Citation Nr: 21031791 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 08-37 589 DATE: May 24, 2021 ORDER Entitlement to a disability rating in excess of 60 percent for left total knee replacement (previously rated as left knee patellofemoral degenerative joint disease) since May 1, 2019 (exclusive of the period from March 30, 2018, until April 30, 2019, during which time a total evaluation was assigned under Diagnostic Code 5055) is denied. Entitlement to a disability rating in excess of 10 percent for left knee patellofemoral degenerative joint disease from April 19, 2006 to March 30, 2018 (exclusive of the period from September 1, 2015, to January 1, 2016, during which time a temporary total evaluation was assigned pursuant to 38 C.F.R.§ 4.30) is denied. Entitlement to an initial compensable disability rating for limitation of extension of the left knee from August 25, 2017 to March 30, 2018 is denied. Entitlement to an initial disability rating in excess of 10 percent for left knee lateral instability prior to August 25, 2017 is denied. Entitlement to a disability rating in excess of 20 percent for left knee lateral instability from August 25, 2017 to March 30, 2018 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due solely to left total knee replacement from November 1, 2019 is granted. Entitlement to special monthly compensation (SMC) at the housebound rate, effective November 1, 2019, is granted FINDINGS OF FACT 1. Since May 1, 2019, the Veteran's left total knee replacement was manifested with chronic residuals consisting of severe painful motion or weakness. 2. From April 19, 2006 to March 30, 2018, the Veteran's left knee patellofemoral degenerative joint disease was manifested at worst be 40 degrees of flexion to include painful motion, flare-ups, and repetitive use; ankylosis was not present. 3. From August 25, 2017 to March 30, 2018, the Veteran's left knee limitation of extension was manifested by at worst 5 degrees of extension to include painful motion, flare-ups, and repetitive use. 4. Prior to August 25, 2017, the Veteran's left knee lateral instability was manifested at worst by slight lateral instability. 5. From August 25, 2017 to March 30, 2018, the Veteran's left knee lateral instability was manifested at worst by moderate lateral instability. 6. From November 1, 2019, the Veteran's service-connected left total knee replacement renders him unable to secure or follow a substantially gainful occupation. 7. From November 1, 2019, the Veteran is now in receipt of TDIU based solely on his service-connected left total knee replacement, and he has additional service-connected disabilities independently rated at 60 percent disabling or more. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 60 percent for left total knee replacement from May 1, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14, 4.27, 4.71a, Diagnostic Code 5055. 2. The criteria for entitlement to a disability rating in excess of 10 percent for left knee patellofemoral degenerative joint disease from April 19, 2006 to March 20, 2018 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14, 4.27, 4.71a, Diagnostic Codes 5260. 3. The criteria for entitlement to an initial compensable disability rating left knee limitation of extension from August 25, 2017 to March 30, 2018 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14, 4.27, 4.71a, Diagnostic Codes 5260. 4. The criteria for entitlement to an initial disability rating in excess of 10 percent for left knee lateral instability prior to August 25, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14, 4.27, 4.71a, Diagnostic Code 5003-5257. 5. The criteria for entitlement to a disability rating in excess of 10 percent for left knee instability from August 25, 2017 to March 30, 2018 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14, 4.27, 4.71a, Diagnostic Code 5003-5257. 6. The criteria for a TDIU due to his left total knee replacement since November 1, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. 7. The criteria for SMC at the housebound rate have been met, effective November 1, 2019. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from November 1981 to March 1983. This matter comes before the Board of Veterans' Appeals (Board) from a June 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2012, the Veteran testified at a video hearing with the undersigned Acting Veterans Law Judge. The case was last remanded in May 2019 and has since been returned to the Board for appellate review. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran's service-connected disability. 38 C.F.R. § 4.14. However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). Where there is a question as to which of two evaluations (ratings) shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. VA should interpret reports of examination in 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 disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). When evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability, and incoordination. 38 C.F.R. § 4.45. Where entitlement to compensation has already been established and 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). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. Hart v. Mansfield, 21 Vet. App. 505 (2007). Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the Veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's residuals of a left knee replacement is currently rated at a rating of 60 percent pursuant to Diagnostic Code 5055, 20 percent for instability pursuant to Diagnostic Code 5003-5257, and noncompensable rating for limitation of extension pursuant to Diagnostic Code 5003-5261. 