Citation Nr: 21032220 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 04-38 603 DATE: May 26, 2021 ORDER Entitlement to a rating of 60 percent, but no higher, for tinea pedis with onychomycosis from May 21, 2010, is granted. Entitlement to a total disability rating based upon individual unemployability (TDIU), on an extraschedular basis from May 13, 2003, to July 23, 2007, is granted. FINDINGS OF FACT 1. From May 21, 2010, the evidence established that the Veteran's service-connected tinea pedis with onychomycosis required oral medication constantly or near-constantly. 2. The evidence is in relative equipoise as to whether, as of May 13, 2003 to July 23, 2007, the Veteran's service-connected disabilities precluded him from securing and following substantially gainful employment consistent with his education and experience. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the Veteran, the criteria for a 60 percent rating for tinea pedis with onychomycosis, but no higher, from May 21, 2010, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.118, DC 7806. 2. Resolving all reasonable doubt in favor of the Veteran, the criteria for the assignment of a TDIU on an extraschedular basis beginning May 13, 2003 to July 23, 2007, have been met. 38 U.S.C. §§ 5103A, 5107 (2012); 38 C.F.R. 3.102, 3.400, 4.16(b). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1975 to December 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran testified before the undersigned Veterans Law Judge during a March 2011 hearing. A transcript of the hearing is associated with the Veteran's claim file. In a January 2018 Board decision, the Board denied entitlement to an initial rating in excess of 10 percent for the Veteran's service-connected tinea pedis with onychomycosis. The Board also granted a TDIU from May 21, 2010, as the Board had found that a TDIU had been raised as part and parcel of the Veteran's increased rating claim. The Veteran subsequently appealed this decision to the United States Court of Appeals for Veterans Claims (Court). By way of a January 2019 Joint Motion for Partial Remand (JMPR), the parties agreed that the January 2018 Board decision should be vacated and remanded because the Board did not provide an adequate statement of reasons or bases to supports its decisions. Specifically, the Court noted that the Board did not address whether the Veteran's constant or near-constant use of topical treatments and use of oral Lamisil tablets constitutes systemic therapy and did not address the combined effects of the Veteran's service-connected disabilities in evaluating TDIU prior to May 21, 2010. The matter was before the Board in July 2019 and July 2020 for development consistent with the January 2019 JMPR. The matter has returned to the Board for adjudication. 1. Entitlement to a rating of 60 percent for tinea pedis with onychomycosis from May 21, 2010 The Veteran's tinea pedis with onychomycosis is rated under hyphenated Diagnostic Code (DC) 7813-7806. 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. The hyphenated diagnostic codes indicate an unlisted skin disease rated by analogy pursuant to 38 C.F.R. § 4.118. Here, the Veteran's condition is most analogous to dermatitis or eczema, rated under DC 7806. The Veteran has been in receipt of a 10 percent rating for his tinea pedis with onychomycosis from May 13, 2003. The July 2020 Board decision denied an initial rating in excess of 10 percent prior to November 5, 2007. The Board found that the evidence of record did not establish that the Veteran's skin disability affected at least 20 percent of his entire body or exposed area or required systemic therapy for a total of six weeks or more. The Board also granted a 60 percent rating, but no higher, from November 5, 2007 to May 21, 2010. In this regard, the Board noted that November 5, 2007 was the date the evidence reflects the Veteran was issued oral Hydroxyzine tablets for his itching and the first instance in which the evidence reflects systemic therapy as treatment for his skin condition. He also had active medications to include Hydroxyzine HCL from November 2007 until at least June 2009 and he used Lamisil therapy that required oral medication once a day for months at a time. On May 21, 2010, the Veteran underwent a matrixectomy of the right great toe and left great toe because the constant to near-constant systemic therapy had not been working for his onychomycosis. The July 2020 Board decision remanded entitlement to a rating in excess of 10 percent for tinea pedis with onychomycosis from May 21, 2020, as a medical opinion was necessary to determine whether the Veteran's disability would require systemic therapy to treat his condition if it were not for his liver condition. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Parts 4. When rating a service-connected disability, the entire history must be considered. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board must consider entitlement to "staged" ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the appeal. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. VA recently published a final rule amending its regulations on skin disabilities effective August 13, 2018. The amendment, in pertinent part, added a General Rating Formula for the Skin for diagnostic codes 7806, 7809, 7813-7816, 7820-7822, and 7824, and amended diagnostic codes 7801,7802,7817,7819,7825, 7826, 7827,7829. See 83 Fed. Reg. 32,592 (July 13, 2018). Claims pending prior to the effective date are to be considered under both old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied. Under the previous regulations, DC 7806 provided the following: a noncompensable rating is warranted if the skin condition covers less than 5 percent of the entire body, or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12-month period; a 10 percent evaluation is warranted if the skin condition covers at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period; a 30 percent evaluation is warranted if the skin condition covers 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; when systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period; a 60 percent evaluation is warranted if the skin condition covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs are required during the past 12-month period. 38 C.F.R. § 4.118, DC 7806 (2008). Under the new regulations, effective August 2018, Diagnostic Code 7806 will be rated under a General Rating Formula for Skin, under which a noncompensable rating will be assigned if the skin condition covers less than 5 percent of the entire body, or less than 5 percent of exposed areas affected, and no more than topical therapy required during the past 12-month period. A 10 percent rating will be assigned if the disability meets at least one of the following: (i) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (ii) at least 5 percent, but less than 20 percent, of exposed areas affected; or (iii) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating will be assigned if the disability meets at least one of the following: (i) characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (ii) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating will be assigned if the disability meets at least one of the following: (i) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (ii) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Alternatively, the disability can be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability. 38 C.F.R. § 4.118, DC 7806. The Federal Circuit addressed the meaning of "systemic" and "topical" for rating skin disabilities under the regulatory criteria prior to August 31, 2018. See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). For these purposes, systemic therapy means treatment pertaining to or affecting the body as a whole, whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. Id. at 1355. The Federal Circuit acknowledged that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, but the Court emphasized that this possibility does not mean that all applications of topical corticosteroids amount to systemic therapy. Id. Rather, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the facts of each case. Id. at 1356. Effective August 31, 2018, VA regulations explicitly state that for the purposes of the skin disability ratings, "systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin." 38 C.F.R. § 4.118(a) (2018). A review of the record shows that the Veteran may have been prohibited from using systemic therapies to treat his tinea pedis with onychomycosis due to a liver condition. In May 2013, a VA treatment record indicated that the VA physician discussed treatment options with the Veteran concerning his onychomycosis of both great toenails including topical and oral medicals as well as nail avulsion procedures but that oral medications must be used judiciously as the Veteran had a history of hepatitis. A July 2015 VA treatment record notes that the Veteran reported using lotions, antifungal creams, and powders without success. Additionally, the treatment record also reflects that although the Veteran inquired as to whether he could take Lamisil for his skin condition again, oral Lamisil was not prescribed as the Veteran had to get his moisture under control first and that he could not take Lamisil due to his liver problems. An August 2015 VA treatment record also shows that the Veteran could not take Lamisil due to his liver problems. At the August 2015 VA skin examination, the VA examiner found that the Veteran's symptoms had increased in severity because the Veteran was using topical anti-fungal medicines daily and that his symptoms were not controlled for this reason. At the August 2019 VA skin examination, the Veteran's skin condition affected five but less than 20 percent of total body area, and none on the exposed area. The VA examiner stated that terbinafine (Lamisil) tablets are an anti-fungal systemic treatment that would have a more "whole body" affect whereas all topical agents have a local affect. Pursuant to the July 2020 Board remand instructions, the Veteran was afforded a VA examination in October 2020. The Veteran was diagnosed with tinea pedis. The VA examiner indicated that the Veteran had been using Ketoconazole, a topical medication on a constant/near-constant basis. The Veteran had visible characteristics on less than five percent total body area and none on the exposed area. The VA examiner described the appearance of his skin condition as thickened, discolored toenails. The same VA examiner who conducted the October 2020 VA