REPLACEMENT OF KNEE WITH PROSTHESIS

I. CANNADAY · 2026 · Case ID: A26033535

MIXED

Summary

The veteran, who served from March 1969 to March 1971 and again from July 1979 to June 1989, appeals multiple rating decisions. The veteran sought increased ratings for bilateral knee conditions and a bilateral eye condition, and entitlement to Total Disability based on Individual Unemployability (TDIU). The Board granted a 60 percent rating for the right knee, effective December 10, 2024, finding chronic residuals of severe painful motion post-total knee arthroplasty, aligning with Diagnostic Code 5055. However, higher ratings for the right knee and any rating above 10 percent for the left knee were denied, as the evidence did not meet the criteria for more severe functional loss or instability. Similarly, higher ratings for the bilateral eye condition were denied, as the evidence did not demonstrate the required number of incapacitating episodes or the specific visual acuity thresholds for higher evaluations under the applicable diagnostic codes. The Board granted entitlement to TDIU prior to August 1, 2023, finding that the veteran's combined service-connected disabilities, including the right knee condition, prevented him from securing or following substantially gainful employment. The Board applied the benefit of the doubt to the TDIU claim, finding the veteran's service-connected disabilities precluded gainful employment.

Rationale

Chronic residuals of severe painful motion post-total knee arthroplasty; Meets 60 percent criteria under Diagnostic Code 5055; Benefit of the doubt applied for 60 percent rating

Special Benefit

TDIU

Diagnostic Code

5055

Docket No.

250821-578513

Full Decision Text

Citation Nr: A26033535
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 250821-578513
DATE: April 10, 2026

ORDER

Entitlement to a 60 percent rating, prior to December 10, 2024 for a total right knee arthoplasty is granted.

Entitlement to a rating in excess of 60 percent for the period beginning December 10, 2024 for total right knee arthroplasty is denied.

Entitlement to a rating in excess of 10 percent for a left knee disability is denied.

Entitlement to an initial rating in excess of 10 percent, prior to December 12, 2024, for a bilateral eye condition is denied.

Entitlement to a rating in excess of 20 percent, for the period beginning December 12, 2024 for a bilateral eye condition is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to August 1, 2023 is granted.

FINDINGS OF FACT

1. Prior to December 10, 2024, the Veteran has been status post right total knee replacement with evidence of severe painful motion or weakness.

2. From December 10, 2024, the Veteran's status post right total knee replacement is rated as the maximum schedular rating.

3. Throughout the period on appeal, the Veteran's left knee disability was manifested by flexion to 90 degrees, at worst.

4. Prior to December 12, 2024, the Veteran's bilateral eye condition did not manifest in documented incapacitating episodes of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider or requiring at least 3 visits for an eye condition during a 12 month period and were not productive of visual acuity of, at worst, 20/70 and 20/40 in his eyes.

5. For the period beginning December 12, 2024, the Veteran's bilateral eye condition did not manifest in documented incapacitating episodes requiring at least 5 visits for an eye condition during a 12 month period and were not productive of visual acuity of, at worst, 20/50 and 20/40 in his eyes

6. Prior to August 1, 2023, the Veteran's service-connected disabilities prevented him from engaging in?substantially gainful?employment.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a 60 percent rating for status post total right knee arthoplasty have been met, prior to December 10, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.71a, Diagnostic Code 5255-5055.

2. Beginning December 10, 2024, a schedular rating greater than 60 percent is not available for the Veteran's status post right total knee arthroplasty. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.68, 4.71a, Diagnostic Code 5055.

3. The criteria for a rating in excess of 10 percent for a left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5260.

4. The criteria for?an initial?rating in excess of 10 percent?rating for a bilateral eye condition have not been met for the period prior to December 12, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.75-4.79, Diagnostic Code 6012-6066.

5. The criteria for?a rating in excess of 20 percent for a bilateral eye condition have not been met for the period beginning December 12, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.75-4.79, Diagnostic Code 6012-6066.

6. The criteria for an award of TDIU prior to August 1, 2023, have been met. 38?U.S.C. §§?1155, 5107;?38?C.F.R. §§?3.40, 3.41, 4.15, 4.16.????
for?a rating in excess of 20 percent for a bilateral eye condition have not been met for the period beginning December 12, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.75-4.79, Diagnostic Code 6012-6066.

6. The criteria for an award of TDIU prior to August 1, 2023, have been met. 38?U.S.C. §§?1155, 5107;?38?C.F.R. §§?3.40, 3.41, 4.15, 4.16.????

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from?March 1969 to March 1971 and from July 1979 to June 1989.?

These matters come before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions by a Department of Veterans Affairs (VA) Regional Office, which serves as the Agency of Original Jurisdiction (AOJ) in this case. A January 2025 rating decision granted service connection for a bilateral eye condition and assigned a 10 percent rating, effective May 7, 2015 and a 20 percent rating from December 12, 2024; a March 2025 rating decision continued a 30 percent rating for a right total knee arthroplasty prior to December 10, 2024 and increased the rating to 60 percent from that date, and continued a 10 percent rating for a left knee disability; and an April 2025 rating decision denied entitlement to TDIU.

In the August 21, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 8, 2025.

