Citation Nr: 21030778 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 12-17 849A DATE: May 19, 2021 ORDER Entitlement to an initial disability rating in excess of 30 percent for service-connected cervical radiculopathy, left upper extremity, is denied. Entitlement to an initial disability rating in excess of 20 percent and a disability rating in excess of 40 percent on and after May 13, 2019, for service-connected lumbar radiculopathy, left lower extremity, is denied. Entitlement to service connection for colon cancer is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran's cervical radiculopathy of the left upper extremity more nearly approximates moderate incomplete paralysis of the lower radicular group. 2. The Veteran's lumbar radiculopathy of the left lower extremity more nearly approximated moderate incomplete paralysis of the sciatic nerve prior to May 13, 2019 and moderately severe incomplete paralysis of the sciatic nerve thereafter. 3. The Veteran's colon cancer is not etiologically related to his military service and/or herbicide or fuel exposure. 4. The Veteran's service-connected disabilities do not preclude him from securing and following substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 30 percent for service-connected cervical radiculopathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 3.957, 4.1-4.10, 4.40, 4.45, 4.123, 4.124a, Diagnostic Code 8512. 2. The criteria for entitlement to an initial disability rating in excess of 20 percent and a disability rating in excess of 40 percent on and after May 13, 2019, for service-connected lumbar 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, 3.321, 3.326(a), 4.7, 4.14, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to service connection for colon cancer have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. 4. The criteria for entitlement to total disability rating based on individual unemployability (TDIU) have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to March 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from May 2010 and February 2014 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2015, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of this proceeding has been associated with the record. The May 2010 rating decision included a denial of service connection for a panic disorder with claimed post-traumatic stress disorder (PTSD) based on no new and material evidence, and an increase in disability ratings for the degenerative joint disease (DJD) and degenerative disc disease (DDD) of the cervical spine and for degenerative joint disease (DJD) of the lumbar spine (both were increased to 20 percent disability) effective June 25, 2009. In March 2016, the Board declared the May 2010 decision final as it pertained to the PTSD claim, but granted the reopening based on new and material evidence. PTSD was subsequently granted in a March 2020 rating decision with a 50 percent rating and is no longer before the Board. Likewise, the Veteran appealed the DJD DDD cervical spine and DJD lumbar spine condition ratings and effective dates. In the March 2016 Board decision, the rating increases were denied; however, no decision was made on the effective date as the RO had not adjudicated the issue. In a March 2018 rating decision, the RO granted an earlier effective date for both the DJD DDD cervical spine and DJD lumbar spine, making them effective September 30, 2008. As such, these matters have been resolved and are also not before the Board. The February 2014 rating decision granted service connection for cervical radiculopathy of the left upper extremity, with an evaluation of 20 percent effective December 19, 2013, and for lumbar radiculopathy of the left lower extremity, with an evaluation of 10 percent effective December 19, 2013. The Veteran appealed those initial ratings. Then, the March 2018 rating decision also granted an earlier effective date for the cervical radiculopathy, left upper extremity, and for the lumbar radiculopathy, left lower extremity, making the new effective date for the initial ratings September 30, 2008. Further, an increase in disability rating to 40 percent was granted for the Veteran's lumbar radiculopathy, left lower extremity, effective May 13, 2019. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant, when rendering a decision on appeal. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has thoroughly reviewed all the evidence in the Veteran's VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Appeals for Veterans Claims (Court). 38 U.S.C. § 7104(d)(1) (2012); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81(Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149(2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Increased Ratings Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. 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 civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history and reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability; resolving any reasonable doubt regarding the degree of disability in favor of the claimant; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating; and evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.2, 4.3, 4.7, 4.10. A veteran's entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath, 1 Vet. App. at 589. The Board must 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 appeal. See Hart v. Mansfield, 21 Vet. App. 505 (2007). For an initial rating claim, consideration will be given to "staged ratings" since service connection was made effective. See Fenderson v. West, 12 Vet. App. 119 (1999). In other words, where the evidence contains factual findings demonstrating distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of a staged rating would be necessary. Id. However, assigning separate ratings for combination may not be permitted to result in pyramiding under 38 C.F.R. § 4.14, which prohibits "[t]he evaluation of the same disability under various diagnoses." See Brady v. Brown, 4 Vet. App. 203, 206 (1993); see also Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (the critical element is if symptoms of one condition are duplicative of or overlapping of another). Notwithstanding the duty to assist, it remains a claimant's responsibility to submit evidence to support his or her claim. See 38 U.S.C. § 5107(a); see also Skoczen v. Shinseki, 564 F.3d 1319, 1328 (Fed.Cir.2009). When there is an approximate balance of evidence regarding an issue material to the determination of a matter, the benefit of the doubt in resolving the issue shall be given to a veteran. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3 (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to an initial disability rating in excess of 30 percent for service-connected cervical radiculopathy of the left upper extremity The Veteran contends that higher ratings are warranted for his service-connected cervical radiculopathy, left upper extremity. By way of history, the Board notes that the February 2014 rating decision established service connection for cervical radiculopathy, left upper extremity and assigned a 20 percent evaluation effective December 19, 2013. A March 2018 rating decision granted an earlier effective date and a higher disability rating at 30 percent effective September 30, 2008. Under Diagnostic Code 8512, mild incomplete paralysis of the lower radicular group is assigned a 20 percent rating for either extremity. Moderate incomplete paralysis merits a 40 percent rating for the major extremity and a 30 percent rating for the minor extremity. Severe incomplete paralysis merits a 50 percent rating for the major extremity and a 40 percent rating for the minor extremity. Complete paralysis merits a 70 percent rating for the major extremity and a 60 percent rating for the minor extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8512. This rating code does not contain provisions for a zero percent evaluation. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. 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. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. 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. Turning to the evidence of record, a June 2018 VA pain management note documented the Veteran's complaint of increased pain radiating down left arm to wrist. No physical exam was provided; physical exercise was discussed, but pain management remained the same. See June 7, 2018 VA treatment records. The Veteran reported a worsening of pain in September 2018, noting he had increasing intermittent pain and muscle spasms. See September 10, 2018 VA treatment records. However, he reported an improvement in October 2018, noting his pain was now "off and on" and he was "dealing with it." See October 4, 2018 VA treatment records. Additionally, the records reveal that, during the period on appeal, the Veteran sought mainly general pain management for chronic back and neck pain, which was managed through medication. See generally 06/27/12, 10/31/13, 04/01/14, 05/24/18, 12/17/18, and 12/03/19 VA treatment records (noting active prescription for hydrocodone/acetaminophen and continued renewals). The Veteran underwent a VA spine examination in December 2013. He reported constant dull pain and occasional sharp pain. Physical exam revealed motor strength appeared normal in both upper extremities. Sensory and reflex test were normal. The examiner noted mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the upper left extremity. The Veteran underwent a VA peripheral nerves examination in September 2017. The examiner noted a diagnosis of left upper extremity radiculopathy. Muscle strength was normal. Sensory and reflex exams were normal. In the left upper extremity, radiculopathy was noted to cause moderate intermittent pain, moderate paresthesia/dysesthesias, and moderate numbness. No other signs and symptoms of left upper radiculopathy were indicated by the examiner. The examiner reported moderate incomplete paralysis of the left lower radicular group. The examiner noted the Veteran would be functionally limited due to his radiculopathy disabilities. Most recently, the Veteran underwent further VA peripheral nerves testing in May 2019. The examiner noted a diagnosis of left upper extremity radiculopathy. The Veteran reported decreased strength in his left hand along with constant numbness and tingling in his fingers. Radiculopathy symptoms included left upper extremity severe intermittent pain, moderate paresthesias/dysesthesias, and severe numbness. Muscle strength and reflexes were normal. A sensory examination revealed decreased sensation on the left forearm and hand/fingers. The examiner opined that the Veteran had moderate incomplete paralysis of the left lower radicular group. In the remarks section, the examiner stated that the Veteran's left upper radiculopathy affected his lower radicular nerve group to a moderate severe degree, and the condition impacted the Veteran's ability to work. Reading the report as a whole, the Board interprets the report as indicating that the best description of the Veteran's incomplete paralysis of the left lower radicular group is "moderate." The comment in the remarks section indicates that the severity exceeds the minimum to be moderate, but does not reach the level of "severe." The physical findings support this interpretation as most of the symptoms are moderate or intermittent. After careful consideration of the lay and medical evidence, the Board finds that the currently assigned 30 percent evaluation is appropriate. Higher ratings are not warranted. In order to warrant