Citation Nr: 1033151 Decision Date: 09/02/10 Archive Date: 09/13/10 DOCKET NO. 08-01 746 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a neck disorder, to include as secondary to residuals of a gunshot wound to the right shoulder. 2. Entitlement to a disability rating greater than 30 percent for limitation of motion of the right arm. 3. Entitlement to a disability rating greater than 20 percent for residuals of a fracture of the right scapula, status post- gunshot wound, with a scar and degenerative joint disease. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and E.C. ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel INTRODUCTION The appellant, who is also the Veteran, served on active duty from September 1948 to May 1952. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a April 2007 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA), which denied the Veteran service connection for a head and neck disorder, claimed as secondary to his service-connected residuals of a gunshot wound, and increased ratings for his disabilities of the right arm and shoulder, status post-gunshot wound. The Veteran subsequently initiated and perfected appeals of these rating determinations. In February 2010, the Veteran testified before the undersigned Acting Veterans Law Judge, seated at the RO. This appeal was initially presented to the Board in March 2010, at which time it was remanded for additional development. The required development has been completed and this case is appropriately before the Board. See Stegall v. West, 11 Vet. App. 268 (1998). Within a June 2010 rating decision, the RO granted the Veteran service connection for headaches, as secondary to his gunshot wound of the right shoulder. Generally, where an appellant is awarded service connection for a claimed disability, that issue is no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). However, in the present case, the Veteran originally sought service connection for a "head and neck condition"; thus, the Board does not find the grant of service connection for headaches to constitute a full grant of the benefit sought on appeal, as he also reported a neck disorder. Therefore, the issue on appeal will be reframed as entitlement to service connection for a neck disorder. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. Competent evidence has not been presented of a nexus between a current neck disorder and a disease or injury incurred during active military service, to include a right shoulder gunshot wound. Such a disorder also did not manifest to a compensable degree within a year of service separation, and is not due to, the result of, or is aggravated by a service-connected disability. 2. The Veteran's degenerative joint disease of the right shoulder joint is characterized by an ability to raise his right (major) arm to approximately shoulder height. 3. The Veteran's fracture of the right scapula, with scarring and degenerative joint disease, resulting from a gunshot wound to the right shoulder, results in some pain and weakness of the right shoulder joint. CONCLUSIONS OF LAW 1. Service connection for a neck disorder, to include as secondary to residuals of a right shoulder gunshot wound, is not warranted. 38 U.S.C.A. §§ 1112, 1131, 1133, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2009). 2. The criteria for a disability rating greater than 30 percent for limitation of motion of the right arm, resulting from a right shoulder gunshot wound have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200-5203 (2009). 3. The criteria for a disability rating greater than 20 percent for fracture of the right scapula, with scarring and degenerative joint disease, resulting from a gunshot wound to the right shoulder have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200-03 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran seeks service connection for a neck disorder, to include as secondary to a gunshot wound of the right shoulder. He also contends that his service-connected limitation of motion of the right arm and residuals of a fracture of the right scapula, status post-gunshot wound, with a scar and degenerative joint disease are more disabling than currently evaluated. Service Connection Issue Service connection may be awarded for a current disability arising from a disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be awarded for certain disabilities, such as arthritis, which manifest to a compensable degree within a year of service separation. 38 U.S.C.A. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Finally, service connection may be awarded for any disability which is due to or the result of, or is otherwise aggravated by, a service-connected disability. 38 C.F.R. § 3.310 (2009); Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any matter material to the claim, the claimant shall be given the benefit of the doubt. 