Citation Nr: 25007643 Decision Date: 06/06/25 Archive Date: 06/06/25 DOCKET NO. 18-47 694 DATE: June 6, 2025 ORDER A 30 percent rating, but no higher, for the residuals of the Veteran's service-connected abdominal shell fragment wound (SFW) is granted. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Throughout the claim period, the evidence of record is in relative equipoise as to whether the residuals of the Veteran's service-connected abdominal SFW have more nearly approximated the criteria for a moderately severe injury of muscle group XIX. 2. Throughout the claim period, the evidence of record persuasively weighs against a finding that the Veteran's service-connected disabilities render him unable to secure or maintain substantially gainful employment. CONCLUSIONS OF LAW 1. Throughout the claim period, the criteria for a 30 percent initial disability rating, but no higher, for the residuals of the Veteran's service-connected abdominal SFW have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.400, 4.1, 4.3, 4.7, 4.10, 4.56, 4.73, Diagnostic Code 5319. 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from October 1968 to October 1970, including service in the Republic of Vietnam for which he was awarded the Purple Heart Medal and the Combat Infantryman Badge, among other decorations. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) (the "February 2017 Rating Decision"). The Veteran's Form 9 indicated that he requested a Board hearing; however, the Veteran's representative notified VA in June 2020 that he wished for his request for a Board hearing to be withdrawn. See 38 C.F.R. § 20.704(d). The Veteran's increased rating claim for his service-connected abdominal SFW was previously denied in a November 2021 Board decision, which the Veteran appealed to the Court of Appeals for Veterans Claims (the Court). In August 2022, the Court vacated the November 2021 Board decision pertaining to the Veteran's abdominal claim, pursuant to a Joint Motion for Partial Remand (JMPR), and remanded the claim for further action consistent with the terms of the JMPR. In June 2024, the Board most recently remanded this appeal for further development, including the procurement of the Veteran's outstanding service treatment records (STRs). There has been substantial compliance with the June 2024 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). See 38 U.S.C. § 7107(a)(2). INCREASED RATING A 30 percent rating, but no higher, for the residuals of the Veteran's service-connected abdominal SFW is granted. In a March 1971 rating decision, the Veteran was awarded service connection for residuals of an abdominal SFW involving muscle group XIX, which he incurred during his combat service in Vietnam, and assigned a 10 percent rating under Diagnostic Code 5319, effective October 14, 1970, the date the Veteran separated from military service. The Veteran has also been awarded the following disability ratings in connection with related injuries he incurred during his combat service in Vietnam: (1) a 10 percent rating for a right knee SFW effective October 14, 1970, and a 30 percent rating for that disability effective March 9, 2016; (2) a 10 percent rating for peritoneal adhesions due to an abdominal laparotomy, secondary to the service-connected abdominal SFW, effective October 14, 1970; (3) a noncompensable (with the exception of a temporary total rating assigned for a portion of 2016) rating for a ventral hernia condition associated with the peritoneal adhesions due to an abdominal laparotomy, secondary to the abdominal SFW, effective June 30, 2016; (4) a noncompensable rating for abdominal scarring associated with the abdominal SFW, effective August 12, 2021; (5) a noncompensable rating for a right knee scar associated with the right knee SFW, effective August 12, 2021; and (6) a noncompensable rating for altered sensation in the right leg associated with the right knee SFW, effective August 12, 2021. The Veteran asserts that his abdominal SFW residuals warrant a rating in excess of 10 percent, as his symptoms most closely approximate the criteria for a 30 percent rating under Diagnostic Code 5319. As further explained below, the Board agrees and finds that a 30 percent rating for the residuals of the service-connected abdominal SFW, but no higher, is warranted throughout the claim period. Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. Diagnostic Code 5319 governs injuries to muscle group XIX, muscles of the abdominal wall, including rectus abdominis; external oblique; internal oblique; transversalis; and quadratus lumborum, and provides as follows: (1) a 50 percent rating is warranted for severe injury; (2) a 30 percent rating is warranted for moderately severe injury; (3) a 10 percent rating is warranted is warranted for moderate injury; and (4) a noncompensable rating is warranted for slight injury. See 38 C.F.R. § 4.73. As relevant here, VA regulations further provide that a through-and-through injury with muscle damage shall be rated as no less than a moderate injury for each group of muscles damaged, and that for VA rating purposes, the cardinal signs and symptoms of muscle disability include the following: loss of power; weakness; lowered threshold of fatigue; fatigue-pain; impairment of coordination; and uncertainty of movement. See 38 C.F.R. § 4.56(b), (c). In addition, moderate, moderately severe, or severe muscle injuries evaluated under Diagnostic Code 5319 are further defined by VA regulations. A finding of a moderate disability is warranted where (i) the type of injury involves a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection; (ii) the history and complaint involves a service department record or other evidence of in-service treatment for the wound; and a record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles; and (iii) the objective findings include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue; some loss of deep fascia or muscle substance or impairment of muscle tonus; and loss of power or lowered threshold of fatigue when compared to the sound side. A finding of a moderately severe disability is warranted where (i) the type of injury involves a through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring; (ii) the history and complaint involves a service department record or other evidence showing hospitalization for a prolonged period for treatment of wound; and a record of consistent complaint of cardinal signs and symptoms of muscle disability and, if present, evidence of inability to keep up with work requirements; and (iii) the objective findings include entrance and (if present) exit scars indicating track of missile through one or more muscle groups, indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side; and tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. A finding of a severe disability is warranted where (i) the type of injury involves a through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring; (ii) the history and complaint involves a service department record or other evidence showing hospitalization for a prolonged period for treatment of wound; a record of consistent complaint of cardinal signs and symptoms of muscle disability as, worse than those shown for moderately severe muscle injuries; and, if present, evidence of inability to keep up with work requirements; and (iii) the objective findings include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; and tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (a) x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; (b) adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; (c) diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; (d) visible or measurable atrophy; (e) adaptive contraction of an opposing group of muscles; (f) atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; (g) induration or atrophy of an entire muscle following simple piercing by a projectile. After careful review, the Board finds that for the entire period on appeal, the residuals of the Veteran's service-connected abdominal SFW have more nearly approximated the criteria for a moderately severe injury of muscle group XIX set forth in Diagnostic Code 5319. Accordingly, for the reasons set forth below, the Board finds that the Veteran's service-connected abdominal SFW residuals warrant a 30 percent rating under Diagnostic Code 5319, and to that extent the claim is granted. Regarding the period under review, effective dates for disability ratings may be established up to one year prior to the date of claim if, based upon all the evidence of record, it can be factually ascertained that an increase in the Veteran's service-connected disabilities occurred during that year preceding the claim. See 38 U.S.C. § 5110(b)(3); C.F.R. § 3.400(o)(2). In this case, the Veteran filed a VA Form 21-0966, Intent to File a Claim, on March 9, 2016 (the "March 2016 Intent to File"), and a VA Form 21-526EZ on October 25, 2016, seeking an increased rating for the service-connected abdominal SFW residuals, which was denied in the February 2017 Rating Decision. Subsequently, the Veteran submitted an April 2017 Notice of Disagreement (NOD) seeking review of the February 2017 Rating Decision; however, an August 2018 Statement of the Case (SOC) again denied the increased rating claim. In October 2017, the Veteran submitted a timely VA Form 9 Substantiative Appeal again seeking review of the February 2017 Rating Decision, which was denied by the Board in February 2021, and remanded by the Court in August 2022. Accordingly, when reviewing this claim, the Board has considered whether the evidence of record supports a finding that it was factually ascertainable that the Veteran's service-connected condition exhibited symptoms warranting an increased rating at any point after March 9, 2015, one year prior to the submission of the March 2016 Intent to File. See 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2). Turning to that evidence, the Veteran's STRs reflect the following: (1) on August 17, 1969, the Veteran was wounded in action (WIA) during his deployment to Vietnam when he was hit by ammunition fragments fired by a rocket-propelled grenade (RPG); (2) the Veteran suffered penetrating fragment wounds of the abdomen, including the liver, as well as the right knee; (3) the Veteran was treated at a field hospital in Vietnam, including wound debridement and an exploratory laparotomy, which revealed a laceration of the left liver lobe; (4) the Veteran returned to the United States for convalescence in September 1969; and (5) in November 1969, the Veteran underwent additional surgery in order to treat a partial small bowel obstruction secondary to post-operative adhesions associated with the exploratory laparotomy. In May 2016, the Veteran was afforded a VA muscle injuries examination to evaluate the service-connected abdominal SFW residuals, which culminated