an evaluation greater than 30 percent, the evidence must support the presence of severe incomplete paralysis or complete paralysis. VA treatment records indicate the Veteran's pain has been appropriately managed with medication. The documented Veteran's complaint of radiating to the left upper extremity in June 2018 was not accompanied by a physical evaluation and was managed through the continued medication regimen and an exercise recommendation. Upon VA examination in December 2013, radiculopathy was noted to cause mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the left upper extremity. Sensory and reflex exams were normal. In September 2017, VA examination, the left upper extremity radiculopathy was reported to cause moderate intermittent pain, moderate paresthesia/dysesthesias, and moderate numbness. No other abnormalities were noted, and the examiner indicated that the Veteran had moderate incomplete paralysis of the lower radicular group. Most recently, in May 2019, radiculopathy symptoms included left upper extremity moderate constant pain, moderate paresthesias/dysesthesias, and moderate numbness. There was decreased strength in his left hand along with constant numbness and tingling in his fingers and decreased sensation on the left forearm and hand/fingers. The examiner reported moderate incomplete paralysis of the lower radicular group and noted that the condition impacted the Veteran's ability to work. The Veteran is competent to provide evidence about his disability; for example, he is competent to describe symptoms of pain and numbness related to his radiculopathy. See Layno v. Brown, 6 Vet. App. 465 (1994). However, he is not competent to identify a specific level of disability according to the appropriate Diagnostic Code. While lay persons are competent to provide opinions on some medical issues, determining the severity of a complex condition such as paralysis of a nerve falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). Competent evidence concerning the nature and extent of the Veteran's radiculopathy was provided by the VA examiner who interviewed and evaluated him during the relevant period. The medical findings as provided in the examination reports directly address the criteria under which this disability is evaluated. Thus, the competent lay evidence is outweighed by the competent medical evidence that evaluates the true extent of the disability. In summary, the Board finds that a rating in excess of 30 percent is not warranted as the Veteran's cervical radiculopathy of the left upper extremity manifested symptoms that approximated no worse than moderate incomplete paralysis. In regard to the left upper extremity radiculopathy, the Board has considered all potentially applicable provisions of the rating schedule, whether or not they have been raised by the Veteran or his representative, as required by Schafrath, 1 Vet. App. 589. However, the evidence of record does not provide a basis upon which to assign increased disability ratings in excess of those recognized above. See 38 C.F.R. § 4.124a, Diagnostic Codes 8510-8540. Finally, a separate rating for limitation of motion or other functional limitations is not warranted because the pain, weakness, and sensory disturbances that contribute to the functional limitations, including loss of range of motion, are expressly addressed by the criteria under Diagnostic Code 8512. See Esteban, 6 Vet. App. at 262. The preponderance of the evidence is against the claim for an increased rating, and the benefit of the doubt rule is not for application. 38 U.S.C. § 5107(b). There is not an approximate balance of evidence. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Assignment of staged ratings has been considered and is not for application. See Fenderson, supra. 2. Entitlement to an initial disability rating in excess of 20 percent and in excess of 40 percent on and after May 13, 2019 for service-connected lumbar radiculopathy of the left lower extremity The Veteran contends that a higher rating is warranted for his service-connected lumbar radiculopathy of the left lower extremity. By way of history, the Board notes that the February 2014 rating decision established service connection for lumbar radiculopathy of the left lower extremity and assigned a 10 percent evaluation effective December 19, 2013. A March 2018 rating decision granted an earlier effective date and a higher disability rating at 20 percent effective September 30, 2008. A March 2020 rating decision granted a rating at 40 percent disability effective May 13, 2019. Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. Diagnostic Code 8520 provides ratings for paralysis of the sciatic nerve. A 10 percent rating is warranted for mild incomplete paralysis, a 20 percent rating is warranted for moderate incomplete paralysis, a 40 percent rating is warranted for moderately severe incomplete paralysis, and a 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Prior to May 13, 2019 Prior to May 13, 2019, the Veteran's lumbar radiculopathy rating, as noted supra, was rated at 20 percent disabling effective September 30, 2008. VA treatment records for the Veteran's lumbar radiculopathy left lower are similar to those noted supra for the cervical radiculopathy left upper in that the Veteran mainly sought general pain medication for his chronic back and neck pain, without specifically noting radiculopathy symptoms such as numbness, tingling or burning. However, in April 2018, a VA treatment notes the Veteran reported he had constant, sharp, tingling and throbbing pain which was worst in his hips, legs and feet. See April 14, 2018 VA treatment records. In June 2018, he reported persistent pain in his back and neck with some radiation down both his legs. See June 7, 2018, VA treatment records. He noted