38 C.F.R. § 4.71(a). The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the instant case, the applicable rating period occurred before the implementation of these revised diagnostic criteria with regard to all evidence submitted after February 7, 2021. Therefore, the February 2021 musculoskeletal criteria apply to aspects of the Veteran's claims on appeal; and the appropriate criteria is discussed below. VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Diagnostic Code 5055 provides for 60 percent rating where the symptoms closely reflect chronic residuals consisting of severe painful motion or weakness in the affected extremity. A 100 percent rating is provided for a period of time following implantation of prosthesis. Intermediate degrees of residual weakness, pain, or limitation of motion (a level of disability in between those contemplated by the 30 and 60 percent ratings) are to be rated by analogy to Diagnostic Codes 5256, 5261, or 5262. 38 C.F.R. § 4.71(a), Diagnostic Code 5055. Ratings can also be assigned for ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). The Veteran has not alleged, and the record does not suggest, that he suffers from ankylosis in the left knee. The normal range of motion of the knee is from zero degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees, and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Ratings can also be assigned when the knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. Meniscal condition is not alleged or supported by evidence during the period on appeal. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). The appeal period for this claim dates back to July 2006. As such, the Board will review all evidence from that time onwards. Increased Ratings for Left Knee Disabilities The Veteran is currently assigned a 60 percent disability rating pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5055, for left total knee replacement, previously rated as left knee patellofemoral degenerative joint disease, lateral instability with ACL tear, and limitation of extension under Diagnostic Code 5260. By the way of history, this claim stems from a July 2006 claim. The left knee disability was rated at 10 percent from April 19, 2006 to August 31, 2015, 100 percent from September 1, 2015 to December 31, 2015, 10 percent from January 1, 2016 to March 29, 2018 under Diagnostic Code 5260. 38 C.F.R. § 4.71a. Under the current Diagnostic Code 5260, the Veteran's left knee was rated at 100 percent from March 30, 2018 to April 30, 2019, and at 60 percent since May 1, 2019. Id. The left knee was service connected at noncompensable rate for limitation of extension from August 25, 2017 to March 30, 2018 under Diagnostic Code 500-5261. Id. The left knee was also service connected for instability rated at 10 percent from April 19, 2006 to August 24, 2017 under Diagnostic Code 5259, and 20 percent from August 25, 2017 to March 30, 2018 under Diagnostic Code 5003-5257. Id. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic codes indicate that the Veteran's knee disabilities are rated, by analogy, under the criteria limitation of extension (Diagnostic Code 5261) and instability (Diagnostic Code 5257). The Veteran asserts that he is entitled to an increased rating for his left total knee replacement condition, instability, and limitation of motion, specifically because his symptoms are more severe than contemplated by the currently assigned ratings. The record indicates that the Veteran underwent a total knee joint replacement of the left knee in 2018. 38 C.F.R. § 4.71(a). Diagnostic Code 5260 provides for a maximum rating of 30 percent, which is less than the rating currently assigned for the Veteran's disability under Diagnostic Code 5055. The Board finds that the appropriate rating for the Veteran's condition is the newly changed Diagnostic Code 5055, as that properly contemplates total knee replacement residuals. The Board notes that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis, and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Board finds that Diagnostic Code 5055 more accurately contemplates the Veteran's residuals of a left knee replacement in that it particularly pertains to residuals of post-knee replacement and provides the Veteran with a higher rating. Thus, the discontinuation of Diagnostic Code 5260 and new rating under Diagnostic Code 5055 is proper. The Veteran reported for a VA examination in November 2006 to determine the severity of the Veteran's left knee disability. During the examination, the Veteran reported to having flare-ups on a daily basis, with the left knee giving up on him and locking. During the range of motion testing, the left knee showed no swelling and nonspecific tenderness on palpation. Flexion was at best 90 degrees with 0 degrees extension to include painful motion. Weakness, fatigue, lack of endurance or incoordination were not seen. During the VA examination in February 2014, the Veteran reported flare-ups which consisted of pain over knee joints and aggravation on routine activity. During the range of motion testing, the left knee showed at worst 75 degrees of flexion and 0 degree of extension to include painful motion. The Veteran did exhibit tenderness or pain on palpation. The examiner was unable to test for