Citation Nr: 21040523 Decision Date: 07/05/21 Archive Date: 07/05/21 DOCKET NO. 13-09 395 DATE: July 5, 2021 ORDER Entitlement to an initial rating in excess of 10 percent prior to July 9, 2019, for cervical sprain with degenerative changes and degenerative disc disease is denied. Entitlement to a rating in excess of 10 percent prior to January 14, 2014, and from March 1, 2014, to July 8, 2019, for lumbosacral sprain and degenerative disc disease of the lumbar spine is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to July 9, 2019, is denied. FINDINGS OF FACT 1. During the relevant period prior to July 9, 2019, the Veteran's service-connected cervical spine disability was manifested by no worse than forward flexion greater than 30 degrees but not greater than 40 degrees. 2. During the relevant period prior to January 14, 2014, and during the period from March 1, 2014, to July 8, 2019, the Veteran's service-connected lumbosacral spine disability was manifested by no worse than forward flexion greater than 60 degrees but not greater than 85 degrees. 3. The Veteran was not unable to secure and follow a substantially gainful occupation due to his service-connected disabilities prior to July 9, 2019. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating in excess of 10 percent prior to July 9, 2019, for cervical sprain with degenerative changes and degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5242-5237. 2. The criteria for entitlement to a rating in excess of 10 percent prior to January 14, 2014, and from March 1, 2014, to July 8, 2019, for lumbosacral sprain and degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5237. 3. The criteria for entitlement to a TDIU prior to July 9, 2019, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1992 to November 1995, from May 2000 to October 2000, from March 2003 to September 2003, from December 2005 to March 2007, and from December 2007 to January 2009. In June 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. The Veteran has been awarded a temporary total rating for his service-connected lumbosacral spine disability from January 14, 2014, to February 28, 2014, based on convalescence. A total rating is the highest available rating for a disability. Therefore, the rating for the service-connected lumbosacral spine disability during the period of the temporary total rating will not be discussed in the decision below. The Veteran has been in receipt of a 100 percent schedular rating and special monthly compensation based on housebound status under 38 U.S.C. § 1114(s) since July 9, 2019. The award of a TDIU on or after July 9, 2019, would result in no further benefit to the Veteran. Therefore, the issue of entitlement to a TDIU from July 9, 2019, is rendered moot, and the Board need not consider that issue. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Accordingly, the Board has characterized the issue on appeal as entitlement to a TDIU prior to July 9, 2019. In October 2019, the Board issued a decision remanding the issue of entitlement to a TDIU and denying the other issues on appeal. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Court vacated the October 2019 Board decision and remanded the issues for further consideration consistent with a Joint Motion for Partial Remand (JMPR) filed by counsel for the Veteran and the VA Secretary. Relevant to the issues considered in this decision, the parties to the JMPR agreed that March 2013, October 2013, June 2016, and August 2016 VA examinations as to the Veteran's service-connected cervical spine disability and October 2012, October 2013, April 2014, June 2015, and August 2015 VA examinations as to the Veteran's service-connected lumbosacral spine disability were inadequate for decision-making purposes because they did not contain sufficient findings in view of Correia v. McDonald, 28 Vet. App. 158, 165 (2016), and Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). The Board remanded the appeals for increased ratings for the service-connected cervical spine and lumbosacral spine disabilities in January 2016, August 2017, and March 2021. It remanded the appeal for entitlement to a TDIU in October 2019 and March 2021. In relevant part, the January 2016 remand directed the Agency of Original Jurisdiction (AOJ) to obtain the Veteran's updated VA treatment records and provide the Veteran with examinations as to his service-connected cervical spine disability and lumbosacral spine disability. The August 2017 remand directed the AOJ to obtain the Veteran's update VA treatment records and provide the Veteran with examinations as to his service-connected cervical spine disability and lumbosacral spine disability. The October 2019 remand directed the AOJ to send the Veteran a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. The March 2021 remand directed the AOJ to obtain a retrospective opinion as to the likely severity of the Veteran's service-connected cervical spine and lumbosacral spine disabilities during the relevant period prior to July 9, 2019. VA completed the January 2016, August 2017, October 2019, and March 2019 remand directives by obtaining the Veteran's updated VA treatment records; providing the Veteran with additional VA examinations in June 2016, August 2016, June 2019, and July 2019; sending the Veteran a VA Form 21-8940 in November 2019; and obtaining a retrospective opinion in April 2021. The additional VA examinations are, in the aggregate, adequate for decision-making purposes because they provide the information necessary to render a full decision as to the issues decided herein. In addition, the April 2021 opinion remedies the deficiencies in the October 2012, March 2013, October 2013, April 2014, June 2015, June 2016, and August 2016 VA examinations discussed in the July 2020 JMPR. Accordingly, the Board finds that VA at least substantially complied with the January 2016, August 2017, October 2019, and March 2021 Board remands and with the July 2020 JMPR. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). 1. Entitlement to an initial rating in excess of 10 percent prior to July 9, 2019, for cervical sprain with degenerative changes and degenerative disc disease 2. Entitlement to a rating in excess of 10 percent prior to January 14, 2014, and from March 1, 2014, to July 8, 2019, for lumbosacral sprain and degenerative disc disease of the lumbar spine The Veteran seeks an initial rating in excess of 10 percent prior to July 9, 2019, for cervical sprain with degenerative changes and degenerative disc disease. The applicable rating period for that issue is from June 7, 2010, the effective date for the award of service connection for that disability, through July 8, 2019. See 38 C.F.R. § 3.400. He also seeks a rating in excess of 10 percent prior to January 14, 2014, and from March 1, 2014, to July 8, 2019, for lumbosacral sprain and degenerative disc disease of the lumbar spine. The applicable rating period for that issue is from August 27, 2011, one year prior to receipt of the claim for an increased rating for the service-connected lumbosacral spine disability, through January 13, 2014, and from March 1, 2014, through July 8, 2019. See 38 C.F.R. § 3.400(o)(2). Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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 will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). The Veteran's cervical sprain with degenerative changes and degenerative disc disease is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237 and 5242, which pertain to lumbosacral or cervical strain and to degenerative arthritis of the spine, respectively. His lumbosacral strain and degenerative disc disease of the lumbar spine is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Diagnostic Codes 5237 and 5242 direct that the disability be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). In relevant part, under the General Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Regarding the service-connected cervical spine disability for the period prior to July 9, 2019, the Board finds that the preponderance of the evidence is against an initial rating in excess of 10 percent. The relevant evidence of record indicates that, for that period, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of limitation experienced during flare-ups, on repetitive use, and on repetitive use over time would not result in limitation of motion more nearly approximating forward flexion of greater than 15 degrees but not greater than 30 degrees or the combined range of motion of the cervical spine not greater than 170 degrees such that a higher initial rating was warranted. VA examinations conducted in July 2010, March 2013, October 2013, April 2014, June 2016, and August 2016 reflect that the Veteran had forward flexion to at least 40 degrees and a combined range of motion of over 170 degrees. They do not indicate that the Veteran had additional functional loss following repetitive-use testing. They also do not show that the Veteran had ankylosis of the spine or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The Veteran's medical treatment records also do not show such limitations or findings. In the April 2021 addendum opinion, the VA examiner opined that, during the relevant period prior to July 9, 2019, the Veteran's service-connected cervical spine disability would be mild to moderate in severity on active range of motion, passive range of motion, weightbearing, and non-weightbearing, and during flareups. He estimated that on active and passive range of motion, both in weightbearing and non-weightbearing, the Veteran would have forward flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 45 degrees, left lateral flexion to 15 degrees, right lateral rotation to 70 degrees, and left lateral rotation to 40 degrees in the cervical spine during the relevant period prior to July 9, 2019. He also opined that the Veteran would have no additional functional loss during flareups during the relevant period prior to July 9, 2019. As a rationale for that opinion, he explained that the Veteran's treatment records do not show changes in activities from the Veteran's reported statements and history, nor do they show any consistent changes in worsening flareups, length of flareups, and severity of flareups based on the Veteran's own reported history and the evaluators' objective examination findings. The Veteran's activity level and own statements would not substantiate additional functional loss during periods of flareups. The Board affords probative value to the April 2021 VA examiner's