Citation Nr: 21031298 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 09-34 268 DATE: May 21, 2021 ORDER Entitlement to service connection for lumbosacral strain with spasms (also claimed as aggravation of scoliosis), including as secondary to service-connected right hip disability is denied. Entitlement to an initial rating higher than 10 percent for right hip limitation of extension is denied. Entitlement to an initial rating higher than 10 percent prior to June 14, 2012 for right hip posttraumatic osteoarthritis is denied. Entitlement to a 20 percent rating from June 14, 2012 to April 20, 2015 for right hip posttraumatic osteoarthritis is granted subject to the laws and regulations governing payment of monetary benefits. Entitlement to a rating higher than 20 percent from April 21, 2015 to April 15, 2019 for right hip posttraumatic osteoarthritis is denied. Entitlement to a rating higher than 10 percent from April 16, 2019 to December 17, 2020 for right hip posttraumatic osteoarthritis is denied. Entitlement to a rating higher than 20 percent from December 18, 2020 for right hip posttraumatic osteoarthritis is denied. Entitlement to an initial rating higher than 20 percent for right shoulder rotator cuff tendonitis is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran's preexisting thoracolumbar scoliosis did not permanently worsen beyond the normal progress of the disease during active duty service. 2. Lumbosacral strain with spasms (also claimed as aggravation of scoliosis), did not manifest in service nor did it manifest within one year of separation, is not otherwise related to service and is unrelated (caused or aggravated) to the service-connected right hip disabilities. 3. The Veteran's right hip extension has been manifested by motion limited to 5 degrees. 4. For the period prior to June 14, 2012 the Veteran's right hip disability was not shown to have limitation of abduction with motion lost beyond 10 degrees or flexion limited to 30 degrees or less. 5. From June 14, 2012 to April 20, 2015 the Veteran's right hip posttraumatic osteoarthritis disability was manifested by limitation of abduction with motion lost beyond 10 degrees. 6. The assigned 20 percent rating from April 21, 2015 to April 15, 2019 for right hip posttraumatic osteoarthritis is the maximum schedular rating available. 7. From April 16, 2019 to December 17, 2020 the Veteran's right hip posttraumatic osteoarthritis did not demonstrate limitation of abduction with motion lost beyond 10 degrees. 8. The assigned 20 percent rating from December 18, 2020 for right hip posttraumatic osteoarthritis is the maximum schedular rating available. 9. The Veteran's right shoulder rotator cuff tendonitis has not been shown to result in range of motion limited to midway between his side and shoulder level. 10. The Veteran's service-connected disabilities have not been shown to preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for lumbosacral strain with spasms (also claimed as aggravation of scoliosis), including as secondary to service-connected right hip disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.306, 3.309(a), 3.310. 2. The criteria for entitlement to an initial rating higher than 10 percent for right hip limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code (Code) 5251. 3. The criteria for entitlement to an initial rating higher than 10 percent prior to June 14, 2012 for right hip posttraumatic osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5253. 4. The criteria for a 20 percent rating from June 14, 2012 to April 20, 2015 for right hip posttraumatic osteoarthritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5253. 5. The criteria for entitlement to a rating higher than 20 percent from April 21, 2015 to April 15, 2019 for right hip posttraumatic osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5253. 6. The criteria for entitlement to a rating higher than 10 percent rating from April 16, 2019 to December 17, 2020 for right hip posttraumatic osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5253. 7. The criteria for entitlement to a rating higher than 20 percent from December 18, 2020 for right hip posttraumatic osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5253. 8. The criteria for entitlement to an initial rating higher than 20 percent for right shoulder rotator cuff tendonitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5003, 5201. 9. The criteria for entitlement to TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from May 1988 to June 1997. These matters were last before the Board of Veterans' Appeals (Board) in December 2020 and remanded to a Department of Veterans Affairs (VA) Regional Office (RO) for issuance of a supplement statement of the case. In October 2019 these matters were remanded for additional development. Private medical records associated with the record after the last supplemental statement of the case in January 2021 are duplicates of records already associated with the Veteran's claims file. In correspondence dated in February 2021 the Veteran requested a compensation examination for his back. As shown below, examination in November 2016, and April 2019 were conducted pertinent to the Veteran's back disorder. In addition, a VA-contract medical opinion for the back was issued in December 2019. As the duty to assist has been fulfilled with the examinations already conducted and the issuance of a medical opinion, another VA examination is not necessary in this instance. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of 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 disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A preexisting disability will be presumed to have been aggravated by military service when there is an increase in disability during such service, unless there is a specific finding that the increase is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). Certain chronic diseases (to include arthritis) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time post-service (one year for arthritis). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. The nexus of a chronic disease to service may be established by showing continuity of symptomatology following service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). Entitlement to service connection for lumbosacral strain with spasms (also claimed as aggravation of scoliosis) The Veteran's lumbar spine disorder is currently diagnosed as degenerative arthritis of the spine, intervertebral disc syndrome and thoracic lumbar scoliosis (lumbar spine disorder). See April 2019 VA back conditions examination report. The Veteran contends his current lumbar spine disorder is due to in-service aggravation of his preexisting scoliosis or alternatively is secondary to his service-connected right hip disability. The Veteran's October 1987 service enlistment medical examination report shows he had asymptomatic mild to moderate scoliosis of the spine that was not considered disabling. The examining physician who conducted the enlistment medical examination in October 1987 noted that the Veteran had a negative back history with no prior knowledge of scoliosis and no symptoms. X-rays revealed scoliosis of 20 degrees at T10 L3. The assessment was moderate thoracolumbar scoliosis unlikely to progress. In his October 1987 service enlistment medical history report, the Veteran indicated he had no bone, joint or other deformity and no recurrent back pain. In February 1990 the Veteran was seen at an in-service clinic and reported he had low back pain since the day before with no history of recent trauma. The assessment was low back pain musculoskeletal spasms. A January 1993 service treatment record shows the Veteran was seen at a service medical clinic with complaints of back pain. A history of scoliosis was noted. The assessment was back spasm. The Veteran's June 1997 service separation medical assessment report is negative for any mention of a back injury or disorder. In June 2009, the Veteran's private physician provided an opinion that the Veteran's scoliosis was more likely than not related to service. The physician noted that there was aggravation of the Veteran's scoliosis as a result of military activities. No explanation or rationale accompanied this opinion. In February 2010, the Veteran underwent a VA spine examination. Following physical examination of the Veteran and review of x-rays, a diagnosis of thoracolumbar scoliosis of the spine was rendered. The examiner noted that he did not think there was any evidence the Veteran's thoracolumbar scoliosis was aggravated by military service. The examiner reasoned that the Veteran was only treated twice in service for low back spasms, and there was nothing to suggest that his condition was permanently aggravated by his service. The Veteran only had about one episode a year, which lasted about 30 minutes. An examination of his lumbosacral spine, other than scoliosis, shows normal range of motion and no neurological changes. The Veteran underwent a VA back conditions examination in November 2016. Following physical examination, the examiner diagnosed degenerative arthritis of the thoracolumbar spine, thoracic lumbar scoliosis, and degenerative disc disease. The examiner related that he was unable to state with 50 percent or greater probability that diagnoses of degenerative joint disease and degenerative disc disease are service connected, as they are conditions that occur over several years commonly not necessarily related to events in active duty service. Further, the examiner noted that the Veteran's current scoliosis appears to be a congenital "disease," indicating that it is capable of improving or deteriorating. Regarding degenerative joint disease and degenerative disc disease, he noted that both conditions develop commonly over extended time during life not necessarily related to any traumatic event especially that described during active duty service in this case. The examiner was unable to state with 50 percent or greater probability that any back condition whether congenital or acquired has any connection to his service-connected right hip with causing or aggravating. The examiner noted there is not enough objective evidence of clinical correlation between these conditions to make that connection. At the February 2018 Board hearing, the Veteran testified that while on active duty any kind of physical activity, including physical training, would cause his back to hurt. In addition, he stated that he hurt his back during an accident in Saudi Arabia involving a generator. He explained that he and other servicemen were about to load a large generator (4,000 pounds) on an aircraft when the aircraft winch broke and it had to be loaded manually by the Veteran and 3 other servicemen. While pushing the generator he strained his back. The Veteran further testified that his duties in the Air Force involved a lot of heavy moving and lifting. He related that the activity from his military service aggravated his diagnosed scoliosis beyond what it would normally be. He stated he had been experiencing sharp pains down his back when he bent over. After service he initially sought treatment for his back at VA in 2007. The Veteran stated he was told that his back is related to his hip. He stated further that his back has been aggravated due to the job he had during his military service and the accident he had in Saudi Arabia. In April 2019 the Veteran underwent a VA back conditions examination. This examination was conducted by the same examiner who conducted the November 2016 VA back examination of the Veteran. Following examination, the examiner diagnosed degenerative arthritis of the spine, intervertebral disc syndrome and thoracic scoliosis. The examiner noted that the Veteran's current scoliosis appears to be a congenital "disease" indicating it is capable of improving or deteriorating. As the examiner has essentially duplicated the responses in the November 2016 examination report the Board will not reprint that part of the examination report here. In a December 2019 VA-contract medical opinion regarding the claimed back disorder, the medical opinion provider opined that the Veteran's back disorder, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an inservice injury, event, or illness. The rationale for the opinion was that the Veteran was noted to have scoliosis on entry that was rated as mild-to-moderate. X-rays in 2011 noted mild scoliosis showing no increase in the anatomical condition itself. For any aggravation to be attributed, it would be necessary to show worsening of the anatomic curvature. Thus, it is less likely than not scoliosis was aggravated by in-service events. As there is no definable aggravation of scoliosis, in general, it is less likely than not that the hip would aggravate scoliosis. The events in service were acute and did not become chronic. However, back complaints did not re-manifest until many years post-service; acute low back strain and spasm would not impact the spine unless chronic. Records do not reflect this situation, therefore there is no evidence that the currently diagnosed degenerative joint disease and other back conditions are the result of the treatment in service. Therefore, it is less likely than not that the current diagnoses are due to the treatment for lumbar condition in service. Moreover, the Veteran's hip condition did not cause or aggravate beyond its natural progression his current back conditions to include degenerative joint disease. It is a widely accepted orthopedic principle, supported by "Wheeless" and other textbooks, that disease in one joint does not cause disease in another joint. Degenerative joint disease in one joint, in particular, does not cause degenerative joint disease in another joint. As to aggravation, it is less likely than not that the hip aggravated the back conditions. To do so would require significant alteration of gait, and that was not manifest per the examination reports. The examiner further noted that scoliosis is a congenital or developmental disease or condition, which is consistent with standard orthopedic practice and principles. The examiner explained that a defect implies a single marker/abnormality. Scoliosis