Citation Nr: 21025154 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-46 073 DATE: April 27, 2021 ORDER A total disability rating based on individual unemployability (TDIU) on an extraschedular basis from March 13, 2015 through December 2, 2018 is granted. REMANDED Entitlement to an initial rating higher than 10 percent for limitation of flexion of the left elbow is remanded. Entitlement to a rating higher than 20 percent for limitation of pronation of the left elbow is remanded. Entitlement to an initial rating higher than 10 percent prior to December 3, 2018, and higher than 20 percent as of that date, for degenerative joint disease of the thoracolumbar spine status post lumbar laminectomy (back disability) is remanded. Entitlement to an initial rating higher than 20 percent for degenerative joint disease of the left shoulder, to include impingement (left shoulder disability), is remanded. FINDINGS OF FACT 1. As of the date of this decision, the ratings assigned the Veteran’s service-connected disabilities do not satisfy the percentage requirements for schedular TDIU prior to December 3, 2018. 2. As of March 3, 2015, but not before, the Veteran’s service-connected disabilities of the back, left shoulder, and left elbow have been sufficiently incapacitating as to render him unable to obtain or maintain substantially gainful activity, in light of his work experience, vocational attainment, skills, and education. CONCLUSION OF LAW The criteria for TDIU on an extraschedular basis have been met effective March 13, 2015 through December 2, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1971 to October 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in April 2010, May 2015, and July 2015 of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned in March 2013 with regard to the issue of entitlement to a higher rating for his left elbow disability; a transcript of the hearing is of record. The Board remanded the issue of entitlement to a higher initial rating for the Veteran’s left elbow disability in January 2014, and denied a higher rating in a November 2014 decision. The Board’s denial was vacated by the United States Court of Appeals for Veterans Claims (Court) in an October 2015 Order, which granted a joint motion for partial remand (JMPR) and remanded the case to the Board for further action consistent with the JMPR. The Board then remanded the claim for further development and action in April 2016, May 2017, and April 2018. In April 2018, the Board remanded the issues of entitlement to higher initial ratings for the Veteran’s disabilities of the back, left shoulder, and left elbow, and the issue of entitlement to TDIU. A July 2019 rating decision granted a TDIU effective December 3, 2018. The issue of entitlement to TDIU prior to December 3, 2018 remains in appellate status. See Rice v. Shinseki, 22 Vet. App. 447 (2009); AB v. Brown, 6 Vet. App. 35, 38 (1993). In August 2020, the Board again remanded the issues of entitlement to higher initial ratings for the Veteran’s disabilities of the back, left shoulder, and left elbow, and the issue of entitlement to TDIU prior to December 3, 2018. Because the ratings assigned the Veteran’s service-connected disabilities have not satisfied the percentage requirements for schedular TDIU prior to December 3, 2018, the case was referred to the Director of Compensation Service (Director) for consideration of entitlement to TDIU on an extraschedular basis for the period prior to that date. See 38 C.F.R. § 4.16(b). In a November 2020 decision, the Director denied extraschedular TDIU prior to December 3, 2018. The Board reviews this issue de novo, and therefore the Director’s decision is not binding on the Board. See Kuppamala v. McDonald, 27 Vet. App. 447, 456-58 (2015). TDIU A. Law Total disability ratings for compensation may be assigned, where the schedular rating is less than 100 percent, 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 one or more service-connected disabilities without regard to advancing age or nonservice-connected disability. 38 C.F.R. §§ 3.340, 3.341(a), 4.16(a), 4.19; Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993) (holding that the central inquiry is whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability). The claimant’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be considered. 38 C.F.R. § 4.16(b). Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 4.15. While the rating is based primarily upon the average impairment in earning capacity, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability, and to the effect of combinations of disability. Id. Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment shall generally be deemed to exist when a veteran’s earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Marginal employment may also be established, on a facts-found basis, when earned annual income exceeds the poverty threshold, including but not limited to employment in a protected environment such as a family business or sheltered workshop. Id. Consideration must be given in all claims to the nature of the employment and the reason for termination. Id. Although the Board must fully consider “the effect of combinations of disability” in its determination, “neither the statute nor the relevant regulations require the combined effect to be assessed by a medical expert.” Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Indeed, regulation places responsibility for the ultimate determination of unemployability on the Board or rating agency, not a medical examiner. Id. (citing 38 C.F.R. § 4.1 (a)). Where separate medical opinions address the impact on employability resulting from independent disabilities, the Board is authorized to assess the aggregate effect of all disabilities. Id. Certain percentage requirements must be satisfied to qualify for schedular consideration of entitlement to TDIU. Specifically, if unemployability is the result of only one service-connected disability, this disability must be ratable at 60 percent or more. 38 C.F.R. § 4.16(a). If it is the result of two or more service-connected disabilities, at least one must be ratable at 40 percent or more, with the others sufficient to bring the combined rating to 70 percent or more. Id. Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system such as orthopedic disabilities, will be considered as one disability for TDIU purposes. Id. If the schedular requirements for TDIU are not satisfied, but the veteran is still found unemployable due to service-connected disabilities, the case will be submitted to the Director of the Compensation Service (Director) for extra-schedular consideration. 38 C.F.R. § 4.16(b). Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (when the evidence supports the claim or is in relative equipoise, the claim will be granted). B. Analysis Prior to December 3, 2018, the Veteran’s service-connected disabilities have had a combined evaluation of 50 percent or less. Therefore, the percentage requirements for schedular TDIU are not satisfied prior to that date. See 38 C.F.R. § 4.16(a). As this case has already been referred to the Director for extraschedular consideration of TDIU, as discussed above, the Board may now issue a decision on this issue. For the following reasons, the Board finds that the criteria for TDIU on an extraschedular basis were met from March 13, 2015 to December 2, 2018, but not prior to March 13, 2015. In Ray v. Wilkie, the United States Court of Appeals for Veterans Claims (Court) held that the phrase “unable to secure and follow a substantially gainful occupation” in section 4.16(b) has two components: one economic and one noneconomic. Id. at 73. The economic component “simply means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person.” 