Citation Nr: 18160642
Decision Date: 12/28/18	Archive Date: 12/27/18

DOCKET NO. 17-42 230
DATE:	December 28, 2018
REMANDED
Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
ORDER
A compensable rating for bilateral hearing loss is denied.
A rating in excess of 10 percent for right knee meniscal tear, fracture, and degenerative arthritis (hereinafter “right knee disability”) under Diagnostic Code 5260 is denied.
A separate rating of 20 percent under Diagnostic Code 5258 for a right knee meniscal tear since May 9, 2017 is granted.
A rating in excess of 10 percent for lumbar strain is denied.
An initial 10 percent rating for left thumb limitation of motion and residuals of left hand strain and old fracture (hereinafter “left thumb disability”) is granted.
A rating in excess of 10 percent for left hand strain residual of old fracture (hereinafter “left hand strain”) is denied.
An initial compensable rating for left ring or little finger limitation of motion and residuals of left hand strain with old fracture (hereinafter “left ring finger disability”) is denied.
FINDINGS OF FACT
1. For the entire appeal period, the Veteran’s service-connected bilateral hearing loss has not been manifested by hearing acuity worse than Level II hearing in the right ear and worse than Level IV hearing in the left ear.
2. For the entire appeal period, at worst, the Veteran’s right knee flexion has been 110 degrees.
3. Since May 9, 2017, the Veteran’s service-connected right knee disability has been manifested by a meniscal tear with frequent episodes of locking, pain, and effusion.
4. For the entire appeal period, the Veteran’s service-connected lumbar strain has not been manifested by Intervertebral Disc Syndrome (IVDS) with incapacitating episodes having a total duration of at least 2 weeks during the past 12 months; forward flexion of the lumbar spine less than 60 degrees; combined range of motion of the lumbar spine less than 120 degrees; muscle spasm, guarding or localized tenderness resulting in abnormal gait or abnormal spinal contour; ankylosis; or neurologic abnormalities (other than right leg sciatic nerve).
5. The Veteran’s service-connected left thumb disability has caused painful limited motion.
6. For the entire appeal period, the Veteran’s service-connected left hand strain has been assigned at 10 percent, the maximum rating authorized, under Diagnostic Code 5229.
7. For the entire appeal period, the Veteran’s service-connected left ring finger disability has been assigned at 0 percent, the maximum rating authorized, under Diagnostic Code 5230.
CONCLUSIONS OF LAW
1. The criteria for entitlement to a compensable rating for bilateral hearing loss have not been met.  38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100 (2018).
2. The criteria for entitlement to a rating in excess of 10 percent for a right knee disability have not been met.  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003-5260, 5261 (2018).
3. The criteria for entitlement to a separate rating of 20 percent for a right knee meniscal tear since May 9, 2017 have been met.  38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5258 (2018).
4. The criteria for entitlement to a rating in excess of 10 percent for lumbar strain have not been met.  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5243 (2018).
5. The criteria for entitlement to an initial 10 percent rating for a left thumb disability have not been met.  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5019-5228 (2018).
6. There is no legal basis for the assignment of a schedular rating in excess of 10 percent for left hand strain.  38 C.F.R. § 4.71a, Diagnostic Code 5019-5229 (2018).
7. There is no legal basis for the assignment of an initial compensable schedular evaluation for left ring finger disability.  38 C.F.R. § 4.71a, Diagnostic Code 5019-5230 (2018).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty in the United States Army from July 1979 to August 2000.  His awards and decorations include the Army Commendation Medal with Combat Distinguishing Device “V” and Combat Infantryman Badge.
In a statement submitted with the March 2016 VA Form 21-0958 (Notice of Disagreement (NOD)), the Veteran reported that the QTC examiner who conducted the April 2015 VA Disability Benefits Questionnaire (DBQ) examination for back (thoracolumbar spine) conditions did not touch his back to complete the clinical evaluation and only asked him questions.  The Board notes that the Veteran was afforded an additional VA DBQ examination for back conditions in May 2017 during the pendency of the appeal.  The May 2017 report is adequate as it was based on a review of the history, examination, and sufficient information was provided to allow the Board to render an informed determination.  Range of motion studies were conducted.  
Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).
Higher Ratings
Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the veteran’s favor.  38 C.F.R. § 4.3.
Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as for the service-connected bilateral hearing loss, right knee disability, lumbar strain, and left hand strain in this case, the present level of disability is of primary concern.  Although a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings.  38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55, 58 (1994).
Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.  Hart v. Mansfield, 21 Vet. App. 505 (2007).  The Veteran’s disability should be viewed in relation to its history.  38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).  Given the nature of the present claims for higher initial evaluations for service-connected left thumb disability and left ring finger disability, the Board has considered all evidence of severity since the effective date for the award of service connection in December 2014.  Fenderson v. West, 12 Vet. App. 119 (1999).  
When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing.  38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011).  Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate.  See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”).
1. Entitlement to a compensable rating for bilateral hearing loss
In an April 2001 VA rating decision, service connection for bilateral hearing loss was granted.  The Veteran was assigned a noncompensable (0 percent) evaluation effective for the entire rating period from September 1, 2000.  See 38 C.F.R. § 4.85, Diagnostic Code 6100.  The Veteran filed a timely Notice of Disagreement and a Statement of the Case was issued in July 2002; however, no timely substantive appeal was associated with the record.
