Citation Nr: 23037814 Decision Date: 07/07/23 Archive Date: 07/07/23 DOCKET NO. 16-03 565 DATE: July 7, 2023 ORDER Entitlement to a separate 10 percent rating, but not higher, for left knee lost flexion from July 26, 2010, is granted. Entitlement to a separate 10 percent rating, but not higher, for right knee lost flexion from July 26, 2010, is granted. Entitlement to a separate 10 percent rating, but not higher, for left knee instability from July 26, 2010, to February 7, 2021, is granted. Entitlement to a separate 20 percent rating, but not higher, for left knee instability from February 7, 2021, is granted. Entitlement to a separate 10 percent rating, but not higher, for right knee instability from July 26, 2010, is granted. Entitlement to a rating in excess of 10 percent for left knee lost extension rated as 10 percent disabling is denied. Entitlement to a rating in excess of 10 percent for right knee lost extension rated as 10 percent disabling is denied. Entitlement to a total rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. From July 26, 2010, the most probative evidence of record shows that the Veteran's left and right knee disorders are manifested by adverse symptomatology that equates to flexion limited to 45 degrees by not 30 degrees or worse even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion. 2. From July 26, 2010, to February 7, 2021, the most probative evidence of record shows that the Veteran's left knee disorder is manifested by adverse symptomatology that equates to slight recurrent subluxation or lateral instability but not moderate subluxation or lateral instability. 3. From February 7, 2021, the most probative evidence of record shows that the Veteran's left knee disorder is manifested by adverse symptomatology that equates to a repaired complete ligament tear that causes persistent instability but not moderate subluxation or lateral instability; recurrent subluxation or persistent instability with an unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribes both an assistive device and bracing for ambulation nor patellar instability with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. 4. From July 26, 2010, the most probative evidence of record shows that the Veteran's right knee disorder is manifested by adverse symptomatology that equates to slight recurrent subluxation or lateral instability but not moderate subluxation or lateral instability; recurrent subluxation or lateral instability with a sprain, incomplete ligament tear, or repaired complete ligament tear that causes persistent instability, an unrepaired or failed repair of a complete ligament tear causes peristent instability with a prescribed assistive device or bracing for ambulation; nor a diagnosis of patellar instability with a prescription for either a brace, cane, or walker. 5. At all times during the pendency of the appeal the most probative evidence of record shows that the Veteran's left and right knee disorders are not manifested by adverse symptomatology that equates to at least extension limited to 15 degrees or worse or ankylosis even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion and during flare-ups; symptomatic removal of semilunar cartilage, removal of the semilunar cartilage when symptomatic, impairment of the tibia and fibula, medial tibial stress syndrome, shin splints, or Genu recurvatum. 6. The most probative evidence of record showed that the Veteran's service-connected disabilities preclude substantial gainful employment. CONCLUSIONS OF LAW 1. From July 26, 2010, the criteria for separate 10 percent ratings, but no higher, for left and right knee lost flexion have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5260 (2020); 38 C.F.R. §§ 3.102, 4.7, 4.10 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 2. From July 26, 2010, to February 7, 2021, the criteria for a 10 percent rating, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2020); 38 C.F.R. §§ 3.102, 4.7, 4.10 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 3. From February 7, 2021, the criteria for a 20 percent rating, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.10 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 4. From July 26, 2010, the criteria for a separate 10 percent rating, but no higher, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2020); 38 C.F.R. §§ 3.102, 4.7, 4.10 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 5. At all times during the pendency of the appeal the criteria for ratings in excess of 10 percent for left and right knee lost extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5256, 5259, 5261, 5262, and 5263 (2020); 38 C.F.R. §§ 3.102, 4.7, 4.10 (2021); 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). 6. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from August 1971 to May 1974 and from June 1975 to January 1978. In August 2016, the Veteran testified at a video hearing before the undersigned Veteran Law Judge. A transcript of that hearing is of record. In October 2018, the Board of Veterans' Appeal (Board) issued a decision that denied the claims for ratings in excess of 10 percent for the left and right knee disorders which had been rated by the RO under Diagnostic Code 5010-5261 due to lost extension and remanded the claim of service connection for an acquired psychiatric disorder including posttraumatic stress disorder (PTSD). As to the claims for ratings in excess of 10 percent for left and right knee disorders, the Veteran appealed the October 2018 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a subsequent August 2019 order, which incorporated the parties Joint Motion for Partial Remand (JMPR), the Court vacated and remanded the October 2018 Board decision to the extent