38 U.S.C.A. § 5107. The Veteran's service treatment records indicate he suffered a gunshot wound as the result of enemy small arms fire in November 1950, specifically, an entrance would just above the right clavicle, and an exit would just above the upper border of the scapula. No nerve or artery involvement was noted. The Veteran also sustained compound fractures of the right scapula and 2nd right rib. These injuries were also without artery or nerve involvement, and healed without complications. He was afforded extended convalescence and physical therapy, which was delayed by a bout of malaria, and he was returned to duty in September 1951. A May 1952 service separation examination noted no abnormality of the neck or spine. The Veteran first filed a claim for service connection for a neck disorder in November 2006. A VA orthopedic examination was afforded the Veteran in November 2007. At that time, the Veteran reported longstanding mechanical neck pain in the right nuchal and suprascapular trapezius muscles. He indicated that he has received conservative treatment over the years, without surgery or steroidal injections. Physical examination of the cervical spine revealed normal curvature, without spinous process tenderness. Tenderness was present in the right suprascapular and nuchal trapezius muscles, but he was without spasm. Sensation was intact in the upper extremities, and motor strength was 5/5. Reflexes were physiologic and symmetric. Range of motion was within normal limits, albeit with pain reported at the extremes of motion across each plane. X-rays indicated some reversal of the cervical lordosis, and some disc space narrowing and degenerative disc disease at C3-5. The examiner offered no opinion regarding the etiology of the Veteran's cervical spine disability. However, in a December 2007 examination report addendum, the examiner stated, upon review of the claims file, that the Veteran's degenerative disc disease of the cervical spine was "less than likely caused by or a result of the gunshot wound of the right shoulder." The examiner could find no studies suggesting degenerative joint disease of an upper extremity joint could result in degenerative changes in the cervical spine. The more likely cause of the degenerative disc disease of the cervical spine was aging, according to the examiner. During his February 2010 personal hearing, the Veteran stated he had long experienced pain and stiffness of the neck following his gunshot wound during military service. Since service, he has managed his neck and shoulder pain with chiropractic care and therapeutic massage. The Veteran was next afforded a subsequent VA orthopedic examination in May 2010. The claims file was reviewed in conjunction with the examination. The examiner noted the history of the Veteran's gunshot wound to the right shoulder, as well as his current complaints and physical findings. Regarding the Veteran's neck pain, the examiner found this was likely the result of muscle spasms of the right trapezius muscle due to the original gunshot wound and subsequent scar tissue. This muscle had its upper border along the base of the neck, causing pain, stiffness, and tension headaches. These symptoms improved with massage. The examiner found no intrinsic cervical spinal issue resulting in the Veteran's current gunshot wound symptomatology and found that it was the musculature, specifically the right trapezium, that was resulting in the Veteran's symptomatology of the neck. After considering the totality of the record, the Board finds the preponderance of the evidence to be against the award of service connection for a neck disability, to include as secondary to a gunshot wound of the right shoulder. Considering first entitlement to service connection for a neck disability on a direct basis, the evidence does not demonstrate and the Veteran does not allege injury to his cervical spine during military service. The service treatment records do not indicate the Veteran's cervical spine was injured during military service, to include as a result of his gunshot wound, and his May 1952 service separation examination was negative for any abnormality of the neck or spine. Additionally, a September 1952 post- service VA medical examination noted no disabilities of the neck or spine at that time and the Veteran did not complain of a neck disorder until November 2006, approximately 54 years after his discharge from military service. In the absence of any competent evidence to the contrary, the Board finds the Veteran did not sustain a neck or cervical spine disorder during military service, nor did one manifest to a compensable degree within a year thereafter. Thus, service connection on a direct basis for a neck disability must be denied. Based on review of the record, the Board must also conclude the Veteran's current neck disability, degenerative disc disease of the cervical spine, is neither caused nor aggravated by his service-connected residuals of a gunshot wound to the right shoulder. According to the December 2007 VA examination report addendum, the Veteran's degenerative disc disease of the cervical spine was "less than likely caused by or a result of the gunshot wound of the right shoulder." The November/December 2007 VA examiner furthermore could find no studies suggesting degenerative joint disease of an upper extremity joint could result in degenerative changes in the cervical spine. The most likely cause of the Veteran's degenerative disc disease of the cervical spine was aging, according to the examiner. The May 2010 VA examiner also found no