Citation Nr: 22012165 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 15-06 135 DATE: March 2, 2022 ORDER Entitlement to a rating in excess of 10 percent prior to August 19, 2020, and in excess of 20 percent from that day forward for right knee chondromalacia patella with meniscal tear is denied. Entitlement to a rating in excess of 10 percent for left knee chondromalacia patella with meniscal tear is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities from April 28, 2005 through August 31, 2010 and from September 25, 2019 through August 18, 2020 is denied. FINDINGS OF FACT 1. Prior to August 19, 2020, the Veteran's right knee disability manifested with painful motion of the knee with no evidence of greater impairment. 2. From August 19, 2020 onward, the Veteran's right knee disability manifested with limitation of flexion up to 30 degrees at its most severe with no evidence of greater impairment. 3. Throughout the entire appeal period, the Veteran's left knee disability manifested with limitation of flexion up to 40 degrees at its most severe with no evidence of greater impairment. 4. From April 28, 2005 through August 31, 2010 and from September 25, 2019 through August 18, 2020, the Veteran was not precluded from participating in substantially gainful employment due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to August 19, 2020, and in excess of 20 percent thereafter for right knee chondromalacia patella with meniscal tear are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for a rating in excess of 10 percent for left knee chondromalacia patella with meniscal tear are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. The criteria for a TDIU due to service-connected disabilities from April 28, 2005 through August 31, 2010 and from September 25, 2019 through August 18, 2020 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from January 1972 to December 1973 and from January 1980 to May 1986. These issues come before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. This matter was recently remanded in June 2021 for additional development. A review of the record shows substantial compliance with the Board's prior remand; therefore, additional development is not needed. Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 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. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The United States Court of Appeals for Veterans' Claims (the Court) since has extended this practice even to established ratings, not just initial ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board notes that the regulations for rating musculoskeletal injuries have changed effective February 7, 2021. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board may not apply a current regulation prior to its effective date, unless the regulation specifically provides otherwise. See VAOPGCPREC 7-2003 (Nov. 19, 2003); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (overruling Karnas v. Derwinski, 1 Vet. App. 307 (1991) to the extent that it conflicts with the precedents of the United States Supreme Court and the Federal Circuit). However, the Board is not precluded from applying prior versions of the applicable regulations to the period on or after the effective date of the new regulation if the prior versions were in effect during the pendency of the appeal. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); see also DeSousa v. Gober, 10 Vet. App. 461, 467 (1997)." As there is no indication that the rating criteria amendments were intended to be applied retroactively, the changes do not apply before the date they became effective. See Kuzma, 341 F.3d at 1329. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54). 1. Entitlement to a rating in excess of 10 percent prior to August 19, 2020, and in excess of 20 percent thereafter for right knee chondromalacia patella with meniscal tear. 2. Entitlement to a rating in excess of 10 percent for left knee chondromalacia patella with meniscal tear. The Veteran contends that his bilateral knee symptomology is worse than the rating currently assigned. A July 2013 rating decision granted service connection for bilateral knee chondromalacia patella with meniscal tear and awarded a rating of 10 percent for each knee effective April 28, 2005. His claim for increased rating was received in August 2013. The April 2014 rating decision on appeal continued the 10 percent rating for each knee. The Veteran timely appealed this determination to the Board. During the pendency of this appeal, a December 2020 rating decision increased the right knee rating to 20 percent effective August 19, 2020, and continued the 10 percent rating for the left knee. The bilateral knee disability is currently rated under Diagnostic Code (DC) 5260 for limitation of flexion. Under DC 5260, a 10 percent disability rating is warranted for flexion limited to 45 degrees. A 20 percent disability rating is assigned for flexion limited to 30 degrees; and a 30 percent disability rating is assigned for flexion limited to 15 degrees. See 38 C.F.R. § 4.71a. Under DC 5261, a 10 percent disability rating is warranted for extension limited to 10 degrees. A 20 percent disability rating is assigned for extension limited to 15 degrees. A 30 percent disability rating is assigned for extension limited to 20 degrees. A 40 percent disability rating is assigned for extension limited to 30 degrees; and a 50 percent disability rating is assigned for extension limited to 45 degrees. Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. In VAOPGCPREC 9-2004, the VA General Counsel interpreted that, when considering Diagnostic Codes 5260 and 5261 together with 38 C.F.R. § 4.71, a veteran may receive a rating for limitation in flexion only, limitation of extension only, or, if the 10 percent criteria are met for both limitations of flexion and extension, separate 10 percent ratings for limitations in both flexion and extension under Diagnostic Code 5260 (leg, limitation of flexion) and Diagnostic Code 5261 (leg, limitation of extension). The Board notes that the rating criteria for DCs 5260 and 5261 were not changed as a result of the amended musculoskeletal ratings effective February 7, 2021. Prior to August 19, 2020 Factual History A review of the post service treatment records note complaints and treatment for bilateral knee pain. In addition, several VA treatment record noted range of motion (ROM) testing results. An August 2014 VA treatment record noted testing results of 5 to 120 degrees. A November 2014 VA treatment record noted an average ROM of 135 and complaints of bilateral knee pain. Subsequent VA treatment records in February 2015 and April 2016 noted testing results of 0 to 120 degrees. A May 2016 VA treatment record also noted ROM testing results of 0 to 130 degrees. The Veteran underwent a VA examination in June 2010. He was diagnosed with bilateral chondromalacia patella. The examiner noted the Veteran's report of injury from in-service jumps and his current complaints of bilateral knee pain that limited walking and standing for five minutes. He endorsed "waxing and waning" flare ups, increased by walking, kneeling, and stairs/squatting. Clinical examination revealed bilateral ROM of 0 to 150 degrees symmetrically with mild evidence of right knee pain. Repetitive testing did not reveal any additional ROM limitations. The Veteran underwent a second VA examination in June 2013. He was diagnosed with bilateral chondromalacia patella. The examiner noted the Veteran's report of knee pain with occasional popping and locking intermittently in both knees. He endorsed flare ups from walking a few blocks. Clinical examination revealed ROM measurements of bilateral knee flexion up to 140 degrees with objective evidence of pain at 120 degrees. There was no evidence of limitation of extension. Repetitive test results revealed no addition ROM limitations. No additional functional loss or ROM limitations were noted by the examiner. Bilateral pain on palpation was noted; however, muscle strength and joint stability was found to be normal. The examiner did not note any evidence of recurrent patellar subluxation, any tibial or fibular impairment, or any meniscal conditions. The examiner noted the Veteran's regular use of a brace and cane for ambulation. In addition, the examiner noted that the bilateral knee disability did not impact the Veteran's ability to work. The Veteran underwent a third VA examination in April 2014. He was diagnosed with bilateral chondromalacia patella. The examiner noted the Veteran's report of knee pain with popping sensation in both knee joints on prolonged standing, walking, going up stairs, running, squatting, and kneeling. The Veteran also endorsed flare ups but was unable to quantify the ROM degree loss as it would vary due to severity of pain, weakness, fatigability, and overuse. Clinical examination revealed ROM measurements of bilateral knee flexion up to 140 degrees with objective evidence of pain at 100 degrees and 120 degrees, respectfully, for the left and right knees. There was no evidence of limitation of extension. The examiner noted additional functional loss in less movement than normal and pain on movement bilaterally. He also noted left knee weakened movement and interference with sitting, standing and weight-bearing. Bilateral pain on palpation was noted. Muscle strength and joint stability was found to be normal. No evidence of patellar subluxation or tibial and/or fibular impairment was noted. The examiner found left knee meniscal tear, but had not undergone a meniscectomy. He also noted bilateral knee pain more prevalent on the left side on prolonged sitting, standing, going up and down the stairs and squatting. The examiner also noted the Veteran's regular use of a brace and cane for ambulation. The examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: bilateral knee pain more prevalent on the left side on prolonged sitting, standing, going up and down the stairs and squatting, and unable to run and to go up and down two flights of stairs. The Veteran underwent a fourth VA examination in April 2016. The examiner noted reports of bilateral knee pain and bilateral degenerative lateral meniscal tears. The Veteran denied flare ups, but endorsed additional functional loss in the use of bilateral knee braces for stability and a cane. Clinical examination revealed ROM measurements of flexion up to 90 degrees for the right knee and up to 100 degrees for the left knee. Extension was found to be limited to 90 degrees with pain noted on examination causing functional loss on flexion. Evidence of pain was found on weight-bearing and on palpation. Repetitive use revealed no additional ROM limitations. The examiner noted pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use, but the examiner did not describe in terms of ROM. The examiner also noted bilateral knee instability of station. Muscle strength was found to be normal. There was no evidence of bilateral knee ankylosis or joint instability. The examiner noted a right side meniscal tear, as well as constant use of hinged knee braces and a cane to ambulate. The examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: the bilateral knee pain would made clutching difficulty driving 18 wheeler trucks, but that the Veteran was unemployed since 2002. The examiner noted that the Veteran had significant other illnesses, so the impact of the knees was difficult to measure. The Veteran underwent a fifth VA examination in July 2016. The examiner noted the reports of chronic bilateral knee pain forcing the Veteran into a wheelchair. He reported being unable to ambulate without assistance and can only walk one city block. He denied flare ups, but endorsed additional functional loss. Clinical examination revealed ROM measurements from 30 to 105 degrees for the flexion and extension of the right knee and from 10 to 90 degrees for the left knee. Objective evidence of pain on flexion, extension, and weight bearing, as well as pain on palpation and crepitus was noted. The examiner found no additional ROM limitations on repetitive use. He also was unable to provide an opinion without mere speculation on additional ROM measurements due to pain, weakness, fatigability, or incoordination. He further noted the following additional contributing factors: less movement than normal due to ankylosis, adhesions, etc.; weakened movement due to muscle or peripheral nerve injury, etc.; swelling, atrophy of disuse; disturbance of locomotion; interference with sitting. The examiner noted decreased muscle strength and muscle atrophy of the right lower extremity. No evidence of ankylosis or joint instability was noted. However, the examiner did note a history of recurrent effusion of the right knee. He also noted the Veteran's left knee arthroscopy with partial meniscectomy. The examiner further noted the Veteran's constant use of a wheelchair and regular use of a right knee brace for ambulation. The examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: [The Veteran] has a mild right knee contracture and some limited range of motion and weightbearing capabilty (sic) at this point; he is fit for perhaps light labor only, based upon the exam today; he remains in wheelchair and cannot participate in weight bearing activities as of right now. Specifically, for the right knee condition, this appears to be arthritic either moderately or severely. Based solely upon the right knee condition, he remains fit for light labor. Member enjoys working on cars for a hobby, but he really can't do that anymore and now he has dropped out of family activities. This was endorsed by daughter in the room and the story is very credible. [L]eft knee: there are similar problems with the left knee; most notably, he cannot be flexed or bend the left knee without severe pain and crepitus of the patellofemoral joint. There is some atrophy of the patellar tendon on the left side. He is not capable of labor and is fit for sedentary job only with his knee condition. The Veteran underwent a sixth VA examination in September 2019. The examiner noted the reports of chronic knee pain with "moderate to severe" flare ups lasting up to