Citation Nr: 21040871 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-14 259 DATE: July 7, 2021 ORDER Entitlement to an increased rating for left hip degenerative joint disease (flexion), rated 10 percent disabling prior to June 18, 2019, and rated 20 percent thereafter is denied. Entitlement to an increased rating for left hip degenerative joint disease (extension) rated 10 percent disabling, effective June 18, 2019 is denied. Entitlement to an increased rating for left hip degenerative joint disease (impairment of thigh), rated 0 percent disabling prior to June 18, 2019, and rated 10 percent disabling thereafter is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to June 18, 2019, to include on an extraschedular basis, is remanded. FINDINGS OF FACT 1. Prior to June 18, 2019, the Veteran's left hip degenerative joint disease (flexion) was manifest by no worse than limitation of flexion to 45 degrees. 2. After June 18, 2019, the Veteran's left hip degenerative joint disease (flexion) was manifest by no worse than limitation of flexion to 30 degrees. 3. The Veteran's left hip degenerative joint disease (limitation of extension) is rated as 10 percent disabling, which is the maximum schedular rating permitted for limitation of extension of the thigh. 4. Prior to June 18, 2019, the Veteran's left hip degenerative joint disease (impairment of thigh) was manifest by limitation of abduction of the thigh, motion possible beyond 10 degrees. 5. After June 18, 2019, the Veteran's left hip degenerative joint disease (impairment of thigh) was manifest by limitation of adduction, cannot cross legs; limitation of rotation, cannot toe-out more than 15 degrees on the affected leg. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left hip degenerative joint disease (flexion) from September 24, 2009 to June 18, 2019, and in excess of 20 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 2. The criteria for a rating in excess of 10 percent for left hip degenerative joint disease (extension) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5251. 3. The criteria for a rating in excess of 0 percent for left hip degenerative joint disease (impairment of thigh) from September 16, 2013 to June 18, 2019, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1977 through December 1978. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran initially filed a claim for service connection for a left hip condition in September 2009 and was awarded one, 10 percent disability rating for "residuals of his left hip injury," effective September 24, 2009. This appeal stems from the Veteran's increased rating claim for his left hip rating filed on September 16, 2013. Thus, the Board will consider the severity of the issues on appeal from September 16, 2013, as well as whether there was any factually ascertainable increase in the severity of the claimed conditions within the year preceding the increased rating claim. See 38 C.F.R. § 3.400(o)(2). Within the June 2014 rating decision, the RO denied an increased rating greater than 10 percent for left hip degenerative joint disease, but separately awarded a 0 percent rating, effective September 16, 2013, the date of his increased rating claim, for a left thigh impairment associated with the left hip disability. The Veteran eventually perfected an appeal to the Board; on his March 2016 substantive appeal, VA Form 9, he indicated he was appealing the left hip rating and "never" intended on filing for anything related to his thigh. In September 2018, the Board remanded the increased rating claim for a left hip disability. In light of the Veteran's comments on the substantive appeal form, the Board only took jurisdiction over the claim for the 10 percent rating for the left hip disability, and not the 0 percent rating for a left thigh impairment at that time. Pursuant to the remand, however, a VA examination was performed in June 2019, with an addendum opinion completed in September 2019, which encompassed all aspects of the Veteran's left hip disability, to include the left thigh impairment. Based on the results of this examination, an April 2020 rating decision granted an increased rating from 10 to 20 percent for left hip degenerative joint disease (flexion), June 18, 2019, but also granted an increased rating from 0 to 10 percent for left hip degenerative joint disease (impairment of thigh), effective June 18, 2019, and, further, awarded service connection for a separate evaluation of left hip degenerative joint disease (extension) with a 10 percent disability rating, effective June 18, 2019. The increased ratings granted throughout time constitute only partial grants of the benefits sought on appeal; therefore, the issue remains on appeal and is for consideration by the Board. See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Although the Veteran indicated on his March 2016 substantive appeal, VA Form 9, that he was "only" appealing the left hip rating and never intended on filing a claim for his "thigh," it is clear that all three ratings awarded throughout time were awarded to compensate his left hip disability. Liberally construing the Veteran's statements and the procedural history in this case, the Board considers all aspects of the Veteran's left hip disability on appeal since the September 2013 filing for an increased rating. The issues have been appropriately recharacterized above. The Board remand in September 2018 also included a claim for TDIU, found to be inextricably intertwined with the left hip disability. The Board determined that the issue of TDIU could not be decided until the left hip disability claim was addressed, and that it should be adjudicated thereafter by the AOJ. The Board finds there was substantial compliance with the September 2018 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545 552 (2008). Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the rating schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the 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."). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). 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). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." Thus, the Court's holding in Correia establishes additional requirements that must be met prior to finding that a VA examination is adequate. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.] Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the AOJ. In Disabled American Veterans v. Sec of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) specifically upheld the validity of 38 C.F.R. § 19.9(b)(2) (now as noted renumbered as 38 C.F.R. § 20.904(d)(2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claim. Under the pre-amended criteria, degenerative arthritis as shown by x-ray studies is rated based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a, DC's 5003. When, however, the limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. A rating of 20 percent may be applied where there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, DC's 5003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. Turning to the evidence of record, VA outpatient treatment records from September 2012 to April 2014 show periodic complaints and treatment for left hip "arthralgia" or pain, to include pain in groin and on rotation. These records also reflect the Veteran was working as an electrician and in September 2012 reported he could not do his work of an electrician due to pain in the neck, arms, back, and legs. In February 2013, the Veteran's left hip was examined and noted to have "weak" hip flexion. An x-ray of the left hip was obtained in May 2013 revealing "mild arthritis" in the joint and fusion of the sacroiliac joint where the low back and pelvis join. VA outpatient treatment records also reflect the Veteran attended some physical therapy sessions, in part, related to left hip pain as well as a surgical consult in September 2013. The Veteran underwent a VA examination in March 2014 where the examiner noted the Veteran's pertinent medical history and current complaints, to include the Veteran's complaints of walking with a "really bad limp" and having more pain over the last 3-4 years. The Veteran reported flare-ups that feel like he wants to "pop it or move it" and that causes him to limp. During flare-ups, the Veteran reported he tries to use heat, without help, and usually he has to "quit walking and rest." Range of motion of the left hip was measured at extension greater than 5 degrees and 90 degrees flexion with no objective evidence of painful motion. Abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran could not cross his legs, and rotation was not limited such that the Veteran could not toe-out more than 13 degrees. There was no documented appreciable functional loss of motion on repetition or due to pain, or any of the DeLuca factors. The examiner, however, did note pain on palpation of the left hip. Hip strength was normal, there was no ankylosis, and there was no other appreciable abnormality of the left hip joint. Abduction was 0 to 40 degrees and, again, there was no change on repetition or due to functional loss. The Veteran also did not indicate he used any assistive devices. As for functional impairment, the examiner noted that the "Veteran may have difficulty walking from one end of a house to the other end of a house repetitively while performing tasks as an electrician due to chronic left hip pain." The examiner also noted that the Veteran last worked as an electrician in April 2013 because he did not have the strength or ability to do the work. The Veteran credits increased back and left hip pain for his inability to continue to do the work. During this examination the Veteran was not having a flare-up and, therefore, the examiner was not able to assess or confirm the physical capabilities of the Veteran's left hip during a flare-up or due to pain, weakness, fatigability or incoordination expressed in terms of the degrees of additional range of motion without resorting to mere speculation. The Veteran took issue with the March 2014 VA examination and believed his condition had worsened. The Veteran also reported experiencing flares and had difficulty climbing ladders and continuing to work because of his back and hip pain. In May 2018, during an examination for his back, the Veteran reported pain in his thighs and in his hips. He indicated there was pain, weakness, and numbness with extended periods of walking or standing in both hips. These complaints were repeated in July 2018, when the Veteran indicated he had intermittent thigh pain, but denied weakness with only minimal numbness and tingling. During examination, the Veteran was found to have " full range of motion" in his bilateral lower extremities. At this time, the Veteran also raised the issue of TDIU, stating that his physical disabilities impeded him from working specifically his hip and back pain. During a November 2018 VA examination for his back, the Veteran's hip flexion was measured. Both hips were reported as 4/5 for range of motion. A left hip study conducted at roughly the same time reported mild degenerative changes of the hips similar to the prior study. The Veteran continued to complain of intermittent pain in his left lower extremity, including the hip and thigh, as well as mild numbness and tingling. A January 2019 physical examination showed weakness to the left hip flexion from a seated position, with diminished reflexes and diminished strength bilaterally in the lower extremities. After the claim for left hip injury was remanded in September 2018, the Veteran received a VA examination in June 2019. The Veteran stated that his left