Citation Nr: 22012829 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 10-21 640 DATE: March 7, 2022 ORDER Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right knee for the period prior to March 28, 2017 is denied. Entitlement to a rating in excess of 30 percent for degenerative joint disease of the right knee for the period from March 28, 2017, to February 11, 2020 is denied. Entitlement to a rating in excess of 20 percent for degenerative joint disease of the right knee for the period since February 12, 2020 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. The weight of evidence shows that prior to March 28, 2017, the right knee disability was not been manifested by flexion limited to 60 degrees, extension limited to 15 degrees, dislocated semilunar cartilage, or at least slight lateral instability or recurrent subluxation. 2. For the period from March 28, 2017, to February 11, 2020, the Veteran's right knee had not been manifested by severely limited motion (to include as due to pain), severe weakness, ankylosis in flexion between 10 and 20 degrees, extension limited to 10 degrees, or nonunion of the tibia or fibula with loose motion, requiring a brace. 3. For the period since February 11, 2020, the Veteran's right knee disability has not been manifested by flexion limited to 15 degrees or less or extension limited to 20 degrees or more. 4. The Veteran's service-connected disability was not shown by the competent medical evidence of record to result in an inability to obtain or maintain substantially gainful employment so as to warrant referral of the TDIU claim on an extraschedular basis. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for degenerative joint disease of the right knee for the period prior to March 28, 2017, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260, 5261 (2020). 2. The criteria for entitlement to a rating in excess of 30 percent for degenerative joint disease of the right knee for the period from March 28, 2017, to February 11, 2020 have been not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260, 5261 (2020). 3. The criteria for entitlement to a rating in excess of 20 percent for degenerative joint disease of the right knee for the period since February 11, 2020 have been not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260, 5261 (2020). 4. The criteria for TDIU have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. § § 3.340, 3.341, 4.3, 4.16, 4.18, 4.19, 4.25 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1974 to June 1978. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision of a Department of Veterans Affairs (VA) regional office (RO). In May 2015, the Board remanded the claim for a Board hearing. In April 2016, the Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge and a transcript of that hearing has been associated with the electronic claims file. In June 2016 and February 2017, the Board remanded the claim for further development. In January 2018, the Board denied the issue of entitlement to a disability rating in excess of 10 percent for the right knee disability. The Veteran appealed that denial to the United States Court of Appeals for Veterans Claims (the Court). In November 2018, the Court granted a Joint Motion for Remand. In December 2019, the Board remanded the claim for further development. In September 2020, the Board denied entitlement to a disability rating in excess of 10 percent for degenerative joint disease of the right knee prior to March 28, 2017, granted entitlement to a 30 percent disability rating, but not higher, for degenerative joint disease of the right knee from March 28, 2017, to February 11, 2020, and granted entitlement to a 20 percent disability rating, but not higher, for degenerative joint disease of the right knee since February 12, 2020. The Veteran appealed the September 2020 Board decision to the Court. In a November 2021 Joint Motion for Partial Remand, the Court vacated and remanded the decision on the claims for a rating in excess of 10 percent for degenerative joint disease of the right knee prior to March 28, 2017, a rating in excess of 30 percent for degenerative joint disease of the right knee from March 28, 2017, to February 11, 2020, and a rating in excess of 20 percent for degenerative joint disease of the right knee since February 12, 2020. As noted in the November 2021 Joint Motion for Partial Remand, a February 2020 VA examiner indicated that the Veteran's right knee disability impacted the Veteran's ability to work and also found that the Veteran could only perform sedentary work. As a result, and in conjunction with the November 2021 Joint Motion for Partial Remand, the Board finds that a claim for TDIU has been reasonably raised by the record pursuant to Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009). The Board has therefore characterized the issues on appeal to include a claim for a TDIU. Higher Ratings Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2012). 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 (2020). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2020). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his knee disability. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). In evaluating 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). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, the amendments did not change the criteria under Diagnostic Codes 5256, 5258, 5259, 5260, or 5261. Notably, the criteria for knee instability under Diagnostic Code 5257 have changed during the period covered by this appeal, effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes, 5257, 5055). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Under 38 C.F.R. § 4.71a, Diagnostic Code 5260, if flexion of the knee is limited to 45 degrees a 10 percent rating is in order. If flexion of the knee is limited to 30 degrees a 20 percent rating is in order. If flexion of the knee is limited to 15 degrees a 30 percent rating is in order. Under 38 C.F.R. § 4.71a, Diagnostic Code 5261, if extension of the knee is limited to 10 degrees a 10 percent rating is in order. If extension of the knee is limited to 15 degrees a 20 percent rating is in order. If extension of the knee is limited to 20 degrees a 30 percent rating is in order. Under the criteria in effect prior to February 7, 2021, under Diagnostic Code 5262, pertaining to impairment of the tibia and fibula, a 10 percent disability rating is assigned for malunion with slight knee or ankle disability, and a 20 percent disability rating is warranted for malunion with moderate knee or ankle disability. A 40 percent disability rating is appropriate where there is nonunion of the tibia and fibula with loose motion requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. Under the revised criteria, Diagnostic Code 5262 now provides a 30 percent evaluation for shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities; a 20 percent rating is warranted for shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity, a 10 percent rating is warranted for shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities; and a noncompensable rating is warranted for shin splints that have treatment less than 12 consecutive months, one or both lower extremities. Under the criteria in effect prior to February 7, 2021, Diagnostic Code 5257 provides a 10 percent rating for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2020). The terms "mild," "moderate," "moderately severe" and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6 (2020). The use of terminology such as "mild" or "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6 (2020). VA General Counsel has also held that separate ratings may be assigned in cases where a service-connected knee disability includes both a compensable limitation of flexion under Diagnostic Code 5260, and a compensable limitation of extension under Diagnostic Code 5261 provided that the degree of disability is compensable under each set of criteria. VAOPGCPREC 09-04; 69 Fed. Reg. 59990 (2004). The basis for the opinion was a finding that a limitation in planes of movement were each compensable. Id. A claimant who has arthritis and instability of the knee may also be rated separately under Diagnostic Code 5003 and Diagnostic Code 5257 and rating a knee disability under both of those codes does not amount to pyramiding under 38 C.F.R. § 4.14 (2020). VAOPGCPREC 23-97 (July 1, 1997), 62 Fed. Reg. 63604 (1997); Esteban v. Brown, 6 Vet. App. 259 (1994). However, a separate rating must be based on additional compensable disability. Under the revised criteria, Diagnostic Code 5257 for recurrent subluxation and instability now provides a 30 percent rating for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation or a sprain incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. A 20 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. For patellar instability under the revised Diagnostic Code 5257, a 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Factual Background and Analysis In an October 1979 rating decision, the RO granted service connection for chondromalacia of the right patella and assigned a zero percent disability rating under Diagnostic Code 5257. In a November 1993 rating decision, a 10 percent disability rating was assigned for the right knee disability under Diagnostic Code 5257. In a November 1997 rating decision, the RO changed the rating code from Diagnostic Code 5257 to Diagnostic Code 5014 (osteomalacia). In August 2002, the disability was reclassified as degenerative joint disease and assigned a 10 percent disability rating under Diagnostic Code 5003. On October 8, 2008, the Veteran filed his claim for an increased rating for the right knee disability. As noted above, in January 2018, the Board denied the issue of entitlement to a disability rating in excess of 10 percent for the right knee disability. In September 2020, the Board denied entitlement to a disability rating in excess of 10 percent for degenerative joint disease of the right knee prior to March 28, 2017, granted entitlement to a 30 percent disability rating, but not higher, for degenerative joint disease of the right knee from March 28, 2017, to February 11, 2020, and granted entitlement to a 20 percent disability rating, but not higher, for degenerative joint disease of the right knee since February 12, 2020 under Diagnostic Code 5003-5261. In addition to the right knee disability, VA examination reports reflect that the Veteran has residuals of a stroke that impacts the right lower extremity. Service connection is not in effect for that disorder. The Board is precluded from differentiating between symptomatology attributed to a non-service-connected disability and a service-connected disability in the absence of medical evidence which does so. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). Period Prior to March 28, 2017 The limitation of motion is currently rated under Diagnostic Code 5003. The medical evidence prior to the VA examination on March 28, 2017, reveals a compensable limitation of extension. The Board will therefore consider whether a higher rating is warranted under Diagnostic Code 5261 (limitation of extension) prior to March 28, 2017, and then whether a separate rating is warranted under Diagnostic Code 5260 (limitation of flexion) prior to March 28, 2017. The Veteran underwent a VA examination in June 2009. The VA examiner diagnosed the Veteran with right knee degenerative joint disease. However, the VA examiner found no constitutional symptoms of arthritis, nor were there any incapacitating episodes of arthritis. With respect to range of motion, the Veteran's right knee affected the motion of his joint. However, his right knee had no ankylosis, no stiffness, no weakness, no incoordination, no decreased speed of joint motion, and no other symptoms. The right knee had no episodes of dislocation, subluxation, symptoms of inflammation, pain flare-ups, and locking episodes. Also, the Veteran exhibited no other evidence of abnormal weight bearing, no loss of a bone or part of a bone, no recurrent dislocations, and no inflammatory arthritis. The Veteran's right knee had repeated effusions. His right knee flexion was from 0 to 135 degrees and his right knee extension was normal at 0 degrees. The Veteran had right knee cartilage removed in 1998, 2000, and 2002. While frequently using a right leg brace, the Veteran was able to stand for 15 to 30 minutes and walk 1 to 3 miles. The Veteran's weight-bearing joint was affected, but his gait was normal. While the Veteran stated that his right knee had clicks or snaps, he did not have any right knee grinding, instability, patellar abnormality, meniscus abnormality, abnormal tendons or bursae, or any other knee abnormalities. The Veteran's left knee flexion was 0 to 135 degrees and left knee extension being normal at 0 degrees. The Veteran's degenerative joint disease had significant effects on his usual occupation due to decreased mobility, problems with lifting and carrying, and pain. As a result of these effects, the Veteran had increased absence from work, with the Veteran choosing to work more or less depending upon his right knee