covers several levels of the spine and is not isolated to one small area. The Board finds that the December 2019 VA-contract medical opinion is highly probative of the matter being considered here and is the most probative of the opinions of record because the medical opinion provider based the conclusions on a thorough review of the available lay and medical evidence, referenced medical treatises, and supported conclusions reached with sufficient rationale. The Board finds that the Veteran's service records and his testimony at the Board hearing do not support that he injured his lumbar spine or that his preexisting scoliosis was aggravated during service. The evidence shows he was treated on two occasions in service, and those incidents were acute and transitory, resolving without residuals. As such, the Veteran did not have a chronic and disabling condition in service. This is further supported by the evidence of record, as the Veteran's separation medical examination is negative for any mention of any disorder of the lumbar spine. Moreover, the earliest indication in the record that the Veteran sought medical treatment for back problems after service was in 2007. The Veteran testified at the Board hearing that he did not go to the doctor after discharge from service but took pain relievers and started going to VA around 2007. This gap of 10 years without seeking medical treatment may be probative evidence against the claim for service connection. Consequently, service connection for a lumbar spine disorder on the basis that it became manifest in service and has persisted since or on a presumptive basis for arthritis of the lumbar spine as a chronic disease under 38 C.F.R. §§ 3.307 and 3.309 is not warranted. In addition, to the extent the Veteran has attempted to support a continuity of symptomatology theory of entitlement, as arthritis is a chronic disease listed in 38 C.F.R. § 3.309(a), continuity of symptomatology is not shown by the record. As noted, the Veteran reported that he sought medical treatment for back pain in 2007, some 10 years after separation from service. While there is no evidence documenting treatment in 2007, the Veteran's private physician in June 2009 noted treatment for scoliosis beginning 2 months prior. Consequently, service connection for a lumbar spine disorder based on a continuity of chronic disease symptomatology is not warranted. On further review, the Board must consider whether there is medical evidence that suggests the claimed lumbar spine disorder may otherwise be related to the Veteran's active duty service. VA examinations in February 2010, November 2016, April 2019, and December 2019 do not establish a nexus to the Veteran's service. Of those reports/opinions, the December 2019 is the most probative. The December 2019 medical opinion provider opined that it is less likely than not that the Veteran's current diagnoses are due to the treatment for lumbar conditions in service. The rationale for the opinion was that the Veteran's initial back complaint in service did not re-manifest until many years post-service. Acute low back strain and spasm that were shown in service would not impact the spine unless they were chronic, and the records do not reflect the Veteran had a chronic lumbar condition in service. There is no evidence that the currently diagnosed degenerative joint disease and other back conditions are the result of the in-service back complaints. The Board finds this opinion is highly probative of the issue at hand, as the examiner based the conclusions on a thorough review of the available lay and medical evidence and supported those conclusions with sufficient rationale. As such, there is no competent evidence of record relating the Veteran's lumbar spine disorder to his active service; and the claim must be denied on that basis. Moreover, there is no competent evidence that the current lumbar spine disorder is proximately due to or aggravated by the service-connected right hip disability. At the February 2018 hearing, the Veteran stated he was told that his back is related to his hip. The Board finds the Veteran's account of what a medical professional purportedly told him, filtered as it was through a layman's sensibilities, is simply too attenuated and inherently unreliable to hold any probative value. Furthermore, the December 2019 VA-contract examiner opined that the Veteran's hip condition did not cause his current back conditions, to include degenerative joint disease. It is a widely accepted orthopedic principle that disease in one joint does not cause disease in another joint. Degenerative joint disease in one joint, in particular, does not cause degenerative joint disease in another joint. As to aggravation, it is less likely than not that the hip aggravated the back conditions. To do so would require significant alteration of gait, and that was not manifest per the examination reports. The Board has also considered whether service connection is warranted for aggravation of the Veteran's thoracolumbar scoliosis. Initially, on the question of whether the Veteran's scoliosis is a congenital or developmental defect or a congenital developmental disease, the December 2019 VA-contract examiner noted that scoliosis is a congenital or developmental disease or condition, which is consistent with standard orthopedic practice and principles. A defect implies a single marker/abnormality. Scoliosis covers several levels of the spine and is not isolated to one small area. In this case, the medical evidence of record is against finding that the Veteran's preexisting scoliosis permanently worsened beyond the normal progress of the disease during the Veteran's active service. The most probative opinion of record addressing this matter is that of the December 2019 VA-contract medical opinion provider, who opined that no increase is shown in service medical or treatment records of the Veteran's diagnosed mild to moderate thoracolumbar scoliosis during service. As earlier noted, there were two incidents of complaints of lumbar spine pain during active service which were found to be acute and not associated with the Veteran's scoliosis. Furthermore, post-service x-rays in 2011 noted mild scoliosis showing no increase in the anatomical condition itself. The December 2019 medical opinion provider noted that for any aggravation to be attributed, it would be necessary to show worsening of the anatomic curvature, which is not shown. The Board acknowledges the June 2009 opinion by the Veteran's primary care physician who opined that the Veteran's scoliosis was more likely than not related to military service. The physician noted that there was aggravation of the Veteran's scoliosis as a result of military activities. The Board finds that this opinion lacks probative value because the physician did not provide a rationale for the opinion and instead merely concluded, without explanation, that the Veteran's thoracolumbar scoliosis was aggravated by his service. Thus, the Board finds that service connection for a lumbar spine disorder on the bases of aggravation of a preexisting disorder is not warranted. The Board has considered the Veteran's hearing testimony regarding the nature of his injury during active duty service and his contentions on the etiology of his lumbar spine disorders. While he is competent to describe events and to report the symptoms he experienced, as a layperson, he is not competent to opine as to the etiology of his current lumbar spine disorders, which are medical questions that require medical expertise. See Jandreau v. Nicholson, 492 F. 3d 1372 (2007). Accordingly, the Board concludes the preponderance of the evidence is against the claim of service connection for a lumbar spine disorder, and the appeal in the matter must be denied. INCREASED RATING Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 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 required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, consideration also must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Hyphenated codes are used when a rating under one code requires use of an additional code to identify the basis for the rating. 