instability. There were no meniscal conditions noted on the examination. During the VA examination in September 2014, the Veteran reported having flare-ups which occurred during excessive walking, routines involving movement and chores involving his wife and children. He also explained he could carry no more than 10-15 pounds. During the range of motion testing, the left knee showed at worst 95 degrees of flexion and 0 degrees of extension to include painful motion and repetitive-use testing. There was tenderness or pain to palpation noted. Joint instability test was performed and showed normal results on the left knee. During the August 2015 VA examination, the Veteran reported to having flare-ups causing stiffness and weakness and reported to difficulty walking down the stairs. Range of motion testing was performed and showed at worst 100 degrees flexion and 0 degrees of extension to include painful motion, flare-ups, and repetitive use testing. Joint stability test was performed and showed no recurrent subluxation or lateral instability. The Veteran submitted a private January 2016 knee and lower leg conditions disability benefits questionnaire. The Veteran continued to report flare-ups which showed swelling and pain, and the examiner tested and showed at worst flexion of 115 degrees with 0 degrees extension with no pain on movement. Joint stability test was performed and showed slight lateral instability. During the March 2016 VA examination, the Veteran reported to having flare-ups which lock up on him preventing him from participating in any sports activity. Range of motion testing was performed and showed at worst 45 degrees of flexion and 0 degrees of extension to include painful motion, repetitive use testing. Joint stability testing showed no recurrent subluxation or lateral instability of the left knee. Meniscectomy was performed on the left knee in September 2015 and was showing residuals of chronic pain and limitation of movements and locking of the left knee once in 2-3 times a week, which did not change ever after the left knee arthroscopic surgery. However, as the Veteran was rated at schedular 100 percent rating post-surgery, a separate meniscectomy rating is not warranted from September 1, 2015 to December 31, 2015. During the October 2016 VA examination, the Veteran did not report to having flare-ups. The Veteran's left knee showed normal flexion and extension to include repetitive use testing. Joint stability test was performed and showed no recurrent subluxation and lateral instability, and no meniscal symptoms. During the August 2017 VA examination, the Veteran reported flare-ups consisting of causing issues when climbing stairs, standing more than 20 minutes, walking more than a block and squatting. Range of motion testing was performed and showed at worst 40 degrees of flexion and 5 degrees extension to include painful motion and flare-ups. The Veteran was unable to perform repetitive motion testing due to severe pain in his back. Joint stability test was performed and showed moderate lateral instability. The Veteran was also shown to have issues with the meniscus, showing meniscal tear, frequent episodes of joint pain, and joint effusion even after the September 2015 meniscectomy. During the March 2019 VA examination, the examiner reported that the Veteran underwent March 2018 total knee joint replacement surgery. The Veteran did not report having flare-ups. Range of motion testing was performed and showed at worst 55 degrees of flexion and 5 degrees extension to include painful motion and repetitive-use testing. Joint stability testing was performed and showed slight recurrent subluxation and lateral instability. The Veteran did not show meniscus condition during this examination. The Veteran was afforded two examinations in January 2020. During the January 1, 2020 VA examination, the Veteran reported that the flare-ups cause him pain when walking, sitting, climbing stairs almost daily at severity of 8/10 for about 30 minutes. Range of motion testing was performed and showed at worst 100 degrees of flexion and 35 degrees of extension to include painful motion and flare-ups, which showed 25 degrees of extension. Repetitive motion testing could not be performed. Joint instability test was performed and showed moderate lateral instability. The meniscal conditions testing showed meniscal tear showing frequent episodes of joint locking and frequent episodes of joint pain. The symptoms of the left knee replacement shows that the Veteran has chronic residuals consisting of severe painful motion or weakness. During the January 28, 2020 VA examination, the Veteran reported flare-ups and explained that they prevent him from moving without pain and be stable while trying to walk. Range of motion testing was performed and showed at worst 80 degrees of flexion and 0 degrees extension to include flare-ups, repetitive use testing, and observed repetitive use over time. Joint stability testing was performed and showed slight lateral instability. The Veteran reported residual meniscal condition to include meniscal tear and frequent episodes of joint locking. The symptoms of the left knee replacement shows that the Veteran has chronic residuals consisting of severe painful motion or weakness and scarring. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported knee symptoms that are worse than those noted above. Under Diagnostic Code 5055, a 100 percent rating is warranted for one year after surgery. From then on, the VA examinations shows that the Veteran's current symptoms are synonymous with the 60 percent rating. Specifically, during both January 2020 VA examinations, the Veteran's left knee replacement manifested with chronic residuals consisting of severe painful motion or weakness in the affected extremity. That is the maximum rating available after the 1 year period post-surgery. Therefore, the Board finds that a rating in excess of 60 percent for left knee replacement is not warranted. The Veteran's limitation of flexion is rated at 10 percent disabling from April 19, 2006 to March 30, 2018 under diagnostic Codes 5260 and limitation of extension at noncompensable under 5003-5261 from August 25, 2017 to March 30, 2018. VA examinations show that during the period of April 19, 2006 to August 31, 2015, the Veteran's left knee flexion showed at worst 75 degrees of flexion to include pain. During the period of January 1, 2016 to March 29, 2018, the Veteran's left knee disability flexion showed at worst 40 degrees to include painful motion and flare-ups. To qualify for a 20 percent rating during either period, the left knee's flexion should be limited to 30 degrees. Regarding the noncompensable rating for the Veteran's left knee extension was at worst 5 degrees during the period of August 25, 2017 to March 30, 2018. Under Diagnostic Code 5261, a compensable rating requires a limitation of extension of 10 degrees. As the Veteran's left knee did not show a flexion limited to 30 degrees or less and extension limited to 10 degrees or more, the Board finds that a rating of 20 percent for limitation of flexion or compensable rating for limitation of extension is not warranted for any period on appeal. Under Diagnostic Code 5257, the Veteran is rated at 10 percent prior to August 25, 2017 and at 20 percent since August 25, 2017. VA examinations show that prior to August 25, 2017, the Veteran's left knee instability manifested at symptoms most closely resembling slight recurrent subluxation or instability. Moderate recurrent subluxation or instability was not shown. Since August 25, 2017 VA examination, the Veteran's left knee instability manifested at symptoms most closely resembling moderate recurrent subluxation or instability. Severe recurrent subluxation or instability was not shown. Therefore, the Board finds that a rating in excess of 10 percent prior to August 25, 2017 and a rating in excess of 20 percent since August 25, 2017 is not warranted. The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate a meniscus injury, ankylosis, impairment of the tibia or fibula, or genu recurvatum during the appeal period, the Veteran is not entitled to a higher or separate rating for his left knee disability. The Board acknowledges the Veteran's statements that his left knee disabilities are more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard, to include pain, difficulty standing and walking. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board finds, however, that neither the Veteran's statement nor medical evidence demonstrates that the criteria for higher ratings for currently rated disabilities of the left knee have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his left knee. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. Accordingly, the Board must deny the claims of entitlement for increased ratings. As the preponderance of the evidence is against the Veteran's claims, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 3 Vet. App. 223 (1992). Entitlement to TDIU In the last Board remand, the Board acknowledged the Veteran's claim for a TDIU under Rice. Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Specifically, in the December 2019 VA 21-8940 Form, the Veteran contended that his knee disabilities prevented him from being able to perform as a prison guard since he underwent a left total knee replacement in March 2018. The Board observes that from March 30, 2018, the Veteran has had a total 100 percent combined schedular rating. Importantly, the United States Court of Appeals for Veterans Claims (Court) held in Bradley v. Peake, 22 Vet. App. 280 (2008), that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) by having an "additional" disability of 60 percent or more ("housebound" rate). See 38 U.S.C. § 1114 (s). Thus, under Bradley, even with the assignment of a total schedular rating, the issue of TDIU was potentially not moot. In this case, from March 30, 2018 to November 1, 2019, the Veteran has been awarded SMC at the housebound rate. As the Veteran has already been awarded SMC during this period and therefore would have no need to establish a TDIU rating in order to qualify for SMC under 38 U.S.C. § 1114 (s), the facts of Bradley are sufficiently differentiable from the facts of this case. Therefore, any TDIU claim during this period is rendered moot. Although the Veteran is already in receipt of a combined schedular rating of 100 percent from November 1, 2019, the issue of entitlement to a TDIU is on appeal from that date as the Veteran has not been awarded SMC. See Bradley v. Peake, 22 Vet. App. 280, 293 (2008) (the receipt of a 100 percent schedular rating does not necessarily render moot a claim for TDIU, as a separate award of TDIU predicated on another single disability may serve as the basis for an award of SMC). VA will grant TDIU when the evidence shows that a veteran is precluded by reason of a service-connected disability or disabilities from securing or following substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. The relevant issue is not whether the veteran is unemployed or has difficulty obtaining employment, but whether the veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Advancing age, any impairment caused by conditions that are not service connected, and prior unemployability status must be disregarded when determining whether a veteran is currently unemployable. 