he took Hydrocodone which helped him walk and exercise. Id. In September 2018, the Veteran reported his pain had worsened due to the weather and complained of intermittent pain and muscle spasms. See September 10, 2018 VA treatment records. As noted supra, in October 2018, the Veteran reported his pain was now decreased and he was dealing with it. See October 4, 2018 VA treatment records. During a January 2010 VA examination, the Veteran reported low back pain with intermittent numbness involving the lower extremities. Additionally, the Veteran reported the occasional use of lumbar corset for support as needed. However, sensory exam was intact to light touch in both upper and lower extremities, muscle stretch reflexes were symmetrical, and motor strength testing was 5/5. In December 2013, the Veteran was afforded a VA examination. The Veteran reported constant aching and occasional sharp pains worsened by prolonged sitting. The examiner diagnosed the Veteran with degenerative joint disease lumbar spine. The examiner noted symptoms of moderate intermittent pain of left lower extremity with mild paresthesias and/or dysesthesias and mild numbness. The examiner reported left sciatic nerve involvement with mild severity. His muscle strength, reflex, and sensory exams were normal. He used a brace occasionally for lumbar support. The examiner noted that the Veteran's symptoms caused impaired ability to sit for prolonged periods of time and repetitive flexion. In September 2017, the Veteran was afforded a VA peripheral nerve examination. The Veteran had left lower extremity symptoms of moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. He had normal muscle strength, reflex, and sensory exams. The Veteran had no trophic changes and normal gait. The examiner indicated that the Veteran had moderate incomplete paralysis of the left sciatic nerve. The examiner noted that the Veteran used a cane and lumbar back brace and cervical spine collar that were prescribed for his left lower extremity radiculopathy. Further, the examiner reported the Veteran was functionally impaired due to his limited his ability to bend, twist, lift, or have any prolonged standing, sitting, or walking. Since September 2008 the Veteran's left lower extremity peripheral neuropathy caused symptoms of moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness, with no marked decrease in sensation in left lower leg/ankle or in left foot and toes, and normal gait. He occasionally required pain medication, the use of a cane and the occasional use of a back brace. His symptoms during this period were determined to be at most moderate in nature. Given these facts, the Board finds that the Veteran's lumbar radiculopathy of the left lower extremity most closely approximated a 20 percent rating for the period on appeal. 38 C.F.R. § 4.7. A 40 percent rating is not warranted as the Veteran's disability has not been determined to be moderately severe as he still retained muscle strength, and normal reflexes. Otherwise, nearly all of his symptoms are moderate at worst. As to the functional limitations, including loss of range of motion, the Board finds they are adequately addressed by the criteria under Diagnostic Code 8520 and a separate rating is not warranted. See Esteban, 6 Vet. App. at 262. From May 13, 2019 to Present In May 2019, the Veteran underwent another VA peripheral nerve examination. The Veteran reported worsening symptoms with bending, lifting, twisting, and turning. He reported he could not lay flat to sleep and had received cortisone injections in his back and neck for pain. The examiner indicated that the Veteran had had left lower extremity symptoms of severe intermittent pain, moderate paresthesias and/or dysesthesias, and severe numbness. He had normal muscle strength and reflex exams. The examiner noted the Veteran had decreased sensation in left lower leg/ankle and completely absent sensation in left foot and toes. The examiner attributed the Veteran's antalgic gait to his lumbar radiculopathy. The examiner indicated that the Veteran had moderately severe incomplete paralysis of the left sciatic nerve. Further, he indicated the Veteran used a prescription brace occasionally and cane regularly for his lumbar radiculopathy. The examiner remarked that the Veteran's left lower radiculopathy affected his sciatic nerve to a moderately severe degree. Since May 13, 2019 the Veteran's left and lower extremity peripheral neuropathy caused symptoms of severe intermittent pain, moderate paresthesias and/or dysesthesias, and severe numbness, decreased sensation in left lower leg/ankle and completely absent sensation in left foot and toes, and an antalgic gait; and required pain medication, use of a cane regularly and occasionally needed a back brace. His symptoms have been determined to be moderately severe. Given these facts, the Board finds that the Veteran's lumbar radiculopathy of the left lower extremity both most closely approximate a 40 percent rating for the period on appeal. 38 C.F.R. § 4.7. A 60 percent rating is not warranted as the Veteran's disabilities have not been determined to be severe as he still retained muscle strength, and normal reflexes, and only expressed severe symptoms of numbness in his toes and severe intermittent pain; otherwise, nearly all of his symptoms are moderate at the worst and the VA examiner described the overall severity as "moderately severe." As to the functional limitations, including loss of range of motion, the Board finds they are adequately addressed by the criteria under Diagnostic Code 8520 and a separate rating is not warranted. See Esteban, 6 Vet. App. at 262. The Board concludes that the preponderance of the evidence is against the claim for an increased rating, and the benefit of the doubt rule is not for application. 