38 C.F.R. § 4.27. In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Court has held the provisions of 38 C.F.R. § 4.59 are also not limited to the evaluation of musculoskeletal disabilities under diagnostic codes predicated on range of motion measurements. See Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the Veterans themselves, when a flare-up is not observable at the time of examination. 1. Entitlement to an initial rating higher than 10 percent for right hip limitation of extension The Veteran contends that symptoms of his service-connected right hip limitation of extension disability are more severe than represented by the 10 percent rating initially assigned for that disability. In an October 2012 rating decision, the Veteran was granted service connection for right hip limitation of extension and assigned a 10 percent rating based on extension of the thigh limited to 5 degrees or less, effective from July 8, 2011 under 38 C.F.R. § 4.71a, Code 5251, limitation of extension of the thigh. Under Code 5251, a maximum 10 percent rating is assigned for limitation of extension of the thigh to 5 degrees. 38 C.F.R. § 4.71a, Code 5251. Here, the Veteran is already receiving the maximum disability rating for his limitation in extension at 10 percent. He has been rated separately for distinct symptoms of his right hip disability. Therefore, as there is no legal basis upon which to award a higher schedular rating under Code 5251, the claim must be denied. Based on the foregoing, the Board finds that an initial rating higher than 10 percent for right hip limitation of extension is not warranted at any time during the appeal period. The Veteran is not entitled to an initial rating higher than 10 percent, as 10 percent is the maximum assigned under Code 5251. The Board has reviewed and considered the Veteran's assertions in support of his claim, including his reports of right hip pain that affects standing, walking, and lifting. However, even considering his complaints of pain and other symptoms described in DeLuca v. Brown, 8 Vet. App. 202 (1995), he is in receipt of the maximum rating available under Code 5251. When a Veteran is already receiving the maximum disability rating available based on symptomology that includes limitation of motion, it is not necessary to consider whether DeLuca, or 38 C.F.R. §§ 4.40 and 4.45 are applicable. See Johnson v. Brown, 10 Vet. App. 80, 85 (1997). Accordingly, the preponderance of the evidence is against a higher rating for right hip limitation of extension disability. The benefit of the doubt doctrine is therefore not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Entitlement to an initial rating higher than 10 percent prior to June 14, 2012 for right hip posttraumatic osteoarthritis 3. Entitlement to a 20 percent rating from June 14, 2012 to April 20, 2015 for right hip posttraumatic osteoarthritis 4. Entitlement to a rating higher than 20 percent from April 21, 2015 to April 15, 2019 for right hip posttraumatic osteoarthritis 5. Entitlement to a rating higher than 10 percent from April 16, 2019 to December 17, 2020 for right hip posttraumatic osteoarthritis 6. Entitlement to a rating higher than 20 percent from December 18, 2020 for right hip posttraumatic osteoarthritis The Veteran filed a claim for an increased rating for his service-connected right hip posttraumatic osteoarthritis disability in July 2007. He contends that his service-connected right hip posttraumatic osteoarthritis disability increased in severity and a higher rating is warranted. He is currently in receipt of staged ratings of 10 and 20 percent for specified periods. His right hip posttraumatic osteoarthritis is currently rated under 38 C.F.R. § 4.71a, Codes 5003-5253. Here, the hyphenated code indicates that the Veteran's disability is assessed under Code 5253, which governs impairment of the thigh, and Code 5003 governs degenerative arthritis and directs that the disability be established by X-ray findings and will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Disabilities of the hip and thigh are rated under Codes 5250-5255. Under Code 5252, flexion limited to 45 degrees warrants 10 percent; flexion limited to 30 degrees warrants 20 percent; flexion limited to 20 degrees warrants 30 percent; and flexion limited to 10 degrees warrants 40 percent. Code 5253 provides a 10 percent rating for impairment of the thigh with limitation of rotation such that the Veteran cannot toe-out more than 15 degrees of the affected leg or limitation of adduction such that the Veteran cannot cross his legs A 20 percent rating is warranted for limitation of abduction such that motion is lost beyond 10 degrees. Higher ratings are also available under Code 5250 for ankylosis of the hip, Code 5254 for flail joint, and Code 5255 for fracture or malunion. However, these other impairments have not been demonstrated (and the Veteran does not contend otherwise), so they will not be further discussed. Normal ranges of motion of the hip include hip flexion from 0 to 125 degrees, hip extension from 0 to 30 degrees, hip abduction from 0 to 45 degrees, hip adduction from 0 to 25 degrees, hip external rotation from 0 to 60 degrees, and hip internal rotation from 0 to 40 degrees. 