in a report (the "May 2016 VA Abdominal SFW Report") diagnosing the Veteran with an SFW of the abdomen and right side, muscle group XIX and further finding as follows: the Veteran's abdominal SFW was caused by a penetrating muscle injury that occurred when the Veteran suffered shrapnel wound injuries to his right side, abdominal area, and right leg in the Republic of Vietnam in August 1969; the Veteran suffered a penetrating wound to the abdominal and peritoneal cavity; the Veteran was treated at a hospital in South Vietnam with an abdominal exploratory laparotomy procedure; the Veteran's abdominal entrance scars are small or linear, indicating short track of missile through muscle tissue as well as track of missile through one or more muscle groups; the abdominal SFW results in some loss of deep fascia of unknown severity but does not cause loss of muscle strength or muscle atrophy; and the abdominal scar is mildly adherent to the underlying fascia of the abdominal wall and is "mildly depressed." In December 2016, the Veteran was afforded a second VA muscle injuries examination to evaluate the service-connected abdominal SFW residuals, which culminated in a report (the "December 2016 VA Abdominal SFW Report") diagnosing the Veteran with an SFW of the abdomen and right side, muscle group XIX and further finding as follows: the Veteran's abdominal SFW was caused by a penetrating muscle injury that occurred when the Veteran suffered shrapnel wound injuries to his right side, abdominal area, and right leg in the Republic of Vietnam in August 1969; the Veteran suffered a penetrating wound to the abdominal and peritoneal cavity; the Veteran was treated at a hospital in South Vietnam with an abdominal exploratory laparotomy procedure; the Veteran's abdominal entrance scars are small or linear, indicating short track of missile through muscle tissue as well as track of missile through one or more muscle groups; the abdominal SFW results in some loss of deep fascia of unknown severity but does not cause loss of muscle strength or muscle atrophy; and the Veteran has residual muscle injuries of mild severity with no residual loss of function. In December 2016, the Veteran was afforded a VA peritoneal adhesion examination to evaluate the service-connected peritoneal adhesions, which culminated in a report (the "December 2016 VA Peritoneal Adhesion Report") diagnosing the Veteran with peritoneal adhesions secondary to the exploratory laparotomy of the abdomen and residuals of the abdominal SFW including the abdominal wall muscles and further finding that the Veteran developed peritoneal adhesions in 1969 secondary to the abdominal exploratory laparotomy surgery, and he underwent a second surgery in 1969 for treatment of the peritoneal adhesions. In August 2021, the Veteran was afforded a third VA muscle injuries examination to evaluate the service-connected abdominal SFW residuals, which culminated in a report (the "August 2021 VA Abdominal SFW Report") diagnosing the Veteran with an SFW of the abdomen and right side, muscle group XIX and further finding as follows: the Veteran was treated at a hospital in South Vietnam with an abdominal exploratory laparotomy procedure; in 2017 the Veteran was treated for a hernia at the laparotomy site necessitating laparoscopic repair; the Veteran has a history of extensive muscle hernia without other injury to the muscle; namely, the rectus abdominis; the Veteran's abdominal SFW residuals are not characterized by loss of muscle strength or muscle atrophy; and the Veteran's abdominal SFW residuals result in functional impact, including "possible limitation with lifting due to abdominal scarring" and his "history of hernia." In September 2024, the Veteran was afforded a fourth VA muscle injuries examination to evaluate the service-connected abdominal SFW residuals, which culminated in a report (the "September 2024 VA Abdominal SFW Report") diagnosing the Veteran with an SFW of the abdomen and right side, muscle group XIX and further finding as follows: the Veteran's abdominal SFW has progressed and worsened since onset; the Veteran's current symptoms include abdominal wall discomfort; and the Veteran reported suffering from occasional fatigue and pain. In light of the medical evidence of record, and resolving any reasonable doubt regarding the degree of disability in the Veteran's favor, the Board finds that the service-connected abdominal SFW residuals warrant a 30 percent rating under Diagnostic Code 5319 throughout the claim period on the following grounds: (1) the abdominal SFW residuals are the result of deep penetrating wounds caused by RPG shrapnel that required debridement, exploratory laparotomy, and hospitalization for a prolonged period for treatment; (2) the abdominal SFW residuals are characterized by entrance scars indicating the track of missile through one or more muscle groups; and (3) the abdominal SFW residuals have resulted in loss of deep fascia; abdominal scarring; and hernia, which results in minimal functional loss, including limitation with lifting, as well as occasional fatigue and pain. The Board further finds that for the entire claim period, the evidence of record persuasively weighs against a finding that the Veteran's service-connected abdominal SFW residuals manifested symptoms that approximate the criteria for a 50 percent rating, as the Veteran's abdominal SFW residuals did not manifest symptoms approximating the