38 U.S.C. § 5107(b). Prior to May 13, 2019 the Veteran warrants a disability rating of 20 percent disability for lumbar radiculopathy; and a 40 percent disability rating thereafter. There is not an approximate balance of evidence. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). 3. Entitlement to service connection for colon cancer The Veteran contends his colon cancer is due to herbicide and/or fuel exposure during his military service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). For veterans who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain chronic diseases, including malignant tumors, if the disability manifested to a compensable degree within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases, including respiratory cancers, are presumed to be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of the disease during service. See 38 U.S.C. § 1116(a); 38 C.F.R. § 3.309(e). The presumption is rebuttable. See 38 C.F.R. § 3.307(d). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Colon cancer is not included in the list of presumptive diseases based on exposure to herbicides. VA has determined that there is no positive association between exposure to herbicide agents and any other condition for which it has not specifically been determined that a presumption of service connection is warranted. See 59 Fed. Reg. 341-46 (1994); see also 61 Fed. Reg. 57586-89 (1996). Because the Veteran's claimed disability, colon cancer, is not listed under 38 U.S.C. § 1116 or 38 C.F.R. § 3.309(e) as a disease associated with herbicide agent exposure, the presumption of service connection for colon cancer based on herbicide agent exposure is not warranted. 38 C.F.R. §§ 3.307, 3.309(e). Further, the Veteran's service treatment records are silent as to complaints of, diagnosis of or treatment for colon cancer. Neither the Veteran nor his representative allege that the Veteran had colon cancer while on active duty. Additionally, there is no competent evidence of record documenting the presence of colon cancer to a compensable degree within one year of discharge which would allow for the grant of service connection for colon cancer as a chronic disease under 38 C.F.R. § 3.307. A claimant is not precluded from establishing service connection for a disease averred to be related to herbicide exposure, as long as there is proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). To establish a right to compensation for a present disability on a direct basis, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds, for the reasons discussed below, that service connection for colon cancer is not warranted on any basis. The Board notes there is no need to address whether Vietnam service is confirmed for the Veteran as colon cancer is not a presumptive disease and there is no nexus linking herbicide or fuel exposure to the Veteran's colon cancer. The record indicates the Veteran was diagnosed with colon cancer in 1989. See January 22, 2009 VA treatment records (noting previous history of colon cancer diagnosed in 1989 with surgical procedure partial colectomy). As such, he has a current disability and the first prong of direct service connection is satisfied. The Veteran states he serviced aircrafts which carried Agent Orange and further testified to an incident where he had fuel exposure due to a fuel leak aboard an aircraft. See January 2015 Hearing transcript. As noted supra, herbicide exposure does not establish a presumptive nexus for colon cancer. Therefore, the question before the Board is whether the Veteran's colon cancer could have been caused by his exposure to fuel in service or alleged herbicide exposure. In January 2015, the Veteran testified that he was exposed to fuel as a result of a ruptured fuel tank line. The aircraft was forced to make an emergency landing in Hahn, Germany. See January 2015 Hearing Transcript. In March 2020, a VA examiner reviewed the Veteran's lay statements and his associated claims file. The examiner opined that the Veteran's has diagnosis of residuals of colon cancer "is less likely than not caused by active service; or, smoke exposure, fuel exposure or herbicide exposure during service." See March 18, 2020 VA examination. The examiner's rationale was based upon review of the record, Veteran's reports, and medical literature. The Veteran had a history of tobacco abuse, which is a risk factor supported by medical literature. He noted that colon cancer is not considered a presumptive diagnosis for herbicide exposure; and there was no evidence-based medical literature to support that fuel exposure and/or herbicide exposure would have predisposed this Veteran to the development of colon cancer more than ten years after military discharge. The Board finds this opinion highly probative as it is consistent with the evidence of record, cited to current medical literature, and provided an alternative etiology. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). The Board acknowledges the lay statements of record and the assertion that the Veteran's colon cancer was related to herbicide/fuel exposure. The Veteran is competent to relate symptoms within the realm of their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). To the extent that the Veteran has argued that his colon cancer is due to his exposure to herbicide agents and/or fuel exposure, this falls outside the realm of common knowledge of a lay person as this is beyond the capability of a lay person to observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Consequently, the Veteran's statements linking his colon cancer to herbicide agent exposure are of no probative value. The Board finds of higher probative value the March 2020 medical opinion, indicating that there is no medical literature to support that the Veteran's colon cancer is related to exposure to fuel and/or herbicide agents, and provided an alternative etiology. Accordingly, service connection for colon cancer based on exposure to fuel and/or herbicide agents is not warranted. See Combee v. Brown, 34 F. 3d. 1039 (Fed. Cir. 1994). There is no competent evidence of record which links colon cancer directly to the Veteran's active duty service. Accordingly, service connection for colon cancer is not warranted on a direct basis. 