Citation Nr: 0809749 Decision Date: 03/24/08 Archive Date: 04/09/08 DOCKET NO. 96-28 866 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an increased evaluation for the residuals of shell fragment wounds (SFW) of the right calf, affecting Muscle Group XI (MG XI), currently evaluated as 10 percent disabling. 2. Entitlement to an increased evaluation for residuals of fractures to right 1st cuneiform and right 1st metatarsal bones, evaluated as noncompensable prior to June 30, 2003, and evaluated as 10 percent disabling beginning June 30, 2003. 3. Entitlement to a separate, compensable evaluation for clinical findings of degenerative arthritis with pain on motion and weightbearing in the right 1st cuneiform and right 1st metatarsal joint. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L.J. Bakke, Counsel INTRODUCTION The veteran served on active duty from November 1959 to January 1967. The veteran's discharge documents reflect that he was awarded the Purple Heart. This appeal arises before the Board of Veterans' Appeals (Board) from rating decisions rendered in April 1996 and September 1997 by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas in which higher evaluations for gunshot wound residuals of MG XI and fracture residuals of the right first metatarsal bones were denied. The veteran testified before the undersigned Veterans Law Judge in September 2004. A transcript of the is associated with the claims file. This case was remanded for further development in December 2003 and December 2004. The requested development has finally been completed. Service medical records reflect that the veteran's 1st cuneiform and 1st metatarsal were both fractured in the inservice landmine explosion that caused the veteran's other injuries. The issues have been recharacterized to reflect the medical evidence of record. The medical evidence shows the veteran manifests various scars that are the result of his service-connected right calf and right foot injuries. These scars have been described as tender and numb in places. A claim for an increased evaluation for his scars is referred to the RO for appropriate action. FINDINGS OF FACT 1. The medical evidence establishes that the residuals of SFWs to the veteran's right leg with involvement of MG XI are manifested by a history of prolonged hospitalization, debridement; pain, weakness, and easy fatigueability; tibia deformity, visible signs of atrophy, and X-ray evidence of multiple scattered retained metallic fragments. The medical evidence does not show nerve, tendon, or vascular involvement attributable to the SWF residuals of right calf and MG XI. 2. The medical evidence establishes that the residuals of fracture to the right 1st cuneiform and right 1st metatarsal bones are manifested by findings of deformity and tenderness on palpation, absent actual malunion or nonunion. 3. The medical evidence reveals degenerative arthritis in the 1st cuneiform and right 1st metatarsal joints with pain on motion and pain on weightbearing, but absent ankylosis. CONCLUSIONS OF LAW 1. The criteria for an evaluation of 30 percent, and no greater, for the residuals of SFWs to the right thigh with injury to MG XI are met throughout the entire period of time under appeal. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.14, 4.55, 4.56, 4.71, Diagnostic Code 5311 (2007). 2. The criteria for an evaluation of 20 percent, and no greater, for the residuals of fracture to the right 1st cuneiform and right 1st metatarsal bones are met throughout the entire period of time under appeal. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002 & 2007); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.14, 4.55, 4.56, 4.73, Diagnostic Code 5283 (2007). 3. The criteria for an evaluation of 10 percent, and no greater, for degenerative arthritis of the right 1st cuneiform and right 1st metatarsal joints with painful motion and pain on weightbearing are met throughout the entire period of time under appeal. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002 & 2007); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.14, 4.55, 4.56, 4.73, Diagnostic Code 5010 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Notice and Assistance Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). VA must request that the claimant provide any evidence in the claimant's possession that pertains to a claim. 38 C.F.R. § 3.159. The notice requirements apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; (3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App.112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO provide notice in April 2004. The notification substantially complied with the requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence; and Pelegrini v. Principi, 18 Vet. App. 112 (2004), requesting the claimant to provide evidence in his or her possession that pertains to the claims. Subsequent additional notice was provided concerning the degrees of disability and effective dates for any grant in September 2007. Neither of the notices discussed the criteria for an increased rating, thus, the duty to notify has not been satisfied with respect to VA's duty to notify him of the information and evidence necessary to substantiate the claim. See Vazquez-Flores v. Peake, No. 05-0355 (U.S. Vet. App. January 30, 2008). In Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007), the U.S. Court of Appeals for the Federal Circuit held that any error by VA in providing the notice required by 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b)(1) is