On December 22, 2014, the Veteran’s request for a compensable evaluation for the issue on appeal was obtained and associated with the record.  The Board considers whether a compensable rating for bilateral hearing loss is warranted at any time since or within one year prior to the date of claim on December 22, 2014.
In evaluating service-connected hearing loss, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed.  Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992).  Evaluations of bilateral hearing loss range from noncompensable to 100 percent based on an organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second.  The rating schedule establishes 11 auditory acuity Levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness.
VA audiological evaluations are conducted using a controlled speech discrimination test together with the results of pure tone audiometry tests.  The vertical line in Table VI (printed in 38 C.F.R. § 4.85) represents nine categories of the percentage of discrimination based on a controlled speech discrimination test.  The horizontal columns in Table VI represent 9 categories of decibel loss based on the pure tone audiometry test.  The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the pure tone decibel loss.  The percentage evaluation is found from Table VII (in 38 C.F.R. § 4.85 and the statement of the case) by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate for the numeric designation for the level for the ear having the poorer hearing acuity.  See 38 C.F.R. § 4.85.
Regulations also provide that, in cases of exceptional hearing loss, defined as when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000 and 4000 hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral.  Each ear will be evaluated separately.  38 C.F.R. § 4.86(a).  The provisions of 38 C.F.R. § 4.86(b) further provide that when the pure tone threshold is 30 decibels or less at 1,000 hertz and 70 decibels or more at 2000, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or VIa, whichever results in the higher numeral.  That numeral will then be evaluated to the next higher Roman numeral.
In addition to dictating objective test results, a VA audiologist must describe the functional effects caused by a hearing disability in his or her final report.  Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007).
Review of the evidentiary record since December 22, 2013 documents the following symptomatology for the Veteran’s bilateral hearing loss.
In April 2015, the Veteran underwent a VA DBQ examination for hearing loss and tinnitus.  The Veteran reported difficulty hearing high pitch tones, alarms, and his cell phone.  Id.  
His pure tone thresholds, in decibels, were as follows:
		HERTZ		
	1000	2000	3000	4000
RIGHT	10	0	85	90
LEFT	10	50	80	100

The average pure tone threshold was 46 in the right ear and 60 in the left ear.  His word recognition score using the Maryland CNC test was 96 percent in the right ear and 96 percent in the left ear.
These audiometric findings equate to Level I hearing in the right ear and Level II hearing in the left ear.  See 38 C.F.R. § 4.85, Table VI.  When those values are applied to Table VII, they result in a 0 percent disability rating for bilateral hearing impairment.  As a result, the currently assigned noncompensable (0 percent) disability rating for the Veteran’s bilateral hearing loss is accurate and appropriately reflects this disability under the provisions of 38 C.F.R. § 4.85.
The bilateral pure tone thresholds in April 2015 do not qualify as exceptional patterns of hearing, as the Veteran did not have pure tone thresholds of 55 decibels or more at each of the frequencies of 1000, 2000, 3000 and 4000 hertz or a pure tone threshold of 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz.  As a result, use of table VIa is not for application in this case.  See 38 C.F.R. § 4.86.
In May 2017, the Veteran underwent an additional VA DBQ examination for hearing loss and tinnitus.  The Veteran reported hearing loss affects his ability to understand speech in backgrounds of noise.  Martinak, 21 Vet. App. 447.  His pure tone thresholds, in decibels, were as follows:
		HERTZ		
	1000	2000	3000	4000
RIGHT	10	15	85	85
LEFT	15	45	80	100

The average pure tone threshold was 49 in the right ear and 60 in the left ear.  His word recognition score using the Maryland CNC test was 84 percent in the right ear and 80 percent in the left ear.
These audiometric findings equate to Level II hearing in the right ear and Level IV hearing in the left ear.  See 38 C.F.R. § 4.85, Table VI.  When those values are applied to Table VII, they result in a 0 percent disability rating for bilateral hearing impairment.  As a result, the currently assigned noncompensable (0 percent) disability rating for the Veteran’s bilateral hearing loss is accurate and appropriately reflects this disability under the provisions of 38 C.F.R. § 4.85.
The bilateral pure tone thresholds in May 2017 do not qualify as exceptional patterns of hearing, as the Veteran did not have pure tone thresholds of 55 decibels or more at each of the frequencies of 1000, 2000, 3000 and 4000 hertz or a pure tone threshold of 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz.  As a result, use of table VIa is not for application in this case.  See 38 C.F.R. § 4.86.
The Board acknowledges the Veteran’s reported worsening and functional impairment of his bilateral hearing loss throughout the appeal period.  In a statement submitted with the March 2016 NOD, the Veteran reported he cannot hear if someone is knocking at his door or rings the doorbell or the house alarm which puts his life at risk.  He further noted that he cannot hear people when they speak to him so he reads their lips to understand.  
The Board has considered the Veteran’s reported history of symptomatology related to the service-connected bilateral hearing loss.  He is competent to report a decrease in hearing acuity because this requires only personal knowledge as it comes through one’s senses.  Layno v. Brown, 6 Vet. App. 465, 470 (1994).  His assertions are also credible.  However, the assignment of a disability rating for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations based on the audiology examination results.  See Lendenmann, 3 Vet. App. at 349.  In this case, such competent evidence concerning the nature and extent of the Veteran’s disability has been provided in the medical evidence of record.  The Veteran in this case is not competent to measure his level of hearing loss and apply it to the rating schedule, as the record does not show he has the expertise or training to conduct audiometric testing to measure the degree of his bilateral hearing loss.