38 C.F.R. § 3.303. 4. Entitlement to total disability unemployment The Veteran seeks entitlement to total disability unemployment benefits due to his service-connected disabilities. By way of background, the issue of entitlement to a TDIU was inferred under Rice v. Shinseki, 22 Vet. App. 447, 453-454 (2009), during the September 2017 peripheral nerve exam when the examiner noted the Veteran was retired, but "due to his left upper and lower extremity radiculopathy he would be limited in bending, twisting, lifting, turning his head, looking up and down or doing any prolonged standing, sitting or walking." When a request for a TDIU is made during the pendency of a claim for an increase, whether expressly raised by the 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 adjudication of the increased rating claim. See id. As such, the claim became part of the increased rating appeal for the Veteran's lumbar radiculopathy left lower, and cervical radiculopathy left upper. The records show that the RO sent the Veteran a custom 5103 Notice in November 2017 indicating that he might be eligible for TDIU benefits and requesting he (a) send the Veteran a VA Form 21-8940 and request that he provide all past employers' information, (b) send any outstanding treatment records or complete a VA Form 21-4142 release so that the VA could request treatment records, and (d) submit lay statements in support of how his disabilities have affected the Veteran. The Veteran was sent subsequent notices in December 2017, and in March 2019. The Veteran did not return the forms or otherwise respond in any way to the RO's request. The RO subsequently denied the claim in a March 2020 rating decision and subsequently in an April 2020 supplemental statement of the case (SSOC). The VA has a duty to assist the Veteran in substantiating his claims, however, that duty is not a one-way street and he has some responsibility to cooperate in the development of evidence relevant to his claim. Woods v. Gober, 14 Vet. App. 214, 224 (2000). Here, the November 2017 Notice and subsequent notices in December 2017 and March 2019 sent by the RO to the Veteran and his representative explained what additional information was needed, that it was ultimately the Veteran's responsibility to make sure VA received the requested evidence to support his appeal. VA's duty to assist vis-à-vis the adequacy of the development letters has been satisfied. VA will grant TDIU benefits when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing and following any form of substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under 38 C.F.R. § 4.16(a), if there is only one service-connected disability, the disability must be rated at 60 percent or more to qualify for schedular TDIU. If there are two or more service-connected disabilities, there must be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38C.F.R. §4.16(a). If the required percentage requirements for a TDIU are not met on a schedular basis, but the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disorders, the Director of Compensation Service should consider whether TDIU may be awarded on an extraschedular basis. 38C.F.R. §4.16(b). The Board may not award a TDIU on an extraschedular basis in the first instance. For extraschedular TDIU claims, a veteran's case is eligible for consideration under 38C.F.R. §4.16(b) by referral to the Director of Compensation Service where there is plausible evidence that a veteran is unable to secure and follow a substantially gainful occupation and where there is not any affirmative evidence to the contrary. See Bowling v. Principi, 15 Vet. App. 1, 10 (2001). In March 2018 a rating decision granted an earlier effective date for the Veteran's service-connected lumbar radiculopathy, left lower extremity with a disability rating of 20 percent, and cervical radiculopathy, left upper extremity with a disability rating of 30 percent effective September 30, 2008. Consequently, from September 30, 2008 to May 12, 2019, the Veteran was service connected for (a) posttraumatic stress disorder with a disability rating of 50 percent, (b) degenerative joint disease of the lumbar spine with a disability rating of 20 percent, (c) degenerative joint disease and degenerative disc disease of the cervical spine with a disability rating at 20 percent, (d) lumbar radiculopathy, left lower extremity with a disability rating of 20 percent, and (e) cervical radiculopathy, left upper extremity with a disability rating of 30 percent, for a combined disability rating of 80 percent. Effective May 13, 2019, the Veteran's lumbar radiculopathy, left upper was granted a higher disability rating of 40 percent, for a combined disability rating of 90 percent. The Veteran therefore met the percentage threshold set forth in 38 C.F.R. § 4.16(a) for consideration of a TDIU on a schedular basis as of September 30, 2008. The Board has considered whether the Veteran is entitled to a TDIU on a schedular basis. As set forth below, the evidence does not establish that the Veteran was not capable of performing the physical and mental acts required by employment for which he was qualified, and thus was not unable to secure and follow any substantially gainful occupation by reason of his service-connected disabilities during the period on appeal. Thus, an award of a schedular TDIU is not warranted. The question of whether the Veteran is "unable to secure and follow a substantially gainful occupation" under section 4.16(b) has two components: one economic and one noneconomic. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). 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; the Veteran's physical abilities (both exertional and non-exertional) and associated limitations, if any; and the Veteran's mental abilities and associated limitations, if any. See Ray, supra. As to the economic component, the Veteran did not provide any information regarding his past income or additional details about his prior employment. The record shows the Veteran has had at least some employment over the years, but there was no information as to when or how long, so it was unknown whether he had marginal or gainful income for the various years on appeal. Since he did not provide the requested income information, there is no evidence on this point. As to the non-economic component, the evidence shows that the Veteran has military training and experience as an Aircraft Maintenance Specialist (Military Occupational Specialty 43151F). See DD Form 214. The Veteran also has a degree in business and a history of construction and zoning work. See March 17, 2009 VA treatment note (Veteran reported he held a business degree and history of construction work for Army Corp engineers); see August 31, 2016 VA treatment records (noting Veteran reported he was a worker for U.S. Army Corp of engineers and zoning director in Miami). In terms of physical abilities and limitations, the Veteran has generally asserted that he suffers from chronic pain and limitations of movement due to fatigue, easy exhaustion, and muscle spasms in his neck, back, and legs. See March 17, 2009 VA treatment note (Veteran reported he was applying to social security disability on the basis of fatigue and easy exhaustion, and muscle spasms in neck and back and legs). The Veteran contended he was unable to stand, sit, or walk for long periods of time due to his back and neck symptoms. A January 2010 VA examination report shows that the Veteran stiffness in the neck and back, fatigue, weakness, and intermittent numbness involving the right upper and lower extremities. His walking tolerance was one block, or about five minutes and occasionally felt unsteady. The examiner noted that the Veteran was independent with walking and activities of daily living, although he was retired and did not work. In a November 2013 VA exam, the VA examiner noted the Veteran was retired, but his functional abilities were impaired due to pain with prolonged sitting and repetitive extension and flexion. In a September 2017 VA peripheral nerve exam, the VA examiner indicated that although the Veteran is retired, due to his left upper and lower extremity radiculopathy he would be limited in bending, twisting, lifting, turning his head, looking up and down or doing any prolonged standing, sitting or walking. Similarly, a May 2019 VA peripheral nerve examiner noted the Veteran's left upper and lower extremity radiculopathy limit his ability to do bending, twisting, lifting, turning his head, looking up and down or doing any prolonged standing, sitting or walking. Similarly, the May 2019 VA examination for psychiatric disorder, the Veteran asserted that he could not do the jobs in which he was previously trained, including work as a mechanic, cook, and a car salesman. He also asserted that no one would hire him because he used narcotic medication for his back pain. A December 2013 VA back examination report shows the Veteran had symptoms of reduced and weakened movement with pain and lack of endurance. The examiner noted that the Veteran's condition did not impact his ability to work but did not provide any rationale for that finding. As noted supra in the previous sections, the Veteran's treatment records show he has been consistently under pain management for his chronic back and neck pain. Even when the Veteran has reported worsening symptomatology due to weather or increased activity, it was intermittent pain with spasms, which after adjustments to his pain medication, were well managed. See generally VA medical treatment records, supra. Further, in June 2018 VA pain management note shows that the Veteran was recommended exercise to help his back and neck pain and his July and subsequent treatment records note the Veteran was exercising. See July 19, 2018 VA treatment records (noting Veteran's pain was stable; was able to exercise more; including daily use of an exercise bike and walking a mile per day). As for his psychiatric treatment, in January 2012, a mental health note states his treatment goal is to reduce social isolation and alienation, and persistent anger and/or aggression that interfere with relationships and the ability to accomplish tasks required for daily living. January 10, 2012 VA treatment records. Further records indicate the Veteran's PTSD has been well managed by medication since 2012, with a few fluctuations based on the Veteran's health and resulting stressors. See generally 11/30/11, 03/27/12, 07/02/13, 09/12/15, 02/03/16, and 08/31/16 VA treatment records (noting Veteran is does well on PTSD medication, is cognitively intact, has coherent speech, and denies suicidal and homicidal ideation). In terms of mental abilities and limitations, during a March 2019 VA post-traumatic stress disorder exam, the Veteran reported symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, and disturbances of motivation and mood. The examiner noted the Veteran had an occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The competent and credible medical evidence of record shows, at best, that the Veteran's service-connected disabilities might preclude him from engaging in employment activities that require extended periods of walking, sitting, or standing, such as working as a construction worker or zoning director, but it does not show that the Veteran is precluded from performing sedentary or supervisory work. Here, the Veteran has a business degree, so the Board may reasonably infer that he would be capable of a variety of forms of employment that would be consistent with his level of education and sedentary employment. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011) (Board is entitled to utilize common sense in drawing reasonable inferences from the facts of record). Moreover, the Veteran has previously worked in a supervisory role as indicated by his zoning director position. Although that position may have required extended periods of standing, walking, or sitting which, giving the Veteran the benefit of the doubt may exceed his physical limitations, given the Veteran's education and admitted ability to engage in physical activities of some duration, the Board may reasonably infer that he could work in a supervisory role if provided reasonable accommodations, such as the ability to alternatively sit or stand as needed. Indeed, the evidence supports finding that the Veteran is not precluded from engaging in a wide variety of administrative, office, and clerical jobs, or other forms of employment, including light duty positions, that would not require the Veteran to spend an extended period of time on his feet, standing or walking, and which could be performed in an alternately standing or seating position. The Board is cognizant that "skills needed to attend school are different from the skills needed to compete successfully in the workplace." Washington v. Derwinski, 1 Vet. App. 459, 465 (1991). Here, however, the Board's findings regarding unemployability are not based on the Veteran having demonstrated that he had the skills to obtain a business degree, but rather that the classes the Veteran took in school indicate on their face the existence of learned knowledge and skills, such as math and writing, that are transferrable to the workplace. Further, the ability to do sedentary work is consistent with review of the Veteran's education and work experience. The United States Court of Appeals for Veterans Claims has instructed that "the meaning and relevance of the term ["sedentary employment"] will have to be discerned on a case-by-case basis from the medical and lay evidence presented and in light of each Veteran's education, training, and work history." Withers v. Wilkie, 30 Vet. App. 139 (2018). As such, the Board interprets sedentary to mean primarily working in an office-type setting with much of the day seated; noting that since "sedentary" is defined as "[r]equiring or marked by much sitting at a sedentary desk job", it interprets this definition to mean that the Veteran could work in a job where he primarily sits down. Webster's II New College Dictionary. Before the Board can rely on an examiner's finding that the Veteran is capable of sedentary work to deny TDIU, it must also ensure the finding is consistent with the medical evidence as a whole, and that it is the Board's "duty to 'interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present.'" Withers, 30 Vet. App. at 148. In this regard, the evidence shows that the Veteran's highest level of education includes a business degree, and his work history includes construction work for Army Corp engineers and experience as a zoning director for Miami, indicating supervisory experience. This history indicates the capability for customer service experience and office environments. Accordingly, the Board finds that the Veteran's education and work history does not preclude him from undertaking sedentary employment in an office environment and/or administrative capacity, exercising job functions that would not require him to undertake labor intensive work, such as lifting, bending, standing, walking, climbing, reaching; and that, in fact, he has experience in such office environments. Finally, the Board finds that the evidence does not show that the Veteran has mental impairments due to his service-connected disabilities that tend to preclude gaining or obtaining employment. Although the Veteran has complained that his PTSD limits his ability to participate in daily activities and has caused social isolation, his physicians have noted his symptoms are well managed with medication; he is cognitively intact; and has good recollection of memory. In an October 2017 psychiatric note, the Veteran reported he had recently hurt his coccyx and had gained weight, but stated his medications were working as before. The psychiatrist noted the Veteran's appearance was neat and clean; normal gait; normal speech; mood is dysphoric when flashbacks or wakes up from nightmares; but all thought processes, orientation, judgment and insight were coherent and good. See October 20, 2017 VA treatment records. There is no evidence of significant psychiatric limitations that indicate he is unable to obtain or maintain employment. In summary, the evidence of record demonstrates that despite the Veteran's functional impairments caused by his service-connected lumbar spine, cervical spine, and left lower and upper extremity radiculopathy conditions, the Veteran remained capable of performing the physical and mental acts required by employment for which he was qualified through education and occupational experience. Accordingly, the Veteran is not entitled to a schedular TDIU for any portion of the period on appeal. The Veteran's claim for a TDIU is denied. The Board had considered the benefit-of-the-doubt doctrine and finds it inapplicable because the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mireya Martinez 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.