Citation Nr: 1002207 Decision Date: 01/13/10 Archive Date: 01/22/10 DOCKET NO. 05-11 928 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to an initial disability rating in excess of 10 percent for residuals, status post cheilectomy of the left metatarsophalangeal joint (MTPJ), postoperative hallux rigidus. 2. Entitlement to an initial disability rating in excess of 10 percent for residuals, status post cheilectomy of the right metatarsophalangeal joint, postoperative hallux rigidus. REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Johnson, Associate Counsel INTRODUCTION The Veteran had active military service from March 1986 to March 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana, which granted service connection for postoperative hallux rigidus, status post cheilectomy of the left and right metatarsophalangeal joints (MTPJs) with a 10 percent rating each, effective from March 19, 1994. In November 2007, the Veteran appeared at the New Orleans RO and testified by videoconference before the undersigned Veterans Law Judge sitting in Washington, D.C. The transcript of that hearing is of record. During the hearing the veteran raised the issue of entitlement to service connection for depression, including as secondary to his service-connected foot disabilities. That issue, which has not been adjudicated, is referred back to the RO for appropriate action. FINDINGS OF FACT 1. Residuals, status post cheilectomy of the left MTPJ, postoperative hallux rigidus have been manifested by pain, tenderness, limited standing tolerance and walking distance, and limited range of motion. 2. Residuals, status post cheilectomy of the right MTPJ, postoperative hallux rigidus have been manifested by pain, tenderness, limited standing tolerance and walking distance, and limited range of motion. CONCLUSIONS OF LAW 1. The criteria for a 20 percent rating for residuals, status post cheilectomy of the left MTPJ, postoperative hallux rigidus have been met. 38 U.S.C.A. § 1155, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic Codes 5280, 5281, 5284 (2009). 2. The criteria for a 20 percent rating for residuals, status post cheilectomy of the right MTPJ, postoperative hallux rigidus have been met. 38 U.S.C.A. § 1155, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic Codes 5280, 5281, 5284 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). Under 38 U.S.C.A. § 5103, VA must notify the claimant of any information or evidence not of record that is necessary to substantiate the claim, as well as what parts of that information or evidence VA will seek to provide, and what parts VA expects the claimant to provide. 38 C.F.R. § 3.159(b) (2009). VA must provide such notice to a claimant prior to an initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (AOJ). See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). For claims pending before VA on or after May 30, 2008, 38 C.F.R. 3.159 was amended to eliminate the requirement that VA request that a claimant submit any evidence in his or her possession that might substantiate the claim. 73 Fed. Reg. 23,353 (Apr. 30, 2008). The Court has also held that that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (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/Hartman v. Nicholson, 19 Vet App 473 (2006). The current appeal arises from the Veteran's disagreement with the initial evaluations assigned with the grant of service connection for his left and right foot disabilities. Courts have held that where the underlying claim for service connection has been granted and there is disagreement as to downstream questions, the claim has been substantiated and there is no need to provide additional VCAA notice or prejudice from absent VCAA notice. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). In consideration of Hartman and Dunlap, further VCAA notice is not required. Duties to Assist The information and evidence associated with the claims file consist of the Veteran's service treatment records and VA and private medical treatment records. The Veteran was also afforded VA examinations in connection with his claim. He has not indicated that there is any outstanding evidence pertinent to his claims and the Board is also unaware of any outstanding evidence. Therefore, the Board is satisfied that the VA has complied with the duty to assist requirements of the VCAA and the implementing regulations. As all notification has been given and all relevant available evidence has been obtained, the Board concludes that any deficiency in compliance with the VCAA has not prejudiced the Veteran and is, thus, harmless error. See Bernard v. Brown, 4 Vet. App. 384 (1993). Background Service treatment records reflect that the Veteran underwent cheilectomies in October 1991 and February 1992 for bilateral hallux rigidus. VA and private post-service treatment records note swelling in both feet and a long history of bilateral foot pain. A May 1994 VA examination indicated significant tenderness to palpation over the MTPJ of the left great toe. Walking reportedly increased his discomfort. He also reported that weightbearing caused increased pain and that he could not be up comfortably for more than 15 to 20 minutes at a time. He was noted to move with a satisfactory gait pattern but did not push off on either great toe. He had 10 degrees of dorsiflexion of the right great toe and 15 degrees of plantar flexion. The left great toe had 5 degrees of dorsiflexion and 15 degrees of plantar flexion. The diagnosis was residuals of bilateral post-operative hallux rigidus. The Veteran