38 C.F.R. § 4.71, Plate II. Prior to June 14, 2012 Prior to June 14, 2012 the Veteran's right hip posttraumatic osteoarthritis disability is rated 10 percent under Code 5253. In order to warrant the next higher 20 percent rating under Code 5253 for that period, the medical evidence of record must show the Veteran's right hip disability was productive of limitation of abduction with motion lost beyond 10 degrees; such is not shown in the record for the stated period. The evidence shows the Veteran underwent a VA joints examination in October 2008. He reported experiencing stiffness in the hip with inactivity such as sitting in a chair and having daily pain with flexion and extension of the right hip. There was no particular muscular weakness in association with the pain. He had mild to moderately severe daily discomfort and some impairment in flexion and extension even when not in pain. On physical examination, the right hip was about 20 degrees lack of full flexion with the Veteran recumbent. Right hip extension was to 110 degrees. Right hip abduction lacked about 10 degrees full and only went to about 35 degrees. X-rays of the right hip suggested osteoarthritis. There was no change in pain or range of motion after 3 repetitions. The impression was osteoarthritis of the right hip. On August 2011 VA joints examination, the Veteran reported having constant pain of the hip and stiffness. He did not have giving way or locking. He had no dislocation or subluxation. He did have lack of endurance. He described flare-ups, including precipitating and alleviating factors. On physical examination, right hip forward flexion was to 80 degrees with pain at the extreme. Internal rotation was 10 degrees and external rotation was 15 degrees on the right with pain at the extremes. There was no change due to pain, fatigue, weakness, lack of endurance, or incoordination, with repetitive testing. His hip musculature was symmetrical. There was no atrophy, deformity, or tenderness. There was no ankylosis. The diagnosis was bilateral degenerative hip with limited motion, pain, and limited mobility. The examiner noted that the Veteran was not working. He had functional limitations on standing and walking, although he could stand for half an hour and walk half a mile. He had a limp on the right-side lower extremity. Based on the foregoing, a rating higher than 10 percent for the period prior to June 14, 2012 is not warranted under Code 5253. Objective findings from the Veteran's VA examinations are consistent with a 10 percent rating and no higher. In order for the next higher, 20 percent rating to be warranted under that Code, the evidence of record must demonstrate that the Veteran's right hip disability had limitation of abduction beyond 10 degrees prior to June 14, 2012 and such is not shown in the record for the stated period. In addition, the Board has considered the applicability of DeLuca, including whether there is a basis for assigning a rating higher than 10 percent due to additional limitation of motion resulting from pain or functional loss. In this instance, the 10 percent rating assigned prior to June 14, 2012 takes into account the Veteran's functional loss associated with his right hip disability. The Board finds that 38 C.F.R. §§ 4.40, 4.45 and 4.59 do not provide a basis for an increased rating prior to June 14, 2012. See id. at 204-07. In other words, the functional loss does not most nearly approximate the criteria for the next-higher 20 percent rating. The Board has considered the Veteran's statements with regard to the severity of his disability during the period prior to June 14, 2012. The Veteran is competent to report on factual matters of which he has firsthand knowledge, such as experiencing pain; and the Board finds that the Veteran's statements have been credible. However, the Board has considered the Veteran's statements along with findings from VA examinations. Where the criteria in the Rating Schedule require medical expertise, which the Veteran has not been shown to have, the objective medical findings provided by the VA examination reports in particular, have been accorded greater probative weight. Accordingly, the preponderance of the evidence is against the Veteran's claim for a rating higher than 10 percent for right hip posttraumatic osteoarthritis disability prior to June 14, 2012. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. From June 14, 2012 to April 20, 2015 For the period from June 14, 2012 to April 20, 2015, the Veteran's right hip disability is rated 10 percent under Codes 5003, 5252 for right hip limitation of flexion. The Board finds, however that an increased rating to 20 percent is warranted for the Veteran's right hip disability from June 14, 2012 to April 20, 2015 under Code 5253 due to right hip limitation of abduction with motion lost beyond 10 degrees. The criteria set forth for a 20 percent rating under Code 5253 have been met, as shown in the medical evidence. The Board is cognizant that the assignment of multiple ratings based on the same symptoms or manifestations constitutes prohibited pyramiding. 38 C.F.R. § 4.14. Here, regarding the Veteran's right hip disability, the RO has assigned separate ratings based on limitation of extension, flexion and rotation and abduction of the right hip under Codes 5251, 5252, and 5253. This does not amount to pyramiding, as separate ratings under different diagnostic codes may be assigned where "none of the symptomatology for any of [the] conditions is duplicative of or overlapping with the symptomatology of the other . . . conditions." Esteban v. Brown, 6 Vet. App. 259 (1994). In this case, this consideration has been met in that limitation of extension, flexion, and rotation in the right hip and abduction or adduction of the right hip concern excursions of movements in different planes, and these limitations therefore constitute different bases for rating the hip. 38 C.F.R. § 4.45. If these limitations are demonstrated, they must be rated separately to adequately compensate for functional loss associated with the service-connected right hip disability. 38 C.F.R. § 4.40; see also VAOPGCPREC 09-2004. However, separate ratings for rotation, abduction, and/or adduction, may not be assigned, as these are all evaluated under the same diagnostic code, 5253. Thus, for the period from June 14, 2012 to April 20, 2015, the medical evidence, in pertinent part, includes a June 2012 VA hip and thigh conditions examination report. During the examination, the Veteran reported he had flare-ups that affected his standing and walking. Range of motion testing revealed right hip flexion with evidence of painful motion was to 45 degrees. Right hip extension with evidence of painful motion was to 5 degrees. Abduction was lost beyond 10 degrees. Adduction was not limited such that the Veteran could not cross his legs. Rotation was limited such that the Veteran could not toe-out more than 15 degrees. The Veteran did not have additional limitation in range of motion of the hip and thigh following repetitive-use testing. The Veteran had functional loss and/or functional impairment with contributing factors of less movement than normal, weakened movement, excess fatigability, pain on movement, disturbance of locomotion, and interference with sitting, standing and/or weight-bearing. Muscle strength testing was normal. There was no ankylosis. The Veteran occasional used a cane. X-rays show degenerative or traumatic arthritis. The diagnosis was osteoarthritis of the right hip. The Veteran's right hip impacted his ability to work in that he had pain and limitation of motion of the right hip such that he could not sit, stand, or lift other than for short periods of time. Here, the evidence shows on range of motion testing during the June 2012 VA hip and thigh conditions examination, the examiner found that the Veteran's abduction was lost beyond 10 degrees. As such, a 20 percent rating for the Veteran's right hip disability, but