Citation Nr: 21032693 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-22 395 DATE: May 27, 2021 ORDER Entitlement to an increased rating in excess of 10 percent for left knee degenerative joint disease based on a limitation of flexion with painful motion is denied. Entitlement to an increased rating in excess of 10 percent for right knee degenerative joint disease based on a limitation of flexion with painful motion is denied. Entitlement to an increased rating for left knee degenerative joint disease based on a limitation of extension, presently rated as 10 percent disabling prior to September 16, 2019, and 30 percent disabling thereafter, is denied. Entitlement to an increased rating for right knee degenerative joint disease based on a limitation of extension, presently rated as 10 percent disabling prior to September 16, 2019, and 20 percent disabling thereafter, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to September 29, 2018, is denied. FINDINGS OF FACT 1. At most, the Veteran's left knee degenerative joint disease has resulted in no less than limitation to 45 degrees of flexion. 2. At most, the Veteran's right knee degenerative joint disease has resulted in no less than limitation to 45 degrees of flexion. 3. Prior to September 16, 2019, the Veteran's left knee degenerative joint disease has resulted in no more than 10 degrees of lost extension; from September 16, 2019, his left knee disability has resulted in no more than 20 degrees of lost extension. 4. Prior to September 16, 2019, the Veteran's right knee degenerative joint disease has resulted in no more than 10 degrees of lost extension; from September 16, 2019, his right knee disability has resulted in no more than 20 degrees of lost extension. 5. Prior to September 29, 2018, the Veteran does not meet the schedular criteria for basic entitlement to TDIU; his combined disability picture has not resulted in such significant symptoms as to interfere with employability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left knee degenerative joint disease based on a limitation of flexion with painful motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5260. 2. The criteria for a rating in excess of 10 percent for right knee degenerative joint disease based on a limitation of flexion with painful motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5260. 3. Prior to September 16, 2019, the criteria for a rating in excess of 10 percent for left knee degenerative joint disease based on a limitation of extension have not been met; thereafter the criteria for a rating in excess of 30 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5261. 4. Prior to September 16, 2019, the criteria for a rating in excess of 10 percent for right knee degenerative joint disease based on a limitation of extension have not been met; thereafter the criteria for a rating in excess of 20 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5261. 5. The criteria for Entitlement to a total disability rating based on individual unemployability (TDIU) prior to September 29, 2018, have not been met. 38 U.S.C. §§ 1151, 5107 ; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1976 to August 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As a matter of procedural background, these issues previously came before the Board in June 2019, at which time the Board denied the increased rating claims and granted TDIU from September 29, 2018, and remanded the issue of entitlement to TDIU prior to that date for further appellate review. The Veteran appealed the Board's denial to the United States Court of Appeals (Court) and in August 2020, the Court granted a joint motion for partial remand, vacating and remanding the increased rating claims for further development and appellate review. In December 2020, the Board issued a new remand for additional development. During the pendency of the appeal, the Veteran has been granted partial increased ratings for the right and left knee based on limitation of extension. The Board has updated the claims to reflect the staged ratings assigned. Increased Rating Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where, as in the case of the issues on appeal in this matter, entitlement to compensation has already been established and an increase in the assigned evaluation is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Consideration of the medical evidence since the date of the claim for increase and consideration of the appropriateness of staged ratings are required. See Fenderson v. West, 12 Vet. App. 119 (1999). "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." 