Therefore, the Board may only consider the evidence of record at the time of the respective AOJ decisions on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

In an interim November 2025 rating decision, the AOJ implemented an October 2025 Board decision and granted entitlement to TDIU effective August 1, 2023. As the issue of entitlement to TDIU has been raised as part of the claims for increase ratings for his right and left knee disabilities and his bilateral eye condition, entitlement to TDIU prior to August 1, 2023 is therefore before the Board.?See Harper v. Wilkie, 30?Vet. App.?356 (2018);?Rice v. Shinseki, 22?Vet. App.?447 (2009).??

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 for higher ratings for his status right total knee arthoplasty, left knee disability, and bilateral eye condition, and entitlement to TDIU prior to August 1, 2023, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included in this decision.

Increased Rating

Disability ratings are?determined?by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as?practically can?be?determined, on average impairment in earning capacity.? Separate Diagnostic Codes?identify?the various disabilities.? 38?C.F.R. Part 4.? When rating a service-connected disability, the entire history must be borne in mind. Schafrath?v.?Derwinski, 1?Vet. App.?589 (1991).? Where there is a question as to which of two ratings shall be applied, the higher rating 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.???????????

Where entitlement to compensation
, as far as?practically can?be?determined, on average impairment in earning capacity.? Separate Diagnostic Codes?identify?the various disabilities.? 38?C.F.R. Part 4.? When rating a service-connected disability, the entire history must be borne in mind. Schafrath?v.?Derwinski, 1?Vet. App.?589 (1991).? Where there is a question as to which of two ratings shall be applied, the higher rating 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.???????????

Where entitlement to compensation has already been?established?and an increase in the disability rating is at issue, the present level of disability is of primary concern.??See?Francisco v. Brown, 7?Vet. App.?55, 58 (1994).? Staged ratings are?appropriate in?any increased-rating claim in which distinct time periods with different ratable symptoms can be?identified.??Hart v. Mansfield, 21?Vet. App.?505 (2007).????????

Knee Disabilities

The Veteran seeks higher ratings for his bilateral knee disabilities. The Veteran's right knee, status post total knee arthroplasty, has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5255 as 30 percent disabling from February 18, 2003, as 100 percent disabling from May 23, 2008, 30 percent disabling from July 1, 2009, and 60 percent disabling from December 10, 2024. His left knee has been rated as 10 percent disabling from November 9, 2009 under Diagnostic Code 5003-5260. He filed his claim for increased ratings in February 2023.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness.??DeLuca v. Brown, 8?Vet. App.?202 (1995).? Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §?4.40.? Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities.??See?38?C.F.R. §?4.45.? These determinations are, if?feasible, to be expressed in terms of the degree of?additional?loss-of-motion due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain.??Mitchell v. Shinseki, 25?Vet. App.?32 (2011).?Painful motion of a joint with periarticular pathology is to be at rated at least at the minimum compensable rating for the joint.?38 C.F.R. § 4.59.?See?id.;?Johnston v. Brown,?10?Vet. App.?80, 84-5?(1997);?Burton v. Shinseki,?25?Vet. App.?1, 5-6?(2011).??

Under the Diagnostic Code 5257 for recurrent subluxation or lateral instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is?warranted?for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is?warranted?for unrepaired or
.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is?warranted?for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is?warranted?for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.?

For patellar instability, a 10 percent rating is?warranted?for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is?warranted?for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is?warranted?for?a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker.?

Words such as "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate?all of?the evidence to the end that its decision is "equitable and just." 38 C.F.R. § 4.6. Use of terminology such as "severe" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. For reference and illustrative purposes, the Merriam-Webster dictionary defines "slight" as small of its kind or in amount; "moderate" as tending toward the mean or average amount or dimension; and "severe" as "of a great degree."?See?https://www. merriam-webster.com/dictionary/slight; www.merriam-webster.com/dictionary/ moderate; www.merriam-webster.com/dictionary/severe.?

Under Diagnostic Code 5055, a 100 percent rating is warranted for a period of four months of convalescence following the implantation of the prosthetic knee or resurfacing for as provided in 38 C.F.R. § 4.30. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Following the period of convalescence, the criteria remain unchanged and the Veteran's knee is assigned ratings under Diagnostic Code 5055. A 30 percent rating, the minimum schedular evaluation, is assigned for status total knee replacement with intermediate degrees of residual weakness, pain or limitation of motion rated by analogy to diagnostic codes 5256, 5261, or 5262. A 60 percent rating, the maximum schedular evaluation is assigned status total knee replacement with chronic residuals consisting of severe painful motion or weakness in the knee.

Diagnostic Code 5258 provides a 20 percent evaluation for dislocation of semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint.?

Diagnostic Code 5259 provides a 10 percent evaluation for removal of semilunar cartilage that is symptomatic.?

Diagnostic Code 5260 contemplates limitation of leg flexion, and assigns 10, 20, and 30 percent ratings when flexion is limited to 45, 30, and 15 degrees, respectively.?

Diagnostic Code?5261?contemplates limitation of leg extension, and assigns 0, 10, 20, 30, 40, and 50 percent ratings when extension is limited to 5, 10, 15, 20, 30, and 45 degrees, respectively.?

For VA compensation purposes, normal flexion of the knee is to 140 degrees, and normal extension is to zero degrees.?38 C.F.R. § 4.71a, Plate II.?

