Citation Nr: 0112647 Decision Date: 05/03/01 Archive Date: 05/09/01 DOCKET NO. 94-35 782 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Entitlement to service connection for impotency secondary to medication used to treat a service-connected disability. 2. Entitlement to an increased evaluation for discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Douglas E. Massey, Associate Counsel INTRODUCTION The veteran served on active duty from June 1982 to November 1988. His claims initially came before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In January 1997, the Board remanded the case to the RO for additional development. That development has been completed by the RO, and the case is once again before the Board for appellate review. The Board notes that the veteran has recently moved to Pennsylvania, and the case has therefore been transferred to the RO in Pittsburgh. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of this appeal has been obtained by the RO. 2. The veteran's impotency (erectile dysfunction) has fully resolved. 3. The veteran is right-hand dominant. 4. The veteran's disability due to supraspinatus tendonitis and bursitis of the right shoulder is manifested by subjective complaints of pain and numbness of the right upper extremity, strength of 5/5, a slightly positive impingement test, 160 degrees of abduction, 60 degrees of extension, and 90 degrees of internal and external rotation. 5. The veteran's disability due to discogenic disease of C4- 5 and C5-6 is manifested by full range of motion, no current complaints of pain, and X-ray evidence of early degenerative changes in the uncovertebral joints at the C4-5 and C5-6 levels. CONCLUSIONS OF LAW 1. The veteran does not currently suffer from impotency as a result of service or a service-connected disability. 38 U.S.C.A. § 1131 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.303, 3.310 (2000). 2. A 20 percent evaluation is warranted for the veteran's supraspinatus tendinitis and bursitis of the right shoulder. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5201 (2000). 3. An evaluation in excess of 10 percent for the veteran's discogenic disease of C4-5 and C5-6 is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 2000); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5003, 5290 (2000). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Impotency This appeal arises out of the veteran's claim of entitlement to service connection for impotency. The veteran maintains that he experienced erectile dysfunction for several years as a result of medication he was taking for his service- connected cervical spine and right shoulder disability. As a preliminary matter, the Board notes that effective November 9, 2000, the Veterans Claims Assistance Act of 2000, was signed into law. See Pub. L. No. 106-475, 114 Stat. 2096 (2000) ("VCAA"). This law sets forth requirements for assisting a claimant in developing the facts pertinent to his or her claim. The Board finds that even though this law was enacted during the pendency of this appeal, and thus, has not been considered by the RO, there is no prejudice to the veteran in proceeding with this appeal. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (when the Board addresses a matter not addressed by the RO, the Board must provide an adequate statement of reasons and bases as to why there is no prejudice to the veteran). The veteran was provided adequate notice as to the evidence needed to substantiate his claim. Although the veteran was initially informed of the evidence needed to establish a "well-grounded" claim, which is no longer a valid basis for service connection, see VCAA, supra, the basic elements for establishing service connection, irrespective of the "well- grounded" doctrine, have remained unchanged. Furthermore, the RO has made satisfactory efforts to ensure that all relevant evidence has been associated with the claims file. The Board notes that the veteran was notified that he had been scheduled for an examination with a VA urologist, but that he failed to appear with no explanation provided. Thus, it appears that all relevant facts have been properly and sufficiently developed as contemplated by the applicable law, and the Board may proceed to adjudicate this claim based on the evidence currently of record. See 38 C.F.R. § 3.655 (2000); see also Woods v. Derwinski, 1 Vet. App. 190, 193 (1991). According to the law, service connection will be granted if it is shown that a veteran has a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease incurred in active military service. See 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. In addition, a disability which is proximately due to or the result of another disease or injury for which service connection has been granted shall be considered a part of the original condition. See 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995). "Generally, to prove service connection, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury." Pond v. West, 12 Vet. App. 341, 346 (1999). In cases of secondary service connection, medical evidence is also required to establish a link between the claimed disability and the service-connected disability. See Jones v. Brown, 7 Vet. App. 134 (1994). Where the determinative issue involves a medical diagnosis, competent medical evidence is required. This burden typically cannot be met by lay testimony because lay persons are not competent to offer medical opinions. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In this case, service connection has been established for discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement. The veteran now claims that he had experienced erectile dysfunction for several years while taking medication for that disability and that service connection is therefore warranted. The record reflects that the veteran was indeed taking Flexeril for his service-connected discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement which may have caused or contributed to his erectile dysfunction. An October 1994 VA outpatient treatment report noted that the veteran should be seen by a urologist for impotence. VA outpatient treatment reports dated in 1994 show that the veteran reported a three-year history of impotency which began the same time he started taking Flexeril. The impression was impotency with an unknown etiology. The veteran also submitted copies of several pages from Delmar's Nurse's Drug Reference which state that impotency was a common side-effect of cyclobenzaprine hydrochloride (Flexeril). Thus, the Board recognizes that the veteran probably experienced erectile dysfunction as a result of taking Flexeril for his service-connected discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement. Nevertheless, it appears that this condition resolved shortly after the veteran discontinued the medication. A VA outpatient treatment report dated in August 1997 noted that the veteran's erectile dysfunction had resolved since he stopped taking medication and that he was now able to spontaneously achieve an erection. The veteran has also admitted in written statements and at a hearing held before the undersigned member of the Board in October 2000 that this condition had fully resolved. However, he argued that VA compensation should be awarded for the period from September 1994 until June 1996 while he experienced erectile dysfunction as a result of taking Flexeril. He explained that this problem impaired his relationship with his wife to such an extent that they divorced in 1999. The Board finds no merit in the veteran's argument. As noted, the veteran must prove that he suffers from a current disability. See Pond, 12 Vet. App. at 346; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of the presently claimed disability, there can be no valid claim). Here, the veteran's erectile dysfunction was a transient condition related to medication and has completely resolved. Under these circumstances, the Board can only conclude that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for impotency. In reaching this conclusion, the Board acknowledges that, under the prior and revised provisions of 38 U.S.C.A. § 5107(b), the benefit of the doubt is to be resolved in the claimant's favor in cases where there is an approximate balance of positive and negative evidence in regard to a material issue. However, as the preponderance of the evidence is against the veteran's claim, that doctrine is not for application in this case. See 38 U.S.C.A. § 5107(b); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-99 (2000) (to be codified as amended at 38 U.S.C. § 5107(b)); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). II. Increased Evaluation for Discogenic Disease of C4-5 and C5-6 with Right Shoulder Upper Extremity Involvement The veteran's service medical records show that he was seen for an eight-month history of right shoulder pain in 1988. The diagnosis was rotator cuff strain. As a result, a December 1988 rating decision granted service connection for a right rotator cuff strain and assigned a noncompensable (zero percent) evaluation, effective as of November 1988. The veteran submitted an August 1989 X-ray report showing early degenerative changes in the uncovertebral joints at the C4-5 and C5-6 levels. The diagnosis was early discogenic disease of the cervical spine. As a result, the RO issued a December 1989 rating decision which granted service connection for discogenic disease of the cervical spine. The RO combined this disability with his service-connected right shoulder disability and characterized it as "discogenic disease of C4-5 and C5-6 with right shoulder and upper extremity involvement." The RO assigned a combined 10 percent disability evaluation, effective as of November 1988. The veteran now claims that this disability has worsened and that a higher disability evaluation is therefore warranted. In such cases, VA has a duty to assist the veteran in developing facts which are pertinent to that claim. See VCAA, supra. The Board finds that all relevant facts have been properly developed, and that all relevant evidence necessary for an equitable resolution of the issue on appeal has been identified and obtained by the RO. That evidence includes the veteran's service medical records, several recent VA examination reports addressing the disability at issue, VA outpatient treatment reports, and a transcript from a hearing held in October 2000 before the undersigned member of the Board. The Board has not been made aware of any additional relevant evidence which is available in connection with this appeal. Therefore, no further assistance to the veteran regarding the development of evidence is required. Id. A. Factual Background In evaluating the veteran's neck and right shoulder disability, the RO considered an August 1990 