38 C.F.R. § 4.7. A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40 With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40 ); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). The Veteran's knee disabilities are rated under Diagnostic Codes (DCs) 5010-5260 and 5010-5261. When rating based on limitation of motion, a separate rating may be assigned for knee disabilities based on limitation of flexion as well as limitation of extension of the knee if both pathologies exist. Likewise, separate ratings may be assigned based on limitation of motion, as well as instability or subluxation, if found. See VAOPGCPREC 23-97 (Multiple Ratings for Knee Disability). Similarly, separate ratings based on locking due to meniscal conditions are also afforded separate ratings if the pathology is shown. Hyphenated Diagnostic Codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. In the present matter, DC 5010-5260 rates for traumatic arthritis manifested by limitation of flexion; DC 5010-5261 rates for traumatic arthritis manifested by limitation of extension. Under DC 5260, flexion limited to 45 degrees or less is assigned a 10 percent disability rating. A 20 percent rating is assigned for flexion limited to 30 degrees or less. A 30 percent rating is assigned for flexion limited to 15 degrees or less. 38 C.F.R. § 4.71a, DC 5260. Under DC 5261, extension limited to 10 degrees or more is assigned a 10 percent rating. Extension limited to 15 degrees or more is afforded a 20 percent rating. Extension limited to 20 degrees or more is afforded a 30 percent rating. A 40 percent rating is assigned based on extension limited to 30 degrees or more. Finally, a 50 percent rating is assigned for extension limited to 45 degrees or more. 38 C.F.R. § 4.71a, DC 5261 It should be noted that, during the course of this appeal, the schedular criteria for evaluating the knee have been amended. Specifically, the criteria pertaining to (1) knee instability and (2) impairment of the tibia and fibula under 38 C.F.R. § 4.71a, DCs 5257 and 5262 respectively, was amended effective February 7, 2021. See 85 Fed. Reg. 76,453 (November 30, 2020). It is noted that the criteria based on limitation of extension or flexion were not amended. Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enactment of the new rule. VAOPGCPREC 07-03 (November 19, 2003). However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran's claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran's right knee disability under both the old and the revised rating criteria and must apply the old rating criteria if the result is more favorable to the Veteran. Id. In the present case, although multiple ratings for knees may be available based on limitation of motion and instability, based on the evidence of record, the Board does not find that an instability rating is supported. Generally speaking, the evidence does not show instability in either knee. Although some medial laxity was shown in April 2015, and the Veteran has made limited subjective reports of a knee giving-way, he has generally stated that his imbalance was due to tripping and not to the knee buckling. This is confirmed by objective testing completed throughout the appeal period which have not found any true evidence of instability, but instead confirm the Veteran's reported cause of falls as consistent with tripping over instability. Likewise, the Board does not find that a rating based on locking due to semilunar cartilage issues is warranted. While a February 2013 VA examination noted a history of symptoms related to a meniscal condition, the remainder of the evidence for the period on appeal outweighs that isolated report. In October 2013, an examiner attributed joint effusion alone to his meniscal tear, which was the result of a work-place accident which occurred after separation from service in November 1986. Further, as recently as March 2019, the meniscal condition was considered asymptomatic. Several isolated references in the VA treatment records note some moderate, temporary effusion and occasional locking for about 5 minutes in the morning. However, the record does not reflect that the Veteran has dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint which are related to service. As such, separate ratings based on locking or semilunar cartilage pathology are also not supported. Finally, the pathology for ratings based on impairment of the tibia or fibula, ankylosis, or genu recurvatum have not been shown, and are not for consideration in this appeal. 1. Entitlement to an increased rating in excess of 10 percent for left knee degenerative joint disease based on a limitation of flexion with painful motion 2. Entitlement to an increased rating in excess of 10 percent for right knee degenerative joint disease based on a limitation of flexion with painful motion The Veteran's bilateral knee disability has been afforded a 10 percent rating based on limitation of flexion with painful motion. He seeks increased ratings. The Board finds that the claims should be denied. The Veteran has generally shown painful motion on flexion throughout the entire appeal period. At a VA examination in February 2013 at that time, right knee flexion was limited to 115 degrees. Left knee flexion was limited to 120 degrees. Objective evidence of pain was at the terminal degree bilaterally. The same limitations were noted on repetitive use testing. Bilaterally, the only functional loss in either leg was less movement than normal with pain on movement. He had some pain on palpation of the soft tissue of the knees. Muscle strength was normal bilaterally. In his own words, the