presumed prejudicial and require reversal unless VA can show that the error did not affect the essential fairness of the adjudication. To do this, VA must show that the purpose of the notice was not frustrated, such as by demonstrating: (1) that any defect was cured by actual knowledge on the part of the claimant; (2) that a reasonable person could be expected to understand from the notice what was needed; or (3) that a benefit could not have been awarded as a matter of law. Although not specifically discussed by the court, some other possible circumstances that could demonstrate that VA error did not prejudice the claimant include where the claimant has stated that he or she has no further evidence to submit, or where the record reflects that VA has obtained all relevant evidence. In this case, the Board finds that the notice errors did not affect the essential fairness of the adjudication as VA has obtained all relevant evidence. Moreover, actions by the veteran and his representative following the February 2006 statement of the case show actual knowledge of the right to submit additional evidence and of the availability of additional process. The Board thus finds that no prejudice to the veteran will result from proceeding with adjudication without additional notice or process. VA has obtained service medical records, assisted the veteran in obtaining evidence including private medical records, has accorded the veteran VA examinations, and has afforded the veteran the opportunity to give testimony before the Board which he did in September 2004. At that time the veteran gave testimony regarding how his disabilities affected his ability to function at home and at work. All known and available records relevant to the issue of service connection for hypertension have been obtained and associated with the veteran's claims file; and the veteran has not contended otherwise. In February 2007, the veteran indicated he had no further statements to make. VA has substantially complied with the notice and assistance requirements and the veteran is not prejudiced by a decision on the claim at this time. II. Increased Evaluation The veteran seeks an increased evaluation for his service connected residuals of SFWs to the right calf, involving MG XI, and an increased evaluation for his service-connected residuals of fracture to the right 1st cuneiform and right 1st metatarsal bones both prior to and after June 30, 2003. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. See 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. Staged ratings (different disability ratings during various time periods) are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, No. 05-2424, slip op. at 4 and 5 (U.S. Vet. App. Nov. 19, 2007) (precedential panel decision). Evaluation of a service-connected disorder requires a review of the veteran's entire medical history regarding that disorder. See 38 C.F.R. §§ 4.1 and 4.2. It is necessary to evaluate the disability from the point of view of the veteran working or seeking work (38 C.F.R. § 4.2) and to resolve any reasonable doubt regarding the extent of the disability in the veteran's favor (38 C.F.R. § 4.3). If there is a question as to which evaluation to apply to the veteran's disability, 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. In determining a disability evaluation, VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The veteran was service connected for muscle injury, group XI, right calf, with retained foreign metallic bodies and healed fracture, 1st cuneiform and base of right 1st metatarsal bone in a March 1967 rating decision, and the disabilities were evaluated as 10 percent and zero percent disabling, respectively, effective in February 1967 under 38 C.F.R. § 4.72, Diagnostic Code 5311, which contemplates impairment of MG XI, and 38 C.F.R. § 4.71a, Diagnostic Code 5299. In October 1967, the RO changed the description of the veteran's right foot disability to fracture, right first metatarsal. However, as noted in the Introduction, service medical records document fracture to the right 1st cuneiform and right 1st metatarsal, thus this decision will contemplate both. The veteran filed his current claim in October 1995. In September 1997, the RO issued a rating decision confirming and continuing the 10 and zero percent evaluations. The veteran appealed this decision. Subsequently, the RO issued a rating decision dated in May 2004, granting a 10 percent evaluation under for the service connected fracture residuals of right 1st cuneiform and right 1st metatarsal bones under Diagnostic Code 5299-5283, for impairment of the affected bones analogous to malunion or non union of the tarsal or metatarsal bones, effective in June 2003. A 10 percent evaluation under Diagnostic Code 5311 contemplates impairment of MG XI that is moderate in severity. MG XI impacts propulsion, plantar flexion of the foot, stabilization of the arch, flexion of the toes, and flexion of the knees and involves the posterior and lateral crural muscles, and muscles of the calf. A higher, 20 percent evaluation is provided for moderately severe impairment, and severe impairment warrants a 30 percent evaluation. A 10 percent evaluation under Diagnostic Code 5283 contemplates malunion or nonunion of the tarsal or metatarsal bones that is moderate in severity. Moderately severe impairment warrants a 20 percent evaluation, and severe impairment warrants a 30 percent evaluation. Residuals of SFWs to MG XI Residuals of SFWs to the various muscle groups are rated generally under the provisions of 38 C.F.R. § 4.73. During the pendency of the veteran's claims, changes were made by regulatory amendment to the schedular criteria for evaluating muscle injury disorders as set forth in 38 C.F.R. §§ 4.40- 4.73, effective July 3, 1997. 62 Fed. Reg. 30235-30240 (Jun. 3, 1997) (codified at 38 C.F.R. pt. 4). When a law or regulation changes while a case is pending, the version most favorable to the claimant applies, absent legislative intent to the contrary. See Dudnick v. Brown, 10 Vet. App. 79 (1997). Revised statutory or regulatory provisions, however, may not be applied to any time period before the effective date of the change. See 38 U.S.C.A. § 7104(c) (West 2002); VAOPGCPREC. 3-2000 (April 10, 2000). The regulatory changes did not result in any material change to the respective rating criteria for the veteran's affected muscle group, which both before and after the regulatory changes are evaluated under Diagnostic Code 5311. 38 C.F.R. § 4.73. For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement. 38 C.F.R. § 4.56(c). Functional loss must also be considered for any musculoskeletal disability. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Evaluation of muscle injuries as slight, moderate, moderately severe, or severe, is based on the type of injury, the history and complaints of the injury, and objective findings. 38 C.F.R. § 4.56(d). A slight muscle disability typically involves a simple muscle wound without debridement or infection. Service medical records should reflect incurrence of a superficial wound with brief treatment and return to duty, healing with good functional results, without complaints of the cardinal signs or symptoms of muscle disability. Objective findings should include minimal scarring, no evidence of fascial defect, atrophy, or impaired tonus, and no impairment of function or metallic fragments retained in muscle tissue. A moderate muscle disability would result from a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. There should be service department records or other evidence of in-service treatment for the wound, reflecting consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. Objectively, a moderate muscle disability would reveal small or linear entrance and (if present) exit scars, indicating short track of missile through muscle tissue, some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. Moderately severe muscle disability results from a through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. Service or other records should show hospitalization for a prolonged period for treatment of wound, reflect consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, reveal evidence of inability to keep up with work requirements. Objective examination should reveal entrance and (if present) exit scars indicating track of missile through one or more muscle groups. In addition, there are indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. Finally, severe muscle disability occurs when there was a through and through or deep penetrating wound due to high- velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. Records should show hospitalization for a prolonged period for treatment of wound, consistent complaints of cardinal signs and symptoms of muscle disability worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective evidence of severe muscle disability includes ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. Additional signs of severe muscle disability, when present, include: X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile; and induration or atrophy of an entire muscle following simple piercing by a projectile. For rating purposes, the skeletal muscles of the body are divided into muscle groups in specified anatomical regions. 38 C.F.R. § 4.55(b). Muscle injury ratings will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. 38 C.F.R. § 4.55(a). The combined evaluation of muscle groups acting upon a single unankylosed joint must generally be lower than the evaluation for unfavorable ankylosis of that joint. 38 C.F.R. § 4.55(d). For compensable muscle group injuries which are in the same anatomical region but do not act on the same joint, the evaluation for the most severely injured muscle group will be increased by one level and used as the combined evaluation for the affected muscle groups. 38 C.F.R. § 4.55(e). Service medical records show the veteran sustained injury in July 1966 when an enemy grenade or landmine detonated nearby him. He sustained multiple wounds, including of the right lower extremity. Hospital records show the right calf injury required debridement and delayed primary closure. Results of X-rays taken showed multiple metallic sutures within the anterior and lateral soft tissues of the left and a few metallic fragments within the calf muscles. Examination showed wounding of the right shin bone but X-rays showed no evidence of fracture. There was no evidence of vascular or nerve involvement. His right calf injuries, with his other injuries, required hospitalization from July 1966 to at least December 1966, as his Medical Evaluation Board (MEB), conducted on November 30, 1966, does not show that he has been discharged from the hospital. The veteran was thereafter recommended for discharge based on the extent of his injuries. VA and private treatment records show continued treatment throughout the entire appeal period for the veteran's right leg with complaints of and treatment for pain, pain on motion