Citation Nr: 21042380 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 05-15 410 DATE: July 12, 2021 ORDER For the period prior to September 29, 2010, entitlement to a rating in excess of 20 percent for a left knee disability with loss of motion due to degenerative joint disease (rated based on episodes of locking, pain, and effusion into the joint) is denied. For the period prior to September 29, 2010, entitlement to a rating in excess of 30 percent for left knee instability is denied. For the period from November 1, 2011 to November 15, 2017, entitlement to a rating in excess of 30 percent for residuals of total left knee arthroplasty is denied. For the period from November 15, 2017, entitlement to a rating in excess of 60 percent for residuals of total left knee arthroplasty is denied. For the period from October 30, 2002 to November 1, 2011, entitlement to extraschedular total disability based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. Prior to September 29, 2010, the Veteran's left knee disability was manifested by episodes of locking, pain, and effusion into the joint. 2. Prior to September 29, 2010, the Veteran's left knee disability was manifested by severe left knee instability. 3. From November 1, 2011 to November 15, 2017, the Veteran's total left knee arthroplasty was manifested by residuals of intermediate degrees of residual weakness, pain or limitation of motion. 4. From November 15, 2017, the Veteran's total left knee arthroplasty was manifested by chronic residuals of severe painful motion or weakness in the affected extremity. 5. From October 30, 2002 to November 1, 2011, the Veteran was precluded from engaging in substantially gainful employment due to his service-connected disabilities. CONCLUSIONS OF LAW 1. Prior to September 29, 2010, the criteria for entitlement to a rating in excess of 20 percent for a left knee disability with loss of motion due to degenerative joint disease (rated based on episodes of locking, pain, and effusion into the joint) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 5010-5258. 2. Prior to September 29, 2010, the criteria for entitlement to a rating in excess of 30 percent for left knee instability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 5257. 3. From November 1, 2011 to November 15, 2017, the criteria for entitlement to a rating in excess of 30 percent for residuals of total left knee arthroplasty have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 5055. 4. From November 15, 2017, the criteria for entitlement to a rating in excess of 60 percent for residuals of total left knee arthroplasty have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 5055. 5. From October 30, 2002 to November 1, 2011, the criteria for entitlement to extraschedular TDIU due to service-connected disabilities have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1969 to November 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from October 2003 and January 2004 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The appeal was last remanded by the Board in May 2020 for additional development. A review of the claims file shows that there has been substantial compliance with the Board's prior remand directives and thus, no further action in this regard is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Ratings 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 appellant working or seeking work. 38 C.F.R. § 4.2. 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. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). With the initial rating assigned with the award of service connection for a disability, "staged" ratings to reflect distinct periods when different levels of impairment were shown are for consideration. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). 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. 38 C.F.R. § 4.59. As such, painful motion should be considered to determine whether a higher rating is warranted on such basis, whether or not arthritis is present. See Burton v. Shinseki, 25 Vet. App. 1 (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 non-weight-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 Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). When determining the severity of musculoskeletal disabilities, which are at least partly-rated on the basis of range of motion, VA must also consider the extent the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated due to the extent of pain/painful motion, limited or excess movement, weakness, incoordination, and premature/excess fatigability, etc., particularly during times when symptoms "flare up," such as during prolonged use, and assuming these factors are not already contemplated in the governing rating criteria. See DeLuca v. Brown, 8 Vet. App. 202 (1995), see also 38 C.F.R. §§ 4.40, 4.45, 4.59. 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. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. 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. Prior to February 7, 2021, Diagnostic Code 5055, which governs knee replacement (prosthesis), provides that for one year following implantation of the prosthesis, the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Effective February 7, 2021, Diagnostic Code 5055 provides that for four months following resurfacing or replacement (prosthesis), the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating for a total replacement is 30 percent. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5055). Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved (here, Diagnostic Codes 5260 or 5261 for the knees). 38 C.F.R. § 4.71a, Diagnostic Code 5003. Under Diagnostic Code 5260, limitation of flexion of the leg at the knee is rated at 10 percent if limited to 45 degrees, at 20 percent if limited to 30 degrees, and at 30 percent, which is the maximum evaluation available, if limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limitation of extension of the leg at the knee is rated at 0 percent if limited to 5 degrees, at 10 percent if limited to 10 degrees, 20 percent if limited to 15 degrees, at 30 percent if limited to 20 degrees, at 40 percent if limited to 30 degrees, and at 50 percent if extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Normal range of knee motion is from 140 degrees (on flexion) to 0 degrees (on extension) to. See 38 C.F.R. § 4.71, Plate II. Ankylosis of a knee warrants a 30 percent evaluation if it is at a favorable angle in full extension, or in slight flexion between 0 and 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5256. Prior to February 7, 2021, Diagnostic Code 5257 addresses recurrent subluxation or lateral instability of the knee. A 10 percent rating is warranted for mild recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateralinstability.38C.F.R. §4.71a, Diagnostic Code 5257. The terms "mild," "moderate," and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "mild" or "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding a higher rating. 