intrinsic cervical spinal issue resulting in the Veteran's current gunshot wound symptomatology. While the May 2010 VA examiner has stated the Veteran has scar tissue of the right trapezius muscle, causing spasm and resulting in tension headaches, the Board observes that service connection has already been awarded the Veteran for such headaches. In the absence of competent evidence to the contrary, service connection must be denied on a secondary basis for a neck disability resulting from his service-connected residuals of a right shoulder gunshot wound. It is acknowledged that the Veteran is competent to give evidence about his observable symptomatology. Layno v. Brown, 6 Vet. App. 465 (1994). It is further acknowledged that lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Here, however, any statements as to continuous neck problems are not found to be persuasive in light of the fact that the Veteran denied problems upon separation and did not raise a claim until approximately 54 years following discharge. For these reasons, continuity of symptomatology has not here been established, either through the competent evidence or through the Veteran's statements and testimony. Moreover, there is no medical evidence in the record that links any current neck disorder to an incident of the Veteran's active military service, to include his service-connected right shoulder disorder The Veteran himself asserts his residuals of a gunshot wound to the right shoulder result in a current disorder of the neck. However, as a layperson, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Furthermore, orthopedic disorders such as degenerative disc disease are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran's statements therein cannot be accepted as competent medical evidence. In conclusion, the preponderance of the evidence is against the award of service connection for a neck disorder. The Veteran's current d degenerative disc disease at C3-5 was not incurred in active military service, manifested to a compensable degree within a year thereafter, and is not due to, the result of, or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55- 57 (1991). Increased Rating Issues Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the veteran. 38 C.F.R. § 4.3. 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 required for that rating. 38 C.F.R. § 4.7. The Board has long recognized that, when considering initial ratings, the degree of impairment since the effective date of the grant of service connection must be considered, to include the possibility that a staged rating may be assigned. See Fenderson v. West, 12 Vet. App. 119 (1998). However, in the case of Hart v. Mansfield [21 Vet. App. 505 (2007)], the U.S. Court of Appeals for Veterans Claims (Court) held that staged ratings are also appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. As such, the Board will consider whether staged ratings are appropriate to the pending appeal. When evaluating musculoskeletal disabilities, the Board must also 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 under 38 C.F.R. §§ 4.40 and 4.45 under any applicable diagnostic code pertaining to limitation of motion. See DeLuca v. Brown, 8 Vet. App. 202 (1995). As above, the Veteran's service treatment records indicate he suffered a gunshot wound as the result of enemy small arms fire in November 1950, specifically, an entrance would just above the right clavicle, and an exit would just above the upper border of the scapula. No nerve or artery involvement was noted. The Veteran also sustained compound fractures of the right scapula and 2nd right rib. These injuries were also without artery or nerve involvement, and healed without complications. He was afforded extended convalescence and physical therapy, and he was returned to duty in September 1951. By rating decision dated in October 1952 the RO granted service connection for GSW (gunshot wound), healed, perforating right posterior thorax with residual pleurisy, chronic, fibrinous, assigning a 20 percent disability rating. By rating decision dated in April 1978 the RO granted a separate 20 percent disability rating for limitation of motion, right arm. Also, by rating decision dated in March 2004 the RO increased the disability rating for limitation of motion, right arm from 20 percent to 30 percent. Upon receipt of an increased rating claim in November 2006, the Veteran was afforded a VA orthopedic examination in March 2007. His reported symptoms included pain, described as 10/10 on occasion, and spasm of the right suprascapular and nuchal trapezius muscles. He took no medication for his pain, and stated it was completely relieved with massage. He had no dysesthesias or paresthesias of the right arm distal to the axilla, and denied that his condition rendered him housebound. On objective examination, the Veteran used no orthopedic device for his right shoulder or arm. He had a 1 cm by 2 cm linear concave scar over the right scapula. The scar was well-healed, without indication of inflammation. On palpation, tenderness was reported involving the right suprascapular and nuchal trapezius muscles. Slight spasm was also present. No subacromial, acromioclavicular, deltoid, or glenohumeral tenderness