opinions because they are based on an accurate understanding of the Veteran's medical history and are supported by appropriate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). The Board accepts the examiner's opinion as probative evidence that on active range of motion, passive range of motion, weightbearing, and non-weightbearing, and during flareups, the Veteran did not have cervical spine forward flexion to 40 degrees or less, a combined range of motion for the cervical spine of 170 degrees or less, ankylosis of the cervical spine, or muscle spasm or guarding of the cervical spine severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. As there is no evidence indicating that the criteria for a rating higher than 10 percent were met under Diagnostic Codes 5237 and 5242 for the service-connected cervical spine disability were met prior to July 9, 2019, there is no basis in the record for awarding a higher initial rating during that period. The Board acknowledges that the Veteran has reported that he has headaches at times due to the pain and other symptoms from his service-connected cervical spine disability. However, his descriptions as to the frequency and severity of those headaches do not indicate that the criteria for a separate compensable rating is warranted based on headaches. Specifically, the record, to include the Veteran's statements, does not indicate that the headaches are prostrating in nature. See 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Veteran has not indicated that he must lay down due to the headaches or that the headaches otherwise render him extremely exhausted or powerless. See Dorland's Illustrated Medical Dictionary 1531 (32nd Ed. 2012). Regarding the service-connected lumbosacral spine disability for the periods from August 27, 2011, to January 13, 2014, and from March 1, 2014 to July 8, 2019, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent. The relevant evidence of record indicates that, for those periods, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of limitation experienced during flare-ups, on repetitive use, and on repetitive use over time would not result in limitation of motion more nearly approximating forward flexion of greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the cervical spine not greater than 120 degrees. VA examinations conducted in October 2012, October 2013, April 2014, June 2016, and August 2016 reflect that the Veteran had forward flexion to at least 65 degrees and a combined range of motion of over 120 degrees. They do not indicate that the Veteran had additional functional loss following repetitive-use testing. They also do not show that the Veteran had ankylosis of the spine or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The Veteran's medical treatment records also do not show such limitations or findings. In the April 2021 addendum opinion, the VA examiner opined that, during the relevant period prior to July 9, 2019, the Veteran's service-connected lumbosacral spine disability would be moderate to severe in severity on active range of motion, passive range of motion, weightbearing, and non-weightbearing, and during flareups. He estimated that on active and passive range of motion, both in weightbearing and non-weightbearing, the Veteran would have forward flexion to 70 degrees, extension to 15 degrees, right lateral flexion to 25 degrees, left lateral flexion to 25 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 25 degrees in the lumbosacral spine during the relevant periods prior to July 9, 2019. He also opined that the Veteran would have no additional functional loss during flareups during the relevant period prior to July 9, 2019. As a rationale for that opinion, he explained that the Veteran's treatment do not show changes in activities from the Veteran's reported statements and history, nor do they show any consistent changes in worsening flareups, length of flareups, and severity of flareups based on the Veteran's own reported history and the evaluators' objective examination findings. The Veteran's activity level and own statements would not substantiate additional functional loss during periods of flareups. In addition, the Veteran underwent a spinal fusion in 2014 that limited his lumbar spine range of motion in all planes of motion. Therefore, he would have additional pain and muscle spasm during flareups, but not typically a change in the range of motion as that is fairly fixed secondary to the fusion. The Board affords probative value to the April 2021 VA examiner's opinions because they are based on an accurate understanding of the Veteran's medical history and are supported by appropriate rationale. See Nieves-Rodriguez, 22 Vet. App. 295; Prejean, 13 Vet. App. 444. The Board accepts the examiner's opinion as probative evidence that on active range of motion, passive range of motion, weightbearing, and non-weightbearing, and during flareups, the Veteran did not have thoracolumbar spine forward flexion to 60 degrees or less, a combined range of motion for the thoracolumbar spine of 120 degrees or less, ankylosis of the thoracolumbar spine, or muscle spasm or guarding of the thoracolumbar spine severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. As there is no evidence indicating