Citation Nr: 21041484 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 15-26 224 DATE: July 9, 2021 ORDER An initial rating in excess of 10 percent prior to July 23, 2020, and in excess of 20 percent thereafter for left hip limitation of flexion is denied. An initial rating in excess of 10 percent for right hip limitation of flexion is denied. As of January 13, 2015, but no earlier, a separate noncompensable rating, but no higher, for left hip limitation of extension is granted, subject to the laws and regulations governing the payment of monetary benefits. As of January 13, 2015, but no earlier, a separate noncompensable rating, but no higher, for right hip limitation of extension is granted, subject to the laws and regulations governing the payment of monetary benefits. As of January 13, 2015, but no earlier, a separate noncompensable rating, but no higher, for left hip limitation of abduction is granted, subject to the laws and regulations governing the payment of monetary benefits. As of January 13, 2015, but no earlier, a separate noncompensable rating, but no higher, for right hip limitation of abduction is granted, subject to the laws and regulations governing the payment of monetary benefits. An initial rating in excess of 10 percent for left knee strain with degenerative joint disease prior to June 4, 2019, and in excess of 30 percent as of August 1, 2020, for total left knee arthroplasty is denied. Prior to June 4, 2019, a separate noncompensable rating, but no higher, for left knee strain with degenerative joint disease with limitation of extension, is granted, subject to the laws and regulations governing the payment of monetary awards. From June 20, 2018, to June 4, 2019, a separate 10 percent rating, but no higher, for left knee strain with degenerative joint disease with slight lateral instability, is granted, subject to the laws and regulations governing the payment of monetary awards. For the appeal period where a 100 percent rating has not been assigned, a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities in combination is granted, subject to the laws and regulations pertaining to the payment of monetary awards. FINDINGS OF FACT 1. Prior to July 23, 2020, the Veteran's left hip disability resulted in flexion limited to, at most, 90 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 2. As of July 23, 2020, the Veteran's left hip disability resulted in flexion limited to, at most, 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 3. For the entire appeal period, the Veteran's right hip disability resulted in flexion limited to, at most, 50 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 4. Prior to January 13, 2015, the Veteran's left and right hip disabilities did not result in limitation of extension and, as of such date, resulted in left and right hip extension limited to, at most, 10 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 5. Prior to January 13, 2015, the Veteran's left and right hip disabilities did not result in limitation of abduction and, as of such date, resulted in left and right hip abduction limited to, at most, 20 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 6. For the entire appeal period, the Veteran's left and right hip disabilities did not result in limitation of adduction such that he cannot cross his legs or limitation of rotation such that he cannot toe-out more than 15 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, ankylosis, flail joint of the hip, or impairment of the femur. 7. Prior to June 4, 2019, the Veteran's left knee strain with degenerative joint disease is manifested by flexion limited to, at most, 105 degrees and extension limited to, at most, 5 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis; no more than slight lateral instability as of June 20, 2018; dislocated semilunar cartilage with frequent episodes of "locking" and effusion into the joint; symptomatic removal of semilunar cartilage; impairment of the tibia and fibula; or genu recurvatum. 8. As of August 1, 2020, the Veteran's total left knee arthroplasty did not result in chronic residuals consisting of severe painful motion or weakness, ankylosis, extension limited to at least 30 degrees, or impairment of the tibia and fibula. 9. Resolving all doubt in favor of the Veteran, for the entire appeal period where a 100 percent rating has not been assigned, his service-connected disabilities in combination rendered him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for an initial in excess of 10 percent prior to July 23, 2020, and in excess of 20 percent thereafter for left hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5252. 2. The criteria for an initial rating in excess of 10 percent for right hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5252. 3. As of January 13, 2015, but no earlier, the criteria for a separate noncompensable rating, but no higher, for left hip limitation of extension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.31, 4.40, 4.45, 4.59, 4.71a, DC 5251. 4. As of January 13, 2015, but no earlier, the criteria for a separate noncompensable rating, but no higher, for right hip limitation of extension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.31, 4.40, 4.45, 4.59, 4.71a, DC 5251. 5. As of January 13, 2015, but no earlier, the criteria for a separate noncompensable rating, but no higher, for left hip limitation of abduction have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.31, 4.40, 4.45, 4.59, 4.71a, DC 5253. 6. As of January 13, 2015, but no earlier, the criteria for a separate noncompensable rating, but no higher, for right hip limitation of abduction have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.31, 4.40, 4.45, 4.59, 4.71a, DC 5253. 7. The criteria for an initial rating in excess of 10 percent for left knee strain with degenerative joint disease prior to June 4, 2019, and in excess of 30 percent as of August 1, 2020, for total left knee arthroplasty have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5010-5260, 5055. 8. Prior to June 4, 2019, the criteria for a separate noncompensable rating, but no higher, for left knee strain with degenerative joint disease with limitation of extension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5261. 9. From June 20, 2018, to June 4, 2019, the criteria for a separate 10 percent rating, but no higher, for left knee strain with degenerative joint disease with slight lateral instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. 10. For the entire appeal period where a 100 percent rating has not been assigned, the criteria for entitlement to a TDIU based on service-connected disabilities in combination have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1969 to March 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in January 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2016, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In October 2018 and January 2021 for additional development. While on remand, a January 2021 rating decision awarded an increased rating of 20 percent for the Veteran's left hip limitation of flexion as of July 23, 2020. Thus, such issue has been recharacterized as shown on the title page of this decision. The case now returns for further appellate review. Increased Rating Claims Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 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. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 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; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. However, such regulations changes do not affect the DCs under which the Veteran's bilateral hip and left knee disabilities are rated. 1. Entitlement to an initial in excess of 10 percent prior to July 23, 2020, and in excess of 20 percent thereafter for left hip limitation of flexion. 