was observed. The drop-arm test was negative. The apprehension and impingement signs were negative. Range of motion testing revealed forward flexion to 180 degrees, abduction to 180 degrees, and external and internal rotation to 90 degrees each. No additional limitation of motion was noted due to such factors as weakness, fatigability, loss or coordination. X-rays of the right shoulder confirmed a slight deformity of the scapular spine with large spurring present on the scapula. No shrapnel was present in the wound site. Mild degenerative joint disease and joint space narrowing were also present in the right acromioclavicular joint. On VA orthopedic examination in November 2007, the Veteran's motor strength was 5/5 for all muscle groups of the upper extremities, and sensation was intact to light touch. Reflexes were also within normal limits. During his February 2010 personal hearing, the Veteran testified he had long experienced pain and stiffness of the neck and right shoulder following his gunshot wound during military service. Since service, he has managed his neck and shoulder pain with chiropractic care and therapeutic massage. The Veteran was next afforded a VA orthopedic examination in May 2010. The claims file was reviewed in conjunction with the examination. The Veteran was noted to have sustained a through and through gunshot wound of the right shoulder during military service, entering in the supraclavicular area and exiting through the right scapula. The bullet transversed the right trapezius muscle. Current symptoms included pain of the right shoulder and weakness with overhead lifting. Range of motion testing indicated full range of motion, without intrinsic shoulder pain. No additional limitation of motion was noted to result from repetitive use, and the Veteran denied incoordination, fatigue, or lack of endurance. Muscle strength was 4+/5, with pain reported. No flare-ups were reported. The impression was of a normal glenohumeral joint, with some trapezius muscle pain and weakness throughout the shoulder range of motion. The examiner concluded that the pain was likely the result of scar tissue in the trapezius muscle resulting from the gunshot wound. 1. Limitation of motion - Right arm The Veteran's right arm disorder is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5201, for limitation of motion of the arm. Because the Veteran is right hand-dominant, the disability ratings for the major upper extremity will be considered. DC 5201 provides a 30 percent rating for limitation of motion of the arm to midway between the side and shoulder level, and a 40 percent rating for motion limited to 25 degrees from the side. A 40 percent rating is the maximum schedular rating under Diagnostic Code 5201. After considering the totality of the record, the Board finds the preponderance of the evidence to be against the award of a disability rating greater than 30 percent for the Veteran's right shoulder disability. According to the March 2007 and May 2010 VA examination reports, the Veteran has both flexion and abduction of the right shoulder which allows raising of the right arm to approximately shoulder level or higher; in fact, his range of motion has been described as full or near full. Thus, because the Veteran's right arm motion exceeds that of 25 degrees from his side, a 40 percent rating under DC 5201 is not warranted. While the Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would reduce his right arm mobility to 25 degrees from his side; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Next, evaluation of the Veteran's right shoulder disability under other criteria for the shoulder joint would not result in an increased rating, as he does not display ankylosis of the shoulder joint or fibrous union of the humerus, as would warrant an increased rating pursuant to DCs 5200 and DC 5202. Finally, insomuch as the Veteran's right shoulder disability has demonstrated an essentially similar degree of impairment during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, supra. The Veteran and his representative have asserted that a separate rating is warranted based on the Veteran's degenerative joint disease of the right shoulder, resulting from his gunshot wound. For VA compensation purposes, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved, with a minimum rating of 10 percent to be assigned for each major joint affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. The Board notes in the present case that the Veteran has already been assigned a disability rating in excess of 10 percent for his limitation of motion of the right arm. To further assign a separate rating for the Veteran's arthritis, in addition to that already assigned for his limitation of motion of the same joint, would amount to pyramiding, a practice which is forbidden by regulation. See 38 C.F.R. § 4.14. In conclusion, the preponderance of the evidence is against a disability rating in excess of 30 percent for the Veteran's limitation of the right arm resulting from his right shoulder gunshot wound. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). 