38 C.F.R. §§ 4.2, 4.6. Effective February 7, 2021, Diagnostic Code 5257 allows a 10 percent rating for sprain, incomplete ligament tear, or complete ligament tear causing persistent instability, without a prescription from a medical provider for an assistive device or bracing for ambulation. A 20 percent rating is warranted for either [1] sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation or [2] unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 30 percent rating is warranted for an unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). Additionally, effective February 7, 2021, VA added patellar instability to Diagnostic Code 5257. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Id. Note 1 to Diagnostic Code 5257 provides that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Id. In addition, VA regulations provide that "pyramiding," or evaluation of the same disability under various diagnoses, is to be avoided. 38 C.F.R. § 4.14. VA has specifically found, however, that limitation of motion of the knee and instability of the knee are not duplicative or overlapping conditions, and that a claimant who has both arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257. VAOPGCPREC 23-97 (July 1997). Separate ratings under Diagnostic Code 5260 for limitation of flexion of the leg and Diagnostic Code 5261 for limitation of extension of the leg may be assigned for disability of the same joint. VAOPGCPREC 09-04. Meaning, separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, without violating the rule against pyramiding. See 38 C.F.R. § 4.14. Separate ratings must be based on additional disability. Previously, VA General Counsel has held that a rating under Diagnostic Code 5259, cartilage, semilunar, removal (see also Diagnostic Code 5258, dislocated semilunar cartilage) already contemplates limitation of motion, such that separate ratings for limitation of motion (e.g., Diagnostic Codes 5003, 5260, or 5261) would violate the regulatory prohibition against pyramiding under 38 C.F.R. § 4.14. See VAOPGCPREC 9-98 (August 14, 1998). However, a recent Court decision has held that evaluation of a knee disability under Diagnostic Code 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under Diagnostic Code 5258 or 5259, and vice versa. Lyles v. Shulkin, 29 Vet. App. 107 (2017). Rather, a separate evaluation in a given case depends on whether manifestations for which a separate evaluation is being sought have already been compensated by an assigned evaluation under a different diagnostic code; and that, in evaluations of musculoskeletal disabilities based on limitation of motion, a manifestation has not been compensated, for separate evaluation and pyramiding purposes, if that manifestation did not result in an elevation of the evaluation under 38 C.F.R. §§ 4.40 and 4.45, pursuant to principles set forth in DeLuca (cite omitted). Id. at 118-119. Consideration of other diagnostic codes for rating knee disability (5256, 5259, 5262, 5263) is inappropriate in this case because the Veteran's bilateral knee disabilities do not include the pathology required in the criteria for those Codes (ankylosis, symptomatic removal of semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. 1. For the period prior to September 29, 2010, entitlement to a rating in excess of 20 percent for a left knee disability with loss of motion due to degenerative joint disease (rated based on episodes of locking, pain, and effusion into the joint). 2. For the period prior to September 29, 2010, entitlement to a rating in excess of 30 percent for left knee instability A January 2000 private treatment record noted that the Veteran's left knee showed genu varum deformity, that he had mild effusion, and that left flexion was to 80 degrees. The Veteran's left knee was primarily tender over the medial joint line and he had significant retropatellar and crepitus on motion. A February 2000 workers compensation medical record notes that the Veteran had continued pain in his knees, was unable to walk distances, was unable to climb stairs, and felt his knee wanting to give way. The record notes that the Veteran wore a brace to prevent his knee from giving way. The record also notes that the Veteran had a long history of osteoarthritis but that his problems were much worse since his occupational fall. A March 2000 private treatment record noted that the Veteran had attempted to work at his home on a ladder and suffered severe pain and swelling for several hours afterward. Examination of the Veteran revealed grinding and crepitus with arthritic changes in the left knee. Range of motion was limited to 100 degrees. The Veteran was afforded a VA examination in April 2000. The Veteran wore a derotation knee brace to the examination. During the VA examination, the Veteran complained of pain, buckling, swelling, and loss of motion in the left knee. He exhibited full extension with left knee flexion limited to 95 degrees. The Veteran had tenderness to palpation over the left knee at the medial and lateral joint lines and over the distal quadriceps. Anterior drawer sign, Lachman sign and patellofemoral compression tests were positive for the left knee. The Veteran could not tolerate attempts to perform McMurray testing. There was a psoriatic plaque noted over the right knee. The VA examiner also discussed the Veteran's work history noting that upon discharge from the service in 1970, the Veteran went to work as an apprentice carpenter and continued to work as a carpenter to the present time. A June 2000 medical record contained in the Veteran's SSA records notes that the Veteran used a cane to walk and could not carry a bag of groceries or a gallon of milk. The record then states that the Veteran could handle only two gallons of milk or three pounds at a time. The Veteran avoided using stairs and sitting or standing for too long due to his knee buckling. The record also states that the Veteran could perform activities of daily living except cleaning his home, doing laundry, shopping for food and clothing, and caring for his children. Although, it was noted that he did perform some work at home. Otherwise, he depended on family members. A June 2000 private treatment record notes that the Veteran had worsening pain, grinding, crepitus, and range of motion from 0 to 110 degrees. The Veteran was afforded another VA examination in April 2003. The VA examiner noted that in 1970 the Veteran had swelling in his left knee and a needle was introduced which caused him to contract an infection. The Veteran was treated for the left knee infection for 7 months in Okinawa. Currently, the Veteran wore a stabilizing brace which he used throughout the day and when walking. At home when he removed his brace, he used a cane to walk. The Veteran's pain ranged from 5-6/10 when his knee locked. The Veteran further reported that his knee sometimes locked during sleep. At the time of the examination, the Veteran walked with a limp and complained of sharp, 6/10 left knee pain that was worse with movement. The VA examiner noted that the Veteran was living a "sedentary life". The Veteran exhibited extension to 0 degrees and flexion to 95 degrees with a grinding sensation and crepitus. The knee joint would not move beyond 95 degrees in flexion even on passive motion. Instability testing was negative. Collateral ligaments on stress test were found to be slightly lax and lateral collateral ligaments on stress test were found to be giving away. The medial collateral ligament was normal. There was tenderness along the medial joint line 3+. Patellofemoral grinding test was positive for 3+ for osteoarthritic changes. There was no palpable effusion or synovial thickening. There was no neurovascular compromise in the leg. Gait was antalgic as the Veteran was walking without an assistive device but wearing a Lenox-Hill brace which was worn after completion of the examination. The Veteran reported that he could only walk about a quarter mile before needing to stop, stand for about 10 to 15 minutes, sit for about 20 minutes, lift about 20 to 30 pounds, and was unable to climb. In regard to activities of daily living, the Veteran was able to feed, dress, drive, and go to the bathroom by himself. The Veteran reported that he worked as a carpenter until January 2000 when he retired due to his left knee disability and began receiving Social Security Administration (SSA) disability benefits. In an April 2004 letter, the Veteran asserted that private treatment records and MRI findings supported his contention that his left knee disability was manifested by lateral instability and recurrent subluxation. The Veteran also stated that he had two authorizations in 1997 and 2004 for a left knee brace to support his knee. The Veteran asserted that his left knee disability prevented him from working and that he had been awarded SSA disability benefits due to his left knee. He explained that a left knee replacement was recommended but that he was delaying it because he was afraid of contacting an infection similar to his in-service left knee infection that resulted in a 7-month hospital stay. A May 2005 VA treatment record notes that the Veteran had severe degenerative joint disease and that the Veteran wanted to wait until after summer to undergo a left knee surgery. The Veteran was afforded a VA examination in May 2005 for his service-connected left knee disability. The VA examiner noted that the Veteran ambulated with an antalgic gait. During the examination, the Veteran reported that he had constant pain that varied in intensity from 5/10 to 9/10. The Veteran stated that he used a cane to ambulate when in his home and not wearing his knee brace. Otherwise, the Veteran used a knee brace daily and reported he was unable to ambulate without the brace due to instability. He also reported constant throbbing, as well as, weakness, stiffness, swelling, giving way, fatigability and lack of endurance. The Veteran experienced flare-ups with activity such as walking greater than 2 to 3 blocks, climbing stairs, kneeling, squatting, and with changes in weather. For example, the Veteran stated that if he used his left knee for greater than 30 to 45 minutes, he had increased pain and throbbing. The Veteran reported that he worked out on an elliptical machine to improve the strength of his knees. The Veteran asserted that his left knee disability adversely affected his quality of life. The Veteran reported that he could not walk greater than 30 to 45 minutes or a distance of approximately 3 blocks with the brace because of buckling and instability. He also reported an inability to kneel, squat, perform household chores, or drive for too long. The Veteran had extension to 5 degrees with increased pain on attempted passive extension. He also had flexion to 95 degrees with pain at 85 degrees with crepitus and passive flexion to 100 degrees with considerable increase in pain. The VA examiner noted that during the course of the examination, the Veteran complained of a "charley horse" in his left thigh when flexing his left knee to 90 degrees. The VA examiner also noted considerable guarding due to left knee pain. The Veteran had tenderness to the medial joint line and parapatellar tenderness of the left knee. The Veteran exhibited instability on varus and valgus stress testing and laxity on anterior drawer testing. The VA examiner stated, "on observation of the Veteran standing and transferring without the brace on, there is instability and buckling noted upon standing from a seated position and transferring to the examination table." The VA examiner noted that the Veteran retired after 30 years as a carpenter and that the Veteran reported that he retired in 2001 because he was unable to work due to his knee pain. A February 2006 VA treatment record noted that the Veteran did not have joint effusion and that instability testing was negative. It further noted that range of motion was from 0 to 90 degrees and with pain. A March 2006 VA treatment record noted that the Veteran reported that after receiving an injection in his left knee, his pain became worse causing his knee to buckle and him to fall. However, the record also notes that instability testing was negative. In January 2009 correspondence, the Veteran asserted that he previously worked as a carpenter but that his left knee disability left him unable to secure a job. He explained that he was awarded SSA disability benefits in July 2000 and argued that he was entitled to TDIU through VA too. A March 2009 VA treatment record notes that the Veteran reported difficulty walking and could only walk a half a block. He also reported worsening difficulty with going up and down stairs. The Veteran rated his pain at 7/10. The Veteran was afforded another VA examination for his left knee disability in March 2009. The VA examiner noted that the Veteran ambulated with a slow, antalgic gait and was unsteady without his knee brace. During the examination, the Veteran described sharp, burning, constant, throbbing pain that was a 7/10. The Veteran also reported experiencing flareups approximately once a week that lasted 30 minutes and resulted in 8/10 pain. The Veteran further reported increased instability and locking episodes, particularly with stairs. However, instability testing was negative for any instability. The Veteran denied any episodes of dislocation or recurrent subluxation or a history of rheumatoid arthritis, lupus, or Lyme disease. However, the Veteran did report a history of gout although allegedly not occurring in his left knee. The Veteran had tenderness to palpation over the medial and lateral joint line. The Veteran had flexion to 75 degrees and extension to 5 degrees. The VA examiner noted that "[p]assively he can be brought to 0 degrees extension with discomfort beyond 5 degrees and he could be passively flexed to 80 degrees with pain beyond 75 degrees." Upon repetitive use testing with three repetitions, the Veteran lost 15 degrees on flexion due to pain. The Veteran had a positive McMurray test on the left knee. During the examination, the Veteran reported that after discharge from the military, he worked for the postal service for a few months and then as a carpenter from May 1971 to January 2000 when he retired due to his knee disability. A May 2010 VA treatment record noted that the Veteran ambulated freely but had 7/10 left knee pain. And, an August 2010 VA treatment record noted that the Veteran ambulated freely but had 6/10 left knee pain. A September 2010 private treatment record noted that the Veteran had been ambulating with a limp for a long time because of his left knee condition. Analysis From November 27, 2002 to September 29, 2010, the Veteran has been awarded the highest schedular rating, a 30 percent rating, under