Citation Nr: 21030710 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-17 170 DATE: May 19, 2021 ORDER Entitlement to an increased evaluation in excess of 20 percent from June 20, 2014 to November 3, 2015, and in excess of 10 percent thereafter for degenerative disc disease of the lumbar spine is denied. Entitlement to an increased evaluation in excess of 10 percent for a right ankle achilles tendon spur is denied. Entitlement to an increased evaluation in excess of 10 percent prior to July 7, 2015 and in excess of 20 percent thereafter for a non-dominant left shoulder disorder is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to June 23, 2015 is denied. FINDINGS OF FACT 1. The evidence supports a finding that from June 20, 2014 to November 3, 2015 the Veteran's degenerative disc disease of the lumbar spine symptoms is not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 2. The evidence supports a finding that after November 3, 2015 the Veteran's degenerative disc disease of the lumbar spine symptoms is not manifested by forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. 3. The evidence supports a finding that the Veteran's right ankle achilles tendon spur is not manifested by evidence of marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) limitation of ankle motion. 4. The evidence supports a finding that prior to July 7, 2015, the Veteran's left shoulder disorder is not manifested by evidence of range of motion at shoulder level with flexion and/or abduction limited to 90 degrees. 5. The evidence supports a finding that after July 7, 2015, the Veteran's left shoulder disorder is not manifested by evidence of range of motion midway between side and shoulder with flexion and/or abduction limited to 45 degrees. 6. The Board finds that the pertinent and more probative evidence of the record does not demonstrate that the Veteran's service connected disabilities alone were of sufficient severity to render him unable to secure and maintain substantially gainful employment, prior to June 23, 2015. CONCLUSIONS OF LAW 1. The criteria for an increased evaluation in excess of 20 percent from June 20, 2014 to November 3, 2015, and in excess of 10 percent thereafter for degenerative disc disease of the lumbar spine are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.25, 4.40, 4.45, 4.59, 4.71a; Diagnostic Code 5237. 2. The criteria for an increased evaluation in excess of 10 percent for a right ankle achilles tendon spur are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38C.F.R. §§ 3.102, 4.1, 4.7, 4.71, Diagnostic Code 5271. 3. The criteria for an increased evaluation in excess of 10 percent prior to July 7, 2015 and in excess of 20 percent thereafter for a non-dominant left shoulder disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.71, 5003, 5201 Diagnostic Code 5201. 4. The criteria for a total disability rating based on individual unemployability prior to June 23, 2015 are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341(a), 4.1, 4.16, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2009 to June 2014. In December 2019, the Board most recently remanded these issues for additional development. The Board finds that there was substantial compliance with the remand directives on appeal as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Pursuant to the Boards December 2019 remand, the regional office (RO) attempted to schedule the Veteran for the pertinent VA examinations necessary to investigate his claims. In a January 2020 notification, the RO was informed by the Veteran that he did not wish to undergo the necessary VA examinations for his claims due to his work schedule. A review of the record indicates that the Veteran has not submitted any additional request since to schedule any VA examinations. Evidence expected from this examination which might have been material to the outcome of this claim could not be considered 38 C.F.R. § 3.655. As such, in the absence of such a request, or an indication that the Veteran is willing to report for an examination, the claim is evaluated based on the evidence of record. Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. A Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Ankle Prior to February 7, 2021, the Veteran's right ankle disorder is rated under Diagnostic Code 5271. A 10 percent rating is assigned for moderate limitation of ankle motion. A 20 percent rating, the maximum rating for the Diagnostic Code, is assigned where there is evidence of marked limitation of ankle motion. 38 C.F.R. § 4.71a, Diagnostic Code 5271 On/after February 7, 2021, the Veteran's right ankle disorder is rated under Diagnostic Code 5271. A 10 percent rating is assigned for moderate (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion) limitation of ankle motion. A 20 percent rating, the maximum rating for the Diagnostic Code, is assigned where there is evidence of marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) limitation of ankle motion. 38 C.F.R. § 4.71a, Diagnostic Code 5271. Back The Veteran's low back disorder is evaluated under Diagnostic Code 5237 for the lumbar spine. A 10 percent rating is warranted 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. A 20 percent rating is warranted 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. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Also, for consideration, diagnostic code 5010, states that arthritis, due to trauma, is to be rated as degenerative arthritis under Diagnostic Code 5003. That code provides that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is no limitation of motion of the specific joint(s) due to arthritis, Diagnostic Code 5003 provides a 20 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. Shoulder Prior to February 7, 2021, the Veteran's left shoulder disorder is evaluated under Diagnostic Code 5201. A 20 percent evaluation for the major and minor shoulder is warranted where the Veteran's range of motion is at shoulder level. A 30 percent evaluation for the major and 20 percent for the minor shoulder is warranted where the Veteran's range of motion is midway between side and shoulder level. A 40 percent evaluation for the major and 30 percent evaluation for the minor shoulder is warranted where the Veteran's range of motion limited to 25 degrees from the side. DC 5201. On/after February 7, 2021, the Veteran's left shoulder disorder is evaluated under Diagnostic Code 5201. A 20 percent evaluation for the major and minor shoulder is warranted where the Veteran's range of motion is at shoulder level with flexion and/or abduction limited to 90 degrees. A 30 percent evaluation for the major and 20 percent for the minor shoulder is warranted where the Veteran's range of motion is midway between side and shoulder with flexion and/or abduction limited to 45 degrees. A 40 percent evaluation for the major and 30 percent evaluation for the minor shoulder is warranted where the Veteran's range of motion with flexion or abduction limited to 25 degrees from the side. DC 5201. The Veteran is right handed, so minor extremity ratings are at issue herein. TDIU The Board notes that, generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent disability evaluation, or, with less disability, if certain criteria are met. Id. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where a 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). This cannot be awarded by the Board in the first instance, but only considered after a preliminary referral to the Director of the Compensation service. 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 not be given to the impairment caused by nonservice connected disabilities. See 38 C.F.R. §§ 3.34, 4.16, 4.19. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Substantially gainful employment is defined as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a Veteran actually works and without regard to a Veteran's earned annual income. See Faust v. West, 13 Vet. App. 342 (2000). The determination as to whether TDIU is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). 1. Entitlement to an increased evaluation in excess of 20 percent from June 20, 2014 to November 3, 2015, and in excess of 10 percent thereafter for degenerative disc disease of the lumbar spine. In an August 2013 VA back examination, the examiner diagnosed the Veteran with degenerative disc disease of the lumbar spine. The Veteran reported a history of intermittent aching low back pain with no radiculopathy symptomology. The Veteran reported flare-ups. Range of motion testing revealed flexion at 90 degree and extension at 30 degrees with no abnormal range of motion noted as contributing to functional loss or objective evidence of painful motion. Also, the examiner noted evidence of localized tenderness with pain on palpitation with muscle spasms noted, but no evidence of guarding. Ankylosis or intervertebral disc syndrome of the lumbar spine was not found. Imaging findings revealed arthritis of the lumbar spine. The Veteran reported the occasional use of a cane as an assistive device for his lumbar spine disorder. Addressing functional and occupational limitations, the examiner noted that the Veteran's low back disorder renders him unable to make sudden moves and prevents him from engaging in any heavy lifting. In a May 2015 VA back examination, the examiner diagnosed the Veteran with degenerative arthritis of the lumbar spine and degenerative disc disease of the lumbar spine. The Veteran reported a history of intermittent aching low back pain with no radiculopathy symptomology. The Veteran reported negative for flare-ups. Range of motion testing revealed flexion of 40 degrees with no abnormal range of motion noted as contributing to functional loss. Also, the examiner noted no evidence of weight bearing pain or localized tenderness with pain on palpitation. Guarding or muscle spasms were not found, with no evidence of ankylosis or intervertebral disc syndrome of the lumbar spine. Imaging findings revealed arthritis of the lumbar spine. The Veteran reported the occasional use of a back brace as an assistive device for his lumbar spine disorder. The examiner noted that the Veteran's low back disorder does not result in any functional and occupational impairment. In a November 2015 VA back examination, the examiner diagnosed the Veteran with a lumbosacral strain lumbar spine and degenerative disc disease of the lumbar spine. The Veteran reported that his low back pain has worsened over time. The Veteran reported negative for flare-ups. Range of motion testing revealed normal findings with flexion of 90 degrees with extension noted at 30 degrees. Pain that does not contribute to functional loss was noted during the examination. Also, the examiner noted no evidence of weight bearing pain, but did diagnosed the Veteran as positive for localized tenderness with pain on palpitation. Moderate guarding or wincing of the low back with no muscle spasms or abnormal gait was noted with no evidence of ankylosis or intervertebral disc syndrome of the lumbar spine. Imaging findings revealed arthritis of the lumbar spine. The Veteran reported no use an assistive device for his lumbar spine disorder. Addressing functional and occupational limitations, the examiner noted that the Veteran's low back disorder renders him unable to run or walk more than fifteen mins at a time. The Board has reviewed and carefully considered the Veteran's lay statements and hearing testimony asserting that the severity of his low back disorder has increased June 20, 2014 to November 3, 2015. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a low back disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 40 percent rating for the Veteran's low back disability from June 20, 2014 to November 3, 2015. As determined by the November 2015 VA examination, although there were findings of low back pain, there were no findings of forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine to warrant a 40 percent evaluation. Although the Veteran reported the occasional use of assistive devices for his low back pain during the period on appeal, range of motion testing revealed normal findings. Moreover, the examiner determined that the Veteran's pain that does not contribute to functional loss in his low back with no evidence of weight-bearing pain. Consideration has also been given to assigning a rating under the Formula for Rating IVDS based on incapacitating episodes. However, the evidence of record during the November 2015 VA examination is against a finding that the Veteran has a diagnosis of IVS or experienced incapacitating episodes as a result of his IVDS or was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board finds that from June 20, 2014 to November 3, 2015, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine to warrant a 40 percent evaluation. The Board finds that based on the evidence of the claims file, the 20 percent evaluation assigned better approximates the trajectory of the Veteran's current low back from June 20, 2014 to November 3, 2015. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 20 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 Turning to the Veteran's contention that he is entitled to an increased evaluation for a low back disorder after November 3, 2015, in a February 2019 VA back examination, the examiner diagnosed the Veteran with degenerative disc disease of the lumbar spine. The Veteran reported negative for flare-ups. Range of motion testing revealed normal findings with flexion of 90 degrees with extension noted at 30 degrees. Pain that does not contribute to functional loss was noted during the examination. Also, the examiner noted no evidence of weight bearing pain, but did diagnosed the Veteran as positive for localized tenderness with pain on palpitation. The examiner noted no evidence of ankylosis or intervertebral disc syndrome of the lumbar spine. The Veteran reported no use an assistive device for his lumbar spine disorder. The examiner noted that the Veteran's low back disorder does not result in any functional and occupational impairment. The Board has reviewed and carefully considered the Veteran's lay statements asserting that the severity of his low back disorder has increased after November 3, 2015. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a low back disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 20 percent rating for the Veteran's low back disability from after November 3, 2015. As determined by the February 2019 VA examination, although there were findings of low back pain, there were no findings of forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees to warrant a 20 percent evaluation. Although the Veteran reported localized tenderness with pain on palpitation, range of motion testing revealed normal findings. Moreover, the examiner determined that the Veteran's pain that does not contribute to functional loss in his low back with no evidence of weight-bearing pain. Consideration has also been given to assigning a rating under the Formula for Rating IVDS based on incapacitating episodes. However, the evidence of record during the November 2015 VA examination is against a finding that the Veteran has a diagnosis of IVS or experienced incapacitating episodes as a result of his IVDS or was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board finds that after November 3, 2015, there is no evidence of forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees to warrant a 20 percent evaluation. The Board finds that based on the evidence of the claims file, the 10 percent evaluation currently assigned better approximates the trajectory of the Veteran's current low back disability after November 3, 2015. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 10 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. 2. Entitlement to an increased evaluation in excess of 10 percent for a right ankle achilles tendon spur In an August 2013 VA ankle examination, the examiner diagnosed the Veteran with right ankle instability. plantar flexion was noted at 45 degrees and dorsiflexion was noted at 20 degrees with no objective evidence of painful motion or functional loss or impairment. Pain and localized tenderness with pain on palpitation was noted as negative with no evidence of ankylosis. The Veteran reported the occasional use of a brace as an assistive device for his right ankle. In an April 2015 VA ankle examination, the examiner diagnosed the Veteran with tendonitis of the right ankle with an achilles tendon spur. The Veteran reported a history of chronic pain of the right achilles which is increased with ambulation. He also reported negative for flare-ups or functional loss of the right ankle. Dorsiflexion was noted at 0 to 20 degrees with plantar flexion was noted at 0 to 45 degrees with evidence of weight-bearing pain and localized tenderness with pain on palpitation. Crepitus and ankylosis was noted as negative with no evidence of joint instability of the right ankle. Imaging testing revealed no findings of arthritis. The Veteran also reported no use of assistive devices for his right ankle. Addressing functional and occupational impairment, the Veteran reported that his right ankle tendonitis with an achilles tendon spur makes his job more difficult as the day progresses. In November 2015 VA ankle examination, the examiner diagnosed the Veteran with tendonitis of the right ankle with an achilles tendon spur. The