Veteran stated that residuals of pain made it difficult to be on his feet for long periods of time, with episodes of swelling and limited range of motion. His painful knees caused gait issues and required him to use an assistive device to walk, although the examiner did not find that such an assistive device was required. A private Disability benefits questionnaire (DBQ) submitted in December 2017, but dated in October 2013. found bilateral flexion to 90 degrees with pain at 90 degrees. The decrease in motion was due to pain. He was able to complete repetitive use testing with no additional loss. He showed pain to palpation of the joint bilaterally. Functionally, the examiner stated that he was unable to kneel or crawl, or climb ladders or stand for any length of time. A letter from a private physician, Dr. J.J., dated in November 2013, noted flexion limited to 90 degrees bilaterally with painful motion. Private treatment records from December 2014 showed flexion to 105 degrees bilaterally with pain at 105 degrees. The knee was stable with no crepitus. Physical therapy records from April 2015 showed flexion to 120 degrees on the right and 85 degrees on the left with pain on movement. In June 2015, the Veteran submitted a VA DBQ completed by a private physician. Right knee flexion was to 125 degrees with evidence of pain at 115 degrees. Left knee flexion was to 90 degrees with evidence of pain at 40 degrees. The examiner stated that the Veteran could not complete repetitive use testing, although no further explanation was given. He declined to answer the remaining questions on the DBQ, stating that physical therapy records may be more accurate than the questionnaire itself. Range of motion on the accompanying physical therapy evaluation noted 120 degrees of flexion in the right, with 85 degrees of limited extension in the left knee. Pain was noted on passive left movement. In a VA examination conducted in January 2018, the Veteran denied flare-ups of his knee symptoms. Functionally, he could no engage in prolonged walking or running. Right knee flexion was to 110 degrees with pain noted at the terminal degree. Left knee flexion was to 90 degrees with pain at the terminal degree. There was no evidence of pain with weight bearing. There was no evidence of crepitus, although mild tenderness on the anterior joint was noted on palpation. No additional loss was found on repetitive use testing, and the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. No additional factors contributed to his disability. Strength was normal bilaterally. A VA examination conducted in March 2019 found intermittent knee pain. Flare ups consisted of pain exclusively, and the Veteran did not assert any additional loss of function. Functionally, flares limited walking, kneeling and squatting. Flexion was to 130 degrees in the right knee; 90 degrees in the left knee. Pain was objectively found at the terminal degrees. There was evidence of crepitus and weight bearing. Functionally, it was difficult to arise out of a chair, squat, or kneel. Over time, right knee flexion increased to 140 degrees bilaterally. With regard to use over time and during periods of flare, flexion was limited to 117 degrees with pain on movement in the right knee, and 81 degrees with pain on movement in the left knee. Muscle strength was normal. Joint stability was normal. No meniscal conditions were noted. A VA examination conducted in September 2019 reported flare-ups putting the Veteran off his feet and requiring elevation and icing of the knees, making it difficult to walk. Flexion was to 80 degrees in the right, and 80 degrees in the left knee with no additional loss on repetitive use and during periods of flare. Pain, fatigue, incoordination and lack of endurance was noted on the terminal degrees bilaterally. Strength was normal bilaterally. Stability was normal. No patellar or meniscal issues or symptoms were noted. Private treatment records submitted following the JMPR noted ongoing treatment for pain in both knees, but did not provide any new range of motion findings or other evidence of compensable symptoms which the Board could use in considering the rating for the Veteran's knee disabilities. Finally, the Veteran was afforded a new VA examination in February 2021. The Veteran reported flareups occurring weekly with sustained activity, resulting in pain preventing him from engaging in walking or standing. Sitting for long periods of time caused stiffening of the joint. Flare-ups were alleviated by rest. He was unable to kneel during a period of flare. Functionally, he stated that flares prevented bending, squatting or kneeling. He denied frequent effusions or instability or subluxation symptoms. Flexion was limited to 50 degrees bilaterally. Pain was noted on motion at the terminal point of movement. No additional loss of movement was found on repetitive use testing or over time. The examination was not conducted during a flare-up but the examiner stated that endpoint of flexion would be to 45 degrees bilaterally. Strength was normal. Stability was normal. There was no meniscal issue or symptoms found. He used a brace to ambulate. After careful consideration of all evidence of record, the Board does not find evidence that the Veteran's knee flexion was limited to 30 degrees or less, which is required for a rating in excess of 10 percent, during any period on appeal, bilaterally. At most, in February 2021, he was shown to have flexion limited to 45 degrees during periods of flare, however, such limitation explicitly provides for a 10 percent rating. During most periods on appeal, the Veteran's loss of flexion has not met the compensable criteria in either knee. Even when accounting for loss as described by the Veteran either in lay statements or to his various examiners, his bilateral knee flexion has not reached a compensable level of loss. As such, the Board finds that the claim for an increased rating for his right and left knee disabilities, as manifested by limitation of flexion with pain on motion, should be denied. I n reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 3. Entitlement to an increased rating for left knee degenerative joint disease based on a limitation of extension, presently rated as 10 percent disabling prior to September 16, 2019, and 30 percent disabling thereafter, 4. Entitlement to an increased rating for right knee degenerative joint disease based on a limitation of extension, presently rated as 10 percent disabling prior to September 16, 2019, and 20 percent disabling thereafter, The Veteran's left knee is rated as 10 percent disabling based on limitation of extension prior to September 16, 2019, and 30 percent disabling thereafter. His right knee disability is rated as 10 percent disabling based on limitation of extension prior to September 16, 2019, and 20 percent disabling thereafter. He seeks higher ratings. The Board finds that the claims should be denied. At a VA examination in February 2013, extension was complete and full bilaterally without any objective evidence of pain. Bilaterally, the only functional loss in either leg was less movement than normal with pain on movement (flexion only). He had some pain on palpation of the soft tissue of the knees. Muscle strength was normal bilaterally. A private DBQ submitted in December 2017, but dated in October 2013, found bilateral flexion to 10 degrees with pain at 10 degrees. The decrease in motion was due to pain. He was able to complete repetitive use testing with no additional loss. He showed pain to palpation of the joint bilaterally. Functionally, the examiner stated that he was unable to kneel or crawl, or climb ladders or stand for any length of time. A letter from a private physician, Dr. J.J., dated in November 2013, noted extension limited to 10 degrees bilaterally with painful motion. In June 2015, the Veteran submitted a VA DBQ completed by a private physician. Right knee extension complete and full, with pain at the terminal degree. Left knee extension was to 15 degrees with painful motion on extension at 15 degrees. The examiner stated that the Veteran could not complete repetitive use testing, although no further explanation was given. He declined to answer the remaining questions on the DBQ, stating that physical therapy records may be more accurate than the questionnaire itself. Range of motion on the accompanying physical therapy evaluation noted full extension in the right, with 10 degrees of limited extension in the left knee. A private DBQ submitted in December 2017 found bilateral flexion to 10 degrees with pain at 10 degrees. The decrease in motion was due to pain. He was able to complete repetitive use testing with no additional loss. He showed pain to palpation of the joint bilaterally. Functionally, the examiner stated that he was unable to kneel or crawl, or climb ladders or stand for any length of time. In a VA examination conducted in January 2018, the Veteran denied flare-ups of his knee symptoms. Functionally, he could no engage in prolonged walking or running. Extension was normal bilaterally and pain was not noted on extension. There was no evidence of pain with weight bearing. No additional loss was found on repetitive use testing, and the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. No additional factors contributed to his disability A VA examination conducted in March 2019 found intermittent knee pain. Flare ups consisted of pain exclusively, and the Veteran did not assert any additional loss of function. Functionally, flares limited walking, kneeling and squatting. Extension was to 5 degrees in the right knee; 10 degrees in the left knee. Pain was objectively found at the terminal degrees. There was evidence of crepitus and weight bearing. Functionally, it was difficult to arise out of a chair, squat, or kneel. With regard to use over time and during periods of flare, extension was limited to 6 degrees with pain on movement in the right knee, and 11 degrees with pain on movement in the left knee. Muscle strength was normal. Joint stability was normal. No meniscal conditions were noted. The Board finds that, prior to September 16, 2019, the Veteran's right and left knee disabilities have not been shown to result in loss of extension such