Diagnostic Code 5257 for severe recurrent subluxation or lateral instability. From February 28, 2000 to September 29, 2010, the Veteran has also been awarded the highest schedular rating, a 20 percent rating, under Diagnostic Code 5258 for his left knee disability with loss of motion due to degenerative joint disease (rated based on episodes of locking, pain, and effusion into the joint). Accordingly, no higher ratings are available under these diagnostic codes. In order to be entitled to a higher rating based on loss of motion, the Veteran would have to meet the requirements for a higher rating under Diagnostic Code 5260 or Diagnostic Code 5261. Here, however, the Veteran has not met the requirements for a 30 percent rating under either Diagnostic Code 5260, which requires that flexion be limited to 15 degrees, nor the requirements for a 30 percent rating under Diagnostic Code 5261, which requires that extension be limited to 20 degrees. In fact, the Veteran has not even met the requirements for a compensable rating under either diagnostic code. At most, the Veteran's flexion was limited to 75 degrees and his extension to 5 degrees. See March 2009 VA examiner's report. In order to be entitled to the minimum compensable rating under Diagnostic Code 5260 the Veteran must exhibit flexion to 45 degrees or less, and to be entitled to a compensable rating under Diagnostic Code 5261 the Veteran must exhibit extension to 10 degrees or less. As such, due to the actual range of motion demonstrated, separate evaluations for limited flexion and extension of the left knee under Diagnostic Code 5260 and/or Diagnostic Code 5261 are not warranted here, as is permitted by VAOPGCPREC 9-2004. With regard to other potentially applicable diagnostic codes, the Board notes that there is no evidence of ankylosis to warrant higher or separate ratings under Diagnostic Code 5256, and there is no evidence during this period of nonunion of the tibia and fibula to warrant higher or separate ratings under Diagnostic Code 5262. The Board also finds that additional or higher increased ratings are not warranted for limitation of motion based on functional impairment under DeLuca during this period. In this regard, the Veteran reported chronic bilateral knee pain and flare-ups of bilateral knee pain, as well as functional impairment, such as inability to walk or stand for prolonged periods of time and inability to climb, bend, kneel, and squat. However, the Board notes that the Veteran's functional impairment is already considered in his currently assignee 20 percent and 30 percent ratings for his episodes of locking, pain, and effusion into the joint and his severe instability. Moreover, a rating based on limitation of flexion or extension would not afford the Veteran a rating higher than his 20 percent rating under 5010-5258 because the Veteran exhibited substantial range of motion even after repetitive use testing with flexion limited at most to 75 degrees and his extension limited at most to 5 degrees. The Board also notes that the Veteran's episodes of locking, pain, and effusion into the joint and his severe instability were considered by the VA examiners when reporting the range of motion of each knee. Thus, a higher rating is not warranted for either knee under the factors set forth in DeLuca. The Board finds that for the period prior to September 29, 2010, the Veteran's left knee disabilities were adequately compensated by Diagnostic Codes 5257 and 5010-5258 and that no higher ratings are available under these diagnostic codes. Additionally, separate evaluations for the Veteran's service-connected left knee disability are not warranted under any other diagnostic code for the period prior to September 29, 2010. 3. For the period from November 1, 2011 to November 15, 2017, entitlement to a rating in excess of 30 percent for residuals of total left knee arthroplasty Factual Background The Veteran was afforded an in-person VA examination in September 2014. The VA examiner noted diagnoses of left knee degenerative joint disease and a left knee replacement that occurred in September 2009. The Veteran exhibited left knee flexion to 90 degrees with evidence of painful motion beginning at 80 degrees. The Veteran was unable to fully extend his left knee with extension ending at 5 degrees and evidence of painful motion beginning at 3 degrees. In regard to pain, the Veteran reported left knee pain at 4/10 while at rest, at 6/10 with standing, 5/10 with walking less than 1 block, 7/10 with walking more than 1 block, and 5/10 with walking up and down steps. The Veteran did not report any flareups. The Veteran was able to perform repetitive-use testing with 3 repetitions with flexion to 80 degrees and extension to 5 degrees. The VA examiner noted that the Veteran had additional limitation in range of motion of the knee and lower leg following repetitive-use testing. The Veteran also had functional loss and/or functional impairment of the knee and lower leg. Other factors contributing to the Veteran's left knee disability included less movement than normal, weakened movement, excess of fatigability, pain on movement, instability of station, disturbance of locomotion, and interference with sitting. The Veteran also had tenderness or pain to palpation for the joint line or soft tissues of the left knee. The Veteran retained 5/5 strength on flexion and extension. Anterior, posterior, and medial-lateral instability testing was all normal. There was no evidence of patellar subluxation or dislocation. The Veteran occasionally used a brace, cane, and walker. The VA examiner noted that the Veteran had a total knee replacement in 2009 and had residuals of intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran reported that after discharge from active duty service, he worked for 30 years as a carpenter until January 2000 when he retired due to left knee pain. Analysis The Board acknowledges that the Veteran had been awarded a 100 percent rating under Diagnostic Code 5055 from September 29, 2010 to October 31, 2011 following the Veteran's left total knee arthroplasty. Thereafter, the Veteran was rated at 30 percent under Diagnostic Code 5055 from November 1, 2011 to November 15, 2017. The Board finds that for the period from November 1, 2011 to November 15, 2017 a rating in excess of 30 percent is not warranted for the Veteran's service-connected left knee disability. Prior to February 7, 2021, Diagnostic Code 5055, which governs knee replacement (prosthesis), provides that for one year following implantation of the prosthesis, the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Effective February 7, 2021, Diagnostic Code 5055 provides that for four months following resurfacing or replacement (prosthesis), the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating for a total replacement is 30 percent. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5055). The Board emphasizes that while the September 2014 VA examiner's report noted that the veteran had weakened movement and pain on movement, the VA examiner noted that the Veteran only had intermediate degrees of residual weakness or pain. There is no evidence for this period showing that the Veteran's left total knee arthroplasty resulted in chronic residuals of severe painful motion or weakness during this period. To the contrary, the Veteran retained 5/5 strength in his left knee and at most only reported 7/10 pain with walking more than one block. Accordingly, since chronic residuals of severe painful motion or weakness have not been shown, a higher, 60 percent rating under Diagnostic Code 5055 is not warranted. The Board has also considered whether a separate (or higher) disability rating is warranted for any other left knee disability during this period. As the evidence of record does not reflect that the left knee is ankylosed, that the semilunar cartilage has been removed, that there is malunion or nonunion of the tibia and fibula, that there is a current diagnosis of genu recurvatum, and/or that the Veteran's left knee has been manifested by limitation of flexion or extension to a compensable degree, a separate (or higher) disability rating is not warranted under Diagnostic Codes 5256 or 5259 through 5263. 38 C.F.R. § 4.71a. The Board acknowledges that the September 2014 VA examiner noted that the Veteran had instability of station. However, the VA examiner also found that anterior, posterior, and medial-lateral instability testing was all normal. And, the VA examiner also found that there was no evidence of patellar subluxation or dislocation. The Board finds that objective testing did not support a finding of instability and that the preponderance of the evidence weighs against a finding of instability. The Board also notes that there is no other lay evidence to support a finding of instability for this period either. Accordingly, the Board finds that a separate rating for instability of the left knee is not warranted under either version of Diagnostic Code 5257. The Board also finds that additional increased ratings are not warranted for limitation of motion based on functional impairment under DeLuca during this period. In this regard, the Veteran reported less movement than normal, weakened movement, excess of fatigability, pain on movement, instability of station, disturbance of locomotion, and interference with sitting. However, the Board notes that the Veteran's functional impairment was already considered in his 30 percent rating based on intermediate degrees of residual weakness, pain or limitation of motion. Moreover, a rating based on limitation of flexion or extension would not afford the Veteran a rating higher than his 30 percent rating under Diagnostic Code 5055 because the Veteran exhibited substantial range of motion even after repetitive use testing with flexion limited at most to 80 degrees and extension limited at most to 5 degrees. The Board also notes that the Veteran's weakened movement, excess of fatigability, pain on movement, instability of station, disturbance of locomotion, and interference with sitting were considered by the VA examiner when reporting the range of motion of each knee. Thus, a higher rating is not warranted for either knee under the factors set forth in DeLuca. Accordingly, for the period from November 1, 2011 to November 15, 2017, the Board finds that a rating in excess of 30 percent for residuals of total left knee arthroplasty is not warranted nor is a separate rating under any other diagnostic code. 4. For the period from November 15, 2017, entitlement to a rating in excess of 60 percent for residuals of total left knee arthroplasty The Veteran was afforded an in-person VA examination in November 2017. The VA examiner noted diagnoses of left knee osteoarthritis, sprain, meniscal injury, and knee replacement. The November 2017 VA examiner noted the Veteran's history of an in-service left knee injury and infection. The VA examiner also noted the Veteran's post-military history including that the Veteran's left knee buckled in January 2000 while working as a carpenter. The Veteran had a high pain level and could not return to work because his left knee disability prevented him from doing the same duties as before. The Veteran reported at the time of the examination that his left knee was still sore. The Veteran reported that his knee would swell when he walked more than a couple blocks and that he could not kneel on it. He also reported throbbing when he sat for too long or at the end of the day. Pain was reported as coming and going and at a pain level of 5-6/10. The Veteran had abnormal range of motion in his left knee with flexion to 125 degrees, but extension was normal to 0 degrees. The VA examiner noted that range of motion itself contributed to functional loss because the Veteran had pain on movement. The Veteran reported having functional loss and functional impairment because he had increased pain in the knees with walking. Pain was noted on flexion and caused functional loss. The Veteran was able to perform repetitive use testing with at least three repetitions but had functional loss due to pain after the repetitions. After three repetitions, flexion was limited 120 degrees. The Veteran was examined immediately after repetitive use over time. The VA examiner noted that pain significantly limited functional ability with repeated use over a period of time with flexion to 120 degrees and extension to 0 degrees. The Veteran retained 5/5 strength with no reduction in muscle strength, however, muscle atrophy was noted. The Veteran did not have ankylosis nor a history of recurrent subluxation, lateral instability, or recurrent effusion. Joint stability testing was performed and revealed no signs of joint instability since anterior, posterior, medial, and lateral instability testing was all normal. The Veteran previously had frequent episodes of joint effusion but underwent an arthroscopy in 2009. Residuals from the Veteran's surgery included left knee pain. The VA examiner noted that the Veteran retired from the carpenters' union and could no longer due that job because his left knee disabilities precluded him from all forms of substantially gainful employment consistent with his education and occupational experience. The Veteran was afforded another in-person VA examination in November 2020. The VA examiner noted diagnoses including left knee strain, knee joint osteoarthritis, instability, cartilage restorage surgery, and total knee arthroplasty. The VA examiner also noted conditions including left knee instability due to degenerative joint disease, loss of range of motion due to degenerative joint disease of the left knee, and total left knee arthroplasty. The VA examiner noted that the Veteran was a retired carpenter. The Veteran reported functional loss or functional impairment of the joint or extremity being evaluated because he was unable to work as a carpenter, and unable to climb, bend, kneel, and squat. Left knee range of motion was abnormal or outside of the normal range because the Veteran only had flexion to 90 degrees, but extension was to 0 degrees. The VA examiner noted that the range of motion itself contributed to functional loss and that the Veteran's total knee arthroplasty had resulted in loss of range of motion. Pain was noted on flexion which caused functional loss. There was no objective evidence of localized tenderness or pain on palpation, pain with weight bearing, or crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions without any additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time but no pain, weakness, fatigability, or incoordination was noted as significantly limiting functional ability with repeated use over a period of time. The Veteran did not report any flareups. The VA examiner noted that no other additional factors contributed to disability. The Veteran retained 4/5 strength on flexion and extension of the left knee and the VA examiner noted that there was no reduction in muscle strength and that the Veteran did not have muscle atrophy. The Veteran also did not have ankylosis, recurrent subluxation, lateral instability, nor joint instability. Anterior, posterior, medial, and lateral instability testing was all normal. The VA examiner noted that the Veteran had a total knee joint replacement in 2010 with resulting intermediate degrees of residual weakness, pain, or limitation of motion. There was no evidence of pain on passive range of motion testing or non-weight bearing testing of the left knee. The VA examiner determined that the Veteran's conditions impacted his ability to perform occupational tasks because the Veteran had difficulty with climbing, bending, and walking more than 1 to 2 blocks. The Veteran did not use any assistive devices. The VA examiner noted the Veteran's occupational history including that the Veteran's knee buckled, and he fell at work. Afterward, the Veteran continued to have effusions and pain. He reportedly became a liability because it was too dangerous for him to be on scaffolding. He retired on disability in 2002 "since carpentry has no light duty." Analysis The Board finds that for the period from November 15, 2011, a rating in excess of 60 percent under Diagnostic Code 5055 is not warranted, nor is a separate rating under any other diagnostic code, for the Veteran's service-connected left knee disability. Prior to February 7, 2021, Diagnostic Code 5055, which governs knee replacement (prosthesis), provides that for one year following implantation of the prosthesis, the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Effective February 7, 2021, Diagnostic Code 5055 provides that for four months following resurfacing or replacement (prosthesis), the knee joint warrants an evaluation of 100 percent. Thereafter, where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity, a 60 percent rating is warranted. Where there are intermediate degrees of residual weakness, pain or limitation of motion, the disability is rated by analogy to diagnostic codes 5256, 5261 or 5262. The minimum rating for a total replacement is 30 percent. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5055). Here, the Veteran underwent his left total knee arthroplasty in 2009, therefore, a 100 percent rating is not for application under 5055 since well over a year, and definitely more than 4 months, had passed since the date of the surgery. The Board finds that the current 60 percent rating adequately compensates the Veteran for his chronic residuals of severe painful motion and weakness and that no higher rating is available under Diagnostic Code 5055. The Board has considered whether a separate (or higher) disability rating is warranted for any other left knee disability during this period. As the evidence of record does not reflect that the left knee is ankylosed, that the semilunar cartilage has been removed, that there is malunion or nonunion of the tibia and fibula, that there is a current diagnosis of genu recurvatum, that the knee left knee is unstable, and/or that the Veteran's left knee has been manifested by limitation of flexion or extension to a compensable degree, a separate (or higher) disability rating is not warranted under Diagnostic Codes 5256, 5257, or 5259 through 5263. 38 C.F.R. § 4.71a. The Board also finds that additional increased ratings are not warranted for limitation of motion based on functional impairment under DeLuca during this period. In this regard, the Veteran exhibited less movement than normal, weakness, and an inability to climb, bend, kneel, and squat. However, the Board notes that the Veteran's functional impairment was already considered in his 60 percent rating based on chronic residuals consisting of severe painful motion or weakness. Accordingly, the Board finds that neither a rating in excess of 60 percent nor a separate rating is warranted for the Veteran's service-connected left knee disability from November 15, 2017. 5. From October 30, 2002 to November 1, 2011, entitlement to extraschedular TDIU Factual Background A February 2000 workers compensation medical record notes that the Veteran had continued pain in his knees, was unable to walk distances, was unable to climb stairs, and felt his knee wanting to give way. The record notes that the Veteran wore a brace to prevent his knee from giving way. The record also notes that the Veteran had a long history of osteoarthritis but that his problems were much worse since his occupational fall. SSA records show that the Veteran became disabled on January 27, 2000. SSA determined that the Veteran's primary diagnosis was osteoarthrosis and allied disorders and his secondary diagnosis was muscle, ligament, and fascia disorders. In a May 2000 SSA record, the Veteran had reported that his wife and children performed their household chores. In regard to driving, his wife would drive for any long distance and he would drive locally only when absolutely necessary. He reported that his knee pain was constant and ranged from dull to severe pain. He also reported that he wore a full knee brace for support and to prevent his knee from buckling. The Veteran described his past work as a civil services bridge carpenter stating that he performed all phases of carpentry and heavy construction work. He explained his work further stating that it also included foundations, roofs, framing, and ceilings. In describing his job details he stated that he would carry tools, material, sheet wood, timber, or doors every day. The Veteran asserted that because of his disability he could no longer work or sit and stand comfortably. A June 2000 medical record contained in the Veteran's SSA records notes that the Veteran used a cane to walk and could not carry a bag of groceries or a gallon of milk. The record then states that the Veteran could handle only two gallons of milk or three pounds at a time. The Veteran avoided using stairs and sitting or standing for too long due to his knee buckling. The record also states that the Veteran could perform activities of daily except cleaning his home, doing laundry, shopping for food and clothing, and caring for his children. However, the record also noted that he did perform some work at home. Otherwise, the Veteran depended on family members. A September 2000 private treatment record notes that the Veteran received SSA disability benefits because he was unable to work due to his arthritic knee. The Veteran's knee disability was so severe that the Veteran had difficulty climbing stairs in his home and was considering selling his home to purchase a ranch style home. The private physician determined that the Veteran had reached maximum medical improvement and that the Veteran should be scheduled at a 50 percent loss and his compensation case closed. A May 2001 City of New York Worker's Compensation document notes that the Veteran filed a worker's compensation claim because of a left knee injury and that the Veteran was authorized to have a total left knee replacement. The Veteran submitted an application for TDIU, VA Form 21-8940, in October 2002. On his application, the Veteran stated that he last worked on January 27, 2000 and that he left his last job because of his disability. The Veteran also stated that his educational history included completing two years of college. The Veteran's private physician submitted a letter in support of the Veteran's claim in November 2002. The private physician stated that the Veteran had significant problems with his knee and would eventually need a total joint replacement. The private physician further asserted that the Veteran was not employable. During an April 2003 VA examination, the VA examiner noted that the Veteran was living a "sedentary life". The Veteran reported that he worked as a carpenter until January 2000 when he retired due to his left knee disability and began receiving SSA disability benefits. The Veteran reported that he could only walk about a quarter mile before he needed to stop, could stand for about 10 to 15 minutes, could sit for about 20 minutes, could lift about 20 to 30 pounds, and was unable to climb. In regard to activities of daily living, the Veteran was able to feed, dress, drive, and go to the bathroom by himself. In May 2003 correspondence, the Veteran explained that his service-connected left knee disability had progressively degenerated until he was injured on January 27, 2000. In an April 2004 letter, the Veteran asserted that his left knee disability prevented him from working and that he had been awarded SSA disability benefits due to his left knee. In August 2004, the Veteran's last employer submitted a VA Form 21-4192 detailing that the Veteran last worked on January 21, 2000 as a carpenter and was employed until April 26, 2000 when he retired due to disability. The employer also noted that the Veteran had lost 116 hours and 5 minutes of work time due to disability in his last 12 months of work. In September 2003 Dr. P.L. testified, related to the Veteran's workers compensation claim, that the Veteran had a severe disability for his job. Dr. P.L. explained that the Veteran could not perform a job that required use of the Veteran's leg for walking or anything of that nature because the Veteran was severely restricted. Dr. P.L. then asserted that the Veteran was not trained, nor did he have the educational background for a desk job. Dr. P.L. further stated that the Veteran would be able to perform a very minimally sedentary job if the Veteran were qualified for such job. Dr. P.L. concluded that the Veteran had a severe partial disability and was certainly not employable in his skill level. The Veteran was afforded another VA examination for his service-connected left knee disability in May 2005. The VA examiner noted that the Veteran retired after 30 years as a carpenter and that the Veteran reported that he retired in 2001 because he was unable to work due to his knee pain. The Veteran asserted that his left knee disability adversely affected his quality of life. The Veteran reported that he could not walk greater than 30 to 45 minutes or a distance of approximately 3 blocks with a brace because of buckling and instability. He also reported an inability to kneel, squat, perform household chores, or drive for too long. The Veteran reported that he worked out on an elliptical machine to improve the strength of his knees. In January 2009 correspondence, the Veteran asserted that he was a carpenter and that his left knee disability left him unable to secure a job. He explained that he was awarded SSA disability benefits in July 2000 and argued that he was also entitled to TDIU through VA. A January 2010 VA treatment record notes that the Veteran's Barrett's esophagus did not affect his activities of daily living. The Veteran was afforded a VA examination for his left knee scar in November 2017 during which the VA examiner determined that the Veteran's scars did not impact his ability to work. The Veteran was also afforded a VA examination in November 2017 for his service-connected left knee disability. The VA examiner noted that the Veteran retired from the carpenters union and could no longer due that job because his left knee disabilities precluded him from all forms of substantially gainful employment that was consistent with his education and occupational experience during this period (at this time). The VA examiner determined that the Veteran's knee and/or lower leg condition impacted his ability to work because he stopped working in 2000 due to the left knee disability. The VA examiner noted that the Veteran's left knee disability impacted his ability to do physical or sedentary type work due to left knee pain which prevented him from sitting at a desk or driving to work without getting up and taking rest periods. The VA examiner further noted that the Veteran was unable to stand and walk for distances greater than 1 block. Moreover, the Veteran could not do carpentry work since it required prolonged standing, walking, and kneeling. A January 2020 advisory opinion from the Executive Director of Compensation Services awarded extraschedular TDIU from November 1, 2011. Analysis Entitlement to TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). 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 age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). However, a total rating may nonetheless be granted on an extraschedular basis in exceptional cases (and pursuant to specifically prescribed procedures) when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. See 38 C.F.R. § 4.16 (b). The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) ("applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner"). The effective date for an increased rating for disability compensation will be the earliest date as of which it is factually ascertainable that an increase in disability occurred if a claim is received within one year from such date; otherwise, the effective date is the date of receipt of the claim. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). A TDIU claim is a claim for increased compensation, and the effective date rules for increased compensation apply to a TDIU claim. Hurd v. West, 13 Vet. App. 449 (2000). The Veteran has been awarded service connection for the following disabilities: a) left knee total arthroplasty rated at 100 percent from September 29, 2010 to October 31, 2011, 30 percent from November 1, 2011; and 60 percent from November 15, 2017; b) left knee instability rated at 10 percent from February 28, 2000 to November 26, 2002 and 30 percent from November 27, 2002 to September 29, 2010; c) left knee loss of range of motion rated at 10 percent from November 20, 1970 to January 31, 2000 and at 20 percent from February 28, 2000 to September 29, 2010; d) surgical scars of the left knee rated at non-compensable from February 28, 2000 to November 26, 2002 and at 10 percent from November 27, 2002; and e) Barrett's esophagus at non-compensable from April 29, 2009. The Veteran's relevant combined ratings were 30 percent from February 28, 2000 to November 26, 2002; 50 percent from November 27, 2002 to September 28, 2010; 100 percent (pursuant to 38 C.F.R. § 4.30) to October 31, 2011 and 40 percent from November 1, 2011. Extraschedular TDIU was awarded from November 1, 2011. The Board notes that although the Director for Compensation Services did not directly address the matter of extraschedular consideration prior to November 1, 2011, the Director impliedly did so, and therefore the Board may proceed to consider extraschedular entitlement. From October 30, 2002 to November 1, 2011, the Veteran did not qualify for schedular TDIU because he did not have any one service-connected disability rated at 60 percent or more. In addition, the combined rating of all the Veteran's service-connected disabilities was less than 70 percent at all times. As a result, schedular TDIU is not for application. However, TDIU may nonetheless be granted on an extraschedular basis in exceptional cases (and pursuant to specifically prescribed procedures) when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. See 38 C.F.R. § 4.16 (b). The Board finds that for the period from October 30, 2002 to November 1, 2011, the Veteran's service-connected disabilities prevented the Veteran from engaging in substantially gainful activities. The Board emphasizes that the Veteran's past work history involved working as a carpenter for over 30 years which required carrying tools, material, sheet wood, timber, or doors every day and working on foundations, roofs, framing, and ceilings. The evidence does not indicate that the Veteran had any advanced education, computer skills, or other skills transferrable to a sedentary position. While the Veteran completed two years of college, he did not obtain a degree, his major was not noted, and he does not appear to have worked in a field relevant to his college education. Dr. P.L. had even testified that the Veteran did not have the educational background or training for a desk job. See September 2003 transcript of Dr. P.L.'s testimony. The record consistently shows for this period that the Veteran had instability and buckling in his left knee which required him to constantly wear a brace or use a cane and that he experienced moderate to high levels of left knee pain constantly. Moreover, the VA examiners consistently noted that the Veteran had physical limitations that caused functional impairment. For example, the April 2003 VA examiner's report noted that the Veteran could only walk about a quarter mile before he needed to stop, could stand for about 10 to 15 minutes, could sit for about 20 minutes, could lift about 20 to 30 pounds, and was unable to climb. The Veteran has expressed that an ability to carry objects such as tools, material, sheet wood, and timber, was necessary in his prior role as a carpenter, however, the April 2003 VA examiner's report indicated that the Veteran would not have been capable of lifting more than 30 pounds which would not be compatible with the physical requirements of a carpenter. Moreover, the Veteran's limited ability to walk, stand, sit, kneel, or climb would further prevent employment as a carpenter. Dr. P.L. testimony is consistent with the other evidence of record and indicated that the Veteran was not employable at his skill level and that the Veteran's left knee disability severely restricted him. See September 2003 transcript of Dr. P.L.'s testimony. The Board finds that the Veteran's left knee disability would prevent the Veteran from climbing and kneeling as required to perform carpentry work on foundations, roofs, framing, and ceilings and also that the Veteran's left knee disability would interfere with his ability to carry items as required by his carpentry trade. In fact, SSA determined that disability benefits were warranted due to the Veteran's left knee disability from January 2001 and the VA Executive Director for Compensation Services determined that extraschedular TDIU was warranted from November 1, 2011. The Board finds that the evidence of record indicates that the Veteran's left knee disability consistently prohibited employment since his January 2001 fall at work. However, because the Veteran did not file his claim for TDIU until October 30, 2002, the Board finds that the effective date for the award of extraschedular TDIU is October 30, 2002. The effective date for an increased rating for disability compensation will be the earliest date as of which it is factually ascertainable that an increase in disability occurred if a claim is received within one year from such date; otherwise, the effective date is the date of receipt of the claim. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). A TDIU claim is a claim for increased compensation, and the effective date rules for increased compensation apply to a TDIU claim. Hurd v. West, 13 Vet. App. 449 (2000). The Board finds that for the period one year prior to October 30, 2002, the evidence does not show that an award of TDIU was warranted. The Board notes that there is little evidence for this period from October 2001 to October 2002 showing the severity of the Veteran's service-connected left knee disability or whether he was employable. Therefore, the Board is unable to find that TDIU was warranted anytime within the one year prior to the Veteran filing his claim in October 2002. Lastly, the Board notes that although the Veteran has been awarded extraschedular TDIU due primarily to his service-connected left knee disability an analysis of special monthly compensation (SMC) for housebound purposes is not warranted for the period from October 30, 2002 to November 1, 2011. SMC is payable at the SMC or "housebound" rate when a veteran has a single service-connected disability rated as 100 percent and, either (1) has additional service-connected disabilities independently ratable at 60 percent, or (2) is permanently housebound by reason of service-connected disabilities. 38 C.F.R. § 3.350 (i) (2015). See 38 U.S.C. § 1114(s) (West 2014). During the period from October 30, 2002 to November 1, 2011, the Veteran did not have an additional service-connected disability rated at 60 percent or greater and the Veteran has not alleged nor has the evidence shown that the Veteran was permanently housebound. Thus, even if the TDIU awarded in this decision were attributed to a single service-connected disorder, there would not be an additional disorder evaluated as at least 60 percent disabling as to raise the matter of SMC. It was not until November 2017 that the service- connected left knee disability was rated at least 60 percent. Accordingly, SMC is not for application prior to November 1, 2011. Moreover, SMC is not for application for the period from November 1, 2011 either because the Veteran's extraschedular TDIU award is based on multiple service-connected knee disabilities and the Veteran's only other service-connected disability, Barrett's esophagitis, was neither claimed nor shown to impact employability. Therefore, SMC is not for application for any period on appeal. In conclusion, the Board finds that an award of extraschedular TDIU is warranted for the period from October 30, 2002 to November 1, 2011. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Palombi 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.