that, during the relevant periods prior to July 9, 2019, the criteria for a rating higher than 10 percent were met under Diagnostic Code 5237 for the service-connected lumbosacral spine disability, there is no basis in the record for awarding a higher rating during that period. Regarding neurological impairment, the Veteran has already been granted service connection for right lower extremity radiculopathy associated with the service-connected lumbosacral spine disability. He has also been service connected for neuropathic symptoms of the bilateral upper extremities and of the left lower extremity associated with his service-connected alcohol use disorder. The lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. The Board acknowledges the Veteran's statement that was received in May 2021 in which he asserts that prior to July 9, 2019, his service-connected cervical spine and lumbosacral spine disabilities shoulder be rated at "a minimum of 40% disabling." The Veteran did not provide any specific argument as to how the criteria for a 40 percent rating were met other than to reference his degenerative disc disease in general and a cervical fusion surgery that occurred after July 9, 2019. As discussed above, the competent medical evidence, to include the May 2021 VA addendum opinion does not show that that the Veteran met the criteria for a rating in excess of 10 percent for the service-connected cervical spine disability or in excess of 10 percent for the service-connected lumbosacral spine disability during the relevant period prior to July 9, 2019. Neither the Veteran nor his representative has raised any other issues with regard to the ratings for the service-connected cervical spine disability and the service-connected lumbosacral spine disability prior to July 9, 2019, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore finds that the criteria have not been met for entitlement to higher ratings for the service-connected cervical spine disability prior to July 9, 2019, or for entitlement to a higher rating for the service-connected lumbosacral spine disability prior to July 9, 2019. As the preponderance of the evidence is against the assignment of higher ratings, the doctrine of reasonable doctrine is not for application, and the appeals must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a TDIU prior to July 9, 2019 The Veteran seeks a TDIU based on the combined effects of his service-connected disabilities. The issue of entitlement to a TDIU was raised as part and parcel to the Veteran's appeals for increased ratings for posttraumatic stress disorder (PTSD) with alcohol dependence, the service-connected cervical spine disability, and the service-connected lumbosacral spine disability. Therefore, the applicable review period is from June 7, 2010, the effective date for the award of service connection PTSD and for cervical sprain with degenerative changes and degenerative disc disease, through July 8, 2019. See 38 C.F.R. § 3.400. A TDIU may be assigned when the schedular rating is less than total and a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. For the purposes of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3)disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table). The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran has the following disabilities that were service connected during the relevant period: PTSD with alcohol dependence, rated at 50 percent prior to June 25, 2015, at 70 percent from June 25, 2015, to December 26, 2016, and at 100 percent from December 27, 2016; neuropathic symptoms of the left upper extremity, rated at 20 percent prior to May 1, 2014, as noncompensable from May 1, 2014, to July 8, 2019, and at 40 percent from July 9, 2019; neuropathic symptoms of the right upper extremity, rated at 20 percent prior to May 1, 2014, and as noncompensable from that date; neuropathic symptoms of the left lower extremity, rated at 10 percent prior to May 1, 2014, as noncompensable from May 1, 2014, to July 8, 2019, and at 10 percent from July 9, 2019; right lower extremity L5-S1 radiculopathy, rated at 10 percent prior to July 9, 2019, and at 20 percent from that date; lumbosacral sprain and degenerative disc disease of the lumbar spine with postoperative residuals of surgery, rated at 10 percent prior to January 14, 2014, at 100 percent from January 14, 2014, to February 28, 2014, at 10 percent from March 1, 2014, to July 8, 2019, and at 20 percent from July 9, 2019; cervical sprain with degenerative changes and degenerative disc disease, rated at 10 percent prior to July 9, 2019, and at 20 percent from that date; and a scar from lumbosacral spine surgery, rated as noncompensable from January 14, 2014. The Veteran's combined rating was 80 percent prior to January 14, 2014; 100 percent from January 14, 2014, to February 28, 2014; 80 percent from March 1, 2014, to April 30, 2014; 60 percent from May 1, 2014, to June 24, 2015; 80 percent from June 25, 2015, to December 26, 2016; and 100 percent from December 27, 2016. Thus, the Veteran had at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more during the relevant period except for from May 1, 2014, to June 24, 2015. Accordingly, the Board may consider the claim for a TDIU on a schedular basis for the relevant period except for from May 1, 2014, to June 24, 2015. 38 C.F.R. § 4.16(a). For the period from May 1, 2014, to June 24, 2015, the Board will consider whether referral for extraschedular consideration is warranted. See 38 C.F.R. § 4.16(b). In addition, because the Veteran was in receipt of a schedular 100 percent rating for his PTSD with alcohol dependence from December 27, 2016, additional benefit may be derived during the period from December 27, 2016, to July 8, 2019, through a finding that his other service-connected disabilities warranted a TDIU independent of the PTSD with alcohol dependence during that period. See Buie, 24 Vet. App. at 250; Bradley, 22 Vet. App. at 294; 38 C.F.R. § 3.350(h)(3)(i). Therefore, the Board's analysis for the period from December 27, 2016, to July 8, 2019, will focus on whether a TDIU was warranted based on the Veteran's service-connected disabilities other than PTSD with alcohol dependence. The Veteran indicated on a VA Form 21-8940 he submitted in February 2013 that he worked fulltime in security from 2010 to 2012 and then as an assistant director at a retirement living community in 2012. He indicated that he became too disabled to work on September 1, 2012, due to his service-connected PTSD and lumbosacral sprain and that he has a high school education with two years of college and no additional training. On a VA Form 21-8940 he submitted in December 2019, he indicated that he worked fulltime in social work from October 2017, to October 2019; that he was a parttime student from October 2011 to October 2018; that he last worked fulltime on October 31, 2019; that he became too disabled to work on June 10, 2008, due to his service-connected PTSD; and that he has a college education with a B.S. in criminal justice. The Veteran remarked on that VA Form, "My PTSD makes it almost impossible to pay bills, work with others, concentrate, remember things, sometimes too nervous to leave the house. Constantly calling off work due to my disability." The Board notes that the Veteran's PTSD was rated at 100 percent at the time the Veteran submitted the December 2019 VA Form 21-8940 and had been so rated since December 27, 2016. Although the Veteran only described periods of fulltime work from 2010 to 2012 and from October 2017 to October 2019 on the VA Forms 21-8940, the record indicates that he held other positions, including fulltime positions, during other periods. The record shows that the Veteran was terminated from his position at the retirement living community in late October 2012 due to behavioral issues, including insubordination. In December 2012, he told a VA healthcare provider that he lost that job due to "going off on his boss." He continued to be unemployed at the time of VA examinations provided in March 2013. However, at an October 2013 VA PTSD examination, he said that he had been working 32 hours per week as an HR assistant since April 2013, that he received verbal reprimands at work, and that it "Takes everything I have to get there though", but that he had not missed work due to his service-connected disabilities. He told an October 2013 VA general medical examiner that he planned to stay on that job, but that if he were to be awarded a TDIU, he would quit the job and instead work on his hobby of making gun holsters. He told a January 2015 VA PTSD examiner that he continued to work as an HR assistant, but recently was promoted to a fulltime position and that work was going well overall. At the June 2015 Board hearing, he testified that he switched jobs to become an assistant general manager at a fast food restaurant. He told a June 2016 VA PTSD examiner that he eventually resigned from the job as a fast food restaurant manager because it required too much social interaction, and then took a position as a general manager at a trading post. That job ended after he had a verbal altercation with a customer. For the 9 months prior to the examination he had been working with recruiters and applicants at a United States Military Entrance Processing office. In early November 2016, he told a VA healthcare provider that he had a new job and got promoted, but was worried about losing the job. In December 2016, he told a VA healthcare provider that he had not worked in the past 2 months due to psychiatric symptoms. In February 2017, he told a VA healthcare provider that he was able to resume his job at a the United States Military Entrance Processing office where he had worked for the prior year and a half. Regarding physical limitations caused by the service-connected disabilities, the Veteran told a July 2010 VA spine conditions examiner that, due to his service-connected cervical spine and lumbosacral spine disabilities, he would have intermittent flares of pain with lifting or standing more than 1 hour and would need to sit down periodically for approximately 30 minutes to relieve the pain. He told an October 2012 VA back conditions examiner that he would stand up to walk around to comfort his low back pain. He told a March 2013 VA general medical examiner that he could sit for one hour at a time, walk for one-quarter mile, lift up to 30 pounds, and work overhead for 20 minutes at a time. The examiner opined that the Veteran would have a mild difficulty with prolonged weightbearing and repetitive