Citation Nr: 24017455 Decision Date: 04/24/24 Archive Date: 04/24/24 DOCKET NO. 18-16 333 DATE: April 24, 2024 ORDER Prior to May 10, 2022, entitlement to an initial rating of 30 percent, but no higher, for a left shoulder disability is granted. From July 1, 2023, a rating of 50 percent, but no higher, for a left shoulder disability is granted. Entitlement to a separate rating for left upper extremity peripheral neuropathy is granted. Entitlement to a total disability due to individual unemployability (TDIU) prior to January 30, 2022, is denied. FINDINGS OF FACT 1. Prior to May 10, 2022, the Veteran's left shoulder disability manifested with reduced range of motion, chronic pain, fatigue, flare-ups with functional loss, and weakness in all ranges of motion. 2. From July 1, 2023, the Veteran's left shoulder disability manifested with chronic residuals consisting of severe, painful motion or weakness. 3. The Veteran's left upper extremity peripheral neuropathy is a progression of his service-connected left shoulder disability. 4. The Veteran was not unable to secure or follow a substantially gainful occupation as a result of service connected disabilities prior to January 30, 2022. CONCLUSIONS OF LAW 1. The criteria for a rating of 30 percent, but no higher, prior to May 10, 2022, for a left shoulder disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 2. The criteria for a rating of 50 percent, but no higher, from July 1, 2023, for a left shoulder disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5051. 3. The criteria for entitlement to service connection for left upper extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. Prior to January 30, 2022, the criteria for entitlement to a total disability based on individual unemployability have not been met. 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16(a), 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1972 to June 1975. These matters come before the Board of Veterans Appeals (Board) on appeal from a December 1975 Rating Decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). The claims before the Board were most recently remanded in June 2023 for a retrospective opinion relating the Veteran's claim for an increased initial rating for a left shoulder disability and for referral to the Director of Compensation Services for extraschedular consideration of the award of total disability due to individual unemployability (TDIU) prior to January 30, 2022, pursuant to 38 C.F.R. §4.16(b). Snider v. McDonough, 35 Vet. App.1 (2021). In November 2023, a VA retrospective opinion was prepared to address the severity of the Veteran's service-connected left shoulder disability and in February 2024, the issue of extraschedular TDIU prior to January 30, 2022, was addressed by the Director of Compensation Services. Upon review of the opinions, the Board finds that the RO substantially complied with the prior remand directives relating to the aforementioned claims. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance). Accordingly, the Board now proceeds to address the merits of the claims. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity. See 38 C.F.R. § 4.10; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A veteran may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran has been assigned a rating under Diagnostic Code 5201-5051. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When rating shoulder disabilities, different ratings are available for the dominant (major) and non-dominant (minor) side. The evidence establishes the Veteran is right-handed, so his left shoulder is rated under impairment of the minor upper extremity. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran applies, 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 has considered the Veteran's appeal with respect to this 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 has been applied. Under both the old criteria and the new criteria for Diagnostic Code 5051, a percentage of 100 is warranted for a full year following the shoulder replacement (prosthesis); a 60 percent rating is warranted when the prosthesis is accompanied by chronic residuals consisting of severe, painful motion or weakness in the affected extremity; and a 30 percent rating is warranted when the Veteran experiences intermediate degrees of residual weakness, pain or limitation of motion, rated by analogy to Diagnostic Codes 5200 and 5203. 38 C.F.R. § 4.71a. The notes accompanying Diagnostic Code 5051 were amended, to be addressed whenever applicable. Under Diagnostic Code 5200, ankylosis of the scapulohumeral articulation is when the scapula and humerus move as one piece. A 30 percent rating is warranted for favorable ankylosis with abduction to 60 degrees (the ability to reach the mouth and head) of the major arm. A 40 percent rating is warranted for intermediate ankylosis, between favorable and unfavorable, of the major arm. A 50 percent rating is warranted for unfavorable ankylosis with abduction limited to 25 degrees from the side. 38 C.F.R. § 4.71a. Diagnostic Code 5201 provides a 20 percent rating for arm motion limited at the shoulder level, major or minor, a 30 and 20 percent rating for arm motion limited midway between the side and shoulder level, major