Citation Nr: 21027021 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 16-23 039 DATE: May 4, 2021 ORDER Entitlement to an initial disability rating in excess of 20 percent for thoracolumbar strain is denied. Prior to October 11, 2019, entitlement to a disability rating in excess of 10 percent for sciatic radiculopathy of the right lower extremity is denied. From October 11, 2019, entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the right lower extremity is denied. Prior to October 11, 2019, entitlement to a disability rating in excess of 10 percent for sciatic radiculopathy of the left lower extremity is denied. From October 11, 2019, entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity is denied. Prior to June 12, 2017, entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, to include on an extraschedular basis, is denied. From October 27, 2019, entitlement to a TDIU due to one service-connected disability is denied. FINDINGS OF FACT 1. At worst, thoracolumbar strain is not shown to have manifested as forward flexion to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 2. Prior to October 11, 2019, sciatic radiculopathy of the right lower extremity did not manifest as moderate incomplete paralysis of the right sciatic nerve. 3. From October 11, 2019, sciatic radiculopathy of the right lower extremity did not manifest as moderately severe incomplete paralysis of the right sciatic nerve. 4. Prior to October 11, 2019, sciatic radiculopathy of the left lower extremity did not manifest as moderate incomplete paralysis of the left sciatic nerve. 5. From October 11, 2019, sciatic radiculopathy of the left lower extremity did not manifest as moderately severe incomplete paralysis of the left sciatic nerve. 6. Prior to June 12, 2017, the evidence of record does not show that the Veteran was unable to secure or follow substantially gainful employment as a result of service-connected disabilities. 7. From October 27, 2019, the evidence of record does not show that the Veteran was unable to secure or follow substantially gainful employment as a result of one service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent for thoracolumbar strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.71a, Diagnostic 5237. 2. Prior to October 11, 2019, the criteria for a disability rating in excess of 10 percent for sciatic radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 5237-8520. 3. From October 11, 2019, the criteria for a disability rating in excess of 20 percent for sciatic radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 5237-8520. 4. Prior to October 11, 2019, the criteria for a disability rating in excess of 10 percent for sciatic radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 5237-8520. 5. From October 11, 2019, the criteria for a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 5237-8520. 6. Prior to June 12, 2017, the criteria for a TDIU have not been met on a schedular or extraschedular basis. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18, 4.19. 7. From October 27, 2019, the criteria for a TDIU based on one disability have not been met. 38 U.S.C. § 1114(s); Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1975 to August 1995. These matters come to the Board of Veterans' Appeals (Board) on appeal from August 2015 and November 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). At the time of the Board's June 2020, the Veteran was in receipt of a TDIU from April 2, 2019 to October 27, 2019. In a December 2020 rating decision, the RO granted an earlier effective date of June 12, 2017. As this earlier effective date for the grant do not constitute a full grant of the benefits sought, the TDIU remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 39 (1993). Increased Disability Ratings The Veteran asserts that the disability ratings assigned to thoracolumbar strain, sciatic radiculopathy of the right lower extremity, and sciatic radiculopathy of the left lower extremity do not contemplate the severity of these service-connected disabilities. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Thoracolumbar strain Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. Deluca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The Court has held that VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202, 206-8 (1995). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. However, the evaluation of painful motion as limited motion only applies when the limitation of motion is noncompensable under the applicable Diagnostic Code. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. See Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). Musculoskeletal VA examinations, to be adequate, must address particular issues when are where that are practicable and medically possible to include active and passive motion; weight bearing and non-weight bearing; range of motion of an opposing joint; and findings as to loss of motion during flare-ups. See Correia v. McDonald, 28 Vet. App. (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The RO has rated this disability under 38 C.F.R. § 4.71a, Diagnostic Code 5237, which compensates for lumbosacral strain, and applies the General Rating Formula for Diseases and Injuries of the Spine. Under that rating criteria, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a, Diagnostic Code 5237. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. An alternative method of evaluating spine disabilities is pursuant to Diagnostic Code 5243, which compensates based on incapacitating episodes due to intervertebral disc syndrome (IVDS). These ratings are not to be combined, and only the rating which results in a higher evaluation is to be granted. 38 C.F.R. § 4.71a, Diagnostic Code 5243. However, in this matter, the Veteran has not shown such pathology, and therefore a rating under Diagnostic Code 5243 is not for consideration. When considering disability of the musculoskeletal system, arthritis is considered. An evaluation of traumatic arthritis, Diagnostic Code 5010, is rated under the criteria for Diagnostic Code 5003, which in turn evaluates disabilities based on the degree of limitation of motion under the appropriate Diagnostic Codes. 