VA hospitalization report. The veteran was seen at that time for a two-year history of neck pain, as well as numbness and tingling of the right second and third fingers. Upon physical examination, the veteran's neck was manifested by generalized pain, paraspinal spasm at the right, and limitation of motion. Range of motion testing showed flexion from zero to 40 degrees, extension from zero to 20 degrees, and normal rotation. No sensory or motor deficits were noted in either upper extremity. The veteran underwent rehabilitation therapy, with a short-term goal of relieving pain and a long-term goal of returning to work. Motivation and prognosis were good. The diagnoses included cervical spondylosis with radiating pain to the right upper extremity. The veteran was afforded a VA orthopedic examination in January 1991, at which time he reported a sharp pain in his right shoulder with radiation to his right hand and fingers. Pain was reportedly continuous and aggravated by any type of movement. He also reported moderate to severe pain of the cervical spine since the onset of right shoulder pain. Upon physical examination, tenderness was present over the cervical spine at the C5 and C6 region and over the superior- lateral aspect of the right shoulder. No sensory or motor deficits were present. Range of motion testing of the right shoulder showed forward flexion and abduction of 180 degrees, external and internal rotation of 90 degrees, and backward extension of 60 degrees. Both upper extremities exhibited motor strength of 5/5, and deep tendon reflexes were 2+ and symmetrical. X-rays of the cervical spine showed slight narrowing at C3-5, especially at C4-5. At a VA orthopedic examination in August 1991, the veteran explained that pain began in his right shoulder and gradually extended to both upper extremities and, to a much lesser extent, the neck. Pain was reportedly located in both shoulders, the deltoid area, the biceps, the forearms, and the hands, particularly the thumbs, the index fingers and the fifth fingers. Pain was described as pulsatile and was not aggravated by any movement. The veteran indicated that this condition was slowly worsening. Objectively, no postural abnormalities or fixed deformities were present. Musculature of the back was normal, with no atrophy present. Range of motion testing of the cervical spine was normal with respect to forward flexion, backward extension, lateral flexion, and rotation. No objective evidence of pain on motion was observed, and reflexes were normal. X-rays revealed no evidence of cervical pathology, as the intervertebral spaces were within normal limits. The examiner concluded with a diagnosis of "history of cervical spine disease with nerve encroachment with very atypical symptomatology, not substantiated on exam today." When hospitalized at a VA facility in December 1991, the veteran related a four-year history of pain in his neck and right shoulder following a football injury in 1986. The veteran indicated that pain was now isolated in his right shoulder with abduction. It was noted that the veteran was employed as a driver and a correctional officer. Objectively, the veteran's neck was supple and demonstrated full range of motion. Cranial nerves II through XII were grossly intact, and motor strength was 5/5 globally. Sensory examination was intact to pin-prick. Deep tendon reflexes were normal except for a slight decrease of the left triceps. The physician indicated that cervical disc herniation was to be ruled out. An EMG revealed occasional fibs and positive waves in the right cervical paraspinous muscles; otherwise, the study was normal. The impression was "unspecified cervical radiculopathy." The veteran returned within six days after being discharged due to constant pain in his neck and right shoulder area. Surgical intervention was discussed. The veteran was released and advised that he could return to work provided that he refrain from lifting over twenty pounds. VA outpatient treatment reports dated from 1992 to 1993 documented the veteran's complaints of right shoulder pain. An MRI performed in March 1992 showed a normal cervical spine. In July 1992, it was noted that the veteran's right shoulder pain should be relieved by therapy. When seen in August 1992, it was noted that his right shoulder had functional range of motion. Radiographs taken in November 1992 disclosed no definite evidence of a supraspinatus tear. In September 1993, the veteran underwent right shoulder arthroscopy at a VA medical center. A report from that procedure noted the veteran's history of a dislocated right shoulder in 1986 with subsequent persistent pain and multiple exacerbations with heavy lifting. Extensive work-up was performed, including EMG and MRI series, all of which showed a normal cervical spine. Physical examination revealed that the veteran's right arm was neurovascularly intact with 2+ peripheral pulses. His right shoulder exhibited full range of motion with pain from 30 to 90 degrees of abduction. No impingement signs were present. There was no weakness, and apprehension testing was negative. A diagnostic arthroscopy revealed some fraying of the glenoid labrum and a small tear both anteriorly and inferiorly. Following surgery, the veteran stated that his shoulder no longer had the same "pinched-type feeling." The diagnoses at discharge included (1) tear of the glenoid labrum, (2) fraying of the glenoid