The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing.  The functional impact that the Veteran describes is contemplated by the rating criteria.  Doucette v. Shulkin, 28 Vet. App. 366 (2017).
The Board has considered the possibility of staged ratings and finds that the proper rating for bilateral hearing loss has been in effect for the entire appeal period.  Accordingly, staged ratings are inapplicable.  See Hart, 21 Vet. App. at 505.
For these reasons, a compensable rating for bilateral hearing loss is denied.  38 C.F.R. §§ 4.3, 4.7.
2. Entitlement to a rating in excess of 10 percent for a right knee disability
In an April 2001 VA rating decision, service connection for residuals of right knee injury was granted.  The Veteran was assigned a noncompensable (0 percent) evaluation effective for the entire rating period from September 1, 2000.  See 38 C.F.R. § 4.71a, Diagnostic Code 5299-5260.  The Veteran filed a timely Notice of Disagreement in June 2001.  In a March 2002 VA rating decision, a temporary rating of 100 percent was assigned effective from May 1, 2001 to June 30, 2001, and the noncompensable rating was continued thereafter.  Id.  In a July 2002 Statement of the Case, a 10 percent rating was assigned for symptomatic removal of the semilunar cartilage effective from September 1, 2000 to May 10, 2001 and since July 1, 2001.  Id. at Diagnostic Code 5299-5259.  No timely substantive appeal was associated with the record.
On December 22, 2014, the Veteran’s request for a rating in excess of 10 percent for the issue on appeal was obtained and associated with the record.  In the May 2015 VA rating decision on appeal, the Agency of Original Jurisdiction (AOJ) recharacterized the disability as right knee meniscal tear, fracture, and degenerative arthritis and continued the 10 percent rating for painful motion.  See 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003-5260.  The Board considers whether a rating in excess of 10 percent for right knee disability is warranted at any time since or within one year prior to the date of claim on December 22, 2014.
Diagnostic Code 5003 provides that degenerative arthritis, established by x-ray findings, is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved.  See 38 C.F.R. § 4.71a.  In the absence of limitation of motion, a 20 percent rating, the maximum available, is assigned for x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations.  Id.  
Diagnostic Code 5260 (limitation of flexion of the leg) provides a 20 percent rating when flexion is limited to 30 degrees and a 30 percent rating, the maximum available, when flexion is limited to 15 degrees.  Id.  For VA compensation purposes, normal range of motion for the knee is flexion to 140 degrees.  38 C.F.R. § 4.71, Plate II. 
Under Diagnostic Code 5261, limitation of extension of the leg, a noncompensable evaluation is warranted when extension is limited to 5 degrees.  A 10 percent evaluation is warranted when extension of the leg is limited to 10 degrees.  A 20 percent evaluation is warranted when extension is limited to 15 degrees.  A 30 percent evaluation is warranted when extension is limited to 20 degrees.  A 40 percent evaluation is warranted when extension is limited to 30 degrees.  A 50 percent evaluation is warranted when extension is limited to 45 degrees.  38 C.F.R. § 4.71a.  For VA compensation purposes, normal range of motion for the knee is extension to 0 degrees.  38 C.F.R. § 4.71, Plate II.
Review of the evidentiary record since December 22, 2013 documents the following symptomatology for the Veteran’s right knee disability.
In April 2015, the Veteran underwent a VA DBQ examination for knee and lower leg conditions.  The Veteran reported his right knee disorder has gotten worse, he is unable to walk, uses a brace and cane, and specified symptoms of stiffness, swelling, and decreased range of motion.  Upon clinical evaluation, he demonstrated right knee flexion to 120 degrees and extension to 0 degrees, pain on flexion and with weight bearing, functional loss characterized as inability to do extended walking, and less movement than normal due to disturbance of locomotion.  The Veteran was also able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion.  While the examiner noted that pain, fatigue, and lack of endurance limited functional ability with repeated use over a period of time.  His muscle strength was normal at 5/5.  The examiner further documented there were no clinical findings of right knee crepitus, localized tenderness or pain on palpation, muscle atrophy, ankylosis, subluxation, instability, recurrent effusion, or abnormalities of the left knee.  The examiner noted that the Veteran had a meniscal tear without locking, pain, and effusion.  
In March 2016, the Veteran submitted a December 2014 private treatment record for broken ribs after a fall from a ladder when his right knee buckled. 
In May 2017, the Veteran underwent an additional VA DBQ examination for knee and lower leg conditions.  The Veteran reported his right knee disorder has gotten worse, has fallen and injured himself twice resulting in broken ribs and a fractured tibia plateau, uses a TENS Unit daily and brace occasionally for stability, and specified symptoms of unable to kneel due to pain, constant pain, limping causing hip pain, being unable to do fun things with his family anymore, and severe pain after extended periods of walking or driving.  Upon clinical evaluation, he demonstrated right knee flexion to 115 degrees and extension to 0 degrees.  He had pain on active flexion but the examiner stated that it did not result in additional functional loss.  He had pain on passive motion testing, pain on non-weight bearing testing, slight tenderness to palpation, less movement than normal, swelling, and disturbance of locomotion.  Muscle strength was normal at 5/5. The Veteran was also able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion.  The examiner noted that pain, fatigue, and lack of endurance limited functional ability with repeated use over a period of time and with flare ups, such impairment was described in terms of flexion to 110 degrees (which is a decrease of 5 degrees) and extension to 0 degrees.  The examiner further documented there were no clinical findings of right knee crepitus, pain with weight bearing, muscle atrophy, ankylosis, subluxation, instability, recurrent effusion, or abnormalities of the left knee.  The examiner noted that the Veteran had a meniscal tear with locking, pain, and effusion.  