that a rating in excess of 10 percent is warranted. At most, the Veteran was shown to have 11 degrees of extension limitation in the left knee in March 2019. The Board does recognize that the June 2015 private DBQ attributed 15 degrees of lost extension to the left knee with pain, however, that DBQ was incomplete and the examiner referred to attached physical therapy records as a better indicator of actual loss of range of motion and other symptoms; those private records only showed 10 degrees of loss of extension in the left knee. Indeed, for much of the period on appeal, the Veteran's right knee has not shown compensable loss of extension at all. Even when considering the Veteran's own lay statements regarding the severity of his loss of extension, there is no evidence that his extension was limited to such a degree that a rating in excess of 10 percent is warranted. A VA examination conducted on September 16, 2019, reported flare-ups putting the Veteran off his feet and requiring elevation and icing of the knees, making it difficult to walk. Extension was to 15 degrees in the right, and 20 degrees in the left knee with no additional loss on repetitive use and during periods of flare. Pain, fatigue, incoordination and lack of endurance was noted on the terminal degrees bilaterally. Strength was normal bilaterally. Stability was normal. No patellar or meniscal issues or symptoms were noted. Private treatment records submitted following the JMPR noted ongoing treatment for pain in both knees, but did not provide any new range of motion findings or other evidence of compensable symptoms which the Board could use in considering the rating for the Veteran's knee disabilities. Finally, the Veteran was afforded a new VA examination in February 2021. The Veteran reported flareups occurring weekly with sustained activity, resulting in pain preventing him from engaging in walking or standing. Sitting for long periods of time caused stiffening of the joint. Flare-ups were alleviated by rest. He was unable to kneel during a period of flare. Functionally, he stated that flares prevented bending, squatting or kneeling. He denied frequent effusions or instability or subluxation symptoms. Extension was limited to 20 degrees in the left knee, but was normal in the right. Pain was noted on motion at the terminal point of movement. No additional loss of movement was found on repetitive use testing or over time. The examination was not conducted during a flare-up but the examiner stated that endpoint of extension would be to 5 degrees in the right knee and 15 degrees in the left. Based on the evidence since September 16, 2019, the Board does not find that ratings in excess of 20 percent for the right knee and 30 percent for the left knee are warranted. At most, his right knee extension has been limited to 15 degrees, when accounting for factors such as pain. His left knee has been limited to no more than 20 degrees when account for factors such as pain. These measurements include consideration of the Veteran's own lay statements regarding the severity of his bilateral knee disability, and account for worsening symptoms from September 2019 to the present. In sum, the Board finds that prior to September 16, 2019, the Veteran's bilateral knee disabilities did not result in limitation of extension which would provide for a rating in excess of 10 percent for each knee. From that date forward, his left knee disability has not resulted in limitation beyond 20 degrees and his right knee has not been limited beyond 15 degrees of extension, which provides for no greater than 30 and 20 percent each, respectively. As such, the claims are denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. TDIU 5. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to September 29, 2018, The Veteran seeks entitlement to TDIU prior to September 29, 2018. The Board finds that the claim should be denied. A TDIU is assigned when a veteran's service-connected disability or disabilities are of such severity that the veteran cannot secure or follow a substantially gainful occupation solely because of that disability or disabilities. 38 C.F.R. § 4.16. Generally, TDIU is awarded on a schedular basis, which requires that, if there is only one service-connected disability, this disability shall be ratable at 60 percent or more. If there is more than one disability, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more 38 C.F.R. § 4.16 (a). In the instant matter, during the applicable appeal period, the Veteran is, at most rated as 60 percent disabling, resultant of a combined rating, and without any disabilities rated as 40 percent disabling independently. As such, he does not meet the basic schedular criteria for a grant of TDIU. Under Roberson v. Principi, 251 F.3d 1378 (2001) and Rice v. Shinseki, 22 Vet. App. 447 (2009), the Board must also consider TDIU even when the schedular criteria are not met. VA policy is that all Veterans unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16 (b), rating boards should refer to the Director of Compensation and Pension Service (Director) for extraschedular consideration