not higher, is supported from June 14, 2012 to April 20, 2015. The Board notes that 20 percent is the maximum schedular rating under Code 5253, and as such, further evaluation is not warranted. Accordingly, a 20 percent rating, but no higher, for the period from June 14, 2012 to April 20, 2015 is assigned. From April 21, 2015 to April 15, 2019 The July 2019 rating decision increased the Veteran's right hip posttraumatic osteoarthritis disability rating to 20 percent rating from April 21, 2015 to April 15, 2019 based on April 2015 VA hip and thigh conditions examination that indicated worsening of the service-connected right hip disability. During the April 2015 VA hip and thigh conditions examination, the Veteran reported that his hips are worse since his last examination. He reported having functional loss or functional impairment of the hips with bathing, walking, standing, and sitting. On range of motion testing, flexion was to 110 degrees, extension was to 40 degrees, abduction was to 30 degrees, adduction was to 15 degrees, external rotation was to 45 degrees and internal rotation was to 40 degrees. There was evidence of pain with weight bearing and evidence of mild localized tenderness or pain on palpation of the joint or associated soft tissue. Pain significantly limited the Veteran's functional ability with repeated use over a period of time. Muscle strength testing revealed normal strength. There was no ankylosis. He regularly uses a cane as an assistive device. X-rays showed degenerative or traumatic arthritis of both hips. The diagnosis was bilateral hip osteoarthritis. The Veteran's right hip disability impacts his ability to perform occupational task in that his walking, sitting, and standing are affected. The Board notes that the Veteran is in receipt of the maximum 20 percent schedular rating under Code 5253 for his right hip disability for the period from April 21, 2015 to April 15, 2019. As the maximum schedular available rating under Code 5253 has been assigned, further evaluation is not warranted. From April 16, 2019 to December 17, 2020 A 10 percent rating is currently assigned under Code 5253 for the Veteran's right hip posttraumatic osteoarthritis disability from April 16, 2019 to December 17, 2020. The Veteran essentially claims that symptoms of his service-connected right hip disability have increased in severity and warrants a rating higher than 10 percent for the stated period. On review, the Board finds that the next higher 20 percent rating is not warranted for the Veteran's right hip posttraumatic osteoarthritis disability from April 16, 2019 to December 17, 2020 under Code 5253 because the evidence does not show the Veteran's right hip disability is manifested by limitation of abduction with motion lost beyond 10 degrees for the period from April 16, 2019 to December 17, 2020. The April 2019 VA hip and thigh conditions examination report shows right hip flexion to 30 degrees, extension to 20 degrees, abduction to 15 degrees and adduction to 10 degrees. Notably the Veteran is separately rated for right hip limitation of flexion with a 20 percent rating from April 16, 2019. Accordingly, the preponderance of the evidence is against finding that a rating higher than 10 percent for right hip posttraumatic osteoarthritis disability from April 16, 2019 to December 17, 2020. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. In addition, the Board has considered the applicability of DeLuca, including whether there is a basis for assigning a rating higher than 10 percent due to additional limitation of motion resulting from pain or functional loss. In this instance, the 10 percent rating assigned from April 16, 2019 to December 17, 2020 takes into account the Veteran's functional loss associated with his right hip disability. The Board finds that 38 C.F.R. §§ 4.40, 4.45 and 4.59 do not provide a basis for an increased rating from April 16, 2019 to December 17, 2020. See id. at 204 -07. In other words, the functional loss does not most nearly approximate the criteria for the next-higher 20 percent rating under Code 5253. From December 18, 2020 The January 2021 rating decision increased the Veteran's right hip posttraumatic osteoarthritis disability rating to 20 percent effective from December 18, 2020 based on the December 2020 VA-contract hip and thigh conditions examination that showed an increase in abduction of the service-connected right hip disability. During the December 2020 VA-contract hip and thigh conditions examination, the Veteran reported having right hip pain off and on all day every day. He stated his hip pops and rattles when he walks. He has difficulty raising his leg and cannot walk or stand for prolonged periods. He has difficulty bending, squatting, kneeling, climbing stairs, and walking on uneven ground. On range of motion testing, right hip flexion was to 55 degrees, extension was to 10 degrees, abduction was to 20 degrees, adduction was to 0 degrees (such that Veteran cannot cross his legs), external rotation was to 5 degrees, and internal rotation was to 15 degrees. Pain caused functional loss with the right hip, and there was evidence of pain with weight bearing. There was no evidence of crepitus. There was additional loss of function after 3 repetitions due to pain. Pain significantly limited functional ability with repeated use over a period of time and with flare-ups. Pain caused functional loss with flexion to 25 degrees, extension to 5 degrees, abduction to 10 degrees, adduction to 0 degrees, external rotation to 5 degrees and internal rotation to 10 degrees. There was objective evidence of pain on passive range of motion testing of the right hip. There was objective evidence of pain on non-weight bearing testing of the right hip. Muscle strength of the right hip was 3/5, active movement against gravity. He did not have muscle atrophy or ankylosis. The diagnoses were posttraumatic osteoarthritis right hip and right hip limitation of extension. The Board notes that the Veteran is in receipt of the maximum 20 percent schedular rating under Code 5253 for his right hip disability for the period from December 18, 2020. As the maximum schedular available rating under Code 5253 has been assigned, further evaluation is not warranted. 7. Entitlement to an initial rating higher than 20 percent for right shoulder rotator cuff tendonitis In a November 2008 rating decision, service connection was granted for rotator cuff injury of the right shoulder with a 0 percent rating effective July 27, 2007. In an October 2012 rating decision a 10 percent rating was assigned for right shoulder disability under 38 C.F.R. § 4.59 based on painful motion of the arm at the shoulder with an effective date of July 8, 2011. In a July 2019 rating decision, the RO increased the rating for the service-connected right shoulder disability to 20 percent effective July 27, 2007, the date of the initial claim. The increase was based on the Veteran demonstrating limited motion of the right arm at shoulder level and painful motion of the right shoulder. Thus, the Veteran's service-connected right shoulder rotator cuff tendonitis disability is currently rated 20 percent under Codes 5003-5201. The hyphenated code indicates that the Veteran's right shoulder disability is evaluated under Code 5201, which governs limitation of motion of the arm, and Code 5003, which governs degenerative arthritis and directs that the disability be established by X-ray findings and will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. The Veteran is right-hand dominant. Under 38 C.F.R. § 4.71a, Code 5201, limitation of motion of an arm at the shoulder level warrants a 20 percent rating, whether it is the major or minor extremity. When motion is limited to midway between the side and shoulder level, a 30 percent rating is warranted for the major extremity and 20 percent for the minor extremity. When motion is limited to 25 degrees from the side, a 40 percent rating is warranted for the major extremity and 30 percent for the minor extremity. Normal range of shoulder flexion and abduction is from zero to 180 degrees, and internal/external rotation is from zero to 90 degrees. 38 C.F.R. § 4.71a, Plate I. In order to warrant the next higher 30 percent rating under Code 5201, the medical evidence of record must show the Veteran's right shoulder disability is productive of limitation of arm motion midway between the side and shoulder level, and such is not shown in the record at any time during the appeal period. The evidence shows on October 2008 VA joints examination, the Veteran's right shoulder had full flexion and abduction each to 180 degrees. Abduction to 180 degrees of the right shoulder was mildly painful. Internal and external rotation of the right shoulder was full to 90 degrees. X-rays of the right shoulder revealed a normal study. The impression was rotator cuff injury of the right shoulder. The examiner noted that the effect of the discomfort in the right shoulder is noteworthy regarding the Veteran's usual daily occupation. In June 2012, the Veteran underwent a VA shoulder and arm conditions examination. On range of motion testing, right shoulder flexion was to 170 degrees with objective evidence of painful motion at 90 degrees. Right shoulder abduction was to 170 degrees, with objective evidence of painful motion at 150 degrees. On repetitive-use testing, there was no change in right shoulder flexion or abduction. The Veteran did not have additional limitation with his range of motion of the right shoulder. He did have functional loss and/or functional impairment with contributing factors of less movement than normal, weakened movement, excess fatigability, and pain on movement. The Veteran's right shoulder muscle strength was 4/5. There was no ankylosis. The diagnosis was right rotator cuff injury. The Veteran's right shoulder disability did not impact his ability to work. On April 2019 VA shoulder and arm conditions examination, the Veteran reported that his right shoulder continues to be painful with stiffness. He stated he is unable to lift anything over his head. The Veteran reported flare-ups with flared days occurring 8 times a month and will last all day and described as increased pain on those days. The Veteran had functional loss or functional impairment in that he was unable to lift overhead due to his shoulders. On range of motion testing, right shoulder flexion and abduction were both to 90 degrees, external rotation was to 30 degrees, and internal rotation was to 80 degrees. Range of motion itself contributed to functional loss, in that the Veteran was unable to lift anything overhead. Pain with passive range of motion caused functional loss. There was evidence of pain with weight bearing, which caused functional loss. There was no additional functional loss or range of motion after 3 repetitions. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. Right shoulder muscle strength was 4/5 (active movement against some resistance). There was a reduction in muscle strength. There was no muscle atrophy or ankylosis. Imaging studies documented degenerative or traumatic arthritis of both shoulders. The diagnosis was right rotator cuff tendonitis. Regarding functional impact in occupational tasks, the examiner noted that the Veteran should be able to do seated activities with breaks such as phone calls based on his service-connected disabilities. In December 2020 the Veteran underwent a VA-contract shoulder and arm conditions examination. The Veteran reported having intermittent pain in the right shoulder and without movement. He stated the pain was dull most of the time. He had pain when he reached across his chest and behind his back. He had limited range of motion with difficulty reaching, lifting/carrying, pushing/pulling, and repetitive motion of the arm. He was unable to do lawn work, housework, or house repairs. He reported having severe flare-ups of the right shoulder that occurs 5 times a week and last 2 to 3 minutes. Range of motion of the right shoulder revealed flexion and abduction each to 95 degrees, external rotation was to 30 degrees, and internal rotation was to 75 degrees. There was objective evidence of pain on passive range of motion testing on the right. Pain exhibited on range of motion tests caused functional loss. There was evidence of pain with weight bearing and non-weight bearing. There was no additional loss of function after 3 repetitions. Pain significantly limited functional ability with repeated use over a period of time and with flare-ups. Muscle strength was 3/5. There was no muscle atrophy or ankylosis. The Veteran had dislocation on the right (acromioclavicular separation or sternoclavicular dislocation). There was tenderness on palpation of the acromioclavicular joint on the right. The diagnosis was right rotator cuff tendonitis. After a careful review of the evidence, the Board finds that the manifestations of the Veteran's service-connected right shoulder disability most closely approximate the criteria for a 20 percent rating and, therefore, an increased rating is not warranted. The next higher rating of 30 percent requires evidence that the Veteran's shoulder motion is limited to midway between the side and shoulder, which the Board interprets as limitation of abduction or flexion to 45 degrees. However, throughout this rating period, the Veteran's recorded ranges of shoulder motion have reflected shoulder abduction and flexion to at least 90 degrees, which is consistent with his currently assigned 20 percent rating. Specifically, the Veteran demonstrated flexion and abduction were both to 180 degrees during his October 2008 VA examination; flexion was to 170 degrees with objective evidence of painful motion at 90 degrees; and abduction was to 170 degrees with objective evidence of painful motion at 150 degrees during his June 2012 VA examination. Flexion and abduction were both to 90 degrees during his April 2019 VA examination; and flexion and abduction were each to 95 degrees during his December 2020 VA-contract examination. Moreover, the Veteran stated at the time of his examinations in April 2019 that he could not lift anything over his head. In December 2020, he stated that he had difficulty