hip "pops out" when walking, that he suffers from flare ups on a weekly basis that are moderate to severe, and last two to three days in duration. The Veteran believes his condition is getting worse. During the examination, the range of motion on the left hip was reported as "abnormal or outside of range." The flexion was 30 degrees, with an extension of 5 degrees, and abduction was listed as 20 degrees out of 45 degrees. The examiner reported that adduction is 10 degrees, and limited "such that the Veteran cannot cross legs." The examiner noted that pain causes functional loss and was present with all ranges of motion as well as weight bearing. The examination was not conducted immediately after repetitive use over time, and the examiner indicated the results were neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Additionally, the examiner noted the left hip had less movement than normal due to ankylosis, adhesions, etc., as well as a disturbance in gait, interference with sitting and standing. The Veteran uses a walker occasionally on flare up days. The examiner stated that active and passive range of motion are identical, and therefore no functional impact noted. The examiner provided an addendum opinion in September 2019 to clarify some of the remarks from the June 2019 examination regarding functional loss due to flare ups at the end of the exam report. Per the remand instructions, the Board also received the Social Security Administration (SSA records). The Veteran applied for social security disability benefits in June 2014. Medical records included in the file provided by the social security administration range in date from August 2012 through December 2014. Records from this time show multiple examinations and treatments for a back condition, with associated examinations for the hips, thigh, and left leg. The Veteran reported pain in both thighs in August 2012, as high as a 6 or 7 out of ten on the pain scale. A physical examination in august 2013 showed limited range of motion on the left leg, indicated as a "positive" on the "Patrick's Test" which measured flexion, abduction, and external rotation. When the Veteran applied for disability benefits, he completed a questionnaire in August 2014 and indicated physical difficulty lifting, squatting, bending, standing, reaching, walking, sitting, and kneeling due to his physical disabilities. During his annual exam in September 2014, the primary care physician noted chronic pain in the low back and down the left leg, with twisting restricted, and a range of motion limited to 60 degrees before pain prevented further movement. The Veteran himself reported a lack of physical activities that he previously enjoyed, such as hiking and fishing, as well as difficulty working as a result of the pain in his back and hip. Under the allegation of impairments listed in the December 2014 decision, it states "left hip; loose socket, future replacement possible." Because the Veteran applied for and received disability benefits in 2014, this document did not include records concerning the Veteran's current disability levels. 1. Entitlement to an increased rating for left hip degenerative joint disease (flexion), rated 10 percent disabling prior to June 18, 2019, and rated 20 percent disabling from June 18, 2019 is denied. The Veteran contends that he is entitled to a higher rating because of the pain and tenderness, limited range of motion, and impact on his daily life that he experiences as a result of the left hip degenerative joint disease. The Veteran's left hip degenerative joint disease (flexion) is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5252, for limitation of flexion of the thigh. Under Diagnostic Code 5252, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. This diagnostic code was not affected by the changes to the criteria for rating musculoskeletal disorders, and therefore is rated using the same criteria explained above. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left hip degenerative joint disease (flexion) prior to June 18, 2019. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to decreased mobility, problems with lifting and carrying, lack of stamina, weakness or fatigue, decreased strength, and pain. The March 2014 examiner reported 90 degree flexion with no objective evidence of painful motion. Despite the conflict between the Veteran's statements and the examiner's recordings, the Board does not have other documentation from that time frame on which to evaluate or base their decision. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he was limping and experiencing tenderness and pain in his hip, did not result in symptoms more nearly approximating flexion limited to 30 degrees. Additionally, despite other examinations for the Veteran's hip pain and for his back issues, range of motion and flexion were not tested and recorded again until June 2019, when an increase was granted. There are no other evaluations indicating limited flexion or other lay statements supporting an increase prior to June 18, 2019. The Board also finds that the preponderance of the evidence is against a rating in excess of 20 percent for left hip degenerative joint disease (flexion) from June 18, 2019, to the present. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, limited range of motion, reduced strength, and regular flare ups. The June 2019 VA examination clearly showed flexion was limited to 30 degrees, thus meeting the qualifications for a 20 percent disability rating. Any additional limitations reflected by the statements that the Veteran's flare ups happen weekly, are moderate to severe levels of pain, and last two to three days would not result in symptoms more nearly approximating flexion limited to 20 degrees. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a rating in excess of 10 percent prior to June 18, 2019, and in excess 20 percent thereafter for left hip degenerative joint disease (flexion). The VA examinations and accompanying statements from both the examiners and the Veteran do not indicate a higher level of disability rating is warranted for either time period. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to an increased rating for left hip degenerative joint disease (extension) rated 10 percent disabling, effective June 18, 2019, is denied. The Veteran contends that he is entitled to a higher rating because of the pain and tenderness, limited range of motion, and impact on his daily life that he experiences as a result of the left hip degenerative joint disease. The Veteran's left hip degenerative joint disease (extension) is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5251, for limitation of extension of the thigh. Under Diagnostic Code 5251, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251. This diagnostic code was not affected by the changes to the criteria for rating musculoskeletal disorders, and therefore is rated using the same criteria explained above. From June 18, 2019, the Veteran is in receipt of the highest schedular rating for limitation of extension of the thigh, there is no basis to award a higher rating. Prior to June 18, 2019, the evidence also does not indicate the Veteran's left hip extension was manifested by compensable limitation of extension. In that regard, 2013 treatment records note "weak" flexion and complaints related to flexion of the left hip. VA examinations, to include one in March 2014 indicated the Veteran's left hip flexion was greater than 5 degrees. Indeed, a May 2018 VA examination noted "full range of motion" of the left hip. It was not until the June 18, 2019, VA examination that the Veteran's left hip extension was noted to be limited to 5 degrees, which warrants a 10 percent rating under DC 5251. Thus, the 10 percent rating is not warranted prior to June 18, 2019, and no increased rating is warranted. The appeal is denied. 3. Entitlement to an increased rating for left hip degenerative joint disease (impairment of thigh), rated 0 percent disabling prior to June 18, 2019, and rated 10 percent disabling thereafter is denied. The Veteran contends that he is entitled to a higher rating because of the pain and tenderness, limited range of motion, and impact on his daily life that he experiences as a result of the left hip degenerative joint disease. The Veteran's left hip degenerative joint disease (impairment of thigh) is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5253, for impairment of the thigh. Under Diagnostic Code 5253, a 10 percent rating is warranted for limitation of rotation of affected leg, cannot toe out more than 15 degrees. A 10 percent rating is also warranted for limitation of adduction, cannot cross legs. A maximum 20 percent rating is warranted for limitation of abduction, motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. This diagnostic code was not affected by the changes to the criteria for rating musculoskeletal disorders, and therefore is rated using the same criteria explained above. The Board finds that the preponderance of the evidence is against a compensable rating for left hip degenerative joint disease (impairment of thigh) from September 16, 2013, through June 18, 2019. The Board acknowledges the impact on the Veteran's thigh from the left hip degenerative joint disease. Under 38 C.F.R. § 4.31, when the schedular rating does not provide a noncompensable, or 0 percent evaluation in the diagnostic criteria, a 0 percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. During this initial rating period, a March 2014 VA examination reported the rotation is not limited such that the Veteran cannot toe-out more than 15 degrees, and did not show adduction limited such that the Veteran cannot cross his legs the criteria for a 10 percent disability rating. The examination did show pain on palpation on the left side, in addition to the other limited ranges of motion, but no other criteria relating to impairment of thigh disability ratings. No other examinations or evaluations for the Veteran's hip or thigh indicate rotation limited such that the Veteran could not toe out or adduction limited to precent the Veteran from crossing his legs. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left hip degenerative joint disease (impairment of thigh) after June 18, 2019. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, tenderness, limited range of motion on both active and passive testing, and pain with weight bearing. The June 2019 VA examination reported adduction limited such that the Veteran cannot cross his legs. It also reported adduction limited to 10 degrees where full range would be 25 degrees, and abduction limited to 20 degrees where full range would be 45 degrees. The Veteran's June 2019 VA examination does not show limitation of abduction, motion lost beyond 10 degrees of motion. The Veteran's lay reports of his symptoms and flare ups, as well as the diagnostic testing for his range of motion consistently show his current impairment most approximately reflects a 10 percent disability rating according to the diagnostic criteria. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a rating in excess of 0 percent from September 16, 2013 to June 18, 2019, and in excess of 10 percent thereafter for left hip degenerative joint disease (impairment of thigh). In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to a TDIU due to service-connected disabilities prior to June 18, 2019, to include on an extraschedular basis, is remanded. The Veteran was granted a TDIU effective June 18, 2019, based on the date when schedular criteria were met. However, because the claim for TDIU was raised in conjunction with the left hip injury and is inextricably intertwined, the Board must consider the entire period on appeal. Again, this appeal stems from the date of the Veteran's increased rating claim, filed on September 16, 2013. A total disability rating for compensation purposes may be assigned where the schedular rating is less than total and where it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a service-connected disability ratable at 60 percent or more as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). To meet the requirement of "one 60 percent disability" or one "40 percent disability," the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment may also be held to exist, on a facts-found basis (including, but not limited to, employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. 38 C.F.R. § 4.16. The term "substantially gainful occupation" is not defined in the rating schedule. Rather, the Court in Ray v. Wilkie, found the phrase has two components: an economic one and a noneconomic one. 31 Vet. App. 58 (2019). In assessing the veteran's ability to secure and follow a substantially gainful occupation, the Board is to consider the veteran's history, education, skill, and training as well as physical abilities and mental abilities required by the occupation at issue. Id. Such specific physical ability factors include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. Id. Specific mental ability factors include memory, concentration, ability to adapt to change, handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. Id. Prior to June 18, 2019, the Veteran's service-connected disabilities did not meet the schedular criteria. The Veteran's service-connected disabilities prior to June 18, 2019 included: radiculopathy, left lower extremity at 20 percent and radiculopathy right lower extremity at 10 percent, both effective July 30, 2018; left hip degenerative joint disease (flexion) at 10 percent; degenerative disc disease, lumbar spine with spinal stenosis at 10 percent (excluding temporary 100 percent rating for convalescence); left hip degenerative joint disease (impairment of thigh) at 0 percent; and surgical scar, post lumbar spine surgery associated with degenerative disc disease at 0 percent; with a combined disability rating of 50 percent. Where, as here, a claimant does not meet the threshold criteria, a total disability evaluation may still be assigned on a different basis. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.18(b). The ratings boards are required to submit all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards, to the Director of Compensation Services (Director) for extraschedular consideration. Id. The Board does not have the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Rather the Board's sole inquiry is whether referral for extraschedular consideration is warranted in light of the evidence showing the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability. In light of the evidence suggesting the possibility that the Veteran's service-connected disabilities were impacting his ability to obtain and maintain substantially gainful employment prior to June 2019, the Board finds the threshold for referral has been met. But see Ray, 31 Vet. App. 58 (emphasizing that referral for extraschedular consideration to the director is merely a quasi-factual finding and not binding on the Board.). The Veteran began working as an auto mechanic while in the military and continued that work for many years after leaving service. He received vocational training in auto technology for two years and earned his GED after leaving service. The Veteran reported in back and left hip VA examinations beginning in 2011 that he was having difficulty completing his work responsibilities as a result of his physical impairments. The Veteran reported difficulty due to pain, inability to squat, climb ladders, or stand for long periods of time in May 2014. The Veteran reported in November 2018 that he had difficulty performing basic chores for himself, including putting socks and shoes on and getting in and out of a car or a boat without using his hands to lift his legs inside the vehicle. The Veteran reported difficulty with walking or standing for long periods of time, trouble with balance, and that he walked with a limp. In May 2020, the Veteran indicated his pain had prevented him from continuing to work as a machinist and electrician past April 2013, when he stopped working and filed for and received SSA benefits. In each of these VA examinations, the examiners noted significant functional impairments and potential difficulty with completing his job. In light of the combination of the Veteran's functional limitations from his service-connected disabilities and his educational and employment background, resolving doubt in favor of the Veteran, the Board finds the lay and medical evidence as a whole suggest the Veteran may have been unable to secure or follow a substantially gainful occupation due to his service-connected disabilities prior to meeting the schedular criteria in June 2019. Accordingly, the Board finds that a remand of the Veteran's claim of entitlement to TDIU is warranted to refer the claim to the Director of Compensation Services for extraschedular consideration. See 38 C.F.R. § 4.16(b); see Floyd v. Brown, 9 Vet. App. 88 (1996); Anderson v. Shinseki, 22 Vet. App. 423 (2009). The matter is REMANDED for the following action: 1. Refer the Veteran's claim of entitlement to TDIU to the Director of Compensation Service for consideration of TDIU on an extraschedular basis under 38 C.F.R. § 4.16(b). Include a full statement as to the Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue. A copy of the Director's decision must be associated with the claims file. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Boivin, 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.