and minor respectively, and a 40 and 30 percent rating for arm motion limited to 25 degrees from the side, major and minor respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Normal ranges of shoulder flexion and abduction are from 0 to 180 degrees, and external and internal rotations are from 0 to 90 degrees. See 38 C.F.R. § 4.71, Plate I. In determining whether a veteran has limitation of motion to shoulder level, it is necessary to consider forward flexion and abduction. See Mariano v. Principi, 17 Vet. App. 305, 314-316 (2003). Recent amendments to Diagnostic Code 5201, effective February 7, 2021, clarify that limitation of motion of the arm to shoulder level is equivalent to flexion and/or abduction limited to 90 degrees and limitation of motion to midway between side and shoulder level is equivalent to flexion and/or abduction limited to 45 degrees. 85 Fed. Reg. 76,453 (Nov. 30, 2020); see also, 38 C.F.R. § 4.71a, Diagnostic Code 5201 (effective February 7, 2021). Under Diagnostic Code 5202, impairment of the humerus for the minor arm, recurrent dislocation of the humerus at the scapulohumeral joint with infrequent episodes and guarding of movement only at the shoulder level is rated at 20 percent; recurrent dislocation with frequent episodes and guarding of all arm movements is also rated at 20 percent; and fibrous union of the humerus is rated at 40 percent; nonunion of the humerus is rated at 50 percent; and a loss of the humerus head is rated at 70 percent. Malunion of the humerus with moderate and marked deformity is rated at 20 percent for the minor arm. Under Diagnostic Code 5203, impairment of the clavicle or scapula in the minor arm, a malunion or nonunion without loose movement is rated at 10 percent, and a nonunion with loose movement or for dislocation of the clavicle is rated at 20 percent. Note (1) under the joint replacement DCs (5050-5056) provides that "When an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under diagnostic codes 5051-5056, an additional rating under § 4.71a may not also be assigned for that joint, unless otherwise directed." Rating in Excess of 20 percent for Left Shoulder Disability The Veteran has been service connected for a left shoulder disability since June 14, 1975. Over the course of nearly 50 years, the pertinent diagnostic code(s) and corresponding ratings associated with his left shoulder have changed, as noted above. The record reflects he is in receipt of a 20 percent rating from June 14, 1975 to May 9, 2022, a 100 percent rating from May 10, 2022 (post-surgery), and a 20 percent rating from July 1, 2023 to the present. Evidence The Veteran underwent left shoulder surgery in March 1974, while in service. He has been afforded numerous examinations throughout the appeal period; however, the VA examinations conducted from October 2020 forward contain findings most consistent with the DeLuca, Correia, and Sharp holdings. DeLuca v. Brown, 8 Vet. App. 202 (1995) (examiners must contemplate additional functional loss due to weakness, fatigability, incoordination, or painful motion); Correia v. McDonald, 28 Vet. App. 158 (2016) (when possible, examiners must include range of motion testing on active and passive motion and in weight-bearing and nonweight-bearing conditions); Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017) (examiner must attempt to elicit information regarding the severity, frequency, duration, and functional loss during flare-ups before determining that additional range of motion loss due to flare-ups cannot be estimated). As such, the Board focuses its attention on the aforementioned examinations and the November 2023 addendum opinion and to the extent possible, apply those findings retroactively to the entire appeal period. The evidence of record reveals that prior to July 2015, the Veteran's left shoulder symptomology reflected aching and stiffness, consistent pain, normal x-ray findings, no atrophy or ankylosis, and minimal loss of ROM. See VA Treatment Records. In a July 2015 VA examination, the Veteran reported ongoing pain intermittently in with no recurrent dislocation. He presented with chronic loss of range of motion and experienced pain lasting for a week at a time and occurring as often as once per month. Left shoulder flexion was limited to 85 degrees, abduction to 85 degrees, external rotation to 50 degrees, and internal rotation 80 degrees. Pain, crepitus, and weakness were present; left shoulder strength was 3/5, instability was noted as well as history of mechanical symptoms. The examiner also noted degenerative arthritis was detected in July 2015 x-rays. In an October 2020 VA examination, the Veteran reported chronic pain, the inability to lift items over 15 pounds with his left upper arm/shoulder or to grip with or push with his left arm without experiencing weakness and pain, and the inability to climb a ladder or perform manual labor. The examiner further noted pain with overhead reaching, lifting, carrying, pushing, or pulling more than 30 lbs. Left shoulder flexion was limited to 120 degrees, abduction to 95 degrees, external rotation to 70 degrees, and internal rotation 90 degrees. There was no evidence of crepitus, ankylosis, or atrophy, left shoulder strength was 5/5, no instability