activities, including standing, walking, bending, pushing, pulling, lifting, and carrying; and that the Veteran would be most limited in terms of working overhead, which would be limited to only very short periods of time between 10 minutes and 15 minutes. The examiner found no objective evidence to suggest any impact on the Veteran's ability sit, as the Veteran managed to sit comfortably for the hour-long interview for the examination. The October 2013 VA general medical examiner opined that, based on the Veteran's presentation, as well as examination and observation of the Veteran, the Veteran is able to sit for reasonable periods, stand, and walk. He can lift and carry reasonable loads. In January 2014, following a microdiscectomy surgery, the Veteran's physician limited him to work involving lifting, carrying, and pushing or pulling no more than 10 pounds; frequent reaching above the shoulders; occasional climbing of stairs; rare bending and squatting; and no climbing of ladders or crawling. The Veteran told an April 2014 VA back conditions examiner that his service-connected lumbosacral spine disability prevents him from performing repetitive lifting, carrying, twisting, standing more than 15 minutes, bending, and stooping. In July 2014, the Veteran's physician cleared him to lift up to 30 pounds. The Veteran told a June 2016 VA back conditions examiner that his low back pain acts up approximately 3 times per month due to sitting at a desk for work, and requires him to get up and move around when that happens. A VA back conditions examiner who examined the Veteran on July 9, 2019, opined that the Veteran's optimal work environment would not require prolonged activities, including sitting, standing, walking, or driving while allowing frequent position changes. Regarding psychological limitations caused by the service-connected disabilities prior to December 27, 2016, in November 2012, the Veteran asserted that his PTSD symptoms have "made it nearly impossible to function properly at work without my symptoms taking over and causing me to act inappropriately". He specifically noted symptoms of extreme agitation, anger, and inability to concentrate and perform daily tasks. In support of those assertions, he submitted paperwork from his job at the retirement living community showing that he was terminated due to behavioral problems, including insubordination. The March 2013 VA PTSD examiner noted that the Veteran had been able to maintain employment in the past in spite of his psychological problems. The examiner opined that the Veteran is limited to work that requires only brief superficial contact with others. In addition, the Veteran's PTSD symptoms impact his ability to cope with stress, and that when under stress the Veteran's concentration is reduced. Therefore, he would do best in work settings where he need not make numerous decisions or need to respond to frequent changes. He would also do best in a position where contact with others is minimal in order to minimize distractions. Finally, although the Veteran's reliability and productivity are reduced, they are not reduced to a level that would preclude all type of work. In his March 2013 notice of disagreement, the Veteran asserted that he could not work due to his drinking, anger, violent outbursts, inability to spatially reason, inability to establish and maintain effective relationship, panic, stress, and obsessional rituals. On a VA Form 9 received in April 2013, he asserted that he has violent outbursts, extreme difficulty with concentrating and maintaining a steady thought process, daily repetitive tasks, and a sense of impending doom. However, the October 2013 VA examiner noted that the "Veteran essentially self-report[ed] that he has all symptoms all the time" on examination. Based on the interview with the Veteran, the examiner opined that the Veteran would have some struggle with irritability and over-reactivity at times during a workday and that such would affect the Veteran's ability to communicate with coworkers and/or customers. However, the Veteran did not show difficulty with memory, ability to follow instructions, show insight, think abstractly, concentrate, or interact during the examination. At the June 2015 Board hearing, the Veteran reported that he has "sheer anger" at work when a noise is made, that he is hypervigilant every day "with the intent to kill at all times", that when a memory is triggered he becomes "just lost", and that at work he at times has to go outside to separate himself from others. At the June 2016 VA PTSD examination, the Veteran reported that he felt his job at the United States Military Entrance Processing office worked well for him because he was able to work alone. Based on a review of the record and the examination of the Veteran, the VA examiner opined that the Veteran would be able to perform the sedentary tasks associated with employment, to include but not limited to communicating, remembering, following instructions, using judgment, showing insight, thinking abstractly, adapting to changes or stress, and concentrating. However, on occasion the Veteran would be impaired in his interactions with others due to his mood and limited frustration tolerance. The VA treatment records show that the Veteran was admitted to a domiciliary substance abuse treatment program on December 27, 2016, the date on which he was granted a 100 percent rating for his service-connected PTSD. The Board affords great weight to the VA examiners' findings and opinions, and to the limitations provided by the Veteran's physician in January and July 2014. The examiners' and the Veteran's physician based their assessments as to the functional impact of the Veteran's service-connected disabilities on in-person examination of the Veteran. The examiners and the Veteran's physician are medical experts who have specialized knowledge of physical and psychological conditions and their impact on a patient's functional capacity. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). Based on the findings and opinions of the VA examiners and the Veteran's physician, the Board finds that, due to his service-connected cervical spine, lumbosacral spine, and neurological disabilities, the Veteran was limited to sedentary work that did not involve constant reaching above the shoulders; more than occasional climbing of stairs; more than rare bending and squatting; or any amount of climbing of ladders or crawling. In that regard, the Board notes that the term "sedentary" is defined for purposes of this decision as work that requires no more than 2 hours of standing and/or walking in an 8-hour workday and involves light lifting of no more than 10 pounds. Additionally, due to his service-connected PTSD with alcohol dependence, the Veteran was essentially limited to simple, routine work that does not require close communication with coworkers, supervisors, or the general public on an ongoing basis. With such an occupational profile, the Veteran would be able to perform work such as sorting, inspection, and/or assembly work, which are repetitive and predictable in nature, are mostly performed independently away from the public, and do not require ongoing training or other activities that would require close communication with coworkers or supervisors. The Board has considered the Veteran's level of education, special training, and previous work experience. See 38 C.F.R. § 4.16. The Veteran had a high school education at the beginning of the relevant period and finished a college degree during the relevant period. Such a level of education is not inconsistent with an ability to perform work of an unskilled or semi-skilled nature, such as sorting, inspection, or assembly work. The Board has also considered the Veteran's work history. He worked during much of the relevant period. The Board acknowledges that he has submitted evidence showing that he has been terminated from jobs or has resigned from jobs due to his service-connected PTSD. However, the reasons for termination and for the Veteran resigning have been related to his difficulties with social interaction. He told the June 2016 VA examiner that his current job worked well for him because he was able to work alone, which is consistent with the Board's finding that he would be able to secure and follow a job that does not require close communication with coworkers, supervisors, or the general public on an ongoing basis. The Board finds that the Veteran's job history during the relevant period, to include the fact that he lost jobs and resigned from jobs due to his PTSD symptoms, does not show that he would be unable to secure or follow a job within the limitations described above. The Board has also considered the Veteran's reported limitations. The Board does not doubt that his service-connected disabilities limited his functional abilities during the relevant period. However, the October 2013 VA PTSD examiner found the Veteran's overreporting of his psychiatric symptoms and their severity. Based on the examiner's finding and the discrepancies between the Veteran's reports and the other evidence of record, the Board finds the Veteran's reports of his symptoms to be not credible. See Caluza v. Brown, 7 Vet. App. 498 (1995) (in determining whether evidence submitted by a Veteran is credible, the Board may consider internal consistency, facial plausibility, and consistency with other information submitted on behalf of the claimant). Instead, the Board relies on the limitations provided by the competent medical sources of record. Based on those limitations, the Board has determined that, during the relevant period, the Veteran was limited to simple, routine sedentary work that did not involve constant reaching above the shoulders; more than occasional climbing of stairs; more than rare bending and squatting; any amount of climbing of ladders or crawling; or close communication with coworkers, supervisors, or the general public on an ongoing basis. With such remaining functional capacity, the Veteran would be able to perform the duties required for sorting, inspection, or assembly work. As such, the evidence of record does not show that the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities during the relevant period. The preponderance of the evidence is against a finding of entitlement to a TDIU prior to July 9, 2019, the doctrine of reasonable doubt is not for application, and the appeal must be denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. J. Anthony, 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.