that it denied these claims. The JMPR also found that the Board failed to adjudicate a claim for a TDIU which had been raised by the record and remanded this issue for further action by the Board. As to the claim of service connection for an acquired psychiatric disorder including PTSD, in a September 2020 decision the Board granted this claim. Therefore, the Board finds that this issue is no longer in appellate status. See 38 U.S.C. § 7104. In February 2020 and February 2022, the Board Remanded the claims for increased ratings for the left and right knee disorders which the RO had rated as 10 percent disabling under Diagnostic Code 5010-5261 due to lost extension as well as Remanded the claim for a TDIU. In a March 2023 rating decision, the RO took the following actions: it granted the Veteran 10 percent ratings for left and right knee lost flexion under Diagnostic Code 5260 or 5003-5260 both effective from February 7, 2023; and granted a 10 percent rating for left knee instability under Diagnostic Code 5003-5257 effective from February 7, 2023. Therefore, because the March 2023 rating decision did not disturb the 10 percent ratings already in place for the left and right knee lost extension each rated as 10 percent disabling under Diagnostic Code 5010-5261 as lost extension and because the appeal has been pending since the Veteran filed his claims for increased ratings on July 26, 2010, the Board has characterized the issues on appeal as they appear above. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Also see AB v. Brown, 6 Vet. App. 35 (1993) (in an appeal in which the veteran expresses general disagreement with the assignment of a particular rating and requests an increase, the RO and the Board are required to construe the appeal as an appeal for the maximum benefit allowable by law or regulation). Lastly, the record shows that the Veteran has a pending claims as to the back and hip. However, the Board finds that these issues cannot be addressed below because they are under the Appeals Modernization Act (AMA) review system (see 38 C.F.R. §§ 3.2400 to 3.2601, 20.200 to 20.205; Also see 84 Fed. Reg. 138 (Jan. 18, 2019)) and the current claims are under the Legacy Appeal review system. Concerns Raised by the JMPR and Post-Remand Compliance As clearly indicated from the above and below, the evaluation of a service-connected disability, particularly a knee, based on a series of Court decisions is multifaceted. As to the concerns raised by the JMPR and post-Remand compliance, the Board finds that the RO's development addressed these concerns and substantially complied with the Remands. The Board has reached this conclusion because the record shows that the Veteran was provided with a VA examination in February 2023 and that examiner provided a medical opinion as to the severity of the appellant's left and right knees disorders after a review of the record on appeal, considering his lay claims regarding observable adverse symptomatology, and considering the Court's holdings in Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017) regarding ranges of motion with and without weight bearing and resistance in passive and active range of motion and during flare-ups. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board also finds that the VA's development of the claims substantially complied with the Remands and the concerns raised by the JMPR because all identified and available VA and private treatment records, including the knee magnetic resonance imaging evaluation (MRI) cited to by the November 2010 VA treatment record as well as the appellant's records on file with the Social Security Administration, were obtained and associated with the claims file. See 38 U.S.C. § 5103A(b). Additionally, and as directed by the JMPR, the below decision adjudicates the Veteran's claim for a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the Board finds that further delay by remanding the appeal to provide the Veteran with a new VA examination or to obtain additional records is not required. See 38 U.S.C. § 5103A(b), (d); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). The Rating Claims The Veteran claims, in substance, that he is entitled to higher and/or separate compensable ratings for his left and right knee disorders at all times during the pendency of the appeal. In this regard, disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). In this regard, the Board notes that when evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, the Court in Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016) held that the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to the evaluation of musculoskeletal disabilities under Diagnostic Codes predicated on range of motion measurements. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. Furthermore, in Jones v. Shinseki, 26 Vet. App. 56, 61-63 (2012) the Court held that the Board may not deny entitlement to an increased rating on the basis of relief provided by medication when those effects are specifically contemplated by the rating criteria. In Chavis v. McDonough, 34 Vet. App. 1 (2021) the Court held that ankylosis of the spine may be shown based on symptoms of fixation of the joint equivalent to ankylosis. In Esteban v. Brown, 6 Vet. App. 259, 261 (1994), that Court held that in cases where the record reflects that the appellant has multiple problems due to service-connected disability, it is possible for an appellant to have "separate and distinct manifestations" from the same injury, permitting separate disability ratings. The critical element is that none of the symptomatology for any of the conditions is duplicative or overlapping with the symptomatology of the other conditions. Id. In this