criteria for a severe muscle injury, including the following: deep penetrating wound due to high-velocity missile or large or multiple low velocity missiles; with shattering bone fracture or open comminuted fracture; a record of consistent complaint of cardinal signs and symptoms of muscle disability worse than those shown for moderately severe muscle injuries; evidence of inability to keep up with work requirements; ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track; palpation showing loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscle swelling and hardening abnormally in contraction; and severe impairment of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side. See 38 C.F.R. § 4.56. Nor do the Veteran's abdominal SFW residuals manifest any of the following signs of severe muscle disability, including: adhesion of scars to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; or induration or atrophy of an entire muscle following simple piercing by a projectile. See id. Accordingly, the Board finds that the symptoms listed in the criteria for a 50 percent rating to describe a "severe injury" are more severe than any listed or unlisted symptoms associated with the Veteran's disability picture, described above, and therefore, the criteria for a 30 percent rating are most closely approximated. The Board has considered whether an increase in disability was factually ascertainable in the one-year period prior to March 9, 2016, but finds that such an increase did not occur. Accordingly, March 9, 2016, is the appropriate effective date for the award of a 30 percent rating. In reaching the above conclusions, the Board has considered the benefit of the doubt doctrine and has applied it in assigning a 30 percent rating effective March 9, 2016. However, as the evidence of record persuasively weighs against the assignment of a rating higher than 30 percent, to that extent the doctrine is not applicable. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021). TDIU Entitlement to a TDIU is denied. The Veteran asserts that his service-connected disabilities have rendered him unemployable since September 2008 and that he is entitled to the award of a TDIU. However, after careful review and for the reasons set forth below, the Board finds that a TDIU is not warranted, and claim must be denied. A TDIU may be assigned where the schedular rating is less than total if the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. See 38 C.F.R. § 4.16(a). In order to qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 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. See id. 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. See id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. See id. Attention should be given to the 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). See id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. See Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). As a result of the Board's decision herein, the Veteran is in receipt of the disability ratings described above, but is now in receipt of a 30 percent, rather than 10 percent, disability rating for his abdominal SFW effective March 9, 2016. From March 9, 2016, the Veteran has a combined disability rating of 60 percent. As all of his service-connected disabilities result from a common etiology or accident, they are considered one disability for purposes of determining whether the schedular criteria for the award of a TDIU are met. 38 C.F.R. § 4.16(a)(2). Thus, the Veteran meets the percentage standards required for the award of a TDIU throughout the review period (as noted above, an increase in disability was not factually ascertainable in the one-year period prior to March 9, 2016). 38 C.F.R. § 4.16(a). Turning to the evidence of record, regarding the economic component of a TDIU, the Veteran reported in his March 2021 VA Form 21-8940 that he last worked full time in September 2008, and that he has not been able to secure or maintain substantially gainful employment since then due to his service-connected disabilities. The Veteran did not provide relevant income information, but he stated that he has completed a high school degree and has worked in maintenance since March 2000 as follows: (1) from March 2000 to October 2006, 30 hours per week; (2) from 2007 to May 2008, 30 hours per week; and (3) from June 2008 to September 2008, 40 hours per week. See 38 C.F.R. § 4.16(a). Regarding the Veteran's service-connected abdominal SFW, the Board finds that the competent evidence of record persuasively weighs against a finding that the Veteran's abdominal SFW residuals result in functional impairment severe enough to prevent the Veteran from securing or maintaining substantially gainful employment, on the following grounds: (1) the May 2016 VA Abdominal SFW Report indicates that the abdominal SFW residuals are characterized by some loss of deep fascia of unknown severity but have no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (2) regarding the Veteran's right abdominal scar, the May 2016 VA Abdominal SFW Report indicates that the abdominal scar is "mildly adherent to the underlying fascia of the abdominal wall;" is "mildly depressed;" and that the Veteran reports no tenderness; no irritation; and no loss of muscle or motor function; (3) the December 2016 VA Abdominal SFW Report also indicates that the abdominal SFW residuals are characterized by some loss of deep fascia of unknown