Citation Nr: 22008048 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 18-19 785 DATE: February 11, 2022 ORDER Entitlement to a rating in excess of 10 percent for limitation of right hip extension is denied. Entitlement to a compensable rating for limitation of right hip flexion prior to August 1, 2020, and in excess of 40 percent thereafter, is denied. Entitlement to a compensable rating for impairment of the right thigh prior to September 23, 2015, and in excess of 20 percent thereafter is denied. Entitlement to a right knee rating based on loss of motion in excess of 10 percent prior to August 1, 2020, and in excess of 20 percent thereafter is denied. Entitlement to a rating in excess of 10 percent for right genu recurvatum is denied. Entitlement to a rating for a leg length discrepancy in excess of 30 percent prior to August 1, 2020 and in excess of 50 percent thereafter is denied. Entitlement to a total disability rating due to individual unemployability (TDIU) based solely on residuals of myxofibrosarcoma (MFX) is denied. FINDINGS OF FACT 1. The Veteran is in receipt of the maximum rating for limitation of extension of the right hip throughout the appeal period. 2. Prior to an August 2020 VA examination, it is not factually ascertainable that the Veteran manifested right hip flexion limited to 30 degrees or less, thereafter he is in receipt of the maximum rating for limitation of flexion. 3. There is no evidence indicating the Veteran manifested right hip limitation of abduction with motion lost beyond 10 degrees, was unable to cross his legs or toe out more than 15 degrees with his right leg prior to a September 2015 VA examination, and thereafter he is in receipt of the maximum rating for impairment of the hip. 4. Prior to August 1, 2020, there is no evidence the Veteran manifested limitation of motion of the right knee to a compensable degree, thereafter he has manifested at most right knee flexion limited to 30 degrees with normal extension. 5. There is no evidence of a diagnosis of right knee genu recurvatum prior to April 1, 2018. 6. The Veteran's leg length discrepancy was measured at approximately 2.5 inches in December 2017 and at just over 3.5 inches in August 2020. 7. The evidence persuasively weighs against finding that the Veteran's MFX residuals alone render him unable to find and maintain gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for limitation of right hip extension have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5251. 2. The criteria for a compensable rating for limitation of right hip flexion prior to August 1, 2020, and in excess of 40 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5252. 3. The criteria for a compensable rating for impairment of the right hip prior to September 23, 2015, and in excess of 20 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5253. 4. The criteria for a right knee rating based on loss of motion in excess of 10 percent prior to August 1, 2020 and in excess of 20 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5260, 5261. 5. The criteria for a rating in excess of 10 percent for right genu recurvatum have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5263. 6. The criteria for a rating in excess of 30 percent prior to August 1, 2020 and in excess of 50 percent thereafter for a leg-length discrepancy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5275. 7. The criteria for entitlement to a TDIU based solely on the Veteran's MFX residuals have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from July 1966 to July 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2016 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). In a December 2019 decision, the Board remanded the issues of increased ratings for the Veteran's right knee and hip disabilities to the AOJ for further development and declined to address the issue of entitlement to a TDIU based solely on residuals of MFX. The Veteran appealed the TDIU issue to the Court of Appeals for Veterans Claims (Court), which initially dismissed the claim for lack of jurisdiction in March 2021. After the Veteran filed a motion to reconsider, the Court issued a May 2021 memorandum decision stating that the Board failed to provide reasons and bases for its failing to address the Veteran's request for remand to the AOJ to address in the first instance the claim of a TDIU based solely on MFX. The Court then remanded the matter to the Board for action consistent with the decision. Increased Rating Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. The Board notes that the rating criteria for the knee and hip were amended effective February 7, 2021, but these updates do not pertain to the Veteran's symptoms. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to a rating in excess of 10 percent for limitation of right hip extension 2. Entitlement to a compensable rating for limitation of right hip flexion prior to August 1, 2020, and in excess of 40 percent thereafter 3. Entitlement to a compensable rating for impairment of the right thigh prior to September 23, 2015, and in excess of 20 percent thereafter In a January 2016 rating decision, the Veteran was assigned a right hip rating of 0 percent due to limitation of flexion, 0 percent for hip impairment, and 10 percent due to painful motion prior to and after a temporary 100 percent rating post-surgery. As noted above, the Board remanded this issue in December 2019 in order to afford the Veteran a contemporaneous hip examination. After the examination and prior to returning the case to the Board, the AOJ issued an August 2020 rating decision increasing the ratings to 40 percent based on limitation of flexion, 20 percent for impairment of the hip and assigning a separate rating 10 percent rating for limitation of extension, all effective August 1, 2020. As this is in some cases less than the maximum available benefit, the issues remain in controversy. See AB v. Brown, 6 Vet. App. 35 (1993). By way of history, the Veteran manifested MFX in his right thigh and in October 2008 underwent surgery to remove the mass, which included his quadriceps as well as a great deal of his hamstring. He subsequently received radiation therapy in the area, and in July 2015 suffered a fractured right femur in the area of the treatment. The Veteran underwent successful surgery to repair the femur. At the outset the Board notes that the diagnostic codes relating to ankylosis, flail joint and impairment of the femur are not for application, as there is no evidence in the medical records that the Veteran has manifested these disorders. See 38 C.F.R. § 4.71a, DC 5250, 5254, 5255. While the Veteran suffered a femur fracture, it was non-displaced and there is no evidence of non-union or malunion of the shaft. Under DC 5251, which addresses extension, a 10 percent rating is warranted when thigh extension is limited to 5 degrees. 38 C.F.R. § 4.71(a). Under DC 5252, which addresses flexion, a 10 percent rating is assigned when thigh flexion is limited to 45 degrees, a 20 percent rating is assigned when flexion is limited to 30 degrees, a 30 percent rating is assigned when flexion is limited to 20 degrees, and a 40 percent rating is assigned when flexion is limited to 10 degrees. Id. DC 5253 addresses limitations on abduction and adduction of the hip. Under this DC, a 20 percent rating is warranted for limitation of abduction of the thigh with motion lost beyond 10 degrees, a 10 percent rating is warranted for limitation of adduction with the inability to cross legs, and a 10 percent rating is warranted for limitation of rotation with the inability to toe-out more than 15 degrees in the affected leg. Id. Normal hip motion is defined as flexion from zero to 125 degrees and abduction from zero to 45 degrees. 38 C.F.R. § 4.71, Plate II. In general, separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Court has also held that "within a particular diagnostic code, a claimant is not entitled to more than one disability rating for a single disability unless the regulation expressly provides otherwise." Cullen v. Shinseki, 24 Vet. App. 74 (2010). Although VA policy as it pertains to range of motion findings for the hip is that separate ratings may be assigned for extension, flexion, abduction, adduction or rotation as they represent distinct disabilities, only one rating from each DC may be assigned. Id. The Veteran was afforded a VA hip examination in September 2015, during which he described persistent right-thigh weakness, pain and fatigability of the quadriceps and hamstring, which he said impaired his driving, pushing/pedaling, and walking. He also reported decreased motion of the hip as well as altered walking mechanics, though he denied flareups. The examiner recorded flexion of 90 degrees, extension to 15 degrees, abduction to 30 degrees, adduction to 20 degrees, as well as 40 degrees external rotation and 50 degrees internal rotation, with pain on all motion and when weight bearing. These measurements were unchanged on repetitive use, and the examiner noted the examination was occurring immediately after repeated use over time with no additional symptoms. The Veteran exhibited three out of five strength flexion, five of five extension, and four of five abduction, with no ankylosis. The examiner noted that the Veteran manifested significant weakness due to the sarcoma removal and was still on crutches two months after his femur surgery, concluding his symptoms of weakness, pain and limited motion impacted his ability to perform manual work. The Veteran participated in physical therapy from December 2017 to October 2018, during which the treating clinicians observed a gross absence of the quadriceps and hamstring