regard, VA General Counsel has held that separate ratings may be assigned in cases where a service-connected knee disorder 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 9-2004; 69 Fed. Reg. 59990 (2004). The basis for the opinion was a finding that a limitation in planes of movement were each compensable. Id. VA General Counsel has also held that separate ratings may be assigned in cases where the service-connected knee disorder includes both arthritis and instability, provided of course, that the degree of disability is compensable under each set of criteria. VAOPGCPREC 23-97 (July 1, 1997). In this regard, the Court in Walleman v. McDonough, No. 20-7299 (June 9, 2022) recently held that the rule against pyramiding does not categorically preclude assigning a separate disability rating under pre-amended Diagnostic Code 5257 for lateral instability when a claimant is already rated under Diagnostic Code 5259 for residuals of a meniscectomy if there are symptomatic residuals of a meniscectomy other than instability that could independently warrant a compensable rating under Diagnostic Code 5259. Even more recently, the Court in Estevez v. McDonough, No. 20-8637 (May 19, 2023) held, in part, that claimants are not entitled to separate 10 percent ratings for painful flexion under Diagnostic Code 5260 and painful extension under Diagnostic Code 5261. In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). As noted above, the Veteran's left knee disorders are rated as follows: " left knee lost extension rated as 10 percent disabling under Diagnostic Code 5010-5261 effective from January 31, 2002; " left knee lost flexion rated as 10 percent disabling under Diagnostic Code 5260 effective from February 7, 2023; and " left knee instability rated as 10 percent disabling under Diagnostic Code 5003-5257 effective from February 7, 2023. See 38 C.F.R. § 4.71a. As noted above, the Veteran's right knee disorders are rated as follows: " right knee lost extension rated as 10 percent disabling under Diagnostic Code 5010-5261 from January 31, 2002; and " right knee lost flexion rated as 10 percent disabling under Diagnostic Code 5003-5260 effective from February 7, 2023. See 38 C.F.R. § 4.71a. Also as noted above, because the appeal has been pending since July 26, 2010, the below adjudication with consider if the Veteran meets the criteria for increased as well as separate compensable ratings for his left and right knee disorders since July 26, 2010. See Hart, supra; AB, supra. i. The Recent Amendments to the Musculoskeletal Rating Criteria Initially, the Board notes that during the pendency of the appeal VA amended some of its' criteria for rating musculoskeletal disabilities effective February 7, 2021. See 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. However, the Board cannot apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). In this case, the regulation does not provide for retroactive application. 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. §?4.71a). Therefore, the Board finds that they are not applicable to the pre-February 7, 2021, time-period. Under 38 C.F.R. § 4.71a, Diagnostic Code 5003 degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. A rating of 20 percent is assigned for each such major joint or group of minor joints, with occasional incapacitating exacerbations, affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under 38 C.F.R. § 4.71a, Diagnostic Code 5256, provides that ankylosis of the knee at a favorable angle in full extension or in slight flexion between 0 degrees and 10 degrees warrants a 30 percent rating; ankylosis with flexion between 10 degrees and 20 degrees warrants a 40 rating; ankylosis with flexion between 20 degrees and 45 degrees warrants a 50 rating; and extremely unfavorable ankylosis (flexion at an angle of 45 degrees or more) warrants a 60 percent rating. Under old 38 C.F.R. § 4.71a, Diagnostic Code 5257, slight recurrent subluxation or lateral instability will be rated as 10 percent disabling. Moderate recurrent subluxation or lateral instability will be rated as 20 percent disabling. And, severe recurrent subluxation or lateral instability, warrants a 30 percent rating. 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. 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. Effective February 7, 2021, VA amended Diagnostic Code 5257. For recurrent subluxation or lateral instability, a 10 percent rating is assigned for a sprain, incomplete ligament tear, or complete ligament tear causing persistent instability without prescribed assistive device or bracing for ambulation. A 20 percent rating is warranted when a) a sprain, incomplete ligament tear, or repaired complete ligament tear causes persistent instability; or b) an unrepaired or failed repair of a complete ligament tear causes peristent instability. A prescribed assistive device or bracing for ambulation is required. A 30 percent rating requires unrepaired or failed repair of complete ligament tear causing persistent instability and a prescription for both an assistive device and bracing for ambulation. For patellar instability also rated under Diagnostic Code 5257, a 10 percent rating is assigned for a diagnosed condition that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted when there is a diagnosed condition with a prescription for either a brace, cane, or walker. A 30 percent rating requires a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for brace and either a cane or a walker. Id. NOTE 1 following the criteria provides, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. NOTE 2 following the criteria provides a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Under 38 C.F.R. § 4.71a, Diagnostic Code 5258, dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint warrants a 20 percent rating. Under 38 C.F.R. § 4.71a, Diagnostic Code 5259, symptomatic removal of the semilunar cartilage warrants a 10 percent rating. 