2. Entitlement to an initial rating in excess of 10 percent for right hip limitation of flexion. 3. Propriety of the separately assigned rating for left hip limitation of extension, evaluated as noncompensably disabling as of November 19, 2019. 4. Propriety of the separately assigned rating for right hip limitation of extension, evaluated as noncompensably disabling as of November 19, 2019. 5. Propriety of the separately assigned rating for left hip limitation of abduction, evaluated as noncompensably disabling as of November 19, 2019. 6. Propriety of the separately assigned rating for right hip limitation of abduction, evaluated as noncompensably disabling as of November 19, 2019. For the entire appeal period stemming from April 16, 2012, the date service connection was established for the Veteran's bilateral hip strains with degenerative joint disease, he is currently in receipt of the following: (1) 10 percent rating prior to July 23, 2020, and a 20 percent rating thereafter for left hip limitation of flexion pursuant to DC 5252; (2) a 10 percent rating for right hip limitation of flexion pursuant to DC 5252; (3) noncompensable ratings as of November 19, 2019, for left and right hip limitation of extension pursuant to DC 5251; and (4) noncompensable ratings as of November 19, 2019, for left and right hip limitation of abduction pursuant to DC 5253. 38 C.F.R. §§ 4.31, 4.59, 4.71a. Normal range of hip motion is 125 degrees of flexion, 140 degrees of extension, and 45 degrees of abduction. 38 C.F.R. § 4.71, Plate II. DC 5251 provides that limitation of extension of the thigh to 5 degrees warrants a 10 percent rating. DC 5252 provides that limitation of flexion of the thigh to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. Flexion limited to 20 degrees warrants a 30 percent rating and flexion limited to 10 degrees warrants a 40 percent rating. DC 5253 provides that impairment of the thigh resulting in limitation of rotation of the affected leg such that the veteran cannot toe-out more than 15 degrees warrants a 10 percent rating. Impairment of the thigh resulting in limitation of adduction and an inability to cross legs warrants a 10 percent rating. Impairment of the thigh resulting in limitation of abduction and motion lost beyond 10 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a. In addition to the foregoing DCs, DC 5250 provides ratings for ankylosis of the hip, DC 5254 provides an 80 percent rating for flail joint of the hip, and DC 5255 provides ratings for impairment of the femur. In regard to the Veteran's reported bilateral hip symptoms, he indicated that such is manifested primarily by pain and stiffness, which results in less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing. Further, at the April 2016 Board hearing, the Veteran reported that he has flare-ups of the hips with deep pain that shoots across the hip and down the back of his leg, and avoids the stairs as much as possible because of his hips. He has also reported that his bilateral hip disabilities limit his ability to walk far and climb stairs. As pertinent to the Veteran's limitation of motion of the bilateral hips, a June 2012 VA examination revealed that, upon range of motion (ROM) testing, flexion was limited to 105 degrees with objective evidence of painful motion at such point. He had extension greater than 5 degrees, abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran cannot cross his legs, and rotation was not limited such that the Veteran cannot toe-out more than 15 degrees. The Veteran was able to perform repetitive use testing with three repetitions without additional limitation of motion. He also reported flare-ups that lasted up to three days and impacted the function of the hip, which was described as increased pain. At a November 2012 VA examination, ROM testing revealed right hip flexion to 110 degrees, which was reduced to 95 degrees following repetitive motion testing, and left hip flexion to 105 degrees, which was reduced to 90 degrees following repetitive motion testing, with objective evidence of painful motion. The Veteran had bilateral extension to 5 degrees without pain on the right and pain at zero degrees on the left, and abduction was lost beyond 10 degrees on the right, but not the left. However, following repetitive motion testing, which usually results in further reduction of ROM, the Veteran had extension to five degrees or greater and abduction was not lost beyond 10 degrees bilaterally. Further, adduction was not limited such that the Veteran could not cross his legs and rotation was not limited such that he cannot toe-out more than 15 degrees bilaterally, to include following repetitive motion testing. Moreover, the findings pertinent to limitation of extension and abduction are contradicted by the ROM findings from the June 2012 VA examination, conducted just five months previously, and all subsequent examinations. Consequently, in light of the internally inconsistent findings, as well as the contradiction with the remainder of the ROM findings, the Board affords the ROM findings pertaining to limitation of extension and abduction at the November 2012 no probative weight. The Veteran reported flare-ups that resulted in difficulty walking and standing. At a July 2014 VA examination, ROM testing revealed right hip flexion to 140 degrees and left hip flexion to 115 degrees, with objective evidence of painful motion. The Veteran had extension greater than 5 degrees, abduction was not lost beyond 10 degrees, and rotation was not limited such that he cannot toe-out more than 15 degrees; however, adduction was limited such that he cannot cross his legs. Nonetheless, the examiner noted that the Veteran's back and knee disabilities limited hamstring length and available range, and he had a relatively anterior right femur with abnormal activation of the surrounding hip musculature, which, in addition to the limitation from his total knee arthroplasty, limited his ability to cross his legs. Thus, such limitation was attributed to disabilities other than the Veteran's bilateral hips. There was no change in his ROM following repetitive use testing with the exception of right hip flexion, which was noted to be to 125 degrees or greater. The Veteran denied experiencing flare-ups of his bilateral hip disabilities, and the examiner indicated that the flare-ups noted at the November 2012 VA examination were due to his back and knee disabilities rather than his hip disabilities. He also found that it is less likely as not that there would be any additional limitation in function or ROM due to pain, weakness, fatigability, or incoordination during flare-ups or when either hip joint is used repeatedly over a period of time. A January 13, 2015, Disability Benefits Questionnaire (DBQ) completed by the Veteran's private physician revealed that, upon ROM testing of the right hip, the Veteran had flexion to 90 degrees, extension to 14 degrees, abduction to 30 degrees, adduction to 25 degrees, external rotation to 20 degrees, and internal rotation to 10 degrees with pain. Upon ROM of the left hip, the Veteran had flexion to 90 degrees, extension to 15 degrees, abduction to 30 degrees, adduction to 25 degrees, external rotation to 35 degrees, and internal rotation to 20 degrees with pain. No repetitive ROM testing was performed due to pain. However, the Veteran did not have pain in weight-bearing or nonweight-bearing, and denied experiencing flare-ups of his bilateral hip disabilities. At a November 19, 2019, VA examination, ROM testing of the right hip revealed flexion to 90 degrees, extension to 30 degrees, abduction to 25 degrees, adduction to 25 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees with pain, to include on weight-bearing, nonweight-bearing, and passive ROM. ROM testing of