31 Vet. App. 58, 72-73 (2019). As for the “noneconomic component,” the Court held that this refers to the individual claimant’s “ability to secure or follow” an occupation earning more than marginal income. Id. (emphasis in original). In determining whether a veteran can secure and follow a substantially gainful occupation, the Court stated that attention must be given to several relevant factors: (1) the veteran’s occupational history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g. sedentary, light, medium, heavy, or very heavy) required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. Id. The Court noted that these potentially relevant factors were not a “checklist that must be completely run through in every case,” and that any factor need only be discussed if the evidence raises it as an issue. Id. Here, the economic component is clearly satisfied for the period under review, as the evidence, including the Veteran’s earnings record from the Social Security Administration (SSA), his March 2016 VA Form 21-8940, and a November 2010 SSA Disability Determination, show that he has not worked since January 2010. Turning to the noneconomic component, the first factor in determining whether and when the Veteran’s service-connected disabilities prevented him from securing and following a substantially gainful occupation prior to December 2018 is review of his occupational history, education, skill, and training. See Ray, 31 Vet. App. at 72-73. In that regard, SSA records pertaining to the Veteran’s claim for disability benefits reflect that from July 1994 to January 2010, the Veteran worked as welder. He stopped working in January 2010 when the company he worked for went out of business. According to a private medical opinion authored by D. Miller Jr., M.D., J.D., the Veteran also had several jobs shortly after service over a period of four to five year that did not involve heavy labor. These jobs included working as a nurse’s aide and at a bakery. His March 2016 application for TDIU (VA Form 21-8940) reflects that he completed high school but did not attend college. His only other education was welding school. The second Ray factor requires consideration of whether the Veteran has had the physical ability (both exertional and nonexertional) to perform the type of activities (e.g. sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. In that regard, in his SSA application, the Veteran stated that in a typical workday in his most recent job, he frequently had to lift 50 pounds or more, and stand and walk for seven hours. He sat for one hour. He kneeled for one half hour, crouched for one half hour, handled, grabbed, or grasped big objects for seven hours, and wrote, typed, or handled small objects for two hours. A March 2020 private vocational assessment report authored by a vocational consultant, F. Fazzolari, CRC (hereinafter Fazzolari report) found that the Veteran’s past work as a welder would be classified at the medium exertional level per the Dictionary of Occupational Titles (D.O.T.). In light of the above findings, the Board next considers the impact of the Veteran’s service-connected disabilities on his physical ability to perform work consistent with his work experience, skills, and educational background. While his past work has been classified as requiring medium exertion, according to the March 2020 Fazzolari report, that does mean that a finding that his service-connected disabilities prevent him from performing work at that physical level would establish entitlement to TDIU; the Board may still determine that he has the ability to perform work involving less intensive physical activity within the restrictions imposed by his service-connected disabilities when considered against the background of his work experience and education. From February 8, 2010 to October 2014, service connection was in effect for the Veteran’s back disability, left elbow disability, a lumbar surgical scar, and functional tendon contracture of the fifth digit (little finger) of the right hand (the effective date of service connection for this disability is March 12, 2010). The combined evaluation of the Veteran’s service-connected disabilities was 20 percent. Effective October 1, 2014, service connection was awarded for the Veteran’s left shoulder disability. The combined evaluation of his service-connected disabilities was 40 percent as of that date. Effective from July 15, 2016, service connection was awarded for impairment of pronation of the left elbow. The combined evaluation was 50 percent. Effective October 6, 2016, service connection was established for lumbar radiculopathy of the right lower extremity involving the sciatic nerve. The combined evaluation remained at 50 percent. Effective from December 3, 2018, service connection was awarded for lumbar radiculopathy of the right lower extremity involving the femoral nerve, for left lower extremity lumbar radiculopathy involving the sciatic nerve, and for left lower extremity radiculopathy involving the femoral nerve. The combined rating as of December 3, 2018 has been 70 percent, and TDIU on a schedular basis has been awarded as of that date. Having provided an overview of the Veteran’s service-connected disabilities, the Board turns to their impact on functioning. An April 2010 VA examination report reflects that the Veteran had weakness, stiffness, lack of endurance, tenderness, and pain of the left elbow. He had flare-ups as often as three times per month, each lasting for twelve hours. The severity level was an out 8 out of 10 (with 10 being the worst). The flare-ups were precipitated by physical activity, and alleviated by rest. The Veteran described the flare-ups as an increase of pain. He had limited ability to lift due to his elbow disability. On examination, the left elbow was tender, and there was slight subluxation. Range-of-motion testing was within normal limits with respect to flexion (0 to 145 degrees), extension (0 degrees) supination, (0 to 85 degrees) and pronation (0 to 80 degrees), both on initial testing and with repetitive testing. See i38 C.F.R. § 4.71, Plate I. The left elbow was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination on repetitive use. There were no signs of edema, instability, abnormal movement, effusion, weakness, tenderness, redness, heat, deformity, guarding of movement, malalignment, or drainage. There was no ankylosis. The examiner stated that the effect of the Veteran’s left elbow disability on occupational functioning was that he had limited repetitive left elbow activity. The April 2010 VA examination report reflects that with regard to the right fifth finger, the condition did not cause pain. The Veteran reported that he did not experience any functional impairment from this condition. A May 2010 SSA examination report reflects that the Veteran’s back condition was stable. It occurred persistently. The location of the pain was the lower back. The pain radiated to the right thigh. Symptoms were aggravated by daily activities, lying/rest, standing, and walking. On examination, passive range of motion of the back was normal, as indicated by the fact that the examiner left the sections blank pertaining to range-of-motion findings. The examiner stated that sections unmarked meant they were within normal limits. The examiner noted that the Veteran had recovered well from his previous lumbar fusion surgery, and had good range of motion. Regarding exertional limitations, the examiner found that the Veteran could occasionally lift and/or carry 20 pounds, frequently lift and/or carry 10 pounds, stand and/or walk with normal breaks for a total of 6 hours in an 8-hour workday, sit about 6 hours in an 8-hour workday, and push and/or pull for an unlimited amount of time. In a November 2010 disability determination, SSA found that the Veteran was disabled for SSA purposes effective January 26, 2010 with a primary diagnosis of disorders of the back, for which service connection is in effect, and a secondary diagnosis of hernias, for which service connection has not been established. A September 2010 VA telehealth record reflects that the Veteran reported dizziness and feeling lightheaded, including when he worked outside or went to the grocery store. He was getting over a cold, and had a runny nose and non-productive cough. He had pain in the bilateral shoulders. He was sweaty with minimal activity and had shortness of breath occasionally. He tired easily. He stayed busy during the day, and felt as though did not have time to call. The Board notes that this record does not show that he reported back issues or elbow issues at this time. An October 2010 VA treatment record reflects that the Veteran was seen to establish case. He reported that he had been “hurting across his shoulders.” He could not lay on his left side. The pain was in his shoulders. The pain started before his left his last job. He stated he had been told he had a deteriorated vertebrae in his neck. The bottoms of his feet hurt often. This record does not reflect that he mentioned back pain or elbow pain. A May 2011 VA treatment record reflects that the Veteran had left elbow pain. He reported fishing the night before. He stated that after working or “doing things” he got pain in his lower back and hips. He had no burning pain in the legs unless lifting and squatting. He requested a handicap placard because his legs were hurting and he could not walk very far. The assessment was back pain with pain in the hips. The Veteran was given a handicap sticker, and prescribed Neurontin. A December 2011 VA elbow examination report reflects that the Veteran had left elbow symptoms of pain, weakness, stiffness, lack of endurance, and tenderness. The Veteran described flare-ups which affected his left elbow functioning. He described this as having a hard time lifting his arm up. Range-of-motion testing showed extension to 0 degrees (i.e. no limitation) and flexion to 145 degrees (i.e. no limitation). There was no objective evidence of painful motion. The Veteran was able to perform repetitive use testing with three repetitions. There was no additional limitation of motion on repetitive use testing, or functional impairment of the elbow and forearm. A June 2012 VA back examination report reflects that the Veteran denied flare-ups of back symptoms. On examination, forward flexion of thoracolumbar spine was 90 degrees, with pain beginning at 80 degrees; extension was to 30 degrees with no objective evidence of painful motion; right and left lateral flexion were each to 30 degrees/ without evidence of painful motion; right and left lateral rotation were to 20 degrees each. There was no further limitation after repetitive use testing. With regard to functional impact of the Veteran’s back disability on his ability to work, the examiner found that he had decreased ability to stoop and squat, and pain with prolonged standing. A July 2012 VA treatment record reflects that the Veteran was seen for chronic health problems. He reported breathing and stomach issues, and also getting muscle spasms in his sides with activity. A May 2013 VA treatment record reflects that the Veteran had been fishing on the bank when he fell and twisted his ankle. A July 2013 VA treatment record reflects that the Veteran had been doing some fishing and bearing weight on his ankle. An August 2013 VA treatment record reflects that the Veteran was prescribed Hydrocodone for back pain and arm pain at his request for a renewal of his medications. In this regard, the Board notes that the VA treatment records show prescriptions for Hydrocodone since March 2009. A September 2013 VA treatment record reflects that the Veteran had been mowing a few days earlier when he hit a bump and lower right side back pain started. He was having problems sitting, walking, and moving. An October 2013 VA treatment record reflects that the Veteran was seen to evaluate his pain condition and pain medication. It was noted that he had a history of back surgery, and pain in his shoulder. He was taking Hydrocodone. Regarding activities of daily living, he did some yard work, but “not a whole lot.” On examination, he walked “fairly well;” his squat was “fairly good;” he had fair extension and flexion of the lower back; his trunk rotation and side bending were stiff. He had pain and limited motion of the left shoulder. He was advised to taper off the opioid medication (i.e. the hydrocodone). The physician noted in this regard that due to the Veteran’s chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, tobacco use, and heart problems, he was not a “suitable candidate” for chronic use of opioid medication, and not at a high dose. The VA treatment records show that in January 2014, the Veteran called requesting an increase in pain medication due to pain in his left arm. A February 2014 note states he was informed that the Hydrocodone medication had been discontinued by his physician, and that no refill was available. The April 2014 VA elbow examination report reflects that the Veteran denied flare-ups of left elbow symptoms. On range-of-motion testing, the Veteran’s left elbow flexion was to 145 degrees, with objective evidence of painful motion at 30 degrees. Extension was to 0 degrees with no objective evidence of painful motion. He was able to perform repetitive-use testing with three repetitions. His left elbow flexion continued to be to 145 degrees after repetitive testing, and his extension to 0 degrees. The examiner found that there was no additional limitation in range of motion following repetitive-use testing. Left forearm supination was to 85 degrees, with objective evidence of painful motion beginning at that point. Left forearm pronation ended at 80 degrees, with objective evidence of painful motion beginning at that point. Post-test supination ended at 85 degrees, and post-test pronation ended at 80 degrees. With regard to functional impairment, the examiner indicated that there was pain on movement of the left elbow. Muscle strength testing was normal (5/5). There was no ankylosis. The Veteran did not have flail joint. The examiner stated that there were contributing factors of pain, weakness, fatigability, and/or incoordination, but no additional limitation of functional ability of the elbow joint during flare-ups or with repeated use over time. However, the examiner added that during flare-ups, the Veteran’s extension was limited to 5 degrees secondary to pain. The examiner found that his left elbow disability did not affect his ability to work, without an explanation. The April 2014 VA back examination report reflects that the Veteran had flare-ups of back symptoms which limited weightbearing. On examination, forward flexion of the thoracolumbar spine was to 90 degrees, with objective evidence of painful motion beginning at 30 degrees; extension was to 30 degrees; left and right lateral flexion were to 30 degrees; and left and right lateral rotation were to 30 degrees. There was no additional loss of motion with repetitive use testing. With regard to functional impact of the Veteran’s back disability on his ability to work, the examiner found that he had limited ability to lift and bend. The examiner noted that the Veteran had an antalgic gait due to back pain and obesity. There were additional contributing factors of pain, weakness, fatigability, and/or incoordination that caused additional limitation of functional ability of the thoracolumbar spine during flare-ups or with repeated use over time. A June 2014 VA treatment record reflects that the Veteran was seen to establish care at a VA outpatient clinic, and for a skin lesion. He also reported back pain, and stated that the pain had gotten worse since discontinuing pain medication. With regard to the left arm, he stated it was the bicep which bothered him. During the winter months the pain was very bad. The February 2015 VA shoulder examination report reflects that the Veteran had limited lifting and overhead activity during flare-ups of left shoulder symptoms. The examiner cited these same functional limitations in assessing the impact of the Veteran’s shoulder disability on his ability to work. There were additional contributing factors of pain, weakness, fatigability, and/or incoordination that caused additional limitation of functional ability of the shoulder during flare-ups or with repeated use over time. VA treatment records dated in March 2015 reflect that the Veteran reported “lots of pain” in his lower back. Nothing was helping. He was seen again about ten days later, at which time he reported that he had been rabbit hunting three weeks earlier. He stated he had bent over to pick up the rabbit and could not lift his leg. The back pain started shortly thereafter. He was seen in the emergency room and given a shot for the pain and a shot for inflammation. The pain was greatly reduced for one week. He still experienced “pressure” but no pain. He was also prescribed Hydrocodone, but had used all the pills prescribed. A May 2015 VA treatment record reflects that the Veteran complained of back, shoulder, and arm pain. He stated that during that past winter he could barely get in and out of his truck. He could not stay on his feet long without pain. He would get worn out driving or doing very little. He stated that his left arm and shoulder pain got better if he kept his elbow near his body. He had no strength. He stated that reaching out to grab something made his left arm and shoulder hurt. VA treatment records dated in January 2016 reflect that the Veteran was seen for pain in his left foot. It felt like something was in the bottom of his foot. He also complained of pain in his low back, hips, legs, and shoulder. He was taking Tylenol with no relief. About ten days later, he again sought treatment, stating he had recently installed a new door and had a painful lesion on his foot; he believed he had stepped on a splinter. Subsequent records dated later that month show that a splinter was removed from his foot. In a March 2016 affidavit, the Veteran wrote that he believed his left shoulder disability, left elbow disability, back disability, and right ring finger disability had worsened in severity and affected his ability to obtain and maintain substantially gainful employment. He stated that after he separated from service, he worked as a laborer and had other welding jobs throughout the 1970’s and 1980’s. He had been a welder his whole life, stating “it’s all I know.” He stated that his conditions always affected his work, but he “usually just worked through the pain.” His most recent job was as a welder from October 1999 until February 2010. He stated that his employer knew about his conditions and allowed him to take breaks as he needed them. He stated he would go into the break room when his conditions started to flare up, and he would relax until the pain subsided, and then go back to work. He noted that his facility started to “get really slow” and eventually shut down. At the same time, his conditions were getting worse, so he decided it would be better if he did not look for any other work. He stated that his left shoulder disability caused constant pain, and he could not lift his arm about his chest at all. He also had severe weakness of that arm. He was unable to pick up or lift more than a light bag of groceries without pain. His left elbow dislocation caused constant pain as well. He usually rested his elbow on his torso when he was sitting so that it did not get aggravated. His back condition made it very difficult to move around the house, sit down, and stand back up. He could not bend or twist without pain. He took Tylenol extra strength, and applied heat and ice for all the conditions. They also “negatively impact[ed]” his sleep, as he was constantly tossing and turning in his sleep, which was very painful. He was never comfortable as he could only lay on his back for a certain amount of time, and it was painful to sleep on his side as well. His nephew did a lot of things for him around the house that he had trouble doing himself. The nephew mowed the lawn and did household chores for the Veteran. The Veteran concluded that he believed that “all this time” he would be unable to obtain or maintain substantially gainful employment due to his service-connected disabilities, and that he had been unable to do so since he stopped working in February 2010. The July 2016 VA elbow examination report reflects that pain significantly limited functional ability of the left elbow with repeated use over a period of time. With regard to the functional impact of the Veteran’s left elbow disability, the examiner stated that the Veteran could not do repetitive lifting, and could not lift more than 15 pounds with the left arm. The August 2016 VA back examination report reflects that the Veteran reported flare-ups during which he could not walk more than a few yards without stopping due to cramps. Regarding functional impairment, the Veteran stated that he could not use a weed eater, could not sit without a pillow under his bottom and one behind his head, and could not walk more than fifty to sixty yards. The examiner found that with regard to functional impact, the Veteran could not lift more than 30 pounds, could not do repetitive bending, or prolonged sitting or standing. The August 2016 VA shoulder examination report reflects that the Veteran’s left shoulder hurt all the time; he could not reach above his chest. The February 2017 VA back examination report reflects that the Veteran could not bend over a lot, and that it was hard to put on his socks and shoes. He needed help to get off the floor, and could not walk very far. Regarding the impact of the Veteran’s back disability on his ability to work, the examiner stated, “[N]o bending, stooping, climbing, or lifting more than 30 pounds. No prolonged weight bearing.” The February 2017 VA shoulder examination report reflects that the Veteran stated that he had no strength in his left arm, and could not raise his arm without pain. He had lots of pain when he had to raise and use his left arm. Regarding the impact on occupational functioning, the examiner stated that the Veteran could not do work above chest height. The February 2017 VA elbow examination report reflects that the Veteran endorsed flare-ups of left elbow or forearm symptoms, which he described as his left elbow becoming tight if he bends it all the way. The examiner indicated that pain significantly limited functional ability with repeated use of the elbow over time. With regard to the impact of the Veteran’s left elbow disability on occupational functioning, the examiner stated that the Veteran could not lift more than 10 pounds with his left upper extremity. A March 2017 VA treatment record reflects that the Veteran was helping his former spouse and father-in-law. The nature of the help is not specified. He was still having back, shoulder, and neck pain. His left lower arm and shoulder were painful. The December 2017 VA back examination report reflects that the Veteran experienced back pain all the time. He could not bend, twist, or pick up things. The examiner found that the Veteran was unable to lift, carry, push, or pull heavy objects, or to perform repetitive bending, twisting, or flexing of the spine due to pain. The December 2017 VA hand examination report reflects a diagnosis of functional tendon contracture of the right fifth digit. The Veteran stated that he could not grip anything. The examiner found that the Veteran’s right fifth finger condition rendered him unable to maintain a tight grip on objects such as a hammer, and interfered with grasping hand tools. The December 2018 VA back examination report reflects that due to back pain, the Veteran had difficulty standing erect, and was unable to walk very far. The examiner cited these same issues in the discussion regarding the impact on occupational functioning. The pain was constant. He used Tylenol extra strength and heating pads on a daily basis for his symptoms. The December 2018 VA elbow examination report reflects that the Veteran’s elbow “pops” and he got muscle spasms in the left hand. He had loss of grip strength, loss of arm strength, chronic pain in the left arm, limited range of motion, and was unable to raise his arm to shoulder height or above. He was unable to lift or carry anything with his left hand or arm. The examiner cited these same issues when addressing occupational impairment. In the October 2016 private medical evaluation, which was based on an interview with the Veteran and review of the claims file, Dr. Miller concluded that the Veteran’s back disability at least as likely as not caused him to be “unable to secure and follow substantially gainful employment and [sic] the work that he had performed for approximately 31 years leading up to his last day of work in 2010.” The Board assumes that in the context of that quoted sentence, Dr. Miller meant to use the word “in” rather than “and,” meaning that the Veteran’s back disability prevented him from performing that type of work. Dr. Miller added that the Veteran had worked in a protective environment during the last two years he was employed full time, and noted that that type of work environment was no longer available after 2010. (The Board here notes that private treatment records show that accommodations were made as early as 2008 following lumbar spine surgery.) Dr. Miller explained that the Veteran’s job position as a welder was an extremely demanding physical occupation. In that regard, Dr. Miller stated earlier in the report that a welder has to bend over for much of the work, and has to use the non-dominant extremity to frequently lift objects, while the dominant hand is using the acetylene torch. The welder must also stand throughout the working day. The March 2020 Fazzolari report is based on review of the claims file and an interview with the Veteran. In the report, the vocational expert found that it is at least as likely as not that the Veteran has been unable to secure and follow substantially gainful employment, to include sedentary unskilled employment, since at least February 2010 as a result of his service-connected back disability, left elbow dislocation, left elbow impairment of pronation, and functional contracture of the 5th digit of the right hand. The vocational expert also found that the Veteran’s service-connected left shoulder disability and radiculopathy of the right lower extremity (sciatic) have at least as likely as not “further precluded him” from securing and following substantial gainful employment since at least October 2014 and October 2016, respectively. In support of those findings, the Fazzolari report first discusses the vocational expert’s interview with the Veteran. In this regard, the Veteran told him, according to the report, that his back hurt all the time, and that he had an inability to rotate his trunk without debilitating pain throughout his lumbar spine. It was exacerbated by prolonged sitting, standing, or walking. He needed to elevate his bilateral lower extremities throughout each day in an attempt to alleviate pressure on his lumbar spine. It was hard for him to get comfortable when he sat, and he had to use a pillow behind his back. He also experienced flare-ups of back pain with any increased activity, and unpredictable flare-ups as well at least once or twice a day. They flare-ups lasted a couple of hours and sometimes into the next day. During the flare-ups, he was significantly limited in his physical capabilities and primarily had to lie down for the duration of the flare-up. The Veteran also described significant pain and limitations with regard to his left elbow, left shoulder, right fifth finger disability, and radiculopathy of the right lower extremity, as detailed in the report. Notably, for each disability, the vocational expert introduced the discussion by stating that the severity of disability as related by the Veteran had been present “since at least February 2010.” For example, with regard to the back disability, the report says that the Veteran “discussed his [back disability] and resulting limitations on his ability to function throughout the day since at least February 2010.” However, the report does not explain why it finds that the Veteran’s descriptions of his present disability level at the time of the March 2020 interview applied in 2010, or specify that the Veteran himself stated that the same severity level had been present since 2010. For example, the Veteran stated that he had to elevate his bilateral lower extremities throughout the day, but the VA treatment records and examination reports do not show that such was the case in 2010, or for a number of years thereafter. The report then addresses “relevant physical limitations” due to the Veteran’s service-connected disabilities with regard to reaching, lifting/carrying, handling and gripping strength, sitting, standing, and walking, as detailed in the report. These findings are based on what the Veteran told the vocational expert over the phone. Again, the report states that with regard to the back, left elbow, and right fifth finger conditions, these limitations had been present “since at least February 2010,” and with regard to the left shoulder disability and right lower extremity radiculopathy, since at least October 2014 and October 2016, respectively. However, it is not clear why the physical limitations described by the Veteran at the time of the March 2020 interview were found by the vocational expert to relate back to the aforementioned dates, which are years earlier. The report then branches out to a discussion of associated problems with energy, sleep, and concentration due to the Veteran’s service-connected disabilities. In this regard, the report states that the Veteran had been prescribed Cyclobenzaprine for pain due to his service-connected conditions, and that he experienced extreme drowsiness after taking the medication. He stated at the interview that he did not like taking it if he had to drive the next day. He would doze off and on all day. The Board here notes that the VA treatment records show an active prescription for Cyclobenzaprine since March 2009. Regarding sleep, the Veteran got approximately four to five hours of intermittent sleep per night due to pain associated with his service-connected disabilities. He had resultant daytime fatigue, and napped each day. Regarding concentration, the vocational expert found that “[s]ince at least February 2010,” the Veteran’s service-connected conditions had significantly “impacted” his ability to concentrate due to distracting chronic pain. In this regard, the Veteran stated during the interview that he was “always distracted because of the pain.” He was unable to maintain concentration throughout the day, even with simple activities such as engaging in a conversation. The vocational expert noted that during the interview the Veteran often veered off topic, requiring frequent redirection. With regard to activities of daily living, the Veteran stated during the interview that his conditions had progressed over time and increasingly impaired his ability to perform activities. He stated that he used to push the mower, then got a riding mower, and now is unable to operate the riding mower. He has someone else mow the lawn. With regard to the Veteran’s occupational background, he stated that his boss would send people to help him and he was able to work at his own pace. He had the ability to take frequent unscheduled breaks “as needed.” After discussing the Veteran’s educational and vocational background, and the exertional requirements of non-skilled sedentary work as defined in the D.O.T., the Fazzolari report provides a detailed discussion regarding the Veteran’s service-connected disabilities and resultant functional impairment based on review of the medical records. For example, with regard to the Veteran’s back disability, the report states that his severe physical limitations as a result of that disability include chronic pain with difficulty sitting, standing, walking, lifting, carrying, and reaching since at least February 2010. The report then states that these limitations are supported by the “below medical and lay evidence of record,” followed by a summary of some of items of medical evidence discussed above in this decision, such as, for example, the May 2010 SSA examination report, the June 2012 VA examination report, the September 2013 VA treatment record, and the March 2016 affidavit by the Veteran, among other evidence. With regard to the back, the report states that under the D.O.T.’s definition of sedentary employment, such employment requires the ability to sit for prolonged periods, but also to stand and walk up to one third of the duration of the work shift. The vocational expert then states that the Veteran is severely limited in his ability to sit, stand, or walk for extended periods due to increased pain, weakness, and numbness as a result of his back condition since February 2010, and his right lower extremity radiculopathy since October 2016 (the date being, presumably, based on the effective date of service connection for that disability). Based on the Veteran’s inability to sit, stand, or walk for prolonged periods of time, the vocational expert found that the Veteran would be unable to meet the physical requirements of work at even the sedentary exertional level since at least February 2010. The vocational expert then states: “This is supported by the 08/23/16 and 02/10/17 Back Conditions Disability Benefits Questionnaires[,] which both noted disturbance of locomotion as well as interference with sitting and standing.” The vocational expert also cites to the October 2016 independent medical review by Dr. Miller. The vocational expert then provides similar discussions with regard to the Veteran’s disabilities of the left elbow, right fifth finger and left shoulder. The Board will not repeat the lengthy discussion in this decision, but will review some of the salient findings. With regard to the left elbow and right fifth finger disabilities, the vocational expert wrote that as even sedentary employment requires the ability to frequently perform repetitive tasks involving fine and gross manipulation with the bilateral upper extremities throughout a work shift, it is at least as likely as not that the Veteran would be unable to perform work at even the sedentary physical level due to his service-connected left elbow and right fifth finger disabilities since at least February 2010. The report states the Veteran’s left shoulder disability “further precluded” the Veteran’s ability to use his left upper extremity for even sedentary work tasks since at least October 2014. The vocational expert explained that the Veteran was incapable of performing any repetitive activities with his bilateral upper extremities due to chronic pain, numbness, weakness, and decreased grip strength. In this regard, the report notes that 92 percent of most jobs at all exertion levels require frequent to constant handling. Most jobs, including sedentary jobs for which the Veteran would be qualified, require functional use of both upper extremities for gross and fine manual dexterity involved in repetitive tasks. For example, manufacturing bench work requires performing assembling, inspecting, and sorting of small objects, which involves the bilateral extremities to perform repetitive processes, with daily pace and production expectations. Clerical occupations also require frequent or greater durations to demonstrate gross and fine motor manipulation, type, write, manipulate records, etc. The report then states that the Veteran “has had a significant reduction of the grip strength in both upper extremities and has also been significantly limited in his ability to lift or reach above shoulder height with the left upper extremity since at least February 2010 due to his left elbow and right [fifth] finger conditions.” The vocational expert found that these limitations would preclude the Veteran from adequately attending to a variety of work tasks, including tasks that require reaching above shoulder level and holding small objects. The report finds that the Veteran’s inability to consistently utilize his bilateral upper extremities to lift, reach, carry, or handle objects would at least as likely as not preclude his ability to work in all occupations, including sedentary work. In addition to the functional limitations caused by the Veteran’s service-connected disabilities in terms of the ability to perform specific work tasks, as reviewed above, the vocational expert also finds that the Veteran would not be able to satisfy employer standards of pace, productivity, and reliability because of distracting pain causing an inability to concentrate on work tasks for two consecutive hours. In addition, the Veteran would have excessive unscheduled breaks to rest, alternate position, and elevate lower extremities in an attempt to alleviate pain which would lead to excessive time spent off task. His chronic sleep impairment due to severe pain would further contribute to his inability to maintain concentration and pace. The vocational expert found that the Veteran’s severe pain and consequent need for unscheduled breaks, daily fatigue, and impairments in concentration would prevent him from sustaining focus for two consecutive hours and from producing the minimal amount of work required in competitive employment, rendering him underproductive and unemployable. Finally, the vocational expert found that the skills the Veteran learned as a welder would not readily transfer to sedentary occupations, and that limitations in his concentration secondary to pain and fatigue due to his service-connected disabilities “100% erode any transferable skills he may have acquired throughout his vocational history in the welding trade.” The Veteran was unable to retain or execute any past transferable skills due to significant difficulty maintaining adequate concentration and pace. His service-connected disabilities and consequent impaired concentration also negatively affected his ability to learn new skills, according to the vocational expert. Based on the evidence reviewed above, the Board finds that an effective date of March 13, 2015, but no earlier, is warranted for TDIU on an extraschedular basis. That is the date when the Veteran sought treatment for increased back pain after he went rabbit hunting a few weeks earlier. From then on, he reported more significant symptoms. The Board will explain its reasons in more detail below. Preliminarily, the Board first notes that the evidence shows a progression in severity of the Veteran’s disabilities over the years, and that the question is at what point does the evidence support a finding that they were sufficiently incapacitating as to prevent him from engaging in substantially gainful employment. For the period prior to March 13, 2015, while the Veteran’s back and left elbow condition caused significant functional impairment that may have prevented him from performing past work as a welder or similar work requiring medium exertion, there is no indication that he could not obtain and maintain substantially gainful employment as a cashier, security guard, custodian, or parking lot attendant, for example, especially where (and with the obvious exception of the custodian job) such jobs would permit some sitting. The SSA and VA examination reports during that period generally show nearly normal range of motion findings, including on repeat testing, with regard to the elbow and lumbar spine. He had more significant limitation of the left shoulder, but that in itself does not equate to being unable to engage in substantially gainful activity in jobs not requiring overhead activities or extensive use of the upper extremities, such as a security guard or parking lot attendant. To find otherwise would mean that any disability of the shoulder causing pain and limited motion, and in this case of the non-dominant extremity, would equate to unemployability, as suggested in the Fazzolari report. That would be an absurd result. The Board also finds it significant that the Veteran generally did not seek treatment for his left elbow condition, which indicates it did not present significant issues most of the time. Tellingly, records dated in May 2011, May 2013, and July 2013 show that he went fishing. He sought treatment in May 2013 because he injured his ankle when he fell while fishing, but otherwise his elbow condition and shoulder condition (and the Board is aware that service connection was not yet in effect for his shoulder condition) did not prevent him from fishing. Presumably, the fishing involved use of his upper extremities for a substantial period of time, as well as prolonged standing and swinging of the pole to cast out the line. He did report some elbow pain in May 2011 after fishing, but as shown in the 2013 VA treatment records, he continued to fish, and also to hunt, as shown in the March 2015 VA treatment record. Notably, he reported that he experienced significant back pain when he bent down to pick up the rabbit, but did not report upper extremity problems associated with the hunting. Also significant is the fact that the Veteran was able to install a door, as shown in the January 2016 VA treatment record. He sought treatment for foot pain thereafter due to a splinter in his foot, but did not indicate that it caused significant back, leg, or upper extremity problems. The fact that he was able to install a new door suggests he had retained significant use of his upper extremities. The Board is aware that installing a door, rabbit hunting, fishing, and mowing were all activities that the Veteran could perform at his own pace, and for limited amounts of time that would not equate to full time work. He may also have had substantial help installing the door. But the fact that he did engage in such activities—and these coming to light only because they happened to be mentioned in the VA treatment records—indicates that he was much more physically able than what has been described elsewhere in the record, and primarily in support of his claims. Again, the examination reports, including the May 2010 SSA examination report, generally show normal or near normal range of motion of the spine and elbow prior to March 2015, including after repetitive testing. The Board also finds it significant that in September 2010, the Veteran reported pain in his bilateral shoulders, but not thoracolumbar spine pain, leg pain, or elbow pain. Indeed, he stated he was busy during the day, and felt he did not have time to call. He reported feeling lightheaded and dizzy when working outside or going to the grocery store, but did not state that his back or left arm conditions caused issues with these activities. Similarly, when the Veteran established in-person care at a VA clinic in October 2010, he reported pain in his shoulders and feet, but did not mention elbow or back issues. The point of this discussion is not to suggest that the Veteran did not have back or elbow pain or limitations prior to March 2015, but that these were not as disabling as later records or statements, including the March 2016 affidavit and the March 2020 Fazzolari report, state that they were at the time. With regard to the right fifth finger, the records dated prior to March 2015 show that the Veteran did not complain of or seek treatment for right hand symptoms, including issues with gripping. According to the April 2010 VA examination report, the Veteran’s right fifth finger condition did not cause pain, and he did not experience any functional impairment from this condition. The VA treatment records dated in 2011, 2013, 2015, and 2016 also indicate that since he was able to mow, fish, hunt, and install a door, that he likely retained significant functional use of his right fifth finger and hand during those years as well. Thus, during the period prior to March 13, 2015, the Veteran’s service-connected disabilities did not prevent him from obtaining or maintaining substantially gainful employment doing lighter work such as being a ticket taker or parking lot attendant, security guard, theater attendant, or perhaps a store clerk. While his work experience was generally limited to welding, he has a high school diploma, and is thus able to read and write. The Board thus finds that his work experience, vocational background and attainment, skills, training, and education would not prevent him from obtaining and maintaining substantially gainful employment involving lighter physical exertion, as in the job examples just cited. The Fazzolari report, while probative on the issue of whether the Veteran’s service-connected disabilities have caused unemployability in recent years, is not probative on the issue of whether they caused unemployability for TDIU purposes prior to March 13, 2015. As shown in the discussion of that report, most of it is based on an interview with the Veteran in March 2020, and examination reports and records dated in 2016 or later. While those records may support the vocational expert’s findings regarding current unemployability, there is no explanation as to how they support the conclusions reached for that earlier period. The general pronouncement by the vocational expert that the Veteran’s back, elbow, and right fifth finger disabilities prevented him from working since at least February 2010 does not account for the fact that the earlier records show a much less severe level of disability and functional impairment than in later years, or otherwise explain why the more recently dated evidence relates back to that earlier period. As noted in that report and as stated a number of times by the Veteran, his disabilities progressively worsened over the years. Tellingly, the Fazzolari report states that the Veteran “has had a significant reduction of the grip strength in both upper extremities and has also been significantly limited in his ability to lift or reach above shoulder height with the left upper extremity since at least February 2010 due to his left elbow and right [fifth] finger conditions.” The vocational expert found that these limitations would preclude the Veteran from adequately attending to a variety of work tasks, including tasks that require reaching above shoulder level and holding small objects. However, as discussed above, the Veteran is not shown to have problems with right hand grip strength until the December 2017 VA hand examination report. He denied any functional impairment with regard to his right fifth finger at the April 2010 VA examination, according to the examiner’s report, and did not otherwise mention problems with his right hand in the VA treatment records. He also did not have problems with left hand grip strength, and retained significant functioning of his left arm, as discussed above. The vocational expert does not reconcile those facts with the conclusion reached for the period prior to March 2015. Indeed, the conclusion that the Veteran had significant reduction in grip strength in both upper extremities since February 2010 is based on an inaccurate factual premise. The fact that the Veteran had some left arm impairment does not support a finding that he was unable to secure and follow any substantially gainful activity, even at a sedentary level as defined in the Fazzolari report, including in the jobs cited as examples above. The Fazzolari report also finds that drowsiness and fatigue due to the side effects of pain medication and sleep impairment caused by pain, and impaired concentration due to pain, would prevent the Veteran from satisfying the persistence, pace, and production standards generally required by employers in the competitive work environment. He would need to take frequent breaks, for example, as discussed in that report. Again, while these findings support unemployability in more recent years, as they are consistent with the medical evidence, they do not account for the records dated prior to March 2015 showing less severe symptoms, or otherwise explain how the more recent symptoms relate back to that earlier period. With regard to drowsiness and fatigue, while the VA treatment records show prescriptions of Cyclobenzaprine since 2009, as well as Hydrocodone through about October 2013, and again in March 2015 to treat an acute exacerbation of back pain, they do not show a level of pain or drowsiness or fatigue sufficient to render the Veteran unable to obtain or maintain substantially gainful employment. The Board notes that a parking lot attendant or security guard, for example, would not need to meet a production standard. The Board also finds it significant that while the Veteran had been taking Cycolobenzaprine since March 2009—and thus well before he discontinued working, which was more than a year later—in 2010 he was keeping busy to the point where he felt he did not have time to call for his regular telehealth appointments, as shown in the September 2010 VA treatment record. Finally, the Veteran himself has not stated that pain or fatigue rendered him unable to engage in substantially gainful activity prior to March 2015. The conclusions in the Fazzolari report regarding the effects of pain, drowsiness and fatigue, sleep impairment, and difficulty concentrating are thus not supported by the record for the period prior to March 2015. They are either in tension or conflict with the evidence date during that period, or at best entirely speculative with respect to that period. Accordingly, for the reasons discussed above, the Board finds the Fazzolari report is not probative on the issue of whether the Veteran’s service-connected disabilities prevented him from obtaining or maintaining substantially gainful activity prior to March 13, 2015. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (holding that the probative value of a medical opinion comes from its reasoning, and that critical pieces of information from a claimant’s medical history can lend credence to the opinion of a medical expert who considers them, and detract from the medical opinions of experts who do not). While SSA found the Veteran to be disabled for SSA purposes since January 2010 with a primary diagnosis of disorders of the back, that decision has little probative value in determining whether the criteria for TDIU are established for the period prior to March 13, 2015. SSA’s legal criteria for establishing disability differ from VA’s criteria for establishing TDIU in several significant ways. For example, SSA bases the disability determination in part on advancing age, which VA may not consider for TDIU purposes. For the reasons discussed above, the probative evidence weighs against a finding of unemployability prior to March 13, 2015, and outweighs SSA decision. Indeed, the May 2010 SSA examination report finds that the Veteran could occasionally lift and/or carry 20 pounds, frequently lift and/or carry 10 pounds, stand and/or walk with normal breaks for a total of 6 hours in an 8-hour workday, sit about 6 hours in an 8-hour workday, and push and/or pull for an unlimited amount of time. According to the Fazzolari report, the D.O.T. defines sedentary work as exerting up to 10 pounds of force occasionally (up to one third of the time0, and/or a negligible amount of force frequently (one third to two thirds of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time, according to the D.O.T. definition cited in the Fazzolari report. “Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.” The findings in the May 2010 SSA examination report regarding the Veteran’s ability to lift, carry, push, pull, stand, walk, and sit, show that the Veteran could perform work at the sedentary level based on this definition, and indeed could perform work requiring more intensive physical activity, such as frequently carrying and/or lifting 10 pounds. Thus, SSA’s disability determination has little or no probative value with regard to whether the Veteran’s service-connected disabilities prevented him from obtaining or maintaining substantially gainful activity prior to March 13, 2015. The October 2016 private medical evaluation by Dr. Miller supports a finding that the Veteran could not perform work as a welder, but does not speak to the issue of whether he could perform work requiring less intensive physical activity. Accordingly, the preponderance of the evidence weighs against a finding of unemployability prior to March 13, 2015, for the reasons discussed above. As of March 13, 2015, the Board finds that the balance of the evidence supports unemployability for TDIU purposes, and resolves any reasonable doubt in favor of the Veteran. From then on, the evidence shows more severe symptoms and functional impairment, as shown in the May 2015 VA treatment record, March 2016 affidavit, and the VA examination reports dated from 2016 forward. It seems the initial increase was an acute exacerbation of back pain when the Veteran bent down to pick up a rabbit, and which improved with treatment, as reflected in the March 13, 2015 VA treatment record. However, the May 2015 VA treatment record reflects that the Veteran stated that during that past winter he could barely get in and out of his truck. He could not stay on his feet long without pain. He would get worn out driving or doing very little. He stated that his left arm and shoulder pain got better if he kept his elbow near his body. He had no strength. He stated that reaching out to grab something made his left arm and shoulder hurt. This record describes much more severe left arm and back symptoms and resultant functional impairment, including limitations with regard to standing and walking, and substantially limited use of his left arm. The Board notes that even still, a few months later the Veteran was able to install a new door, which complicates the more severe disability picture described in other records. Presumably, that project would involve intensive use of the arms, legs, and back. Nevertheless, the evidence from that point forward generally shows a much more severe level of functional impairment, and the Board is aware that he may have received substantial help in installing the door that is not mentioned in the VA treatment record in which he reported that activity. In the March 2016 affidavit, for example, the Veteran stated that his nephew did a lot of things for him around the house that he had trouble doing himself, including mowing the lawn and household chores. In short, the balance of the evidence from March 13, 2015 forward, when considered in itself and in light of the findings in the Fazzolari report that are based on such evidence, supports a finding that due to his service-connected disabilities, the Veteran has not had the physical ability to perform work at even the sedentary level consistent with his work experience, skills, and education as of that date. In that regard, the fact that his work experience has consisted of employment primarily as a welder, that he has no other skills training, and that his education has been limited to completing high school, further supports a finding that even if his service-connected disabilities did not render him physically or mentally unable to perform jobs involving mostly office or clerical work, it would not be reasonable to expect that he could obtain or maintain such employment. See Ray, 31 Vet. App. at 72-73; 38 C.F.R. § 4.16(b). The Board notes that it has remanded the issues of entitlement to higher ratings for the Veteran’s back disability, left shoulder disability, and left elbow disability for further development, as discussed below. As there is no reasonable possibility that such development or further adjudication of the claims would affect the Board’s findings regarding entitlement to TDIU, which is based on distinct criteria, the Board finds no prejudice in proceeding with a decision on that issue at this time. In sum, resolving reasonable doubt in favor of the claim, the Board finds that the criteria for entitlement to TDIU on an extraschedular basis have been met effective March 13, 2015, but no earlier. See 38 C.F.R. § 4.16(b); see also 38 C.F.R. § 3.400. As the preponderance of the evidence weighs against TDIU prior to that date, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND In August 2020, the Board remanded the increased rating claims for an adequate opinion addressing additional functional loss in terms of range of motion during flare-ups or with repeated use over time, explaining that the VA examination reports did not comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017) in that respect. VA opinions were obtained in October 2020 in which the examiner concluded that “[f]ollowing review of the Veteran’s history including subjective complaints, relevant evidence, objective examination findings, and using my clinical judgment and medical expertise, I have identified no basis to offer [estimates of] additional losses of motion or function during a flare up.” The same opinion was provided for the back, shoulder, and elbow. As it is not supported by an explanation, and does not otherwise comply with the Board’s remand directives or the requirements of Sharp, from which those directives flow, remand is warranted for a new opinion that adequately addresses the Sharp criteria. Although a TDIU has been granted effective March 13, 2015, this does not render moot the issue of entitlement to higher schedular ratings under the rating criteria. See Acosta v. Principi, 18 Vet. App. 53, 60-61 (2004). The matters are REMANDED for the following action: 1. Left elbow disability: Obtain a VA medical opinion that adequately addresses the Veteran’s flare-ups or additional functional loss with repeated use over time with respect to his left elbow disability in accordance with Sharp. In rendering the opinion, the examiner must discuss the frequency, duration, and severity of flare-ups, their effect on functioning, and precipitating and alleviating factors. If necessary, the Veteran should be contacted to obtain this information from him. The examiner is advised that according to the December 2018 VA examination report, the Veteran would not do repeat range-of-motion testing due to fear of pain; however, it is unclear whether that was owing to his elbow condition or his left shoulder condition. The examiner must then provide an estimate of additional range of motion loss during a flare-up or with repeated use over time, including based on the Veteran’s description of functional loss. If the examiner is still unable to provide such an estimate without resort to mere speculation, then a complete explanation must be provided. To that end, the examiner must clarify whether the inability to provide an estimate is due to the limitation of knowledge in the medical community at large, or a limitation—whether based on lack of expertise, insufficient information, or unprocured testing—of the individual examiner. As part of this obligation, the examiner should identify what specific facts cannot be determined that would be necessary to provide the estimate. 2. Back disability: Obtain a VA medical opinion that adequately addresses the Veteran’s flare-ups or additional functional loss with repeated use over time with respect to his back disability in accordance with Sharp. In rendering the opinion, examiner must discuss the frequency, duration, and severity of flare-ups, their effect on functioning, and precipitating and alleviating factors. If necessary, the Veteran should be contacted to obtain this information from him. The examiner must then provide an estimate of additional range of motion loss during a flare-up or with repeated use over time, including based on the Veteran’s description of functional loss. If the examiner is still unable to provide such an estimate without resort to mere speculation, then a complete explanation must be provided. To that end, the examiner must clarify whether the inability to provide an estimate is due to the limitation of knowledge in the medical community at large, or a limitation—whether based on lack of expertise, insufficient information, or unprocured testing—of the individual examiner. As part of this obligation, the examiner should identify what specific facts cannot be determined that would be necessary to provide the estimate. 3. Left shoulder disability: Obtain a VA medical opinion that adequately addresses the Veteran’s flare-ups or additional functional loss with repeated use over time with respect to his left shoulder disability in accordance with Sharp. In rendering the opinion, examiner must discuss the frequency, duration, and severity of flare-ups, their effect on functioning, and precipitating and alleviating factors. If necessary, the Veteran should be contacted to obtain this information from him. The examiner must then provide an estimate of additional range of motion loss during a flare-up or with repeated use over time, including based on the Veteran’s description of functional loss. If the examiner is still unable to provide such an estimate without resort to mere speculation, then a complete explanation must be provided. To that end, the examiner must clarify whether the inability to provide an estimate is due to the limitation of knowledge in the medical community at large, or a limitation—whether based on lack of expertise, insufficient information, or unprocured testing—of the individual examiner. As part of this obligation, the examiner should identify what specific facts cannot be determined that would be necessary to provide the estimate. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.