Citation Nr: 21029832 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 14-37 801 DATE: May 17, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for lumbar strain prior to April 11, 2013, and in excess of 40 percent thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for left hamstring strain prior to November 23, 2013, and in excess of 40 percent thereafter, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to April 11, 2013, the Veteran's lumbar spine disability was manifested by forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; thereafter, his lumbar spine disability was manifested by forward flexion of the thoracolumbar spine to 30 degrees or less. 2. Prior to November 23, 2013, the Veteran's left hamstring strain was manifested as a moderate muscle injury to muscle group XIII; thereafter, the Veteran's left hamstring strain has been assigned the maximum 40 percent schedular rating available under Diagnostic Code 5313. 3. The Veteran's service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for lumbar strain prior to April 11, 2013, and in excess of 40 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. The criteria for an initial rating in excess of 10 percent for left hamstring strain prior to November 23, 2013, and in excess of 40 percent thereafter, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.56, 4.73, DC 5313. 3. The criteria for a total disability rating based on individual unemployability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.1, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2002 to July 2006. This matter comes before the Board of Veterans' Appeals (Board) from a November 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in August 2018 and July 2020 for further development. The Board finds that there has been substantial compliance with its prior remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. 1. Entitlement to an initial rating in excess of 20 percent for lumbar strain prior to April 11, 2013, and in excess of 40 percent thereafter is denied. The Veteran contends entitlement to an initial rating in excess of 20 percent for his lumbar strain prior to April 11, 2013, and in excess of 40 percent thereafter. Service connection for lumbar strain was granted in a November 2010 rating decision with a 20 percent rating effective March 1, 2010. The period on appeal stems from this original grant of service-connection. An August 2014 rating decision granted a 40 percent rating effective April 11, 2013. For the reasons that follow, the Board finds entitlement an increased rating is not warranted. The Veteran's lumbar strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Initially, the Board recognizes that, effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C.A. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. All diseases and injuries of the spine, other than IVDS, are rated under the general rating formula for diseases and injuries of the spine (general rating formula). IVDS is rated either under the general rating formula or under the Formula for Rating IVDS based on incapacitating episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. The new rating criteria do not involve changes to the specific rating criteria within either the general rating formula or the Formula for Rating IVDS based on incapacitating episodes. However, under the old criteria, Note 6 of the general rating formula directs evaluation of DC 5242 to also see DC 5003. The new rating criteria direct ratings under DC 5242 to see either DC 5003 or 5010. DC 5003 provides that degenerative arthritis established by x-ray findings be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. DC 5010 provides that arthritis, due to trauma, substantiated by X-ray findings, be rated as arthritis, degenerative. 38 C.F.R. § 4.71a. The only change made to DC 5003 in the new regulation is to clarify it as pertaining to degenerative arthritis, other than post-traumatic. The new DC 5010 indicates post-traumatic arthritis is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint, and, if there are two or more joints affected, each rating shall be combined in accordance with § 4.25. The only other change to the regulations pertaining to rating the spine involved DC 5244, traumatic paralysis, which is not applicable in this case. Under the general rating formula, a 20 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine is 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 in height. A 40 percent rating is warranted where forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. The only higher schedular ratings under the general rating formula are 50 percent for unfavorable ankylosis of the entire thoracolumbar spine and 100 percent for ankylosis of the entire spine. In addition, under the formula for rating intervertebral disc syndrome (IVDS) based on incapacitating episodes a 40 percent rating is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note 1 to the Formula for Rating IVDS based on incapacitating episodes defines an incapacitating episode as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. The current version of DC 5243 for IVDS instructs adjudicators to assign that DC only when there is disc herniation with compression and/or irritation of the adjacent nerve root, and to assign DC 5242 for all other disc diagnoses. The former version provides no such instruction. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent prior to April 11, 2013, and in excess of 40 percent thereafter. As a preliminary matter, the Board notes that although the Veteran presented for VA examinations in October 2010 and April 2013, these examinations were not fully compliant with the requirements set forth by Correia, 28 Vet. App. 158 and Sharp, 29 Vet. App. at 33. However, the reports do contain some relevant findings that are included herein. An October 2010 VA examination reflects the Veteran reported he can walk without limitation but experiences falls due to his spine condition. He reported the following symptoms associated with his spinal condition: stiffness, spasms, and decreased motion. He denied fatigue, paresthesias, numbness, weakness, erectile dysfunction, or bowel problems. He indicated his back pain occurs two times per day and lasts for four hours. He reported his pain can be exacerbated by physical activity and stress. He reported flare-ups with functional impairment, including extreme pain and limitation of motion of the joint. He reported one day of incapacitating episode with recommended bed rest by a chiropractor. Range of motion testing revealed flexion to 60 degrees with pain at 45 degrees, extension to 15 degrees with pain at 15 degrees, bilateral lateral flexion to 20 degrees with pain at 20 degrees, and bilateral rotation to 20 degrees with pain at 20 degrees. The examiner noted that the joint function of the spine is not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The examiner indicated there were no signs of lumbar intervertebral disc syndrome (IVDS). An October 2010 radiology report notes a normal examination of the lumbar spine. An August 2011 private chiropractic treatment record reflects constant back pain that begins when the Veteran wakes up. August 2011 and August 2012 VA treatment records similarly note chronic back pain. An October 2012 VA treatment record indicates the Veteran's back pain is aggravated by bending and prolonged sitting. An April 2013 VA x-ray report notes minimal scoliosis but no major abnormality. The Veteran underwent a VA examination in April 2013 during which he reported flare-ups that decrease function 'dramatically.' Range of motion testing revealed forward flexion to 15 degrees with pain at 15 degrees, extension to 10 degrees with pain at 10 degrees, bilateral lateral flexion to 15 degrees with pain at 15 degrees, and bilateral lateral rotation to 15 degrees with pain at 15 degrees. The Veteran was able to perform repetitive-use testing with three repetitions without additional loss of range of motion. The examiner noted less movement than normal and pain on movement after repetitive use. Physical examination revealed tender paraspinal muscles but no guarding or muscle spasm. The examiner noted decreased right foot/toes sensation to light touch and mild right lower extremity numbness. No muscle atrophy, ankylosis, or IVDS was found on examination. An October 2017 VA treatment record notes low back pain but no swelling, loss of sensation, paresthesias, gait disturbance, or falls. An October 2019 exam scheduling request indicates the Veteran failed to show for a VA spine examination. October 2020 thoracic and lumbar spine radiology reports reflect mild early degenerative changes in the thoracic spine and minimal spondylosis L1 to L5, mild disc degeneration at L4-L5, and facet joint arthritis from L3-4 to L5-S1. The Veteran underwent a VA examination in October 2020 wherein the examiner diagnosed lumbosacral strain and degenerative arthritis of the spine. The Veteran reported flare-ups that occur an average of two episodes a week and lasts hours to days. Flare-ups are precipitated by daily normal activities such as getting out of bed and are alleviated by muscle relaxants. During a flare-up, the Veteran has difficulty performing physical activities, house chores, and any activity that requires bending. Range of motion testing revealed forward flexion to 60 degrees, extension to 25 degrees, right lateral flexion to 15 degrees, left lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees. The examiner indicated that range of motion itself does not contribute to functional loss. The Veteran was able to perform repetitive-use testing with at least three repetitions with resulting forward flexion to 40 degrees, extension to 15 degrees, right lateral flexion to 15 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The examiner indicated pain significantly limits functional ability with repeated use over a period of time and during a flare-up. The examiner described this functional loss as forward flexion to 40 degrees, extension to 15 degrees, right lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees. Physical examination also revealed guarding and muscle spasm not resulting in abnormal gait or abnormal spinal contour. No muscle atrophy, abnormal sensory exam, radiculopathy, ankylosis, other neurological abnormalities, or IVDS were found on examination. After a review of the evidentiary record, the Board finds the preponderance of the evidence weighs against finding entitlement to a rating in excess of 20 percent prior to April 11, 2013, or in excess of 40 percent thereafter. Based on the foregoing, the Board finds no basis to award a higher rating for the Veteran's service-connected lumbar strain. The Board acknowledges the Veteran's lay reports of symptoms indicating functional loss due to pain, repetitive use over time, and during flare-ups. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine prior to April 11, 2013, or more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine thereafter. Prior to April 11, 2013, when considering additional functional loss due to pain and repetitive use, the Veteran's lumbar spine disability resulted in forward flexion to no less than 45 degrees. Favorable or unfavorable ankylosis has not been demonstrated at any time during the appeal period. Moreover, even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate the entire spine fixed in flexion or extension and one of the additional symptoms set forth in Note 5. Consideration has also been given to assigning a rating under the Formula for Rating IVDS Based on Incapacitating Episodes. However, the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating at any time during the appeal period. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. See, e.g., October 2020 VA examination. The Board also finds there is no evidence to warrant a higher rating effective February 7, 2021 based upon the new musculoskeletal rating criteria. Regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. In reaching this conclusion, the Board acknowledges that the April 2013 VA examination revealed right foot/toes sensation to light touch and mild right lower extremity numbness; however, the Board notes the record is otherwise silent for lay or medical evidence of a neurological abnormality. While the Veteran would be competent to report symptomatology that he experiences, he has not reported neurological symptoms nor has he shown that he has the medical experience or training to relate the condition(s) to his lumbar strain, which is a medically complex determination that cannot be based on lay observation alone. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Thus, the Board finds preponderance of the evidence is against finding the Veteran has a neurological abnormality. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 20 percent prior to April 11, 2013, and in excess of 40 percent thereafter for service-connected lumbar spine disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to an initial rating in excess of 10 percent for left hamstring strain prior to November 23, 2013, and in excess of 40 percent thereafter, is denied. The Veteran seeks an initial rating in excess of 10 percent for left hamstring strain prior to November 23, 2013, and in excess of 40 percent thereafter. Service connection for left hamstring strain was granted in a November 2010 rating decision with a noncompensable rating effective March 1, 2010. The period on appeal stems from this original grant of service-connection. An August 2014 rating decision granted a 10 percent rating effective March 1, 2010, and a 40 percent rating from November 23, 2013. The Veteran's left hamstring strain is rated under 38 C.F.R. § 4.73, Diagnostic Code 5313. Diagnostic Code 5313 provides evaluations for a disability of Muscle Group XIII (posterior thigh/hamstring muscles). The functions of these muscles are as follows: extension of hip and flexion of knee; outward and inward rotation of flexed knee; and acting with rectus femoris and sartorius (see XIV, 1, 2) synchronizing simultaneous flexion of hip and knee and extension of hip and knee by belt-over-pulley action at knee joint. Under Diagnostic Code 5313, for muscle group XIII, a noncompensable rating is assigned for slight disability. A 10 percent rating is assigned for moderate disability. a 30 percent rating is assigned for moderately severe disability. A maximum 40 percent rating is assigned for severe disability. 38 C.F.R. § 4.73, DC 5313. The factors to be considered in evaluating disabilities residual to healed wounds involving muscle groups are set forth in 38 C.F.R. §§ 4.55 and 4.56. A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. 38 C.F.R. § 4.56 (b). For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56 (c). The type of injury associated with a moderate muscle disability is a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history with regard to this type of injury should include service department record or other evidence of in-service treatment for the wound and record of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56 (d)(2). The type of injury associated with a moderately severe muscle disability is a through-and-through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history with regard to this type of injury should include service medical record or other evidence showing prolonged hospitalization for treatment of wound, record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56 (d)(3). The type of injury associated with a severe disability of muscles is a through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. A history consistent with this type of injury would include service department record or other evidence showing hospitalization for a prolonged period for treatment of wound, record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings of a severe disability would