Citation Nr: A25020002 Decision Date: 03/05/25 Archive Date: 03/05/25 DOCKET NO. 240725-460797 DATE: March 5, 2025 ORDER A rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. A rating in excess of 20 percent for left lower extremity (LLE) radiculopathy is denied. REMANDED Entitlement to an initial rating in excess of 10 percent prior to May 21, 2021, and in excess of 20 percent thereafter for thoracolumbar degenerative disc disease with arthritis is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to October 27, 2020, is remanded. FINDINGS OF FACT 1. For the entire appeal period, the Veteran's PTSD is manifested by psychiatric symptomatology resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, without more severe manifestations that more nearly approximate occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. For the entire appeal period, the Veteran's LLE radiculopathy resulted in, at most, moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a in excess of 20 precent rating for LLE radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.120, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1969 to March 1973. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2023 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA), which, after performing a higher level review of a May 2022 rating decision, continued the denial of the Veteran's claims. In July 2024, he timely appealed such rating decision by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). Therefore, the Board may only consider the evidence of record at the time of the May 2022 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. With respect to the claims denied herein, if the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, as the Board is remanding the claims for higher initial ratings for the Veteran's back disability and entitlement to a TDIU prior to October 27, 2020, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claims. 38 C.F.R. § 3.103(c)(2)(ii). While the Veteran originally appealed the with respect to the propriety of the award of a TDIU as of May 21, 2021, he is in receipt of a schedular 100 percent rating with special monthly compensation (SMC) at the housebound rate as of October 27, 2020. Consequently, as of such date, a TDIU is moot. Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). Thus, the Board has recharacterized the issue as shown on the title page of this decision. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods 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). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The appeal period before the Board begins on May 21, 2021, the date VA received the Veteran's Application for Increased Compensation Based on Unemployability (VA Form 21-8940) wherein he alleged that his PTSD and LLE radiculopathy associated with his back disability, in part, rendered him unemployable, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). 1. Entitlement to a rating in excess of 30 percent for PTSD. For the entire appeal period, the Veteran's PTSD has been evaluated as 30 percent disabling pursuant to DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. In this regard, such provides a 30 percent rating where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships. A 100 percent rating is warranted when there is total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118; 38 C.F.R. § 4.130, DC 9411. The Veteran and his representative contend that his PTSD is more severe than as reflected by the currently assigned 30 percent rating. In this regard, his representative asserts that the symptomatology the Veteran has endorsed reflects a disability of greater severity, to include significant social impairment, that meets the criteria for a 70 percent disability rating. However, upon review of the pertinent evidence of record, the Board finds that a rating in excess of 30 percent for his PTSD is not warranted. In this regard, a May 2021 VA treatment record reflects that the Veteran was doing okay, with occasional nightmares, and reported that he took his family to a Rangers game. The clinician noted no increased depression, no hopelessness, no suicidal ideation, and he had been able to keep his anger in check. A September 2021 VA treatment record indicates that the Veteran has been recently more isolative, dysphoric, and irritable as the Afghanistan withdrawal triggered memories of his own experience in Vietnam. The clinician noted possible auditory hallucinations that may be memories of conversations rather than true psychotic symptoms, without displaying any other symptoms of psychosis. Upon VA examination in October 2021, the examiner determined that the Veteran's PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. At such time, the Veteran reported that he remained in his marriage of 52 years and, while he had four children, he only maintained regular contact with two of his children, as well as his brother. He further indicated that he previously worked in a warehouse for a freight company where he drove a truck, but retired in March 2012 due to back and breathing problems. In connection with addressing the diagnostic criteria for PTSD, it was noted that the Veteran distressing memories and dreams, avoidance of such distressing memories, negative beliefs, diminished interest or participation in significant activities, feelings of detachment or estrangement from others, irritable behavior and angry outbursts, hypervigilance, problems with concentration, and sleep disturbance. It was further noted that the Veteran's current psychiatric symptomatology included depressed mood, anxiety, and chronic sleep impairment, and mental status examination was normal. In this regard, his thought process and communication appeared within normal limits, and he denied any symptoms of delusions or hallucinations and none were apparent. The Veteran's behavior was appropriate, and he denied suicidal and homicidal ideation, plan, or intent. He appeared to maintain personal hygiene and activities of daily living, was well-orientated, and his short- and long-term memory appeared to be without deficits. A December 2021 VA treatment record indicates that the Veteran takes medication that helps with his anger, his depression is moderate, and he socializes with another veteran once a week. In May 2022, the October 2021 VA