Citation Nr: 21042588 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-30 494 DATE: July 13, 2021 ORDER Entitlement to a rating in excess of 10 percent for service-connected left knee retropatella pain syndrome is denied. Entitlement to a rating in excess of 10 percent for service-connected right knee retropatella pain syndrome is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. Throughout the entire appeal period, the Veteran's left knee retropatella pain syndrome was manifested by no worse than flexion limited to 120 degrees, normal extension, and there was no evidence of ankylosis, instability, subluxation, meniscus (semilunar cartilage) condition, a tibia or fibula impairment, or genu recurvation. 2. Throughout the entire appeal period, the Veteran's right knee retropatella pain syndrome was manifested by no worse than flexion limited to 125 degrees, normal extension, and there was no evidence of ankylosis, instability, subluxation, meniscus (semilunar cartilage) condition, a tibia or fibula impairment, or genu recurvation. 3. The evidence does not demonstrate that the Veteran is unable to obtain or maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for the Veteran's service-connected left knee retropatella pain syndrome have not been met. See 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5260. 2. The criteria for a rating in excess of 10 percent for the Veteran's service-connected right knee retropatella pain syndrome have not been met. See 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5260. 3. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1990 to February 1998. In May 2020, the Board remanded this case for additional evidentiary development. That development was completed, and the case has been returned to the Board for further appellate consideration. Increased Rating Claims 1. Entitlement to a rating in excess of 10 percent for service-connected left knee retropatella pain syndrome. 2. Entitlement to a rating in excess of 10 percent for service-connected right knee retropatella pain syndrome. The Veteran is seeking higher disability ratings for his service-connected left and right knee disabilities. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Individual disabilities are assigned separate diagnostic codes (DCs). Id. The basis of disability evaluations 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. See 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability. See 38 C.F.R. §§ 4.1, 4.2; see also Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. See 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal exertion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. In that regard, painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. See 38 C.F.R. § 4.59; see Burton v. Shinseki, 25 Vet. App. 1 (2011). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claims 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. In this regard, the Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the agency of original jurisdiction. In Disabled American Veterans v. Sec of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) specifically upheld the validity of 38 C.F.R. § 19.9(b)(2) (now as noted renumbered as 38 C.F.R. § 20.904(d)(2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claims. Knee disabilities are rated under DCs 5256 to 5263. The Veteran's service-connected left and right knee disabilities are both rated 10 percent disabling under the criteria of hyphenated DC 5299-5260. Generally, hyphenated DCs are used when an unlisted disability is at issue. See 38 C.F.R. § 4.27. In this case, the RO assigned a hyphenated DC to recognize that the Veteran's diagnosed retropatella pain syndrome is an unlisted disability (5299) that has been evaluated under the code for limitation of flexion of the knee (5260). Nevertheless, in analyzing the current severity of the Veteran's service-connected left and right knee disabilities, the Board will consider all potentially applicable DCs under 38 C.F.R. § 4.71a. Prior to February 7, 2021, the rating criteria are as follows: DC 5256 provides a 30 percent rating for ankylosis with favorable angle in full extension, or in slight flexion between 0 and 10 degrees; a 40 percent rating for ankylosis in flexion between 10 and 20 degrees; a 50 percent rating for ankylosis in flexion between 20 and 45 degrees; and a 60 percent rating for extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more. Under DC 5257, a 10 percent rating is warranted for slight 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 lateral instability. DC 5258 provides a 20 percent rating for cartilage, semilunar dislocated with frequent episodes of locking, pain, and effusion into the joint. DC 5259 provides a 10 percent rating for symptomatic removal of the semilunar cartilage. DC 5260 addresses limitation of flexion of the leg and provides a noncompensable rating if flexion is limited to 60 degrees, a 10 percent rating where flexion is limited to 45 degrees, a 20 percent rating where flexion is limited to 30 degrees, and a 30 percent rating where flexion is limited to 15 degrees. DC 5261 addresses limitation of extension of the leg and provides a noncompensable rating if extension is limited to 5 degrees, a 10 percent rating if extension is limited to 10 degrees, a 20 percent rating if extension is limited to 15 degrees, a 30 percent rating if extension is limited to 20 degrees, a 40 percent rating if extension is limited to 30 degrees, and a 50 percent rating if extension is limited to 45 degrees. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. See 38 C.F.R. § 4.71, Plate II. DC 5262 addresses tibia and fibula impairment and provides a 10 percent rating for malunion with slight knee disability. A 20 percent rating for malunion with moderate knee disability. A 30 percent rating for malunion with marked knee disability. A 40 percent rating for nonunion of, with loose motion, requirement a brace. DC 5263 provides a 10 percent rating for genu recurvatum (acquired traumatic with weakness and insecurity in weight bearing objectively demonstrated). Under the new rating criteria, no changes were made to DCs 5256, DC 5258, 5259, 5260, 5261, or 5263. However, effective February 7, 2021, the following changes were made to DC 5257 and DC 5262: DC 5257 now provides: For patellar instability A 10 percent rating 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 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 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 walker. For recurrent subluxation or instability A 10 percent rating for sprain, incomplete ligament tear or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability without a prescription from a medical provider for an assistive device (e.g. cane(s), crutches(es), walker) or brace for ambulation. A 20 percent rating for one of the following: a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive devices (e.g. cane(s), crutch(es), walker) for ambulation. b) Unrepaired or failed repair of complete ligament tear causing persistent instability and medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), or a walker) or bracing for ambulation. A 30 percent rating for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribe both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. DC 5262 now provides: For malunion, evaluate under DC 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. For medial tibial stress syndrome (MTSS) or shin splints: A noncompensable rating for treatment less than 12 consecutive months, one or both lower extremities. A 10 percent rating for treatment requiring no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities. A 20 percent rating for treatment requiring no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity. A 30 percent rating for treatment requiring no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. A 40 percent rating for nonunion of, with loose motion, requiring brace. The evidence of record shows that the Veteran has experienced ongoing left and right knee problems throughout the appeal period. The Veteran was afforded VA knee examinations in May 2015, August 2019, and July 2020. On VA examination in May 2015, the Veteran diagnosed the Veteran as having bilateral patellofemoral pain syndrome. The Veteran described his symptoms as "knees swell up sometimes...never had specific knee injury, trauma, or surgery on either knee." The Veteran reported that he was not experiencing any flare-ups in his knee pain. Range of motion testing revealed flexion to 130 degrees and extension to 0 degrees for both knees. There was no pain noted on examination, including during weight bearing. The examiner found that there was no additional functional loss or loss of range of motion after repetitive use. The examiner was unwilling to speculate whether pain, weakness, fatigability, or incoordination would significantly limit functional ability with repeated use over time. Muscle strength was normal for both knees. There was no evidence of muscle atrophy, ankylosis, recurrent subluxation, lateral instability, or recurrent effusion. There was no evidence of joint instability or meniscal conditions. On VA examination in August 2019, the Veteran complained of having occasional knee pain with severe flare-ups occurring approximately three times per month, with the pain usually precipitated by certain activities and alleviated by rest. The examiner indicated that the Veteran's bilateral knee disability, diagnosed as patellofemoral pain syndrome, resulted in difficulty standing and walking. Range of motion testing revealed normal flexion to 140 degrees and normal extension to 0 degrees for both knees. The examiner found objective evidence of mild tenderness or pain on palpation of the joint or associated soft tissue. The examiner found no change in the range of motion measurements after observed repetitive use, after repeated use over time, or during flare-ups. The examiner found no reduction in muscle strength for either knee, no muscle atrophy, no ankylosis, no history of recurrent subluxation or lateral instability, and no joint instability. Similarly, the examiner found no evidence of recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. The examiner found no evidence of any meniscal conditions. Objective evidence of pain was noted during rest/nonmovement. However, there was no evidence of pain on passive range of motion testing or during non-weight bearing testing. On VA examination in July 2020, the VA examiner diagnosed the Veteran as having retropatella pain syndrome. The Veteran reported that his knee pain had worsened since his last examination. He described experiencing a burning/throbbing sensation in both knees. He indicated that he had not experienced any flare-ups in his condition. When asked about functional loss/functional impairment, the Veteran stated, "I mean I can still stand but toward the end of the day my knees are sore. I have trouble standing for long periods of time." Range of motion testing revealed flexion to 125 degrees for the right knee and flexion to 120 degrees for the left knee. Extension was normal for both knees. Pain was noted on flexion, but the examiner reported that the pain did not result in/cause functional loss for either knee. The examiner found that there was no additional loss of function or range of motion after repetitive use. The examiner did not test range of motion for repeated use over time. Muscle strength was normal in both knees. The examiner found no evidence of muscle atrophy, ankylosis, recurrent subluxation, lateral instability, or recurrent effusion. The examiner found no evidence of joint instability and no evidence of recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. The examiner found no evidence of any meniscal conditions. The examiner noted that the Veteran occasionally walks with a cane. The examiner noted that there was no objective evidence of pain when either knee joint is used during passive range of motion testing and in non-weight bearing. After thorough consideration of the evidence of record, including his medical treatment records, the Board concludes that disability ratings in excess of 10 percent for left and right knee limitation of motion are not warranted. The Veteran's left and right knee disabilities are already rated 10 percent disabling based on the Veteran having painful motion. See 38 C.F.R. §§ 4.45, 4.59. The Board is prohibited from assigning separate 10 percent ratings for each knee based on limitation of flexion under DC 5260. Likewise, there is no evidence that flexion of the left or right knee was ever limited to 30 degrees (the criteria for the 20 percent rating under DC 5260) at any point during the appeal period. Even during a flare-up and with repeated use over time, and in consideration of any functional limitation caused by pain, the Veteran's flexion was limited to no less than 125 degrees for the right knee and 120 degrees for the left knee. Additionally, as the objective evidence of record shows, the Veteran had full extension in both knees during the appeal period, and there is no basis to assign separate or higher ratings for limitation of extension under DC 5261. Other potentially applicable diagnostic codes have also been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). However, there was no evidence of ankylosis, instability, subluxation, meniscus (semilunar cartilage) condition, a tibia or fibula impairment, or genu recurvation at any time during the appeal period. See 38 C.F.R. § 4.71a, DCs 5256, 5257, 5258, 5259, 5262, 5263. The Board has considered staged ratings but determined that staged ratings are not warranted. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board acknowledges the Veteran's statements regarding the severity of his symptoms and the impact of his disabilities. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the medical personnel who have examined him or his medical records during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which this disability is evaluated. As such, the Board finds these records to be more probative than the Veteran's subjective observations. In summary, the Veteran's left and right knee disabilities do not warrant ratings in excess of the 10 percent ratings previously assigned. The preponderance of the evidence is against the claims on appeal, and there is no doubt to be resolved. See 38 C.F.R. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As a final matter, the Veteran has not raised any other issues with respect to his claims on appeal, nor have any other assertions been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). TDIU 3. Entitlement to a TDIU due to service-connected disabilities. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 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. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The fact that a veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361. The law provides that a total disability rating may be assigned where the schedular rating is less than total 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 disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). The Veteran is currently service connected for the following: Right foot disability, status post osteotomy and excision of nucleated keratosis, third metatarsal, with hammertoes (second through fifth digits), rated 10 percent disabling from September 2, 2009, and 30 percent disabling from September 20, 2014 (except for a temporary 100 percent rating from May 28, 2015 to September 1, 2015); Left foot disability, including hyperkeratosis, third metatarsal, with hammertoes (second through fifth digits), rated 10 percent disabling from September 2, 2009, and 30 percent disabling from September 20, 2014 (except for a temporary 100 percent rating from September 22, 2016 to January 1, 2017); Mechanical low back pain, rated 10 percent disabling from April 16, 2003; Right knee retropatella pain syndrome, rated 10 percent disabling from April 16, 2003; Left knee retropatella pain syndrome, rated 10 percent disabling from April 16, 2003; Residual right foot surgical scar, rated 0 percent disabling from September 2, 2009; and Residual right foot surgical scar, rated 0 percent disabling from September 2, 2009. The Veteran's combined evaluation for compensation is 30 percent from April 16, 2003; 40 percent from September 2, 2009; 70 percent from September 20, 2014; 100 percent from May 28, 2015; 70 percent from September 1, 2015; 100 percent from September 22, 2016; and 70 percent from January 1, 2017. See 38 C.F.R. § 4.25. Therefore, the Board finds that the Veteran meets the schedular criteria for TDIU from September 20, 2014. See 38 C.F.R. § 4.16(a). The question that remains, then, is whether the Veteran's service-connected disabilities preclude him from obtaining or engaging in substantially gainful employment. The Veteran contends that the collective effect of his service-connected disabilities is the reason he can no longer obtain and maintain a job. The record indicates that the Veteran completed high school and worked as a truck driver and warehouseman after he separated from military service. The electronic claims file also contains records showing that the Veteran received Chapter 31 vocational rehabilitation benefits to pursue a Bachelor of Arts degree in digital filmmaking and video production. According to a February 2015 Rehabilitation Closure Statement, the Veteran successfully completed the rehabilitation program and started his own business in film production, editing, and distribution. The report noted that his company had grown to the point that he had hired three additional employees and that running the company was a full time position that was suitable and satisfactory to the Veteran. In a June 2020 application for increased compensation based on unemployability (VA Form 21-8940), the Veteran did not reference his Bachelor of Arts degree or managing his own film production/editing/distribution company. Instead, he reported that he last worked as a truck driver until he became "too disabled to work" in July 2018. In an accompanying statement, the Veteran indicated, "all my service connected disability [sic] is preventing me from holding stable employment." He goes on to describe the functional impairments caused by his service-connected disabilities and indicated that he had a background in warehousing and truck driving. During the pendency of the claim, the Veteran was provided numerous VA examinations for his service-connected disabilities. The May 2015 VA knee examination revealed that the Veteran's bilateral knee disability would not preclude physical or sedentary employment or prevent him from securing and maintaining gainful employment. The May 2015 VA back examination revealed that the Veteran's service-connected lumbar spine disability would not preclude physical or sedentary employment and that his range of motion did not result in a functional deficit that would interfere with securing or maintaining gainful employment. The May 2015 VA foot examination indicated that the Veteran has severe pain with standing and walking and that he works in videography which requires standing and walking. The examiner noted that the Veteran was scheduled to have upcoming foot surgery which would temporarily preclude employment as a videographer. The August 2019 VA knee examination revealed that the Veteran's service-connected left and right knee disabilities did not have any impact on his ability to work. The August 2019 VA back examination revealed that the Veteran's service-connected low back disability did not impact his ability to work. The August 2019 VA foot examination revealed that the Veteran's service-connected bilateral foot disability would prevent the Veteran from standing and walking more than four hours in an eight hour workday (with normal breaks) which would impact physical employment. The July 2020 VA knee examination revealed that the Veteran's service-connected left and right knee disabilities were manifested by pain that caused the Veteran to have difficulty with prolonged standing and walking and difficulty with heavy lifting. The examiner, however, did not find that the Veteran was precluded from securing or maintaining substantially gainful employment. The Veteran's VA and private treatment records during the pendency of the appeal do not indicate that the Veteran's service-connected disabilities have more of an adverse impact on the Veteran's occupational impairment than reported in the VA examinations. Based upon a review of the evidence of record, the Board finds that the record shows that the severity, symptomatology, and difficulties attributable to the Veteran's service-connected disabilities are contemplated by the assigned rating criteria. The Board acknowledges that the Veteran's service-connected foot, knee, and low back disabilities cause the Veteran significant pain, problems, and secondary disabilities (this is not in dispute). The Veteran's combined 70 percent disability rating is, itself, recognition that the combined impact of his disabilities makes it difficult to perform occupational tasks and maintain employment that involves standing or walking. The Board also reiterates that the fact that the Veteran is unemployed, is not determinative; the ultimate question is whether he was incapable, due to service-connected disabilities, of performing the physical and mental acts required by employment. Here, the evidence of record shows that, as a result of his service-connected disabilities, the Veteran has pain with prolonged walking, standing, and sitting. However, the medical evidence does not indicate that the Veteran would be precluded from sedentary employment. Further, the available record and Veteran's educational background does not indicate that the Veteran is incapable of performing the mental acts required by employment. The Board also notes that the Veteran successfully completed his rehabilitation program and earned a bachelor's degree in digital filmmaking and video production. According to the evidence of record, the Veteran also successfully started his own film production, editing, and distribution company. While the specifics of managing that company are not entirely clear, when afforded the opportunity to address his occupational limitations in his application for a TDIU, he did not address the fact that he managed his own company nor did he provide any evidence to refute that he was unable to continue managing that company. The Board acknowledges lay statements from the Veteran addressing the impact of his service-connected disabilities on his ability to work. No one is suggesting the Veteran's service-connected disabilities do not cause the Veteran many problems. If he did not have issues with his service-connected problems, there would be no basis for compensable evaluations for these disabilities. While the Veteran is competent to report symptoms he experiences, an opinion as to the limitations on gainful employment due to his service-connected disabilities (and not his age or nonservice-connected problems) is beyond his medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Admittedly, the Veteran's bilateral foot disability will likely make it difficult for him to perform work that requires prolonged standing or walking. However, the Veteran has not demonstrated that he is unable to perform work that involves sitting or minimal standings/walking or a job that provides him with breaks if required to stand or walk. As part of its May 2020 remand, the Board gave the Veteran the opportunity to provide any information that he felt was pertinent to helping VA understand the impact of his service-connected disabilities on his ability to secure and maintain employment. As previously mentioned, he did not provide any information that would lead the Board to the conclusion that working as a videographer or managing a digital production company would require him to constantly be standing or walking or that he could not perform his job responsibilities in any capacity. It is important for the Veteran to understand that the medical findings provide highly probative evidence against the claim that the Board cannot, unfortunately, ignore. The medical findings outweigh the Veteran's belief that he is entitled to a TDIU and provide a highly clear basis for the opinion. Therefore, the Board provides more weight to the competent medical evidence of record and must deny the claim. Thus, the Board finds that while the Veteran's service-connected disabilities are productive of some occupational limitations, the objective medical evidence, to include VA examination reports, does not support a finding that the Veteran's service-connected disabilities, separately or combined, precluded his employment. Considering the Veteran's education and work history, the limitations on prolonged walking and standing, as noted in recent VA examinations, would not preclude the Veteran from securing or maintaining substantially gainful employment. In this regard, the Board has also considered the aggregate effect of all the Veteran's service-connected disabilities on his employability and functional ability. However, a detailed review of the record simply does not support a TDIU finding. Based on the foregoing, the Board finds that the preponderance of the evidence does not support a finding that the Veteran is unable to secure or follow substantially gainful employment due to service-connected disabilities alone. Accordingly, the Board finds that the criteria for a TDIU have not been met and the claim must be denied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. The Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). April Snoparsky Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael L. Marcum, 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.