include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, a severe injury would also show x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56(d)(4). In this case, the Veteran underwent a VA examination in October 2010. The examiner noted the extent of the injury did not involve underlying structures such as blood vessels, bone, fascia, or nerve. During the examination, the Veteran reported constant pain and cramping in the left hamstring that is exacerbated by physical activity. He also reported swelling, loss of strength, weakness, and pain. The examiner noted the injury affects body functioning, including difficulty picking up large items and inability to weight train with heavy weights. Palpation of the muscle revealed no loss of deep fascia or muscle substance and no impairment of muscle tone. The examiner noted no muscle wound, signs of lowered endurance or impaired coordination, or effect on the particular body part it controls. The examiner found normal muscle strength and no muscle herniation. The examiner indicated the injury does not involve any tendon, bone, joint, or nerve damage. An August 2010 VA treatment record notes no musculoskeletal weakness, joint pain, or numbness. A December 2010 VA treatment record notes not extremity pain or swelling. An August 2012 VA treatment record notes no extremity edema or joint tenderness. A November 2012 VA treatment record notes '5/5' muscle strength of the left lower extremity. An November 2013 VA examination indicates the Veteran does not have a penetrating muscle injury or a non-penetrating muscle injury. The examiner noted a history of an injury to group XIII. The examiner found no scars or fascial defects associated with a muscle injury. The examiner indicated the Veteran's muscle injuries affect muscle substance or function through muscle swelling and hardening abnormally in contraction. The examiner noted consistent weakness and occasional 'fatigue-pain' attributable to his muscle injury. The Veteran displayed normal left extremity muscle strength and no muscle atrophy on examination. A May 2016 VA treatment record notes no swelling, loss of sensation, paresthesias, gait disturbance, or falls. An October 2017 VA treatment record notes no musculoskeletal swelling, gait disturbance, or loss of sensation. A July 2019 VA treatment record notes no swelling, edema, cyanosis, or clubbing of the extremities. An October 2019 exam scheduling request indicates the Veteran failed to show for a VA muscle injuries examination. A May 2020 VA radiology report notes linear metallic fragments in the posterior aspect of the femur suggestive of metallic foreign bodies. The Veteran underwent a VA examination in October 2020. The examiner noted the Veteran does not have a penetrating or non-penetrating muscle injury. The examiner noted a group XIII muscle group injury. The examiner noted no history of rupture of the diaphragm with herniation; history of an extensive muscle hernia of any muscle; history of injury to the facial muscles; history of rhabdomyolysis; history of compartment syndrome, scars, or fascial defects or evidence of fascial defects associated with any muscle injuries. The examiner indicated his muscle injury affects muscle substance or function through pain to mid lateral quadricep and mild abnormal contraction. The examiner noted no loss of power, weakness, lowered threshold of fatigue, fatigue and/or pain, impairment of coordination, or uncertainty of movement. Normal muscle strength and no muscle atrophy was found on examination. The examiner noted there are linear metallic fragments in the posterior aspect of the femur suggestive of metallic foreign bodies that do not appear to be shell fragments, shrapnel, or multiple scattered foreign bodies indicating intermuscular trauma or explosive effect of a missile. After a review of the evidentiary record, the Board finds the preponderance of the evidence weighs against finding entitlement to a rating in excess of 10 percent prior to November 23, 2103, or in excess of 40 percent thereafter. Based on the foregoing, the Board finds no basis to award a higher rating for the Veteran's service-connected left hamstring strain. Prior to November 23, 2013, the Veteran's left hamstring strain is not demonstrated as manifesting with indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side as would be consistent with a severe muscle disability. Instead, prior to November 23, 2013, the Veteran's left hamstring strain manifest with normal muscle strength, pain, cramping, swelling, loss of strength, and weakness. Moreover, from November 23, 2013, the Board notes the Veteran is in receipt of the maximum evaluation available under Diagnostic Code 5313. An increased rating for the muscle group XIII injury is not warranted under other diagnostic codes. There is no evidence that the Veteran's muscle group XIII injury results in loss of use, such that a rating based on amputation at the elective level would be warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5160. The Veteran is specifically noted to have a muscle group XIII injury, and therefore rating by analogy to diagnostic codes governing other muscle groups is not appropriate. Copeland v. McDonald, 27 Vet. App. 333, 33637 (2015). The Board acknowledges the Veteran's contention that his left hamstring disability