three days which was precipitated by walking or standing and are alleviated with rest. The Veteran also reported additional functional loss due to pain while walking, standing, or bending. Clinical examination revealed bilateral ROM measurements of flexion and extension up to 130, with pain noted on flexion that did not result in functional loss. In addition, the examiner found no objective evidence of pain on weight-bearing, pain on palpation, or crepitus. The examiner found additional ROM of flexion and extension up to 125 degrees on repetitive use and during flare ups based on pain complaints. No additional factors were found to contribute to the Veteran's bilateral knee disability. Muscle strength testing was found to be normal; however, the examiner noted evidence of right lower extremity muscle atrophy. No objective evidence of ankylosis was noted. Joint stability testing was found to be normal. No other evidence of a tibial or fibular impairment was noted. The examiner noted bilateral meniscal tears as well the Veteran's use of a cane for ambulation. The examiner also noted objective evidence of pain on bilateral passive ROM and non-weight bearing. The examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: Limited prolonged standing and walking, limited lifting. Suitable working around desk. The Board observes that most of the VA examination reports do not include the passive ROM measurements for the knees. Passive ROM is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active ROM because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive ROM and active ROM provide information about the amount of motion permitted by the associated joint structures (passive ROM) relative to the individual's ability to produce motion at a joint (active ROM). Cynthia Norkin & D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry 8-9 (2016). Here, there is no indication that passive ROM in this case would be more limited than active. As such, the Board concludes that the absence of findings related to passive ROM does not render the available evidence inadequate for rating purposes and will evaluate the Veteran's joint range of motion based on the measurements recorded for active ROM and look at the Veteran's total bilateral knee disability picture. Analysis Based on the evidence of record, the Board finds that the right knee disability symptomology warrants, at most, a 10 percent rating throughout the appeal period. Flexion was not shown to be limited to 45 degrees or less. Regarding the left knee disability, the Board finds that the symptomology warrants, at most, a 10 percent rating based on painful motion under 38 C.F.R. § 4.59. However, a rating of 20 percent is not warranted for either knee as the evidence does not demonstrate flexion limited to 30 degrees. As to the Veteran's limitation of extension, there is no basis for a separate rating based on limitation of extension. VAOPGCPREC 9-2004 (2004) (separate ratings may be assigned under DCs 5260 and 5261, where there is compensable limitation of flexion and extension). While the July 2016 VA examiner noted limitation of extension of 10 percent for the left knee and 30 degrees for the right knee, the vast majority of the probative medical evidence of record did not demonstrate extension limited to 10 degrees. The Board notes that it must consider an applicable rating based on the totality of the evidence of record for this appeal period. The Board finds the single instance of extension limitation is outweighed by all the other clinical findings which indicate extension was full during the appeal period. As the record does not show that there was compensable limitation of both flexion and extension, a separate rating for limitation of extension is not warranted. In addition, a separate rating is not warranted under 38 C.F.R. § 4.59 for limitation on extension, as the Veteran already received the minimum compensable rating for his bilateral knees. The Board has considered the potential application of the other provisions of 38 C.F.R., Parts 3 and 4. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The other criteria for rating knee disabilities are provided under DCs 5256 (ankylosis), 5257 (recent subluxation or lateral instability), 5258 (dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint), 5259 (cartilage, semilunar, removal of, symptomatic), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum or traumatic genu recurvatum). The evidence does not show that the Veteran's right knee disability manifestations have included ankylosis, knee instability, a meniscus condition, shin splints, or genu recurvatum. Therefore, the Board finds that separate or higher ratings under DCs 5256, 5257, 5258, 5259, 5262, and 5263 are not warranted. The Board acknowledges that under 38 C.F.R. § 4.59, examination of certain joints should include testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing. Correia v. McDonald, 28 Vet. App. 158 (2016). To the extent that these examinations cited herein did not explicitly provide these findings, the Board reiterates the pertinent ratings of the spine with or without symptoms such as pain. Thus, any deficiency of the examinations of record in this regard is harmless, as assessment of pain in accordance with 38 C.F.R. § 4.59 would not provide a basis for the assignment of any higher rating. Additionally, to the extent that these examinations discussed herein did not explicitly provide findings of pain on both active and passive motion, or in weight-bearing and non-weight-bearing, they are nonetheless the most probative evidence available with regard to the severity of the bilateral knee disability at the time those examinations were conducted. Any additional medical opinion with regard to those periods would be retrospective and entitled to less probative value than the contemporaneous range of motion evidence already of record. Therefore, remand for any additional retrospective opinion is not warranted. See Soyini v. Derwinski, 1 Vet. App. 540 (1991) (remand is unnecessary where it would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant). In light of the aforementioned evidence, the Board determines that a rating of 10 percent, but no higher, is warranted for the Veteran's bilateral knee disability throughout this appeal period. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Veteran testified at his Board hearing that he experienced worsening knee symptoms. In addition, the Veteran's wife, son, daughter-in-law, and fellow service members has submitted statements observing his pain complaints and his inability to undergo activities of daily living. The Board acknowledges that the Veteran and his family members are competent to give evidence about what they observes or experiences. Layno v. Brown, 6 Vet. App. 465 (1994). That stated, these allegations of worsening symptomology are undercut by the other evidence of record, which does not favor a finding that the Veteran is entitled to a higher rating than the 10 percent currently assigned for his bilateral knee disability during the appeal period based on the symptomology present. His current symptomology is encapsulated in the current rating assigned under the Rating Schedule, with no evidence of symptomology warranting extra-schedular consideration. Since a preponderance of the evidence weights against the Veteran, he is not entitled to the benefit of the doubt. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed Cir. 2001). Therefore, his claim for an increased rating is denied. Factual History From August 19, 2020 onward A review of the post service clinical treatment records note complaints and treatment for bilateral knee pain. As these reports do not discuss additional rating criteria relating to knee disabilities, the Board will not discuss these reports further. See Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but need not discuss each piece of evidence). The Veteran underwent a VA examination in December 2020. The examiner noted the reports of worsening knee pain when walking, bending, or twisting. The Veteran also endorsed flare ups and additional functional loss. Clinical examination revealed right knee ROM measurements of flexion and extension up to 30 degrees with painful motion and objective evidence of pain on palpation and weight-bearing. Left knee ROM measurements were noted as flexion and extension up to 40 degrees with painful motion and objective evidence of pain on palpation and weight-bearing. No additional ROM limitations were found on repetitive use or during flare ups. Muscle strength was found to be normal, with no evidence of muscle atrophy. No objective evidence of ankylosis was noted. Joint stability testing was found to be normal. The examiner noted the Veteran's history of bilateral meniscus tears and regular use of a cane to ambulate. He also noted objective evidence of bilateral knee pain on non-weight bearing. However, no passive ROM test results were noted. In addition, the examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: difficulty with prolonged lifting, walking, and standing requiring rest breaks. The Veteran underwent a second VA examination in September 2021. The examiner noted the reports of worsening constant knee pain and bilateral instability. The Veteran also endorsed flare ups and additional functional loss. Clinical examination revealed bilateral knee ROM measurements of flexion and extension up to 110 degrees on active ROM, 130 degrees on right knee passive ROM, and 120 on left knee passive ROM. Painful motion and objective evidence of pain on weight-bearing causing functional loss was noted by the examiner. He also noted additional ROM limitations of flexion and extension of 100 degrees for the right knee and 105 degrees for the left knee based on repetitive use. No additional ROM limitations were noted during flare ups. The examiner noted the following additional contributing factors: interference with standing, disturbance of locomotion, weakened movement, and swelling. The examiner found no evidence of muscle atrophy or ankylosis. The examiner noted a history of recurrent subluxation or persistent instability of the right knee with no ligament tear that required a prescription for a cane and brace for ambulation, but evidence of recurrent instability. No objective evidence of left knee persistent instability was noted by the examiner. She also noted bilateral meniscal tears with frequent episodes of joint locking and joint pain. Finally, the examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: difficulty with just walking, must walk with a cane, can no longer work on cars or play racquetball due to knee pain. Analysis Based on the evidence of record, the Board finds that the right knee disability symptomology warrants, at most, a 20 percent rating from August 19, 2020 to the present. The evidence demonstrated that flexion of the right knee was limited to 30 degrees at its most severe. However, a rating of 30 percent is not warranted as the evidence does not demonstrate flexion limited to 15 degrees. Regarding the left knee, the Board finds that the symptomology warrants a 10 percent rating throughout the appeal period. Flexion was shown to be limited to 40 degrees at its most severe. However, a rating of 20 is not warranted as the evidence does not demonstrate flexion limited to 30 degrees. As to the Veteran's limitation of extension of the knees, there is no basis for a separate rating based on limitation of extension. VAOPGCPREC 9-2004 (2004) (separate ratings may be assigned under DCs 5260 and 5261, where there is compensable limitation of flexion and extension). Throughout the appeal period, ROM testing did not reflect extension limited to 10 degrees. As the record does not show that there was compensable limitation of both flexion and extension, a separate rating for limitation of extension is not warranted. In addition, a separate rating is not warranted under 38 C.F.R. § 4.59 for limitation on extension, as the Veteran already received the minimum compensable rating for his left knee. The Board has considered the potential application of the other provisions of 38 C.F.R., Parts 3 and 4. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The other criteria for rating knee disabilities are provided under DCs 5256 (ankylosis), 5257 (recent subluxation or lateral instability), 5258 (dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint), 5259 (cartilage, semilunar, removal of, symptomatic), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum or traumatic genu recurvatum). The evidence does not show that the Veteran's right knee disability manifestations have included ankylosis, recent subluxation, a meniscus condition, shin splints, or genu recurvatum that would warrant higher ratings for each knee. Furthermore, the Board notes that the Veteran is in receipt of separate ratings for knee instability under DC 5257. Therefore, the Board finds that separate or higher ratings under DCs 5256, 5257, 5258, 5259, 5262, and 5263 are not warranted. In light of the aforementioned evidence, the Board determines that a rating of 20 percent, but no higher, is warranted for the Veteran's right knee disability beginning August 19, 2020 and 10 percent rating at most, is warranted for the left knee disability throughout this appeal period. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board acknowledges that the Veteran, his family members, and fellow service members are competent to give evidence about what they observe or experience. Layno v. Brown, 6 Vet. App. 465 (1994). That stated, these allegations of worsening symptomology are undercut by the other evidence of record, which does not favor a finding that the Veteran is entitled to a higher rating than the ratings currently assigned for his bilateral knee disability during the appeal period based on the symptomology present. His current symptomology is encapsulated in the current rating assigned under the Rating Schedule, with no evidence of symptomology warranting extra-schedular consideration. Since a preponderance of the evidence weighs against the Veteran, he is not entitled to the benefit of the doubt. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed Cir. 2001). Therefore, his claim for an increased rating is denied. 3. Entitlement to a TDIU due to service-connected disabilities. The Veteran contends that he is unable to work as a result of her service-connected disabilities. A TDIU claim, either expressly raised by a veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board notes that the Veteran's increased rating claims for his bilateral knees have been pending since April 28, 2005. Law and Regulations Total disability means that there is present any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.15. A substantially gainful occupation has been defined as "employment at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the Veteran resides." M21-1 VA Adjudication Procedure Manual, Part IV.ii.2.F.1.c. It also has been defined as "an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the Veteran actually works and without regard to the Veteran's earned annual income." Faust v. West, 13 Vet. App. 342 (2000). Marginal employment shall not be considered substantially gainful employment. Substantially gainful employment is defined as work that is more than marginal, which permits the individual to earn a "living wage." Id. When jobs are not realistically within his physical and mental capabilities, a veteran is determined unable to engage in a substantially gainful occupation. Moore v. Derwinski, 1 Vet. App. 356 (1991). In making this determination, consideration may be given to factors such as the veteran's level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2018); Van Hoose v. Brown, 4 Vet. App. 361 (1993). A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more service-connected disabilities, provided that one of those disabilities is ratable 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16 (a). Whether a veteran is capable of substantially gainful employment is determined by the VA adjudicator and is not a medical determination. 38 C.F.R. § 4.16 (a). When evaluating TDIU entitlement, the pertinent inquiry is whether a claimant's service-connected disability alone is of sufficient severity to produce unemployability. The impact of non-service connected disabilities is not to be considered. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993); Pratt v. Derwinski, 3 Vet. App. 269, 272 (1992). The ultimate question is whether a claimant is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Thus, the sole fact that a claimant is unemployed or has difficulty obtaining employment is insufficient to establish entitlement to a TDIU. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Notably, in a recent precedential case, in Ray v. Wilkie, the Court defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16 (b) to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Merriam-Webster online dictionary defines "sedentary" as (a) "doing or requiring much sitting" or (b) "not physically active." https://www.merriam-webster.com/dictionary/sedentary. The Board employs this definition in the current analysis. See Withers v. Wilkie, 30 Vet. App. 139, 148 (2018) (before the Board can rely on an examiner's finding that a veteran is capable of sedentary work to deny TDIU, it must also ensure that the finding is consistent with the medical evidence as a whole). As an initial matter, the Board notes that the Veteran has been in receipt of a 100 percent combined rating for his service-connected disabilities from September 2010 through September 24, 2019, and from August 19, 2020 through the present date, which would render a TDIU claim moot. However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establishes entitlement to special monthly compensation (SMC) at the housebound rate under 38 U.S.C. § 1114, including whether the award of TDIU would provide entitlement to SMC. See AB v. Brown, 6 Vet. App. 35; Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); see Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). SMC may be warranted pursuant to 38 U.S.C. § 1114 if a Veteran has a service-connected disability rated as 100 percent disabling and (1) has an additional service-connected disability or disabilities independently rated at 60 percent or more, or (2) by reason of such service-connected disability or disabilities is permanently housebound. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Board specifically finds that the exceptions to the rule that a 100 percent schedular disability rating moots a TDIU claim based on "less than total" rating do not apply in this case, as discussed below. See 38 C.F.R. § 4.16 (a) (providing TDIU "where the schedular rating is less than total"); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). In Bradley, the Court held that a TDIU based on a single disability will satisfy the statutory requirement of a single disability with a total rating for the purposes of awarding SMC. In Buie, the Court held that an award of TDIU based on combined effects for multiple disabilities cannot be used to satisfy the requirement of a single disability rated as totally disabling. However, VA's duty to maximize benefits requires VA to assess all of a claimant's disabilities, regardless of the order in which they were service connected, to determine whether any combination of disabilities establishes SMC under 38 U.S.C. § 1114. This case is distinguishable from both Bradley and Buie exceptions to the rule that a 100 percent combined schedular disability rating moots a TDIU. Under the unique facts of Bradley, SMC was available where a veteran had been granted TDIU based on a "less than total" 70 percent rating for only one disability and had subsequently obtained service connection for multiple orthopedic disabilities that combined to 60 percent. Under those circumstances, there was no "duplicate counting of disabilities." Bradley at 293. This case is distinguishable from Bradley because the Veteran is not in receipt of a less than 100 percent schedular disability rating for any one service-connected disability upon which a TDIU is granted. Rather, the 100 percent schedular disability rating assigned from September 1, 2010 through September 24, 2019 and from August 19. 2020 to the present date is based on the combined ratings of multiple service-connected disabilities. Concerning both Bradley and Buie, in this case, the Veteran is currently service connected for multiple disabilities and has previously contended that the combination of these disabilities renders him unemployable. To award a TDIU rating for the period from September 1, 2010 through September 24, 2019, and from August 19, 2020 (when the 100 percent combined schedular disability rating began) would result in duplicate counting of disabilities. 