was noted or any mechanical symptoms. In a March 2021 VA examination, the Veteran noted constant pain with limited motion and debilitating pain radiating into his chest requiring rest for a few hours. He further stated that he had limited use of his left shoulder and used his right (dominant) arm for tasks. He reported flare-ups of the left shoulder lasting 2-3 hours, pain in his chest. Left shoulder flexion was limited to 70 degrees, abduction to 60 degrees, external rotation to 40 degrees, and internal rotation 40 degrees. There was no evidence of crepitus, ankylosis, atrophy, instability, or any mechanical symptoms. Significantly, the examiner diagnosed the Veteran with left upper extremity peripheral neuropathy. May 2021 VA treatment records reflect that the Veteran was receiving shoulder injections for pain and ROM tests revealed left shoulder flexion was limited to 90 degrees, abduction to 50 degrees, external rotation to 0 degrees, and internal rotation 0 degrees. In a November 2021 VA examination, the Veteran reported that his left shoulder progressively worsened over the years, with chronic pain increasing in severity after 2014. ROM and other testing could not be done due to pain. The record reflects that the Veteran underwent double reverse shoulder surgery on the right shoulder in February 2022, and on the left shoulder in May 2022. From May 10, 2022 to July 1, 2023 the Veteran was in receipt of a 100 percent rating for convalescence. In a March 2023 VA examination, ROM tests revealed left shoulder flexion was limited to 80 degrees, abduction to 65 degrees, external rotation to 35 degrees, and internal rotation 15 degrees. The examiner noted he observed the Veteran's inability to button and take off his shirt and acknowledged the Veteran's reports of difficulty with carrying and lifting items, difficulty with ADL's including getting dressed, bathing, scratching back, buttoning shirts, putting on coat, and brushing teeth. Instability was noted as the Veteran was unable to abduct arm to 90 degrees and flex elbow 90 degrees. Lastly, a November 2023 VA retrospective medical opinion provided that the Veteran's left shoulder manifested with pain and limitation of ROMs, including recent ROMs that show his left shoulder flexion estimated to around 30 degrees, external rotation to be 0 degrees, and internal rotation being very limited. Analysis Period Prior to May 10, 2022 Based on the foregoing and resolving any reasonable doubt in favor of the Veteran, a disability rating of 30 percent for the Veteran's left shoulder is warranted for the period prior to May 10, 2022. Medical evidence from 1975 to 2022 reveal limited ROM in daily tasks, inability to lay on his left side, chronic and persistent pain, aching and stiffness, and mild instability (popping). VA examinations note the Veteran experienced chronic pain and limited movement. The examiners confirmed the Veteran experienced pain, fatigue, and weakness in all ranges of motion, and a general lack of endurance, and pain in flexion, abduction, external rotation, and internal rotation. The examiner further noted any repetitive use caused greater reduced ROM and overuse caused flare-ups of pain that impacted the function of his left shoulder. The Board further notes that the Veteran is competent to report his observable left shoulder symptoms. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Thus, the Veteran's statements are found to be credible because they are consistent with the VA examinations of record. See Caluza v. Brown, 7 Vet. App. 498 (1995). Accordingly, for the period prior to May 10, 2022, pursuant to DC 5201, the Veteran is entitled a rating of 30 percent for his left shoulder disability, which is the maximum rating for a minor shoulder under DC 5201. The Board finds that application of the regular schedular standards is adequate to rate this single service-connected disability and that the disability is not so exceptional or unusual as to render the schedular standards impractical. Thus, extraschedular consideration is not warranted in this case. 38 C.F.R. § 3.321(b)(1). Period from July 1, 2023 As of July 1, 2023, the evidence reveals that the Veteran's left shoulder disability results in chronic residuals consisting of severe painful motion consistent with the criteria for a 50 percent evaluation under DC 5051 for shoulder replacement of the minor joint. A 50 percent disability rating is the maximum rating for a minor shoulder replacement pursuant to DC 5051. The Board acknowledges the evidence of the Veteran's pain and functional limitations. However, his severe, painful motion and weakness and accompanying functional loss are explicitly considered in the maximum 50 percent rating he has been awarded under DC 5051. As such, the Board again finds that application of the regular schedular standards is adequate to rate the Veteran's left shoulder disability and the disability is not so exceptional or unusual as to render the schedular standards impractical. Thus, extraschedular consideration is not warranted in this case. 38 C.F.R. § 3.321(b)(1). Accordingly, after considering all of the evidence of record, the Board finds that from July 1. 2023, a 50 percent rating under DC 5051 is warranted for the Veteran's left shoulder disability. The Board notes that, although 38 C.F.R. § 4.20 allows for ratings by analogy, the United States Court of Appeals for Veterans Claims (Court) held that when a condition is specifically listed in VA's schedule for rating disabilities, it may not be rated by analogy. See Copeland v. McDonald, 27 Vet. App. 333, 336-37 (2015). DC 5051 includes an exception to rating by analogy as it expressly includes that possibility under DCs 5200 and 5203, and the Board has considered the applicability of these diagnostic codes. The record does not establish, and the Veteran has not alleged, ankylosis, loss of head of the humerus, nonunion of the humerus, fibrous union of the humerus, malunion of the humerus, or impairment of the clavicle or scapula. Therefore, consideration under Diagnostic Codes 5200, 5202, and 5203, is not warranted. The Veteran was separately granted service connection and assigned a 10 percent rating for left shoulder scars under DC 7804. In May 2022 and March 2023 VA examinations, the examiner noted the Veteran's left shoulder scars presented with pain and numbness, resulting in the assignment of a 10 percent rating. As the Veteran did not advance any specific argument as to the propriety of the currently assigned rating for his scars, nor was the issue addressed in either rating decision on appeal, the Board need not address it now. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Entitlement to a Separate Rating for Peripheral Neuropathy The Board further finds that entitlement to a separate rating for a left upper extremity neurological disability is reasonably raised by the record and logically relates to the increased rating claim on appeal. The evidence of record supports the assignment of a separate rating the Veteran's diagnosed left upper extremity peripheral neuropathy as a complication of his left shoulder disability. The March 2021 VA examiner noted that the Veteran's neuropathy was a progression of the previous left shoulder diagnosis, and that the Veteran had paresthesias with sharp shooting pain in the left shoulder radiating across the chest with movement. See March 2021 VA C&P Examination; March 2023 VA C&P Examination (reporting numbness). As the March 2021 and March 2023 examinations showed potentially compensable evaluations, the Board finds that a separate disability rating is warranted for left upper extremity peripheral neuropathy as a complication of the Veteran's left shoulder disability. Accordingly, a separate evaluation is for assignment; the RO shall assign it in the first instance. TDIU The Veteran is in receipt of an award of TDIU, effective January 30, 2022, the date he met schedular eligibility. In June 2023, the Board remanded the matter for referral of the claim to the Director of Compensation Service for consideration of whether a TDIU prior to January 30, 2022, on an extraschedular basis, was warranted. On February 12, 2024, the Director of the Compensation Service denied an earlier effective date for the Veteran's award of a TDIU. Veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. TDIU may be assigned where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In assessing a claim for TDIU, consideration may be given to a veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by any nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to a veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and non-exertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of a TDIU is an individualized determination, specific to a veteran's particular circumstances. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). Rather, the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). As such, the focus of the findings obtained on examination is not whether a veteran is unemployable due to his service-connected disabilities, but rather the functional impairment caused solely by his service-connected disabilities in concert. The Board has considered the entire record, including the Veteran's VA examinations and treatment records, testimony, and private medical records. While these records demonstrate symptoms and treatment, they are not discussed in detail in this decision. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence in granularity. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board has addressed in this decision the evidence pertinent to the Veteran's claim for a TDIU prior to January 30, 2022. As noted above, the Veteran meets the schedular requirements for a TDIU effective January 30, 2022, with a 30 percent rating for insomnia disorder, effective January 30, 2022; for a right shoulder disability rated at 20 percent from May 7, 2021, 100 percent from February 14, 2022, and 30 percent effective April 1, 2023; left shoulder, rated at 20 percent from June 14, 1975 to February 26, 2021, 100 percent from May 10, 2022, and 20 percent from July 1, 2023; and 10 percent for left and right shoulders scar from February 26, 2021. Yielding a combined rating of 60 percent as due to disabilities resulting from a common etiology or a single accident considered a single disability. See 38 C.F.R. § 4.16(a). He does not meet the schedular requirements prior to January 30, 2022. When a veteran fails to meet the schedular requirements for eligibility for a total rating as set forth in 38 C.F.R. § 4.16(a), discussed above, the case may be submitted to the Director of the Compensation Service for extraschedular consideration. 38 C.F.R. § 4.16(b). The Board is precluded from granting a total rating under section 4.16(b) unless the issue is initially reviewed by the Director of the Compensation Service. Floyd v. Brown, 9 Vet. App. 88 (1996); Bagwell v. Brown, 9 Vet. App. 337 (1996). As previously mentioned herein, the issue of entitlement to an extraschedular TDIU was referred to, and considered by, the Director of Compensation Services, in February 2024, who denied an extraschedular TDIU, prior to January 30, 2022. The Veteran states that he has not worked since September 1, 2009, after suffering a back injury which required surgery. See August 2022 VA Form 21-8940. He reported his highest gross earnings as $89,000 in 2002, and that he graduated from high school and completed approximately 2 years of college. Prior to 2009, he was self-employed as the owner of an agricultural feed and supply store. In a July 2015 VA examination, the examiner noted that the Veteran was unable to lift over 15 pounds with his left upper arm/shoulder, unable to grip with or push with the left arm without experiencing weakness and pain, and unable to climb a ladder, or perform manual labor. Private treatment notes from the same time reflect that the Veteran's numbness and pain in his arms improved by about 50 percent. In May 2017 VA treatment records, the Veteran reported continued chronic back and knee pain impacting his ability to walk more than one block. He reported being independent in the activities of daily living, and June 2017 VA records reveal treatment for severe left knee pain resulting in impairment of ambulation. In an October 2020 VA examination, the Veteran reported chronic shoulder pain and the inability to lift heavy items over 15 pounds with his left upper arm/shoulder, to grip with or push with his left arm without experiencing weakness and pain, and the inability to climb a ladder or perform manual labor. The examiner noted pain with overhead reaching, lifting, carrying, pushing, or pulling more than 30 lbs. In a March 2021 VA examination, the Veteran noted limited use of his left shoulder requiring use of his right (dominant) arm. He reported flare-ups of the left shoulder occur when he uses his arms to lift. In a May 2021 VA examination, the Veteran reported he was barely able to do work in his yard because of his shoulder pain. Yet, in May 2021 private treatment records, the Veteran reported that he was able to hunt and fish with limitations, that he recently ceased side work building sheds, gardened with difficulty, mowed the lawn, and was recently able to repair plumbing, albeit with pain. In a November 2021 VA examination, the Veteran reported being unable to lift a gallon of milk or to get shirts on or off without assistance because of his right shoulder with 0-1 week of work time lost in the preceding 12-month period. He reported difficulty using his right arm to lift or grip objects. The Social Security Administration (SSA) found the Veteran disabled from July 2009 based on a primary diagnosis of degenerative disc disease of the lumbar spine. See SSA Profile. The Board acknowledges the Veteran's assertion that his service-connected disabilities preclude substantially gainful employment, however, the record suggests that his non-service-connected lower back and knee disabilities played the primary roles in his overall disability picture prior to January 30, 2022. The Board finds that the credible evidence of record fails to reflect that any of his service-connected disabilities or a combination of the effects of those disabilities yield an exceptional situation that precludes all types of gainful employment prior to January 30, 2022, and for which the application of schedular criteria would be rendered impractical. Rather, the Board finds that his disability ratings, of 30 percent and then 50 percent (from July 1, 2023), adequately compensate for the functional impact on his ability to work. 38 C.F.R. § 4.1. Accordingly, the Board finds that the most probative evidence in the record is against a finding that the Veteran's service connected right and left shoulder disabilities and associated scars served as a preclusion to sedentary employment. Therefore, an effective date prior to January 30, 2022, for the award of a TDIU is denied. (Continued on the next page) ? In reaching the above findings and conclusions, the Board has carefully considered the benefit-of-the-doubt rule that requires the Board to find in the Veteran's favor where the evidence nearly approximately balances between findings for and against any issue material to the determination of the matter. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F. 4th 776, 781 (Fed. Cir. 2021). However, the Board holds that the weight of the evidence of record persuasively favors the findings and conclusions herein and application of the benefit-of-the-doubt rule does not change the outcome in this appeal. RAY BARTO SLABBEKORN, JR. Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Regnart, Glenda M. 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.