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. If extension of the knee is limited to 30 degrees a 40 percent rating is in order. If extension of the knee is limited to 45 degrees a 50 percent rating is in order. Full range of motion of the knee is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. Under old 38 C.F.R. § 4.71a, Diagnostic Code 5262, impairment of the tibia and fibula with slight knee or ankle disability warrants a 10 percent rating; with moderate knee or ankle disability warrants a 20 percent rating; with marked knee or ankle disability warrants a 30 percent rating; and with nonunion (loose motion requiring brace) warrants a 40 percent rating. Effective February 7, 2021, VA amended Diagnostic Code 5262. Medial tibial stress syndrome (MTSS), or shin splints is rated as 0 percent disabling with treatment less than 12 consecutive months, one or both lower extremities; 10 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities; 20 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity; and 30 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. Tibia and fibula are rated as 40 disabling with nonunion with loose motion, requiring brace. Tibia and fibula with malunion are evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Under 38 C.F.R. § 4.71a, Diagnostic Code 5263, Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) warrants a 10 percent rating. As the Veteran can clearly see, the evaluation of knee problems over time is multifarious. Court decisions are issued, regulations are changed, in part, to address the concerns raised in those Court decisions. Other Court decisions are then issued, which then leads to additional development as the condition itself becomes worse as in this case. As noted above, prior to February 7, 2021, the Board will apply the prior rating criteria. See Kuzma, supra. From February 7, 2021, onward, the Board applies the criteria that is more favorable to the Veteran. Id. In this regard, because the Board finds that a Remand to provide the Veteran with notice of these new rating criteria and have the claims adjudicating applying them is not required because he is not prejudiced by any lack of notice. See Sabonis, supra. ii. Correia and Sharp Compliance Next, in adjudicating below whether the Veteran meets the criteria for higher and/or separate ratings for his left and right knee disorders, the Board has not overlooked the Court's holdings in Sharp v. Shulkin, 29 Vet. App. 26 (2017) and Correia v. McDonald, 28 Vet. App. 158 (2016). Tellingly, the Board finds that in this Veteran's appeal the record is adequate to address the concerns raised by the Court in these cases because the February 2023 VA examination provided range of motion studies of the left and right knee that considers his complaints of pain with and without weight bearing and resistance, in passive and active range of motion, as well as during flare-ups. See Owens, supra. Therefore, the Board finds that further delay by remanding the appeal to provide the Veteran with a new VA examination is not required. See Sabonis, supra. Further, and for the record, that Board believes that another examination, in light of this record, is distinctly not warranted. iii. The Merits of the Left Knee Rating Claim a. Left and Right Knee Lost Flexion from July 26, 2010 i. Separate compensable ratings for left and right knee lost flexion under Diagnostic Code 5260 from July 26, 2010. As noted above, the RO already granted the Veteran separate 10 percent ratings for left and right knee lost flexion under Diagnostic Code 5260 effective from February 7, 2023. However, the Veteran's claims for increased ratings have been pending since July 26, 2010. Therefore, the first question the Board will address is whether the Veteran is entitled to at least 10 percent ratings for his left and right knee lost flexion from July 26, 2010, under Diagnostic Code 5260 from July 26, 2010. In this regard, the Board notes that "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." See Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010) (discussing assignment of an effective date for a reduction in disability rating under Diagnostic Code 7528); see also Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014) (holding that a medical opinion can diagnose the presence of the condition and identify an earlier onset date based on preexisting symptoms). Therefore, the Board finds that when rating the severity of the Veteran's left and right knee disorders it may consider all medical evidence generated during the pendency of the appeal (i.e., since July 26, 2010) which evidence includes the February 2023 VA examination report that the RO relied upon in the March 2023 rating decision that granted him 10 percent ratings for lost flexion because it shows, among other things, flexion limited to 40 degrees. Id. Accordingly, when considering the Veteran's complaints of pain as per 38 C.F.R. §§ 4.40, 4.45, 4.59 and the Court's holding in Chavis, Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, as well as when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra) and when resolving all reasonable doubt in his favor, the Board finds that the most probative evidence of records shows that his adverse symptomatology approximates the criteria for at least 10 percent ratings under Diagnostic Code 5260 at all times from July 26, 2010, because it shows that flexion of the left and right knee were 45 degrees or less because they were 40 degrees. See 38 C.F.R. § 