38 C.F.R. § 4.14. Therefore, the Board will only focus on the following appeal periods: April 28, 2005 through August 31, 2010 and from September 25, 2019 through August 18, 2020. From April 28, 2005 through August 31, 2010, compensable service connection was in effect for the following disabilities: strain of volar carpal ligament, left wrists with neuropathy of left median nerve, with a 30 percent rating assigned; carpal tunnel syndrome, right, with a 20 percent rating assigned; tinnitus, with a 10 percent rating assigned; bilateral knee chondromalacia patella, with a 10 percent rating assigned for each knee. Because the bilateral carpal tunnel and knee disabilities resulted from a common etiology (in-service parachute jumps), for TDIU purposes they are considered a single disability rated at 60 percent. From September 25, 2019 through August 18, 2020, compensable service connection was in effect for the following disabilities: major depressive disorder with posttraumatic stress disorder, with a 70 percent rating assigned; carpal tunnel syndrome, left median nerve, with a 30 percent rating assigned; carpal tunnel syndrome, right median nerve, with a 20 percent rating assigned; bilateral knee chondromalacia patella with meniscal tear, with a 10 percent rating assigned for each knee; left great toes degenerative arthritis, with a 10 percent rating assigned; bilateral wrist chronic sprain, with a 10 percent assigned for each wrists. The Board finds that the schedular criteria for TDIU have been met for each appeal period. 38 C.F.R. § 4.16 (a). The central inquiry, therefore, is whether the Veteran is unable to secure or follow a substantially gainful employment as a result of his service-connected disabilities. The Board finds a preponderance of the evidence to be against the Veteran. Therefore, his claim of entitlement to a TDIU is denied. The record reflects that the Veteran has been unemployed since 2002, that his last occupation was as a truck driver for Navy Public Works, and that he has a high school education. Finally, the record reflects that this position required special vocational training, the use and operation of various equipment, the use of technical knowledge, and the ability to write reports or complete forms. From April 28, 2005 through August 31, 2010 Factual History A review of the post-service VA and private treatment records note complaints and treatment for the Veteran's service-connected disabilities. However, none of the Veteran's treating physicians have given a positive opinion that the Veteran is unable to secure or follow a substantially gainful employment as a result of his service-connected disabilities for this appeal period. The Veteran underwent a VA wrists examination in October 2003. The examiner noted complaints of pain and swelling of his hands that result in not being able to grasp very well. However, the Veteran reported being able to attend to activities of daily living (ADL's). The examiner also noted that the Veteran was unemployable for other reasons besides his bilateral wrists. While this evidence is outside the appeal period, it is instructive in determining the Veteran's ability to maintain employment during this current appeal period. The Veteran underwent a VA hearing examination in July 2005. He reported post-service job involving loud noises where hearing protection was also used a required. In addition, he reported difficulties hearing others and feeling that his ears were "plugged up" which occurred every day for approximately 30 minutes, causing him to not hear. Furthermore, he reported experiencing a constant bilateral tinnitus that "sounds like a scratching noise." No other opinion on functional impact was rendered. The Veteran underwent a second VA hearing examination in June 2008. He reported functional impairment in the form of an inability to hear things well due to constant, bilateral tinnitus. However, no functional impact opinion was rendered by the examiner. The January 2010 VA knee examiner reported that the Veteran endorsed pain complaints that limited walking and standing for five minutes. He also endorsed "waxing and waning" flare ups, increased by walking, kneeling, and stairs/squatting. Clinical examination revealed bilateral ROM of 0 to 150 degrees symmetrically with mild evidence of right knee pain. Repetitive testing did not reveal any additional ROM limitations. No other functional impact was noted by the examiner. The Board finds that these VA opinions are adequate, as they were based upon a complete review of the evidence of record, consideration of the Veteran's lay statements and contentions, and clinical examination of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). These opinions are also probative because it is based on an accurate medical history and provide an explanation that contain a clear conclusion and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent that earlier examinations discussed herein did not explicitly provide adequate findings, they are nonetheless the most probative evidence available with regard to the severity of the Veteran's service-connected disabilities at the time those examinations were conducted. Any additional medical opinion with regard to those periods would be retrospective and entitled to less probative value than the VA examinations already of record. Furthermore, the Board recognizes that the VA's duty to assist does not require a "combined-effects medical examination report or opinion" to adjudicate a TDIU claim. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2014). The ultimate responsibility for a TDIU determination is a factual rather than a medical question and is an adjudicative determination made by the Board or the AOJ. Id. Therefore, a remand for any additional retrospective opinion is not warranted. See Soyini v. Derwinski, 1 Vet. App. 540 (1991) (remand is unnecessary where it would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant). Analysis Based on the foregoing, the Board finds no persuasive evidence that the Veteran was unable to secure or follow any substantive gainful employment during this appeal period due to his service connected disabilities. The Board's finding is supported by the VA examiners' determinations that the Veteran's service-connected disabilities did not preclude him from securing such employment. The evidence of record shows that, while there is evidence of interference with employment, the Veteran's service-connected disabilities alone did not preclude all forms of employment. In reaching this conclusion, the Board has considered the combined effects of the Veteran's service-connected disabilities but finds that the impact is not so severe as to preclude the Veteran from being able to follow substantially gainful employment consistent with his education, skills, and work experience during the period on appeal. The VA examinations reports note that while the Veteran's service-connected disabilities impacted his ability to undertake ADL's, these conditions did not preclude the Veteran from securing or maintaining gainful employment. Furthermore, the Board notes that the Veteran's ability to work was due to several non-service connected disabilities, rather than his service-connected disabilities. The pertinent evidence of record demonstrates that the Veteran has been unable to work due to cirrhosis and a low back injury, which he is not service-connected for. Indeed, an April 2015 VA request for employment information from the Veteran's last employer revealed that the Veteran retired due to disabilities resulting from low back and liver failure. Finally, the Board notes that the Veteran filed for SSA disability benefits in March 2003. SSA determinations are not binding on the Board, and it is the duty of the Board to assess the credibility and weight to be given such evidence. Washington v. Derwinski, 1 Vet. App. 459, 465-66 (1991); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); see also Murincsak v. Derwinski, 2 Vet. App. 363, 372 (1992) (finding that SSA determinations should be given appropriate consideration and weight in determining to award or deny an appellant TDIU). The Board notes that the Veteran applied for SSA disability benefits based on chronic liver disease and cirrhosis, which he is not service-connected for. In addition, SSA records demonstrate that the Veteran sustained a low back injury while working in November 2002, which he is not service-connected for during this appeal period. The Board finds this evidence also supports the determination that the Veteran is not unemployable solely as a result of his service connected disabilities. As such, entitlement to a TDIU for this appeal period is not warranted. While the Board is cognizant of the Veteran's limited educational experience, his lack of formal/additional specialized training, volunteer work experience, or vocational training, as well as his work experience heavily confined to physical manual/labor work, the evidence demonstrates that he would be qualified for non-physical or sedentary employment as a result of his service-connected disabilities, despite his assertions to the contrary. Indeed, his ability to obtain technical knowledge in his post-service occupation, write reports or complete forms, undertake multiple activities of daily living, and his 12th grade education demonstrates that he would have transferable skills that would have qualified him for various non-physical or sedentary occupations. His vocational background would also involve such transferrable skills as time management; showing up on time; perform general support tasks; use of a telephone, and conveying information to others. Such skills would transition to most sedentary environments. Thus, the pertinent medical evidence indicating that his specific service-connected disabilities did not preclude all forms of employment, including sedentary employment as defined above, weighs against the TDIU claim. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Veteran and his wife both testified at his Board hearing that he was unable to work due to his service-connected disabilities. The Board acknowledges that the Veteran and his wife are competent to give evidence about what they observe or experience. Layno v. Brown, 6 Vet. App. 465 (1994). That stated, the evidence of record does not favor a finding that the Veteran's service-connected disabilities rendered him unable to secure or follow gainful employment. The Board further notes that the Veteran's allegations of the cause of his inability to work due to his service-connected disabilities is contradicted by prior reports to Social Security that he was unemployable due to cirrhosis of the liver and a low back injury (which he is not service-connected for). The inconsistent reports which contradict the contemporaneous evidence leads the Board to place reduced probative value on the Veteran's self-reported medical history and his alleged reasons for why he was unemployable during the appeal period. Given the foregoing, the Board finds that the Veteran's non-service connected disabilities had a much greater impact on his ability to maintain employment than his service-connected disabilities. These non-service connected disabilities cannot be a basis for a TDIU. The pertinent evidence of record shows that the Veteran was not rendered unable to obtain or maintain substantially gainful employment by virtue of his service-connected disabilities during this appeal period. For the aforementioned reasons, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. From September 25, 2019 through August 18, 2020 Factual History A review of the post-service VA and private treatment records note complaints and treatment for the Veteran's service-connected disabilities. The Board noted that several medical providers rendered opinions on the Veteran's ability to work due to his service-connected disabilities. March 2016 and April 2016 private medical reports noted that the Veteran was not able to work due to the severity of his health conditions, including his bilateral carpal tunnel syndrome, bilateral knee disability, and low back disorder. A December 2016 VA treatment record noted that the Veteran was considered unemployable as a result of his psychiatric disability. Several July 2018 private treatment records noted that the Veteran was unable to maintain gainful employment due to his bilateral knee and wrist disabilities. However, the Board notes that these opinions are inadequate based on a lack of rationale articulated by each clinician. Therefore, they are entitled to low probative value. The April 2016 VA examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: the bilateral knee pain would made clutching difficulty driving 18 wheeler trucks, but that the Veteran was unemployed since 2002. The examiner noted that the Veteran had significant other illnesses, so the impact of the knees was difficult to measure. The July 2016 VA examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: [The Veteran] has a mild right knee contracture and some limited range of motion and weightbearing capabilty (sic) at this point; he is fit for perhaps light labor only, based upon the exam today; he remains in wheelchair and cannot participate in weight bearing activities as of right now. Specifically, for the right knee condition, this appears to be arthritic either moderately or severely. Based solely upon the right knee condition, he remains fit for light labor. Member enjoys working on cars for a hobby, but he really can't do that anymore and now he has dropped out of family activities. This was endorsed by daughter in the room and the story is very credible. [L]eft knee: there are similar problems with the left knee; most notably, he cannot be flexed or bend the left knee without severe pain and crepitus of the patellofemoral joint. There is some atrophy of the patellar tendon on the left side. He is not capable of labor and is fit for sedentary job only with his knee condition. The September 2019 VA examiner noted the following impact of the Veteran's bilateral knee disability on his ability to work: Limited prolonged standing and walking, limited lifting. Suitable working around desk. The Veteran underwent a VA mental health examination in September 2019. He was diagnosed with PTSD, chronic, major depressive disorder, recurrent, moderate with anxious distress, and polysubstance use disorder is sustained remission. The Veteran reported that he did not believe that he was employable given his daily panic attacks, verbal outbursts, persistent depression, and physical pain symptoms. As a result, he reported that he has not looked for work and reported struggling with chores at home. The examiner found that the mental health symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner also noted the following occupational limitations: The irritability and angry outbursts as well as his daily panic attacks would make it very difficult for claimant to work extensively around other people. Additionally, his persistent depressed mood, fatigue, and amotivation would make it difficult for him to consistently get to work on time and be able to work a full day. His poor concentration and problems with short-term memory would make it difficult for him to focus on tasks that require sustained attention. The Board finds that these VA opinions are adequate, as they were based upon a complete review of the evidence of record, consideration of the Veteran's lay statements and contentions, and clinical examination of the Veteran. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). These opinions are also probative because it is based on an accurate medical history and provide an explanation that contain a clear conclusion and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). To the extent that earlier examinations discussed herein did not explicitly provide adequate findings, they are nonetheless the most probative evidence available with regard to the severity of the Veteran's service-connected disabilities at the time those examinations were conducted. Any additional medical opinion with regard to those periods would be retrospective and entitled to less probative value than the VA examinations already of record. Furthermore, the Board recognizes that the VA's duty to assist does not require a "combined-effects medical examination report or opinion" to adjudicate a TDIU claim. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2014). The ultimate responsibility for a TDIU determination is a factual rather than a medical question and is an adjudicative determination made by the Board or the AOJ. Id. Therefore, a remand for any additional retrospective opinion is not warranted. See Soyini v. Derwinski, 1 Vet. App. 540 (1991) (remand is unnecessary where it would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant). Analysis Based on the foregoing, the Board finds no persuasive evidence that the Veteran was unable to secure or follow any substantive gainful employment during this appeal period under review due to his service connected disabilities. The Board's finding is supported by the VA examiners' determinations that the Veteran's service-connected disabilities did not preclude him from securing such employment. The evidence of record shows that, while there is evidence of interference with employment, the Veteran's service-connected disabilities alone did not preclude all forms of employment. In reaching this conclusion, the Board has considered the combined effects of the Veteran's service-connected disabilities but finds that the impact is not so severe as to preclude the Veteran from being able to follow substantially gainful employment consistent with his education, skills, and work experience during the period on appeal. The VA examinations reports note that while the Veteran's service-connected disabilities impacted his ability to undertake ADL's, these conditions did not preclude the Veteran from securing or maintaining gainful employment. Furthermore, the Board notes that the Veteran's ability to work was due to several non-service connected disabilities, rather than his service-connected disabilities. The pertinent evidence of record demonstrates that the Veteran has been unable to work due to cirrhosis and a low back injury, which he is not service-connected for. The Board notes that the Veteran applied for SSA disability benefits based on chronic liver disease and cirrhosis and that the Veteran sustained a low back injury while working in November 2002, which he is not service-connected for. The Board finds this evidence also supports the determination that the Veteran is not unemployable solely as a result of his service connected disabilities. As such, entitlement to a TDIU for this appeal period is not warranted. While the Board is cognizant of the Veteran's limited educational experience, his lack of formal/additional specialized training, volunteer work experience, or vocational training, as well as his work experience heavily confined to physical manual/labor work, the evidence demonstrates that he would be qualified for non-physical or sedentary employment as a result of his service-connected disabilities, despite his assertions to the contrary. Indeed, his ability to obtain technical knowledge in his post-service occupation, write reports or complete forms, undertake multiple activities of daily living, and his 12th grade education demonstrates that he would have transferable skills that would have qualified him for various non-physical or sedentary occupations. His vocational background would also involve such transferrable skills as time management; showing up on time; perform general support tasks; use a telephone, and conveying information to others. Such skills would transition to most sedentary environments. Thus, the pertinent medical evidence indicating that his specific service-connected disabilities did not preclude sedentary employment, as defined above, weighs against the TDIU claim. In adjudicating this claim, the competence and credibility of lay statements must be considered by the Board. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board acknowledges the Veteran and his wife's Board hearing testimony and are competent to give evidence about what they observe or experience. Layno v. Brown, 6 Vet. App. 465 (1994). That stated, the evidence of record does not favor a finding that the Veteran's service-connected disabilities rendered him unable to secure or follow gainful employment. The Board further notes that the Veteran's allegations of the cause of his inability to work due to his service-connected disabilities is contradicted by prior reports to Social Security that he was unemployable due to cirrhosis and a low back injury (which he is not service-connected for). The inconsistent reports which contradict the contemporaneous evidence leads the Board to place reduced probative value on the Veteran's self-reported medical history and his alleged reasons for why he was unemployable during the appeal period. Given the foregoing, the Board finds that the Veteran's non-service connected disabilities had a much greater impact on his ability to maintain employment than his service-connected disabilities. These non-service connected disabilities cannot be a basis for a TDIU. The pertinent evidence of record shows that the Veteran was not rendered unable to obtain or maintain substantially gainful employment by virtue of his service-connected disabilities during this appeal period. For the aforementioned reasons, the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.T. Massey, 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.