underwent a VA examination in June 2003. He reported occasional loss of balance due to the pain. He also reported an altered gait, in that he walked on the lateral aspects of the toes of his feet. The pain was reportedly greater on the left, than the right. He further indicated that he worked as a supervisor for a sheet metal company which required him to go up and down ladders daily. At the end of the day or the next day, his feet were extremely painful, especially around the metatarsal area; however, he continued to work despite his extreme pain. It was noted that the prior surgical procedures for pain of the first big toe were not successful for relief of pain and increased range of motion. On physical examination, there was excessive wear on the lateral heels and soles of both shoes. There were 30 degrees of hallux dorsiflexion on the left and 40 degrees on the right, which the examiner noted was "painful during the passive range of motion." The Veteran was observed to walk on the lateral aspect, avoiding the hallux area bilaterally. X-rays showed severe degenerative joint disease first MTPJ bilaterally. The clinical impression was severe degenerative joint disease of first MTPJ bilaterally, overload syndrome of the first metatarsal secondary to the hallux rigidus bilaterally; altered gait secondary to severe degenerative joint disease of first MTPJ bilaterally, overload syndrome of the first metatarsal secondary to the hallux rigidus bilaterally; and history of balance loss due to severe degenerative joint disease of first MPJ bilaterally, overload syndrome of the first metatarsal secondary to the hallux rigidus bilaterally. The June 2003 examiner also commented on the presence of bilateral foot scars. There was a scar 6 inches in length that was freely movable and extended up to the midshaft of the proximal phalanx and up proximally. In a November 2003 letter, a private physician stated that the first metatarsophalangeal joints of both the Veteran's feet were painful. X-rays showed severe hallux rigidus in both metatarsophalangeal joints. Fusion surgery was recommended. An August 2004 VA outpatient treatment record indicated that the range of motion of the Veteran's first MTPJ bilaterally, was severely limited with pain upon dorsiflexion and plantar flexion. There was 12 degrees range of motion, left great toe and 15 degrees on the right. X-rays showed severe joint narrowing of the first SMPJ with osteophytic bone. The Veteran was treated with custom molded semi-rigid orthotics with a rigid Morton's extension. Additional VA outpatient treatment records dated between January 2005 and December 2006 reflect that conservative measures, such as rigid shoes, rigid inserts, steroidal injections, non-steroidal anti- inflammatories failed to relieve the Veteran's discomfort. Private medical records from Dr. R. reflect complaints of severe foot pain with pain rated as a 7 on a good day and 10 on a bad day on a scale of 10. A May 2006 record shows there was 15 degrees of motion at the MTP joint bilaterally. Moderate swelling and pain was also present. X-rays confirmed severe degenerative joint disease of first metacarpal phalangeal joint bilaterally. Fusion surgery was recommended. The claims file also contains letters from some of the Veteran's employers in which they attested to the impact his foot disabilities had on his employment. In an undated letter, J. M. indicated that the Veteran had worked for him over a year and a half, and had worked with him for about 8 to 10 years. J. M. stated that the Veteran had a marked interference with his ability to climb ladders. He also noted that the Veteran's feet had gotten worse as time went by and that the Veteran was told by BTC sheet metal that he would have to find other work if he could not climb ladders. In a March 2007 letter, a representative from G.M.C., Inc. wrote that he had worked with the Veteran over the past 12 years. This individual indicated that he had noticed the Veteran's difficulty with climbing ladders and construction obstacles, and had a marked interference with his work requirements over the years. He recommended that the Veteran be transferred and hired on at NM Co., as a non-working supervisor. A letter dated in May 2007 reflects that the Veteran accepted employment at NM Co., with duties restricted to that of a strictly supervisory nature. The letter further stated that the Veteran had been experiencing a marked interference with employment efficiency and job performance, and that his physical constraints were directly attributable to his diminished work performance. At a November 2007 hearing before the undersigned, the Veteran testified that his foot problems caused his activities of daily living to decline, and he was no longer able to enjoy activities with his wife or hunt with his brothers. He also testified that he wore VA-prescribed braces on his feet to prevent pronation. The Veteran also stated that he had to transfer from a job where he was a foreman/supervisor/superintendent to basically having an office job because he could not climb ladders or stairs and had difficulty walking over the obstacles out on the job sites. He indicated that although he was hired on at his new company (NM, Co.) as a supervisor; he went from working an average 60-70 hour week (that was "killing" him) to a 40- hour week and losing some of the benefits he had. He testified that prior to the transfer, he was in charge of anywhere between four or five people. His duties included reading blueprints, helping to hang ductwork, and other various