labrum, and (3) fraying of the teres minor muscle. Follow-up examination in October 1993 noted that the veteran's right shoulder demonstrated good range of motion. He reported pain at extremes of motion, as well as with lifting and pushing, but added that pain had improved since surgery. No neurological findings were reported. When seen in December 1993, the veteran's right shoulder had good range of motion. In March 1994, the veteran said he continued to experience right shoulder pain. Objectively, the right upper extremity was neurovascularly intact with no sign of impingement. Pain was present from 60 to 90 degrees of abduction. The diagnosis was recurrent right shoulder pain. In July 1994, the veteran said he reinjured his right shoulder after returning to work and that he now experienced left shoulder pain. Upon physical examination, however, the right shoulder exhibited full range of motion, with no evidence of impingement or instability. The diagnosis was bilateral shoulder pain with mild tenderness. When examined by VA in January 1994, the veteran reported that his right shoulder had improved since surgery but that an aching, throbbing pain was still present which increased with lifting and cold weather. He indicated that pain radiated to his right hand and was worse with abduction. He also described numbness and weakness of the right arm and hand. Physical examination revealed no evidence of swelling or deformity. Range of motion testing revealed that flexion, extension and rotation were normal, but that abduction was decreased by 25 degrees. X-ray examination of the right shoulder was within normal limits. The examiner concluded with diagnoses of decreased abduction of the right shoulder and status post arthroscopic surgery of the right shoulder by history. Pursuant to the Board's January 1997 Remand, the veteran was afforded orthopedic and neurological examinations by VA to determine the nature and severity of his neck and right shoulder disability. At a neurological examination in May 1997, it was noted that the veteran's initial injury of the back, neck and right shoulder had resolved except for his right shoulder injury. It was further noted that he reinjured his right shoulder following surgery in 1993. His current complaints involved pain in the forearm and numbness in the arm and fingers. Upon physical examination, pain was present in the right shoulder on palpation but not in the neck area. Strength was 5/5 in the deltoids, biceps, triceps, wrist extensor, and wrist flexors. Reflexes were 2+ throughout. There was no symmetry of sensation to light touch or pinprick in any dermatomal distribution. The examiner's impression was "history of unspecified cervical radiculopathy, currently asymptomatic except for pain in the right upper shoulder which may be related to musculoskeletal injury." At a VA orthopedic examination in June 1997, the veteran reported pain in his right shoulder which increased with overhead activity or any prolonged positioning of his shoulder. He explained that the pain was tolerable most of the time but was occasionally severe and limited activities. Physical examination of the right shoulder disclosed no evidence of paraspinal atrophy or spasm. The right shoulder demonstrated 160 degrees of active abduction and 90 degrees of internal and external rotation, with pain on internal rotation. Impingement testing was slightly positive, and pain was present on supraspinatus testing. There was no anterior instability to translation on the glenoid. Relocation testing was negative. The right upper extremity was otherwise neurologically intact. Motor strength was 5/5, sensory was intact, and deep tendon reflexes were 2+ and symmetric. Hoffmann's testing was negative. Physical examination of the cervical spine showed forward flexion of 90 degrees, extension of 20 degrees, left and right rotation of 70 degrees, and left and right lateral bending of 50 degrees. X-rays of the right shoulder were negative. Based on these findings, the assessment was supraspinatus tendinitis and mild bursitis of the right shoulder, with no evidence of frank neurologic or cervical disorder. At his October 2000 hearing before the undersigned member of the Board, the veteran testified that his right shoulder pain had actually worsened since surgery in 1993. He explained that he returned to his job as a corrections officer on the day after surgery because he was unaware that he was supposed to stay home and rest for four weeks. He indicated that he reinjured his right shoulder at work, and that pain was now constant and severe and had extended to his right forearm. He described a "pinching-type" pain, but said his right arm had full movement and no longer popped out of joint. He said he quit his job as a corrections officer before moving to Pennsylvania from Georgia, and that he was temporarily employed reading meters. B. Analysis Disability ratings are intended to compensate reductions in earning capacity as a result of the specific disorder. The ratings are intended, as far as practicably can be determined, to compensate the average impairment of earning capacity resulting from such disorder in civilian occupations. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. When the evidence is in relative equipoise, the veteran is accorded the benefit of the doubt. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The RO has evaluated the veteran's disability due to discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement under Diagnostic Code 5003, which provides that degenerative arthritis is to be evaluated based upon limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is to be assigned for X-ray evidence of involvement of two or more major joints or two or more minor joint groups. A 20 percent evaluation is warranted with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. Loss of range of motion of the cervical spine is evaluated under Diagnostic Code 5290. This code provision provides a 10 percent evaluation for slight loss of motion, a 20 percent evaluation for moderate loss of motion, and a 30 percent evaluation for severe loss of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5290. Loss of motion of the shoulder is evaluated under Diagnostic Code 5201. The record indicates that the veteran is right- handed. Under Diagnostic Code 5201, a 20 percent evaluation is assigned where motion of either arm is limited to the shoulder level. A 30 percent evaluation is provided where motion of the major arm is limited from midway between the side and shoulder level. Finally, a 40 percent rating is assigned where motion of the major arm is limited to 25 degrees from the side. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. See 38 C.F.R. § 4.71, Plate I (showing normal shoulder motion as extending from 0 to 180 degrees of forward elevation (flexion), 0 to 180 degrees of abduction, and 0 to 90 degrees of internal and external rotation). Initially, the Board notes that the veteran's discogenic disease of C4-5 and C5-6 with right shoulder upper extremity involvement appears to cause separate functional impairments that have been grouped together and assigned a combined 10 percent rating rather than assigned individual ratings. In Esteban v. Brown, 6 Vet. App. 259 (1994), the United States Court of Appeals for Veterans Claims (Court) held that separate ratings may be allowed if the symptomatology for the disorders is not duplicative or overlapping. In this case, the evidence demonstrates that the veteran's right shoulder pain is attributable to a diagnosis of supraspinatus tendonitis and bursitis, which is unrelated to his service- connected discogenic disease of C4-5 and C5-6. As such, the Board will evaluate the veteran's cervical spine and right shoulder disabilities separately. 1. Supraspinatus tendonitis and bursitis of the right shoulder Turning to the veteran's supraspinatus tendonitis and bursitis of the right shoulder, the Board finds that the evidence supports a separate 20 percent evaluation under Diagnostic Code 5201. As noted above, a 20 percent evaluation is assigned under this diagnostic code where motion of the major arm is limited to the shoulder level. In the instant case, the veteran is able to abduct his right arm above shoulder level. For example, the January 1991 VA examination report noted he was able to abduct his right arm to 180 degrees, which is essentially normal. When seen in August 1992, September 1993, and October 1993, full range of motion of the right shoulder was reported. The January 1994 VA examination report noted that abduction was decreased by only 25 percent, while the June 1997 VA examination report noted active abduction of 160 degrees. Thus, the veteran's right arm is not limited to the shoulder level as required for a 20 percent evaluation under Diagnostic Code 5201. Nevertheless, in addition to the above criteria, the Board must consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint. See 38 C.F.R. §§ 4.40 and 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The Board finds that a 20 percent evaluation is warranted for the veteran's right shoulder disability based on his complaints of pain and weakness which limit activities. The record documents the veteran's consistent complaints of pain since he initially filed his claim for an increased disability evaluation over ten years ago, which are consistent with the clinical evidence of record. In this regard, the August 1990 hospitalization report noted that the veteran suffered from generalized pain in his right upper extremity. Shortly after his surgery in October 1993, pain was reported on range of motion testing at extremes of motion. A March 1994 entry also noted that pain was present from 60 to 90 degrees of abduction. More recently, the June 1997 VA orthopedic examination noted that pain was reported on internal rotation. The Board finds that the veteran's complaints of right shoulder pain have been confirmed by extensive clinical evidence, and are therefore credible. Accordingly, a 20 percent evaluation is warranted under Diagnostic Code 5201. See DeLuca, 8 Vet. App. at 204-207. In reaching this decision, the Board finds that the preponderance of the evidence is against an evaluation in excess of 20 percent under applicable criteria. As noted, range of motion of the veteran's right arm is essentially normal, albeit with some pain, thereby precluding an evaluation in excess of the 20 percent rating assigned by virtue of this decision. The Board also finds that no other potentially applicable diagnostic code affords the veteran an evaluation in excess of 20 percent for his right shoulder disability. Diagnostic Code 5203 pertains to impairment of the clavicle or scapula, but does not provide an evaluation in excess of 20 percent. See 38 C.F.R. § 4.71a, Diagnostic Code 5203 (2000). The Board also