all cases where Veterans are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements set forth in 38 C.F.R. § 4.16 (a). In sum, the Board cannot grant an extraschedular TDIU in the first instance, but may determine whether referral for such consideration is warranted. In its June 2019 decision, the Board remanded the question of entitlement to an extraschedular TDIU to the Director. In September 2020, the Director concluded that an extraschedular TDIU was not warranted. Despite the Veteran reporting having last worked in July 2009, he had completed two years of college. He left his job in 2009 on retirement. While he did have a variety of physical ailments, over the years, particularly with regard to his service-connected knee disabilities, they would not completely prevent employment. Rather, the Veteran's physical disabilities would more likely interfere with heavy physical employment. However, lighter physical employment and sedentary employment was not precluded. At most, his working limitations included prolonged standing or walking, frequent bending or lifting, and heavy lifting. Although a private examiner previously noted that he could no longer engage in the activities of his previous employment, that was not synonymous with all employment. During the period on appeal, the Veteran was able to engage in various activities such as golf, walking, hunting, and fishing (as confirmed by a private treatment record from his physical therapist in April 2015). Therefore, lighter physical employment and sedentary employment was not ruled out. When assessing extraschedular TDIU, the Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b). In this matter, the Veteran's work history indicates that he was a firefighter. However, he has at least two years of a college education. Here, the Board recognizes the Court's decision in Withers v. Wilkie, 30 Vet. App. 139, 148 (2018), where it held that the Board must provide reasons or bases as to its interpretation of sedentary work in the appellant's case, although not going so far as to prescribing any definition of sedentary employment. Specifically, the Court in Withers also noted that any explanation of how a finding that the Veteran is capable of sedentary employment squares with the Veteran's educational and occupational history. Id. (citing inter alia, Pederson v. McDonald, 27 Vet. App. 276, 287 (2015)). The Board agrees with the Court that the term "sedentary employment" is not specifically defined in any regulation or prior Court decision. The issue is additionally clouded by the fact that many of the same occupations could be both "active" and "sedentary" based on whether the person involved sits in a chair or not. Such a determination may also be specific to the veteran in question. Indeed, the Board would note that, in Withers, the veteran was service-connected for a gunshot wound and osteomyelitis, which is a much more severe situation than the one presented here. In this case, however, the ability of this particular Veteran to perform work that one might reasonably see as "sedentary," however it may be defined, is fairly obvious. Specifically, the Veteran is an educated and intelligent individual with a work history that includes far more than mere physical labor. While he did work as a firefighter, that profession consists of more than mere physical labor. He has at least two years of college education to his name. Further, he has provided well-written and reasoned statements to the Board in support of his claim, indicating his ability to engage in academic or non-physical pursuits. There is no indication that he is incapable of administrative or even managerial work. The Board does not contest that the Veteran's various service-connected disabilities interfere with physical labor. Both the VA examiners and his own private treatment records indicate as such. However, this is not a situation where the Veteran's only skill is manual labor. Obviously, every job requires some minimal level of physical movement, but few would characterize working in a laboratory (or the practice of law, for that matter) as anything other than "sedentary" work, regardless of how it is applied. Based on the evidence of record, the Board finds that the Veteran was capable of more than sedentary work prior to September 29, 2018. In fact, he has asserted to his physical therapist in 2015 that he could engage in various physical pursuits outside of the home. There is nothing in the record to suggest that the Veteran could not use a telephone, operate a computer, or perform any number of tasks despite his service-connected disabilities. In sum, the Board finds that the Veteran's service-connected disabilities, either independently or combined, did not interfere with his ability to obtain and maintain gainful sedentary employment prior to September 29, 2018. As such, there is no indicia of an exceptional or unusual disability picture, such as marked interference with employment. By his own admission, his disabilities have not resulted in frequent periods of hospitalization. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Pryce, Counsel