examination provided a medical opinion in February 2021. The VA examiner explained that the Veteran has onychomycosis that is mild in nature, affecting his 5th digit (pinky) toenails. A January 2008 podiatry note indicated that the Veteran needs to control moisture with betadine. He stated that the Veteran had undergone nail avulsions of his great toenail in the past, which is the definitive treatment for the condition, but he has declined definitive treatment of his 5th pinky toes. The Veteran was encouraged to use betadine to control moisture in April 2015 at a podiatry appointment. It was noted that oral Lamisil would not work due to excess moisture. The examiner noted that the Veteran is diabetic and sees podiatry for his nail care and cutting of his toenails. The note in November 2020 referred to continuation of Ketoconazole. Definitive treatment was offered at the January 2014 podiatry appointment at SID Foot and Ankle Centers of Ohio but was deferred. The VA examiner stated that removal of the affected toenails with ongoing topical treatment is considered to be the definitive treatment for the Veteran's condition. He has elected to defer regarding definitive treatment. His treating providers have not treated with Lamisil (terbinafine) as it is felt that treatment with oral anti-fungal would not allow for greater/better results than treatment with a topical anti-fungal. The examiner noted that Lamisil can be used in patients that have hepatitis-however liver functions are measured every month rather than every six weeks. Additionally, terbinafine has a less than 50% "cure rate" for the treatment of onychomycosis. He stated that the Veteran's liver function studies of AST and ALT have been within normal limits and as such are not an absolute contraindication to treatment with oral Lamisil. The VA examiner summarized that treatment with oral terbinafine MAY be of benefit, however, the risk to benefit ratio has led to not using the medication. The Veteran's condition has not been significant/bothersome enough that he would like to undergo definitive treatment for his condition. The Veteran's condition has remained stable over the past five years with the use of topical medications. Here, the VA examiner opined that the Veteran's treatment with oral terbinafine may be of benefit, although the risk to benefit ratio has led to not using the medication. The evidence does not show that from May 21, 2010, the Veteran's skin condition covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, but the Board finds that the evidence is at least in equipoise as to whether the Veteran's condition may have required oral terbinafine, a systemic therapy, with constant, or near-constant duration in the past twelve months. Additionally, the Veteran asserts that his condition does not improve with lotions, antifungal creams, and powders. Furthermore, the August 2015 VA examiner found that the Veteran's symptoms had increased in severity because the Veteran was using topical anti-fungal medicines daily and that his symptoms were not controlled for this reason. As such, this corresponds with a 60 percent disability rating for the Veteran's service-connected diagnosis of tenia pedis with onychomycosis. The Board resolves all reasonable doubt in the Veteran's favor and finds that a 60 percent rating from May 21, 2010, is warranted. This is the highest schedular rating available under 38 C.F.R. § 4.118, DC 7806. 2. Entitlement to a TDIU from May 13, 2003 to July 23, 2007 The Veteran asserts that he is unable to work due to his service-connected tinea pedis and right knee disabilities. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, the disability shall be ratable at 60 percent or more, and that, if there are two or more service connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the above purposes of one 60 percent disability or one 40 percent disability. 38 C.F.R. § 4.16(a). In the alternative, if the Veteran does not meet the percentage requirements, but is nevertheless rendered unable to obtain or maintain substantially gainful employment by reason or one or more service-connected disabilities, the matter must be submitted to the Director of Compensation Service for extraschedular consideration. 38 C.F.R. § 4.16(b). Under VA law, the Board is precluded from assigning a TDIU rating on an extraschedular basis in the first instance. Instead, the Board must refer any claim that meets the criteria for referral for consideration of entitlement to TDIU on an extraschedular basis to the Director, Compensation Service. Bowling v. Principi, 15 Vet. App. 1 (2001). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but it may not be given to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Substantially gainful employment is "that which is ordinarily followed by the non-disabled to earn their livelihood with earnings common to the particular occupation in the community where the Veteran resides." Moore v. Derwinski, 1 Vet. App. 356 (1991). The Board must consider whether the Veteran's service-connected disabilities rendered the Veteran unable to secure or follow a substantially gainful occupation. The Court has held that the central inquiry in determining whether a Veteran is entitled to a total rating based on individual unemployability is whether service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Here, the Veteran's tinea pedis with onychomycosis was granted from March 13, 2003, the date his claim for service connection for tinea pedis was received. As such, the appeal period under consideration begins from March 13, 2003. The Veteran does not meet the schedular criteria for a TDIU prior to July 24, 2007. From May 13, 2003, the Veteran was combined to be 30 percent disabling, with a 20 percent rating for his residuals of medial meniscectomy of the right knee with degenerative arthritis and 10 percent for bilateral tinea pedis. From April 30, 2005, he is combined 40 percent disabling with a 20 percent evaluation for residuals of medial meniscectomy of the right knee with degenerative arthritis, a 10 percent for recurrent subluxation/lateral instability of the right knee, and a 10 percent evaluation for tinea pedis. From June 20, 2007, the Veteran is combined 50 percent disabling with a 20 percent evaluation for residuals of medial meniscectomy of the right knee with degenerative arthritis, a 10 percent for recurrent subluxation/lateral instability of the right knee, a 10 percent for arthritis and limitation of motion of the right knee, and a 10 percent evaluation for tinea pedis. The July 2020 Board decision remanded the issue of entitlement to a TDIU on an extraschedular basis, prior to July 24, 2007. The Board had found that the Veteran was in receipt of a 100 percent combined schedular rating for his service-connected disabilities from September 1, 2008 and in receipt of a temporary total rating from July 24, 2007, to September 1, 2008. The Board remanded the matter for referral to the VA's Director of Compensation Service for initial consideration. In a December 2020 advisory opinion, the Director of Compensation Service found that the Veteran was entitled to an extraschedular TDIU based on his service-connected conditions alone from June 20, 2007 through July 23, 2007. The Director specified that a June 2007 VA joint examination showed that the Veteran's right knee had significant increase in hypertrophic changes. There was also diffuse tenderness on palpation and range of motion showed much cracking and popping throughout all range of motion. He used a cane at the time of examination, which he stated he has at all times. He also had a knee brace he used as needed. The Director noted that during a June 2007 VA skin examination, the Veteran stated that his athlete's feet condition is an intermittent problem and that his tinea pedis flare-ups about twice monthly and can last up to one week per episode. In a January 2021 rating decision, the RO granted entitlement to a TDIU on an extraschedular basis from June 20, 2007 through July 23, 2007 and indicated that this was a full grant of benefits. However, as noted above, the appellate period begins from March 13, 2003 and an earlier effective date for the grant of a TDIU must be addressed. In a March 13, 2003 statement, the Veteran indicated that due to his very tender, very painful right knee, he can only walk for a short period of time. His knee swells and gets very painful. He stated that he can only sit for very short periods of time and avoids stepping up and down. The Veteran stated that he has worked only two jobs in the last year and a half and has been putting up with the pain for years wearing a brace and using a cane. He stated that he cannot work. The Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation based on Unemployability in May 2003. The Veteran reported that he last worked full-time in January 2003 and that he became too disabled to work in January 2002. The Veteran had graduated from high school but did not have a college education. In his Vocational Rehabilitation Needs Inventory worksheet from 2003, the Veteran noted that he lasted worked as a cutter, cutting carrots before his knees went out. He was also a brick stacker in June 2002, but his knees went out and could not carry on. He stated that it would not be possible to return to work in a former occupation or for a former employer because he could barely stand too long on his right knee. The Veteran noted that he has limited standing, lifting, stooping, and bending due to his right knee disability. The Veteran stated that he used a cane for over twenty years and a knee brace. In an April 2003 physical therapy knee evaluation, the Veteran was stated that he has intermittent pain about eight hours a day. At rest, he noted the pain was 5/10 and with activity, 10/10. The objective examination findings showed that the Veteran can ambulate but needs a cane and has a limp. He also had a knee brace. The examiner also noted that the Veteran had too much guarding on McMurray's testing to accurately test the right knee. The Veteran was afforded a VA joint examination in April 2004. The Veteran noted that he had arthroscopic surgery in 1998, but the surgery did not improve his right knee. Since his surgery, he has had weakness, pain, and some stiffness in the right knee with on and off swelling. The Veteran reported having flare-ups, with the knee hurting more during flare-ups. They occur five or six times a month and he must limit his activity for one or two days. He is unable to kneel or squat without severe difficulty and pain. He used to have a brace, but