4.71a; Owens, supra; Fenderson, supra; Hart, supra; Tatum, supra; Young, supra. ii. Ratings in excess of 10 percent for left and right knee lost flexion under Diagnostic Code 5260 from July 26, 2010. As to claims for ratings in excess of 10 percent for left and right knee lost flexion under Diagnostic Code 5260 from July 26, 2010, the Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Chavis, Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for at least 20 percent ratings because the most probative evidence of record shows that flexion of the left and right knee were not limited to at least 30 degrees at all times from July 26, 2010, because at their worst they were 110 degrees at the January 2011 VA examination, 90 degrees at the March 2015 VA examination, 140 degrees at the November 2017 VA examination, 90 degrees at the June 2021 VA examination, and 40 degrees at the February 2023 VA examination. See Owens, supra. Moreover, while the Veteran's treatment records document his complaints and treatment for left and right knee problems, the Board finds that the above VA examiners ranges of motion are not contradicted by any other medical evidence of record because treatment records never document less flexion in the left and right knee. Id. Additionally, the Board finds that the Veteran is not qualified to provide range of motion findings in the left and right knee because this is a medical finding. See Davidson, supra. Similarly, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black v. Brown, 10 Vet. App. 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). Therefore, the Board finds that the criteria for ratings in excess of 10 percent for left and right knee lost flexion under Diagnostic Code 5260 are not met from July 26, 2010. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. b. Left and Right Knee Instability from July 26, 2010. i. Separate compensable ratings for left and right knee instability under Diagnostic Code 5257 from July 26, 2010. As noted above, the RO already granted the Veteran a separate 10 percent rating for left knee instability under Diagnostic Code 5260 effective from February 7, 2023. See VAOPGCPREC 23-97. However, it did not grant the Veteran a separate 10 percent rating for right knee instability under Diagnostic Code 5260. Therefore, because the Veteran's claims for increased ratings have been pending since July 26, 2010, the first question the Board will address is whether he is entitled to at least a 10 percent rating for his left knee instability under old Diagnostic Code 5260 from July 26, 2010, as well as whether he is entitled to a separate compensable rating for right knee instability under old Diagnostic Code 5260 from July 26, 2010. See Fenderson, supra; Hart; supra; VAOPGCPREC 23-97 Next, and as noted above, the Board notes that "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." See Tatum, supra; see also Young, supra. Therefore, the Board finds that when rating the severity of the Veteran's left and right knee disorders it may consider all medical evidence generated during the pendency of the appeal (i.e., since July 26, 2010) which evidence includes the February 2023 VA examination report in which it was opined, among other things, that the claimant's right and left knee each had recurrent subluxation or persistent instability. Id. Accordingly, when considering the Veteran's competent reports of his observable adverse symptomatology (see Davidson, supra) and when resolving all reasonable doubt in his favor, the Board finds that the most probative evidence of records shows that his left knee's adverse symptomatology approximates the criteria for at least a 10 percent rating under old Diagnostic Code 5257 at all times from July 26, 2010, and his right knee's adverse symptomatology approximates the criteria for at least a separate compensable 10 percent rating under old Diagnostic Code 5257 at all times from July 26, 2010, because the February 2023 VA examination shows he had adverse symptomatology equates to at least slight recurrent subluxation or lateral instability in both knees. See 38 C.F.R. § 4.71a; Owens, supra; Fenderson, supra; Hart, supra; Tatum, supra; Young, supra; VAOPGCPREC 23-97. ii. Ratings in excess of 10 percent for left and right knee instability under old and new Diagnostic Code 5257 from July 26, 2010. (a) Old Diagnostic Code 5257 Initially, as to the question of whether the Veteran meets the criteria for ratings in excess of 10 percent for his left and right knee instability from July 26, 2010, under old Diagnostic Code 5257, the Board finds that the most probative evidence of record are the results from the Veteran's January 2011, March 2015, November 2017, June 2021, and February 2023 VA examinations which show his adverse symptomatology does not include at least moderate recurrent subluxation or lateral instability. See 38 C.F.R. § 4.71a; Owens, supra. In this regard the Board finds it significant that, while the February 2023 VA examiner opined that the Veteran's right and left knee each had recurrent subluxation or persistent instability, the January 2011 VA examiner opined that the knee stability testing was normal bilaterally, the March 2015, November 2017, and June 2021 VA examiners opined that the right and left knee did not have recurrent subluxation or lateral instability, and neither the treatment records nor the VA examinations ever show the claimant's adverse symptomatology in either knee being characterized as moderate in severity. See Colvin, supra. Moreover, the Board finds that the Veteran is not competent to provide the missing diagnosis of moderate recurrent subluxation or lateral instability because this is a medical finding. See Davidson, supra. Additionally, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black, supra. Given the above record, the Board finds that the most probative evidence of record shows that the Veteran does not have at least moderate recurrent subluxation or lateral instability in either the right or left knee. See Owens, supra. Consequently, the Board finds that the criteria for ratings in excess of 10 percent for left and right knee instability under old Diagnostic Code 5257 have not been met at any time from July 26, 2010. See 38 C.F.R. § 4.71a; Fenderson, supra; Hart, supra. (b) New Diagnostic Code 5257 Next, the Board will address the question of whether the Veteran meets the criteria for ratings in excess of 10 percent for his left and right knee instability under new Diagnostic Code 5257 from February 7, 2021. See 38 C.F.R. § 4.71a; Fenderson, supra; Hart, supra; Kuzma, supra. The Left Knee In this regard, the Board notes that the Veteran has a history of knee arthroscopies in 2010 (see, e.g., VA examination dated in March 2015). Moreover, the November 2017 VA examiner reported that he regularly used a cane, the June 2021 VA examiner reported that he regularly used a cane and brace, and the February 2023 VA examiner reported that he regularly used a cane and brace as well as occasionally used a crutch. Additionally, the February 2023 VA examiner reported that a January 2010 MRI showed a complex medial meniscus tear of the left knee, opined that the Veteran had, or had, a diagnosis of a meniscal tear, as well as opined that he currently had recurrent subluxation or persistent instability. Accordingly, when considering the Veteran's competent reports of his observable adverse symptomatology (see Davidson, supra) and when resolving all reasonable doubt in his favor, the Board finds that the most probative evidence of records shows that his left knee's adverse symptomatology approximates the criteria for at least a 20 percent rating under new Diagnostic Code 5257 at all times from February 7, 2021, because the above record shows he had adverse symptomatology equates to at least a "repaired complete ligament tear that causes persistent instability." See 38 C.F.R. § 4.71a; Owens, supra; Fenderson, supra; Hart, supra; Tatum, supra; Young, supra; VAOPGCPREC 23-97. However, the Board finds that the criteria for a rating in excess of 20 percent for the left knee instability under new Diagnostic Code 5257 from February 7, 2021, have not been met. See Owens, supra. As to new Diagnostic Code 5257's recurrent subluxation or persistent instability criteria, the Board has reached this conclusion because the record is negative for the complex medial meniscus tear not being repaired or the 2010 surgery failing despite the assistive devices that were reported he used at the November 2017, June 2021, and February 2023 VA examination, the history of a knee arthroscopy in 2010, the January 2010 MRI showing a complex medial meniscus tear, and the February 2023 VA examiner's report of both a meniscal tear and recurrent subluxation or persistent instability,. See Owens, supra. As to new Diagnostic Code 5257's patellar instability criteria, the Board has reached this conclusion because the record, including the January 2011, March 2015, November 2017, June 2021, and February 2023 VA examinations, are negative for the Veteran being diagnosed with patellar instability. See Colvin, supra. In fact, the March 2015, November 2017, June 2021, and February 2023 VA examiners all opined that he did not have patellar dislocation and these medical opinions are not contradicted by any other medical evidence of record. Id. Moreover, the Board finds that the Veteran is not competent to provide the missing diagnoses of the complex medial meniscus tear not being repaired or the 2010 surgery failing nor a diagnosis of patellar instability, because these are medical findings. See Davidson, supra. Additionally, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black, supra. Accordingly, the Board finds that the Veteran does not meet the criteria for a rating in excess of 20 percent for his left knee instability under new Diagnostic Code 5257 at any time from February 7, 2021. See 38 C.F.R. § 4.71a; Hart, supra; Fenderson, supra; Kuzma, supra. The Right Knee In this regard, the Board again notes that the March 2015 VA examiner reported that the Veteran had a history of an arthroscopy in 2010. Moreover, the November 2017 VA examiner reported that he regularly used a cane, the June 2021 VA examiner reported that he regularly used a cane and brace, and the February 2023 VA examiner reported that he regularly used a cane and brace as well as occasionally used a crutch. Additionally, the February 2023 VA examiner opined that the right knee had recurrent subluxation or persistent instability. However, the Board notes that neither the January 2011, March 2015, November 2017, June 2021, or the February 2023 VA examiner nor the Veteran's treatment records show the claimant's right knee adverse symptomatology includes, at least, any of the following: recurrent subluxation or persistent instability with a sprain, incomplete ligament tear, or repaired complete ligament tear that causes persistent instability, an unrepaired or failed repair of a complete ligament tear that causes peristent instability with a prescribed assistive device or bracing for ambulation nor a diagnosis of patellar instability with a prescription for either a brace, cane, or walker. See 38 C.F.R. § 4.71a; Owens, supra. In fact, the March 2015, November 2017, June 2021, and February 2023 VA examiners opined that the right knee did not have patellar dislocation. Similarly, the June 2021 and February 2023 VA examiners opined that the right knee did not have a ligament tear (sprain) or a meniscus (semilunar cartilage) condition. These medical opinions are not contradicted by any other medical evidence of record. See Colvin, supra. Moreover, the Board finds that the Veteran is not competent to provide the missing diagnoses because these are medical findings. See Davidson, supra. Additionally, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black, supra. Accordingly, the Board finds that the Veteran does not meet the criteria for a rating in excess of 10 percent for his right knee instability under new Diagnostic Code 5257 at any time from February 7, 2021. See 38 C.F.R. § 4.71a; Hart, supra; Fenderson, supra; Kuzma, supra. c. Left and Right Knee Lost Extension During the Pendency of the Appeal As to the claims for ratings in excess of 10 percent for left and right knee lost extension under Diagnostic Code 5261 from July 26, 2010, the Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for at least 20 percent ratings at all times during the pendency of the because the most probative evidence of record shows that extension of the left and right knee were not limited to at least 15 degrees because they were 10 degrees at the January 2011 VA examination, 0 degrees at the March 2015 VA examination, 0 degrees at the November 2017 VA examination, 10 degrees at the June 2021 VA examination, and 10 degrees at the February 2023 VA examination. See Owens, supra. Moreover, while the Veteran's treatment records document his complaints and treatment for left and right knee problems, the Board finds that above VA examiners ranges of motion are not contradicted by any other medical evidence of record because treatment records never document less extension in the left and right knee. Id. Additionally, the Board finds that the Veteran is not qualified to provide range of motion findings in the left and right knee because this is a medical finding. See Davidson, supra. Similarly, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black, supra. Therefore, the Board finds that the criteria for ratings in excess of 10 percent for left and right knee lost extension under Diagnostic Code 5261 are not met at any time during the pendency of the appeal. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra. As to higher evaluations for the Veteran's left and right knee disorders by rating them as ankylosis under Diagnostic Code 5256, the Board finds that even when considering the Veteran's reports of pain as per 38 C.F.R. §§ 4.40, 4.45, 4.59 and the Court's holding in Correia, Sharp, Mitchell, Burton, Southall-Norman, DeLuca, and Chavis, as well as when considering his competent reports of observable adverse symptomatology (see Davidson, supra), the left and right knee do not meet the criteria for higher ratings by rating them as ankylosis. See Owens, supra. The Board has reached this conclusion because the record, including the January 2011, March 2015, November 2017, June 2021, and February 2023 VA examinations, is uniform in documenting at least some left and right knee motion and ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Colvin, supra. In fact, the VA examiners in January 2011, March 2015, November 2017, June 2021, and February 2023 opined that the left and right knee were not ankylosed and these medical opinions are not contradicted by any other medical evidence of record. See Colvin, supra. Moreover, the Board finds that the Veteran is not competent to provide the missing diagnosis of ankylosis because this is a medical finding. See Davidson, supra. Additionally, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have greater medical training. See Black, supra. Therefore, the Board finds that the criteria for ratings in excess of 10 percent for the Veteran's left and right knee disorders by rating them as ankylosis under Diagnostic Code 5256 are not met at any time during the pendency of the appeal. See 38 C.F.R. § 4.71a; Fenderson, supra; Hart, supra. As to higher evaluations for the Veteran's left and right knee disorders by rating them under old Diagnostic Code 5258 for symptomatic removal of semilunar cartilage, Diagnostic Code 5259 for removal of the semilunar cartilage when symptomatic, under Diagnostic Code 5262 for impairment of the tibia and fibula, under new Diagnostic Code 5262 for medial tibial stress syndrome or shin splints, and/or under Diagnostic Code 5263 for Genu recurvatum, the Board finds that the left and right knee disorders do not include any of the above adverse symptomatology and/or the 10 percent ratings already assigned meets the maximum rating possible under these Diagnostic Codes. See 38 C.F.R. § 4.71a; Colvin, supra; Also see VA examinations dated in January 2011, March 2015, November 2017, June 2021, and February 2023. In fact, the March 2015, November 2017, June 2021, and February 2023 VA examiners specifically opined that the Veteran right or left knee did not have recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. See Colvin, supra. Therefore, the Board finds that the criteria for ratings in excess of 10 percent for the left and right knee disorders by rating them under these criteria are not met at any time during the pendency of the appeal. See 38 C.F.R. § 4.71a; Butt's, supra; Hart, supra; Fenderson, supra. Conclusion In reaching the above conclusions, the Board considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence of record is against the claims to the extent outlined above (i.e., the evidence for and again the claims is not approximately in balance), the Board finds that the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Lynch, supra. The TDIU Claim The Veteran claims, in substance, that his service-connected disabilities prevent him from obtain and maintaining gainful employment. The Board notes that a total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation because of a service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. In calculating if the Veteran met the above schedular criteria VA combines the Veteran's service-connected orthopedic disorders. The existence or degree of non-service-connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran's service-connected disabilities render his incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned where the schedular rating is less than total if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Further, marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). With the above criteria in mind, the Board notes that the record shows that during the pendency of the appeal the Veteran was service-connected as follows: " an acquired psychiatric disorder rated as 30 percent and thereafter 50 percent disabling; " left knee lost flexion rated as10 percent disabling; " right knee lost flexion rated as10 percent disabling; " left knee instability rated as10 percent and thereafter 20 percent disabling; " right knee instability rated as10 percent disabling; " left knee lost extension rated as10 percent disabling; " right knee lost extension rated as10 percent disabling; and " tinnitus rated as10 percent disabling. In summary, the Board finds that this record shows that during the pendency of the appeal the Veteran met the schedular requirements of 38 C.F.R. § 4.16(a) because he has two or more service-connected disabilities with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. See 38 C.F.R. § 4.16(a)(1) to (5). Thus, the question for the Board to consider is when, if ever, his service-connected disabilities rendered him incapable of substantial gainful employment. See 38 C.F.R. § 4.16(a). Tellingly, when making this determination the Board must consider the combined effects of all the Veteran's service-connected disabilities. See Allday v. Brown, 7 Vet. App. 517, 527 (1995). In this regard, the Veteran's VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability (TDIU Claim Form), dated in May 2022, reported that he had not worked full-time and became too disabled to work because of his service-connected disabilities since September 2013. As to his work history, the Veteran reported that he worked as an inspector for the Department of Agriculture full-time from January 2005 to September 2013. As to his education, the Veteran reported that he had 4-years of college. As to the Veteran's being able to work performing jobs that require sedentary employment and non-sedentary employment, including his past employment as an inspector as well as other possible employment that could make use of his work experience and 4-years of college, the Board finds that the medical records show that the problems caused by his service-connected acquired psychiatric disorder, bilateral knee disabilities, and tinnitus, when taken together, adversely impact his ability to work in any field because of the overall impairment they have to his body and mind to include the stamina needed to work a full-day, concentrate on the tasks required by employment, and interact effectively with co-workers and/or customers, and carry out the tasks required by employment. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) (holding that the determination of whether a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question and that it is an adjudicative determination properly made by the Board or the regional office); Also see Allday, supra. In this regard, the Board also finds that the Veteran's service-connected acquired psychiatric disorder, bilateral knee disabilities, and tinnitus would make it dangerous for him and his co-workers for him to work in most non-sedentary employments including in his old employment as an inspector. Id. Similarly, the Board finds that that his service-connected acquired psychiatric disorder and tinnitus would make it very difficult to learn the new skills needed to work in most sedentary employments for the first time because of the problems they would cause interacting with his co-workers as well as any customers, carry out the duties required by such employment, and to learn the new skills needed for such employment. Id. The Board also finds that his service-connected bilateral knee disabilities would adversely impact his ability to sit a desk all day. Id. Therefore, given the above, the Board finds that the Veteran's service-connected disabilities prevent him from securing or following a "substantially gainful" occupation given his prior vocational history, work experience, and the impact his service-connected acquired psychiatric disorder, bilateral knee disabilities, and tinnitus, when taken together, have on obtaining and maintaining substantially gainful non-sedentary employment and sedentary employment, including in his past employment as an inspector, because of the problems they would cause in any work environment. See Owens, supra; Also see Allday, supra. Further development of this issue is simply not warranted in light of the history of this case. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's service-connected disabilities render him incapable of substantial gainful employment given his prior vocational history, work experience, and the impact his service-connected disabilities had on all employment and the claim for a TDIU is granted. See 38 C.F.R. § 4.16(a); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). In reaching the above conclusion the Board makes no finding as to the effective date of the grant of the TDIU because this issue is not before us. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Werner, Neil T. 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.