38 C.F.R. § 4.71a. If the disability is noncompensable under the appropriate Diagnostic Code for the joint involved, a 10 percent rating will be for application for such major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a. The rating criteria pertaining to Diagnostic Code 5010 was revised effective February 7, 2021. Posttraumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under an affected joint. If there are two or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Evidence and Analysis A collection of private physical therapy and chiropractic records reveals that the Veteran engaged in therapeutic exercise programs in 2014. Upon inspection, providers noted spinal swelling and tenderness. The Veteran endorsed pain. Other early private treatment records disclose endorsements of unbalanced walking; loss of bladder control; exacerbated pain with walking and standing; and absenteeism. These records show that the Veteran was able to work. In a January 2014 lay statement, the Veteran's friend of 30 years submitted a statement. In pertinent part, she wrote that the Veteran's back issue has gotten progressively worse. The Veteran has difficulty walking and using his hands; she also conveyed that the Veteran had undergone several procedures, which have not alleviated his symptoms. The Veteran's sister-in-law also submitted a lay statement in January 2014. She conveyed that the Veteran experiences severe back pain. Over the years, the Veteran's condition has become more severe and his mobility has diminished, to the degree that it is robotic and stiff. Lastly, she reported that the Veteran needs to wear a back brace to get around. The Veteran's spouse also submitted a statement in which she reported that the Veteran limps and experiences stiffness. Over the past years, his symptoms and pain have worsened. She also reported that that Veteran could become paralyzed if he were to be injured (as a self-employed trucker). As to this point, she wrote that the Veteran needs his work for incomewhen the Veteran's back goes out, he falls on the floor. In May 2014, the Veteran reported for a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran's lay accounts and conducted an appropriate evaluation (hereinafter "VA exam protocols"). The Veteran endorsed pain and stiffness. The Veteran also endorsed flare-ups. The Veteran had forward flexion to 45 degrees, with pain; extension to 20 degrees, with pain; right lateral flexion to 20 degrees, with pain; left lateral flexion to 20 degrees, with pain; right lateral rotation to 20 degrees, with pain; and left lateral rotation to 20 degrees, with pain. The Veteran was capable of repetitive use (of at least three repetitions) without additional loss in ranges of motion. The clinician identified functional loss of less movement than normal. The Veteran did not have localized tenderness or pain on palpation of the soft tissue/joints of the thoracolumbar spine. There was no evidence of muscle spasm, muscle atrophy, and the Veteran commanded normal muscle strength. Likewise, the Veteran commanded normal reflexes and normal sensory responses. The clinician indicated that there was no evidence of radiculopathy, neurological abnormalities, IVDS, or arthritis. As to functional impact, the clinician reported that back pain, stiffness, limited range of motion, and bending will cause issues. Additionally, this disability would produce difficulties lifting heavy objects, prolonged walking, and/to traversing stairs. In a July 2014 encounter note, a physician at a private spine center reported that the Veteran endorsed low back pain; however, the Veteran denied frequent radiation of this pain to his legs. Dr. S., a private physician, submitted a letter in August 2014. She indicated that the Veteran has been a patient for 13 years and throughout the period he has suffered chronic neck pain, which worsened in 2014. The Veteran's mother-in-law submitted a lay statement in August 2014. In pertinent part, she wrote that the Veteran has been in pain for many years and walks in an unstable and unbalanced manner. She indicated that the Veteran's lower back pain has worsened to the degree that he uses heat pads, ice packs and a walker to avoid falling. The Veteran also submitted a lay statement in August 2014 indicating, over the last several years, his back has worsened to the degree that he will be forced to retire because he cannot continue to work with chronic back pain. The Veteran also contended that a nerve block procedure and narcotics have been ineffective. Additionally, the Veteran endorsed increasing leg weakness and muscles spasms. In a February 2015 encounter note, a physician at a private spine center reported that the Veteran endorsed low back pain, which radiates down his legs. The Veteran also conveyed that his legs feel weak. The physician indicated that the Veteran still reports "benefit" with pain medication. In April 2015, the Veteran reported for a VA thoracolumbar spine conditions examination. A clinician followed VA exam protocols. The Veteran reported flare-ups of pain in the buttocks; back stiffness; loss in ranges of motion in the back and the legs; and depression and crankiness. The Veteran had forward flexion to 70 degrees with pain; extension to 10 degrees with pain; right lateral flexion to 10 degrees with pain; left lateral flexion to 10 degrees with pain; right lateral rotation to 10 degrees with pain; and left lateral rotation to 10 degrees with pain. There was no evidence of ankylosis. The Veteran was capable of repetitive use (of at least three repetitions) without additional loss in ranges of motion. The clinician indicated functional impairment after repetitive use of less movement than normal; weakened movement; excess fatigability; and pain on movement. The clinician also reported localized tenderness or pain on palpation of the soft tissue/joints of the thoracolumbar spine; however, there was no evidence of muscle spasm, guarding, or muscle atrophy. The Veteran commanded normal muscle strength, normal reflexes, and normal sensory responses. Again, the clinician reported that there was no evidence of radicular pain or symptoms and no evidence of other neurological abnormalities. There was no evidence of IVDS. The Veteran reported that he constantly uses a cane. There was no evidence of arthritis. As to functional impact on the ability to work, the clinician noted that this disability impacts the Veteran's ability