has considered Diagnostic Code 8518 (paralysis of the circumflex nerve) and Diagnostic Code 8519 (paralysis of the long thoracic nerve). Diagnostic Code 8518 provides a 30 percent evaluation for severe incomplete paralysis of the circumflex nerve, while Diagnostic Code 8519 provides a 30 percent evaluation for severe incomplete or complete paralysis of the long thoracic nerve. See 38 C.F.R. § 4.124a, Diagnostic Codes 8518, 8519 (2000). While the veteran has reported numbness and tingling in his right upper extremity, no significant neurological findings have been shown on clinical evaluation. As such, an evaluation in excess of 20 percent is not warranted under either of these Diagnostic Codes. In conclusion, the Board finds that the evidence supports a 20 percent disability evaluation for the veteran's service- connected supraspinatus tendonitis and bursitis of the right shoulder based on his complaints of painful motion which have been objectively shown on clinical examination. The Board also finds that the preponderance of the evidence is against an evaluation in excess of 20 percent under all applicable criteria. 2. Discogenic disease of C4-5 and C5-6 Next, the Board finds that the preponderance of the evidence is against an evaluation in excess of 10 percent for the veteran's discogenic disease of C4-5 and C5-6. The Board recognizes that findings pertaining to the veteran's cervical spine were shown in the late 1980's and early 1990's. X-rays performed in August 1989 revealed evidence of early degenerative changes in the uncovertebral joints at the C4-5 and C5-6 levels, which was the basis for the diagnosis of early discogenic disease of the cervical spine. When examined in January 1991, the veteran reported moderate to severe pain of the cervical spine. X-rays taken at that time revealed slight narrowing at C3-5, especially at the C4-5 level. Since then, however, the veteran's cervical spine has not been productive of any significant findings and appears to have resolved. Moreover, evidence also indicates that the veteran's complaints primarily involve his service-connected right shoulder disability. The August 1991 VA examination report included no objective findings concerning the cervical spine, and X-ray examination revealed no evidence of cervical pathology. The diagnosis included "history of cervical spine disease with nerve encroachment with very atypical symptomatology, not substantiated on exam today." When hospitalized in December 1991, the veteran specifically denied cervical pain and indicated that pain was now isolated to his right shoulder. MRIs performed in March 1992 and September 1993 also showed a normal cervical spine. At his VA neurological examination in May 1997, the veteran said his initial injury of the back, neck and right shoulder had resolved except for his right shoulder, which is consistent with findings noted on physical examination. Finally, in June 1997 a VA examiner concluded that there was no evidence of neurologic or cervical disorder. It is thus evident that the veteran no longer suffers from any cervical pathology. No limitation of motion of the cervical spine has been demonstrated, and pain in the cervical spine apparently resolved in 1991 and is now isolated to the right shoulder. Under these circumstances, it is clear that the veteran's cervical spine does not even demonstrate slight limitation of motion, even with consideration of 38 C.F.R. §§ 4.40, 4.45, and 4.59. Accordingly, the Board finds that the preponderance of the evidence is against an evaluation in excess of 10 percent for his discogenic disease of C4-5 and C5-6. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the veteran's claim, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, § 4, 114 Stat. 2096, 2098-99 (2000) (to be codified as amended at 38 U.S.C. § 5107(b)); Gilbert, 1 Vet. App. at 55-56. C. Consideration of an Extraschedular Evaluation In exceptional cases where schedular evaluations are found to be inadequate, the RO may refer a claim to the Under Secretary for Benefits or the Director, Compensation and Pension Service, for consideration of "an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities." 38 C.F.R. § 3.321(b)(1). "The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." Id. In this case, there has been no showing that either of the veteran's service-connected disabilities at issue have independently caused marked interference with employment, necessitated frequent periods of hospitalization, or otherwise rendered impracticable the regular schedular standards. The veteran said he left his job as a corrections officer in Georgia because he moved to Pennsylvania. He also indicated that he was currently employed temporarily reading meters. The Board also notes that a temporary total rating was assigned for a period of convalescence following his right shoulder surgery in 1993. Under these circumstances, and in the absence of factors suggestive of an unusual disability picture, further development in keeping with the procedural actions outlined in 38 C.F.R. § 3.321(b)(1) is not warranted. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER Entitlement to service connection for impotency is denied. A 20 percent evaluation for tendonitis and bursitis of the right shoulder is granted. An evaluation in excess of 10 percent for discogenic disease of C4-5 and C5-6 is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals