KNEE IMPAIRMENT OF

Summary

The veteran, who served from January 2010 to March 2014 and August 2018 to December 2021, appeals the reduction of his disability ratings for lumbosacral strain and left knee strain. The Board found that the reductions were improper because the VA examinations used to justify them were inadequate. Specifically, the examinations failed to consider the ameliorative effects of medication on the veteran's symptoms, rendering the findings incomplete. The Board concluded that the prior ratings of 20 percent for lumbosacral strain and 30 percent for left knee strain should be restored, effective January 29, 2025, and March 18, 2025, respectively. The veteran also claimed entitlement to Total Disability based on Individual Unemployability (TDIU), asserting that his service-connected PTSD, asthma, knee, or back conditions rendered him unemployable. The Board denied TDIU, finding that while the veteran met the schedular requirements for TDIU based on common etiology for his back and knee conditions, the non-economic component was not met. The Board found the veteran's lay statements regarding his unemployability lacked credibility due to inconsistencies with medical records and his employer's statements. The Board noted the veteran's pursuit of education and potential employment in graphic art and respiratory therapy, suggesting he was capable of substantially gainful employment. The Board found the evidence weighed against unemployability solely due to service-connected disabilities.

Rationale

Reduction improper due to inadequate VA examination; Failure to consider ameliorative effects of medication; Restoration of prior 30 percent rating warranted

Full Decision Text

Citation Nr: A26032191
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 250618-557316
DATE:    April 8, 2026

ORDER

The reduction of the disability rating for service-connected left knee strain, from 30 percent to 10 percent, effective March 18, 2025, was improper; restoration is granted.

The reduction of the disability rating for service-connected lumbosacral strain, from 20 percent to 10 percent, effective January 29, 2025, was improper; restoration is granted.

A total disability rating based on individual unemployability due to service-connected disabilities (TDIU), to include whether TDIU can be based on a single disability, is denied.

FINDINGS OF FACT

1. The reduction in rating for the Veteran's left knee disability, from 30 percent to 10 percent, effective March 18, 2025, was based on an inadequate examination.

2. The reduction in rating for the Veteran's lumbosacral strain, from 20 percent to 10 percent, effective January 29, 2025, was based on an inadequate examination.

3. The persuasive evidence of record weighs against finding the Veteran's service-connected disabilities alone prevent him from securing and following substantially gainful employment.

CONCLUSIONS OF LAW

1. The criteria for restoration of a 30 percent disability rating for left knee strain, effective March 18, 2025, are met. 38 U.S.C. §§ 5107, 5112; 38 C.F.R. §§ 3.105(e), 3.334, 4.3, 4.71a, Diagnostic Code 5261.

2. The criteria for restoration of a 20 percent disability rating for lumbosacral strain, effective January 29, 2025, are met. 38 U.S.C. §§ 5107, 5112; 38 C.F.R.

 §§ 3.105(e), 3.334, 4.3, 4.71a, Diagnostic Code 5237.

3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2010 to March 2014 and from August 2018 to December 2021.

The rating decisions on appeal were issued in March 2025 and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Reductions

The provisions of 38 C.F.R. § 3.105(e) allow for the reduction in rating of a service-connected disability when warranted by the evidence, but only after VA has met certain procedural and substantive requirements. Procedurally, where the reduction in the rating of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. 38 C.F.R. § 3.105(e). As explained below, the back and left knee reductions, effective January 29, 2025, and March 18, 2025, respectively, did not result in a reduction in compensation benefits. Accordingly, the provisions of 38 C.F.R. § 3.105(e) do not apply. 

Where, as
 but only after VA has met certain procedural and substantive requirements. Procedurally, where the reduction in the rating of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. 38 C.F.R. § 3.105(e). As explained below, the back and left knee reductions, effective January 29, 2025, and March 18, 2025, respectively, did not result in a reduction in compensation benefits. Accordingly, the provisions of 38 C.F.R. § 3.105(e) do not apply. 

Where, as in this Veteran's case, a disability rating has been in effect for less than five years at the time the reduction is implemented, a rating reduction is warranted where reexamination of the disability discloses improvement of that disability. 38 C.F.R. § 3.344(c). In making this determination, VA is required to comply with several regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of a veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred, but it must also be determined that the observed improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000).

The law provides that where a rating reduction was made without observance of law, although a remand for compliance with that law would normally be an adequate remedy, in a rating reduction case the erroneous reduction must be vacated and the prior rating restored. See Schafrath, 1 Vet. App. at 594.

1. The propriety of rating reduction for left knee strain, from 30 percent to 10 percent, effective March 18, 2025.

2. The propriety of rating reduction for lumbosacral strain, from 20 percent to 10 percent, effective January 29, 2025.

A September 2024 rating decision awarded service connection for lumbosacral strain, and assigned a 20 percent rating, and service connection for left knee strain, and assigned a 30 percent, each effective from February 24, 2023. See Rating Decision (September 2024). On September 27, 2024, VA received the Veteran's VA Form 21-8940 claim for TDIU, which the AOJ construed as including a claim for increase for his left knee and back disabilities. See VA 21-8940 (September 2024). A March 13, 2025, rating decision reduced the Veteran's lumbosacral strain rating from 20 percent to 10 percent, effective January 29, 2025, and a March 26, 2025, rating decision reduced his left knee disability rating from 30 percent to 10 percent, effective March 18, 2025. See Rating Decisions (March 2025). March 2025 VA letters notified the Veteran of the reductions, but explained that his combined rating (90 percent) did not change. See Notification Letters (March 2025). This appeal arises from the Veteran's disagreement with the rating reductions. See VA Form 10182 (June 2025).

The Board concludes that the rating reductions were improper and that restoration of the 20 percent rating for lumbosacral strain from January 29, 2025, and restoration of the 30 percent rating for left knee strain from March 18, 2025, is warranted. 38 U.S.C. § 5107, 5112; 38 C.F.R. § 3.105(e), 3.334, 4.3, 4.71a, Diagnostic Code 5237 and 5261.

Here, the Veteran's left knee disability was assigned
2025). This appeal arises from the Veteran's disagreement with the rating reductions. See VA Form 10182 (June 2025).

The Board concludes that the rating reductions were improper and that restoration of the 20 percent rating for lumbosacral strain from January 29, 2025, and restoration of the 30 percent rating for left knee strain from March 18, 2025, is warranted. 38 U.S.C. § 5107, 5112; 38 C.F.R. § 3.105(e), 3.334, 4.3, 4.71a, Diagnostic Code 5237 and 5261.

Here, the Veteran's left knee disability was assigned a 30 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5261, and his lumbosacral strain was assigned a 20 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5237, both effective from February 24, 2023. As such, the ratings were in effect for less than five years, and 38 C.F.R. § 3.344(c) is applicable. See Rating Decision - Codesheet (March 2025).

The Veteran's left knee strain was rated 30 percent disabling under 38 C.F.R. 

§ 4.71a, Diagnostic Code 5261, for limitation of extension of the leg. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

The Veteran's lumbosacral Strain was rated 20 percent disabling under 38 C.F.R. 

§ 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion (ROM) of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined ROM of the thoracolumbar spine not greater than 120 degrees; or, 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 rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. 

In Jones v. Shinseki, the Court held that, when assigning a disability evaluation, the Board may not consider the ameliorative effects of medication when those effects are not explicitly contemplated by the rating criteria. Id., 26 Vet. App. 56, 61 (2012). Most recently, the Court in Ingram v. Collins, 38 Vet. App. 130 (2025), held that Jones applies to the evaluation of musculoskeletal conditions. The Court vacated the Board's decision in that case because of a lack of consideration regarding whether the veteran was taking any medications, or whether the veteran's range of motion (ROM) improved with medication use, and if so, to what extent; and because the Board also did not address whether the frequency of the veteran's flare-ups lessened with medication, and if so, to what extent.

The Court has rejected prior Board argument that, because 38 C.F.R. § 4.40 and Sharp v. Shulkin, 29 Vet. App. 26 (2017), Mitchell v. Shinseki, 25 Vet. App. 
5), held that Jones applies to the evaluation of musculoskeletal conditions. The Court vacated the Board's decision in that case because of a lack of consideration regarding whether the veteran was taking any medications, or whether the veteran's range of motion (ROM) improved with medication use, and if so, to what extent; and because the Board also did not address whether the frequency of the veteran's flare-ups lessened with medication, and if so, to what extent.

The Court has rejected prior Board argument that, because 38 C.F.R. § 4.40 and Sharp v. Shulkin, 29 Vet. App. 26 (2017), Mitchell v. Shinseki, 25 Vet. App. 32 (2011), and DeLuca v. Brown, 8 Vet. App. 202 (1995) already require examiners to provide ROM estimates of impairment under the worst-case scenario of a flare-up, and thus applying Jones would serve no useful purpose.

Diagnostic Codes 5261 and 5237 do not account for the use of medication. See 38 C.F.R. § 4.71a.

Based on a review of the evidence, the Board finds that the reduction in rating for the Veteran's left knee disability from 30 percent to 10 percent, effective March 18, 2025, and reduction in rating for lumbosacral strain from 20 percent to 10 percent, effective January 29, 2025, were based on inadequate VA examinations and the rating reductions were improper.

In regards to the Veteran's lumbosacral strain rating reduction, a Back Conditions Disability Benefits Questionnaire (DBQ) was obtained on January 29, 2025. See C&P Exam (March 2025). The Boards find the January 2025 examination report that formed the basis of the reduction at issue is inadequate because it does not reflect consideration of the ameliorative effects of medication when determining the frequency, severity, and duration of the Veteran's lumbosacral strain symptoms. See Jones, 23 Vet. App. at 389; McCarroll, 28 Vet. App. at 271; see also C&P Exam (March 2025). Indeed, the VA examination report shows the Veteran reported experiencing flare-ups of back symptomology 1-2 times weekly, and taking NSAIDs and using icy hot to alleviate symptomatology. See C&P Exam (March 2025). However, the examination report does not reflect whether the ameliorative effects of the Veteran's medication were discounted when evaluating his back symptomology, and thus, those clinical findings are incomplete and are inadequate to evaluate the severity of his lumbosacral strain disability. Thus, the AOJ's decision to reduce the assigned rating was improper

In regards to his left knee disability rating reduction, the Veteran challenges the adequacy of the March 2025 VA-obtained examination report because the examining clinician was "unprofessional, quick, un-knowledgeable, and seemed very off and or fraudulent." See Correspondence (March 2025). Absent clear evidence to the contrary, VA examiners are presumed to have properly discharged their duties as health professionals, and this presumption of regularity extends to the accuracy of a VA examiner's report. See Francway v. Wilkie, 940 F.3d 1304 (2019). "[O]nce the veteran raises a challenge to the competency of the medical examiner, the presumption has no further effect, and... [VA] must satisfy its burden of persuasion as to the examiner's qualifications." Id. at 1308. The Board has reviewed the March 2025 examination report, which appears to be a comprehensive examination, in that it identifies the Veteran's symptomatology and documents his reported symptoms in an objective manner. However, for reasons discussed below, the Board finds the March 2025 VA-obtain examination inadequate and reliance on this examination for the purpose of reduction of disability benefits is improper. See Schafrath, 1 Vet. App. at 595.

Here, the March 2025 VA-obtained left knee examination report that formed the basis of the reduction at issue is also inadequate because it does not reflect consideration of the ameliorative effects of medication when determining the frequency, severity, and duration of the Veteran's left knee symptoms. See Jones, 23 Vet. App. at 389; McCarroll, 28 Vet. App. at 271; see also C&P Exam (March 2025). Indeed, the VA examination report shows the Veteran reported taking Meloxicam as needed to relieve left knee symptomatology. See C&P Exam (March 2025). However, the examination report does not reflect whether the ameliorative effects of the Veteran's medication were discounted when evaluating his left knee symptomology,
ained left knee examination report that formed the basis of the reduction at issue is also inadequate because it does not reflect consideration of the ameliorative effects of medication when determining the frequency, severity, and duration of the Veteran's left knee symptoms. See Jones, 23 Vet. App. at 389; McCarroll, 28 Vet. App. at 271; see also C&P Exam (March 2025). Indeed, the VA examination report shows the Veteran reported taking Meloxicam as needed to relieve left knee symptomatology. See C&P Exam (March 2025). However, the examination report does not reflect whether the ameliorative effects of the Veteran's medication were discounted when evaluating his left knee symptomology, and thus, those clinical findings are incomplete and are inadequate to evaluate the severity of his left knee disability. Thus, the AOJ's decision to reduce the assigned rating was improper.

In sum, the Board finds that the rating reductions are improper because they were based on incomplete and inadequate VA-obtained examination results.

Accordingly, the claim for restoration of a 20 percent rating for lumbosacral strain, effective January 29, 2025, and restoration of a 30 percent rating for left knee strain, effective March 18, 2025, are granted.

TDIU

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a).

For the purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3) disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. 

§ 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018).

A total rating based on individual unemployability may be assigned on an extraschedular basis in the case of a veteran who fails to meet the percentage requirements but who is unemployable by reason of service-connected disability. 38 C.F.R. § 4.16(b). The Board may adjudicate entitlement to an extraschedular TDIU rating in the first instance. Witkowski v. Collins, 38 Vet. App. 459 (2025).

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. 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 the Veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.341, 4.16.

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 means 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. Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person
 to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.341, 4.16.

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 means 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. Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a).

Marginal employment may also be held to exist, on a fact-found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. Id. Marginal employment, odd-job employment, and employment at half the usual remuneration is not incompatible with a determination of unemployability if the restriction to securing or retaining better employment is due to disability. 38 C.F.R. § 4.17(a). The United States Court of Appeals for Veterans Claims indicated that factors to consider in determining whether marginal employment exists may include the "magnitude of the veteran's job responsibilities and the degree of accommodation necessary for successful, full-time work." Cantrell v. Shulkin, 28 Vet. App. 382, 396 (2017).

Employment in a "protected environment" means employment in a lower-income position that, due to the Veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market. LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).

The non-economic component includes consideration of the veteran's history, education, skill, and training; whether the veteran has the physical ability (both exertional and non-exertional) to perform the type 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).

Entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a veteran may "secure and follow a substantially gainful occupation" based on all evidence of record. See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

3. Entitlement to TDIU.

The Veteran asserts that he is unemployable due to his disabilities. See Correspondence (September 2024); VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability (September 2024). He contends that his service-connected posttraumatic stress syndrome (PTSD), left knee condition, or back condition, each alone and independently, render him unemployable. See VA Form 10182 (June 2025). 

On February 24, 2023, VA received the Veteran's claim for compensation for several service-connected disabilities, to include left knee strain and lumbosacral strain. See VA 21-526EZ (February 2023). Service connection for a left knee strain and lumbosacral strain were awarded, in part, pursuant to a September 2024 rating decision. See Rating Decision (September 2024). On September 27, 2024, VA received the Veteran's VA 21-8940, claim for TDIU, which the AOJ construed as including a claim for increase for the Veteran's service-connected posttraumatic stress disorder (PTSD), asthma, lumbosacral strain, and left knee strain. VA 21-8940 (September 2024). March 13, 2025, and March 26, 2025, rating decisions denied entitlement to TDIU and reduced or denied the claims for increase. See Rating Decision (March 2025). 

Thus, the relevant rating review period for entitlement to TDIU begins on February 24, 2023-the date VA received VA Form VA 21-526EZ -and ends on March 26
 VA 21-8940, claim for TDIU, which the AOJ construed as including a claim for increase for the Veteran's service-connected posttraumatic stress disorder (PTSD), asthma, lumbosacral strain, and left knee strain. VA 21-8940 (September 2024). March 13, 2025, and March 26, 2025, rating decisions denied entitlement to TDIU and reduced or denied the claims for increase. See Rating Decision (March 2025). 

Thus, the relevant rating review period for entitlement to TDIU begins on February 24, 2023-the date VA received VA Form VA 21-526EZ -and ends on March 26, 2025, the date of the rating decision on appeal.

The Board concludes that the criteria for an award of TDIU are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

During the rating review period, the Veteran is service-connected for PTSD (70% from August 2, 2023); asthma (30% from February 23, 2023); irritable bowel syndrome (30% from August 2, 2023); lumbosacral strain (20% from February 24, 2023, herein); left knee strain (30% from February 24, 2023, herein); hemorrhoids (0% from February 24, 2023); and chronic allergic rhinitis (0% from September 12, 2024). His combined rating, from February 24, 2023, to August 2, 2023, was 70 percent, and 90 percent from August 2, 2023. 

Between February 24, 2023, and August 2, 2023, the combined rating is 70 percent. Although there is no single disability rated at 40 percent, his left knee and back strain disabilities are the result of the same in-service injury, an airborne jump in 2019. See e.g., VA 21-526EZ, Fully Developed Claim (Compensation) (February 2023); C&P Exam (June 2024). Thus, the disabilities have a common etiology, equal at least a 40 percent rating, and the requirements for a schedular TDIU are met. See 38 C.F.R. § 4.16(a)(2) (providing that disabilities resulting from a common etiology or a single accident are considered one disability for purposes of TDIU); 38 C.F.R. § 4.25. Accordingly, the Veteran met the schedular requirements for a TDIU during the entire rating review period. 38 C.F.R. § 4.16(a).

Thus, the issue is whether the Veteran's service-connected disabilities cause the Veteran to be unable to secure and follow a substantially gainful occupation, considering both economic and noneconomic components. Ray, 31 Vet. App. at 73. 

In his September 2024 VA Form 21-8940, TDIU Application, the Veteran reportedly last worked fulltime on June 7, 2023, as an electrician. See VA Form 21-8940 (September 2024). He reported that he stopped working due to his service-connected PTSD, asthma, left knee disability and low back disability. 

There are two Employment Information forms associated with the claims file in relation to the Veteran's electrical job. One form was submitted by the Veteran at the time of his September 2024 claim for benefits, and reported that the Veteran was provided with restroom breaks and time to take his asthma medication, and that he quit after taking some time off. See VA 21-4192 Request for Employment Information in Connection with Claim for Disability (September 2024). The other employment form was submitted by the employer directly, pursuant to January 2025 VA correspondence. See Subsequent Development Letter (January 2025); VA 21-4192 Request for Employment Information in Connection with Claim for Disability (February 2025). The February 2025 Employment Information form denies that any concessions were made to the Veteran and that no time was lost due to his disabilities. It further reports that the Veteran left the job because he moved. 

The Veteran reported earning his Associate's Degree in respiratory therapy. See VA 21-8940 (September 2024). He reported working as a respiratory therapist in between his periods of active duty. See C&P Exam (June 2024). The claims file reflects that the Veteran has been enrolled in college from the fall of 2023 until at least the issuance of the March 2025 rating decision on
2025); VA 21-4192 Request for Employment Information in Connection with Claim for Disability (February 2025). The February 2025 Employment Information form denies that any concessions were made to the Veteran and that no time was lost due to his disabilities. It further reports that the Veteran left the job because he moved. 

The Veteran reported earning his Associate's Degree in respiratory therapy. See VA 21-8940 (September 2024). He reported working as a respiratory therapist in between his periods of active duty. See C&P Exam (June 2024). The claims file reflects that the Veteran has been enrolled in college from the fall of 2023 until at least the issuance of the March 2025 rating decision on appeal. See VA 21-8940; C&P Exam (June 2024) ("the [V]eteran described enrolling in online classes at WGU maybe in the Fall of 2023 as a fulltime student."); CAPRI (March 2025) (March 2025 treatment reflects the Veteran was studying business.). He told his treating physicians that he was "unemployed intentionally while in school." CAPRI at 2 (August 2024). During VA mental health treatment, the Veteran repeatedly reported that he wanted to obtain his respiratory license in North Carolina and resume working in respiratory therapy. See CAPRI (March 2025). During January 2025 VA treatment, the Veteran reported that he was presented with a job opportunity in illustrating a graphic novel, which was an area he was passionate about. See CAPRI (January 2025). March 2025 VA treatment records reflect that the Veteran reported that the "illustration for the graphic novel [was] going well and that they [were] beginning work in earnest in the next week." See CAPRI at 3 (March 2025). VA treatment records also reflect that the Veteran worked in a "nutrition job" at some point in 2023. See CAPRI at 27. (May 2024). 

First, the Board finds that the economic component has been met from June 7, 2023. Prior to June 7, 2023, the evidence of record does not reflect that the Veteran's employment was protected or involved accommodations which would render his work to have taken place in a sheltered work environment. See 38 C.F.R. § 4.16(a). Specifically, the evidence shows that the Veteran last worked as an electrician with no more than reasonable accommodations provided. Additionally, the March 2025 rating decision on appeal found that the Veteran was not working. This is a favorable finding by the AOJ. 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).

Second, the Board finds that the non-economic component of TDIU is not met. The Board finds that persuasive evidence of record weighs against finding that the Veteran is unemployable solely due to his service-connected disabilities. See Ray, 31 Vet. App. at 66.

The medical evidence and the Veteran's reports, is that during the relevant time period there was back and left knee pain with functional limitations, to include limited range of motion, interference with sitting, standing, and walking, and limits on bending and lifting. But the evidence also shows that there was full muscle strength of the back and lower extremity muscles and a normal gait. See e.g., C&P Exam (June 2024; March 2025); CAPRI (June 2023; May 2024; September 2024; January 2025; March 2025). Treatment records also reflect that the Veteran reported that he enjoyed biking with his son, demonstrating that he has significant range of motion. See CAPRI at 2 (August 2024). His IBS caused weekly straining and/or urgency, bloating, and mucorrhea. The Veteran's asthma caused shortness of breath with physical exertion. See C&P Exam (June 2024; March 2025). 

Regarding impact on the Veteran's occupational functioning due to PTSD, June 2024 and February 2025 DBQs reflect that the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. See C&P Exam (June 2024; February 2025). Additionally, the February 2025 DBQ states that the Veteran's PTSD would likely contribute to problems sustaining concentration and managing distractions while working, as well as difficulty learning new information, and that he would work best alone or in a small group environment. However, VA mental health records for the entire period on review reflect that the Veteran was consistently noted to be oriented to person, place and situation, linear and intact, memory grossly intact, and logical and goal directed
4 and February 2025 DBQs reflect that the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. See C&P Exam (June 2024; February 2025). Additionally, the February 2025 DBQ states that the Veteran's PTSD would likely contribute to problems sustaining concentration and managing distractions while working, as well as difficulty learning new information, and that he would work best alone or in a small group environment. However, VA mental health records for the entire period on review reflect that the Veteran was consistently noted to be oriented to person, place and situation, linear and intact, memory grossly intact, and logical and goal directed. He was always noted to be well-groomed, appropriately dressed, and properly engaged. See CAPRI (June 2023; May 2024; September 2024; January 2025; March 2025). 

The Board finds that the evidence of record calls the Veteran's and his spouse's credibility into question. On his claim for TDIU, outside of his military service, the Veteran only reported his 6-month employment as an electrician. See VA 21-8940 (September 2024). He did not report his prior experience as a respiratory therapist, or in nutrition. Further, in pursuit of TDIU, the Veteran reported leaving his job due to his service-connected disabilities. See Correspondence (September 2024). However, his reports to his providers reflect that he was intentionally unemployed while he attended school, and his previous employer reported that he left his job because of a move. See CAPRI at 2 (September 2024); VA 21-4192 Request for Employment Information in Connection with Claim for Disability (February 2025). Accordingly, the Veteran's lay statements are of limited probative value. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996).

The Board has also considered the statement submitted by the Veteran's spouse in March 2025. See Correspondence (March 2025). She contends that the Veteran is entitled to a TDIU rating, and lists both service-connected and nonservice-connected symptoms that prevent gainful employment. She reported that the Veteran was a fall risk, and that he used a knee brace and avoided uneven surfaces. She reported that the Veteran had to change his underwear 6-8 times daily because of constant urinary leakage, and he struggled with balance and tripping issues. She also noted shoulder pain, and loss of sensation in his extremities, causing him to drop items. She also reported that he dropped out of school due to depression. The Veteran's spouse is competent to report such symptoms. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). However, the Board does not find these assertions to be credible, as to the time period at issue, as they conflict with the evidence of record. See Caluza, 7 Vet. App. 498, 511. VA treatment records dated during the rating review period do not demonstrate reports of urinary leakage, use of assistive devices, or that the Veteran was a fall risk. See CAPRI (August 2024; March 2025); C&P Exam (June 2024; March 2025). The Board finds that if these symptoms had been present during the rating review period, they would have been reported. See Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (noting that silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record). This is because during the rating review period, the Veteran was seen regularly for various disorders and attended multiple VA examinations assessing his conditions. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (providing that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist). Thus, the March 2025 spouse statement is not credible as to the rating review period. 

Based on the available evidence concerning the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the
 ordinarily have been recorded in the medical record). This is because during the rating review period, the Veteran was seen regularly for various disorders and attended multiple VA examinations assessing his conditions. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (providing that where there is a lack of notation of medical condition or symptoms where such notation would normally be expected, the Board may consider this as evidence that the condition or symptoms did not exist). Thus, the March 2025 spouse statement is not credible as to the rating review period. 

Based on the available evidence concerning the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the Board finds that the Veteran is capable of work resulting in a level of substantially gainful employment. 

Despite his back, knee and asthma conditions, which would likely preclude him from positions requiring significant manual labor, there is insufficient evidence to show that his service-connected disabilities would preclude him from light physical labor to non-manual labor positions. In this regard, the evidence indicates that the Veteran has training and experience in non-physically strenuous areas of employment, like respiratory therapy, nutrition, and graphic art. Further, regular access to a bathroom, as necessitated by his IBS symptoms, is a reasonable accomodation in a non-manual labor position. While the Board acknowledges that the Veteran's PTSD has an impact in an occupational setting, the limited evidence provided by the Veteran regarding his current schooling suggests that he has successfully maintained enrollment in online courses throughout the period on review. This demonstrates self-motivation and the ability to adapt to stressful situations. Such evidence is not indicative that the Veteran was unable to engage in mental acts required by his prior employment.

The Board has also considered the Veteran's representative emphasis on the findings of the February 2025 DBQ, which concluded that the Veteran was likely to work best alone or in small group settings, and the limitations on the Veteran's ability to bend and lift. See VA Form 10182 (June 2025). While these limitations would certainly cause some occupational impairments, the overall evidence, taken as a whole, does not support a finding that the Veteran's service-connected disabilities prevent him from obtaining and maintaining all forms of substantially gainful employment. In so finding, the Board emphasizes that a disability rating in itself is recognition that the ability to work is impaired. 38 C.F.R. § 4.1.

Accordingly, the claim of entitlement to a TDIU, to include whether TDIU can be based on a single disability, is denied. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. 

§ 5107(b); Lynch v. McDonough, 21 F.4th 776 (2021).

 

 

AMANDA G. ALDERMAN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T.F.

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.