38 C.F.R. §§ 4.16 (a), 4.19. A total disability rating may be assigned when the schedular rating is less than total, where, if there is only one disability, the disability is rated at 60 percent or more, or where, if there are two or more disabilities, at least one disability is rated 40 percent or more and there is sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). From November 1, 2019, the Veteran's service-connected left total knee replacement has been rated as 60 percent disabling. Therefore, the schedular criteria for entitlement to TDIU based on this disability alone have been met. Based on review of the record and when resolving the benefit of the doubt in favor of the Veteran, the Board finds the Veteran's service-connected left total knee replacement renders him unable to secure or follow substantially gainful employment consistent with his education and occupational experience. The evidence of record shows that the Veteran last worked in March 2018 when he underwent left knee surgery. He was previously employed as a corrections officer, which required him being on his feet most of the day. He also had two years of college. Importantly, the February 2020 VA examiner found that the Veteran's left total knee replacement did impact his ability to work. The Veteran experienced pain with every movement and also had functional loss during ambulation and was unable to perform simple house tasks and activities of daily living without being in excruciating pain. SSA records also show that the Veteran was considered disabled at least in part due to his left knee disability from March 2018. In sum, when considering the totality of the functional impairment caused by his service-connected left total knee replacement as described by the medical evidence of record, as well as taking into consideration his work history, education and experience, and when resolving all doubt in his favor, the Veteran would be precluded from substantially gainful employment due to his service-connected total left knee replacement. The Board recognizes that the VA examiner was discussing both knees; however, it is clear from the description that the functional impairment described can also be attributed solely to the left knee. In conclusion, based on the analysis above, the Board finds that a TDIU based solely on left total knee replacement is warranted, effective November 1, 2019. 38 U.S.C. § 5107 (b). The Board recognizes that a TDIU based solely on the Veteran's total right knee replacement is also arguably warranted. However, as discussed further below, the Veteran has been granted herein an award of SMC based on a total schedular rating for total left knee replacement and additional service-connected disabilities independently ratable at 60 percent or more. As the Veteran has already been awarded SMC throughout the appeal period, there is no longer a need to establish a TDIU rating in order to qualify for SMC under 38 U.S.C. § 1114 (s). In turn, the holding in Bradley is no longer applicable in this case. Therefore, any additional TDIU claim is rendered moot. Entitlement to SMC SMC may be awarded at the housebound rate if a veteran has a single service-connected disability rated as total and, (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, or (2) by reason of service-connected disability or disabilities, is permanently housebound. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). An award of TDIU predicated solely on one disability qualifies as a single service-connected disability rated as total for purposes of establishing entitlement to SMC. See Bradley, 22 Vet. App. at 293. With the grant of TDIU based solely on left total knee replacement, the Veteran meets the statutory requirements for entitlement to SMC at the housebound rate. From November 1, 2019, service connection has also been in effect for right total knee replacement, degenerative arthritis of the thoracolumbar spine, recurrent ventral hernia, radiculopathy of the left and right lower extremities, and right and left hip disabilities as well as numerous other disabilities. The combined rating for the Veteran's service-connected disabilities other than left total knee replacement was at least 60 percent. See 38 C.F.R. § 4.25. As the criteria for SMC under the provisions of 38 U.S.C. § 1114 (s) have been met, SMC at the housebound rate is granted, effective November 1, 2019. The Board notes that the issue of entitlement to SMC for aid and attendance has not been raised by the record and is not before the Board at this time, as the evidence of record does not indicate that the Veteran is rendered so helpless due to his service-connected disabilities so as to require regular aid and attendance of another person during this period. See Akles v. Derwinski, 1 Vet. App. 118 (1991) (the issue of entitlement to SMC is part and parcel of a claim for increased compensation and does not require submission of a separate claim). J.N. MOATS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. J. Kim, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.