because it is more uncomfortable and more difficult to get his pant up over it, he now uses a knee sleeve. On examination, the Veteran was able to flex the knee to 105 degrees but was not passively able to flex the knee further with pain on range of motion. On weight bearing, the Veteran had an antalgic gait. He used a cane in his right hand, and he put a lot of his weight on the cane to lessen the weight on his right leg and right knee as he walked. The examiner observed that the Veteran walked fairly slow with an obvious limp. He was not able to get a positive McMurray test on examination today. He was diagnosed with degenerative arthritis of the right knee, with antalgic gait, cane required today for ambulation. The Veteran reported in a March 2005 VA treatment record that his right knee pain is constant, with numbing at night and throbbing during the day. He stated that sitting and walking for long periods worsens this. The Veteran was examined again by the VA for his right knee in April 2005. The Veteran again stated that he did not feel that his surgery improved his knee very much and his pain has been increasing. The Veteran complained of locking in the knee and this is much worse when he is on his feet or walking for a long time. The Veteran uses a cane on his right hand and does walk with an antalgic gait. The Veteran stated that he does have some buckling and giving way episodes of the knee. The physical examination showed that the Veteran is unable to stand symmetrically on examination favoring his right knee. He was unable to do a single leg stance on the right side without balance problems. He was also unable to do a single leg hop on the right side but was able to do this on the left side without difficulty. The McMurray test was painful for him and he had significant weakness of the knee with patellofemoral crepitus. The examiner diagnosed the Veteran with post meniscectomy arthritic changes of the right knee with severely deconditioned and stiff right knee. In an August 2005 VA addendum to the April 2005 VA examination, the VA examiner stated that with repetitive attempts at deep squat, the Veteran demonstrated inability to squat with knee range of motion to 0 to 50 degrees, at which point he stops due to weakness, as the Veteran has an extremely difficult time and favors the knee significantly. The Veteran does have some component of pain, but appears to be more weakness than anything else, which has the major functional impact. An August 2006 VA treatment records notes that the Veteran reported pain is consistent and that he wakes a night, unable to ambulate long distances. He also reported mechanical symptoms of locking and catching. He reported feelings of knee weakness. Physical examination revealed an antalgic gait and the Veteran walked with a cane. In a September 2006 statement, the Veteran stated that his athlete's foot has gotten out of control. The Veteran stated in a January 2007 statement that his right knee is no longer weight bearing at all. Regarding his tinea pedis, the Veteran was afforded a VA examination in June 2007. He reported that he has had intermittent flare ups of athlete's feet to both of his feet and utilizes over-the-counter creams and soaking his feet in bleach and water. He needed to peel away the skin. He stated that this is an intermittent problem for him, and flare ups occur about twice a month lasting up to one week per episode. He must utilize white cotton socks. He also has a foul odor of his feet, easily sweating of his feet with burning between the toes, itching, and an overall soreness. The Veteran also stated in June 2007 that he used over-the-counter medicines for his tinea pedis which slowed it down, but it keeps flaring up. He stated that there is a very foul odor which he has had for years. See June 2007 Statement in Support of Claim. Based on the foregoing, with consideration of all factors bearing on the issue, to include his employment history and educational and vocational attainment, the Board finds that the evidence is at least in equipoise as to whether the Veteran's service-connected disabilities in combination preclude him from engaging in substantially gainful employment. The Veteran's right knee condition was such that it caused decreased mobility and weakness in which he was required to use a cane and knee brace or sleeve. He was unable to sit and stand for long periods of time and at times he was unable to put any weight on his right knee. He has intermittent flare ups of his tinea pedis and he reported cracked feet with a foul odor. He had burning, itching, and soreness of his feet. The Veteran had a high school education and was primarily limited to physical, manual work. The Board resolves any doubt in the Veteran's favor and finds that the evidence is at least in relative equipoise as to whether his service-connected disabilities prevented him from engaging in substantially gainful employment. As such, the Board finds that the criteria for TDIU on an extraschedular basis are met from May 13, 2003, the date the VA received the Veteran's claim for an informal TDIU, until July 23, 2007, the day prior to when he was in receipt of a temporary total rating. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. 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.