examiner opined that the Veteran is likely to be mildly impaired in a work environment that required frequent interactions with customers, co-workers or supervisor, contained moving machinery or equipment, required frequent driving, required the ability to sustained concentration and focus as normally found in most jobs, is fast paced, complex, and/or frequently changing, and required a rigid adherence to a set work schedule (i.e., scheduled work hours). Based on the foregoing, the Board finds that the nature, frequency, severity, and duration of the Veteran's psychiatric symptomatology during the appeal period, including, but not limited to, occasional nightmares, isolating behavior, diminished interest or participation in significant activities, problems with concentration, dysphoric and/or depressed mood, irritability, anxiety, and chronic sleep impairment, resulted in, at most, occupational and social impairment with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. In this regard, the Board notes that, in September 2021, the Veteran's treatment provider noted possible auditory hallucinations; however, he indicated that such that may be memories of conversations rather than true psychotic symptoms, and there were no other symptoms of psychosis and, a month later at the October 2021 VA examination, the Veteran denied hallucinations and none were noted on mental status evaluation. Additionally, the evidence does not show that the Veteran manifests a greater degree of psychiatric symptomatology that more nearly approximates a higher rating under the General Rating Formula. In this regard, he does not exhibit any symptoms that are indicative of a 50, 70, or 100 percent rating, with the possible exception of disturbances of motivation and mood, which is contemplated in the criteria for a 50 percent rating under the General Rating Formula, as evidenced by diminished interest or participation in significant activities and dysphoric and/or depressed mood. However, the Board finds that the nature, frequency, severity, and duration of such psychiatric symptomatology, in addition to the foregoing symptoms, does not more nearly approximate occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. In this regard, with respect to the Veteran's occupational functioning, he has been retired for the entire appeal period, but, prior thereto, he worked as a truck driver for over 30 years. In this regard, he reported that he discontinued working due to physical limitations related to his back and breathing rather than as a result of psychiatric symptomatology. Furthermore, in May 2022, the examiner found that the Veteran would be no more than mildly impaired by his psychiatric symptomatology in regard to his ability to engage in occupational tasks. Further, with respect to the Veteran's social functioning, he has been married for more than 50 years, has regular contact with two of his children and his brother, and reported that he interacts with a fellow veteran once per week. Furthermore, the October 2021 VA examiner, who is a psychologist with the appropriate expertise to evaluate psychiatric disabilities, considered the totality of the Veteran's symptomatology and found that his PTSD resulted in no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation, which is consistent with the currently assigned 30 percent rating assigned under the General Rating Formula. Thus, the Board finds that a higher rating for the Veteran's PTSD is not warranted. 2. Entitlement to a rating in excess of 20 percent for LLE radiculopathy. For the entire appeal period, the Veteran's LLE radiculopathy has been evaluated as 20 percent disabling pursuant to DC 8520. In this regard, such pertains to paralysis of the sciatic nerve, and provides for a 20 percent rating for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating for moderately severe incomplete paralysis of the sciatic nerve; and a 60 percent rating for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. Further, an 80 percent rating is warranted where there is complete paralysis of the sciatic nerve where the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a. VA regulations provide that, in rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Although the words "mild," "moderate," "moderately severe," and "severe" are not defined in the VA rating schedule the Board must evaluate all of the evidence in order to render a decision that is "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, it 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. Additionally, "VA's Adjudication Procedures Manual [M21-1] provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions," and "[a]lthough the Board is not bound by the M21-1, the standards provided in the M21-1 are 'relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims,' which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision." Chavis v. McDonough, 34 Vet. App. 4, 17-18 (2021) (citing Healey v. McDonough, 33 Vet. App. 321 (2021) and Overton v. Wilkie, 30 Vet. App. 257, 264 (2018)). In this regard, the M21-1 provides that, in cases where a peripheral nerve disability is only manifested by sensory impairment, 38 C.F.R. § 4.124a directs decision makers to assign the evaluation corresponding with the mild or at most the moderate degree of impairment. M21-1, V.iii.12.A.2.b. Such further provides that, to make a choice between mild and moderate, the adjudicator should consider the evidence of record and the following guidelines: The mild level of evaluation would be more reasonably assigned when sensory symptoms are: recurrent but not continuous; assigned a lower medical grade reflecting less impairment; and/or affecting a smaller area in the nerve distribution. Reserve the moderate level of evaluation for the most significant and disabling cases of sensory-only involvement. These are cases where the sensory symptoms are: continuous; assigned a higher medical grade reflecting greater impairment; and/or affecting a larger area in the nerve distribution. The M21-2 also provides general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves. M21-1, V.iii.12.A.2.c. A "mild" degree of incomplete paralysis is characterized by disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis. "Moderate" is the maximum evaluation available for the most significant cases of sensory-only impairment and is characterized by symptoms described by the claimant and medically graded as significantly disabling and involving a larger area in the nerve distribution. Other sign or symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate. "Moderately severe" contemplates motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Additionally, atrophy may be present; however, for marked muscular atrophy, a rating contemplating severe incomplete paralysis is warranted. "Severe" is characterized by motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes may be seen in severe long-standing neuropathy cases. For the sciatic nerve, marked muscular atrophy is expected. Although severe incomplete paralysis cases should show findings substantially less than those for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs or symptoms that resemble some of those expected in cases of complete paralysis of the nerve. Turning to the evidence of record, at a September 2021 VA examination, the Veteran reported moderate constant pain and numbness in the LLE, but denied intermittent pain. Upon examination, his strength was 4/5, which demonstrates active movement against some resistance, throughout the LLE without muscle atrophy, reflexes in the left knee and ankle were hypoactive at 1+, and his sensation was normal throughout the LLE. In light of the foregoing, the examiner found that the Veteran had LLE radiculopathy affecting the sciatic nerve. Based on the foregoing, the Board finds that the foregoing clinical assessment of the severity of the Veteran's LLE radiculopathy does not reflect a basis for finding that such disability results in more than moderate incomplete paralysis of the sciatic nerve as contemplated by the M21-1. Specifically, as noted previously, a moderate level of severity is reserved for the most significant and disabling cases of sensory-only involvement contemplated by symptoms that are continuous, assigned a higher medical grade reflecting greater impairment, and/or affecting a larger area in the nerve distribution. Conversely, a moderately severe level of severity reflects motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability, which may include atrophy. In this regard, at the September 2021 VA examination, the Veteran reported subjective symptoms that were only moderate in severity, and objective examination revealed, at most, slight deviations from normal reflexes and strength, reflexes. Specifically, he had 4/5 strength, which represents active movement against some resistance, without muscle atrophy and 1+/hypoactive reflexes. Moreover, sensation was normal upon objective examination. Thus, consistent with the guidance in the M21-1, the Board finds that the Veteran's aforementioned subjective symptoms and such minimal objective findings result in, at most, moderate incomplete paralysis of the sciatic nerve. Thus, a rating in excess of 20 percent for such disability is not warranted. Other Considerations In reaching such determination, the Board acknowledges the Veteran's sincerely held belief that his PTSD and LLE radiculopathy are more severe than the assigned ratings. In this regard, while the Board recognizes that he is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptoms in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected PTSD and LLE radiculopathy; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (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). Therefore, the Board finds that increased ratings for the Veteran's PTSD and LLE radiculopathy are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim, the benefit of the doubt doctrine is not applicable in the instant appeal and his increased rating claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 4. Entitlement to an initial rating in excess of 10 percent prior to May 21, 2021, and in excess of 20 percent thereafter for thoracolumbar degenerative disc disease with arthritis. Throughout the course of the appeal stemming from August 31, 2012, the date of service connection for the Veteran's back disability, he was afforded VA examinations so as to determine the nature and severity of such disability in March 2013 and September 2021. As pertinent, during the former VA examination, the Veteran reported daily flare-ups of his low back pain that occurred on occasions with movement that increased his pain from 6 to 9 on a 10-point scale. While the examiner performed range of motion testing, to include following repetitive use testing with three repetitions, he did not provide the range of motion on passive motion, state whether there was pain on weight-bearing and nonweight-bearing on range of motion testing, or address whether there was additional loss of range of motion following repeated use over time or during a flare-up. Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Therefore, the Board finds that a remand is necessary to cure such pre-decisional duty to assist error by obtaining a retrospective opinion addressing such matters. 5. Entitlement to a TDIU prior to October 27, 2020. The Veteran contends that he is unable to secure or follow a substantially gainful occupation due, in part, to his back disability, which is remanded herein. Therefore, as the development and adjudication of such claim may affect his TDIU claim, to include in regard to whether his combined disability rating meets the schedular threshold for a TDIU under 38 C.F.R. § 4.16 (a) throughout the appeal period stemming from August 31, 2012, the date of service connection for such disability, the latter claim is inextricably intertwined with the former claim, and must likewise be remanded. Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). In this regard, the Board notes that, at present, the Veteran does not meet the threshold schedular criteria for a TDIU under 38 C.F.R. § 4.16 (a) prior to October 27, 2020. In this regard, total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In the instant case, prior to October 27, 2020, the Veteran is service-connected for valvular heart disease with left ventricular hypertrophy, evaluated as 30 percent disabling; PTSD, evaluated as 30 percent disabling as of June 26, 2015; bilateral hearing loss, evaluated as 20 percent disabling; a back disability, evaluated as 10 percent disabling; primary cutaneous vasculitis with chloracne, evaluated as 10 percent disabling; and tinnitus, evaluated as 10 percent disabling as of July 26, 2016. Thus, his combined schedular rating was 60 percent prior to June 26, 2015, and 70 percent thereafter, and his service-connected disabilities may not be considered as one disability for TDIU purposes. Furthermore, for the period where a 70 percent combined schedular rating is in effect, the Veteran did not have at least one disability ratable at 40 percent or more. Nonetheless, the Board finds there is sufficient evidence to substantiate a reasonable possibility that the Veteran is unemployable by reason of his service-connected disabilities so as to require referral of the case to the Director of Compensation Service (Director) for consideration of a TDIU on an extra-schedular basis pursuant to 38 C.F.R. § 4.16(b) for any period prior to October 27, 2020, where he does not meet the threshold schedular criteria for a TDIU. Ray v. Wilkie, 31 Vet. App. 58 (2019); Snider v. McDonough, 35 Vet. App. 1 (2021). In this regard, in his May 2021 Application for Increased Compensation Based on Unemployability (VA Form 21-8940), the Veteran reported that he last worked full-time as a truck driver in February 2012, a position he held since January 1992, and he had a high school education. In August 2015, he clarified that he left high school before graduating to join the Navy, but later obtained his GED. The Veteran also indicated that, following his separation from service, he worked in a warehouse for 10 years and then worked as a truck driver until he retired in March 2012. In this regard, he reported that he had too many back problems and problems breathing that were making it hard to pass physicals. Similarly, in reports to his VA treatment providers in May 2014, September 2014, June 2015, and September 2021, the Veteran indicated that he had to retire from his position as a trucker due to his back pain. Also, in May 2014 and September 2014, he stated that he did well as a truck driver because he did not have to deal with people and, at an August 2015 VA examination, it was noted that his PTSD did not interfere with his work as he was able to work alone without interacting with others. While March 2013 and October 2020 VA examiners found that the Veteran's heart, back, and skin disabilities did not impact his ability to work, March 2013 and September 2021 VA examiners indicated that his bilateral hearing loss and tinnitus resulted in his need to concentrate on the speaker and learn to read what they are saying, and hearing muffled sounds, asking people to repeat themselves, and interference with his sleep; August 2015 and October 2021 VA examiners found that his PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; an October 2020 VA examiner indicated that the Veteran's heart disability resulted in difficulty with walking and running for long periods, climbing/descending stairs, squatting, kneeling, and lifting heavy objects, and caused low endurance, easy fatigability, and weakness; and a September 2021 VA examiner noted that his back disability forced him to retire. Additionally, in March 2022, a VA examiner stated that the Veteran's back disability forced him to retire from his employment as a truck driver as he had difficulty crawling up and out of his truck every day, could not stand for more than 10 minutes or walk 100 yards or less without increased pain, and could not bend over, stoop, squat, or lift on a job as a truck driver. Additionally, as indicated previously, in May 2022, a VA examiner opined that the Veteran's PTSD would result in mild impairment in a work environment that required frequent interactions with customers, co-workers or supervisor, contained moving machinery or equipment, required frequent driving, required the ability to sustained concentration and focus as normally found in most jobs, is fast paced, complex, and/or frequently changing, and required a rigid adherence to a set work schedule (i.e., scheduled work hours). Thus, as the Veteran only has a GED, and his prior career as warehouse worker and truck driver require mental and physical activities that may be incompatible with his service-connected disabilities, the Board finds that there is sufficient evidence to substantiate a reasonable possibility that he is unemployable by reason of his service-connected disabilities so as to require referral of the case to the Director for consideration of a TDIU on an extra-schedular basis pursuant to 38 C.F.R. § 4.16(b) for any period prior to October 27, 2020, where he does not meet the threshold schedular criteria for a TDIU. The matters are REMANDED for the following action: 1. Forward the record, to include a copy of his remand, to an appropriate VA examiner so as to obtain a retrospective opinion addressing the nature and severity of the Veteran's back disability. Following a full review of the March 2013 VA examination report, the examiner should address the following inquiries: (A) State whether there was pain on weight-bearing and/or nonweight-bearing on range of motion testing. (B) Offer an opinion as to the range of motion of the Veteran's back in all planes on passive motion. (C) Offer an opinion as to whether, and to what extent, the Veteran's range of motion of the back is additionally limited following repeated use over time and/or during a flare-up, expressed, if possible, in terms of degrees. In offering such opinion, the examiner should consider the Veteran's contemporaneous report wherein he described daily flare-ups of his low back pain that occurred on occasions with movement that increased his pain from 6 to 9 on a 10-point scale. If the examiner cannot provide an opinion as to (A), (B), and/or (C) without resorting to mere speculation, the examiner must make clear that s/he has considered all procurable data, but any member of the medical community at large could not provide such an opinion without resorting to speculation. A rationale for any opinion offered should be provided. 2. For any period prior to October 27, 2020, where the Veteran does not meet the threshold schedular criteria for a TDIU, refer the case to the Director for consideration of a TDIU on an extra-schedular basis pursuant to 38 C.F.R. § 4.16(b). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pettit, Andrew 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.