condition. The Veteran's right knee condition also affected his usual daily activities, with severe effects on his sports, moderate effects on his exercise and chores, and mild effects on his shopping, recreation, traveling, and driving. With respect to pain, the Veteran noted pain in his right knee. He exhibited tenderness and guarding of movement of his right knee and experienced pain when the right knee was in the flexed position. Additionally, there was objective evidence of pain with active motion on both the left and right sides. There was also objective evidence of right knee pain following repetitive motion, but no additional limitations after three repetitions in range of motion. The Veteran underwent a VA examination in April 2010. The examiner diagnosed the Veteran with right knee degenerative joint disease. The VA examiner noted that the Veteran said that the Veteran had no history of locking or instability of the right knee. The Veteran's right knee condition did not affect the Veteran's occupation and activities of daily living and that the Veteran experienced no flare-ups. The Veteran used a right knee brace when he did physical exertion. With respect to right knee range of motion, the Veteran's right knee was normal for stability, palpation for tenderness, crepitus, and McMurray testing. His right knee extension was 0 degrees, with pain at 0 degrees. His flexion was 0 to 80 degrees, with pain at 80 degrees. This range of motion measured was not additionally limited following repetitive use. With respect to pain, the Veteran's moderate pain was residual to the Veteran's recent post-right knee arthroscopic surgery. His right knee pain was constant, with a 7 to 8 on a 10 point pain scale. At the April 2016 Board hearing, the Veteran testified that his right knee disability had gotten worse. The Veteran said that he was constantly taking medicine for his knee pain and that he had to constantly wear a knee brace because he needed a knee replacement. He said that he was told by his doctors that his right knee ligaments and tendons had deteriorated. The Veteran also said that he had to use a walker due to his right knee disability. He said that he needed somebody to help him get up and down steps because he could not use his right leg for a long period of time. Additionally, the Veteran said that he could not drive due to his right leg and that he had a stroke in November 2014. The Veteran underwent a VA examination in August 2016. The VA examiner stated the Veteran was service-connected for right knee degenerative joint disease and that the Veteran was complaining of chronic right knee pain. With respect to right knee range of motion, the Veteran did not report any functional loss or functional impairment of the right knee joint, including, but not limited to, repeated use over time. However, the Veteran's right knee exhibited abnormal range of motion. The Veteran's right knee flexion was 0 to 110 degrees and extension was 140 to 0 degrees. This abnormal range of motion contributed to functional loss, with difficulty in the activities of daily living that would entail prolonged walking, standing, and squatting. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional functional loss or range of motion after three repetitions. However, the VA examiner was unable to describe the range of motion functional loss because it was variable with real life use. The Veteran's right knee exhibited a 4 out 5 score on flexion and extension strength testing, with a reduction in muscle strength due to the Veteran's claimed right knee disability. However, the Veteran's right knee exhibited no atrophy, no ankylosis, no recurrent subluxation, no lateral instability, and no recurrent effusion. Additionally, the Veteran's right knee had no joint instability, no anterior instability, no posterior instability, no medial instability, and no lateral instability. The Veteran also never had any right knee recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome, meniscus condition, or any other tibial and/or fibular impairment. The VA examiner noted that the Veteran had a meniscectomy of the right knee joint performed on him twice. The Veteran used a leg brace as an assistive device constantly as a normal mode of locomotion, even though occasional locomotion by other methods may have been possible. The Veteran's claimed right knee condition affected his ability to perform any type of functional task due to difficulty in walking, standing, and squatting. The VA examiner concluded that the Veteran had functional limitation secondary to pain and loss in range of motion of his right knee. The VA examiner opined that the Veteran may continue to suffer increased pain with additional temporal loss in range of motion with repetitive real life use. However, the VA examiner was unable to state the exact degree of range of motion loss since it would require mere speculation. With respect to right knee pain, the Veteran experienced pain causing functional loss on both flexion and extension, and pain during weight bearing and with crepitus. After repetitive use over time, the Veteran also showed pain, weakness, fatigability, or incoordination that significantly limited his functional ability with repeated use over time. However, there was no objective evidence of localized tenderness or pain on palpation of the right knee joint or associated soft tissue and the Veteran reported no flare-ups in his right knee or lower leg. Upon review of all relevant evidence of record, the Board finds that the disability picture associated with the Veteran's right knee does not meet or more nearly approximate the criteria for an evaluation greater than 10 percent for the period prior to March 18, 2017. Notably, the June 2009 VA examination report reflects that range-of-motion testing was from 0 to 125 degrees in the right knee, the April 2010 VA examination report reflects that range-of-motion testing was from 0 to 125 degrees in the right knee and the August 2016 VA examination report reflects that range-of-motion testing was from 10 to 110 degrees in the right knee. Prior to the VA examination on March 28, 2017, flexion was not limited to 45 degrees. Therefore, a compensable rating based on limitation of flexion prior to March 28, 2017, is not warranted. Prior to March 28, 2017, extension was not limited to 15 degrees. Thus, a rating in excess of 10 percent based on limitation of extension prior to March 28, 2017, is not warranted. The Board has considered the holding in DeLuca and 38 C.F.R. §§ 4.40, 4.45, and 4.59 regarding the right knee limitations of