and weightbearing, weakness, and fatigue. Metallic fragments continue to be present on clinical findings. VA examination reports reflect findings of small metallic foreign bodies in the right leg with one appearing to be in the proximal fibular cortex, slight deformity of the right lower leg surface in 1998, and of a lack of good position sense in both feet in 1999. Photographs taken in July 1999 show disparity in circumference of the veteran's right leg above the ankle and extending to the right calf when compared to the left. In May 2003, the examiner observed the veteran's right tibia to have a slight prominence in the mid portion. The examiner noted the veteran had a good gait and was able to toe and heel walk, but in May 2004, the veteran was observed to walk with a cane. In November 2005, the examiner noted the veteran's right calf condition had become progressively worse since his injury. The examiner found no atrophy, loss of deep fascia or muscle substance, and no nerve or vascular injury residuals. However, the examiner noted the veteran exhibited decreased strength and coordination, and difficulty walking due, in part, to easy fatigability of the gastrocnemius muscle. This evidence reveals findings that that meet the criteria for moderately severe muscle impairment of MG XI in type of injury, history and complaint, and objective findings. However, even conceding that the veteran's prolonged hospitalization was necessitated by his other injuries, in addition to the injury to his right calf, documented consistent complaints of pain, weakness, fatigue, and current findings of pain, weakness, impaired coordination; visual observation in photographs of what appears to be decreased circumference in the right leg above the ankle and at the lower part of the calf as compared to the left; and clinical findings of retained metallic fragments support the argument that the veteran's right calf injury ought to be evaluated as severe under the criteria. The service medical records corroborate this conclusion, noting that the veteran had to be casted, that he sustained bone injury (but not a break) of the tibia, and that some findings had not been immediately grasped due to the severity of his other injuries (including the loss of his left eye). Accordingly, a 30 percent evaluation is warranted for the veteran's service connected residuals of SFWs to the right calf with injury to MG XI. This is the highest evaluation afforded for this disability under the diagnostic code. No other muscle group has been identified as associated with the residuals of this injury. And the medical evidence does not show any neurological, vascular, or tendon injury associated with the residuals of this injury, as indicated above. The preponderance of the evidence is thus against an evaluation greater than 30 percent for the service connected residuals of SFWs to the right calf affecting MG XI. Records show that the veteran has subsequently been diagnosed with, and service-connected for, diabetes mellitus, peripheral neuropathy of the right and left lower extremities, and arteriosclerotic cardiovascular disease of the right and left lower extremities. Manifestations attributable to these other service connected disabilities, i.e., abnormalities in sensation, ulcerations, and vascular problems are contemplated under the appropriate diagnostic codes, as reflected in the other rating decisions of record, and cannot therefore be considered here. See 38 C.F.R. § 4.14. Residuals of Fracture of the Right 1st Cuneiform and Right 1st Metatarsal In the July 1966 injury, the veteran also sustained injury to the right foot. Results of X-rays taken during active service showed multiple metallic densities over the right foot with fracture involving the 1st cuneiform and base of the 1st metatarsal. Bony callus formation was also present. VA and private treatment records show continued treatment for the veteran's right foot with complaints of and treatment for pain, pain with weightbearing, and pain on motion throughout the entire period under appeal. Degenerative arthritis was observed as early as in 1996, and metallic fragments continue to be present on clinical findings from 1966 to the present. VA examination reports reflect findings of metallic fragments in the right 1st cuneiform and in the right 1st metatarsal bones with degenerative changes in 1998. Range of dorsiflexion and plantar flexion was found to be in good range and equal bilaterally in 1999 with inversion and eversion motion not quite normal but also equal bilaterally. The examiner observed the veteran manifested pain on walking but that the pain did not prevent him from being able to walk. In May 2003, the examiner opined that the veteran's right foot problem was symptomatic, but observed that he had a good gait and was able to heel and toe walk. X-rays showed post-traumatic distortion of the right 1st and 2nd cuneiform bones and the base of the right 1st metatarsal bone with retained metal fragments and degenerative joint disease. A heterotopic bone spur was found medial to the base of the right 1st metatarsal. In May 2004, the examiner observed the veteran to walk with a cane. Dorsiflexion of the right foot was measured at 30 degrees, and plantar flexion, at 20 degrees. There was no evidence of unusual weightbearing or of callus formation, and the Achilles tendon was observed to be aligned normally. The examiner stated he was unable to determine to what degree the veteran's range of motion would be limited by pain, fatigue, or weakness, but he opined that the veteran's predominant impact of the foot injury was pain. In November 2005 and May 2007, palpable bony deformity was observed on the plantar and dorsal aspect of the right foot. The examiner observed tenderness over the deformity, but no malunion, drainage, edema, erythema, or locally increased temperature. In May 2007, the examiner explained that there is no measurable motion in the cuneiform-metatarsal joint, as it is a minimally gliding joint. However, the examiner observed the veteran to evidence pain with motion of the foot when weight was placed on it, and that the veteran walked with a limp because of it. No other functional abnormalities in walking or standing were noted. No callosities, breakdown, or unusual shoe wear was noted and attributed to the fracture residuals, and ankylosis was not present. The examiner stated there was no additional functional impairment other than pain after repetitive use. However, moderate to severe degenerative arthritis was present in the joint. Given that the medical evidence shows plantar and dorsal deformity with tenderness on palpation and retained metal fragments, the criteria for moderately severe impairment analogous to moderately severe malunion of the metatarsal bones are met. Therefore, an evaluation of 20 percent is warranted under Diagnostic Code 5299-5283. An evaluation greater than 20 percent is not warranted, however, as the preponderance of the medical evidence does not show functional impairment in walking or standing other than pain on palpation of the deformity and pain on weightbearing, which will be discussed further below. The veteran was found to exhibit pain on weightbearing and on motion of the cuneiform-metatarsal joint-to the extent that the minimal glide of the joint is considered motion. This manifestation-pain on weightbearing and pain on motion- combined with findings of traumatic arthritis, warrants a separate 10 percent evaluation under Diagnostic Code 5010, for traumatic arthritis of a joint shown by clinical evidence and manifested by limited or painful motion not otherwise uncompensable under the criteria. An evaluation greater than 10 percent is not warranted as the preponderance of the evidence does not establish that the veteran exhibits limitation of range of ankle motion or of foot motion, overall, that is attributable solely to the residuals of fracture of the right 1st cuneiform and right 1st metatarsal joint. Availability of separate or higher evaluations under Diagnostic Codes 5277, 5278, 5279, 5280, 5281, 5282, or 5284 were considered. But the preponderance of the evidence shows that the veteran does not exhibit claw foot, metatarsalgia, hallux valgus, hallux rigidus or hammer toes as the result of or part and parcel of his residuals of fracture to the right 1st cuneiform and right 1st metatarsal bone. The preponderance of the evidence further shows that the veteran does not demonstrate bilateral weak foot or other injury of the foot that has not already been considered in the evaluations herein awarded under Diagnostic Codes 5299-5283 and 5010. Records show that the veteran has subsequently been diagnosed with, and service-connected for, diabetes mellitus, peripheral neuropathy of the right and left lower extremities, and arteriosclerotic cardiovascular disease of the right and left lower extremities. Manifestations attributable to these other service connected disabilities, i.e., abnormalities in sensation, ulcerations, and vascular problems are contemplated under the appropriate diagnostic codes, as reflected in the other rating decisions of record, and cannot therefore be considered here. See 38 C.F.R. § 4.14 Summary The assignment of staged ratings has been considered, in accordance with Hunt, supra. However, for reasons discussed above the evidence does not support the assignment of staged ratings for the time period in consideration in this case. Rather, the evidence supports assignment throughout the entire period under appeal of 30 percent under Diagnostic Code 5311 for the residuals of SFWs to the right calf affecting MG XI; of 20 percent under Diagnostic Code 5299- 5283 for the residuals of fractures to the right 1st cuneiform and right 1st metatarsal bones; and of 10 percent under Diagnostic Code 5010 for degenerative arthritis of the right 1st cuneiform and right 1st metatarsal joints. Application of an extraschedular evaluation under 38 C.F.R. Section 3.321(b)(1) has been considered, but is not here warranted, as the medical evidence does not present exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). ORDER A 30 percent evaluation, but no greater, is granted for the residuals of SFWs to the right calf, involving MG XI, beginning with the veteran's date of claim in October 1995, subject to the laws and regulations governing the award of monetary benefits. A 20 percent evaluation, but no greater, is granted for the residuals of fracture to the right 1st cuneiform and the right 1st metatarsal bones beginning with the veteran's date of claim in October 1995, subject to the laws and regulations governing the award of monetary benefits. A 10 percent evaluation, but no greater, is granted for clinical findings of degenerative arthritis with pain on motion and weightbearing in the right 1st cuneiform and right 1st metatarsal joint beginning with the veteran's date of claim in October 1995, subject to the laws and regulations governing the award of monetary benefits. ____________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs