Citation Nr: 21025939 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 12-31 095 DATE: April 29, 2021 ORDER Entitlement to a rating in excess of 10 percent for right foot metatarsalgia with arthritis (right foot disability) is denied. Entitlement to a rating in excess of 10 percent for left foot metatarsalgia with arthritis (left foot disability) is denied. Entitlement to a compensable rating for hemorrhoids is denied. Entitlement to a total rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran’s right and left foot disabilities are not manifested by adverse symptomatology that equates to at least a moderately severe foot injury even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups any time during the appeal. 2. The preponderance of the evidence shows that the Veteran’s hemorrhoids are not manifested by adverse symptomatology that equates to at least large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue hemorrhoids evidencing frequent recurrences at any time during the appeal. 3. The Veteran’s service-connected disabilities preclude substantial gainful employment. CONCLUSIONS OF LAW 1. The criteria for ratings in excess of 10 percent for right and left foot disabilities have not been met at any time during the appeal. 38 U.S.C. §§ 1155, 5100, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326, 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.27, 4.71a, Diagnostic Code 5284. 2. The criteria for a compensable rating for hemorrhoids have not been met at any time during the appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.14, 4.114, Diagnostic Code 7336. 3. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from November 1980 to November 1983 and from December 1985 to June 1991. The Veteran also had an intervening period of service with a Reserve Component. In March 2014, the Veteran testified at a video conference hearing before the undersigned Veterans’ Law Judge (VLJ). A transcript of that proceeding is of record. In an August 2016 decision, the Board of Veterans’ Appeal (Board) granted separate 10 percent ratings for the Veteran’s right and left foot disabilities. In August 2016, the Board also remanded the Veteran’s claims for higher ratings for hemorrhoids and a right hip disorder as well as entitlement to a TDIU. As to the claim for a higher rating for a right hip disorder, this issue was remanded for the regional office (RO) to issue a statement of the case (SOC). However, following the issuance of the August 2016 SOC, the Veteran did not perfect his appeal by filing a substantive appeal. Therefore, the Board finds that this issue is not in appellate status and it need not take any further action as to this issue. As to the Board’s denial of ratings in excess of 10 percent for right and left foot disabilities, the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a July 2017 order, which incorporated the parties Joint Motion for Partial Remand (JMPR), the Court and vacated and remanded the Board decision to the extent that it denied ratings in excess of 10 percent for right and left foot disabilities. In December 2017, the Board thereafter remanded the Veteran’s claims for ratings in excess of 10 percent for right and left foot disabilities. In October 2019, the Board again remanded the Veteran’s claims for ratings in excess of 10 percent for right and left foot disabilities as well as remanded his claims for a compensable rating for hemorrhoids and for a TDIU. Lastly, the Board notes that additional evidence was added to the record since the issuance of the December 2020 supplemental statement of the case (SSOC). However, the Board finds that this evidence is not pertinent as to either of the rating issues being adjudicated below. Therefore, the Board finds that it can adjudicate the appeal without obtaining a waiver or remanding for agency of original jurisdiction review. See 38 C.F.R. § 19.31 (a supplemental statement of the case will be furnished to the veteran when additional pertinent evidence is received after a statement of the case has been issued). Post-JMPR and Remand Compliance In this regard, the Board finds that the post-Remand development both addressed the concerns raised in the JMPR and complied with the Remands because the VA examinations/addendums dated in April 2020, August 2020, October 2020, and November 2020 provide, collectively, VA with medical evidence adequate to rate the Veteran’s right and left foot disabilities, to include which adverse symptomatology is due to the nonservice-connected foot disabilities and which are due to his service-connected right and left foot disabilities (i.e., foot metatarsalgia with arthritis) and the opinions as to the severity of the foot disabilities considered his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups because the examiners provided sufficient findings to addressed each of these concerns. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board also finds that the post-Remand development complied with the Remands because while the appeal was in Remand status all identified and available VA and private treatment records were obtained and associated with the record. Id. Therefore, the Board finds that further delay by remanding the appeal to provide the Veteran with a new VA examination or obtain additional treatment records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). There is no basis to remand this appeal. The Rating Claims The Veteran claims, in substance, that he is entitled to higher ratings for his right and left foot disabilities as well as his hemorrhoids at all times during the pendency of the appeal. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Furthermore, in Jones Shinseki, 26 Vet. App. 56, 61-63 (2012) the Court held that the Board may not deny entitlement to an increased rating on the basis of relief provided by medication when those effects are specifically contemplated by the rating criteria. In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Right and Left Foot Disabilities The Veteran’s right and left foot disabilities are each rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5284. In this regard, the Board notes that during the pendency of the appeal VA amended some of its’ criteria for rating musculoskeletal disabilities. See 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). However, the Board finds that none of the amendments change how the Veteran’s foot disabilities are rated under Diagnostic Code 5284. Therefore, the Board finds that a Remand to provide the Veteran with notice of these new rating criteria and have his claims adjudicating applying them is not required. See Sabonis, supra. As to rating the Veteran’s right and left foot disabilities, the Board notes that Diagnostic Code 5284 provides a 10 percent rating for a moderate foot injury, a 20 percent rating for a moderately severe foot injury, and a 30 percent rating for a severe foot injury. Initially, the Board notes that the terms mild, moderate, moderately severe and severe are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. The use of terminology such as mild or moderate by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board also notes that when evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, the United States Court of Appeals for Veterans Claims (Court) in Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016) held that the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to the evaluation of musculoskeletal disabilities under Diagnostic Codes predicated on range of motion measurements. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. Initially, in adjudicating below whether the Veteran meets the criteria for higher evaluations for his right and left foot disabilities, the Board has not overlooked the Court’s holdings in Correia, supra, and Sharp, supra. Tellingly, the Board finds that the record is adequate to address the concerns raised by the Court in both these cases because the August 2020 examiner specifically considered the range of motion of the feet taking into account the Veteran’s complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. With the above criteria in mind, the Board finds that the record does not suggest that the disabilities approximates the degree of severity required for at least 20 percent ratings. Specifically, the Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as DeLuca, Mitchell, Burton, Correia, and Sharp, the appellant’s right and left foot disabilities do not meet equate to a “moderately severe” foot injury. See Owens, supra. The Board has reached this conclusion because the post-Remand VA examiners were able to distinguish the adverse symptomatology due to the Veteran’s service-connected bilateral foot disabilities and therefore they allow the Board to rate the severity of his service-connected bilateral foot disabilities without taking into account his nonservice-connected bilateral foot disabilities despite the Court’s holding in Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam) (holding that “when it is not possible to separate the effects of the [service-connected condition and the non-service-connected condition], VA regulations at 38 C.F.R. § 3.102, which require that reasonable doubt on any issue be resolved in the appellant’s favor, clearly dictate that such signs and symptoms be attributed to the service-connected condition. 61 Fed. Reg. 52698 (Oct. 8, 1996).”). See VA examinations/addendums dated in April 2020, August 2020, October 2020, and November 2020. The Board has also reached this conclusion because the only adverse symptomatology seen on examination that is due to the service-connected bilateral foot disabilities was bilateral foot pain/inflammation with overuse such as walking greater than one city block and prolonged standing, pain with weight bearing, pain without weight bearing, tenderness, and swelling as well as increased pain and swelling with flare-ups. See VA examinations/addendums dated in March 2011, July 2014, September 2015, September 2018, April 2020, August 2020, October 2020, and November 2020. In this regard, the Board notes that the July 2014 VA examiner characterized the adverse symptomatology seen at that examination as “moderate.” X-rays of the Veteran feet in July 2014 showed mild degenerative changes. Likewise, the September 2018 VA examiner characterized the adverse symptomatology seen at that examination as “mild.” Furthermore, the post-Remand VA examiners were uniform in opining that the adverse symptomatology due to the service-connected bilateral foot disabilities seen at those examinations were best characterized as “moderate” in severity. See VA examinations/addendums dated in April 2020, August 2020, October 2020, and November 2020. Tellingly, because the above VA examiners characterization are supported by the medical findings at those VA examinations and because they are not directly contradicted by any other medical evidence of record, the Board finds that they are the most probative evidence of record. See Owens, supra; Colvin, supra. The Board has also reached this conclusion because, while the Veteran’s treatment records periodically document his complaints and treatment for his right and left foot disabilities, nothing in these treatment records show his adverse symptomatology worse than what was reported at the above VA examinations/addendums. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Likewise, the Board finds the VA examiners opinions more probative than the claims from the Veteran regarding more service adverse symptomatology because as a lay person he does not have the required training to provide medical opinions even though he can report on what comes to him via his own senses (see Davidson, supra) and as medical experts the Board finds the opinions by the VA examiners have greater probative value (see Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data)). Therefore, because the most probative evidence of record shows that the Veteran does not have at least a “moderately severe foot injury” because his adverse symptomatology is limited to pain, tenderness, and swelling opined to be mild or moderate in severity and mild arthritis, the Board finds that he is not entitled to ratings in excess of 10 percent for his right foot and left disabilities under Diagnostic Code 5284 at all times during the pendency of the appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5284; Owens, supra; Fenderson, supra; Hart, supra. Furthermore, given the nature and location of the Veteran’s right and left foot disabilities, the Board finds that they should not be rated under one of the other Diagnostic Codes for rating foot disabilities (see 38 C.F.R. § 4.71a, Diagnostic Codes 5276 to 5282, and 5283) because he has never been diagnosed with these other foot disorders, his VA examiners specifically opined that his service connected disabilities did not include these disorders and/or he did not have many of these disorders (see, e.g., VA examinations/addendums dated in March 2011, July 2014, September 2015, September 2018, April 2020, August 2020, October 2020, and November 2020), and/or because the 10 percent ratings already assigned each foot meets the maximum rating possible for some of the Diagnostic Codes in question. See 38 C.F.R. § 4.71a; Butts, supra; Owens, supra. Therefore, the Board also finds that the criteria for ratings in excess of 10 percent for the Veteran’s right and left foot disabilities are not met at any time during the appeal under 38 C.F.R. § 4.71a, Diagnostic Code 5284. See Fenderson, supra; Hart, supra; Davidson, supra; Colvin, supra. Hemorrhoids The Veteran’s hemorrhoids are rated as noncompensable under 38 C.F.R. § 4.114, Diagnostic Code 7336. Diagnostic Code 7336 provides that hemorrhoids (external or internal) will be rated as zero percent disabling when they are mild or moderate. A 10 percent disability rating is warranted when they are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. And, a 30 percent disability rating is warranted when they cause persistent bleeding with secondary anemia, or fissures. With the above criteria in mind, the Board notes that at the July 2014 VA examination, while the Veteran reported that he treated his hemorrhoids with an ointment, on examination he did not have any external hemorrhoids. The examiner thereafter opined that the Veteran did not have any findings, signs, or symptoms attributable to hemorrhoids including scars. Thereafter, at the September 2016 VA examination the Veteran reported that he continued to treat his hemorrhoids with an ointment as well as reported that they caused him to bleed when wiping after a bowel movement and they itched. Next, it was noted that an examination was not conducted because an August 2016 colonoscopy showed “some small internal hemorrhoids.” The examiner thereafter opined that the Veteran had mild or moderate symptoms. Thereafter, at the September 2018 VA examination the Veteran reported that he did not currently treat his hemorrhoids. His examination was normal with no external hemorrhoids, anal fissures, or other abnormalities. The examiner opined that the Veteran did not have any findings, signs, or symptoms attributable to hemorrhoids including scars. Nonetheless, the examiner thereafter opined that the Veteran had mild or moderate symptoms. Initially, the Board notes that the Veteran’s treatment records periodically document his complaints and treatment for hemorrhoids. However, the Board finds that nothing in these records shows his adverse symptomatology to be worse than what was reported by the above VA examiner; to include the records being negative for, at least, large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences. See Colvin, supra Likewise, while the Veteran is both competent and credible to report on the observable manifestations of his hemorrhoids (see Davidson, supra.), not only has he never claimed that they are large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences, but the Board finds more probative the findings at the above VA examinations because healthcare providers have greater medical training and the diagnosing of large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences requires medical training the appellant does not have. See Black, supra.). Therefore, the Board notes that the most probative evidence of record is the findings by the July 2014 and September 2018 VA examiners that the Veteran did not have hemorrhoids at the time of these examinations, the August 2016 colonoscopy that showed only “some small internal hemorrhoids,” and the September 2016 and September 2018 examiners opinions that his symptoms were only mild or moderate. In severity. See Colvin, supra; Owens, supra. Accordingly, the Board finds that the preponderance of the evidence of record shows that a compensable rating for hemorrhoids is not warranted under Diagnostic Code 7336 at all times during the pendency of the appeal because the record is negative for at least large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences. See 38 C.F.R. § 4.114; Fenderson, supra; Hart, supra. Conclusion In reaching the above conclusions, the Board has also considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the probative evidence is against the rating claims to the extent outlined above, the Board finds that this doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz, supra; Gilbert, 1 Vet. App. at 55-56. The TDIU Claim The Veteran claims, in substance, that he is entitled to a TDIU because his service-connected disabilities prevent him from working. 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. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation because of a service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. In calculating if the Veteran met the above schedular criteria VA combines the Veteran’s service-connected orthopedic disorders. The existence or degree of non-service-connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran’s service-connected disabilities render his incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned where the schedular rating is less than total if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Further, marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). The record shows that the Veteran is service-connected for the following disabilities: • Right knee status post toral arthroplasty rated as 20 percent disabling from October 20, 2010, 100 percent disabling from December 11, 2020, and 30 percent disabling from February 1, 2022; • Left knee disability rated as 20 percent disabling from October 20, 2010; • Back disability rated as 20 percent disabling from June 16, 2015, 10 percent disabling from February 25, 2016, and 20 percent disabling from May 24, 2019; • Right leg radiculopathy rated as 10 percent disabling from May 24, 2019; • Left leg radiculopathy rated as 10 percent disabling from May 24, 2019; • Right foot disability rated as 10 percent disabling from October 20, 2010; • Left foot disability rated as 10 percent disabling from October 20, 2010; • Right hip disability rated as 10 percent disabling from April 6, 2011; • Tinnitus rated as 10 percent disabling from January 11, 2016; • Left third proximal interphalangeal joint (PIP) dislocation rated as noncompensable from October 22, 1992; • Right little finger PIP fusion rated as noncompensable from April 17, 1996; • Hemorrhoids rated as noncompensable from July 31, 1996; and • Right knee scar rated as noncompensable from December 11, 2020. In summary, the Board finds that this record shows that the Veteran meets the schedular requirements of 38 C.F.R. § 4.16(a)(1)-(4) because he has one disability rated as 40 percent or higher when considering his back disability and radiculopathy as one and he has a combined rating of 70 percent or higher from April 6, 2011. The next question for the Board to consider is when, if ever, his service-connected disabilities render him incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). In this regard, the Veteran’s VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability (TDIU Claim Form), dated in December 2015, reported that he had not worked full-time and became he is too disabled to work in November 2014 because of his service-connected disabilities. As to his work history, the Veteran reported that from 1994 to 2015 he worked 40 hours a week at the United States Postal Service as a laborer. As to his education, the Veteran reported that he had 3-years of college. Additionally, while not binding on the Board, it nonetheless notes that a September 2015 letter from the United States Office of Personnel Management (OPM) reported that he was disabled as a mail handler with the United States Postal Service because of his service-connected back disability. As to the Veteran’s being able to work performing jobs that require sedentary employment and non-sedentary employment, including his past employment as a mail handler at the United States Postal Service as well as other possible employment that could make use of his work experience and 3-years of college, the Board finds that the medical records show that the problems caused by his service-connected bilateral knee disabilities, back disability, bilateral leg radiculopathy, bilateral foot disability, right hip disability, tinnitus, left third PIP dislocation, right little finger PIP fusion, hemorrhoids, and right knee scar adversely impact his ability to work in any field because of the overall impairment they have to his body and mind to include the stamina needed to work a full-day, concentrate on the tasks required by employment due to pain, and interact effectively with co-workers and/or customers due to pain, and carry out the tasks required by employment. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) (holding that the determination of whether a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the regional office). The Board also finds that his service-connected bilateral knee disabilities, back disability, bilateral leg radiculopathy, bilateral foot disability, right hip disability, tinnitus, left third PIP dislocation, and right little finger PIP fusion would make it dangerous for the Veteran and his co-workers for him to work in most non-sedentary employments. Id. Similarly, the Board finds that that the pain and lack of manual dexterity caused by his bilateral knee disabilities, back disability, bilateral leg radiculopathy, bilateral foot disability, right hip disability, tinnitus, left third PIP dislocation, and right little finger PIP fusion would make it very difficult to learn the new skills needed to work in most sedentary employments, sit for prolonged periods of time, and interact with his co-workers as well as any customers, and carry out the duties required by such employment for the first time. Id. Given the above, the Board finds that the Veteran’s service-connected disabilities prevent him from securing or following a “substantially gainful” occupation given his prior vocational history, work experience, and the impact his service-connected bilateral knee disabilities, back disability, bilateral leg radiculopathy, bilateral foot disability, right hip disability, tinnitus, left third PIP dislocation, right little finger PIP fusion, hemorrhoids, and right knee scar have on obtaining and maintaining substantially gainful non-sedentary employment and sedentary employment, including in his past employment as a mail handler at the United States Postal Service, because of the problems they would cause in any work environment. Further development of this issue is simply not warranted in light of the history of this case. Therefore, the Board finds that the most probative evidence of record shows that the Veteran’s service-connected disabilities render him incapable of substantial gainful employment given his prior vocational history, work experience, and the impact his service-connected disabilities have on all employment and the claim for a TDIU is granted. See 38 C.F.R. § 4.16(a). In reaching the above conclusion, the Board has not made any finding as to the effective date of the award of the TDIU because this issue is not before us. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.T. Werner, 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.