, this functional impairment has been taken into account in the disability ratings in effect for these disabilities. The Board finds that the appellant would not be precluded from working if he had the ability to alternate positions, such as between standing and sitting, to alleviate his right lower extremity pain. Indeed, the appellant has an Associate’s degree in Business and has more than two decades of experience working at an aerospace company, where he was Director of Program Management and had a history of international business negotiations. This education and experience includes successful interpersonal interaction, and notwithstanding some difficulty discerning speech with other noise, the disabilities for which service connection is in effect prior to September 5, 2018, bilateral hearing loss, tinnitus, right hip disability, right knee disability, and right ankle disability, did not preclude the appellant from performing negotiations or other interpersonal occupational tasks, so long as he was able to change position due to right lower extremity pain. The appellant and his spouse have offered varying reasons for the appellant no longer working at the aerospace company. The appellant has reported that it was because he was no longer able to do the required international travel due to pain in his leg and hip. However, in January 2019, the appellant’s spouse reported that her husband’s coworkers that the appellant was depressed, not getting along with management, offered illogical arguments, and could not function with other employees anymore. As such, the company worked out a separation package for the appellant in 2015 and the appellant had not worked since. This statement of the appellant’s spouse suggests that the appellant stopped working at least in part due to psychiatric symptoms, for which service connection was not in effect prior to September 5, 2018. The appellant testified in October 2019 that he had a stock interest in a company and was allowed to come in a few times and sit around. However, he stated that he did not contribute anything and they did not really want him around. Even assuming arguendo that this particular situation may be protected employment, the most probative evidence of record still establishes that the appellant was not unable to secure or follow a substantially gainful occupation prior to September 5, 2018. Notably, in January 2019, the appellant’s spouse reported that the appellant had to turn over operation of their business to their son because the appellant was having problems getting up and going to the business. It is unclear if this is the same company in which the appellant holds a stock interest, and/or if this is the “quick lube” oil change company. The appellant only reported the part-time work at the “quick lube” oil change company on his October 2020 VA Form 21-8940 in addition to making more than $200,000 in the final year he worked at the aerospace company. This form directs a claimant to list all employment including self-employment for the last five years he worked. No mention was made of the appellant having owned and operated a business of his own. Indeed, aside from general statements, the appellant has not provided information regarding the company he owned. Although VA has a duty to assist the appellant in the development of his claim, such duty is not “a one-way street.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), aff’d on reconsideration, 1 Vet. App. 406 (1991). Rather, the appellant also has an obligation to assist in the adjudication of his claim. “If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Wood, 1 Vet. App. at 195. The evidence certainly establishes that the appellant would not have been able to work full-time at the “quick lube” oil change in a position where he had to perform physical labor and climb stairs repeatedly throughout the work day. These right lower extremity symptoms likely would preclude the appellant from performing aircraft maintenance, although he holds an Aviation Mechanic Certificate which included both Airframe and Powerplant (A and P) ratings. Even assuming arguendo that the appellant’s service-connected right lower extremity disabilities precluded the appellant from traveling as part of his regular work duties and performing aircraft maintenance prior to September 5, 2018, based on the appellant’s education, training, and experience, the record does not substantiate a reasonable possibility that the appellant was unemployable by reason of his or her service-connected disabilities prior to September 5, 2018. Ray v. Wilkie, 31 Vet. App. 58, 66 (2019). Rather, the record reflects that his then-service connected disabilities did not preclude his ability to engage in all employment activities. For example, the evidence establishes that he could have worked in a position where he interacted with clients so long as he had the ability to adjust position as needed to alleviate right lower extremity pain. Notably, prior to September 5, 2018, service connection was not in effect for an acquired psychiatric disorder. As such, prior to September 5, 2018, any functional impact caused by a psychiatric disability cannot be taken into consideration. Further, the November 2020 private medical opinion of Dr. Ellis, submitted by the appellant and his representative, states that the appellant has only been unemployable since June 2020. Further, while Dr. Ellis attributes the appellant’s unemployability solely to musculoskeletal disabilities of the bilateral lower extremities, he includes nonservice-connected disabilities including bilateral foot and left knee disabilities as those which render the appellant unemployable. While the Board recognizes the limitations the appellant faces due to his service-connected disabilities, these limitations were considered in the disability ratings he receives for such. Again, the assignment of the schedular ratings is recognition of the functional limitations caused by his disabilities; and those ratings contemplate the severity and overall impact the symptoms have on his life. The Board finds that the appellant was not incapable of performing the physical and mental acts required for employment prior to September 5, 2018 when only his service-connected disabilities are taken into account. By all accounts, the appellant had a long and successful career as Director of Program Development. The appellant also owned and operated a company of his own, and has worked part-time as a cashier generally during lunch hours to support staff at a “quick lube” oil change company. For the foregoing reasons and bases, the Board finds that referral for extraschedular consideration is not warranted because there is not sufficient evidence to substantiate a reasonable possibility that the appellant was unemployable by reason of his or her service-connected disabilities prior to September 5, 2018. As the evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Behlen, 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.