Review of VA treatment records documents reported right knee pain and ongoing treatment for right knee arthritis, to include use of a brace.  In October 2015, the Veteran suffered a right knee injury when he fell 5-6 steps when his right knee gave out on him.  CT scan of the right knee showed mild nondisplaced fracture of the lateral tibial plateau.  The physician noted the injury essentially just changed the slope of the tibia and there was no split or any other injuries on either x-rays or CT scans.  A follow-up December 2015 treatment record noted the Veteran’s right knee tibial plateau fracture was healing and he demonstrated full range of motion with essentially no tenderness to palpation or change in fracture alignment.
The Board acknowledges the Veteran’s reported worsening and functional impairment of his right knee disability throughout the appeal period.  In statements submitted with the March 2016 NOD, the Veteran reported that since his in-service right knee injury, he physical ability has deteriorated tremendously.  Specifically, he noted he is unable to do any activities with his children for the past 10 to 15 years or complete basic household chores and his right knee buckled in December 2014 and October 2015, both incidents resulting in falls with injuries.  He further noted he can do some weight bearing but is unable to bend, stoop, kneel, crawl, or walk for long periods of time, and experiences pain and swelling on a daily basis and continues to use his brace.  
A.	Rating in excess of 10 percent
After a review of the evidence discussed above, the Board finds that the Veteran’s service-connected right knee disability has not been manifested by x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, flexion limited to 30 degrees or less or extension limited by 15 degrees or more.  Symptomatology, including right knee pain, decreased flexion, and inability to complete extended walking, is encompassed in the assigned 10 percent rating for arthritis.  In fact, the Veteran has demonstrated full extension and limited flexion, at worst, to 110 degrees during a flare-up.  As a result, a rating in excess of 10 percent for service-connected right knee disability is denied at any time during the pendency of the appeal.  See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5260.  Moreover, the Veteran’s disability picture is not more closely approximated by the next-higher rating of 20 percent based on the presence of additional functional loss based on the criteria set forth in 38 C.F.R. §§ 4.40 4.45, 4.59, and the holdings in DeLuca, 8 Vet. App. at 206.  In fact, the Veteran has demonstrated limited flexion, at worst, to 110 degrees after repeated use over a period of time and with flare ups in May 2017, and both VA examiners noted there no findings of additional loss of function or range of motion after repetitive-use testing.
Separate ratings are also available for limitation of flexion and limitation of extension under Diagnostic Codes 5260 and 5261. VAOPGCPREC 9-2004 (2004).  The Veteran’s extension has been consistently normal and without pain.  A separate rating under Diagnostic Code 5261 is not warranted.  
The Board considers whether an additional rating is warranted in this case under any other applicable criteria for evaluating knee disability, such as Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (recurrent subluxation or lateral instability), or Diagnostic Code 5262 (impairment of tibia and fibula).  38 C.F.R. § 4.71a.  
After a review of the evidence discussed above, to include the Veteran’s lay statements, the Board finds the Veteran’s right knee disability has not been manifested by ankylosis.  Diagnostic Code 5256 is not applicable.  
VA’s General Counsel has held that a claimant who has arthritis as shown by x-ray and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257.  VAOPGCPREC 23-97; 62 Fed. Reg. 63,604 (1997).  
The Board acknowledges the Veteran’s assertions of right knee buckling and instability in the December 2014 private treatment record, October 2015 VA treatment record, and statement submitted with the March 2016 NOD that describes the two incidents.  In this case, the appeal period begins one year prior to December 22, 2014.  During the appeal period, there were two reports of the Veteran’s knee giving out.  The Veteran’s assertion in his NOD that his knee “buckled twice” is competent and credible, and confirmed by medical evidence.  “Recurrent” is defined as, “returning or happening time after time.”  Merriam-Webster’s Collegiate Dictionary 1041 (11th ed. 2012).  The VA examiners found no history of recurrent instability or subluxation.  Two instances of instability over a period of more than four years does not constitute “recurrent.”  
Additionally, both the April 2015 and May 2017 VA examination reports show that right knee joint stability testing was performed and there were no clinical findings of instability, to include normal results from testing for anterior instability, posterior instability, medial instability, and lateral instability.  A separate rating for slight recurrent instability of the knee under Diagnostic Code 5257 is not warranted in this case.  
The Veteran was treatment for a mild right knee tibial plateau fracture in October 2015.  However, he does not have malunion or nonunion of the tibia and fibula.  Therefore, a rating under Diagnostic Code 5262 is not warranted.  The fracture was documented as healed in a December 2015 VA treatment record and the May 2017 VA examination report did not document any findings of a right tibia impairment.  
The Board considers the Veteran’s reported history of symptomatology related to the service-connected right knee disability.  See Layno, 6 Vet. App. at 470.  In this case, although the descriptions of his symptoms are competent and credible, they do not show that the criteria for a higher rating for his right knee disability have been met.  Kahana v. Shinseki, 24 Vet. App. 428 (2011).  
The Board has considered the possibility of staged ratings and finds that the proper rating for right knee disability has been in effect for the entire appeal period.  Accordingly, staged ratings are inapplicable.  See Hart v. Mansfield, 21 Vet. App. 505 (2007).