construction/sheet metal trade duties. With the transfer, he basically had a desk job, but he still has to get up and walk around and go out to the field and look at things. Additional VA outpatient treatment records, dated between December 2006 and March 2009 reflect ongoing complaints of bilateral foot pain. The Veteran is shown to have reinjured his right foot in April 2007. The treatment notes indicate that he was climbing a ladder when he heard a "pop" and his big toe joint became swollen and painful. X-rays revealed evidence of proximal dislocation of sesamoids when compared to previous X-rays. The diagnosis was possible hallux flexor rupture. The Veteran presented in March 2008 with a complaint of increased bilateral foot pain especially in the left great toe, with swelling and warmth. Objectively, there was tenderness in the left MTPJ joint on palpation, but swelling and warmth were absent. He was able to ambulate independently and without assistance. No passive motion was possible in the left great toe. The claim was remanded by the Board in January 2008, in part for a VA examination. At the outset of the examination in September 2008, the examiner stated the claims file was reviewed. Subjectively, pain was reportedly present in both feet, with standing, walking, and at rest. Fatigability, lack of endurance, lack of motion, and loss of balance reportedly occurred with standing and walking on the left. On the right, he reported pain while standing, walking and resting; stiffness; fatigability; and lack of motion and balance while standing and walking. There were weekly or more flare-ups upon weight-bearing, walking, and standing. The Veteran noted that he was only able to stand for 15-20 minutes and walk a limited distance of 200 feet before stopping. He used a foot brace to keep the first MTPJ from moving and to prevent walking on the side of his feet. On physical examination, there was evidence of painful motion and swelling localized to the first MTPJ, bilaterally. Tenderness was present in the great toe and first MTPJ, bilaterally. There was evidence of weakness in the bilateral forefoot, and of abnormal weight-bearing, in the form of callosities. There was no evidence of instability in either foot. On the left foot, the first metatarsophalangeal toe joint was in rectus position. There was 0.1 degree of available dorsiflexion and no available plantar flexion at the first MTPJ. The examiner noted that he really had to force to obtain motion within the joint. On the right foot, there was 5 degrees of available dorsiflexion with pain and no available plantar flexion at the first MTPJ. There was no evidence of a skin or vascular abnormality, no pes cavus, no mal/nonunion of the tarsal or metatarsal bones, atrophy or other foot deformity, in either foot. Left foot X-rays showed degenerative arthritic changes, especially in the first metatarsophalangeal joint and diffuse demineralization. Right foot X-rays showed soft tissue swelling about the foot and degenerative changes at the MTPJ of the right first toe. As for scars, on the left foot there was a dorsal surgical scar, that was hypopigmented and non-keloidal. The scar measured 4.5 cm in length and there was no limitation of motion due to the scar. On the right foot, a dorsal surgical scar measured 5 cm in length. It was non-keloidal and caused no limitation of motion. The scars on both feet moved freely. A joints examination was also provided in September 2008 which found the hips were normal but there was mild degenerative joint disease in the knees and ankles. The examiner found no correlation between the foot pathology and the mild degenerative joint disease of the knees and ankles but did find a correlation to his obesity and occupation. Regarding the Veteran's employment history, the foot examiner noted he was then employed as a sheet metal worker with limited duties. He was employed full-time and had lost 6 weeks from work in the last 12 month period due to pain in both feet. The examiner stated that the severe degenerative joint disease, first MTPJ bilaterally had a significant effect on occupational activities in that it interfered with the Veteran's ability to lift and carry, and caused a lack of stamina, weakness, fatigue, and pain. As a result, the Veteran was assigned different duties. The foot disorder was noted to have a severe effect on chores, prevented exercise and sports, had a moderate effect on recreation and a mild effect on driving. Legal Criteria Disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. Where, as here, the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. Fenderson v. West 12 Vet. App. 119, 126 (1999). The veteran is presumed to be seeking the maximum benefit allowed by law and regulation. AB v. Brown, 6 Vet. App. 35, (1993). In evaluating musculoskeletal disabilities, the Board must assess functional impairment and determine the extent to which a service-connected disability adversely affects the ability of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2009). Ratings based on limitation of motion do not subsume the various rating factors in 38 C.F.R. §§ 4.40 and 4.45, which include pain, more motion than normal, less motion than normal, incoordination, weakness, and fatigability. These regulations, and the prohibition against pyramiding in 38 C.F.R. § 4.14, do not forbid consideration of a higher rating based on a greater limitation of motion due to pain on use, including flare-ups. DeLuca v. Brown, 8 Vet. App. 202, 206- 08 (1995). In other words, when rated for limitation of motion, a higher rating may be assigned if there is additional limitation of motion from pain or limited motion on repeated use of the joint. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40 (2009). However, if a claimant is already receiving the maximum disability rating available based on symptomatology that includes limitation of motion, it is not necessary to consider whether 38 C.F.R. § 4.40 and 4.45 are applicable. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Diagnostic Code (DC) 5003 provides that arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003 (2009). When the limitation of motion of a specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added, under DC 5003. For the purposes of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are each considered groups of minor joints, ratable on a parity with major joints. 38 C.F.R. § 4.45(f) (2009). Diagnostic Code 5281 instructs that hallux rigidus is to be rated as hallux valgus, severe. See 38 C.F.R. § 4.71a, DC 5281 (2009). Diagnostic Code 5280 pertains to unilateral hallux valgus. Under this code, a single, 10 percent disability rating is authorized for severe hallux valgus, if equivalent to amputation of the great toe or if operated upon with resection of the metatarsal head. 38 C.F.R. § 4.71a, DC 5280 (2009). Disabilities from other foot injuries are rated 10 percent when moderate, 20 percent when moderately severe, and 30 percent when severe. 38 C.F.R. § 4.71a, DC 5284 (2009). With actual loss of use of the foot, a 40 percent rating is assigned. 38 C.F.R. § 4.71a, DC 5167 (2009). With actual loss of use of the foot, a 40 percent rating is assigned. 38 C.F.R. § 4.71a, DC 5167 (2009). Words such as "moderate," "moderately severe" 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 decisions are "equitable and just." 38 C.F.R. 4.6 (2009). 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. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Analysis Each of the Veteran's service-connected left and right foot cheilectomy residuals are separately rated as 10 percent disabling, the maximum allowable under Diagnostic Codes 5280 and 5281. He seeks an initial rating in excess of 10 percent. As noted, VA examination reports reflect that the Veteran's bilateral hallux rigidus foot disability is manifested by chronic pain, mostly localized to the first MTPJ. This pain causes limited standing tolerance, walking distance, and range of motion of the great toes. The June 2003 examiner found an altered gait and history of a balance loss., The January 2008 examiner noted that there was loss of motion, pain localized to the first MTPJ bilaterally, swelling, forefoot weakness, and lack of endurance-with weekly or more flare-ups. See 38 C.F.R. §§ 4.40, 4.45. After reviewing the evidence, both subjective and objective, the Board believes that the degree of impairment resulting from the hallux rigidus of both great toes approximates moderately severe foot disabilities under DC 5284, thereby, warranting separate 20 percent ratings. The assignment of a 20 percent evaluation takes into consideration the DeLuca factor, wherein a higher rating may be assigned based on a greater limitation of motion due to pain on use, including flare-ups. DeLuca v. Brown, 8 Vet. App. 202, 206- 08 (1995). A 30 percent evaluation under DC 5284 is not warranted for either foot disability because the disability picture does not more nearly approximate a severe disability. See 38 C.F.R. § 4.7. For comparison purposes, in order to warrant separate 30 percent evaluations for each foot under the provisions of DC 5276, for pronounced acquired flatfoot there would need to be marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276 (2009). Similarly, a 30 percent evaluation is assigned under the provisions of DC 5278, for pes cavus, there would need to be multiple significant problems involving marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. 38 C.F.R. § 4.71a, DC 5278 (2009). The Veteran's bilateral great toe disabilities, while significant, do not involve the extensive symptomatology needed for a 30 percent evaluation under Diagnostic Codes 5276 or 5278. Neither the VA examiners nor the Veteran have indicated any symptoms involving with the second, third, fourth and fifth toes. The January 2008 examiner specifically indicated there was no evidence of any other foot deformity, in either foot. The fact that "severe" hallux rigidus has been diagnosed does not mean that it is equivalent to a "severe" foot injury under Diagnostic Code 5284, since hallux rigidus only involves the big toe and not the whole foot. Rather, as noted above, the evidence as a whole must be evaluated to determine the severity of the Veteran's bilateral foot disability. 38 C.F.R. §§ 4.2, 4.6. Additionally, the criteria for a rating in excess of 20 percent is not warranted under any other diagnostic code since the only other diagnostic codes that provide for a higher evaluation involve either amputation of the great toe with removal of metatarsal head or severe malunion or nonunion of the tarsal or metatarsal bones, which are not present in this case. See 38 C.F.R. § 4.71a, DCs 5171, 5283 (2009). Moreover, while the functioning of both the Veteran's feet is limited, no medical evaluation or opinion on file indicates that he has actually lost the use of either foot to warrant a 40 percent rating under DC 5167. The Board has also considered whether the Veteran is entitled to a separate evaluation based on the post-operative dorsal scars surgical on the Veteran's bilateral feet. Under Diagnostic Code 7801, scars that are deep or that cause limited motion and exceed an area of 6 square inches (39 sq. cm). warrant a 10 percent evaluation, A deep scar is associated with underlying soft tissue damage. Note (2). 