flexion and extension. The June 2009 VA examination report reveals that there was objective evidence of pain with active motion as well as following repetitive motion but that there were no additional limitations after three repetitions of range of motion. The April 2010 VA examination report reflects that there was pain at 0 degrees and 80 degrees but that range of motion was not additionally limited following repetitive use. At the August 2016 VA examination, the examiner indicated that there was pain on flexion and extension during range-of-motion testing and that the pain caused functional loss. The examiner indicated that pain on motion caused difficulty with prolonged walking, standing, and squatting. There was pain on weight bearing. At the examination, the Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The examiner noted that pain, fatigue, weakness, lack of endurance, and incoordination caused functional loss with repeated use over a period. The Veteran did not report flare-ups. The examiner also noted that with repetitive real-life use, the Veteran may suffer increased pain with additional temporal loss in range of motion. The examiner added that he was unable to state an exact degree of motion lost because stating such would be mere speculation. Given that the Veteran is already being compensated for pain on motion and without evidence of other significant limitations, a disability rating in excess of 10 percent pursuant to DeLuca prior to prior to March 28, 2017, is not warranted. 38 C.F.R. §§ 4.10, 4.40, 4.45, and 4.59. The medical evidence shows that the pain on extension in the right knee is part of the current 10 percent disability rating under Diagnostic Code 5262. Similarly, the medical evidence does not show that the painful flexion approximates a limitation of flexion warranting a 10 percent rating. Therefore, a higher or separate rating based on limitation of motion in the right knee prior to March 28, 2017, under Diagnostic Code 5261 is not warranted. In short, the weight of evidence shows that prior to March 28, 2017, the right knee disability was not been manifested by flexion limited to 60 degrees, extension limited to 15 degrees, dislocated semilunar cartilage, or at least slight lateral instability or recurrent subluxation. Accordingly, a disability rating in excess of 10 percent prior to March 28, 2017 is not warranted and that claim is denied. Period from March 28, 2017 to February 11, 2020 The Veteran underwent a VA examination in March 2017. The Veteran was diagnosed the Veteran with right knee patellofemoral pain syndrome and noted that imaging studies showed right knee degenerative traumatic arthritis. With respect to right leg range of motion, the Veteran's history of strokes complicated the VA examination. Since the Veteran's active range of right knee motion was minimal due to the residual weakness of his stroke, his active range of motion was 0 to 15 degrees and his passive range of motion was 0 to 90 degrees, with significant pain flexing and extending. The Veteran's right knee passive range of motion was approximately 90 degrees as he sat on the end of the examination table. The Veteran was unable to flex or extend his right leg with intention and sat with his knee propped up most of the time. The Veteran had residual right side weakness and foot drop and a gait consistent with right-sided weakness. The Veteran lifted his knee high to accommodate the right foot drop, planted his right foot and leg, then fully extended and locked the right knee to transfer weight to his right leg. The Veteran was unable to perform repetitive use testing with at least three repetitions for his right knee. The Veteran's right knee scored 3 out of 5 points on both flexion and extension strength testing. However, the VA examiner did not attribute the loss of strength to the Veteran's claimed right knee disability, but rather to the residuals of the Veteran's non-service-connected stroke. Furthermore, even though the Veteran used a cane and walker constantly due to right-sided instability from residuals of the stroke, the VA examiner opined that the Veteran's claimed right knee disability did not impact the Veteran's ability to perform any type of occupational task. With respect to right knee pain, the Veteran experienced pain in flexion and extension during the examination that caused functional loss of the Veteran's right leg. He experienced pain with weight-bearing and localized tenderness or pain on palpation of the right knee joint or associated soft tissue. This pain was peripatellar and a joint line pain with palpation, with objective evidence of crepitus. The Veteran also exhibited pain when his right knee joint was used in a non-weight bearing capacity and great pain during passive range of motion. Further, if he did too much walking and squatting, the Veteran said that he would experience several flare-ups daily. The flare-ups consisted of a sharp, stabbing pain that was 9 on a 10 point pain scale that were alleviated by pain pills and rest, the. As a result of flare-up pain, the Veteran avoided ambulating and activity during flare-ups. The VA examiner noted that the Veteran had a meniscectomy performed on his right knee. The March 2017 VA examination was conducted during a right knee flare-up, with factors like pain weakness, fatigability or incoordination significantly limiting the right knee's functional ability. Since the Veteran had residual right-sided weakness due to the stroke, the VA examiner was unable to describe how these factors affected the right knee range of motion. Also, since the VA examiner did not observe the right knee after prolonged or repeated use, she could not determine if these factors significantly limited the right knee functional ability over a period of time. While the Veteran had right knee functional loss and functional impairment, the VA examiner concluded that it was the non-service-connected stroke condition that aggravated the Veteran's right knee condition beyond its natural progression. The VA examiner also evaluated the Veteran's left knee. With respect to left knee range of motion, the VA examiner noted that it was abnormal. Flexion was from 0 to 130 degrees and extension was from 130 to 0 degrees. However, left knee range of motion did not contribute to left knee functional loss and the left leg had normal range of motion and strength. There was no additional functional loss or range of motion after three repetitions of the left knee. The Veteran's left knee exhibited normal strength, with a 5 out 5 points on both flexion and extension testing. With respect to left knee pain, the left leg caused the Veteran no pain on passive range of motion, with no flare-ups affecting the left knee. Pain, weakness, fatigability or incoordination did not significantly limit the Veteran's left knee functional ability with repeated use over a period of time. The left knee joint caused no pain when used in a non-weight bearing capacity because the left knee was undamaged. The left knee exhibited no evidence of pain on weight bearing, no localized tenderness or pain on palpation of the joint or associated soft tissue, and no objective evidence of crepitus. As such, the Veteran had no factors contributing to any left knee disability. With respect to both the left and right knees, the VA examiner noted that the Veteran did not have muscle atrophy, ankylosis, recurrent subluxation, lateral instability, joint instability, anterior instability, medial instability, posterior instability or recurrent effusion. Further, the Veteran never had recurrent patellar dislocation, "shin splints," fractures, chronic exertional compartment syndrome, tibial or fibular impairment, or a meniscus condition. The March 2017 VA examiner stated that the non-service-connected stroke disability aggravated the right knee disability beyond its natural progression. The March 2017 VA examiner noted that the active range of motion in the right knee was minimal due to residual weakness from the stroke. A February 12, 2020, VA examiner stated that the findings on the March 2017 VA examination regarding recurrent effusions, decreased range of motion, and pain to the right knee joint are due to the progression of degenerative joint disease that worsens over time. The February 2020 VA examiner added that the previous physical findings were not consistent with residuals of a stroke. Given the conflicting medical evidence on whether the decreased range of motion in the right knee was due to residuals of a stroke or degenerative joint disease, the evidence is in equipoise as to whether all right knee symptomatology is attributable to the degenerative joint disease. Notably, the March 2017 VA examination report reflects that the examiner stated that she was unable to test range of motion because the Veteran had had a stroke affecting his right side. Nonetheless, the examiner again reported that active range-of-motion testing was from 0 to 15 degrees in the right knee. Passive range of motion was from 0 to 90 degrees. The examiner indicated that there was pain on flexion and extension during range-of-motion testing and that the pain caused functional loss. There was pain on weight bearing. At the examination, the Veteran was unable to perform repetitive-use testing with at least three repetitions and was not examined immediately after repetitive use over time. The examiner noted that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time because the Veteran was not observed after prolonged or repeated use. The examiner indicated that the exam was conducted during a flare-up. The examiner stated that pain, fatigue, weakness, lack of endurance, and incoordination caused this functional loss. The examiner was unable to describe the functional loss in terms of range of motion because the Veteran had residual right-sided weakness due to stroke. The examiner noted that passive range of motion was very painful and that there was pain when the joint was used in non-weight-bearing. Following a review of the evidence and the Veteran's contentions, the Board finds that symptomatology and findings associated with the Veteran's right knee disability do not warrant a disability rating in excess of 30 percent for the period from March 28, 2017 to February 11, 2020. The Board notes that the maximum rating for limited flexion of the knee does not exceed 30 percent. Hence, Diagnostic Code 5260 is inapplicable. As noted above, to warrant an increased rating for a right knee disability in excess of 30 percent, the Veteran would have to be found to have extension limited to 10 degrees as separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, without violating the rule against pyramiding. See 38 C.F.R. § 4.14. However, for this time period there is no indication that the Veteran ever had extension of the right knee limited to 10 degrees or more, even with consideration of the DeLuca factors, to warrant a separate compensable rating for limitation of extension under Diagnostic Code 5261 as the March 2017 VA examiner specifically found that there was no limitation of extension. Notably, the Parties in the November 2018 Joint Motion for Partial Remand determined that the March 2017 VA examination was inadequate due to noncompliance with legal precedent. Specifically, the November 2018 Joint Motion for Partial Remand noted that the March 2017 VA examination did not include the testing required under 38 C.F.R. § 4.59, Correia v. McDonald, and Sharp v. Shulkin. As noted by the Board in its December 2019 remand, the March 2017 VA examiner indicated active and passive range of motion testing results, but did not report range of motion measurements on weight-bearing and non-weight-bearing positions. Also, it was noted that the examiner was unable to say without mere speculation that pain, weakness, fatigability, or incoordination significantly limits the Veteran's functional ability of his right knee with repeated use over a period of time, but failed to provide an adequate explanation. Rather, the examiner simply provided that the such estimation on functional limitation could not be reported because the Veteran was not observed after prolonged or repeated use. Further, the examiner did not distinguish the symptoms of the Veteran's service-connected right knee disability and his non-service-connected stroke residuals while providing an opinion that "the [Veteran's] non-service-connected stroke condition has aggravated beyond natural progression of his service-connected right knee condition." However, while these deficiencies rendered the examination inadequate, they did not render all testing results and information contained in the report inadequate. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("[E]ven if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight."). Notably, while the March 2017 examination contained deficiencies as indicated above, there is no credible evidence that the examiner's documented results were inaccurate or that the other information contained in the examination report is inaccurate. Additionally, an inadequate VA examination can still have probative value especially considering the Veteran's lay statements of symptoms during the examinations per Monzingo v. Shinseki. The Board finds that despite the March 2017 VA examination's deficiencies regarding Correia v. McDonald, and Sharp v. Shulkin, the cited medical results and information are credible and highly probative of the extension of the Veteran's right knee during the time period from March 28, 2017, to February 11, 2020. Significantly, while the VA examiner indicated that there was pain on extension during range-of-motion testing, the examiner nevertheless reported that active range-of-motion testing was from 0 to 15 degrees and passive range of motion was from 0 to 90 degrees in the right knee. As a result, even with consideration of the DeLuca factors, the evidence as a whole does not show that the criteria for a separate compensable rating based on limitation of extension are approximated. For these reasons, the Board concludes that a higher rating is not warranted based on functional loss due to pain and other symptoms as contemplated by Deluca. The Veteran is again receiving the maximum schedular rating for limitation of flexion. Therefore, a higher rating pursuant to DeLuca and 38 C.F.R. §§ 4.40, 4.45, and 4.59 under Diagnostic Code 5260 is not warranted. Without evidence of other significant limitations, a separate compensable disability rating based on painful extension pursuant to DeLuca is not warranted. 38 C.F.R. §§ 4.10, 4.40, 4.45, and 4.59. The medical evidence does not show that the painful extension approximates a limitation of extension warranting a 10 percent rating. Therefore, a separate rating based on limitation of extension in the right knee is not warranted for the period from March 28, 2017, to February 11, 2020. Accordingly, the Board finds that a rating in excess of 30 percent for the period from March 28, 2017, to February 11, 2020 for the Veteran's right knee disability is not warranted. Period Since February 12, 2020 The February 12, 2020, VA examination report reveals that the Veteran has a compensable limitation of extension. The Board will therefore consider whether a higher rating is warranted under Diagnostic Code 5261 (limitation of extension) and then whether a separate rating is warranted under Diagnostic Code 5260 (limitation of flexion). The February 12, 2020, VA examination report reflects that range-of-motion testing was from 5 to 100 degrees in the right knee. The limitation of flexion does not warrant a zero percent disability rating under Diagnostic Code 5260. The limitation of extension warrants a zero percent disability rating under Diagnostic Code 5261. The Board has considered the holding in DeLuca and 38 C.F.R. §§ 4.40, 4.45, and 4.59 regarding the right knee limitations of flexion and extension. At the February 2020 VA examination, the examiner indicated that there was pain on flexion and extension during range-of-motion testing and that the pain caused functional loss. There was pain on weight bearing. At the examination, the Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time. The February 2020 examiner noted, however, that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner noted that the Veteran had pain and weakness with repeated use over a period of time. The examiner described the functional loss in terms of range of motion with the resulting range of motion being 10 to 95 degrees. The Veteran was not examined during a flare-up. The February 2020 examiner noted, however, that the examination was medically consistent with the Veteran's statements describing functional loss during a flare-up. The examiner noted that the Veteran had pain and weakness during flare-ups. The examiner described the functional loss in terms of range of motion with the resulting range of motion being 15 to 90 degrees. The February 2020 VA examiner noted that there was no objective evidence of pain on passive motion or when the joint was used in non-weight-bearing. Given the examiner's finding of a limitation of extension to 15 degrees during a flare-up, the evidence is in equipoise as to whether since February 12, 2020, the right knee disability has been manifested by extension limited to 15 degrees. Given that the Veteran is being compensated for functional loss during flare-ups and without evidence of other significant limitations, a rating in excess of 20 percent under Diagnostic Code 5261 since February 12, 2020, is not warranted. The medical evidence shows that the pain and weakness on extension in the right knee are part of the current 20 percent disability rating under Diagnostic Code 5261. As for painful flexion, without evidence of other significant limitations, a separate compensable disability rating based on painful flexion pursuant to DeLuca is not warranted. 38 C.F.R. §§ 4.10, 4.40, 4.45, and 4.59. The medical evidence does not show that the painful flexion with weakness approximates a limitation of flexion warranting a 10 percent rating. Therefore, a separate rating based on limitation of flexion in the right knee is not warranted. Other Diagnostic Codes including Diagnostic Code 5257 for all Periods The Board notes that the Veteran has undergone two arthroscopies of the right knee. The August 2016, March 2017, and February 2020 VA examination reports reflect that the Veteran does or did not ever have a meniscus (semilunar cartilage) condition. Regardless of whether the Veteran has or has had a meniscus condition, he is not entitled to a separate rating under Diagnostic Code 5259 at any time during the appeal period because loss of motion is considered in that diagnostic code. Furthermore, his right knee disability is already rated 10 percent disabling based on limitation of motion and his disability cannot be rated higher under Diagnostic Code 5259 because 10 percent is the maximum rating under that code. As for a higher rating under Diagnostic Code 5258, the June 2009 VA examination report reflects that the Veteran had repeated effusions but no locking episodes. The August 2016, March 2017, and February 2020 VA examination reports reflect that the Veteran does or did not ever have a meniscus (semilunar cartilage) condition. Therefore, a higher rating under Diagnostic Code 5258 is not warranted at any time during the appeal period. Regarding a separate rating under Diagnostic Code 5257, as noted by the November 2021 Joint Motion for Partial Remand, there is favorable evidence that the Veteran has instability of the right knee which would possibly warrant a separate rating under Diagnostic Code 5257. Notably, the Veteran testified that his right knee was "wobbly" because "my right knee and my right side don't work period". Additionally, at the February 2020 VA examination the Veteran noted that he had regular use of a brace, wheelchair and walker while an August 2015 VA treatment note reported that the Veteran's right knee "remains, painful, wearing brace consistently". The March 2017 VA examination also noted the use of assistive devices for "right sided stability due to residuals of stroke", an August 2016 VA examiner noted the constant use of a brace and the Veteran testified that he wore his brace every day as the Board notes that the Veteran has credibly and consistently maintained throughout the appeal that he has had right knee instability. However, the Board finds the most probative evidence demonstrates that there is no history of recurrent patellar subluxation/dislocation or knee instability. In making these findings, the Board is cognizant of the duty to consider and weigh all pertinent evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (it is the "duty [of] the Board to analyze the credibility and probative value of evidence"); Owens v. Brown, 7 Vet. App. 429, 433 (1995) (it is the province of the Board to weigh and assess the evidence of record). The Board also notes that a Veteran is considered competent to report symptoms that are capable of ordinary observation, and objective medical evidence is not required to establish knee instability under Diagnostic Code 5257. English v. Wilkie, 30 Vet. App. 347 (2018). The Board however finds the objective medical evidence is more probative on the issue of instability of the right knee than the Veteran's lay assertions. As noted above, weight is given to the medical opinions provided by the examiners during the August 2016 and February 2020 VA examinations because they are well-supported by the objective clinical findings and is consistent with past examination findings. Some weight is given to the Veteran's lay testimony, but the Board finds the objective examination findings regarding instability to be more probative. In coming to this conclusion, the Board reviewed the entire medical record. While treatment records reveal that in January 2009 the Veteran complained of swelling in the right knee and a physical examination revealed mild joint laxity, a June 2009 VA examination report reveals that the Veteran did not have any instability while at an April 2010 VA examination, the testing for stability was normal. Notably, the Veteran again did not exhibit knee instability as the April 2010, August 2016 and February 2020 VA examinations have all specifically found that there is no showing of instability even upon specific instability testing. The August 2016 and February 2020 VA examination reports reveal that there was no history of recurrent subluxation or lateral instability as anterior instability (Lachman test), posterior instability (posterior drawer test), medial instability (valgus pressure), and lateral instability (varus pressure) tests were all normal. Most recently, the February 2020 VA examiner, after noting the Veteran's reports of instability, specifically indicated that there was no history of joint instability of the right knee and there were no findings of joint instability of the right knee as the right knee anterior instability test, posterior instability test, medial instability test and lateral instability test results again were all normal. Based on this, the Board finds the preponderance of the evidence is against finding the Veteran has right knee instability. Thus, a separate rating under Diagnostic Code 5257 for recurrent subluxation and lateral instability is not warranted. TDIU Laws and Regulations A TDIU may be assigned when a disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a) (2020). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. Id. Even if a veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), rating boards should refer to the Director, Compensation and Pension Service for extra-schedular consideration all cases where the veteran is unable to secure or follow a substantially gainful occupation by reason of service- connected disability. 38 C.F.R. § 4.16(b) (2020). See also Fanning v. Brown, 4 Vet. App. 225 (1993). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training and previous work experience, but not to his age or to any impairment caused by nonservice- connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Board emphasizes entitlement to an extraschedular rating under 38 C.F.R. § 3.321(b) (1) and a TDIU extraschedular rating under 38 C.F.R. § 4.16(b), although similar, are based on different factors. See Kellar v. Brown, 6 Vet. App. 157 (1994). An extraschedular rating under 38 C.F.R. § 3.321(b)(1), as discussed above, is based on the fact that the schedular ratings are inadequate to compensate for the average impairment of earning capacity due to the Veteran's disability. Exceptional or unusual circumstances, such as frequent hospitalization or marked interference with employment, are required. In contrast, 38 C.F.R. § 4.16(b) merely requires a determination that a particular veteran is rendered unable to secure or follow a substantially gainful occupation by reason of his or her service-connected disabilities. See VAOPGCPREC 6-96. Additionally, the Board cannot assign an extraschedular evaluation in the first instance. See Floyd v. Brown, 9 Vet. App. 88 (1996); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Instead, the Board must refer the Veteran's claims to the Under Secretary for Benefits or Director of Compensation and Pension Service for this special consideration when the issue is either raised by the claimant or is reasonably raised by the evidence of record. See Thun v. Peake, 22 Vet. App. 111, 115 (2008); Barringer v. Peake, 22 Vet. App. 242 (2008). Only after the Director has determined whether an extraschedular evaluation is warranted does the Board have jurisdiction to decide the merits of the extraschedular aspect of the claims. As noted by the Parties in the November 2021 Joint Motion for Partial Remand, the February 2020 VA examiner reported that the Veteran's right knee disability impacted his ability to work by "limiting his ability to stand and work that was required for job" while also noting that the Veteran lost 0-1 weeks of work in the last 12 months in his job as a retired landscaper. The examiner also completed a "Individual Unemployment Statement" and indicated that the Veteran could perform sedentary work. For the period prior to March 28, 2017, the Veteran was service connected for a right knee disability at a 10 percent disability rating, for a right renal calculus, post nephrectomy disability at a 10 percent disability rating and for residual right flank scars at a noncompensable rating. The Veteran's combined disability rating was 20 percent. For the period from March 28, 2017 to February 12, 2020, the Veteran was service connected for a right knee disability at a 30 percent disability rating, for a right renal calculus, post nephrectomy disability at a 10 percent disability rating and for residual right flank scars at a noncompensable rating. The Veteran's combined disability rating was 40 percent. For the period since February 12, 2020, the Veteran is service connected for a right knee disability at a 20 percent disability rating, for a right renal calculus, post nephrectomy disability at a 10 percent disability rating and for residual right flank scars at a noncompensable rating. The Veteran's combined disability rating is 30 percent. As a result, the Veteran does not have one service-connected disability rated at least 60 percent, or two or more disabilities with a combined rating of at least 70 percent, with one disability rated at 40 percent during any time period. As such, the criteria for a schedular TDIU under 38 C.F.R. § 4.16 (a) are not met. On review of the record, the Board finds that the Veteran is not unemployable by reason of his service-connected disabilities and that referral to the Director, Compensation and Pension Services, for extra-schedular consideration is thus not warranted. Notably, the medical evidence does not contain an opinion that the Veteran's service-connected disabilities precluded him from obtaining or engaging in substantially gainful employment and the Veteran has not presented or identified any such existing medical evidence or opinion. While the Board is sympathetic for the restrictions that encompassed these disabilities, the evidence clearly demonstrates that the Veteran's service-connected disabilities do not preclude all forms of employment. Again, the central inquiry is whether the Veteran's service-connected disabilities, alone, are of sufficient severity to preclude him from obtaining and maintaining all forms of substantially gainful employment. See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Notably, the June 2009 VA examiner found that the Veteran's degenerative joint disease had significant effects on his usual occupation due to decreased mobility, problems with lifting and carrying, and pain and as a result of these effects, the Veteran had increased absence from work, with the Veteran choosing to work more or less depending upon his right knee condition. An August 2016 VA examiner also noted that the Veteran's right knee condition affected his ability to perform any type of functional task due to difficulty in walking, standing, and squatting. The March 2017 VA examiner however reported that even though the Veteran used a cane and walker constantly due to right-sided instability from residuals of the stroke, the Veteran's claimed right knee disability did not impact the Veteran's ability to perform any type of occupational task. Additionally, as noted above, while the February 2020 VA examiner reported that the Veteran's right knee disability impacted his ability to work by "limiting his ability to stand and work that was required for job", the examiner also completed a "Individual Unemployment Statement" and indicated that the Veteran could perform sedentary work. The Board notes that VA regulations contain many factors to be considered as part of a TDIU analysis. See 38 C.F.R. §§ 4.16, 4.19. Whether a veteran can perform "sedentary work" or "sedentary employment" is not among them. In fact, neither the term nor any similar phrase is mentioned, much less defined, in any relevant VA statute or regulation. The Court recently held that if the Board basis its denial of TDIU in part on the conclusion that a veteran is capable of performing sedentary work, then it must define that term considering the specific facts of each case, including a particular veteran's work history, education, and training. See Withers v. Wilkie, 30 Vet. App. 139, 150-51 (2018). Merriam-Webster online dictionary defines sedentary as (a) doing or requiring much sitting or (b) not physically active. See https://www.merriam-webster.com/dictionary/sedentary (last visited March 15, 2019). Under 20 C.F.R. 404.1567 (a), the Social Security Administration (SSA) defines sedentary work as work that involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Id. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Id. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. Id. The Board finds these definitions are persuasive for purposes of this claim, as the Department of Labor and SSA have expertise in and are charged with defining the exertional requirements of different jobs in the national economy, and SSA is charged with determining the capacity of an individual to satisfy those requirements in adjudicating disability claims. Accordingly, the February 2020 VA examiner's findings that the Veteran should be able to do sedentary sitting work is consistent with DOT's and SSA's definition of sedentary employment. As a result, the evidence clearly demonstrates that the Veteran's service-connected disabilities did not preclude all forms of employment. The Board also notes that the Veteran has been awarded Social Security Administration (SSA) benefits. Although VA is required to consider the SSA's findings, the Board is not bound by the findings of disability and/or unemployability made by other agencies, including SSA. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). Adjudication of VA and SSA claims is based on different laws and regulations. Thus, SSA's determination has little probative value in this matter, and is not sufficient, in this case, to overcome the other evidence in the record. Accordingly, the Board concludes that the most probative evidence of record weighs heavily against finding that the Veteran's service-connected disabilities preclude him from obtaining or engaging in substantially gainful employment. The statements of the Veteran as to his employability as a result of his service-connected disabilities have been considered and they are found to be competent, credible and probative as to the symptoms experienced and observed. However, they are outweighed by the evidence of record. Accordingly, the Board finds that referral for consideration of entitlement to TDIU on an extraschedular basis is not required. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable and the claim is denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.