B.	Separate rating of 20 percent for right knee meniscal tear
The Board considers whether an additional rating is warranted in this case under Diagnostic Code 5258 for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint.  38 C.F.R. § 4.71a.
After a review of the evidence, to include the Veteran’s lay statements, the Board finds the Veteran’s right knee meniscal tear has been manifested by a meniscal tear with frequent episodes of locking, pain, and effusion during the appeal period since May 9, 2017.  The Board acknowledges that the April 2015 VA examination report documents the Veteran’s right meniscal tear, but no additional symptomatology was noted.  The Veteran reported right knee pain and locking in a June 2015 VA treatment session; however, diagnostic testing in July 2015 revealed a right medial meniscal tear with small effusion.  Findings of frequent episodes of locking, pain, and effusion associated with this meniscal tear, as well as positive McMurray test results, were not documented until the May 9, 2017 VA examination report.  It is not factually ascertainable to determine the exact date that these symptoms began.  As a result, the Board finds that a separate rating of 20 percent, the maximum available, is warranted for right knee meniscal tear since May 9, 2017 under Diagnostic Code 5258.  See 38 C.F.R. § 4.71a.  
3. Entitlement to a rating in excess of 10 percent for lumbar strain
In an April 2001 VA rating decision, service connection for low back pain was granted.  The Veteran was assigned a 10 percent rating effective for the entire rating period from September 1, 2000.  See 38 C.F.R. § 4.71a, Diagnostic Code 5295.  The Veteran filed a timely Notice of Disagreement and a Statement of the Case was issued in July 2002; however, no timely substantive appeal was associated with the record.
On December 22, 2014, the Veteran’s request for a rating in excess of 10 percent for the issue on appeal was obtained and associated with the record.  In the May 2015 VA rating decision on appeal, the AOJ recharacterized the disability as lumbar strain and continued the 10 percent rating.  Id. at Diagnostic Code 5243.  The Board considers whether a rating in excess of 10 percent for lumbar strain is warranted at any time since or within one year prior to the date of claim on December 22, 2014.
Intervertebral disc syndrome (preoperatively or postoperatively) is evaluated either on the total duration of incapacitating episodes over the past 12 months or by combining under 38 C.F.R. § 4.25 (the combined rating table) separate evaluations of its chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities, whichever method results in the higher evaluation.  38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.  
Intervertebral disc syndrome warrants a 20 percent evaluation is warranted when the veteran has incapacitating episodes having a total duration of a least 2 weeks but less than 4 weeks during the past 12 months.  A 40 percent evaluation is warranted when the Veteran has incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months.  A 60 percent evaluation is warranted when the Veteran has incapacitating episodes having a total duration of at least 6 weeks during the past 12 months.  
For purposes of assigning evaluations under Code 5243, an “incapacitating episode” is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.  38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1.  
Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent evaluation is warranted when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or, there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, there is vertebral body fracture with loss of 50 percent or more of the height.  
A 20 percent evaluation is warranted when the forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 
A 40 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine is 30 degrees or less; or, there is favorable ankylosis of the entire thoracolumbar spine.  
A 50 percent evaluation is warranted when there is unfavorable ankylosis of the entire thoracolumbar spine.  Finally, a 100 percent evaluation is warranted when there is unfavorable ankylosis of the entire spine.  38 C.F.R. § 4.71a (2015).  
The criteria under the General Rating Formula are to be applied with or without symptoms of pain (whether or not it radiates), aching, or stiffness in the area of the spine involved.  38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine (2015).  Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment are to be evaluated separately under an appropriate Diagnostic Code.  Id. at Note (1).  
For VA compensation purposes, normal forward flexion of the lumbar spine is zero to 90 degrees.  See 38 C.F.R. § 4.71a, Plate V.
Ankylosis is complete immobility of the joint in a fixed position, either favorable or unfavorable.  See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996).  For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.  See 38 C.F.R. § 4.71a, Note (5).  Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  Id. 
Review of the evidentiary record since December 22, 2013 documents the following symptomatology for the Veteran’s lumbar strain.
In April 2015, the Veteran underwent a VA DBQ examination for back conditions.  The Veteran reported his back condition has gotten worse and has limited movement.  Upon clinical evaluation, he demonstrated IVDS, forward flexion to 85 degrees and 80 degrees with pain, and combined range of motion to 210 degrees and 180 degrees with pain.  The examiner noted functional impairment due to less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and/or weight-bearing.  Nevertheless, the examiner did note there were no changes in range of motion findings following repetitive-use testing.  The examiner further documented there were no clinical findings of localized tenderness, muscle spasm or guarding, ankylosis, or any incapacitating episodes over the past 12 months due to IVDS.  
In May 2017, the Veteran underwent an additional VA DBQ examination for back conditions.  The Veteran reported he cannot do any sports with his family or go dancing with his wife and it is difficult to complete household chores.  Upon clinical evaluation, he demonstrated pain on non-weight bearing, forward flexion to 90 degrees and combined range of motion to 215 degrees, both with no changes due to pain, as well as slight tenderness to palpation of the mid lower back and muscle spasm but not resulting in abnormal gait ot abnormal spinal contour.  The examiner noted functional impairment due to less movement than normal, but there were changes in range of motion findings following repetitive-use testing, with repeated use over a period of time, or with a flare up.  The examiner further documented there were no clinical findings of pain with weight bearing, pain on passive motion, guarding, ankylosis, or IVDS.