to bend, left, and carry. As such, the clinician indicated that the disability affects physical employment. In a September 2015 unsigned "claimant medical history," the preparer indicated that the Veteran is crippled when it (presumably back pain) hits. After this happens, the Veteran is bedridden for 2 to 4 days, reliant upon care and a wheelchair. The preparer noted that pain is overwhelming and radiates down the legs and feet. Additionally, the preparer reported muscle spasms; burning sensations; weakness; aching; lack of coordination; inability to walk, stand, sit, lay without excruciating pain; pain in buttocks; and numbness in both feet. The preparer indicated that the Veteran has been unable to work since October 2014. In October 2015, the Veteran reported for a VA thoracolumbar spine conditions examination. A clinician followed VA exam protocols. The Veteran endorsed flare-ups of heightened pain, to the degree that brushing his teeth is painful and the Veteran endorsed a functional impact of maneuvering around the house. The Veteran had forward flexion to 50 degrees; extension to 20 degrees; right lateral flexion to 20 degrees; left lateral flexion to 20 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. The clinician noted that forward bending beyond 50 degrees causes pain. There was evidence of pain with weight-bearing. The Veteran was capable of repetitive use (of at least three repetitions) without additional loss in ranges of motion. Examination took place after repetitive use over time. However, examination did not occur during a flare-up. The clinician indicated that there was no evidence of muscle spasm; however less movement than normal contributed to this disability. The Veteran commanded normal muscle strength, normal reflexes, and normal sensory responses. The clinician indicated that the Veteran had lower extremity radicular pain and symptoms. There was mild bilateral constant pain, mild bilateral intermittent pain, mild bilateral paresthesias and/or dysesthesias, and no evidence of bilateral numbness. However, the clinician indicated numbness and tingling in the Veteran's sciatic nerve areas as well as involvement of the sciatic nerve roots. Overall, the clinician reported mild bilateral lower extremity radiculopathy. There was no evidence of ankylosis, other neurological abnormalities, or IVDS. The Veteran reported that he used a cane constantly. There was no evidence of arthritis. The clinician reported functional impact on the Veteran's ability to work, namely in situations requiring bending, prolonged sitting, prolonged standing, prolonged walking, an carrying objects of heavy weight. In April 2015, Dr. C., a private physician, indicated that the Veteran endorsed constant burning and tingling in his lower extremities. The Veteran also reported weakness, bouts of falling, difficulty with fine motor skills, and a worsening gait (over the last year). In an April 2016 letter, Dr. S. wrote that the Veteran suffers from lower back pain. She indicated that this painalong with neck, hands, and arms paininterferes with daily functioning. Consequently, she has recommended bedrest due to incapacitating episodes. Dr. S.'s letter is bereft of any clinical treatment records or testing results. As such, this letter provides little in the way of clinical guidance as to the severity of the Veteran's thoracolumbar spine strain. As such, the Board assigns diminished probative weight to this letter. See Sklar v. Brown, 5 Vet. App, 140 (2003). In June 2016, Dr. Seymore, the physician at the private spine center noted above, submitted a letter. In pertinent part, this physician indicated that the Veteran experience chronic low back pain, which radiates down his lower extremities. This pain interferes with activities of daily living, include sleeping and mobility. And, the Veteran requires narcotics on a daily basis as well as "interventional procedures" every 3-4 months to help assuage neck, arm, back, and leg pain. A review of 2017 Tricare treatment records shows that the Veteran frequently complained of his low back pain and pain in his bilateral lower extremities. Clinicians prescribed a host of medications and monitored the Veteran's pain control protocols. In November 2018, Dr. Spenser, a private family physician, opined that the Veteran is totally disabled due to a back injury which causes severe back pain. As such, the Veteran is medically unable to work. However, in a clinical record of this same month, Dr. Spenser reported that the Veteran denied bowel and bladder dysfunctions, lower extremity paresthesia, lower extremity muscle weakness, and difficulty walking. Indeed, Dr. Spencer's letter and his clinical records do not concatenate. As such, the Board assigns diminished probative weight to Dr. Spencer's conclusory letter of opinion. See Sklar, 5 Vet. App. 140. In an April 2019 lay statement, the Veteran indicated that he is still undergoing pain management for his lower back (and neck). Procedures to alleviate pain have been unsuccessful. The Veteran also reported that he almost had a heart attack in 2018. And, the Veteran noted that he still takes pain medication. In a May 2019 Tricare record, clinical notations indicate that the Veteran experience pain in his back and legs of a dull and burning nature. Additionally, the Veteran experience difficulty with fine motor skills, coordination, maintaining balance, and walking. In a May 2019 report, Dr. Spencer noted that the Veteran's legs show no instability. And, the Veteran muscle strength and gait are normal. Functionally, Dr. Spencer indicated that the Veteran is able to walk several stepsthen turn and comeback with smoothness and easy balance. The Veteran denied bladder and bowel dysfunction, lower extremity paresthesia, lower extremity muscle weakness, and difficulty walking. In October 2019, the Veteran reported for a VA thoracolumbar spine conditions examination. A clinician followed VA exam protocols. The clinician indicated present diagnoses of lumbosacral strain and degenerative arthritis of the spine. The Veteran endorsed daily flare-ups of severe 10/10 pain, which last for 24 hours. The Veteran endorsed functional loss squatting, pushing, pulling, standing, walking, and lifting. He had forward flexion to 40 degrees with pain; extension to 10 degrees with pain; right lateral flexion to 10 degrees with pain; left lateral flexion to 10 degrees with pain; right lateral rotation to 10 degrees with pain; and left lateral rotation to 10 degrees with pain. Range of motion contributed to functional loss with squatting, pushing, pulling, standing, walking, and lifting. There was evidence of pain with weight-bearing; however, there was no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. The Veteran did not acquiesce to undergo repetitive use testing because of a fear of pain. Thus, the clinician could offer no opinion as to the results of such testing. The clinician indicated that the examination was not conducted during a flare-up. The clinician reported that pain, fatigue, weakness, lack of endurance, and incoordination limit functional ability with flare-ups. The clinician did not translate this into ranges of motion, noting that range of motion is so severely limited that there would be no additional limitation in range of motion of the joint upon repeated use over time and during a flare-up. Muscle spasm resulted in abnormal gait or abnormal spinal contour. The clinician indicated that disturbance of locomotion, interference with sitting, and interference with standing contributed to this disability. Muscle strength testing was abnormal; however, there was no evidence of muscle atrophy. The Veteran commanded decreased sensory results. The clinician indicated radiculopathy of the bilateral lower extremities as follows: 1) no bilateral extremity constant pain; 2) moderate bilateral lower extremity intermittent pain; 3) moderate bilateral lower extremity paresthesias and/or dysesthesias; and 4) moderate bilateral lower extremity numbness. There was involvement of the sciatic nerve root bilaterally. The clinician indicated that the severity of bilateral lower extremity was moderate. There was no evidence of ankylosis or other neurological abnormalities whatsoever. The clinician indicated IVDS with no episodes of bedrest over the past 12 months. The Veteran reported that he used a wheelchair, cane, and shopping scooter. October 2019 x-ray imaging of the lumbar spine revealed degeneration at L3-L4 and L5-S1. As to functional impact on the Veteran's ability to work, the clinician indicated that the Veteran had to retire early because of an inability to stand, life, and climb (requisites of his job performance). Passive range of motion and nonweight-bearing were not appropriate for the spine. In a December 2019 private treatment record, a clinician reported that the Veteran complained of pain in the back and bilateral extremities. Additionally, a clinician reported claudication, poor balance, and unsteady gait. In a January 2020 progress note, the Veteran underwent an L3-L5 laminectomy for L5-S1 decompression with foraminotomy. Dr. P., a private hospitalist, reported that the Veteran complained of urinary incontinence following surgery. In a progress note of February 2020, Dr. P. indicated that the Veteran's surgical incision was healing as expected and the Veteran was complying with postoperative activity restrictions. Moreover, the Veteran endorsed improvement status post procedureimproved ambulating and diminished symptoms of radiculopathy. In February 2020, the Veteran's spouse submitted a statement. In pertinent part, she wrote that the Veteran sustained a fall and now has a hard time getting around with a walker and cane. The Veteran mostly uses a wheelchair and commands very limited use of his lower extremities due to pain and weakness. In July 2020, VA received the Veteran's Social Security Administration (SSA) medical records. Upon review of these records, SSA's calculus of disability determination addressed the Veteran's back disorders (discogenic and degenerative) as well as irritable bowel syndrome, fibromyalgia, arthritis, depression, sleeplessness, and diabetes mellitus. The medical evidence concerning the instant issues before the Board is redundant of the evidence of record, as discussed above. Stated differently, this medical evidence does not include findings that add to the medical evidence as to the severity of the Veteran's thoracolumbar strain, sciatic radiculopathy of the right lower extremity, or sciatic radiculopathy of the left lower extremity. The Veteran contends that his thoracolumbar strain is more severe than that contemplated by a 20 percent disability. Indeed, the Veteran is competent to report that which is discernable, such as low back pain. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). However, he lacks the medical knowledge and orthopedic expertise to assess the clinical severity of a thoracolumbar strain. See 38 C.F.R. § 3.159(a)(1). As such, this lay evidence does not constitute competent medical evidence. The current 20 percent rating under Diagnostic Code 5237 is assigned for this disability. To receive a higher disability rating, there would need to be a showing of forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The pertinent evidence is summarized above. No examination during the evaluation period found forward flexion of the thoracolumbar spine with an endpoint of 30 degrees or less. At worst, at the October 2019 examination, the Veteran's forward flexion of the thoracolumbar spine had an endpoint of 40 degrees. Moreover, no examination during the evaluation period indicated the presence of any degree of ankylosis. Consequently, an initial rating in excess of 20 percent under Diagnostic Code 5237 is not warranted. The Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca 8 Vet. App. 202. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Here, more than the minimal compensable rating for the thoracolumbar spine is already assigned, and analysis must turn to whether functional loss warranting a higher than 20 percent rating is reasonably shown. The most recent October 2019 VA clinician indicated that pain, fatigue, weakness, lack of endurance, and incoordination limit functional ability with repetitive use over a period of time and during flare-ups. However, the clinician could not ascertain with any certainty what such additional limitation constituted in terms of degrees. As already noted, the Veteran did not acquiesce to undergo repetitive use testing because of a fear of pain. Thus, the clinician could offer no opinion as to the results of such testing. And, the Veteran endorsed daily flare-ups of severe 10/10 pain, which last for 24 hours. As such, then, flare-ups (as endorsed) constitute the normal state of affairs. Therefore, the clinician opined that the Veteran's range of motion is so severely limited that there would be no additional limitation in range of motion of the joint, upon repeated use over time and during a flare-up. The private medical evidence of record likewise does not show functional limitations warranting a compensable rating. Consequently, an increased rating based on functional limitations due these factors is not warranted. While the Veteran has been shown to experience pain of the thoracolumbar spine, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but of itself does not constitute functional loss. See Saunders, 886 F. 3d 1356. Rather, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," to constitute functional loss warranting an increased rating. Id.; see 38 C.F.R. § 4.40. The Board has no reason to question that the Veteran's thoracolumbar strain results in the functional limitations such as squatting, pushing, pulling, standing, walking, and lifting. Such limitations are contemplated by the criteria for the 20 percent rating that is assigned. The Board also finds that the thoracolumbar strain symptoms and impairment are adequately addressed by the schedular rating criteria. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claim for an initial rating higher than 20 percent for thoracolumbar strain. Accordingly, the appeal in this matter must be denied. Sciatic radiculopathy of the right lower extremity Sciatic radiculopathy of the right lower extremity Diagnostic Codes 8520-8720 address ratings for paralysis of the peripheral nerves affecting the lower extremities, neuritis, and neuralgia. Diagnostic Codes 8520, 8620, and 8720 provide ratings for paralysis, neuritis, and neuralgia of the sciatic nerve. Neuritis and neuralgia are rated as incomplete paralysis. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted for complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Diagnostic Codes 8526, 8626, and 8726 provide ratings for paralysis, neuritis, and neuralgia of the anterior crural nerve (femoral). A 10 percent disability rating is warranted for mild of the anterior crural nerve, a 20 percent disability rating is warranted for moderate paralysis of the anterior crural nerve, a 30 percent disability rating is warranted for severe paralysis of the anterior crural nerve, and a 40 percent disability rating (the maximum) is warranted for complete paralysis of the anterior crural nerve. 38 C.F.R. § 4.124a. Words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. 38 C.F.R. §§ 4.123, 4.124a, Diagnostic Code 8620. Similarly, neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum rating equal to moderate incomplete paralysis. 38 C.F.R. §§ 4.124, 4.124a, Diagnostic Code 8720. In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Evidence and Analysis Inasmuch as the evidence discussed above pertains to these two claims, the Board incorporates it herein. Prior to October 11, 2019 A collection of private physical therapy and chiropractic records reveals that the Veteran engaged in therapeutic exercise programs in 2014. In a January 2014 lay statement, the Veteran's friend of 30 years reported that the Veteran had difficulty walking. This same month, the Veteran's sister-in-law reported that the Veteran's mobility has diminished. And, the Veteran's spouse reported that the Veteran limps. At the May 2014 VA thoracolumbar spine conditions examination, the clinician indicated that there was no evidence of radiculopathy, neurological abnormalities, IVDS, or arthritis. In a July 2014 encounter note, a physician at a private spine center, reported that the Veteran endorsed low back pain; however, the Veteran denied frequent radiation of this pain to his legs. In August 2014, the Veteran submitted a lay statement in which he conveyed that he was experiencing increasing leg weakness. In a February 2015 encounter note, a physician at a private spine center, reported that the Veteran endorsed low back pain, which radiates down his legs. The Veteran also conveyed that his legs feel weak. The physician indicated that the Veteran still reports "benefit" with pain medication. At the April 2015 VA thoracolumbar spine conditions examination, the clinician indicated that there was no evidence of radicular pain or symptoms and no evidence of other neurological abnormalities In the September 2015 unsigned "claimant medical history," the preparer reported burning sensations; weakness; aching; lack of coordination; inability to walk, stand, sit, lay without excruciating pain; pain in buttocks; and numbness in both feet. At the October 2015 VA thoracolumbar spine conditions examination, the clinician indicated that the Veteran had lower extremity radicular pain and symptoms. There was mild bilateral constant pain, mild bilateral intermittent pain, mild bilateral paresthesias and/or dysesthesias; and no evidence of bilateral numbness. However, the clinician indicated numbness and tingling in the Veteran's sciatic nerve areas as well as involvement of the sciatic nerve roots. Overall, the clinician reported mild bilateral lower extremity radiculopathy. At this time, Dr. C., a private physician, indicated that the Veteran endorsed constant burning and tingling in his lower extremities. The Veteran also reported weakness, bouts of falling, difficulty with fine motor skills, and a worsening gait (over the last year). In his June 2016 letter, Dr. Seymore indicated that the Veteran experiences chronic low back pain, which radiates down his lower extremities. 2017 Tricare treatment records shows that the Veteran frequently complained of pain in his bilateral lower extremities. In November 2018, Dr. Spenser reported that the Veteran denied bowel and bladder dysfunctions, lower extremity paresthesia, lower extremity muscle weakness, and difficulty walking. The May 2019 Tricare record shows that the Veteran endorsed pain in his back and legs of a dull and burning nature. In his May 2019 report, Dr. Spencer noted that the Veteran's legs show no instability. And, the Veteran's muscle strength and gait are normal. Functionally, Dr. Spencer indicated that the Veteran is able to walk several stepsthen turn and comeback with smoothness and easy balance. The Veteran denied bladder and bowel dysfunction, lower extremity paresthesia, lower extremity muscle weakness, and difficulty walking. The Veteran asserts that sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity are more severe than that contemplated by a 10 percent disability. Indeed, the Veteran is competent to report that which is discernable, such as bilateral lower extremity pain. See Jandreau, 492 F. 3d 1372. However, the Veteran lacks the medical knowledge and neurological expertise to assess the clinical severity of sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity. See 38 C.F.R. § 3.159(a)(1). As such, this lay evidence does not constitute competent medical evidence. Prior to October 11, 2019, a 10 percent rating under Diagnostic Code 5237-8520 is assigned for each of these disabilities. To receive a higher disability rating, there would need to be a showing of moderate incomplete paralysis of the bilateral sciatic nerve. The pertinent evidence is summarized above. No examination during this evaluation period found that there was moderate incomplete paralysis of the bilateral sciatic nerve. At the October 2015 examination, the clinician indicated that sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity manifested as mild constant pain, mild intermittent pain, mild paresthesias and/or dysesthesias; and no evidence of numbness whatsoever. Indeed, this clinician reported involvement of the bilateral sciatic nerve root; however, the clinician opined that both sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity were, from an overall perspective, mild. The Board finds that such clinical findings as to the severity of sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity are more-than-adequately addressed through a 10 percent rating. The Board has no reason to question that the Veteran's sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity result in functional limitations. Nevertheless, such limitations are contemplated by the criteria for the 10 percent ratings that are assigned. The Board also finds that impairments shown do not include any that are not adequately addressed by the schedular rating criteria. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claims for a rating higher than 10 percent for sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity prior to October 11, 2019. Accordingly, the appeal in these matters must be denied. From October 11, 2019 At the October 11, 2019 VA thoracolumbar spine conditions examination, the clinician indicated radiculopathy of the bilateral lower extremities as follows: 1) no bilateral extremity constant pain; 2) moderate bilateral lower extremity intermittent pain; 3) moderate bilateral lower extremity paresthesias and/or dysesthesias; and 4) moderate bilateral lower extremity numbness. There was involvement of the sciatic nerve root bilaterally. The clinician indicated that the severity of bilateral lower extremity was moderate. In October 2019, the Veteran reported for a VA peripheral nerve conditions examination. The clinician followed VA exam protocols. This clinician noted a diagnosis of bilateral upper and lower extremity radiculopathy. The clinician indicated that the Veteran's gait was unsteady due to this bilateral disability. The clinician noted moderate incomplete paralysis of the bilateral radial nerve, median nerve, ulnar nerve, musculocutaneous nerve, circumflex nerve, long thoracic nerve, upper radicular group, middle radicular group, and lower radicular group. Specifically as to bilateral lower extremity nerves, the clinician indicated bilateral moderate incomplete paralysis of the sciatic nerve, external popliteal nerve, musculocutaneous nerve, anterior tibial nerve, internal popliteal nerve, posterior tibial nerve, anterior crural nerve, internal saphenous nerve, obturator nerve, external cutaneous nerve of the thigh, and ilio-inguinal nerve. As to the functional impact of sciatic radiculopathy of bilateral lower extremities, the clinician reported that the Veteran is unable to walk or stand. In a December 2019 private treatment record, a clinician reported that the Veteran complained of pain in the back and bilateral extremities. Additionally, a clinician reported claudication, poor balance, and unsteady gait. In January 2020 VA arranged for a VA addendum report to reconcile the findings in the two October examinations, as discussed above. A clinician indicated, upon a comprehensive review of the extant evidence of record, that the thoracolumbar spine exam, noted above, which indicates bilateral sciatic nerve root only being affected with moderate severity is the more accurate representation of the veteran's current bilateral lower extremity radiculopathy condition. This clinician opined that the x-rays done in October 2019 only show degeneration at L3-L4 and L5-S1 level. This is more representative of the sciatic nerve. There are no studies of record which indicate that additional nerves have been affected for the lower extremities. The previous thoracolumbar exam, performed on October 2015, also only indicated that the sciatic nerve was affected, and at that time the severity was only mild. As such, the October 2019 thoracolumbar spine examination should be considered the accurate representation of the affected sciatic nerve severity to represent this veteran's bilateral lower extremity radiculopathy and not the nerves selected for the lower extremities on the October 2019 peripheral nerve examination. Here, the Board again notes that the October 2019 peripheral nerve conditions clinician assessed both bilateral upper extremity radiculopathy and bilateral lower extremity radiculopathy. Moreover, in the VA thoracolumbar examinations of record, which indicated that the Veteran had bilateral lower extremity radiculopathy, the only nerve root indicated was sciatic. Thus, the findings in the October 2019 peripheral nerve conditions examination are outliers. Otherwise, the Veteran's disabilities are definitively qualified as sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity. See Sklar, 5 Vet. App. 140. The Veteran believes that sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity are more severe than that contemplated by a 20 percent disability from October 11, 2019. Clearly, the Veteran is competent to report that which is discernable, such as bilateral lower extremity pain. See Jandreau 492 F. 3d 1372. However, the Veteran lacks the medical knowledge and neurological expertise to assess the clinical severity of sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity. See 38 C.F.R. § 3.159(a)(1). As such, this lay evidence does not constitute competent medical evidence. The pertinent evidence is summarized above. No examination during this evaluation period found that there was moderately severe incomplete paralysis of the bilateral sciatic nerve. At the October 11, 2019 examination, the clinician reported radiculopathy of the bilateral lower extremities as follows: 1) no bilateral extremity constant pain; 2) moderate bilateral lower extremity intermittent pain; 3) moderate bilateral lower extremity paresthesias and/or dysesthesias; and 4) moderate bilateral lower extremity numbness. There was involvement of the sciatic nerve root bilaterally. The clinician indicated that the severity of bilateral lower extremity was moderate. The Board finds that such clinical findings as to the severity of sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity are more-than-adequately addressed through a 20 percent rating from October 11, 2019. The Board has no reason to question that the Veteran's sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity result in functional limitations. Nevertheless, such limitations are contemplated by the criteria for the 20 percent rating that is assigned from October 11, 2019. The Board also finds that impairments shown are adequately addressed by the schedular rating criteria. Considering the foregoing, the Board finds that the preponderance of the evidence is against the claims for a rating higher than 20 percent for sciatic radiculopathy of the right lower extremity and sciatic radiculopathy of the left lower extremity from October 11, 2019. Accordingly, the appeal in these matters must be denied. Entitlement to a TDIU, to include on an extraschedular basis, prior to June 12, 2017 In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. §§ 4.16(a), "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § § 4.16(a) The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, supra; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. § § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. §§ 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). Prior to June 12, 2017, the Veteran was service-connected for the following disabilities: 1) thoracolumbar strain at 20 percent, effective from September 11, 2013; 2) sciatic radiculopathy of the right lower extremity at 10 percent, effective from July 28, 2015; and 3) sciatic radiculopathy of the left lower extremity at 10 percent, effective from July 28, 2015. Thus, the Veteran did not meet the schedular requirements for entitlement to a TDIU. See 38 C.F.R. §§ 4.16(a). Therefore, in accordance with 38 C.F.R. § 4.16(b), the Board will consider whether the Veteran's claim for TDIU should be referred to the Director of the Compensation Service for extraschedular consideration prior to June 12, 2017. Bowling v. Principi, 15 Vet. App. 1, 10 (2001) (the Board cannot consider entitlement to TDIU under 38 C.F.R. § 4.16(b) in the first instance, but must first remand the claim for referral to VA's Director of Compensation Service if such consideration is warranted). The Board finds that the evidence of record does not substantiate a reasonable possibility that the Veteran is unemployable by reason of his service-connected disabilities alone prior to June 12, 2017. Ray v. Wilkie, 31 Vet. App. 58 (2019) (holding that the initial extraschedular referral decision under § 4.16(b) addresses whether there's sufficient evidence to substantiate a reasonable possibility that a veteran is unemployable by reason of his or her service-connected disabilities). In a January 2014 lay statement, the Veteran's spouse reported that the Veteran could become paralyzed if he were to be injured (as a self-employed trucker). She did note that the Veteran worked because he needed the income. At the May 2014 VA thoracolumbar spine conditions examination, the clinician indicated that the Veteran's disability would produce difficulties lifting heavy objects, prolonged walking, and/or traversing stairs. In August 2014, the Veteran contended that his thoracolumbar strain has worsened to the degree that he will be forced to retire because he cannot continue to work with chronic back pain. At the April 2015 VA thoracolumbar spine conditions examination, the clinician indicated that the Veteran's thoracolumbar strain impacts the Veteran's ability to bend, lift, and carry. As such, the clinician indicated that the disability affects physical employment. However, this clinician did not opine that this disability precluded physical (or any other type of) employment. The September 2015 "claimant medical history" (of unknown provenance) advanced that the Veteran has been unable to work since 2014. At the October 2015 VA thoracolumbar spine conditions examination, the clinician opined that the Veteran's thoracolumbar strain and mild bilateral sciatic lower extremity radiculopathy functionally impacts work situations requiring bending, prolonged sitting, prolonged standing, prolonged walking, and carrying objects of heavy weight. However, this clinician did not opine that these disabilities rendered the Veteran unable to obtain or maintain gainful employment. In December 2015, both the Veteran and his spouse submitted lay statements addressing the status of the Veteran's mental health. The Board has considered these lay accounts; however, the record discloses that the Veteran is service connected for depression effective October 27, 2019almost 4 years after these lay endorsements of mental health symptoms. In June 2016, Dr. Seymore reported that spine and radiculopathy pain interfere with activities of daily living, including sleeping and mobility. However, Dr. Seymore did not opine that these disabilities precluded employment. In fact, upon close parsing of Dr. Seymore's letter, there is simply no commentary as to the Veteran's employability. The Veteran has reported that he has a high school degree and has completed two years of university work. Professionally, the Veteran has indicated that he is self-employed as a truck driver. During active duty, the Veteran's military occupation specialties (MOS) was that of a wardroom galley supervision and a bachelor quarter specialist. The evidence of record also discloses that the Veteran was able to drive, and in fact did drive, prior to June 12, 2017. While the Veteran asserts that his service-connected disabilities rendered him unable to obtain or retain employment consistent with his education and experience prior to June 12, 2017, the evidence of record shows that the Veteran has earned the equivalent of half of a college degree and has supervisory and entrepreneurial professional experience as an independent contractor. Collectively, the Board finds that this combination of education and work experiences, prior to July 12, 2017, were more-than-sufficient for the Veteran to obtain and maintain substantial employment considering his specific education and specific work as an independent self-employed contractor and entrepreneur. See Withers v. Wilkie, 30 Vet. App. 139 (2018). In accordance with the Court's holding in Ray, the Board has considered the economic and noneconomic components of the Veteran's TDIU claim. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The Board recognizes that, prior to June 12, 2017, the Veteran experienced difficulties with work duties requiring bending, prolonged sitting, prolonged standing, prolonged walking, and carrying objects of heavy weight due to his service-connected disabilities of thoracolumbar strain, sciatic radiculopathy of the right lower extremity, and sciatic radiculopathy of the right lower extremity. However, these limitations did not rise to the level of rendering the Veteran totally impaired physically, occupationally, or socially. Indeed, the evidence of record does not reveal that any one of his service-connected disabilities, or the entirety of his three service-connected disabilities, precluded him from obtaining and maintaining gainful employment prior to June 12, 2017. Here, the Board also notes that only the September 2015 "claimant medical history" (of unknown provenance) advanced that the Veteran has been unable to work since 2014. However, in 2014 the Veteran's spouse conveyed that the Veteran did work, albeit with fears of injury. Prior to June 12, 2017, the Veteran's experience as a self-employed contractor would have lent itself to a host of employment possibilities as a coach/trainer in the skills of working as an independent proprietor; logistics and dispatching operations for a trucking concern; and in operations and accountinggleaned through years of experience operating an independent business. Indeed, prior to June 12, 2017, many employers, in logistics, dispatching, and large trucking firms offered accommodations pursuant to the ADA, to allow for downtime due to disabilities. In the Veteran's case, it would have been feasible for an employer to provide an adjustable desk, whereby the Veteran could alternate between prolonged sitting and prolonged standing. Likewise, it would have been feasible for an employer to accommodate the Veteran by limiting sustained walking and heavy lifting. As already noted, the Veteran did not meet the schedular requirements for entitlement to a TDIU prior to June 12, 2017. And, the evidence of record fails to reveal that exceptional circumstances existed prior to July 12, 2017 which would warrant consideration under 38 C.F.R. § 4.16(b). The rating schedule was created as a guide to evaluating disabilities resulting from all types of diseases and injuries encountered, and the percentage ratings that are assigned represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Accordingly, a TDIU on an extraschedular basis is denied prior to June 17, 2017 is denied. Entitlement to a TDIU from October 27, 2019. The receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. See Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). See id. Thus, the Court reasoned, it might benefit the Veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted. See Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010) (requiring VA to assess all of the claimant's disabilities to determine whether entitlement to SMC under 38 U.S.C. § 1114(s) is established whenever a Veteran with a total disability rating is subsequently awarded service connection for any additional disability or disabilities even in the absence of an express claim for SMC). The evidence of record discloses that the Veteran has been in receipt of a 100 percent combined schedular disability rating effective from October 27, 2019. Thus, the issue is whether the Veteran is entitled to a separate award of TDIU predicated on a single disability. The record discloses that the Veteran's disability with the highest schedular rating is depressionat 50 percent effective from October 27, 2019. Upon an October 2019 VA mental health conditions examination, a clinician, who followed VA exam protocols, opined the Veteran's service-connected thoracolumbar strain contributes to significant limitations in the Veteran's mobility and issues with chronic pain. Consequently, the Veteran reported that he is unable to engage in many of the activities that he enjoyed previously. Also, the Veteran's use of assistive devices has made getting around difficult. Thus, the Veteran's pain and restrictions have resulted in depression. Stated differently, the Veteran's depression is ineluctably bound to his thoracolumbar strain and other physiological disabilities, the highest rated of these disabilities are right upper extremity radiculopathy and left upper extremity radiculopathy which are each rated at 40 percent. As such, the evidence of record does not support a finding that depression alone warrants a separate award of a TDIU. Bradley, 22 Vet. App. 280. Moreover, there is no evidence to suggest that any other single service-connected disability, alone, warrants a separate TDIU award. Therefore, the Board must conclude that close scrutiny of the evidence of record fails to show that the Veteran is unable to obtain or maintain employment because of a single service-connected disability. This being the case, the aforementioned provisions are not for application in this case. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, 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.