38 C.F.R. § 4.118, DC 7801 (2008). Under Diagnostic Code 7802, scars that are superficial and that do not cause limitation of motion and that exceed 144 sq. inches warrant a 10 percent evaluation. A superficial scar is not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7802 (2008). Under Diagnostic Code 7803, a superficial and unstable scar warrants a 10 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7803 (2008). Under Diagnostic Code 7804, a superficial and objectively painful scar warrants a 10 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2008). Pursuant to Diagnostic Code 7805, scars that cause limitation of motion are to be rated on the limitation of the part affected. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2008). The Board notes that the regulations pertaining to scars were recently amended. See 73 Fed. Reg. 54710 (October 23, 2008), however, none of the amendments are applicable here. A separate rating on the basis of the bilateral dorsal surgical scars is not warranted as the scars are not deep (DC 7801); do not exceed or even approximate 144 sq. inches (DC 7802); are not shown to be unstable or painful (DCs 7803 and 7804); and cause no limitation of motion or function of the foot (DC 7805). In sum, separate 20 percent ratings, and no higher, are warranted for the Veteran's service-connected great toe disabilities. In reaching this decision, the Board considered the issue of whether the Veteran's service-connected great toe disabilities standing alone present an exceptional or unusual disability picture, as to render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2009); Bagwell v. Brown, 9 Vet. App. 337, 338- 39 (1996); Floyd v. Brown, 9 Vet. App. 88, 94 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Veteran has reported that he had to change jobs as a result of the disabilities. The Veteran's great toe disabilities are manifested by limited motion in the bilateral first MTPJs, with associated symptoms of pain and stiffness. While the original rating criteria pertaining to hallux rigidus were not adequate to rate the disability, the Board herein found that he was entitled to a higher schedular rating under other rating criteria. The rating criteria used in this appeal reasonably contemplates these symptoms and the assigned schedular evaluations are, therefore, adequate. Moreover, there is no indication in the record that the there is such an exceptional disability picture that the available schedular evaluations, to include under DC 5284, are inadequate. In addition, these great toe disorders have not required recent frequent periods of hospitalization, nor are they shown to have caused a marked interference with employment. The Board has considered the letters from the Veteran's employers attesting that his disabilities have caused marked interference with his employment as a sheet metal supervisor. The Veteran has also testified that he went from working an average 60-70 hour week to a 40-hour week. At the most recent VA examination the Veteran reported losing 6 weeks from work in the last 12 month period due to pain in both feet and the VA examiner stated that service-connected foot disorder had a significant impact on the Veteran's occupational activities. The Board however, notes that the letters and testimony show that despite his difficulties the Veteran has been able to consistently maintain full-time employment in his field, in a supervisory position, even though his duties have been varied to account for his foot problems and his 60-70 hour work week has now become a 40-hour work week. Also, while the Veteran reports having recently missed a brief period of work, throughout the entire course of the claim period, he has not lost significant time from work due to his foot disabilities and has continued to work on a full-time basis. The 20 percent rating assigned to each disability already recognizes that there are industrial limitations associated with the disabilities. Accordingly, the regular schedular standards and the assigned 20 percent ratings adequately compensate the Veteran for any adverse impact caused by his great toe disabilities. The Board finds that the criteria for submission for assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) are not met. Finally, where a veteran: (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability, the requirement in 38 C.F.R. § 3.155(a) that an informal claim "identify the benefit sought" has been satisfied and VA must consider whether the veteran is entitled to a total rating for compensation purposes based on individual unemployability (TDIU). Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). TDIU may be a part of a claim for increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran is employed full time and has not alleged that he was unemployable during the course of the appeal. Moreover, there is no evidence of unemployability, accordingly, TDIU is not raised by the record. ORDER A 20 percent disability rating for residuals, status post cheilectomy of the left metatarsophalangeal joint, postoperative hallux rigidus is granted. A 20 percent disability rating for residuals, status post cheilectomy of the right metatarsophalangeal joint, postoperative hallux rigidus is granted. ____________________________________________ S.S. Toth Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs