Citation Nr: 22010522 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 17-38 538 DATE: February 23, 2022 ORDER Entitlement to an initial disability rating in excess of 10 percent for left knee osteoarthritis status post arthroscopy and meniscectomy is denied. Entitlement to a separate disability rating of 10 percent, though no higher, for a left knee disability based on limitation of extension is granted. Entitlement to an initial disability rating of 30 percent, though no higher, prior to September 19, 2016 for left shoulder superior labrum from anterior to posterior (SLAP) tear, postoperative, and acromioclavicular (AC) joint osteoarthritis is granted. Entitlement to an initial disability rating of 30 percent, though no higher, from September 19, 2016 for left shoulder SLAP tear, postoperative, and AC joint osteoarthritis is granted. Entitlement to an initial 10 percent disability rating, though no higher, prior to September 19, 2016 for left wrist triangular fibrocartilaginous complex injury (TFCC) with ulnar styloid fracture, marrow edema and degenerative arthritis is granted. Entitlement to an initial disability rating in excess of 10 percent from September 19, 2016 for left wrist TFCC with ulnar styloid fracture, marrow edema and degenerative arthritis is denied. Entitlement to an initial disability rating of 30 percent, though no higher, prior to May 24, 2017 for gastroesophageal reflux disease (GERD) is granted. Entitlement to an initial disability rating in excess of 70 percent for major depressive disorder with anxious distress is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) based on single service-connected disability is denied. FINDINGS OF FACT 1. Throughout the duration of the appeal, the Veteran's left knee disability has been productive of, at worst, flexion limited to 90 degrees with pain, extension limited to 0 degrees with pain, reported limitations with flare ups and X-ray evidence of arthritis; there was no objective evidence of ankylosis, subluxation or instability. 2. Throughout the duration of the appeal, the probative evidence of record reflects that the Veteran's left shoulder disability has been productive of, at worst, limitation of motion of the arm to 75 degrees flexion and 90 degrees abduction and the inability to perform three repetitions of range of motion due to pain; there are no findings of ankylosis or impairment of the humerus. 3. Throughout the duration of the appeal, the probative evidence of record demonstrates that the Veteran's left wrist disability has been productive of, at worst, pain, palmar flexion limited to 40 degrees, dorsiflexion limited to 65 degrees and X-ray evidence of arthritis; there are no objective findings of ankylosis or additional functional impairment akin to ankylosis. 4. For the period prior to May 24, 2017, the probative evidence of record demonstrates that the Veteran's GERD was, at worst, manifested by symptoms productive of considerable impairment of health including, persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation and substernal pain. 5. Throughout the duration of the appeal, the probative evidence of record indicates the Veteran's major depressive disorder with anxious distress, at worst, was productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, and not productive of total occupational and social impairment 6. Throughout the duration of the appeal, the evidence of record does not demonstrate that the Veteran was unable to secure or follow substantially gainful employment as a result of a single service-connected disability. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for left knee osteoarthritis status post arthroscopy and meniscectomy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.71a, Diagnostic Codes (DCs) 5003, 5260 (2020); 38 C.F.R. § 4.71a, DCs 5003, 5260 (2021). 2. The criteria for a separate disability rating of 10 percent, though no higher, for a left knee disability based on limitation of extension have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.71a, DCs 5003, 5261 (2020); 38 C.F.R. § 4.71a, DCs 5003, 5261 (2021). 3. The criteria for an initial disability rating of 30 percent, though no higher, prior to September 19, 2016 for left shoulder SLAP tear, postoperative, and AC joint osteoarthritis have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5201(2020); 38 C.F.R. § 4.71a, DCs 5003, 5201 (2021). 4. The criteria for an initial disability rating of 30 percent, though no higher, from September 19, 2016 for left shoulder SLAP tear, postoperative, and AC joint osteoarthritis have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5201 (2020); 38 C.F.R. § 4.71a, DCs 5003, 5201 (2021). 5. The criteria for an initial 10 percent disability rating, though no higher, prior to September 19, 2016 for left wrist TFCC with ulnar styloid fracture, marrow edema and degenerative arthritis have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5215 (2020); 38 C.F.R. § 4.71a, DCs 5003, 5215 (2021). 6. The criteria for an initial disability rating in excess of 10 percent from September 19, 2016 for left wrist TFCC with ulnar styloid fracture, marrow edema and degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5215 (2020); 38 C.F.R. § 4.71a, DCs 5003, 5215 (2021). 7. The criteria for an initial disability rating of 30 percent, though no higher, prior to May 24, 2017 for gastroesophageal reflux disease (GERD) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, DC 7346. 8. The criteria for an initial disability rating in excess of 70 percent for major depressive disorder with anxious distress have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, DC 9434. 9. The criteria for a TDIU have not been met. 38 U.S.C. § 1114(s); Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2007 to July 2015. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Board, in pertinent part, remanded the issues listed on the title page for additional development. Although entitlement to a TDIU was denied in the July 2017 rating decision based upon the finding that the issue was moot as the Veteran was in receipt of a 100 percent disability rating, the Board finds that the claim was not fully adjudicated and the TDIU claim has been raised by the Veteran during the pendency of this appeal and is part and parcel of the claims on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher evaluation; otherwise, the lower evaluation will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different "staged" ratings may be warranted for different time periods. Where the question for consideration is the propriety of the initial evaluation assigned after the granting of service connection, separate ratings may also be assigned for separate periods of time based on facts found, i.e., "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 38 C.F.R. § 4.40 does not require a separate rating for pain but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). In order to be adequate, VA examinations must include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the most recent July 2017 VA examinations of the knees, shoulders and wrists documented whether there was pain on movement in active and passive ranges of motion as well as pain in weight-bearing and in non-weightbearing positions in both the affected joint and non-affected opposite joint. The VA examiner also provided opinions regarding flare ups of the knees, shoulders and wrists and discussed the estimated limitation of motion with flare ups, repetitive motion and repeated use over time. In discussing whether pain, incoordination, weakness or fatigue caused additional functional limitation with flare ups in the knee, the examiner explained that he was unable to provide this opinion without speculation because it was unobserved. The Board finds the examiner provided a reasonable explanation as to why an opinion could not be provided and a remand requiring the examiner to provide an opinion after they explained why they could not provide an estimation without observation would not benefit the Veteran in this case and delay adjudication further. As the July 2017 VA examinations addressed flare ups, weight bearing, non-weight-bearing, and active and passive motion in accordance with the Correia and Sharp cases, a remand would be unnecessary. Finally, the Board observes that changes were made to several musculoskeletal rating codes in 38 C.F.R. § 4.71, effective February 7, 2021. Regarding the codes pertaining to the wrist, there were no changes. Although recent changes to the knee codes included defining DCs 5257 and 5262 pertaining to knee instability, subluxation and impairment of the tibia and fibula, the Board is awarding a separate disability rating under DC 5261 and the knee disability does not demonstrate any findings demonstrating instability or impairment of the tibia or fibula under either the old or amended criteria. Therefore, DCs 5257 and 5262 do not apply to the current knee disabilities, discussed below, and adjudication of this claim is not prejudicial to the Veteran. In addition, the Board observes that the only change made to DC 5201 included an additional description that limited motion included flexion or abduction of the arm and specified that midway was 45 degrees and shoulder level was 90 degrees. Thus, the Board observes that adjudication of the claim for an increased rating for the left shoulder disability is not prejudicial to the Veteran. 1. Left Knee Osteoarthritis Status Post Arthroscopy and Meniscectomy and Left Knee Disability Based on Limitation of Extension During the pendency of this appeal, the Veteran's left knee disability was rated under 38 C.F.R. § 4.71a, DCs 5003 and 5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5003 pertains to arthritis, and if only one major joint is involved, rates each joint by limitation of motion. Diagnostic Code 5260 addresses limitation of flexion. As set forth above, during the pendency of this appeal, the provisions of 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 76,453, 76,464 (Nov. 30, 2020), revised, 85 Fed. Reg. 85,523 (Dec. 29, 2020), revised, 85 Fed. Reg. 8142 (Feb. 4, 2021). Therefore, the Board will consider the Veteran's claims under both the former and revised rating criteria, and the more favorable criteria will be applied. If the revised criteria are more favorable, they will only be applied from February 7, 2021, when the regulations became effective. DC 5003 provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, DC 5003 provides a 20 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under DCs 5013 to 5024, inclusive. Id. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. Id. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Under the former rating criteria prior to February 7, 2021, DC 5257 provides ratings for other impairment of the knee that includes recurrent subluxation or lateral instability. Slight recurrent subluxation or lateral instability of the knee is rated 10 percent disabling; moderate recurrent subluxation or lateral instability of the knee is rated 20 percent disabling; and severe recurrent subluxation or lateral instability of the knee is rated 30 percent disabling. 38 C.F.R. § 4.71a, DC 5257 (2020). The words slight, moderate, moderately severe, marked, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence in reaching a decision that is "equitable and just." 38 C.F.R. § 4.6. Under the revised criteria from February 7, 2021, Diagnostic Code 5257 provides ratings for recurrent subluxation or instability, in which a 10 percent disability rating is assigned for sprain, incomplete ligament tear, or complete ligament tear causing persistent instability, without a prescription from a medical provider for an assistive device. A 20 percent rating is assigned for one of the following: (a) 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 (b) 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 assigned for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. Under the revised criteria from February 7, 2021, Diagnostic Code 5257 also provides ratings for patellar instability, assigning a 10 percent disability 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 is assigned 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 assigned 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. Under both the former and revised criteria of DC 5258, dislocation of the semilunar cartilage of the knee with frequent episodes of "locking," pain, and effusion into the joint warrants a 20 percent rating. 38 C.F.R. § 4.71a. Under both the former and revised criteria, DC 5260 provides ratings based on limitation of flexion of the leg. Flexion of the leg limited to 60 degrees is rated noncompensably (0 percent) disabling; flexion of the leg limited to 45 degrees is rated 10 percent disabling; flexion of the leg limited to 30 degrees is rated 20 percent disabling; and flexion of the leg limited to 15 degrees is rated 30 percent disabling. 38 C.F.R. § 4.71a. See VAOPGCPREC 09-04 (separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint). Under both the former and revised criteria, DC 5261 provides ratings based on limitation of extension of the leg. Extension of the leg limited to 5 degrees is rated noncompensably (0 percent) disabling; extension of the leg limited to 10 degrees is rated 10 percent disabling; extension of the leg limited to 15 degrees is rated 20 percent disabling; extension of the leg limited to 20 degrees is rated 30 percent disabling; extension of the leg limited to 30 degrees is rated 40 percent disabling; and extension of the leg limited to 45 degrees is rated 50 percent disabling. 38 C.F.R. § 4.71a. See VAOPGCPREC 09-04 (separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint). Separate disability ratings are possible for arthritis with limitation of motion under DC 5003 (providing rating for arthritis) and instability of a knee under DC 5257. VAOPGCPREC 23-97; 62 Fed. Reg. 63,604 (1997). When x-ray findings of arthritis are present and a veteran's knee disability is rated under DC 5257, the veteran would be entitled to a separate compensable rating under DC 5003 if the arthritis results in noncompensable limitation of motion and/or objective findings or indicators of pain. See VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998). VA's General Counsel has held that a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003/5010 and 5257, respectively, and that a separate rating could also be provided for limitation of knee extension and flexion of the same knee joint. VAOPGCPREC 9-2004; 69 Fed. Reg. 59,990 (2004). Throughout the duration of the appeal, the probative evidence of record, including VA medical records, and June 2015, November 2016 and July 2017 VA examinations, reflects that the Veteran's left knee disability was productive of, at worst, flexion limited to 90 degrees with pain, extension limited to 0 degrees with pain, reported limitations with flare ups and X-ray evidence of arthritis. The probative evidence of record also reflects there was no objective evidence of ankylosis, subluxation or instability. Accordingly, the probative medical evidence of record more nearly approximates the currently assigned 10 percent disability rating for the Veteran's left knee disability under DCs 5003 and 5260. However, in considering the probative evidence of record demonstrating X-ray evidence of arthritis in the left knee and pain with limitation of motion, including extension, the assignment of a separate 10 percent disability rating, though no higher, is warranted for a left knee disability based on limitation of extension under DC 5261. The objective medical findings of record do not reflect any findings of limitation of extension to 15 degrees or more, even considering the limitations of function and motion noted throughout the record. Although the probative evidence of record reflects pain and limitation of function in the knees, there have been no findings of pain or other limitations causing additional limitation of extension to 15 degrees or more, limitation of flexion to 30 degrees or less, or any findings that were akin to ankylosis of the left knee. In fact, even considering reports of pain and limitations with flare ups of the left knee and the Veteran's use of assistive devices, the objective medical evidence of record does not demonstrate any additional limitations of motion or function upon physical examination with repetitive motion, repeated use over time and flare ups. Hence, the VA examinations reflect the Veteran's left knee disability demonstrated ranges of motion that were not akin to ankylosis. Thus, in considering his complaints of pain and reported limitations, in conjunction with 38 C.F.R. § 4.40, 4.45, 4.59, and consistent with the decision in DeLuca v. Brown, 8 Vet. App. 202 (1995), the Board finds the evidence does not support the assignment of a higher disability rating in excess of the 10 percent ratings currently assigned for the left knee based on limitation of flexion and extension. See Voyles v. Brown, 5 Vet. App. 451, 454 (1993); Johnston v. Brown, 10 Vet. App. 80, 85 (1997); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Other potentially applicable DCs also have been considered. As the Veteran's service-connected left knee disability does not reflect findings of instability, subluxation, ankylosis or impairment of the tibia or fibula under the former or revised criteria at any time during the pendency of the appeal, DCs 5256, 5257 and 5262 do not apply. The Board observes the Veteran has also been rated separately under DC 5259 for a left knee meniscus tear, an issue which is not on appeal currently. The Board observes that there are no objective findings of record which demonstrate the left knee was in a fixed position in either flexion or extension. By definition, then, he does not have the required ankylosis, favorable or unfavorable to be evaluated under DC 5200. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999); Lewis v. Derwinski, 3 Vet. App. 259 (1992) [citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)]. The Board has considered the lay statements of record regarding the severity of the Veteran's left knee disability and has relied on these reports in determining appropriate disability ratings under the benefit-of-the-doubt doctrine. 38 C.F.R. §§ 4.3, 4.7. The Veteran is competent to report on factual matters of which he has firsthand knowledge and his statements regarding his symptoms are also credible, and thus, probative. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Baldwin v. West, 13 Vet. App. 1 (1999). Where the Veteran has not discussed particular findings that are necessary for application to the rating criteria, the Board has accorded greater probative weight to objective medical findings of record which specifically address the rating criteria. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, the Veteran's left knee disability with limitation of extension warrants a separate 10 percent disability rating, though no higher, under DC 5261 and the left knee osteoarthritis status post arthroscopy and meniscectomy does not warrant a disability rating in excess of 10 percent under DCs 5003, 5260 and 5261. 38 C.F.R. §§ 4.3, 4.7, 4.71a; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 2. Left Shoulder Labral Tear with Postoperative SLAP procedure and AC Joint Osteoarthritis The Veteran's left shoulder disability has been rated under DCs 5003-5201. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5003 provides ratings for arthritis, and if only one major joint is involved, rates each joint by limitation of motion. DC 5201 provides ratings for limitation of motion of the arm. As set forth above, during the pendency of this appeal, the provisions of 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 76,453, 76,464 (Nov. 30, 2020), revised, 85 Fed. Reg. 85,523 (Dec. 29, 2020), revised, 85 Fed. Reg. 8142 (Feb. 4, 2021). Therefore, the Board will consider the Veteran's claims under both the former and revised rating criteria, and the more favorable criteria will be applied. If the revised criteria are more favorable, they will only be applied from February 7, 2021, when the regulations became effective. DC 5003 provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, DC 5003 provides a 20 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under DCs 5013 to 5024, inclusive. Id. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. Id. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 to 180 degrees, abduction from 0 to 180 degrees, external rotation from 0 to 90 degrees, and internal rotation from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I (2021). Under the previous version of DC 5201, a rating of 20 percent is warranted when motion of the minor arm is limited to shoulder level. A 20 percent evaluation is warranted for limitation of motion of the minor arm midway between the side and shoulder level. A 30 percent rating contemplates limitation of motion of the minor arm to 25 degrees from the side. 38 C.F.R. § 4.71a, DC 5201 (2020). The revised version of DC 5201 clarifies that a 20 percent disability rating is warranted for flexion and/or abduction limited to 90 degrees (shoulder level) in the minor arm and that a 20 percent disability rating is warranted for flexion and/or abduction limited to 45 degrees (midway between the side and shoulder level) in the minor arm. A 30 percent disability rating is warranted for flexion and/or abduction limited to 25 degrees from the side. 38 C.F.R. § 4.71a, DC 5201 (2021). The Board notes that the revised version of Diagnostic Code 5201 clarifies the measurements for the various disability ratings by stating the measurements in terms of degrees. Thus, the revised version of Diagnostic Code 5201 does not contain any substantive changes. Diagnostic Code 5200 provides that ratings from 20 percent to 40 percent are warranted depending on whether the ankylosis in the minor arm is favorable, unfavorable, or between favorable and unfavorable. 38 C.F.R. § 4.71a, Diagnostic Code 5200 (2021). Diagnostic Code 5203 provides that ratings from 10 percent to 20 percent are warranted depending on whether dislocation, or malunion or nonunion of the minor scapula is present. 38 C.F.R. § 4.71a, Diagnostic Code 5203 (2021). Throughout the duration of the appeal, including the periods prior to and from September 19, 2016, the probative evidence of record, including VA medical records, and June 2015, November 2016 and July 2017 VA examinations, demonstrates that the Veteran's left shoulder disability is productive of, at worst, limitation of motion of the arm to 75 degrees flexion and 90 degrees abduction and the inability to perform three repetitions of range of motion due to pain. This evidence also does not demonstrate any findings of ankylosis of the arm or impairment of the humerus. The VA examinations demonstrate the Veteran's left shoulder is the non-dominant (minor) arm. In considering the findings above, especially that the Veteran was unable to perform repetitive range of motion due to pain in the July 2017 VA examination, the Board finds that the Veteran's left arm disability more nearly approximates the criteria for a 30 percent disability rating, though no higher, under DC 5201. The Board observes that 30 percent is the maximum rating provided under DC 5201 for the minor arm. Higher ratings for the shoulder and arm are available under other potentially applicable DCs, specifically DCs 5200 and 5202. However, these findings do not meet the criteria of a disability rating higher than the 30 percent disability rating already assigned under DC 5201. The probative evidence of record throughout the duration of the appeal does not reflect any findings of ankylosis or impairment of the humerus. The Board observes that there are no objective findings of record which demonstrate the left shoulder was in a fixed position in either flexion or abduction. By definition, then, he does not have the required ankylosis, favorable or unfavorable to be evaluated under DC 5200. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999); Lewis v. Derwinski, 3 Vet. App. 259 (1992) [citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)]. The disability rating takes into account 38 C.F.R. §§ 4.40, 4.45, 4.59, as additional limitation of function with repetitive use over time and flare ups due to pain were recorded in the VA examinations and the Board has considered whether the additional limitation reflects changes that more nearly approximated the next higher rating criteria under DC 5200 or 5202 and are consistent with the decision in DeLuca v. Brown, 8 Vet. App. 202 (1995). See also Voyles v. Brown, 5 Vet. App. 451, 454 (1993); Johnston v. Brown, 10 Vet. App. 80, 85 (1997); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In this case, range of motion testing and the physical examination of the shoulder overall did not demonstrate findings that more nearly approximate ankylosis (as noted above) or impairment of the humerus so as to warrant a higher rating under DCs 5200 or 5202. The Board has considered the lay statements of record regarding the severity of the Veteran's left shoulder disability and has relied on these reports in determining appropriate disability ratings under the benefit-of-the-doubt doctrine. 38 C.F.R. §§ 4.3, 4.7. The Veteran is competent to report on factual matters of which he has firsthand knowledge and his statements regarding his symptoms are also credible, and thus, probative. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Baldwin v. West, 13 Vet. App. 1 (1999). Where the Veteran has not discussed particular findings that are necessary for application to the rating criteria, the Board has accorded greater probative weight to objective medical findings of record which specifically address the rating criteria. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, the Veteran's left shoulder SLAP tear, postoperative, and AC joint osteoarthritis warrants the assignment of a disability rating of 30 percent, though no higher for the periods prior to September 19, 2016 and from September 19, 2016 under DC 5201. 38 C.F.R. §§ 4.3, 4.7, 4.71a; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 3. Left Wrist TFCC with Ulnar Styloid Fracture, Marrow Edema and Degenerative Arthritis The Veteran's left wrist disability is currently rated under 38 C.F.R. § 4.71a, DC 5003-5215. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5003 pertains to arthritis, and if only one major joint is involved, rates each joint by limitation of motion. Diagnostic Code 5215 addresses the wrist joint motion. As set forth above, during the pendency of this appeal, the provisions of 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 76,453, 76,464 (Nov. 30, 2020), revised, 85 Fed. Reg. 85,523 (Dec. 29, 2020), revised, 85 Fed. Reg. 8142 (Feb. 4, 2021). Therefore, the Board will consider the Veteran's claims under both the former and revised rating criteria, and the more favorable criteria will be applied. If the revised criteria are more favorable, they will only be applied from February 7, 2021, when the regulations became effective. The Board notes that the rating criteria pertaining to the wrists were not changed significantly. In fact, the only change pertaining to the wrists pertains to wrist replacement with prosthesis. As the Veteran has not undergone left wrist replacement, there is no prejudice to him in the Board considering the claim. DC 5003 provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a (2021). When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, DC 5003 provides a 20 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Note (1) provides that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under DCs 5013 to 5024, inclusive. Id. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. Id. DC 5215 provides disability ratings for limitation of motion of the wrist joint. A 10 percent rating is assigned for dorsiflexion less than 15 degrees or palmar flexion that is limited in line with the forearm. 38 C.F.R. § 4.71a (2021). Normal ranges of motion of the wrist are dorsiflexion from 0 degrees to 70 degrees, and palmar flexion from 0 degrees to 80 degrees. 38 C.F.R. § 4.71, Plate I (2021). Ankylosis of the wrist is rated under DC 5214. Unfavorable ankylosis, in any degree of palmar flexion or with ulnar and radial deviation warrants a 50 percent rating in the major extremity and 40 percent in the minor extremity. Ankylosis in any other position, except favorable, warrants a 40 percent rating in the major extremity and 30 percent rating in the minor extremity. Favorable ankylosis in 20 degrees to 30 degrees dorsiflexion warrants a 30 percent rating in the major extremity and a 20 percent rating in the minor extremity. 38 C.F.R. § 4.71a, DC 5214 (2021). The probative evidence of record, including VA medical records and the June 2015, November 2016 and July 2017 VA examinations, demonstrates that, throughout the duration of the appeal, residuals of a commuted fracture of the right wrist have been productive of, at worst, pain, palmar flexion limited to 40 degrees, dorsiflexion limited to 65 degrees and X-ray evidence of arthritis. There are no objective findings of ankylosis or additional functional impairment akin to ankylosis. Accordingly, the Veteran's left wrist disability more nearly approximates a 10 percent disability rating, though no higher, for the period prior to September 19, 2016 and more nearly approximates the 10 percent disability rating currently assigned from September 19, 2016 under DC 5215. See 38 C.F.R. § 4.71a. The Board observes a 10 percent disability rating is the maximum rating available under DC 5215. The physical examinations of the left wrist in the June 2015, November 2016 and July 2017 VA examinations explicitly found no ankylosis of the left wrist. Thus, the probative evidence of record does not indicate that the Veteran's left wrist disability is in a fixed position in either dorsiflexion or palmar flexion. By definition, then, he does not have the required ankylosis, favorable or unfavorable to be evaluated under DC 5214. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999); Lewis v. Derwinski, 3 Vet. App. 259 (1992) [citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)]. Despite the above findings, there has been no probative evidence of pain causing additional limitation that is akin to marked limitation of motion or ankylosis of the wrist. See id. In considering the findings and complaints of pain, in conjunction with 38 C.F.R. § 4.40, 4.45, 4.59, consistent with the decision in DeLuca v. Brown, 8 Vet. App. 202 (1995), the probative medical evidence more nearly approximates the criteria for limitation of motion of the left wrist, but not ankylosis, and does not support a disability rating in excess of the 10 percent currently assigned. See Voyles v. Brown, 5 Vet. App. 451, 454 (1993); Johnston v. Brown, 10 Vet. App. 80, 85 (1997); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board has considered the lay statements of record regarding the severity of the Veteran's left wrist disability and has relied on these reports in determining appropriate disability ratings under the benefit-of-the-doubt doctrine. 38 C.F.R. §§ 4.3, 4.7. The Veteran is competent to report on factual matters of which he has firsthand knowledge and his statements regarding his symptoms are also credible, and thus, probative. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Baldwin v. West, 13 Vet. App. 1 (1999). Where the Veteran has not discussed particular findings that are necessary for application to the rating criteria, the Board has accorded greater probative weight to objective medical findings of record which specifically address the rating criteria. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, the Board concludes that the Veteran's left wrist TFCC with ulnar styloid fracture, marrow edema and degenerative arthritis warrants a 10 percent disability rating, though no higher, prior to September 19, 2016 and does not warrant a disability rating in excess of 10 percent from September 19, 2016 under DC 5215. 38 C.F.R. §§ 3.102, 4.3, 4.71a. See also 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 4. GERD prior to May 24, 2017 The severity of a digestive system disability is ascertained, for VA rating purposes, by application of the criteria set forth in VA's Schedule for Rating Disabilities at 38 C.F.R. § 4.114. Ratings under DCs 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. Id. The Veteran's service-connected GERD has been rated under 38 C.F.R. § 4.114, DC 7346, pertaining to hiatal hernia. Under DC 7346, a 10 percent rating is warranted when there are two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, causing considerable impairment of health. A 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, DC 7346. For the period prior to May 24, 2017, the probative medical evidence of record, including VA treatment records, the June 2015 and November 2016 VA examinations demonstrate that the Veteran's GERD, was, at worst, manifested by symptoms productive of considerable impairment of health including, persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation and substernal pain. In addition, the November 2016 VA examination, the Veteran's symptoms also included nausea and sleep disturbance caused by GERD, both averaging one to nine days and occurring four times a year. Accordingly, the Veteran's GERD more nearly approximates a 30 percent evaluation for the period prior to May 24, 2017 under DC 7346. See 38 C.F.R. § 4.114, DC 7346. The Board has considered the assignment of a higher disability rating under DC 7346; however, the record is absent of any findings of symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health so as to warrant a 60 percent disability rating able under DC 7346. Additionally, in considering other rating codes of the digestive system, the Veteran's symptoms do not more nearly approximate higher ratings under these diagnostic criteria and do not more nearly approximate the type of symptomatology rated in the other digestive DCs. Accordingly, the Board concludes that, prior to May 24, 2017, the Veteran's GERD warrants a disability rating of 30 percent, though no higher, under DC 7346. 38 C.F.R. §§ 4.3, 4.7, 4.114; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 5. Major Depressive Disorder with Anxious Distress The Veteran's major depressive disorder with anxious distress is currently rated as 70 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9434, which is evaluated under the general rating formula for mental disorders. Under this general rating formula, a 70 percent rating is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. The symptoms recited in the criteria in the rating schedule for evaluating mental disorders are "not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Further, the symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed.Cir.2013) the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The Veteran contends that his major depressive disorder with anxious distress has been characterized by depressed mood, hopelessness, passive suicidal ideation, anxiety, irritability and difficulty controlling anger, sleep difficulty, memory loss, poor focus, diminished appetite and anger outbursts. The Board finds that the evidence of record persuasively favors against finding that a rating in excess of 70 percent for the Veteran's depressive disorder is warranted. The probative evidence of record, including VA medical records and June 2015, November 2016 and June 2017 VA examinations, demonstrates that the Veteran's major depressive disorder with anxious distress, at worst, was productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. This evidence reflects psychiatric symptoms included: depressed mood; anxiety; chronic sleep impairment; mild memory loss; difficulty in adapting to stressful circumstances; suicidal ideation; feelings of hopelessness, guilt and/or worthlessness; weight gain; irritability; impaired impulse control without periods of violence; anger outbursts; reduced energy; disturbances in motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Mental status examinations noted that the Veteran was adequately and appropriately groomed, casually dressed and cooperative. He was alert and oriented. His affect was described as constricted and dysphoric. Thoughts and speech processes were logical and coherent. The Veteran reported his mood as depressed and he was always on edge. He also reported having low energy, low self-esteem, poor sleep, poor focus and poor memory. There were no signs of a thought disorder, hallucinations or delusions. VA treatment records have been associated with the claims file and note ongoing reports of depression, anxiety, irritability, difficulty sleeping and memory problems. VA mental health treatment also reflect the Veteran maintained relationships with his family, including his wife, children and brother, and had a few close friends. He was found to have a strong and healthy support system. These records also demonstrate the Veteran had been attending college. In a November 2015 VA outpatient treatment report, the Veteran was found to have largely intact cognitive skills with no evidence of a neurocognitive disorder. Mental status examinations noted that the Veteran is fully alert and oriented. Finally, VA treatment records also reflect the Veteran regularly attended VA mental health appointments. Accordingly, the probative lay and medical evidence of record more nearly approximates the criteria for the 70 percent disability rating currently assigned. Based on the lay and medical evidence of record the Board finds that the Veteran's major depressive disorder with anxious distress does not more nearly approximate the level of severity contemplated by an increased 100 percent rating during the appeal period. Although VA examinations and VA outpatient treatment reports reflect findings of irritability and anger outbursts, he has not been violent with others and was found to be a low risk of suicide acts, self-harm or harming others. Although impaired impulse control was found in the July 2017 VA examination, it was noted to be without periods of violence. In addition, VA outpatient mental health reports reflect the Veteran continued to have had a strong and healthy social support system. The overall nature, frequent and severity of the Veteran's symptoms have not risen to the level of an increased 100 percent evaluation. Although a 70 percent disability rating is warranted, the evidence persuasively favors against a finding of entitlement to a disability rating exceeding 70 percent at any time throughout the duration of the appeal. As noted in Mauerhan, the Veteran need not have all or even most of the particular symptoms in order to warrant a higher, 70 percent evaluation or a 100 percent evaluation; however, his psychiatric symptomatology does not demonstrate total social and occupational impairment. See Mauerhan, 16 Vet. App. 436. The probative evidence does not demonstrate the above reported symptoms contribute to total social and/or total occupational impairment. VA mental health evaluations during the appeal period are absent of any findings of: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Taking a holistic analysis of the signs and symptoms of the Veteran's major depressive disorder with anxious distress, his overall occupational and social impairment does not more nearly approximate the criteria for a higher 100 percent rating. The Board has considered the lay statements of record regarding the severity of the Veteran's major depressive disorder with anxious distress and has relied on these reports in determining appropriate disability rating under the benefit-of-the-doubt doctrine. 38 C.F.R. §§ 4.3, 4.7. The Veteran is competent to report on factual matters of which he has firsthand knowledge and his statements regarding his symptoms are also credible, and thus, probative. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Baldwin v. West, 13 Vet. App. 1 (1999). Where the Veteran has not discussed particular findings that are necessary for application to the rating criteria, the Board has accorded greater probative weight to objective medical findings of record which specifically address the rating criteria. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, the Board concludes that the Veteran's major depressive disorder with anxious distress warrants a disability rating of 70 percent, though no higher, throughout the duration of the appeal under DC 9434. 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130. See also 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Alemany v. Brown, 9 Vet. App. 518, 519 (1996). TDIU 6. TDIU Based on a Single Service-Connected Disability As noted above, entitlement to a TDIU was denied in a July 2017 rating decision during the pendency of this appeal based upon the finding that the issue was moot as the Veteran was in receipt of a 100 percent disability rating. The Board observes, however, that a full adjudication of this issue was not considered. The receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. See Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). See id. Thus, the Court reasoned, it might benefit the Veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted. See Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010) (requiring VA to assess all of the claimant's disabilities to determine whether entitlement to SMC under 38 U.S.C. § 1114(s) is established whenever a Veteran with a total disability rating is subsequently awarded service connection for any additional disability or disabilities even in the absence of an express claim for SMC). As a result of the above grants for increase, the Veteran is in receipt of a 100 percent combined schedular disability rating effective the entire appeal period from July 10, 2015. Thus, the issue is whether the Veteran is entitled to a separate award of TDIU predicated on a single disability at any time during the appeal period. The record discloses that the Veteran's disability with the highest schedular rating is major depressive disorder with anxious distress depression, rated at 70 percent effective from July 10, 2015. In light of the probative evidence of record, including VA medical records and VA examinations, the Board finds that the Veteran's service-connected left knee disability, left shoulder disability, left wrist disability, GERD and major depressive disorder with anxious distress, taken together, preclude his ability to secure or follow substantially gainful employment. In this regard, the Board observes the July 2017 VA examinations demonstrate the Veteran's functional impairment and ability to work is affected by his physical limitations from the left knee, left wrist and left shoulder, which prevented him from lifting overhead, lifting over 15 pounds, the ability to perform only light sedentary work without standing or walking for more than 10 minutes and the inability to use the left wrist for power gripping. Additionally, the October 2019 VA examination of GERD reflected symptoms of nausea and vomiting would require him to work while he stayed at home. Finally, the July 2017 VA examination demonstrated the Veteran's major depressive disorder with anxious distress resulted in occupational and social impairment in most areas, though not total occupational and social impairment and this examination also noted he had functional limitations due to his physical ailments as well. As such, the evidence of record does not support a finding that major depressive disorder with anxious distress alone warrants a separate award of a TDIU. Bradley, 22 Vet. App. 280. Moreover, there is no evidence to suggest that any other single service-connected disability, alone, warrants a separate TDIU award. Therefore, the probative evidence of record fails to show that the Veteran has been unable to obtain or maintain employment because of a single service-connected disability. This being the case, the aforementioned provisions are not for application in this case. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Saira Spicknall, 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.