is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno, 6 Vet. App. 465, 469. The Board finds, however, that neither the Veteran's statements nor the medical evidence demonstrates that the criteria for a rating in excess of 10 percent have been met prior to November 23, 2013. In conclusion, the Board finds the preponderance of the evidence is against entitlement to a rating in excess of 10 percent prior to November 23, 2013, or in excess of 40 percent thereafter for the Veteran's service-connected left hamstring strain. Therefore, the benefit of the doubt doctrine is not applicable and such higher rating claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. The Veteran contends his service-connected disabilities preclude him from obtaining or maintaining substantial employment. The claim for a TDIU was raised in an April 2018 correspondence. When a request for a TDIU is made during the pendency of an increased rating claim, whether expressly raised by a veteran or reasonably raised by the record, it is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability as part of the initial adjudication of the claim. Rice v. Shinseki, 22 Vet. App. 447, 453-454 (2009). Thus, the period on appeal mirrors the period on appeal for the increased rating claims decided herein, which begins March 1, 2010. For the reasons that follow, the Board finds entitlement to a TDIU is not warranted. 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 as a result of 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. 38 C.F.R. § 4.16(a). The Court recently defined the term "unable to secure and follow a substantially gainful occupation" to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Ray v. Wilkie, 31 Vet. App. 58, 72-73 (2019). The central inquiry is whether service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. § 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration shall be given to the Veteran's level of education, special training, and previous work experience. Therefore, the Board must evaluate whether there are circumstances in the Veteran's case, apart from any non-service-connected conditions and advancing age, which would justify a TDIU rating. 38 C.F.R. § 3.341 (a), 4.16 (a), 4.19. The Veteran is service-connected for lumbar strain (20 percent prior to April 11, 2013, and 40 percent thereafter); left hamstring strain (10 percent prior to November 23, 2013, and 40 percent thereafter); cervical spine strain (30 percent from July 20, 2011); right knee strain (20 percent from July 20, 2011); left knee patellofemoral pain syndrome (10 percent prior to July 20, 2011, and 20 percent thereafter); tinnitus (10 percent from March 1, 2010); and left ear mild sensorineural hearing loss (noncompensable from March 1, 2010). Therefore, the Veteran meets the schedular requirement for a TDIU from July 20, 2011. Nevertheless, entitlement to a TDIU may still be granted prior to July 20, 2011, on an extra-schedular basis under §4.16(b). This additional subpart of this governing VA regulation indicates "that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled." Id. (emphasis added). The Board does not have the authority to assign an extraschedular TDIU in the first instance. Bowling v. Principi,15 Vet. App. 1 (2001). As a preliminary matter, the Board notes that a formal application for a TDIU, or a VA Form 21-8940, has not been received. In compliance with the Board's prior remand directives, the Veteran was sent an appropriate notice pursuant to the Veterans Claims Assistance Act and asked to complete a VA Form 21-8940. While failure to complete the form is not fatal to a TDIU claim in and of itself, the failure to do so deprives the Board of information as to the Veteran's employment history, educational history and training, and income information necessary to properly address a claim for TDIU. The Veteran's failure to complete the VA Form 21-8940 leaves the Board without the ability to request information from his prior employers as to his reason for leaving employment and without sufficient evidence to assess his employment status for the appeal period. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran's DD Form 214 reveals a military occupational specialty of aviation supply specialist. In July 2011, the Veteran submitted a job description for his role as a supply technician, which indicates the employee must be able to work indoor and outdoor and climbing may be required from time to time. The Veteran indicated the job does not contribute to his back problems. An August 2011 private treatment record notes the Veteran works as a supply technician. A March 2017 VA treatment record notes the Veteran works at a utility company, which he describes as good and stress free. 2015 and 2016 VA vocational rehabilitation and education (VRE) documents indicate the Veteran has an Associates of Science in Business, a Bachelor of Science in Management with a minor in Economics, and a Master's in Business Administration. VRE documents also indicate the Veteran has worked in supply chain management for 11 years and has been employed in various roles since October 2006. A July 2010 VA hearing loss examination indicates the Veteran's left ear hearing loss and tinnitus affects his usual occupation because he is unable to use the phone on his left ear because the words are unclear and his left ear is sensitive to loud sounds. An April 2018 VA hearing loss examination similarly indicates that the Veteran's hearing loss and tinnitus impact ordinary conditions of his daily life, including his ability to work because they interrupt his focus and concentration. An October 2010 VA left knee examination indicates the Veteran experiences difficulty bending, standing, and walking. The October 2010 VA examiner noted the Veteran's condition affects his usual occupation due to limited bending, stooping, crouching, kneeling, jumping, and walking on uneven terrain such that his daily activity is minimally impaired. An April 2013 VA knee examination reflects limited bending and being confined to a sitting or laying down position during a flare-up. The examiner indicated the Veteran's knee condition impacts the Veteran's ability to work because he is limited from frequent kneeling, jumping, and walking on uneven terrain. An April 2018 VA knee examination indicates the Veteran's knee disabilities limit standing and walking. An April 2013 VA neck examination reflects the examiner found the Veteran's cervical spine condition impacts his ability to work. The examiner noted the Veteran is limited from frequent crawling and climbing ladders. An October 2010 VA back examination reveals the Veteran experiences decreased limitation of motion due to pain. An April 2013 back examination indicates the examiner found the Veteran's lumbar spine condition impacts his ability to work because he is limited from repetitive bending, stooping, crouching, and heavy lifting. An October 2020 VA back examiner also indicated the Veteran's back condition impacts his ability to work as he has difficulty performing physical activities, house chores, and any activity that requires bending. The examiner noted the Veteran currently works as a project manager and the pain causes him to take time off work due to flare-ups. An October 2010 VA left hamstring examination indicates his muscle injury results in difficulty picking up large items and inability to weight train with heavy weights, but he can keep up with his normal work requirements. A November 2013 VA muscle injuries examination indicates the examiner found the Veteran's left hamstring strain impacts his ability to work because he has difficulty with prolonged running, walking, sitting, squatting, and running. The examiner noted the Veteran reported being unable to pass the physical training test when he tried to pursue his career in law enforcement. An October 2020 VA muscle injuries examiner indicated his left knee condition impairs his ability to work due to impairment of walking and daily physical activities such as house chores and ability to exercise. An April 2018 private treatment record notes the Veteran reported his tinnitus interferes with his sleep and causes him to be tired and impairs his working at a normal pace. After a review of the evidentiary record, the Board finds referral for consideration of entitlement to a TDIU prior to July 20, 2011, on an extraschedular basis and/or entitlement to a TDIU from July 20, 2011, is not warranted. In reaching this determination, the Board has considered both the economic and non-economic components that pertain to a determination as to whether the Veteran in this case is capable of securing and following substantially gainful employment that is consistent with his history, education, skill, and training. Regarding the economic component, and based on the evidence of record, the Board finds that the Veteran has been in full-time or substantially gainful employment throughout the appeal period. There is no indication in the record that his current employment is marginal, at the poverty threshold, or in a protected environment. Regarding the noneconomic component, the evidence demonstrates that the Veteran's service-connected disabilities have some impact on his ability to work but do not preclude him for obtaining or maintaining substantial employment. The Board is sympathetic to the Veteran's assertions regarding the impact his service-connected disabilities has on him; however, the impact of his service-connected disabilities is compensated by his current schedular rating for such conditions. Van Hoose v. Brown, 4 Vet. App. 361 (1993). Moreover, while the Veteran's service-connected disabilities cause some economic impairment, his assigned disability ratings contemplate this level of occupational impairment. A TDIU claim is not purely a medical question. Here, the Board has considered both the relevant medical evidence as well as the non-medical evidence such as work history and lay statements. Notably, the VA examiners did not find that the Veteran's service-connected disabilities would preclude the Veteran from securing and maintaining gainful employment and the record indicates the Veteran has maintained employment throughout the appeal period. Therefore, because the evidence of record does not show functional impairment caused by the Veteran's service-connected disabilities result in an inability to secure and maintain a substantially gainful occupation, entitlement to a TDIU is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. A. ADAMSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, Associate 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.