Separate ratings may be assigned for limitation of flexion, limitation of extension and instability of the knee of the same knee. VAOPGCPREC 9-04 (Sept. 17, 2004),?69 Fed. Reg. 59990?(
limitation of leg extension, and assigns 0, 10, 20, 30, 40, and 50 percent ratings when extension is limited to 5, 10, 15, 20, 30, and 45 degrees, respectively.?

For VA compensation purposes, normal flexion of the knee is to 140 degrees, and normal extension is to zero degrees.?38 C.F.R. § 4.71a, Plate II.?

Separate ratings may be assigned for limitation of flexion, limitation of extension and instability of the knee of the same knee. VAOPGCPREC 9-04 (Sept. 17, 2004),?69 Fed. Reg. 59990?(2005); VAOPGCPREC 23-97 (July 1, 1997),?62 Fed. Reg. 63604?(1997).?

The Veteran's VA treatment records reflect that he underwent a total right knee replacement in 2008. The records also reflects that he continuously reported having chronic bilateral knee pain.

In a May 2023 VA physical therapy treatment note, the Veteran reported having right knee pain when he was walking. He described right knee pain as 0 out of 10 with 5 out of 10 at its worst. It was aggravated by walking, getting up in the morning and stair negotiation, and was eased by rest and opiod pain medications. Right and left lower extremity knee extension and flexion strength were normal. He had a mild antalgic gait with reduced hip extension.

At a July 2024 videoconference hearing before the Board, the Veteran testified that that after his right knee replacement, he continued to have a sharp chronic knee pain. He described it as sharp shooting pains and that his wife recommended, he use a cane to keep from falling. He testified that he had fallen a few times as his knee would unlock. He testified that he did not have any knee pain during the hearing, but he would get pain if he tried to stand up and walk too far. He testified that his pain was consistently severe and he continued to take narcotic pain medication, including hydrocodone. Regarding his left knee, the Veteran testified that he continued to have issues. He testified that when he would need to sit down in specific positions to get his left knee to be comfortable and not in pain. He would also get injections due to inflammation. He also testified that his knee would give way at times.

In an October 2024 private medical evaluation, based on a review of the record, the private examiner opined that the Veteran's current ratings for his right and left knee disabilities did not accurately reflect the severity of his symptoms. They noted that at the July 2024 hearing, the Veteran testified that over the decade following his 2008 right total knee arthoplasty he has experienced a progressive worsening of the pain, which he described as being sharp and severe in nature. He rated it as 8 out of 10 in severity. They also noted that the Veteran's knee will intermittently catch and release which result in him falling. He also had been taking a large dose of narcotic medication for pain, but that had been recently reduced. Regarding the Veteran's left knee disability, the private examiner opined that it was a result of his service-connected right knee symptoms.

In a December 2024 VA contract knee examination, right knee total arthroplasty status post femur fracture and bilateral knee osteoarthritis were diagnosed. The Veteran reported that since his total right knee replacement in 2008 he continued to have a progression of pain and knee issues. The Veteran reported that his knee was aggravated and painful with walking, bending, and going up stairs. He was not able to sustain prolong standing or walking without pain. He also had painful episodes triggered by frequent changing of position from sitting to standing, episodes can occur multiple times a day and could occur daily depending on if he had to walk for lengthy periods of time. His pain was treated with Vicodin. He reported having daily flare-ups of his knee conditions, moderate in severity, lasting hours to all day, consisting of pain at his joint. His flare-ups were precipitated with prolonged sitting or standing. Functional impairment during flare-ups included being unable to pick up objects from the floor. He did not have a history or report of instability or recurrent subluxation of the knee or of frequent effusion of the knee.

On active range of motion testing, both right and left flexion was to 120 and extension was normal. He had pain on both flexion and extension with no additional loss of motion. Passive motion was the same as active motion. His pain caused functional loss as he was unable to pick up objects from
He reported having daily flare-ups of his knee conditions, moderate in severity, lasting hours to all day, consisting of pain at his joint. His flare-ups were precipitated with prolonged sitting or standing. Functional impairment during flare-ups included being unable to pick up objects from the floor. He did not have a history or report of instability or recurrent subluxation of the knee or of frequent effusion of the knee.

On active range of motion testing, both right and left flexion was to 120 and extension was normal. He had pain on both flexion and extension with no additional loss of motion. Passive motion was the same as active motion. His pain caused functional loss as he was unable to pick up objects from the floor. There was objective evidence of crepitus. There was also objective evidence of localized tenderness or pain on palpation of the joint located at his patella, moderate in severity. The Veteran was able to perform repetitive use testing with at least three repetitions with both knees, with no additional loss of function or loss of range of motion.

The examiner noted that the Veteran was not being examined immediately after repeated use over time, but evidence suggested that the Veteran had pain which limited functional ability with repeated use over time. The examiner estimated that range of motion after repeated use over time was right knee flexion was to 110 degrees and extension was normal. The examiner estimated that range of motion after repeated use over time was left knee flexion was to 110 degrees and extension was normal. The examiner noted that the Veteran was not being examined during a flare-up, but evidence suggested that the Veteran had pain which limited functional ability during a flare up. The examiner estimated that range of motion during a flare-up was right knee flexion was to 90 degrees and extension was normal. The examiner estimated that range of motion during a flare-up was left knee flexion was to 90 degrees and extension was normal.

The examiner specifically found that the Veteran did not have muscle atrophy or ankylosis in either knee. There was no recurrent subluxation or persistent instability in either knee, no ligament tear in either knee, and no recurrent patellar instability in either knee. The examiner noted that the Veteran did not require a prescription for an assistive device to aid in ambulation.

The examiner noted that the Veteran had a right knee total replacement in 2008 and it resulted in chronic residuals consisting of severe painful motion or weakness and surgical scarring. The Veteran also constantly used a cane to help him walk due to arthritis in both knees. The examiner opined that there was no functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. The examiner also opined that that the Veteran's knee disabilities impacted his ability to perform any type of occupational tasks as occupational tasks that required prolonged sitting, standing, or walking longer than 10 minutes would likely have a negative impact on his ability to function in the workplace.

In the March 2025 rating decision on appeal, the rating of the Veteran's right knee disability was increased to 60 percent, effective December 10, 2024, the date of the December 2024 VA contract examination. The rating of the Veteran's left knee disability was continued at 10 percent.

At a December 2025 videoconference hearing, the Veteran testified that he continued to have left knee pain, which he rated as 4 out of 10. He testified that his right knee pain was at a 6 out of 10. He described he would have pain in his right knee when he would walk. He described that his pain was at that level for about the last three years. He testified that he constantly used a cane to help him walk. He testified that he would stumble when he walked. He testified that he had flare-ups of both knees, which would get so severe he would have to lay down or sit down. He described that his flare-ups would happen daily and sometimes he would fight through them. These flare-ups have been consistent for at least four or five years. He also had difficulty bending and picking things up during flare-ups. He also had swelling in his knees and difficulty sleeping because of knee pain.

Right Knee

Based on a review of the record, the Board concludes that a 60 percent rating, but no higher, is warranted throughout the period on appeal.

In the December 2024 VA contract examination, the only examination of record during the period on appeal, the VA contract examiner specifically found that the Veteran's 2008 right knee total replacement had resulted in chronic residuals consisting of severe painful motion, which meets the 60 percent criteria under Diagnostic Code 5055. Throughout the Veteran's VA treatment and during
These flare-ups have been consistent for at least four or five years. He also had difficulty bending and picking things up during flare-ups. He also had swelling in his knees and difficulty sleeping because of knee pain.

Right Knee

Based on a review of the record, the Board concludes that a 60 percent rating, but no higher, is warranted throughout the period on appeal.

In the December 2024 VA contract examination, the only examination of record during the period on appeal, the VA contract examiner specifically found that the Veteran's 2008 right knee total replacement had resulted in chronic residuals consisting of severe painful motion, which meets the 60 percent criteria under Diagnostic Code 5055. Throughout the Veteran's VA treatment and during both the July 2024 and December 2025 videoconference hearing, the Veteran consistently reported having continued severe pain following his 2008 total right knee replacement. Accordingly, in providing the Veteran with the benefit of the doubt, the Board finds that his right knee disability has manifested in such symptoms throughout the period on appeal, and a higher 60 percent rating is warranted for the period prior to December 10, 2024.

A rating higher than 60 percent is not warranted at any point during the period on appeal. A 60 percent rating under Diagnostic Code 5055 is the maximum schedular disability rating available under this that code (excluding a 100 percent disability rating assigned for four months following implantation of prosthesis under the revised criteria, or the twelve months under the previous criteria). The record does not reflect that the Veteran underwent an additional knee replacement in his right knee after 2008.

The Board has considered all potentially applicable diagnostic codes for the Veteran's right knee disability in accordance with Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, there is no higher rating available under any other provision governing the evaluation of knee disabilities.

The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable, other than to the extent of allowing a 60 percent rating?for the Veteran's?status right knee total arthroplasty, because otherwise the evidence is?persuasively against the assignment of higher ratings beyond that awarded by this decision.? 38 U.S.C. §?5107 (b); 38?C.F.R. §§ 4.3, 4.7.???

Left Knee

Based on a review of the record, the Board concludes that a higher rating is not warranted based on limitation of flexion of the left knee at any point during the period on appeal.??At worst during the period on appeal,?with consideration of the Veteran's description of pain on range of motion, after repetitive use, and during flare-ups,?his left knee flexion was to 90 degrees; which was shown on December 2024 VA contract examination; the 10 percent rating currently assigned is based on painful motion, which has been shown consistently throughout the period on appeal. The Board finds that the criteria for a higher 20 percent rating under Diagnostic Code 5260, for limitation of flexion, are not met as the record does not show flexion limited to 30 degrees.??

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. ?Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. ?See Esteban v. Brown, 6?Vet. App.?259, 261-62 (1994); Lyles v. Shulkin, 29?Vet. App.?107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

The Board finds that compensable ratings are also not warranted under any additional Diagnostic Codes for the Veteran's left knee disability. ? While on the December 2024 VA contract examination the Veteran was noted to have painful motion on extension, at no point did he have any limitation of extension. However, the Veteran's 10 percent rating for limitation of flexion was based on painful motion. Accordingly, the provisions of 38 C.F.R. § 4.59 for a minimal compensable rating for painful motion was no longer applicable and for the Veteran to maintain a compensable rating under Diagnostic Code 5251, a compensable level is necessary. That is not shown, as the record reflects that the Veteran's limitation of extension was normal throughout the period on appeal.

Additionally, throughout the period on appeal, the Veteran does not assert and there is no evidence in the record of a diagnosis of a meniscus (semilunar cartilage) condition, diagnosis of recurrent subluxation or instability, no diagnosis of patellar instability, and no evidence of
rating for limitation of flexion was based on painful motion. Accordingly, the provisions of 38 C.F.R. § 4.59 for a minimal compensable rating for painful motion was no longer applicable and for the Veteran to maintain a compensable rating under Diagnostic Code 5251, a compensable level is necessary. That is not shown, as the record reflects that the Veteran's limitation of extension was normal throughout the period on appeal.

In deciding the?Veteran's claims for increase, the Board has also considered the Veteran's lay statements that?his service-connected left and right knee instability were worse than?currently evaluated.? He is competent to report symptoms, because this requires only personal knowledge as it comes to him through his senses. Layno?v. Brown,?6?Vet. App.?465, 471?(1994). He is not, however, competent to identify a specific level of disability of this disorder according to the appropriate Diagnostic Codes. Jandreau v. Nicholson,?492 F.3d 1372, 1376-77?(Fed. Cir. 2007). Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by?the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations.? The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which?his?disabilities are evaluated.?As such, the Board finds these records to be more probative than the Veteran's subjective complaints of increased symptomatology.????

In making the above findings, the Board is?cognizant?of the fact that the Veteran has used medication?to treat his?bilateral?knee disabilities. The Court has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria.?See?Jones v. Shinseki, 26?Vet. App.?56 (2012). More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities" and held that "Jones applies in the evaluation of musculoskeletal disabilities where the relevant [diagnostic code] does not reference medication as a factor in evaluation."?Ingram v. Collins, 38?Vet. App.?130 (2025).?

Indeed, even when considering factors such as increased pain, and disregarding any ameliorative effects of medication, the most probative evidence of record does not indicate flexion of the Veteran's left knee flexion would be limited to 30 degrees or less, or his left knee extension limited to 15 degrees to warrant a rating in excess of 20 percent under Diagnostic Codes 5260 and 5261. In that regard, the evidence does not suggest, nor is there any other medical evidence from the current appeals period showing flexion or extension would be limited to such an extent to warrant a higher rating, without considering his use of medication. The December 2024 examiner also considered the Veteran's lay reports of his own symptoms when providing the range of motion estimates for flareups and repeated use over time and determined pain would limit flexion to 90 degrees with no impairment on extension.

The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable, other than to the extent of allowing a 10 percent rating?for the Veteran's?left knee disability, because otherwise the evidence is?persuasively against the assignment of higher ratings beyond that awarded by this decision.? 38 U.S.C. §?5107 (b); 38?C.F.R. §§ 4.3, 4.7.???

Bilateral Eye Condition

The Veteran seeks higher initial ratings for his bilateral eye condition, which includes primary open angle glaucoma, nuclear sclerosis, and pseudophakia. His bilateral eye condition has been rated under 38 C.F.R. § 4.79, Diagnostic Code 6012-6066 as 10 percent disabling from May 7, 2015, and as 20 percent disabling from December 12, 2024.

Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned. See 38 C.F.R. § 4.27.

During the pendency of the appeal, VA issued
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Bilateral Eye Condition

Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned. See 38 C.F.R. § 4.27.

During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15,316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments.

Both the former and revised criteria for Diagnostic Code 6012 provide a minimum 10 percent rating if continuous medication is required.

Under the former criteria, Diagnostic Code 6012 instructed to evaluate based on incapacitating episodes. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted.

A Note following the former Diagnostic Code 6012 indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider.

Under the revised criteria, Diagnostic Code instructs the rater to evaluate pursuant to the General Rating Formula for Diseases of the Eye.

Under the revised criteria, the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation.

Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted.

Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091.

With regard to visual impairment, the amendments made no substantive changes to how visual acuity is rated. The use of a Goldmann chart is no longer required for visual field and muscle function examinations. There are otherwise no substantive changes to how those types of visual impairment are rated. Impaired visual acuity is rated under diagnostic codes 6061-6066 based on the best corrected distance vision. 38 C.F.R. §§ 4.76, 4.79. Impairment of visual fields are rated under Diagnostic Code 6080-6081 based on the average concentric contraction of the visual field of each eye; asymmetric impairments are converted to their visual acuity equivalents. 38 C.F.R. §§ 4.77, 4.79. Impaired muscle function is rated under Diagnostic Code 6090
mann chart is no longer required for visual field and muscle function examinations. There are otherwise no substantive changes to how those types of visual impairment are rated. Impaired visual acuity is rated under diagnostic codes 6061-6066 based on the best corrected distance vision. 38 C.F.R. §§ 4.76, 4.79. Impairment of visual fields are rated under Diagnostic Code 6080-6081 based on the average concentric contraction of the visual field of each eye; asymmetric impairments are converted to their visual acuity equivalents. 38 C.F.R. §§ 4.77, 4.79. Impaired muscle function is rated under Diagnostic Code 6090-6091 with an evaluation for diplopia being assigned to only one eye. 38 C.F.R. §§ 4.78, 4.79.

When both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, the evaluation is determined by separately evaluating the visual acuity and visual field defect (expressed as a level of visual acuity) and combined under the provisions of 38 C.F.R. § 4.25. See 38 C.F.R. § 4.77 (c).

The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. 38 C.F.R. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id.

Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c).

The table of Impairment of Central Visual Acuity encompasses Diagnostic Codes 6061-6066.

Diagnostic Code 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Where the visual acuity in one eye (the poorer eye) is 20/50, the following ratings apply. A 10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. Where the visual acuity in one eye (the poorer eye) is 20/70, the following ratings apply. A 30 percent rating is warranted where vision in the other eye is also 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40.

Where the visual acuity in one eye (the poorer eye) is 20/100, the following ratings apply. A 50 percent rating is warranted where vision in the other eye is also 20/100. A 30 percent rating is warranted where vision in the other eye is 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40.

Where visual acuity in one eye (the poorer eye) is 20/200, the following ratings apply. A 70 percent rating is warranted where vision in the other eye is also 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40.

Where visual
20/50. A 10 percent rating is warranted where vision in the other eye is 20/40.

Where visual acuity in one eye (the poorer eye) is 15/200, the following ratings apply. An 80 percent rating is warranted where vision in the other eye is also 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40.

Where visual acuity in one eye (the poorer eye) is 10/200, the following ratings apply. A 90 percent rating is warranted where vision in the other eye is also 10/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 50 percent rating is warranted where vision in the other eye is 20/70. A 40 percent rating is warranted where vision in the other eye is 20/50. A 30 percent rating is warranted where vision in the other eye is 20/40.

In a May 2015 VA eye clinic treatment note, the Veteran was seen for a follow-up and reported no complaints or eye pain. The provider noted he was positive for glaucoma. His vision was noted to be 20/20 in the right eye and 20/40-1 in the left eye.

In a July 2015 VA eye clinic treatment note, the Veteran reported a little pain in his left eye when it was touched.

In December 2016, the Veteran underwent a laser trabeculoplasty procedure for his left eye. at a VA facility.

In his May 2017 claim, he reported having blindness in his eyes.

In an August 2019 VA contract eye examination, the examiner noted primary open angle glaucoma was diagnosed in the 2000s, nuclear sclerosis was diagnosed in 2017, and pseudophakia was diagnosed in 2017. He had primary open angle glaucoma in both eyes, nuclear sclerosis affected the right eye, and pseudophakia affected the left eye. The Veteran used medication to reduce eye pressure and pain. On physical examination, visual acuity for uncorrected distance of the right eye was 20/40 and for the left eye 20/200. Corrected distance for the right eye was 20/40 and for the left eye 20/70. Uncorrected near distance (reading) for the right eye was 20/100 and for the left eye was 5/200 or worse. Corrected near distance (reading) for the right eye was 20/40 and for the left eye was 20/70. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the vision being worse. His pupils were not round and reactive or light and there was no afferent pupillary defect present. The Veteran had corneal irregularity that resulted in severe irregular astigmatism He did not use contact lenses to correct the irregularity or for visual acuity. Tonometry was performed using the Goldmann applanation and right eye pressure was 22 and left eye pressure was 13. The examiner found that the Veteran did not have any incapacitating episodes attributable to an eye condition. The examiner opined that the Veteran's eye condition impacted his ability to work because he had poor vision in his left eye and loss of depth perception may make vision intensive activities more difficult.

At the July 2024 hearing, the Veteran testified that he injured his eyes during service and had continued
there was no afferent pupillary defect present. The Veteran had corneal irregularity that resulted in severe irregular astigmatism He did not use contact lenses to correct the irregularity or for visual acuity. Tonometry was performed using the Goldmann applanation and right eye pressure was 22 and left eye pressure was 13. The examiner found that the Veteran did not have any incapacitating episodes attributable to an eye condition. The examiner opined that the Veteran's eye condition impacted his ability to work because he had poor vision in his left eye and loss of depth perception may make vision intensive activities more difficult.

At the July 2024 hearing, the Veteran testified that he injured his eyes during service and had continued symptomatology since his separation. He testified that a few years after service he had eye surgery for glaucoma.

In a December 2024 VA examination, bilateral glaucoma, left eye pseudophakia, and right eye cataract were diagnosed. The examiner noted that treatment for his eye conditions included past medication, cataract surgery, glaucoma surgery, and eyedrops. They noted his current symptoms included poor vision, headaches with a throbbing sensation. His current treatment included eye drops. His eye condition impacted his ability to perform occupational functioning and ordinary activities, difficulty with reading, and he did not drive or cook. On physical examination, visual acuity for uncorrected distance of the right eye was 20/40 and for the left eye 20/100. Corrected distance for the right eye was 20/20 or better and for the left eye 20/50. Uncorrected near distance (reading) for the right eye was 20/4 and for the left eye was 5/100. Corrected near distance (reading) for the right eye was 20/20 or better and for the left eye was 20/40. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the vision being worse. His pupils were round and reactive or light, but there was no afferent pupillary defect present. The Veteran did not have corneal irregularity that resulted in severe irregular astigmatism. Tonometry was performed using the Goldmann applanation and right eye pressure was 14 and left eye pressure was 12. The examiner found that the Veteran did not have any incapacitating episodes attributable to an eye condition. The examiner opined that the Veteran's eye condition impacted his ability to work because his glaucoma caused blurs that caused difficulty with reading and driving.

In a January 2025 rating decision, service connection for a bilateral eye condition, to include primary open angle glaucoma, nuclear sclerosis, and pseudophakia was granted and assigned a 10 percent rating, effective May 7, 2015, and a 20 percent rating effective December 12, 2024.

At the December 2025 videoconference hearing, the Veteran testified that he was blind in his left eye, but he did not see that as a problem because he had his right eye. He described as long as he could see out of his right eye it was not a problem. He testified that he received treatment at a VA clinic and two weeks prior he was seen for a set of glasses.

Based on a review of the record, the Board concludes that higher initial ratings for the Veteran's bilateral eye condition are not warranted at any point during the period on appeal.

For the period prior to December 12, 2025, an initial rating higher than 10 percent is not warranted. In the January 2025 rating decision, the AOJ assigned a 10 percent rating for this period based on continuous medication being required for the Veteran's bilateral eye condition, which is the minimum evaluation under Diagnostic Code 6012. Higher ratings under both the prior and current rating criteria are not warranted under the General Rating Formular for Diseases of the Eye, which provides ratings based on the number of documented incapacitating episodes in a 12 month period, with the only difference being how incapacitating episodes were defined. For the prior criteria, incapacitating episodes were a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider and the current criteria provides that an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes During this period, the evidence record does not reflect that based on the Veteran's eye condition he was prescribed bed rest and treatment by a physician or other health care provider at least 3 times in 12 months during this period. While the Veteran received VA treatment for his eye condition during this period, to include a laser treatment for
number of documented incapacitating episodes in a 12 month period, with the only difference being how incapacitating episodes were defined. For the prior criteria, incapacitating episodes were a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider and the current criteria provides that an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes During this period, the evidence record does not reflect that based on the Veteran's eye condition he was prescribed bed rest and treatment by a physician or other health care provider at least 3 times in 12 months during this period. While the Veteran received VA treatment for his eye condition during this period, to include a laser treatment for his left eye, the evidence of record does not reflect that during this period his eye condition required a clinic visit specifically for treatment purposes at least 3 times in 12 months during this period. Accordingly, the criteria for a higher 20 percent rating under the General Rating Formula for Diseases of the Eye have not been met, prior to December 12, 2024, under both the prior and amended criteria.

Under the amended criteria, beginning May 13, 2018, the General Rating Formula for Diseases of the Eye instructs to evaluate the disability based on incapacitating episodes or visual impairment, whichever is greater. At worst during this period, the Veteran's visual acuity for corrected distance on the August 2019 VA contract examination was 20/70 in his left eye and 20/40 in his right eye. Under Diagnostic Code 6066, vision of 20/70 in one eye and 20/40 in the other eye corresponds to a 10 percent rating. Accordingly, an initial rating in excess of 10 percent for the period prior to December 12, 2024, is denied

For the period beginning December 12, 2024, a rating higher than 20 percent is not warranted. During this period, the evidence record does not reflect that based on the Veteran's eye condition he was prescribed bed rest and treatment by a physician or other health care provider at least 5 times in 12 months during this period. Additionally, the evidence of record does not reflect that during this period his eye condition required a clinic visit specifically for treatment purposes at least 5 times in 12 months during this period. Accordingly, the criteria for a higher 40 percent rating under the General Rating Formula for Diseases of the Eye have not been met during the period beginning December 12, 2024, under both the prior and amended criteria.

Regarding visual acuity, at worst during this period, the Veteran's visual acuity for corrected distance on the December 2024 VA examination was 20/50 in his left eye and 20/20 or better in his right eye. Under Diagnostic Code 6066, vision of 20/50 in one eye and 20/20 in the other eye corresponds to a 10 percent rating. Accordingly, a rating in excess of 20 percent for the period prior beginning December 12, 2024, is denied.

In deciding the Veteran's claim for increase, the Board has considered his lay statements that his service-connected disability is more severe than currently evaluated. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno, 6?Vet. App.?at 465. He is not, however, competent to identify a specific level of disability of this disorder according to the appropriate Diagnostic Codes. Jandreau, 492 F.3d at 1376-77. Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the qualified personnel who have treated him during the current appeal, and who have rendered pertinent opinions in conjunction with the evaluations. The competent medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which his disabilities are evaluated. As such, the Board finds these records to be more probative than the Veteran's subjective complaints of increased symptomatology.??

The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the evidence is persuasively against the assignment of higher ratings.?38?U.S.C. §?5107?(b); 38?C.F.R. §§?4.3, 4.7.???

TDIU prior to August 1, 2023

As noted above, in his August 2025 VA Form 10182 the Veteran appealed the denial of entitlement to TDIU as addressed in an April 2025 rating decision and in an interm. November 2025 rating decision entitlement to TDIU was granted, effective August 1, 2023. As the issue of TDIU has been raised as part
doctrine of reasonable doubt but has determined that it is inapplicable because the evidence is persuasively against the assignment of higher ratings.?38?U.S.C. §?5107?(b); 38?C.F.R. §§?4.3, 4.7.???

TDIU prior to August 1, 2023

As noted above, in his August 2025 VA Form 10182 the Veteran appealed the denial of entitlement to TDIU as addressed in an April 2025 rating decision and in an interm. November 2025 rating decision entitlement to TDIU was granted, effective August 1, 2023. As the issue of TDIU has been raised as part of his claims for increased ratings for his right and left knee disabilities and his bilateral eye condition, the issue of entitlement to TDIU prior to August 1, 2023 is therefore before the Board.? See Harper, 30?Vet. App.?at 356;?Rice, 22?Vet. App.?at 447.

Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to?render?it impossible for the average person to follow a?substantially gainful?occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341(a). In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15.???

A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a).???

The term unable to secure and follow a substantially gainful occupation in 38 C.F.R. § 4.16 (b) includes two components.? First, there is an economic component which essentially contemplates 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. Second, there is a non-economic component dealing with the individual veteran's ability to follow and secure employment. For the second component, attention must be given to (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31?Vet. App.?58 (2019). As sedentary is defined as doing or requiring much sitting, the Board finds that sedentary employment is a job where the worker primarily sits down. Merriam-Webster's Collegiate Dictionary 1123 (2003).?

The Court of Appeals for Veterans Claims defined "employment in a protected environment" within?38 C.F.R. §?4.16?(a) to unambiguously mean "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?(2024).??

The Veteran's service-connected disabilities prior to August 1, 2023 are right total knee arthroplasty, rated as 30 percent disabling from February 18, 2003, 100 percent from May 23, 2008, 30 percent disabling from December 10, 2024, and in accordance with this decision, 60 percent disabling from February 8, 2023; unspecified depressive disorder, rated as 50 percent from July 27, 2023; bilateral eye condition rated as 10 percent disabling from May 7, 2015 and as 20 percent disabling from December 12, 2024; and left knee disabling rated as 10 percent disabling from November 9, 2009. Accordingly, the schedular criteria for TDIU have been met beginning February 8, 2023 with the above grant of a higher 60 percent rating.? 38 C.F.R. § 4.16 (a)(2).

The Veteran's VA treatment records reflect that the Veteran had a high school diploma and two years of college education. He had a history of working construction from 2001 to 2002 when he became a superintendent. After that his VA treatment records reflect that he worked part time as a grocery bagger, working 4 days a week. He lost his job in 2014 and in July 2016 he reported he was working stocking shelves and on his feet all day.

In a May 2015 VA knee examination, the Veteran reported that his knee condition limited his ability to walk to one to two blocks at a time. He also had limited ambulatory endurance and ability to climb stairs. The examiner opined that the Veteran's knee disabilities impacted his ability to perform any type of occupational task as it had a significant impact on ambulation.

At the July 2024 videoconference hearing, the Veteran testified that he had not worked since 2008 when he worked in construction. He testified that he had a noticeable limp after his right knee replacement. He also testified that his age was part of his difficulties finding a job. He testified that his eyes were starting to get worse and having difficulty seeing.

At the June 2025 travel board hearing, the Veteran testified that he last worked in 2002 when he worked for a construction company. He testified that he left the company because his knees were too bad and he could not do things like walk on top of houses, inspect roofs, and other things to build houses. He testified that he worked for the company for 10 years and he would have continued to work if he could. He described that he could not sit down for too long a period of time and could not stand for a considerable period of time. He testified he had an associate's degree in psychiatry.

In an October 2025 decision, the Board found that entitlement to TDIU was warranted based on his service-connected disabilities. A November 2025 rating decision implemented the decision, and the AOJ assigned an effective date of August 1, 2023 for the award of TDIU.

At the December 2025 videoconference hearing, the Veteran testified that he last worked before his right knee surgery. He testified that he worked in construction and then was a building superintendent which he worked at for about 8 years. After his surgery he could no longer work because he could not walk due to his knees.

The ultimate question of whether a Veteran is capable of securing or following substantially gainful employment is an adjudicatory determination, not a medical one. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013).

The Board finds that a TDIU is warranted prior to August 1
, 2023 for the award of TDIU.

The Board finds that a TDIU is warranted prior to August 1, 2023. The Veteran's claim for TDIU is part and parcel with his claims for increased ratings for his right and left knee disabilities and his bilateral eye condition. See Harper, 30 Vet. App. at 356. Giving the Board's finding above that a 60 percent rating for status post a total right knee arthoplasty is warranted for the entire period on appeal, which began February 8, 2023, the Veteran met the schedular criteria beginning that date.

While the Veteran asserts that he has been unemployed since 2008, the record reflects that he has either been unemployed or employed in a protected environment throughout the period on appeal. Ray, 31 Vet. App. at 73. The Veteran's work history included construction, building superintendent, and then as a part-time grocery store employee. The record reflects that prior to August 1, 2023, the Veteran's right and left knee disabilities manifested in symptoms that limited his ability to work for long periods or long distances and limited his ability to climb stairs, which would limit his ability to perform the activities necessary to work in construction or as a building superintendent. Additionally, the Veteran's bilateral eye condition manifested in poor vision in his left eye and a loss of depth perception, which the August 2019 VA contract examiner opined impacted his ability to work because it could make vision intensive activities more difficult.

Accordingly, and resolving any reasonable doubt in the Veteran's favor, the Board finds that the Veteran has been precluded from securing and following gainful employment prior to August 1, 2023 due to his service connected disabilities.

I. Cannaday

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Struening, Eric

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.

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