Veteran reported sharp anterior and posterior right ankle pain with increased weakness over time. He also reported negative for flare-ups but expressed functional loss of the right ankle making it difficult to walk long distances or run. Dorsiflexion was noted at 0 to 20 degrees with plantar flexion was noted at 0 to 45 degrees with evidence of weight-bearing. Pain and localized tenderness with pain on palpitation was noted with objective evidence of moderate guarding or wincing of the achilles tendon. Crepitus and ankylosis was noted as negative with no evidence of joint instability of the right ankle. The Veteran also reported no use of assistive devices for his right ankle. Addressing functional and occupational impairment, the Veteran reported that his right ankle tendonitis with an achilles tendon spur impacts his ability to run or walk for more than fifteen minutes. In February 2019 VA ankle examination, the examiner diagnosed the Veteran with tendonitis of the right ankle with an achilles tendon spur. The Veteran's right ankle pain with increased weakness and instability over time. Dorsiflexion was noted at 0 to 20 degrees with plantar flexion was noted at 0 to 45 degrees with evidence of weight-bearing. There was also no evidence of marked limitation of motion. Pain and localized tenderness with pain on palpitation was noted with objective evidence of moderate guarding or wincing of the achilles tendon. Weight bearing pain was noted with not findings of crepitus or ankylosis diagnosed. The examiner also diagnosed findings of right ankle instability. The Veteran reported no use of assistive devices for his right ankle. The examiner noted that the Veteran's right ankle disorder does not result in any functional and occupational impairment. The Board has reviewed and carefully considered the Veteran's lay statements asserting that the severity of his right ankle disorder has increased. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a right ankle disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 20 percent rating for the Veteran's right ankle achilles tendon spur. As determined by the February 2019 VA examination, there were no findings of marked limitation of ankle motion. There were also no findings of dorsiflexion less than 5 degrees or plantar flexion less than 10 degrees to warrant the assignment of a 20 percent evaluation under diagnostic code Diagnostic Code 5271. Although weight bearing pain and localized tenderness with pain on palpitation was noted with objective evidence of moderate guarding or wincing of the achilles tendon, there were no findings of crepitus or ankylosis diagnosed to warrant the assignment of a 20 percent evaluation under diagnostic code Diagnostic Code 5270. Moreover, the examiner determined that the Veteran's right ankle disorder does not result in any functional and occupational impairment. The Board finds that, there is no evidence of marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) to warrant a 20 percent evaluation. The Board finds that based on the evidence of the claims file, the 10 percent evaluation currently assigned better approximates the trajectory of the Veteran's current right ankle disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 10 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 3. Entitlement to an increased evaluation in excess of 10 percent prior to July 7, 2015 and in excess of 20 percent thereafter for a non-dominant left shoulder disorder In an August 2013 VA left shoulder examination, the examiner diagnosed the Veteran as negative for a current left shoulder disorder. Flexion was noted at 180 degrees with abduction noted at 180 degrees with objective evidence of painful motion at 150 degrees. Localized tenderness or pain on palpation of the joint or associated soft tissue was diagnosed as negative. There was also no evidence of weight bearing pain, crepitus, or ankylosis. Hawkins impairment of the rotator cuff was tested and revealed normal findings. Left shoulder instability was not found. The Veteran also reported negative for the use of assistive devices for left shoulder. Imaging testing of the left shoulder revealed no findings of arthritis. Addressing functional and occupational impairment, the Veteran expressed that he cannot lift objects with his left heavy objects or use his left shoulder to climb. In a November 2015 VA left shoulder examination, the examiner diagnosed the Veteran with left shoulder impingement. The Veteran reported that his left shoulder pain has worsened over time. The Veteran also reported functional loss of the left shoulder and expressed that he cannot lift objects with his left hand heavier than 15 lbs. or raise objected over his head. Flexion was noted at 180 degrees with abduction noted at 180 degrees with no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was also evidence of weight bearing pain in the left shoulder, but no evidence of objective crepitus or ankylosis was diagnosed. Hawkins impairment of the rotator cuff was diagnosed with weakness of the left shoulder noted in empty-can testing. Left shoulder instability was noted as negative. The Veteran also reported negative for the use of assistive devices for left shoulder. Addressing functional and occupational impairment, the Veteran expressed that he cannot lift objects with his left hand heavier than 15 lbs. or raise objects over his head. The Board has reviewed and carefully considered the Veteran's lay statements asserting that the severity of his left shoulder disorder prior to July 7, 2015 has increased. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a left shoulder disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 20 percent rating for the Veteran's left shoulder disorder prior to July 7, 2015. As determined by the November 2015 VA examination, the Veteran's left shoulder disorder was not manifested by flexion and/or abduction limited to 90 to warrant the assignment of a 20 percent rating prior to July 7, 2015. The Board finds that based on the evidence of the claims file, the 10 percent evaluation currently assigned better approximates the trajectory of the Veteran's current left shoulder disorder prior to July 7, 2015. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 10 percent prior to July 7, 2015 for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 Turning to the Veteran's contention that that he is entitled to an increased evaluation for his left shoulder disorder after July 7, 2015, in a February 2019 VA left shoulder examination, the examiner diagnosed the Veteran with a left shoulder strain. The Veteran reported no functional loss or flare-ups of the left shoulder. Flexion was noted at 100 degrees with abduction noted at 100 degrees with no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was also no evidence of weight bearing pain, objective crepitus, or ankylosis diagnosed. Hawkins impairment of the rotator cuff was diagnosed with weakness of the left shoulder noted in empty-can testing. Left shoulder instability was noted as negative. The Veteran also reported negative for the use of assistive devices for his left shoulder. The examiner noted that the Veteran's left shoulder disorder does not result in any functional and occupational impairment. The Board has reviewed and carefully considered the Veteran's lay statements asserting that the severity of his left shoulder disorder after July 7, 2015 has increased. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses. However, the Board must emphasize that the Veteran is not competent to interpret accurately clinical findings pertaining to a left shoulder disorder, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a 30 percent rating for the Veteran's left shoulder disorder after July 7, 2015. As determined by the February 2019 VA examination, the Veteran's left shoulder disorder was not manifested flexion and/or abduction limited to 25 degrees from side to warrant a 30 percent rating after July 7, 2015. The Board finds that based on the evidence of the claims file, the 20 percent evaluation currently assigned better approximates the trajectory of the Veteran's current left shoulder disorder after July 7, 2015. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 20 percent after July 7, 2015 for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 4. Entitlement to a total disability rating based on individual unemployability prior to June 23, 2015 The Veteran essentially contends that he is entitled to a total disability based on individual unemployability prior to June 23, 2015. Prior to July 23, 2015, the Veteran was service connected for the following disorders: PTSD at 50 percent; sleep apnea at 50 percent; headaches at 0 percent; left shoulder pain at 10 percent; tinnitus at 0 percent; right ankle achilles tendon at 10 percent; degenerate disc disease at 20 percent; hypertension at 0 percent; and tinea pedis of the feet at 0 percent. As the Veteran does have two or more disabilities with one at least ratable at 40 percent or more, and a sufficient additional disability to bring the combined rating to 70 percent or more, the Veteran currently meets the schedular requirements for consideration of individual unemployability prior to June 23, 2015 In a July 2015 TDIU application form, the Veteran reported period of employed at Tesco Corporation as a mechanic from September 2014, to January 2015. His reported salary was $45, 000. He also reported a period of employment at Hobas Pipe USA as a mechanic from February 9, 2015 to June 18, 2015. Furthermore, a request for Employment Information to Hobas pipe revealed that that Veteran's last date of employment was July 22, 2015. His reported salary increased to$53,000. The Veteran also indicated on the TDIU application form that his total earned income for the past twelve months was $65,000. Moreover, the Veteran reported that the service connected disorders which rendered him unable to secure of follow employment were his PTSD rated at 50 percent and his low back pain rated at 20 percent prior to June 23, 2015. Lastly, the Veteran indicated on the TDIU form June 18, 2015 was the last time he was employed fulltime as an Army aviation school trained mechanic. The Veteran also reported that he did not became too disabled to work until June 18, 2015. Pursuant to 38 C.F.R. §§ 3.340, the Veteran disability must be of a sufficient severity to warrant a total disability rating. Moreover, the disability must have required extended, continuous, or intermittent hospitalizations, or have produced total period of industrial incapacity for at least 1 year, or be subject to recurring, severe, frequent, or prolonged exacerbations. 38 C.F.R. §§ 3.340(a)(i)(ii). After a review of the record, the Board has determined that prior to June 23, 2015 the Veteran actively secured and followed gainful employment. Moreover, during the period on appeal, the Veteran was capable of, and did secure fulltime employment as a mechanic which yielded a substantial salary increase. Furthermore, there is no evidence in the record to support a finding that the Veteran's service connected PTSD and back disorder were of an incapacitating nature to render the Veteran incapable of maintaining employment. Lastly, as there does not appear to be any educational, income, or service connected disorders rendering the Veteran incapable of securing and following substantially gainful employment prior to June 23, 2015, the evidence in the record does not support the granting of TDIU prior to June 23, 2015. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elliot. Harris 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.