reaching, lifting/carrying, pushing/pulling, and with repetitive motion of the arm. The Board finds these statements indicate the Veteran's right shoulder range of motion is not limited to midway between the side and shoulder level. Thus, based on the recorded ranges of motion and the Veteran's self-reporting, an increased rating pursuant to Code 5201 is not warranted at any time during the appeal period. The Board also has considered whether an increased rating is warranted for additional impairment during flare-ups. The Board acknowledges the Veteran's reports that he experiences flare-ups of his right shoulder disability and that during his flare-ups, he experiences increased pain with activities. However, the competent, medical evidence of record fails to provide for a higher rating even when considering the Veteran's credible reports of functional loss during flare ups. Specifically, the April 2019 VA examiner and the December 2020 VA-contract examiner reported there was no additional functional loss or range of motion after 3 repetitions. The April 2019 VA examiner found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. In contrast, the December 2020 examiner found that pain significantly limited functional ability with repeated use over a period of time and with flare-ups. However, given the totality of this evidence, the Board concludes that the Veteran's additional impairment associated with functional loss does not more nearly approximate the rating criteria for the next higher rating of 30 percent. There is also no evidence of ankylosis of scapulohumeral articulation (Diagnostic Code 5200) or other impairment of the humerus (Diagnostic Code 5202). As the evidence of record fails to indicate a basis for awarding a rating higher than 20 percent for the Veteran's service-connected right shoulder disability, the preponderance of the evidence is against the Veteran's claim. Accordingly, there is no benefit of the doubt to resolve on the Veteran's behalf, and an increased rating for the Veteran's right shoulder rotator cuff tendonitis disability is not warranted at any time during the appeal period. For each of the increased rating claims, neither the Veteran nor his representative have raised any other issues regarding the claims, nor have any other issues been reasonably raised by the record, with respect to such claims. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). 8. Entitlement to TDIU The Veteran contends that his service-connected right hip and right shoulder disabilities prevent him from securing any substantially gainful occupation and therefore a TDIU is warranted. TDIU is warranted where the evidence shows the Veteran is precluded from obtaining or maintaining substantially gainful employment consistent with his education and occupational experience because of service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. A total disability rating may be assigned where the schedular rating is less than total and when the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided, however, that if there is only one such disability, it must be rated at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the rating to 70 percent or more. 38 C.F.R. § 4.16(a). Assignment of TDIU evaluation requires that the record reflect some factor that "takes the claimant's case outside the norm" of any other Veteran rated at the same level. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Id. In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the Court interpreted the phrase "unable to secure and follow a substantially gainful occupation" to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person, and the noneconomic component requires more than determining the presence or absence of employment producing income exceeding any particular threshold. The ultimate inquiry on the Veteran's ability to secure or follow that type of employment. The Court also provided that to determine whether a Veteran can secure and follow a substantially gainful occupation, attention must be given to the Veteran's history, education, skill, and training; whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. The Veteran is currently service-connected for a combined rating of 60 percent resulting from rotator cuff tendonitis, right hip limitation of flexion, right hip posttraumatic osteoarthritis, and impairment of the right clavicle/scapula; each with a 20 percent rating and right hip limitation of extension rated 10 percent. Chronic maxillary sinusitis, bilateral pes planus, and pseudofolliculitis barbae are each rated 0 percent. See 38 C.F.R. § 4.25. As the Veteran has a combined disability evaluation of 60 percent resulting solely from compensable musculoskeletal disorders, such musculoskeletal disorders are considered a single disability meeting the criteria for consideration under 38 C.F.R. § 4.16(a). That said, the question remains whether the full criteria for TDIU have been met. On his October 2020 individual unemployability application, the Veteran indicated that his service-connected right hip and right shoulder disabilities and his non-service connected back disorder prevent him from securing or following any substantially gainful occupation. The Veteran indicated in his application that he completed his senior year of college. He last worked as a window clerk for a postal service; and prior to that as an operator for a wood specialty company. He became too disabled to work in August 2012 and last worked full-time in October 2012. The April 2019 VA hip and thigh and shoulder and arm conditions examiner noted the Veteran should be able to do seated activities with breaks such as phone calls on the basis of his service-connected disabilities. On the December 2020 VA-contract hip and thigh examination report, the examiner indicated there was no impact from his right hip disability on his ability to perform any type of occupational task. The Board acknowledges that the Veteran was awarded benefits from the Social Security Administration primarily for osteoarthritis and secondarily for disorder of the back. However, the Board finds overall that the evidence of record does not establish that the Veteran's service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation. Notably, service connection is not in effect for any disabilities of the back/spine. The Board is aware that the Veteran's service-connected disabilities pose a challenge to his occupational functioning, such as limiting physical activities. This challenge is adequately contemplated by the assigned disability evaluations, however. The legal standard here is not simply whether the Veteran's occupational capacity was impacted by his disabilities, but whether he was rendered unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. The evidence of record does not establish such pervasive interference with his capabilities as to result in this level of interference with employment. Instead, VA examiner assessed the Veteran's occupational limitations and set forth circumstances in which employment is feasible. Accordingly, the claim for TDIU is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.