Review of VA treatment records show ongoing treatment for low back pain.  Moreover, the Board acknowledges the Veteran’s reported worsening and functional impairment of his lumbar strain throughout the appeal period.  In a statement submitted with the March 2016 NOD, the Veteran reported that his back pain has worsened over the years and unable to go hunting, camping, or skiing with his children, drive long distances because of back spasms, or complete basic household chores.  His statements are competent and credible.  
With regard to whether a rating in excess of 10 percent is warranted under Diagnostic Code 5243, the Board finds that the Veteran’s service-connected lumbar strain has not been manifested by IVDS with incapacitating episodes having a total duration of at least 2 weeks during the past 12 months.  As discussed above, the relevant symptomatology includes the April 2015 VA DBQ examination report which documents the Veteran has IVDS without any incapacitating episodes and the May 2017 VA DBQ examination report which documents the Veteran does not have IVDS.  Moreover, review of private and VA treatment records is silent for any prescribed bed rest due to the service-connected lumbar strain.   
With regard to whether a rating in excess of 10 percent is warranted under the General Rating Formula for Disease and Injuries of the Spine (Diagnostic Codes 5235-5242), the Board finds that the Veteran’s service-connected lumbar strain has not been manifested by at least forward flexion of the lumbar spine less than 60 degrees; combined range of motion of the lumbar spine less than 120 degrees; muscle spasm, guarding or localized tenderness resulting in abnormal gait or abnormal spinal contour; or ankylosis.  As discussed above, the relevant symptomatology includes forward flexion, at worst, to 85 degrees, combined range of motion, at worst, to 180 degrees, painful motion, less movement than normal, excess fatigability, interference with sitting, standing, and/or weight-bearing, and localized tenderness and muscle spasm without abnormal gait or abnormal spinal contour; nevertheless, such symptomatology is contemplated in the currently assigned 10 percent disability rating.  As a result, a rating in excess of 10 percent is not warranted at any time during the appeal period for service-connected lumbar strain.
Next, the Veteran’s disability picture has not more closely approximated by a higher rating based on the presence of additional functional loss based on the criteria set forth in 38 C.F.R. §§ 4.40, 4.45 and the holdings in DeLuca, 8 Vet. App. at 206.  As discussed above, the Veteran’s service-connected lumbar strain has not been manifested by symptomatology to warrant a rating in excess of 10 percent under Diagnostic Code 5243 or Diagnostic Codes 5235-5242.  Such findings were not shown, even when considering the Veteran’s reported symptomatology for the lumbar spine, to include painful motion, less movement than normal, excess fatigability, and interference with sitting, standing, and/or weight-bearing.  In fact, his forward flexion was, at worst, to 80 degrees with pain and his combined range of motion was, at worst, to 180 degrees, as noted in the April 2015 VA examination report.  The Veteran’s reported symptomatology did not, when viewed in conjunction with the medical evidence, tend to establish additional functional loss to the degree that would warrant a rating in excess of 10 percent for the service-connected lumbar strain at any time during the appeal period under 38 C.F.R. §§ 4.40, 4.45 and the holdings in DeLuca.
The Board considers whether a separate evaluation may be warranted for any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, under an appropriate Diagnostic Code.  See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243, Note (1).  At the outset, the Board notes that service connection for right leg sciatic nerve was granted in the May 2015 VA rating decision because the disability was deemed to be directly related to his service-connected lumbar strain.  It was assigned a 10 percent rating under Diagnostic Code 8620, which contemplates neuritis of the sciatic nerve.  “Neuritis is defined as inflammation of a nerve, a condition attended by pain and tenderness over the nerves, anesthesia and paresthesias, paralysis, wasting, and disappearance of the reflexes.”  Barclay v. Brown, 4 Vet. App. 161, 163 (1993).  
The rating criteria for Diagnostic Code 8620 are listed in Diagnostic Code 8520, under which mild incomplete paralysis of the sciatic nerve is rated as 10 percent disabling; moderate incomplete paralysis is rated as 20 percent disabling; moderately severe incomplete paralysis is rated as 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated as 60 percent disabling. Complete paralysis of the sciatic nerve warrants an 80 percent evaluation; with complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost.  38 C.F.R. § 4.124a.  
The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured 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.  38 C.F.R. § 4.124a.
At his April 2015 VA spine examination, the examiner noted the Veteran did not have radiculopathy in his left leg, but did have it in his right leg.  He did not have constant pain due to radiculopathy.  He had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness in the right leg.  He did not have any other symptoms.  The examiner described the severity as moderate.  
At his April 2015 VA peripheral nerves examination, the examiner found that the Veteran did not have constant pain in his right leg.  He had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness.  Strength and reflexes were normal for the right knee and ankle.  His sensory examination was normal for the right upper anterior thigh and thigh/knee.  He had decreased sensation in his right lower leg/ankle and foot/toes.  There were no trophic changes.  The examiner concluded that the Veteran’s sciatic nerve disability resulted in mild incomplete paralysis of the right leg.  
However, at his May 2017 VA examination, the examiner found that the Veteran did not have radiculopathy in either leg.  A 20 percent rating is not warranted.  One VA examiner noted moderate severity, another noted mild incomplete paralysis, and the third noted no presence of radicular symptoms.  A higher rating for his sciatic disability is not warranted.  
With regard to any other associated neurological abnormalities associated with the service-connected lumbar strain, the record is silent for any additional findings.  In fact, the April 2015 and May 2017 VA DBQ examination reports show normal neurological findings of the left lower extremity and include indications of “no” for the Veteran having any other objective neurological abnormalities or findings associated with the thoracolumbar spine.  As a result, the Board finds a separate evaluation for any associated objective neurological abnormality (other than right leg sciatic nerve) associated with the service-connected lumbar strain is not warranted in this case.
Next, the Board considers the Veteran’s reported history of symptomatology related to the service-connected lumbar strain, including his reports of pain and problems walking.  See Layno, 6 Vet. App. at 470; Kahana, 24 Vet. App. at 428.  In this case, competent evidence concerning the nature and extent of the Veteran’s lumbar strain has been provided in the medical evidence of record.  As such, the Board finds these records to be more probative than the Veteran’s subjective reported worsened symptomatology.  See Cartright, 2 Vet. App. at 25.
The Board further acknowledges the Veteran’s submission in August 2017 of two journal and one internet articles regarding lumbar spine disorders and military service.  While a medical article or treatise “can provide important support when combined with an opinion of a medical professional,” if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least “plausible causality” based upon objective facts rather than on an unsubstantiated lay medical opinion.  Mattern v. West, 12 Vet. App. 222, 228 (1999).  In this case, these articles submitted by the Veteran do not show the current severity of the service-connected lumbar strain in this case; therefore, they are not probative evidence.
The Board has also considered the possibility of staged ratings and finds that the proper rating for lumbar strain has been in effect for appropriate period on appeal.  Accordingly, staged ratings are inapplicable.  See Hart, 21 Vet. App. at 505.
4. Entitlement to an initial compensable rating for a left thumb disability
During the course of the appeal for a higher rating for service-connected left hand strain, service connection for left thumb disability was granted on a secondary basis in the August 2016 VA rating decision on appeal.  The Veteran was assigned a noncompensable (0 percent) evaluation effective for the entire rating period from December 22, 2014.  See 38 C.F.R. § 4.71a, Diagnostic Code 5228-5019.  The Board considers whether an initial compensable rating for left thumb disability is warranted at any time since the date of claim on December 22, 2014.
The disabilities under Diagnostic Codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under Diagnostic Code 5002.  See 38 C.F.R. § 4.71a, Note.  In this case, the Veteran does not have arthritis or gout in the left hand, as noted in a May 2017 VA x-ray report and May 2017 VA DBQ examination report; therefore, analysis under 38 U.S.C. § 4.71a, Diagnostic Codes 5002, 5003 and 5010 are not relevant and will not be discussed further.
Diagnostic Code 5228 denotes limitation of motion of the thumb.  38 C.F.R. § 4.71a.  The next-higher 10 percent disability rating is warranted for a gap of one to two inches (2.5 to 5.1) centimeter between the thumb pad and the fingers, with the thumb attempting to oppose the fingers.  A 20 percent rating, the maximum available, is warranted for a gap of more than two inches (5.1) centimeter between the thumb pad and the fingers, with the thumb attempting to oppose the fingers.  Id.
Review of the evidentiary record since December 22, 2014 documents the following symptomatology for the Veteran’s left thumb disability.
In June 2015, the Veteran underwent a VA DBQ examination for hand and finger conditions.  Following the clinical evaluation, the examiner documented there were no findings of limitation of motion or evidence of painful motion of the left thumb or a gap between the left thumb pad and the fingers, both on active testing and after repetitive-use testing.  There were also no findings of functional loss or pain on palpation of the left thumb.
In May 2017, the Veteran underwent an additional VA DBQ examination for hand and finger conditions.  Upon clinical evaluation, the Veteran demonstrated limited flexion by 10 degrees of the left thumb, but there was no gap found between the left thumb pad and the fingers.  There were no findings of functional loss or pain on palpation of the left thumb.
Review of VA treatment records are silent for any complaints or treatment for the left thumb disability.  The Board also acknowledges the Veteran’s reported worsening and functional impairment of his left thumb disability throughout the appeal period, to include as noted in a statement submitted with the March 2016 NOD.
The May 2017 VA examiner found that the Veteran had limitation of flexion of the thumb as well as pain in all fingers.  The provisions of 38 C.F.R. § 4.59 establish that the Veteran is entitled to at least the minimum compensable evaluation for motion that is accompanied by pain.  See Burton v. Shinseki, 25 Vet. App. 1 (2011).  A 10 percent rating is therefore granted.  
After review of the evidence discussed above, the Board finds the Veteran’s service-connected left thumb disability has not been manifested by a gap of more than 2 inches or (5.1 centimeters) between the thumb pad and the fingers with the thumb attempting to oppose the fingers.  As a result, an initial 20 percent raring for service-connected left thumb disability is denied at any time during the pendency of the appeal.  See 38 C.F.R. § 4.71a, Diagnostic Code 5228.  
The Veteran’s disability picture has not more closely approximated by a 20 percent rating based on the presence of additional functional loss based on the criteria set forth in 38 C.F.R. §§ 4.40, 4.45 and the holdings in DeLuca, 8 Vet. App. at 206.  The Veteran’s reported symptomatology did not, when viewed in conjunction with the medical evidence, tend to establish additional functional loss to the degree that would warrant a 20 percent rating the service-connected left thumb disability at any time during the appeal period under 38 C.F.R. §§ 4.40, 4.45 and the holdings in DeLuca.
Next, the Board considers the Veteran’s reported history of symptomatology related to the service-connected left thumb disability.  See Layno, 6 Vet. App. at 470; Kahana, 24 Vet. App. at 428.  In this case, competent evidence concerning the nature and extent of the Veteran’s left thumb has been provided in the medical evidence of record.  As such, the Board finds these records to be more probative than the Veteran’s subjective reported worsened symptomatology.  See Cartright, 2 Vet. App. at 25.
The Board has also considered the possibility of staged ratings and finds that the proper rating for left thumb disability has been in effect for appropriate period on appeal.  Accordingly, staged ratings are inapplicable.  See Hart, 21 Vet. App. at 505.
5. Entitlement to a rating in excess of 10 percent for left hand strain 
In an April 2001 VA rating decision, service connection for residuals of left hand injury was granted.  The Veteran was assigned a noncompensable (0 percent) evaluation effective for the entire rating period from September 1, 2000.  See 38 C.F.R. § 4.71a, Diagnostic Code 5299-5226.  The Veteran filed a timely Notice of Disagreement and a Statement of the Case was issued in July 2002; however, no timely substantive appeal was associated with the record.
On December 22, 2014, the Veteran’s request for a compensable evaluation for the issue on appeal was obtained and associated with the record.  In the August 2015 VA rating decision on appeal, a 10 percent rating was assigned effective for the entire appeal period from December 22, 2014.  Id. at Diagnostic Code 5019-5229.  Since the 10 percent disability rating is not the maximum rating available during the appeal period, the issue has been characterized accordingly.  See AB v. Brown, 6 Vet. App. 35 (1993).  The Board considers whether a rating in excess of 10 percent compensable rating for left hand strain is warranted at any time since or within one year prior to the date of claim on December 22, 2014.
Again, the disabilities under Diagnostic Codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under Diagnostic Code 5002.  See 38 C.F.R. § 4.71a, Note.  In this case, analysis under 38 U.S.C. § 4.71a, Diagnostic Codes 5002, 5003 and 5010 is not relevant and will not be discussed in this case.
Since the Veteran’s service-connected left hand strain has been assigned the maximum schedular rating available for the index or long finger, the Board finds there is no legal basis upon which to award a higher schedular evaluation for the left hand strain.  As such, entitlement to a rating in excess of 10 percent for left hand strain is not warranted on a schedular basis.  See Sabonis v. Brown, 6 Vet. App. 426 (1994).
6. Entitlement to an initial compensable rating for left ring finger disability
During the course of the appeal for a higher rating for service-connected left hand strain, service connection for left ring finger disability was granted on a secondary basis in the August 2016 VA rating decision on appeal.  The Veteran was assigned a noncompensable (0 percent) evaluation effective for the entire rating period from December 22, 2014.  See 38 C.F.R. § 4.71a, Diagnostic Code 5230-5019.  The Board considers whether an initial compensable rating for left ring finger disability is warranted at any time since the date of claim on December 22, 2014.  Under Diagnostic Code 5230, the only available rating is a noncompensable one, for “any limitation of motion” of the right or little finger.  
Again, the disabilities under Diagnostic Codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under Diagnostic Code 5002.  See 38 C.F.R. § 4.71a, Note.  In this case, analysis under 38 U.S.C. § 4.71a, Diagnostic Codes 5002, 5003 and 5010 is not relevant and will not be discussed in this case.
Since the Veteran’s service-connected left ring finger disability has been assigned the maximum schedular rating available for the ring or little finger, the Board finds there is no legal basis upon which to award an initial compensable schedular evaluation for the left ring finger disability.  As such, entitlement to an initial compensable rating for left ring finger disability is not warranted on a schedular basis.  See Sabonis, 6 Vet. App. at 426.
The Board has considered the possibility of staged ratings and finds that the proper rating for left ring finger disability has been in effect for the entire appeal period.  Accordingly, staged ratings are inapplicable.  See Hart, 21 Vet. App. at 505.
REASONS FOR REMAND
Entitlement to a TDIU
During the appeal period for the issues of entitlement to higher ratings for service-connected right knee, lumbar strain, left hand, and left finger disabilities, the Veteran reported in statements submitted with the March 2016 NOD that his right knee injuries in December 2014 and October 2015 put him out of work and lost his job in Honduras because unable to do any weight bearing for three months.  He explained that he is unable to work due to his physical limitations and unable to find a job that does not require the performance of physical work.  The Veteran also reported that he cannot seem to get a job because his left hand and left finger disabilities affect his work performance.  He specified that during the past 5 years he has required assistance from his wife to type any reports, which was his job, and that he cannot type reports fast enough in order to keep his job.  Additionally, the April 2015 VA DBQ examination for back conditions noted the impact of the Veteran’s lumbar strain on the ability to work is the inability to lift heavy objects.  
As such, the Board finds that the issue of entitlement to a TDIU has been raised by the record in connection with the service-connected right knee, lumbar strain, left hand, and left finger disabilities on appeal.  See Rice v. Shinseki, 22 Vet. App. 447 (2009).  Additional development is needed, such as asking the Veteran for information about his employment and income.  
The matters are REMANDED for the following actions:
1. Provide the Veteran and his representative with notice concerning how to substantiate the claim for a TDIU since December 22, 2014.  Ask the Veteran to complete a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) to obtain relevant employment information.
2. Then, adjudicate the claim for TDIU.  If the decision is unfavorable to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response.  Then, return the case to the Board.

 
D. Martz Ames
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T. Carter, Counsel 

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