the left hip revealed flexion to 90 degrees, extension to 30 degrees, abduction to 20 degrees, adduction to 25 degrees, external rotation to 25 degrees, and internal rotation to 20 degrees with pain, to include on weight-bearing, nonweight-bearing, and passive ROM. Adduction of either hip was not limited such that the Veteran cannot cross his legs. There was no additional loss of ROM following repetitive use testing. The examiner found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time, but could not express whether there was additional loss of ROM. In this regard, he explained that, after a review of the Veteran's records, history, and complaints, and using his medical knowledge and expertise, he had no basis to offer additional loses of function or motion with repeated use over time. The Veteran denied experiencing flare-ups of his bilateral hip disabilities. At a July 23, 2020, VA examination, ROM testing of the right hip revealed flexion to 50 degrees, extension to 10 degrees, abduction to 20 degrees, adduction to 20 degrees, external rotation to 20 degrees, and internal rotation to 20 degrees with pain, but not on weight-bearing. ROM testing of the left hip revealed flexion to 30 degrees, extension to 10 degrees, abduction to 20 degrees, adduction to 20 degrees, external rotation to 20 degrees, and internal rotation to 20 degrees with pain, but not on weight-bearing. The examiner found that there was a poor effort given on ROM testing as normal ROM was observed during other portions of the examination. Specifically, he noted that the Veteran was able to sit upright in a chair with knees bent and feet on the floor, and was able to drive to the appointment. Passive and nonweight-bearing ROM was not performed as such was not medically appropriate. There was no additional loss of ROM following repetitive use testing. The Veteran reported severe flare-ups of his bilateral hip disabilities that occur daily and are manifested by increased pain. With respect to repeated use over time and during flare-ups, the examiner found that, although the Veteran reported functional impairment associated with such events, the current examination and medical record finds were inconsistent with a functional loss. Thus, he found that, while the Veteran would experience increased pain during such events, there was no further loss of ROM. Additionally, while the Veteran's treatment records reflect ongoing treatment for hip complaints, such do not contain ROM findings or suggest a greater degree of impairment than as reflected in the foregoing examination reports. Thus, based on the foregoing, the Board finds that, prior to July 23, 2020, the Veteran's left hip disability resulted in flexion limited to, at most, 90 degrees, and, as of such date, resulted in flexion limited to, at most 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Consequently, an initial rating in excess of 10 percent prior to July 23, 2020, and in excess of 20 percent thereafter for left hip limitation of flexion is not warranted under DC 5252. Similarly, based on the foregoing, the Board finds that, for the entire appeal period, the Veteran's right hip disability resulted in flexion limited to, at most, 50 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Consequently, an initial rating in excess of 10 percent for right hip limitation of flexion is not warranted under DC 5252. As pertinent to the propriety of the separately assigned ratings for right and left hip limitation of extension pursuant to DC 5251, evaluated as noncompensably disabling as of November 19, 2019, the Board observes that, outside of the nonprobative November 2012 VA examination, the Veteran first exhibited limitation of extension at the January 13, 2015 DBQ when such was noted to be limited to 14 degrees on the right and 15 degrees on the left. Consequently, the Board finds that the separate ratings for limitation of extension of the bilateral hips are warranted as of such date. However, at such time, and at all subsequent VA examinations, such has not been shown to be limited to 5 degrees. Rather, the Veteran's bilateral hip extension has been limited to, at most, 10 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Consequently, compensable ratings for such disabilities is not warranted. See 38 C.F.R. § 4.31 (in every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met). As pertinent to the propriety of the separately assigned ratings for right and left hip limitation of abduction pursuant to DC 5253, evaluated as noncompensably disabling as of November 19, 2019, the Board observes that, outside of the nonprobative November 2012 VA examination, the Veteran first exhibited limitation of abduction at the January 13, 2015, DBQ when such was noted to be limited to 30 degrees bilaterally. Consequently, the Board finds that the separate ratings for limitation of abduction of the bilateral hips are warranted as of such date. However, at such time, and at all subsequent VA examinations, such has not been shown to be limited to 10 degrees, i.e., lost beyond such point. Rather, the Veteran's bilateral hip abduction has been limited to, at most, 20 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Consequently, compensable ratings for such disabilities is not warranted. See 38 C.F.R. § 4.31. Furthermore, the Veteran's bilateral hip disabilities are not shown to result in limitation of adduction such that he cannot cross his legs or limitation of rotation such that he cannot toe-out more than 15 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. As noted previously, while the former was noted at the July 2014 VA examination, such was attributed to disabilities other than the Veteran's bilateral hips, and such limitations are not otherwise shown. Thus, a compensable rating under DC 5253 based on such factors is not warranted at any time during the appeal period. Furthermore, at the June 2012, November 2012, July 2014, November 2019, and July 2020 VA examinations, and January 2015 DBQ, there was no ankylosis, flail joint of the hip, or malunion or nonunion (impairment) of the femur. Consequently, higher and/or separate ratings are not warranted under DCs 5250, 5254, or 5255. 7. Entitlement to an initial rating in excess of 10 percent for left knee strain with degenerative joint disease prior to June 4, 2019, and in excess of 30 percent as of August 1, 2020, for total left knee arthroplasty. For the appeal period prior to June 4, 2019, the Veteran's left knee disability, characterized as left knee strain with degenerative joint disease, is rated as 10 percent disabling pursuant to DC 5010-5260. Following a total left knee arthroplasty on such date, he was assigned a 100 percent rating until August 1, 2020, at which time such disability was rated as 30 percent disabling pursuant to DC 5055. For the appeal period prior to June 4, 2019, DC 5010 pertains to traumatic arthritis and is evaluated as degenerative arthritis. Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. DC 5003 provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. In the absence of limitation of motion, DC 5003 provides for a 10 percent rating with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating under DC 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5260 provides for a zero percent rating where flexion of the leg is only limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. For a 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees a 50 percent rating may be assigned. VA's General Counsel has also stated that separate ratings under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). DC 5055 provides that, for one year following implantation of knee prosthesis for a service-connected knee disability, a 100 percent rating is assigned. Thereafter, a 60 percent rating is assigned when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity; or, a minimum 30 percent rating is assigned. When there are intermediate degrees of residual weakness, pain, or limitation of motion, these intermediate residuals are to be rated by analogy under DCs 5256 (ankylosis), 5261 (limitation of extension), or 5262 (impairment of tibia and fibula). 38 C.F.R. § 4.71a. In regard to the Veteran's reported left knee symptoms for the period prior to June 4, 2019, he indicated that such is manifested primarily by pain and swelling, which results in less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, disturbance of locomotion, and interference with sitting, standing, or weight-bearing. As pertinent to the Veteran's limitation of motion of the left knee for such period, a February 2012 VA examination, which was conducted in regard to the Veteran's right knee, revealed flexion to 135 degrees and extension to zero degrees without objective evidence of pain. There was no additional loss of ROM following repetitive use testing. At a June 2012 VA examination, ROM testing revealed left knee flexion to 125 degrees and extension to 5 degrees with objective evidence of pain. There was no additional loss of ROM following repetitive use testing. The Veteran reported flare-ups of his left knee disability described as spasms, increased pain, and cramping. At a November 2012 VA examination, ROM testing revealed left knee flexion to 120 degrees and extension to 5 degrees with objective evidence of pain. There was no additional loss of ROM following repetitive use testing. The Veteran reported flare-ups of his left knee disability resulting in difficulty standing, walking, to include on uneven ground, and climbing stairs. At a July 2014 VA examination, ROM testing revealed left knee flexion to 105 degrees with objective evidence of pain and extension to zero degrees without objective evidence of pain. There was no additional loss of ROM following repetitive use testing; rather, the Veteran's flexion increased to 110 degrees. The Veteran reported flare-ups only in regard to his right knee disability. The examiner stated that it is less likely than not that there would be any additional limitation in function or ROM due to pain, weakness, fatigability, or incoordination during flare-ups or when the left knee joint was repeatedly used over a period of time. A January 2015 DBQ completed by the Veteran's private physician revealed that, upon ROM testing of the left knee, the Veteran had flexion to 138 degrees and extension to 2 degrees with pain on active and passive ROM testing, weight-bearing, and nonweight-bearing. There was no additional loss of ROM following repetitive use testing. The Veteran reported flare-ups described as episodic knee pain and instability, but did not specify the affected knee. Nonetheless, the Board notes that the private physician noted a diagnosis of right knee instability in connection with such examination, and the Veteran's left knee was stable on examination. At a May 2015 VA examination, which was conducted in regard to the Veteran's right knee, ROM testing revealed left knee flexion to 125 degrees and extension to 5 degrees with objective evidence of pain. However, there was no pain on weight-bearing. There was no additional loss of ROM following repetitive use testing. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time, and the Veteran denied experiencing flare-ups. On June 27, 2017, an MRI showed that the anterior and posterior cruciate, and medial and lateral collateral, ligaments were of normal signal intensity and morphology. The quadriceps and patellar tendons were intact. The medial meniscus demonstrated a complex tear in the posterior horn with parameniscal cysts, and the lateral meniscus demonstrates diffuse maceration in the body and posterior horn. On June 20, 2018, it was noted that the Veteran had a history of meniscal surgery in the remote past. MRI showed partial ACL and meniscal tears. On examination, there was no swelling, erythema, and effusion. ROM was from zero to 120 degrees. Anterior drawer and posterior drawer tests were negative. The Veteran had no laxity at the LCL, but had mild laxity at the MCL. In October 2018, the Veteran reported that his left knee keeps giving out and he had fallen twice. In December 2018, it was noted that he had left knee patellofemoral compartment osteoarthritis with meniscal and ACL tears, with a remote history of left meniscal surgery. On examination, there was no swelling, erythema, and effusion. ROM was from zero to 120 degrees. Anterior drawer and posterior drawer tests were negative. The Veteran had no laxity at the LCL, but had mild laxity at the MCL. An MRI showed a partial tear of the ACL, degenerative changes, and complex tear of the lateral meniscus with partial tear of the posterior root. In February 2019, the Veteran continued to report left knee instability with falls. He was evaluated for a brace with patella-tracking. In March 2019, he reported weakness of the left lower extremity resulting in falls. Upon examination of the left knee, the Veteran had no palpable effusion. Varus and valgus stress testing, and anterior and posterior drawer testing, were negative. Thus, the Veteran's physician found that it was unclear if the etiology of the Veteran's left knee "giving out" is solely mechanical due to his knee or if there was ongoing left-sided radiculopathy due to his back disability. However, an MRI revealed the Veteran had a macerated medial and lateral menisci, and partial tears and sprains of the anterior cruciate ligament and posterior cruciate ligament. In April 2019, it was noted that the Veteran had known osteoarthritis of the left knee with a superimposed left ACL injury resulting in a painful and unstable knee. He also had a previous arthroscopy to debride his menisci. On examination, he had anterior and posterior instability, but there was no medial lateral instability. Ultimately, he elected to undergo a total knee arthroplasty, which was performed on June 4, 2019. Additionally, while the remainder of the Veteran's treatment records reflect ongoing treatment for left knee complaints, such do not contain ROM findings or suggest a greater degree of impairment than as reflected in the foregoing examination reports. Thus, based on the foregoing, the Board finds that, prior to June 4, 2019, the Veteran's left knee disability resulted in flexion limited to, at most, 105 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Consequently, an initial rating in excess of 10 percent prior to June 4, 2019, is not warranted under DC 5260. As pertinent to whether a higher or separate rating is warranted under DC 5261, the Board observes that the Veteran's left knee disability resulted in extension limited to at most, 5 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, which is consistent with a noncompensable rating. However, as such is not limited to 10 degrees, a compensable rating is not warranted. Thus, the Board finds that, for the entire appeal period prior to June 4, 2019, a separate noncompensable rating, but no higher, for limitation of extension of the Veteran's left knee is warranted under DC 5261. VAOPGCPREC 9-04. The Board further notes that, at February 2012, June 2012, November 2012, July 2014, and May 2015 VA examinations, and January 2015 DBQ, there was no ankylosis, stability testing was normal, there was no evidence or history of recurrent patellar subluxation/dislocation, and the Veteran did not have any meniscal conditions. However, on June 27, 2017, an MRI showed that the medial meniscus demonstrated a complex tear in the posterior horn with parameniscal cysts, and the lateral meniscus demonstrated diffuse maceration in the body and posterior horn, thereby representing dislocated semilunar cartilage. In this regard, under DC a 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. However, while the Veteran demonstrated a torn meniscus as of such date, the record does not demonstrate locking or effusion into the joint. Furthermore, the Veteran's left knee pain is already contemplated in the currently assigned rating under DC 5260. Thus, assigning a separate rating based on the same symptomatology would be tantamount to pyramiding and is prohibited by law. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Furthermore, while records show a remote history of a meniscectomy, such did not occur during the appeal period and no residuals of such have been shown. Consequently, a separate rating under DC 5259 for symptomatic removal of semilunar cartilage is likewise not warranted. Furthermore, while all stability testing was normal at the aforementioned VA examinations and DBQs, and the June 2017 MRI revealed showed that normal signal intensity and morphology of the anterior and posterior cruciate, and medial and lateral collateral, ligaments, and the quadriceps and patellar tendons were intact, on June 20, 2018, an MRI showed a partial ACL tear. However, anterior drawer and posterior drawer tests were negative and the Veteran had no laxity at the LCL. Nonetheless, as he had mild laxity at the MCL, the Board finds that a separate rating of 10 percent, but no higher, is warranted for slight lateral instability under DC 5257 as of such date. In this regard, such is shown to be manifested by no more than mild laxity at the MCL resulting in instability and falls. However, absent evidence of moderate lateral instability, a higher rating unde such DC is not warranted. Furthermore, as the evidence of record does not demonstrate ankylosis, impairment of the tibia or fibula, or genu recurvatum at any time prior to June 4, 2019, DCs 5256, 5262, and 5263 are not for application. As of June 4, 2019, the date the Veteran underwent a total left knee arthoplasty, he was awarded a 100 percent rating pursuant to DC 5055. As of August 1, 2020, a 30 percent rating under such DC was awarded. In this regard, for such portion of the appeal period, the Board notes that a November 2019 VA examination, which was performed six months after the Veteran's total knee arthroscopy and while he was in receipt of a 100 percent rating, revealed that, upon ROM testing of the left knee, flexion was to 110 degrees and extension was to zero degrees with pain, to include on passive ROM and with weight-bearing and nonweight-bearing. There was no additional loss of ROM following repetitive use testing. However, the examiner estimated that the Veteran's flexion would be further limited to 100 degrees following repeated use over time. No additional loss of extension was estimated to occur at such time, and no additional ROM was estimated to occur during a flare-up. The Veteran had 5/5 muscle strength on left knee flexion and extension, and there was no ankylosis. The examiner found that the Veteran's left total knee replacement resulted in intermediate degrees of residual weakness, pain, or limitation of motion without chronic residuals consisting of severe painful motion or weakness. At a July 2020 VA examination, which was performed just prior to the assignment of a 30 percent rating, revealed that, upon ROM testing of the left knee, flexion was to 30 degrees and extension was to zero degrees with pain, but not on weight-bearing. Passive and nonweight-bearing ROM was not performed as such was not medically appropriate. There was no additional loss of ROM following repetitive use testing. The Veteran reported severe flare-ups of his left knee disability that occur daily and are manifested by increased pain and weakness. With respect to repeated use over time and during flare-ups, the examiner found that, although the Veteran reported functional impairment associated with such events, the current examination and medical record finds were inconsistent with a functional loss. Thus, he found that, while the Veteran would experience increased pain during such events, there was no further loss of ROM. The Veteran had 5/5 muscle strength on left knee flexion and extension, and there was no ankylosis. The examiner found that the Veteran's left total knee replacement resulted only in intermittent pain, without intermediate degrees of residual weakness, pain, or limitation of motion or chronic residuals consisting of severe painful motion or weakness. Additionally, while the Veteran's treatment records reflect ongoing treatment for left knee complaints, such do not contain ROM findings or suggest a greater degree of impairment than as reflected in the foregoing examination reports. Therefore, based on the foregoing, the Board finds that the Veteran's left total knee did not result in chronic residuals consisting of severe painful motion or weakness, ankylosis, extension limited to at least 30 degrees, or impairment of the tibia and fibula. In this regard, while he reported weakness of the left knee, his strength was normal on examination in November 2019 and July 2020. Furthermore, the Veteran had no ankylosis or limitation of extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, or impairment of the tibia and fibula. Consequently, a rating in excess of 30 percent under DC 5055 for the Veteran's left knee disability as of August 1, 2020, is not warranted. Other Considerations Additionally, the Board has contemplated whether this case should be referred for extra-schedular consideration. Specifically, at the April 2016 Board hearing, the Veteran's representative raised the issue of whether the Veteran's bilateral hip and left knee disabilities warrant referral for extra-schedular consideration, but did not describe the symptoms and/or functional impairment that prompted such argument. In this regard, an extra-schedular disability rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court explained how the provisions of 38 C.F.R. § 3.321 are applied. Specifically, the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under 38 § 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. Id. In the October 2018 and January 2021, the Board remanded the case for the Agency of Original Jurisdiction (AOJ) to consider whether extra-schedular referral to the Director of Compensation Service was warranted in the readjudication of the Veteran's claims. In the January 2021 supplemental statement of the case, the AOJ found that the evidence of record did not indicate that the Veteran's disability presented an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent period of hospitalization to render impractical the application of the regular rating schedule standards. The Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected bilateral hip and left knee disabilities with the established criteria found in the rating schedule. However, he Board finds that the Veteran's symptomatology is fully addressed by the rating criteria under which such disabilities is rated. Here, the Veteran's bilateral hip disabilities are manifested by subjective complaints of pain and stiffness with limitation of ROM, which result in functional impairment as previously noted. However, such symptoms are specifically contemplated by the currently assigned ratings under DCs 5251, 5252, and 5253. Similarly, the Veteran's left knee disability is manifested by subjective complaints of pain and swelling with limitation of ROM, a meniscal tear as of June 2017, instability as of June 2018, and a total knee arthroplasty as of June 4, 2019, which result in functional impairment as previously noted. However, such symptoms are specifically contemplated in the currently assigned ratings under DCs 5260, 5257, and 5055. Thus, the most probative evidence of record indicates that the Veteran's documented symptoms and their resulting impairment are contemplated by the rating schedule. Consequently, the Board finds that the schedular rating criteria reasonably describes the Veteran's disability level and symptomatology of his service-connected bilateral hip and left knee disabilities. As such, the Board finds that the rating schedule is adequate to evaluate the Veteran's disability picture in regard to his bilateral hip and left knee disabilities. Consequently, the Board concludes that referral of this case for consideration of an extra-schedular rating is not warranted. Thun, supra; Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). In reaching its conclusions in the instant case, the Board acknowledges the Veteran's belief that his bilateral hip and left knee disabilities are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Thus, assigning additional staged ratings for such disabilities is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine, which has resulted in partial awards of separate ratings for the Veteran's bilateral hip and left knee disabilities. However, insofar as the Board has denied higher or separate ratings for the disabilities on appeal, the preponderance of the evidence is against such aspects of the Veteran's claims. Thus, the benefit of the doubt doctrine is not applicable in such regard and his initial rating claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 8. Entitlement to a TDIU. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 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. 38 C.F.R. § 4.16(a). Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16 (a). Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. Id. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran's education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran's experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran's 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran's master's degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means 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. The non-economic component includes consideration of the veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. As of April 16, 2012, the date service connection was awarded for the disabilities on appeal and without consideration of the ratings assigned for the disabilities awarded herein, the Veteran has been assigned a 100 percent schedular rating with the exception of the following periods: November 1, 2012, to March 31, 2014; May 1, 2015, to June 8, 2015; January 1, 2016, to July 14, 2017; and September 1, 2017, to June 4, 2019, where he is in receipt of a combined disability rating of 90 percent. Thus, he has met the schedular criteria for a TDIU for the entire appeal period. Furthermore, he has been awarded SMC at the housebound rate for the following periods: September 18, 2012, to November 1, 2012; March 31, 2014, to May 1, 2015; June 8, 2015, to January 1, 2016; July 14, 2017, to September 1, 2017; and June 4, 2019, to July 31, 2020. Thus, a TDIU for such periods is moot. In this regard, VA has a "well-established" duty to maximize a claimant's benefits. Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. See Bradley at 294 (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"). Subsection 1114(s) requires that a disabled veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for SMC provided by that statute. Under the law, subsection 1114(s) benefits are not available to a veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. For SMC purposes, a TDIU based on a single service-connected disability satisfies the requirement of a "service-connected disability rated as total." See Buie at 251; Bradley at 293. Therefore, the claim of entitlement to a TDIU based on all service-connected disabilities for the periods from November 1, 2012, to March 31, 2014; May 1, 2015, to June 8, 2015; January 1, 2016, to July 14, 2017; and September 1, 2017, to June 4, 2019, and based on a single disability from April 16, 2012, to September 18, 2012, and as of August 1, 2020, is properly before the Board. For the entire appeal period, the Veteran is in receipt of service connection for bilateral knee, back, and bilateral hip disabilities, radiculopathy of the bilateral lower extremities and right knee scar as of September 18, 2012, and a psychiatric disability, characterized as adjustment disorder with anxiety and depressed mood, as of February 13, 2020. At the April 2016 Board hearing, the Veteran alleged that his service-connected orthopedic disabilities, to include his bilateral hip and left knee disabilities, rendered him unemployable. In this regard, he reported that he last worked in 2010 or 2012 as a carpenter. Further, in a February 2020 TDIU application, the Veteran again alleged that his orthopedic disabilities consisting of his back, bilateral knee, and bilateral hip disabilities prevent him from securing or following any substantially gainful occupation. He reported that he previously worked on a full-time basis from June 1975 to December 1, 2010, at which time he retired following a total right knee replacement, as a self-employed wood worker. At a June 2012 RO hearing, the Veteran reported that he finished high school and went to an opportunity school for seven and a half years as a machine tool designer. He further reported that he did custom woodworking for high-end residential homes, as well as limited production projects and architectural mill work. The Veteran stated that he could not handle the physical weight of his projects, some of which weighed several hundred pounds. He indicated that he quit working about two years ago and completely closed down his company a year and a half ago. In a March 2013 Rehabilitation Needs Inventory, completed for VA's Veteran Readiness and Employment Services program, the Veteran reported that he was the full-time owner of a woodworking company from June 1983 to May 2010. He stated that he did all of the design work, and led four employees. He stated that he left such employment because his right knee completely failed, and he could no longer stand. He also reported difficulty climbing stairs or ladders and lifting weights. He reported that he had a high school education, and he completed training in machine tool design. A May 2013 letter states that the Veteran's vocational rehabilitation was suspended because he was pursuing a business venture that summer, and he was unable to complete the required evaluation. In a June 2015 VA Occupational Therapy Consult, the Veteran reported that he is typically independent with activities of daily living, but he needs assistance for the physically demanding activities of daily living. His spouse did the household tasks, and they both drive. The Veteran reported that he was a semi-retired woodworker. He lost his shop with the medical challenges of the past few years, and he was doing word-of-mouth jobs with the equipment he had in his garage. In a March 2020 Rehabilitation Needs Inventory, the Veteran expressed his desire to improve his skills with 2-D and 3-D AutoCAD software. He reported that he worked as a woodworker from 1991 to 2010, and he left his job because his injuries from active service had worsened; however, he subsequently declined to receive VA's vocational and educational services. At a June 2020 VA examination for the Veteran's mental disorder, he reported that he graduated high school in 1969 and enlisted in the Army that September. After leaving service, the Veteran worked for 18 months for a department store doing retail work. In 1975, he started his own business doing housing remodeling work, and he eventually got involved in building new homes. In 2010, he needed to declare bankruptcy because he could not stand anymore due to problems with both knees. Since then, the Veteran had done some intermittent carpentry and helped friends remodel their homes, and last worked about three years ago. In regard to the functional impairment associated with the Veteran's bilateral hip disabilities, a June 2012 VA examiner found that such impacted his ability to work insofar as he had difficulty moving. At a July 2014 VA examination, the examiner stated that the Veteran's bilateral hip disabilities did not impact his ability to work, and his private physician indicated that such did impact his ability perform occupational tasks, but did not provide a description of the limitations. At the April 2016 Board hearing, the Veteran reported that he avoids the stairs as much as possible. At a November 2019 VA examination, the examiner found that the Veteran's bilateral hip disabilities impacted his ability to perform occupational tasks in that such caused weight-bearing hip pain that interfered with ambulation and using the stairs; however, the July 2020 VA examiner found that such disabilities did not impact his ability to perform occupational tasks. As pertinent to the functional impairment associated with the Veteran's bilateral knee disabilities, in May 2012, the Veteran's physician noted that he was unable to work full-time due to his right knee disability as he could not stand in a woodshop full time. Thus, he found that the Veteran would be unemployable until his next right knee surgery was performed. At a June 2012 RO hearing, the Veteran reported, when he sits, he has to continually stretch his right knee out every now and then, and he can walk two blocks before he is forced to stop because of pain. He noted that going down the stairs is worse than going up the stairs. The Veteran also stated that he does a little bit of yard work, but he cannot get up and down on his knees, and uses a self-propelled lawn mower. The Veteran reported that he worked as a woodworker and carpenter for 42 years, and when he was doing his job, his knee would sometimes give out and cause him to fall. He stated that he lost his job and his house because he could not work as a result of his knee. He can drive a vehicle, but he does not do well on long trips. He reported that he used his stationary bike every day, and he had been doing exercises to strengthen his knee. At the June 2012 RO hearing, a fellow woodworker testified that he had seen the Veteran have pain going up the stairs, and stated that he could not do the physically demanding part of the woodworking job, which involved standing most of the day and pushing boards through machines, as well as lifting, carrying, and moving things on carts. However, he stated that the Veteran would now be able to do consulting work because he has been in the business for so long and knows it well. At a June 2012 VA examination, the VA examiner stated that the Veteran's bilateral knee disabilities impacted his ability to work in that he had difficulty walking and he was unable to run, squat, or bend, and he was unable to hold a full-time job. Following his second right total knee arthroplasty in September 2012, a November 2012 VA treatment record reflected that he worked as a contractor in construction making cabinets, and he could not kneel or do the things he needed to do to be employed and, thus, was unemployed. In a June 2013, the Veteran stated that he had worked as a carpenter, which is a very physical job, and he was unable to pursue such occupation as a carpenter as he cannot lift, bend, or stoop as a result of knee, hip, and back problems. The examiner stated that he would find the Veteran unable to maintain gainful employment in his chosen field. The examiner noted that he is also going to have difficulty sitting for prolonged periods in school. Thus, in September 2013, it was found that the Veteran was not able to do the work he used to do, and he would not be able to go back to school at this time. In June 2014, the Veteran's physician opined that it did not seem feasible that the Veteran would be able to kneel and crawl to an extent that would allow for gainful employment, and he was unable to pursue gainful employment as a cabinetmaker. In a June 2014 letter, the Veteran's private physician, Dr. LJ, stated that the Veteran continued to experience lower back and hip pain, which prevented him from being able to work and, at times impeded his daily functioning and mobility due to its severity. In this regard, Dr. LJ noted that the Veteran was unable to kneel, which was an important position for him due to the nature of his work as a carpenter. He further opined that, given the Veteran's compensatory patterns and learned behavior of pain avoidance with his right knee, along with his knee flexion of less than 120, his right knee has contributed to his chronic low back and hip pain issues, and he would be unable to return to working as a carpenter at full capacity. At a July 2014 VA examination, the examiner did not address the functional impact of the Veteran's bilateral knee disabilities. In a December 2014 letter, another private physician, Dr. LL, stated that the Veteran has not been able to work as a carpenter, he complained of difficulty with walking and standing due to lower back pain, and lifting and kneeling were limited. The January 2015 DBQ reflects the Veteran's physician's assessment that such disabilities impacted his ability to work in that he could not walk on uneven surfaces, and could not squat, crawl, or climb. At a May 2015 VA examination, the examiner found that the Veteran's bilateral knee disabilities impacted his ability to perform occupational tasks in that he cannot climb ladders with heavy loads, and had limitations with crouching and being on his knees. He found that stated the Veteran could do sedentary work. At a July 2015 VA examination, it was found that the Veteran's right knee disorder impacted his ability to perform occupational tasks in that he is unable to walk on uneven ground or climb the stairs, and could only walk one and a half blocks without knee pain. In November 2015, the VA examiner stated that the Veteran's knee disability would cause decreased ability to climb, kneel, or walk on uneven surfaces. Additionally, prolonged walking, sitting, or standing would be compromised. At the April 2016 Board hearing, the Veteran reported that could no longer stand on concrete, carry excess weight, or go up and down ladders. At a November 2019 VA examination, the examiner found that the Veteran's bilateral knee disabilities impacted his ability to perform occupational tasks in that such caused weight-bearing knee pain, which interfered with ambulation, prolonged standing, and using stairs. In July 2020, the VA examiner found that the Veteran's bilateral knee disabilities did not impact his ability to perform occupational tasks. As pertinent to the Veteran's right knee scar, which is service-connected as of September 18, 2012, VA examinations conducted in July 2015 and November 2019 found that such did not impact his ability to work. In regard to the Veteran's back disability, with associated radiculopathy of the bilateral lower extremities as of September 18, 2012, a June 2012 VA examiner found that such disability impacted his ability to work in that he had difficulty working or lifting any weight. At a July 2014 VA examination, the examiner found that the Veteran's back disability did not impact his ability to work; rather, he determined that his right knee affected his ability to work. A January 2015 DBQ reflects the Veteran's physician's determination that the Veteran's back disability impacted his ability to perform occupational tasks in that he could not lift, bend, squat, climb, or crawl. He could not lift over 5lbs, and he could not walk on uneven ground. In April 2015, the Veteran reported that he cannot walk much due to his back disability and associated radiculopathy, which inhibited him from doing his normal work as a carpenter. At a July 2015 VA examination, the VA examiner found that the Veteran's back disability impacted his ability to work as needed to avoid all lifting, could only walk one block at a time during an eight-hour day, and could only sit or stand less than 20 minutes at a time during an eight-hour day. At a December 2015 VA examination, the examiner found that the Veteran's back disability impacted his ability to work in that reported that he closed his wood-working shop three years ago due to back problems. The examiner noted that the Veteran currently had a post-operative lifting restriction and signs of claudication that would restrict him to sedentary work with frequent breaks and sitting, standing, or walking to 30-45 minutes at a time. The examiner opined that, at this point in time, he would not be able to tolerate full-time work and will likely not be able to return to such in the future. In this regard, in February 2016, the Veteran reported that he had tried to get back to work, but he could not get through the day. At a September 2016 VA examination, the examiner found that the Veteran's back disability impacted his ability to work. In this regard, he stated that the Veteran would be poorly suited for occupations that require traversing more than one flight of stairs per day, walking on uneven terrain, sitting for longer than five to seven minutes without the option to reposition, continuously standing for longer than two minutes, walking for longer than 10 minutes, or lifting more than 10lbs. In July 2017, a VA examiner noted that the Veteran's back disability impacted his ability to work in that he could not do any manual labor and would also not be able to sit at a desk. At a July 2020 VA examination, the examiner found that the Veteran's back disability did not impact his ability to work. Finally, in regard to the Veteran's psychiatric disability, which is service-connected as of February 13, 2020, a June 2020 VA examiner found that such is manifested by mild to moderate symptoms of depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, and resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Board further notes that the November 2012 VA examiner found that the Veteran's physical disabilities resulted in an inability to lift more than 20lbs, sit for more than one hour, stand for more than 10 minutes, or walk for more than 15 minutes. He also required assistance climbing stairs. However, the VA examiner noted that the Veteran was capable of performing sedentary work for eight hours, but must change position every 30 to 45 minutes or as needed. Nonetheless, he could safely perform grasping, gripping, reaching overhead, and/or keyboard work. Similarly, a May 2015 VA examiner found that the Veteran could perform sedentary work and a November 2019 VA examiner found that it is at least as likely as not that the Veteran is able to perform sedentary work, which was defined as sitting most of the time and may involve occasional walking or standing for brief periods of time, in a normal eight-hour workday, exerting up to 10lbs of force occasionally or negligible amounts of force frequently to lift, carry, push, or pull. However, additional evaluations reflect a greater degree of limitation in regard to the Veteran's ability to work in a physical or sedentary capacity. Specifically, such reflect that he has difficulty walking; is unable to crawl, lift, bend, stoop, run, squat, kneel, or bend; and cannot lift more than 5lbs. Moreover, treatment records dated in 2013 reflect the finding that the Veteran would have difficulty sitting for prolonged periods in school, and thus he would not be able to go back to school at such time. Moreover, the July 2015 VA examiner found that the Veteran needed to avoid all lifting, could only walk one block at a time during an eight-hour day, and could only sit or stand for less than 20 minutes at a time during an eight-hour day. Further, the November 2015 VA examiner found that prolonged walking, sitting, or standing would be compromised and the December 2015 VA examiner determined that the Veteran would be restricted to sedentary work with frequent breaks and sitting, standing, or walking limited to 30-45 minutes at a time. Moreover, the latter examiner opined that he would not be able to tolerate full-time work and will likely not be able to return to such in the future. Furthermore, the September 2016 VA examiner found that the Veteran would be poorly suited for occupations that require traversing more than one flight of stairs per day, walking on uneven terrain, sitting for longer than five to seven minutes without the option to reposition, continuously standing for longer than two minutes, walking for longer than 10 minutes, or lifting more than 10lbs, and, in July 2017, a VA examiner found that he could not do any manual labor and would also not be able to sit at a desk. Thus, based on the foregoing, the Board resolves all doubt in favor of the Veteran, and finds that, for the entire appeal period where a 100 percent rating has not been assigned, his service-connected disabilities in combination rendered him unable to secure or follow a substantially gainful occupation consistent with his education and work history. In this regard, the evidence of record indicates that the Veteran has a high school education and, while he does not have a college education, he successfully ran his own business for over 30 years. He did all the design work in his woodworking business, and led four employees. The primary reason he was not able to maintain employment as a carpenter in his woodworking business was because of the extensive physical demands of the job. Furthermore, while he has experience in managing his own business and possibly consulting in the carpentry industry as suggested at the June 2012 RO hearing, the Board finds that the evidence is in relative equipoise as to his ability to work in a sedentary capacity, defined by the November 2019 VA examiner as sitting most of the time and may involve occasional walking or standing for brief periods of time. Specifically, while some examiners found that such ability was not compromised so long as he could change positions frequently, other examiners found that his ability to sit was compromised to the point where he could only do so for five to seven minutes at a time or he was rendered unable to work entirely in a sedentary capacity. Moreover, in reaching such determination, the Board notes that the Veteran has reported that he had done some intermittent carpentry and helped friends remodel their homes in the time period since he last worked full-time in December 2010; however, the Board finds that, due to the informal and intermittent nature of such reported work, as well as the question of whether he received any compensation for his work, such is no more than marginal in nature. Thus, the Board finds that, for the entire appeal period where a 100 percent rating has not been assigned, the criteria for entitlement to a TDIU based on service-connected disabilities in combination have been met and the appeal is granted to such extent. However, the Board finds that, for the periods where a 100 percent rating is in effect and SMC at the housebound rate has not been awarded, a single service-connected disability did not render the Veteran unable to secure and follow a substantially gainful occupation consistent with his education and work history. Specifically, as discussed at length previously, his inability to work is based on a combination of his bilateral hip, bilateral knee, and back disabilities, and it is not shown that any single disability resulted in the foregoing limitations that precluded employment. Consequently, a TDIU based on a single service-connected disability is not warranted. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.