severity and "residual muscle injuries of mild severity," with "no residual loss of function;" no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (4) the August 2021 VA Abdominal SFW Report indicates that the Veteran's abdominal SFW residuals manifest no signs or symptoms, including no known fascial defects or evidence of fascial defects associated with any muscle injuries, and have no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements, but that they might result in a "possible limitation" on his ability to lift "due to abdominal scarring" and his "history of hernia;" (5) the September 2024 VA Abdominal SFW Report indicates that the abdominal SFW residuals are characterized by "abdominal wall discomfort" and "occasional fatigue and pain," but do not result in fascial defects and have no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements. Regarding the Veteran's service-connected peritoneal adhesions, the Board finds that the competent evidence of record persuasively weighs against a finding that the Veteran's peritoneal adhesions result in functional impairment severe enough to prevent the Veteran from securing or maintaining substantially gainful employment, on the following grounds: (1) in May 2016, the Veteran was afforded a VA peritoneal adhesion examination to evaluate the service-connected peritoneal adhesions, which culminated in a report (the "May 2016 VA Peritoneal Adhesion Report") diagnosing the Veteran with peritoneal adhesions secondary to the exploratory laparotomy of the abdomen and residuals of the abdominal SFW including the abdominal wall muscles and further indicating that peritoneal adhesions are characterized by "persistent episodes of abdominal pain and abdominal cramping," with an intensity level described as 7 out of 10 "when it is severe;" 3 out of 10 "when it is mild;" and 0 out of 10 when he is not active; that the condition does not result in any "residual problems," such as bowel obstructions or abdominal conditions necessitating hospitalization or surgical treatment; that the condition results in mild symptoms, including "intermittent episodes of abdominal pain with cramping," especially in connection with "physical exertion and after eating greasy or spicy foods," which have had no impact on the Veteran's ability to work or to keep up with work requirements; (2) the December 2016 VA Peritoneal Adhesion Report indicates that the peritoneal adhesions residuals are characterized by mild symptoms; that his "intermittent episodes of abdominal pain with cramping" "essentially resolved" after his August 2016 hernia surgery; that since the August 2016 hernia surgery, he has only "minimal episodes of abdominal pain" which the examiner found have no impact on the Veteran's ability to work or to keep up with work requirements; and (3) in September 2021, the Veteran was afforded a VA peritoneal adhesion examination to evaluate the service-connected peritoneal adhesions, which culminated in a report (the "September 2021 VA Peritoneal Adhesion Report") diagnosing the Veteran with peritoneal adhesions secondary to the exploratory laparotomy of the abdomen and further indicating that the Veteran's peritoneal adhesions are characterized by moderate symptoms, including occasional episodes of constipation; abdominal pain with an intensity level described as 4 or 5 out of 10 which sometimes impacts his walking; that the abdominal symptoms would affect his ability to complete heavy lifting or hard labor; but that the Veteran reported that, prior to his retirement, his work was not limited by his abdominal symptoms because his work requirements involved "mostly light work with occasional lifting." Regarding the Veteran's service-connected right knee SFW, the Board finds that the competent evidence of record persuasively weighs against a finding that the Veteran's right knee SFW residuals result in functional impairment severe enough to prevent the Veteran from securing or maintaining substantially gainful employment, on the following grounds: (1) in May 2016, the Veteran was afforded a VA right knee SFW examination to evaluate the service-connected right knee SFW residuals, which culminated in a report (the "May 2016 VA Right Knee SFW Report") diagnosing the Veteran with shell fragment wound scars of the right knee, and posterior and lateral right leg muscle (Muscle Group XI) and indicating that right knee SFW residuals are characterized by some loss of deep fascia of unknown severity but have no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (2) in December 2016, the Veteran was afforded a VA right knee SFW examination to evaluate the service-connected right knee SFW residuals, which culminated in a report (the "December 2016 VA Right Knee Report") diagnosing the Veteran with right knee SFW residuals and right knee degenerative arthritis unrelated to the right knee SFW residuals and indicating that the right knee SFW residuals are characterized by "sharp and burning sensation" from the right lateral knee to the right lateral ankle, which is worse at night and keeps him awake twice per week for an hour or two, but manifest no additional contributing factors of disability; have no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (3) in August 2021, the Veteran was afforded a VA right knee examination to evaluate the service-connected right knee SFW residuals, which culminated in a report (the "August 2021 VA Right Knee Report") indicating that the Veteran's right knee SFW residuals manifest no signs or symptoms, including no known fascial defects or evidence of fascial defects associated with any muscle injuries, and have no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; and (4) in December 2021, VA obtained the report of a medical opinion (the "December 2021 VA Right Knee Report") which opines that the Veteran's right knee osteoarthritis is less likely than not due to his military service on the grounds that right knee arthritis appears in the medial compartment of the right knee while the SFW appears on the lateral side of the distal femur. Regarding the Veteran's service-connected hernia, the Board finds that the competent evidence of record persuasively weighs against a finding that the Veteran's hernia residuals result in functional impairment severe enough to prevent the Veteran from securing or maintaining substantially gainful employment, on the following grounds: (1) in December 2016, the Veteran was afforded a VA hernia examination to evaluate the service-connected hernia, which culminated in a report (the "December 2016 VA Hernia Report") diagnosing the Veteran with a healed postoperative ventral hernia repair; and (2) the December 2016 VA Hernia Report indicates that (a) the Veteran is status post laparoscopic surgical repair of the ventral (abdominal wall) hernia; (b) that the hernia has resolved; (c) that the Veteran has been issued no activity restrictions due to the hernia; and (d) that the hernia has no impact on the Veteran's ability to work or to keep up with work requirements. Regarding the Veteran's service-connected scars, the Board finds that the competent evidence of record persuasively weighs against a finding that the Veteran's service-connected scars result in functional impairment severe enough to prevent the Veteran from securing or maintaining substantially gainful employment, on the grounds that VA scar examinations in May 2016, December 2016, August 2021, and September 2024 all conclude that the Veteran's service-connected scars are not painful; unstable; or otherwise symptomatic; and they have no impact on the Veteran's ability to work or to keep up with work requirements. In sum, although the Veteran has obliquely asserted in the March 2021 Form 21-8940 that his service-connected disabilities have rendered him unemployable since September 2008, the competent evidence of record persuasively weighs against such a finding due to the following: (1) the VA examination reports of record have found the Veteran's service-connected abdominal SFW residuals to be no more than mild, with no residual loss of function; no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (2) despite the finding in the September 2024 VA Abdominal SFW Report of "abdominal wall discomfort" and "occasional fatigue and pain," the examiner found no fascial defects; no effect on muscle substance; no effect on muscle function; no effect on muscle strength; no effect on muscle atrophy; and no impact on the Veteran's ability to work or to keep up with work requirements; (3) the May 2016 VA Peritoneal Adhesion Report and the December 2016 VA Peritoneal Adhesion Report both found that the Veteran's service-connected peritoneal adhesions also have no functional impact, and further found that the Veteran's "intermittent episodes of abdominal pain with cramping" "essentially resolved" after his August 2016 hernia surgery, and since the August 2016 hernia surgery, he has experienced only "minimal episodes of abdominal pain" which the examiner found have no impact on the Veteran's ability to work or to keep up with work requirements; (4) despite the September 2021 VA Peritoneal Adhesion Report finding that the Veteran's abdominal symptoms would affect his ability to complete heavy lifting or hard labor, the Veteran reported that, prior to his retirement, his work was not limited by his abdominal symptoms because his work requirements involved "mostly light work with occasional lifting;" (5) the functional impairment caused by the Veteran's right knee limited range of motion is attributed to the non-service-connected right knee osteoarthritis rather than the service-connected right knee SFW; (6) the Veteran's service-connected hernia disability does not result in functional impairment; and (7) the Veteran's service-connected scar disabilities are asymptomatic and do not result in functional impairment. In short, as described above, the Veteran's individual service-connected disabilities cause minimal functional impact. Considered collectively, there is no indication that their combined functional impact would prevent the Veteran from performing, with reasonable breaks, a job that requires occasional lifting and light physical work, which is how he characterized the work he performed before retiring, and in which he has experience. (Continued on the next page) ? Therefore, the Board finds that the evidence of record weighs persuasively against a finding that the Veteran's service-connected disabilities preclude him from securing or maintaining substantially gainful employment. As the record does not present an "approximate balance" of positive and negative evidence, the benefit-of-the-doubt rule does not apply. See Lynch, 21 F.4th at 781-782. Accordingly, the Veteran's TDIU claim must be denied. L. STEPANICK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Marsdale, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.