atrophy as well as an antalgic gait but no tenderness to palpation of the thigh. The Veteran denied further falls and indicated he ambulated with a cane in his home as well as with the cane and a rollator in the community. In March 2018 he reported right hip soreness due to the therapy exercises but denied pain, falls or swelling. In October 2018 the Veteran demonstrated improved gait speed with his cane and was described as "overall doing well." The Veteran was afforded an additional VA hip examination in August 2020, during which he reported sharp pains that come when walking too much or climbing stairs, lasting a few hours and improving with rest. He also described flareups a few times per week during which he avoided walking, running, climbing steps or standing for a long time. The examiner noted diagnoses of a right hip strain with degenerative joint disease (DJD) and a sarcoma with quadriceps removal. The Veteran exhibited 0 degrees flexion, 15 degrees extension, as well as 10 degrees abduction, adduction, external rotation, and internal rotation. The measurements were the same after repetitive use testing and the Veteran could cross his legs afterwards, although pain was noted on all movement. During flareups and after repeated use over time, the examiner estimated flexion at 0 degrees as well as extension, abduction, adduction, internal and external rotation to 5 degrees, with an inability to cross the legs. The examiner measured atrophy of the thigh due to quadriceps removal and a leg length discrepancy of 9 cm, although the Veteran did not manifest ankylosis. The examiner concluded that the Veteran was best suited for sedentary work only due to weakness and impairment of the right thigh and leg with complete dependence on a cane for ambulation. After review of the evidence, the Board finds that increased ratings for the Veteran's hip disorders are not warranted. According to his September 2015 VA examination, he manifested at worst noncompensable limitations of flexion, extension, abduction, adduction, and rotation. The 10 percent rating assigned by the AOJ for this time period represents the minimum compensable rating for the joint assigned as a result of painful motion. See 38 C.F.R. §§ 4.45, 4.71a. Although the Veteran complained of worsening symptoms prior to the August 2020 VA examination, the Board cannot factually ascertain that he manifested motion limited to such a degree so as to be compensable under the DCs pertaining to the hip and thigh. Therefore, the Board cannot assign an earlier effective date for the higher ratings granted by the August 2020 rating decision. Similarly, during the August 2020 VA examination, the examiner determined that the Veteran did not manifest ankylosis, but recorded impairment of extension, flexion and abduction during flareups and after repetitive use severe enough to warrant the highest possible ratings under the respective DCs. The AOJ has awarded separate ratings under DCs 5251 (extension), 5252 (flexion) and 5253 (impairment of the thigh), effective the date of the August 2020 examination. As noted above, while the Veteran has also manifested reduced adduction and rotation of the hip, separate ratings under the same DC are prohibited absent the regulation expressly providing otherwise. Cullen, 24 Vet. App. 74. As a trained clinician has determined that the Veteran did not manifest ankylosis or a hip flail joint, nor mal or nonunion of the femur, and he is in receipt of the maximum ratings under the appropriate diagnostic codes, higher ratings for his hip disorders are not warranted. Finally, the issue of referral for extraschedular consideration is discussed below. 4. Entitlement to a right knee rating based on loss of motion in excess of 10 percent prior to August 1, 2020, and in excess of 20 percent thereafter 5. Entitlement to a rating in excess of 10 percent for right genu recurvatum 6. Entitlement to a rating in excess of 30 percent prior to August 1, 2020 and in excess of 50 percent thereafter for a leg-length discrepancy In a January 2016 rating decision, the Veteran was assigned a right knee rating of 10 percent due to painful motion. As noted above, the Board remanded this issue in December 2019 in order to afford the Veteran a contemporaneous examination. After the examination and prior to returning the case to the Board, the AOJ issued an August 2020 rating decision increasing the rating to 20 percent based on limitation of flexion effective the date of the examination and assigning a separate rating 10 percent rating for genu recurvatum, effective February 15, 2018. This decision also granted a rating of 30 percent for a leg length discrepancy prior to August 1, 2020 and 50 percent thereafter. As this is less than the maximum available benefit, the issues remain in controversy. See AB, 6 Vet. App. 35. Included within 38 C.F.R. § 4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). The Board notes that there is no evidence in the Veteran's treatment records that indicate he manifests right knee ankylosis, recurrent subluxation, lateral instability, a meniscal condition, or impairment of the tibia or fibula. Under DC 5260, a noncompensable rating is assigned when flexion of the leg is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under DC 5261, a noncompensable rating is assigned when extension of the leg is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. Id. Under DC 5263, a 10 percent rating is assigned for genu recurvatum, described as "acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated." Id. Finally, under DC 5275, a 10 percent rating is warranted for a shortening of a lower extremity of 1.25 to 2 inches (3.2 to 5.1 cm). A 20 percent rating is warranted for 2 to 2.5 inches (5.1 to 6.4 cm), a 30 percent rating is warranted for 2.5 to 3 inches (6.4 to 7.6 cm), a 40 percent rating is warranted for 3 to 3.5 inches (7.6 to 8.9 cm), and a 50 percent rating is warranted for 3.5 to 4 inches (8.9 to 10.2 cm). A 60 percent rating is warranted for a shortening over 4 inches (10.2 cm). Following surgery to repair his right femur, the Veteran was afforded a September 2015 VA knee examination. He reported right knee pain that began in 2008 after removal of a right thigh sarcoma and gradually worsened with prolonged sitting, standing, and walking. He also stated that this caused decreased motion in his right knee and altered his walking mechanics. The VA examiner recorded range of motion of 90 degrees flexion and 0 degrees extension, with no difference after repetitive use. Pain was noted on palpation and weight bearing. The Veteran denied flareups and the examiner noted he was being examined immediately after repeated use over time, with no additional symptoms. His muscle strength was rated as five out of five on flexion and three out of five on extension, with the reduced strength attributed to his MFX residuals. The examiner noted no instability, subluxation, effusion or meniscal condition, and all stability testing was normal. Finally, the examiner noted that the Veteran reported regular use of crutches to ambulate in the two months since his surgery. The Veteran's functional loss in combination with this thigh/hip disability was described as limited motion and pain impacting his ability to perform and maintain manual work, especially while recovering from surgery. VA physical therapy records from December 2017 to October 2018 note the Veteran reported no instability, demonstrated an antalgic gait despite lack of pain, worked full time as a software engineer, and ambulated with a cane at home as well as a cane or rollator in the community. December 2017 records note the Veteran's right leg was approximately 2.5 inches shorter than his left, causing him to limp. In March 2018 he denied pain other than muscle soreness in his hip due to rehab exercises but expressed safety concerns when going downstairs or ambulating long distances due to right leg weakness. However, he stated he remained "very active," working as a software programmer and navigating his two-story house. In July 2018 he arrived at therapy utilizing a single point cane and demonstrating an antalgic gait. He denied swelling or falls but reported joint pain. In October 2018 he described inconsistent use of a knee brace due to work constraints but demonstrated improved gait speed with a single point cane. The Veteran was afforded an additional VA examination in August 2020, during which he reported a sharp throbbing pain that comes with walking, lasts a few hours and improves with rest. He stated he avoided too much running, squatting, climbing steps as well as walking or standing for long periods, describing flareups a few times per week. The examiner noted diagnoses of a right knee strain with DJD, genu recurvatum and a leg length discrepancy, recording 50 degrees flexion with 0 degrees extension both normally and on repetitive use and with pain on both. The Veteran reported pain, weakness, fatigue, lack of endurance and incoordination causing functional loss during flareups and after repeated use over time, which the examiner estimated would reduce his flexion and extension to 30 and 0 degrees, respectively. His muscle strength was four out of five, and the examiner observed no ankylosis, instability or meniscal condition, but recorded a leg length discrepancy of 9 cm. The examiner noted constant use of a cane and concluded that the "Veteran is best suited for sedentary work only due to weakness and impairment of his right thigh/leg and right knee with complete dependence on [an] ambulatory device." After review of the evidence, the Board finds that increased ratings for the Veteran's right knee disabilities are not warranted. The September 2015 VA knee examination indicates the Veteran did not manifest right knee ankylosis, recurrent subluxation or lateral instability, a meniscal condition, impairment of the tibia or fibula, genu recurvatum, or loss of flexion or extension to a compensable degree. The first indication of weakness or insecurity with weight bearing is during his 2017 to 2018 VA physical therapy treatment. This is contemplated in the AOJ's currently assigned effective date of April 1, 2018, and he is in receipt of the maximum rating under DC 5263. The Board observes there is no evidence of a clinical diagnosis of genu recurvatum until after the current effective date. With regard to limitation of motion, while the Veteran reported worsening knee symptoms, the Board cannot ascertain that he manifested loss of flexion to a compensable degree prior to the August 2020 VA examination, where it was estimated that flexion was limited to 30 degrees during flareups or after repeated use over time. Therefore, an earlier effective date is not warranted, nor is a rating in excess of 20 percent, as the Veteran was assigned a rating corresponding to his maximum loss of motion during flareups or after repetitive use and the trained clinician did not note any of the disorders described by the remaining knee DCs. The Board also finds that an increased rating for a leg length discrepancy is not warranted. In December 2017 a VA physical therapist noted a discrepancy of 2.5 inches, while the August 2020 examiner recorded a discrepancy of 9 cm, or just over 3.5 inches. Under DC 5275, 30 percent is the maximum rating for a leg length discrepancy of 2.5 to 3 inches, while the 9 cm recorded in August 2020 warrants a 50 percent rating. As these are the only precise measurements of the Veteran's leg length discrepancy of record, the Board cannot find that a rating in excess of 30 percent was warranted prior to August 2020. Finally, in the original notice of disagreement, the Veteran's representative stated, "his leg injury is severe, if the schedule can only provide two 10 percent ratings, then an extraschedular rating should be assigned." Referral for an extraschedular rating may be warranted where the rating criteria do not adequately contemplate the symptoms of a veteran's service-connected disability, and where the disability is productive of frequent hospitalizations or marked interference with employment. See Thun v. Peake, 22 Vet. App. 111 (2008). In Morgan v. Wilkie, 31 Vet. App. 162, 164 (2019), the Court held that the Board must consider using available schedular rating tools, including a TDIU, prior to referral for an extraschedular rating, as it does not have the power to grant such a rating in the first instance. The Board finds that in this case the symptoms caused by the Veteran's right hip and leg MFX residuals are contemplated by the assigned rating criteria. The Veteran has described his symptoms as sharp pains that come when walking too much, climbing stairs, chronic pain, loss of motion in the hip and knee, right thigh muscle weakness, a leg length discrepancy, as well as weakness and insecurity with weight bearing and an altered gait. As discussed above, these symptoms are contemplated by the assigned ratings in the DCs compensating him for a leg length discrepancy causing him to limp, hip impairment, limitation of flexion and extension of the thigh, limitation of flexion of the knee and genu recurvatum causing weakness and insecurity in weight bearing. Therefore, referral for consideration of an extraschedular rating is not warranted. See Thun 22 Vet. App. 111; see also Long v. Wilkie, 33 Vet. App. 167 (2020). 7. Entitlement to a TDIU solely on the basis of MFX residuals The Veteran initially filed a November 2016 application for a TDIU, alleging his MFX, cardiomyopathy, femur fracture, degenerative joint disease, and lumbar spine disorder rendered him unable to work. In a February 2018 rating decision, the AOJ granted entitlement to a TDIU, effective April 1, 2016, stating that this consisted of a full grant of the benefits sought on appeal. In August 2018, the Veteran filed a notice of disagreement, alternately contending that his unemployability stemmed solely from his MFX and residuals, and that his femur fracture and back disability alone rendered him unemployable. In July 2019 correspondence, the Veteran's representative noted that VA did not respond to the notice of disagreement and requested remand to the AOJ for the issuance of a statement of the case. As noted above, the Court has remanded this issue to the Board, citing Robinson v. Peake, 21 Vet. App. 545, 552-56 (2008), which holds that the Board has a duty to address all issues reasonably raised by either the Veteran or the record. Although the Veteran's representative has requested that the Board remand the issue of entitlement to a TDIU based solely on MFX residuals to the AOJ for consideration in the first instance, this is not necessary as the TDIU claim is considered to be part and parcel of the increased ratings claims which have been returned to the Board. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). A total disability rating based upon individual unemployability may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Entitlement to a total rating must be based solely on the impact of a veteran's service-connected disabilities on his ability to keep and maintain substantially gainful employment. See 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." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). A veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b). The term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16(b) includes two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran's ability to follow and secure employment. For the second component, attention must be given to (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58 (2019). At the outset, the Board observes that the Veteran has been granted entitlement to a TDIU based on the combined effects of his service-connected disabilities from April 1, 2016. However, the Board will only consider, at the request of the Veteran, whether the residuals of his MFX of the right thigh, claimed by the Veteran as lumbar spine, right hip and right thigh impairment, have rendered him unemployable since April 1, 2016. The factual record with regard to these disabilities has been discussed at length above. After review of the evidence of record, the Board finds that a TDIU based solely on the Veteran's MFX residuals is not warranted. The Board observes that in the Veteran's November 2016 TDIU application, his last employment was listed as an information technology (IT) position from February to June 2014, earning $3,000 per month. He also reported income in IT positions ranging from $7,200 to $8,300 per month from previous employers. Finally, he indicated attempting to gain employment in IT with two other companies in September 2014 and August 2015. The Veteran did not describe his prior education or training and has not provided updated employment information since this application. However, December 2017 VA physical therapy records indicate that the Veteran was working full time as a software consultant, primarily in front of a computer. March 2018 records note that he remained very active working as a software programmer. During a September 2015 VA spine examination, the examiner opined that the Veteran's back disorder did not impact his ability to function in an employment environment, while a concurrent VA examiner noted his knee and hip disorders would impact his ability to perform and maintain "manual work." Finally, an August 2020 VA examiner noted the "Veteran was best suited for sedentary work only due to weakness and impairment of his right thigh/leg and right knee with complete dependence on [an] ambulatory device." As sedentary is defined as "doing or involving a lot of sitting; not doing or involving much physical activity," the Board finds that sedentary employment is a job where the duties are primarily performed sitting down. https://www.merriam-webster.com/dictionary/sedentary. This is contrasted with physical employment, which is defined as "characterized by especially rugged and forceful activity." https://www.merriam-webster.com/dictionary/physical. Although VA examiners have noted that the Veteran's hip, knee and back disorders cause difficulty walking, standing, climbing stairs or performing other physical activities, there is no indication he is unable to perform sedentary tasks such as computer programming. The evidence available to the Board indicates that he is not only able to perform sedentary employment, but that he was employed full time "sitting in front of a computer" up until at least March 2018. The Board notes that the Veteran's service-connected cardiomyopathy is also attributed to his MFX treatment, and that during his last VA heart examination in September 2015 the examiner opined that he would be "limited to sedentary employment." Finally, the Board observes that the Veteran's entire listed work history is both gainful and in the IT field, so there is no reason to doubt his latest employment in IT is similarly gainful. There is also no evidence in the claims file indicating that he lacks the skills to find and maintain such gainful and sedentary employment in the future if indeed he is not currently so employed. As such, the Board finds that a preponderance of the evidence is against finding that he is unemployable solely as a result of his MFX residuals, and the claim is denied. N. RIPPEL Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. C. Schumacher, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.