2. Fracture - Right scapula The Veteran's fracture of the right scapula is currently rated under 38 C.F.R. § 4.71a, DC 5203, for impairment of the clavicle or scapula. As noted above, because the Veteran is right-handed, the ratings for the major upper extremity apply. DC 5203 awards a maximum 20 percent schedular evaluation for dislocation or nonunion of the clavicle or scapula, with loose movement. In the alternative, a rating may be assigned based on impairment of function of the contiguous joint. After considering the totality of the record, the Board finds the preponderance of the evidence is against a disability rating greater than 20 percent for the Veteran's residuals of a fracture of the right scapula resulting from his gunshot wound to the right shoulder. As noted above, the Veteran has already been awarded the maximum schedular rating under DC 5203 for impairment of the clavicle or scapula of the major upper extremity. Furthermore, evaluation of the Veteran's right shoulder disability under other criteria for the shoulder joint would not result in an increased rating, as he does not display ankylosis of the shoulder joint or fibrous union of the humerus, as would warrant an increased rating. The Board also observes that the Veteran has already been afforded a separate compensable rating of 30 percent under DC 5201, for limitation of motion of the right arm. Consideration under the criteria for muscle or nerve injuries is not warranted, as the Veteran has full or near-full strength and motor function of the right upper extremity, and his neurological responses are within normal limits. Thus, evaluation of his disability under the diagnostic criteria for muscles and/or nerves would not result in a disability rating in excess of 20 percent. Finally, insomuch as the Veteran's right shoulder disability has demonstrated an essentially similar degree of impairment during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, supra. In reviewing the Veteran's claim, the Board is also aware that separate ratings may be awarded for distinct symptomatology or manifestations of the service-connected disability at issue. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (holding that evaluations for distinct disabilities resulting from the same injury could be combined so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition). In the present case, the Veteran has a gunshot wound scar of the right shoulder. However, according to the March 2007 examination report, his scar is well-healed and asymptomatic on objective evaluation. Based on these findings, a separate 10 percent rating is not warranted at present under the criteria for skin disabilities. See 38 C.F.R. § 4.118, DCs 7800-05. In conclusion, the preponderance of the evidence is against a disability rating in excess of 20 percent for the Veteran's residuals of a fracture of the right scapula, secondary to a gunshot wound, with degenerative joint disease and scarring. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). Extraschedular consideration Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the Veteran. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (claim for an increased rating includes consideration of whether a total disability rating by reason of individual unemployability is warranted under the provisions of 38 C.F.R. § 4.16). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. To accord justice in an exceptional case where the schedular standards are found to be inadequate, the RO is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1). The criterion for such an award is a finding that the case presents an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical application of regular schedular standards. Id. The Court has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court further held that the Board must address referral under 38 C.F.R. §3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In Thun v. Peake, 22 Vet. App. 111 (2008), the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. Either the RO or the Board must first determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. If the RO or the Board finds that the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether the Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. In this case, the symptoms described by the Veteran fit appropriately with the criteria found in the relevant DCs for the disabilities at issue. The Board observes the Veteran is retired after working for many years, and has not required frequent or extended hospitalization for his service-connected residuals of his gunshot wound to the right shoulder during the pendency of this appeal. Additionally, no examiner has stated the Veteran's service-connected disabilities alone are the cause of any marked interference with employment. In short, the rating criteria contemplate not only his symptoms but the severity of his disabilities. The Board does not find that the schedular criteria have been inadequate for rating the manifestations of the service-connected disabilities on appeal. See 38 U.S.C.A. § 1155 (Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity). For these reasons, referral for extraschedular consideration is not warranted. Notice and Assistance Upon receipt of a complete or substantially complete application for benefits and prior to an initial unfavorable decision on a claim by an agency of original jurisdiction, VA is required to notify the appellant of the information and evidence not of record that is necessary to substantiate the claim. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159; Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The notice should also address the rating criteria or effective date provisions that are pertinent to the appellant's claim. Dingess v. Nicholson, 19 Vet. App. 473 (2006). For an increased-compensation claim, section 5103(a) requires, at a minimum, that the Secretary (1) notify the claimant that to substantiate a claim, the claimant must provide, or ask the Secretary to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment; (2) provide examples of the types of medical and lay evidence that may be obtained or requested; (3) and further notify the claimant that "should an increase in disability be found, a disability rating will be determined by applying relevant [DC's]," and that the range of disability applied may be between 0% and 100% "based on the nature of the symptoms of the condition for which disability compensation is being sought, their severity and duration, and their impact upon employment." Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), vacated on other grounds sub nom. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). With regard to the service connection issue, compliant notice was sent in December 2006 and April 2010 letters and the claim was readjudicated in a June 2010 supplemental statement of the case. Mayfield, 444 F.3d at 1333. With regard to the increased rating issues, such notice was not provided in this case. Although the appellant received inadequate notice, the record reflects that the purpose of the notice was not frustrated. Vazquez-Flores, 22 Vet. App. at 49. In December 2006 and April 2010 letters, the RO stated that to establish entitlement to an increased evaluation for his service- connected disabilities, the evidence must show that his condition "ha[d] worsened enough to warrant the payment of a greater evaluation." The letter also explained that the VA was responsible for (1) requesting records from Federal agencies, (2) assisting in obtaining private records or evidence necessary to support his claim, and (3) providing a medical examination if necessary. The April 2007 rating decision explained the criteria for the next higher disability rating available for the service- connected disabilities under the applicable diagnostic codes. The January 2008 statement of the case provided the appellant with the applicable regulations relating to disability ratings for his service-connected disabilities, as well as the requirements for an extraschedular rating under 38 C.F.R. § 3.321(b) and stated that, pursuant to 38 C.F.R. § 4.10, disability evaluations center on the ability of the body or system in question to function in daily life, with specific reference to employment. Moreover, the record shows that the appellant was represented by a Veteran's Service Organization and its counsel throughout the adjudication of the claims. Overton v. Nicholson, 20 Vet. App. 427 (2006). Thus, based on the record as a whole, the Board finds that a reasonable person would have understood from the information that VA provided to the appellant what was necessary to substantiate his increased rating claims, and as such, that he had a meaningful opportunity to participate in the adjudication of his claims such that the essential fairness of the adjudication was not affected. The Board further finds that VA has complied with the duty to assist by aiding the appellant in obtaining evidence. It appears that all known and available records relevant to the issues on appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's service treatment records, as well as any reported VA and non-VA medical records. He has also been afforded VA medical examinations on several occasions, most recently in May 2010. The Board notes that the VA examination reports contain sufficiently specific clinical findings and informed discussion of the pertinent history and clinical features of the disability on appeal and are adequate for purposes of this appeal. In February 2010, the Veteran was afforded the opportunity to testify before the undersigned Acting Veterans Law Judge. All known and available records relevant to the issues on appeal have been obtained and associated with the appellant's claims file; and the appellant has not contended otherwise. VA has substantially complied with the notice and assistance requirements and the appellant is not prejudiced by a decision on the claim at this time. ORDER Service connection for a neck disorder, to include as secondary to residuals of a gunshot wound of the right shoulder is denied. A disability rating greater than 30 percent for limitation of motion of the right arm, due to a gunshot wound of the right shoulder is denied. A disability rating greater than 20 percent for residuals of a fracture of the right scapula, secondary to a gunshot wound of the right shoulder, with degenerative joint disease and scarring is denied. ____________________________________________ APRIL MADDOX Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs