Citation Nr: 1034786 Decision Date: 09/15/10 Archive Date: 09/21/10 DOCKET NO. 04-33 684 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for a right hand disorder. 2. Entitlement to service connection for residuals of a left ankle injury. 3. Entitlement to a compensable rating for residuals of a sprained ulnar collateral ligament of the right thumb. 4. Entitlement to a rating in excess of 10 percent for osteoarthritis of the right knee with a lateral meniscus tear. 5. Entitlement to an initial compensable rating for residuals of a right ankle injury. 6. Entitlement to service connection for a psychiatric disorder to include posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD D. Bredehorst INTRODUCTION The Veteran served on active duty from September 1975 to September 1978 and from May 1985 to February 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from March 2003 and May 2007 rating decisions by the Jackson RO. In March 2008, the Veteran testified at a Travel Board hearing before the undersigned; a transcript of this hearing is associated with the claims file. In August 2008, the Board remanded these matters for additional development. The issues of service connection for tinnitus, hearing loss, a left knee disorder, carpal tunnel syndrome, a lumbar disorder, and diabetes mellitus have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. The Veteran's right ankle and psychiatric disability claims are addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran is not shown to have a right hand disorder due to disease or injury that was incurred in or aggravated by military service and arthritis of the right hand is not shown to have manifested in the first postservice year. 2. In May 2010, prior to the promulgation of a decision in the appeal, the Veteran expressed his intent to withdraw the appeal on the issue of service connection for residuals of a left ankle injury; there are no questions of fact or law remaining before the Board in this matter. 3. The service-connected residuals of a sprained ulnar collateral ligament of the right thumb are manifested by pain and limitation of motion; a gap of 2 inches when attempting to oppose the thumb to the other fingers is not shown. 3. The service-connected arthritis of the right knee is manifested by full extension with pain and flexion to 78 degrees; neither ankylosis nor related subluxation or instability is demonstrated. 4. The lateral meniscus tear of the right knee is related to the right knee arthritis and is shown to be productive of frequent episodes of "locking," with pain, swelling, and fluid in the knee. CONCLUSIONS OF LAW 1. The Veteran does not have a right hand disorder that was due to disease or injury that was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2009). 2. The criteria for withdrawal of a Substantive Appeal by the Veteran have been met; the Board has no further jurisdiction in the matter of service connection for residuals of a left ankle injury. 38 U.S.C.A. §§ 7104, 7105(d)(5) (West 2002); 38 C.F.R. §§ 20.101, 20.202, 20.204 (2009). 3. The criteria for a 10 percent rating for service-connected residuals of a sprained ulnar collateral ligament of the right thumb have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a including Diagnostic Code (Code) 5228 (2009). 4. The criteria for a rating in excess of 10 percent for the service-connected right knee arthritis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a including Codes 5010, 5260, 5261 (2009). 5. The criteria for a separate 20 percent rating for a lateral meniscus tear of the right knee are met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a including Code 5258 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). VCAA applies to the instant claims. Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1) (including as amended effective May 30, 2008, 73 Fed. Reg. 23353 (Apr. 30, 2008)). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims (Court) held that the notice requirements of the VCAA applied to all 5 elements of a service connection claim (i.e., to include the rating assigned and the effective date of award). VCAA also requires generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings are assigned. Vazquez- Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). Given the Veteran's expression of intent to withdraw his appeal on the issue of service connection for residuals of a left ankle injury, further discussion of the impact of the VCAA on this claim is not necessary. Regarding the remaining claim of service connection, the April 2002 pre-decisional letter informed him of the evidence and information necessary to substantiate his claim, the information required of him to enable VA to obtain evidence in support of his claim, and the assistance that VA would provide to obtain information and evidence in support of his claim. While he did not receive timely (i.e., pre-decisional) notice regarding disability ratings and effective dates of awards, he had ample opportunity to respond after such notice was ultimately given (in September 2008); significantly, such notice is not critical unless service connection is granted. July 2006, August 2006, and September 2008 letters provided proper notice of the information and evidence needed to substantiate his increased rating claims, the evidence VA would obtain, and evidence or information he should submit. He was also given general notice regarding how disability ratings are assigned, disability ratings, and effective dates of awards consistent with Dingess and Vazquez. The Board also finds that VA has made reasonable efforts to assist the Veteran in obtaining evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A (West 2002). To the extent possible, VA secured the Veteran's service treatment records for association with his claims file and obtained all pertinent/identified records that could be obtained. The RO also arranged for VA examinations. VA's duty is met. Service Connection Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on her behalf be discussed in detail. Rather, the Board's analysis will focus specifically on what evidence is relevant to this claim for increase, and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). A. Left Ankle The Board has jurisdiction where there is a question of law or fact on appeal to the Secretary. 38 U.S.C.A. § 7104; 38 C.F.R. § 20.101. Under 38 U.S.C.A. § 7105, the Board may dismiss any appeal, which fails to allege specific error of fact or law in the determination being appealed. A Substantive Appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.202. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In a statement received in May 2010, the Veteran expressed his intent to withdraw the issue of service connection for residuals of a left knee injury. Thus there are no allegations of error of fact or law for appellate consideration on this claim. Accordingly, the Board does not have jurisdiction to consider an appeal in this matter. B. Right Hand The Veteran contends that he has a right hand disorder related to his service. In March 2004, he indicated that he hurt his hand while in the field. Aside from a right thumb injury, the only other hand complaint noted in the Veteran's service treatment records is a May 1977 record that indicates his hand was sore and that he had cut himself. Otherwise, the records are silent for complaints, findings, or diagnoses of the right hand. In November 2004, the Veteran reported having a 2 week history of hand swelling. The following month he sought a physical and he again reporting having problems with his right hand. He reported that he broke his hand in 1977 while playing football. The assessment was osteoarthritis; however, December 2004 x-rays of the right hand were normal. In March 2005, the Veteran testified about the football injury to his right hand that occurred during service. He stated he had a fracture and torn ligaments. He complained of numbness, pain, and limitation of hand motion. On May 2005 VA examination, x-rays of the right hand revealed no acute fracture or dislocation. There were moderate degenerative changes at the radiocarpal joint with mild degenerative joint disease of the intercarpal joints. A July 2005 treatment record indicates the Veteran complained of bilateral hand pain, weakness, numbness, and tingling. The impression was numbness, paresthesias, and pain in both hands that was likely carpal tunnel syndrome. A September 2005 treatment record notes complaints of bilateral wrist pain and right hand numbness. The impression was bilateral carpal tunnel, bilateral de Quervain's, and ulnar nerve entrapment. On June 2009 VA examination, the Veteran's claims file was reviewed. The physician noted that x-rays had revealed degenerative changes in right hand and opined that these changes were age related. The record shows that the Veteran has arthritis in his right hand; however, what remains to be established is whether such disability is related to his military service. Aside from his assertions that he injured his right hand in service, the service treatment records contain no indication that such an injury occurred. Certain chronic diseases, including arthritis, may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active military service. 38 U.S.C.A. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In the present case, x-rays of the right hand that were taken 2 years after service showed no evidence of arthritis. Thus, service connection for arthritis on a presumptive basis is not warranted. The Veteran has not submitted nor does the record contain any medical evidence that suggests the Veteran's right hand arthritis had its onset in service. The only medical evidence that addresses this point is against the claim. A VA physician who examined the Veteran and reviewed his records and contentions opined to the effect that the Veteran's arthritis was due to his age rather than his service. The only evidence offered in support of his claim is his own lay assertions that his right hand disorder is related to his service. Under certain circumstances, lay statements may serve to support claims by supporting the occurrence, diagnosis, or etiology of a disability. Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the Board finds that the Veteran's lay assertions alone cannot constitute competent evidence for the purpose of establishing the etiology of his right hand arthritis since the medical progression of arthritis is not the type of event that lends itself to cause and effect-type observations by a lay person. In view of the above, the Board finds that a preponderance of the evidence is against finding that the Veteran had a right hand disorder that is related to his military service. Accordingly, service connection for a right hand disorder is not warranted. Increased Rating Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2009). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings under a particular Code applies, the higher evaluation is assigned if the disability picture more closely approximates the criteria for the higher rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in severity, it is necessary to consider the complete medical history of the Veteran's disability. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. §§ 4.40 and 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). With any form of arthritis, painful motion is an important factor of disability. It is the intention of the rating schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as at least minimally compensable. 38 C.F.R. § 4.59. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in the claimant's favor. 38 C.F.R. §§ 3.102, 4.3. Once the evidence is assembled, the Board is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). A. Right Thumb On August 2006 VA examination, the Veteran complained of thumb pain that was aggravated by activity or use of the right hand. In particular, driving provoked pain and discomfort. The Veteran also complained of associated arm weakness and occasional thumb swelling and stiffness. His symptoms interfered with his work but they were not incapacitating. He was functionally independent in all basic activities of daily living. An examination of the right thumb revealed the Veteran experienced pain and tenderness at the interdigital web between the first and second web on the dorsum aspect. There was also tenderness at the first interphalangeal joint. His grip was strong and repetitive motion did not produce a change in range of motion. Incoordination or lack of endurance was not detected. The associated occupational therapy note indicates there was limitation in the right thumb with pain upon pinch/grip activities. Fatigue, pain, and edema were noted as well as a limitation in grip. Palmar abduction was from 0 to 60 degrees, radial abduction was from 0 to 54 degrees, IP extension was from 0 to 10 degrees, IP flexion was from 0 to 54 degrees, MP extension and flexion were from 0 to 52 degrees, and opposition from the tip of the thumb to tip of the other digits was to 3/4 of an inch. At the March 2008 Travel Board hearing, the Veteran testified that he was unable to hold things with his right hand due, in part, to right thumb pain. It also interfered with typing. On June 2009 VA examination of the right thumb, the Veteran complained of having right thumb pain with increased use of the hand or accidental bumping of the thumb. It was noted that he wore a molded spica on his thumb. He reported having chronic pain rather than intermittent flare-ups. His employment involved a lot of writing and computer use, which caused thumb pain after extended periods of use. The examiner noted that the Veteran is right hand dominant. A physical examination of the right thumb revealed there was no evidence of redness, heat, deformity, or swelling. There was tenderness to palpation over the ulnar aspect of the thumb metacarpal. The MP joint demonstrated extension and flexion from 0 to 45 degrees, and the IP joint demonstrated extension and flexion from 0 to 35 degrees. There was pain at the base of the metacarpal on range of motion testing but there was no additional limitation with repetitive motion. He made a satisfactory fist but he was unable to oppose the thumb to the tip of the small finger. Grip strength was 4/5. The Veteran's right thumb disability is rated 0 percent under Code 5228, which provides a non-compensable (0 percent) rating for a gap of less than one inch (2.5 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers; a 10 percent rating for a gap of between one to two inches (2.5 cm to 5.1 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers; and a 20 percent rating for a gap of more than two inches (5.1 cm) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Based on the findings of painful motion and opposition of the thumb to the other fingers with a 3/4 inch gap, the Board finds that the Veteran's right thumb disability more nearly approximates the criteria for a 10 percent rating. A rating of 20 percent is not warranted as the evidence does not reflect that there was a gap of more than 2 inches with the thumb opposing the other fingers. The Veteran was shown to make a satisfactory fist and on his most recent examination the only finger he could not oppose was the smallest finger. There was no additional functional impairment due to repetitive motion, incoordination, or fatigue that would approximate the next higher rating. As there is no distinct period in which a higher rating is assignable, a staged rating is not warranted. The Board has also considered whether referral for an extraschedular rating is indicated. See 38 C.F.R. § 3.321(b); Thun v. Peake, 22 Vet. App. 111, 115 (2008). There is nothing in the record that reflects or suggests that the Veteran's right thumb involve factors such as marked interference with employability or frequent hospitalizations so as to render the schedular criteria inadequate. Further, when comparing the Veteran's disability level and symptomatology to the rating schedule, the degree of disability throughout the appeal is contemplated by the rating schedule. The schedular rating takes into account that a disability will produce some degree of interference with employment, but the Veteran has not provided any information or documentation to suggest that the right thumb disability is exceptional or so unusual as to render the schedular evaluation inadequate. B. Right Knee A March 2006 VA treatment record indicates the Veteran reported that he was unable to bear weight or rise up on his knee alone and that it felt like his knee popped and slipped when trying to arise. There was a slight shift to the anterior drawer sign. His complaints included joint pain, stiffness, and deformity. An evaluation of the right knee revealed slight increase in laxity with anterior drawer. Based on April 2006 X-rays, it was suspected that there was a small amount of fluid in the suprapatellar pouch of the right knee. Complaints similar to those noted in March 20006 were also reported in June and July 2006. There was no right knee effusion at the time, but tenderness to palpation and crepitus with range of motion were noted. The knee was stable to varus and valgus stress. The Veteran also reported that his knee locked up. The Veteran was issued a hinged knee support. In August 2006, it was noted that he had a tear of the posterior horn of the lateral meniscus and that surgery was offered but declined. The Veteran reported that when he hyperflexed his right knee it would catch or pop. He also indicated that the brace was not very effective. On November 2006 VA examination, the Veteran complained of a constant aching pain in his right knee, occasional giving way approximately twice a month, locking several times a day, and pain with popping upon the knee unlocking. He reported that he could perform the activities of daily living unassisted and that he wore a splint on his knee. His right knee disability interfered with his job in that prolonged sitting cause knee stiffness, which made getting out of a chair difficult. The Veteran reported that 2 months earlier he had a flare-up of pain and that he missed one day of work as a result. This was the only episode of this nature in the past 12-month period. An examination of the knee revealed it was normal in appearance. Right knee extension was full but it was painful at the end point of 0 degrees. Flexion was from 0 to 96 degrees, but after repetitive motion it was only to 78 degrees. Pain was noted objectively at the non-zero limits of flexion. Collateral and cruciate ligament tests revealed normal stability. Popping was felt on the right knee. At the March 2008 Travel Board hearing, the Veteran stated that he was unable to walk for long periods due to pain associated with his right knee disability. He also had difficulty straightening his knee after sitting and he stated his knee locked up every time he sat down. On June 2009 VA examination, the Veteran complained of having recurrent right knee pain with walking 1/2 mile. He also reported having knee swelling, catching, popping, and having to grasp the knee to straighten it out, at times. Flare-ups occurred approximately once a week with extended periods of weight-bearing and these episodes lasted about one day. Physical examination of the right knee revealed no swelling, or ligament instability. Right knee extension was to 0 degrees and flexion was to 130 degrees with pain at the endpoint. The diagnosis was degenerative joint disease and lateral meniscus tear of the right knee. The physician stated he could not provide an opinion regarding a relationship between the right knee arthritis and lateral meniscus tear without resorting to speculation because the two disabilities were "inextricably intertwined". The Board finds that separate disability ratings are warranted for the Veteran's service-connected right knee arthritis and the right knee meniscus tear. The VA examiner who was asked to opine regarding the etiology of the meniscus tear was somewhat ambiguous in his response; however, he essentially found the two disabilities to be related as he stated that they were "inextricably intertwined". Accordingly, they will be assigned separate ratings. The Veteran's right knee arthritis is rated 10 percent disabling under Code 5010-5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27 (2009). Here, the Veteran's service-connected right knee arthritis is rated under Code 5010. Diagnostic Code 5010 states that traumatic arthritis, substantiated by X-ray findings is rated as degenerative arthritis. See 38 C.F.R. § 4.71a. Diagnostic Code 5003 indicates that degenerative 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 involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such 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, Codes 5003, 5010. The knee is considered a major joint. 38 C.F.R. § 4.45(f) (2009). The normal range of motion of the knee is from zero to 140 degrees. 38 C.F.R. § 4.71, Plate II (2009). Limitation of flexion of the knee to 15 degrees warrants a 30 percent rating, a 20 percent rating for limitation to 30 degrees, a 10 percent rating for limitation to 45 degrees, and a noncompensable evaluation for limitation to 60 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension of the knee to 45 degrees warrants a 50 percent rating, a 40 percent rating for limitation to 30 degrees, a 30 percent rating for limitation to 20 degrees, a 20 percent rating for limitation to 15 degrees, a 10 percent rating for limitation to 10 degrees, and a noncompensable evaluation for limitation to 0 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In VAOPGCPREC 9-98 (1998); 64 Fed. Reg. 52,376 (1999), the VA General Counsel further explained that, when a Veteran has a knee disability evaluated under Diagnostic Code 5257, to warrant a separate rating for arthritis based on X-ray findings, the limitation of motion need not be compensable under Diagnostic Code 5260 or Diagnostic Code 5261; rather, such limited motion must at least meet the criteria for a zero-percent rating. In the alternative, a compensable rating may be granted by virtue of 38 C.F.R. § 4.59. In VAOPGCPREC 9-2004 (2004); 69 Fed. Reg. 59,990 (2004), the VA General Counsel held that when considering Diagnostic Codes 5260 and 5261 together with 38 C.F.R. § 4.71, a Veteran may receive a rating for limitation in flexion only, limitation of extension only, or separate ratings for limitations in both flexion and extension under Diagnostic Code 5260 (leg, limitation of flexion), and Diagnostic Code 5261 (leg, limitation of extension). Throughout the appeal, flexion was limited to no less than 78 degrees, which is not sufficiently limited to warrant a rating in excess of 10 percent under code 5260. Right knee extension was essentially full, but with pain. Since extension was not limited to 15 degrees, a rating in excess of the current 10 percent rating is not warranted. Even taking into consideration factors noted in 38 C.F.R. § 4.40, 4.45, and 4.59 there is no additional functional impairment that is to a degree that would warrant a higher rating. Although a separate rating may be assigned based on knee instability, both VA examiners have found the Veteran's right knee to be stable. Accordingly, Code 5257 (for other impairment of the knee) is not applicable. See 38 C.F.R. § 4.71a The medical evidence in this case does not show ankylosis, removal of semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. Therefore, Codes 5256, 5259, 5262, and 5263 are not for application. See 38 C.F.R. § 4.71a. The lateral meniscus tear warrants a separate rating of 20 percent. The extent of the disability more nearly approximates the criteria under Code 5278, in which 20 percent is the maximum and only rating available. Such a rating is warranted when there is cartilage, semilunar, dislocated, with frequent episodes of "locking", pain, and effusion into the joint. See 38 C.F.R. § 4.71a. The record shows that the Veteran's right knee lateral meniscus tear is manifested by frequent locking and pain in addition to swelling and fluid in the knee. The Board's findings above are based on schedular evaluation. Here, referral for extraschedular consideration is not warranted since the applicable rating criteria reasonably describe the Veteran's disability levels and symptomatology. Furthermore, the evidence does not show marked interference with employment in excess of that contemplated by the rating schedule. On a VA examination, the Veteran reported missing only missing 1 day of work during the past 12-month period due to his right knee disability. Accordingly, there is no evidence of marked interference with the Veteran's employment. There is also no evidence showing hospitalization or other evidence that would render impractical the application of the regular schedular standards. For these reasons, the Board is not required to remand the Veteran's claim for consideration of extraschedular ratings under 38 C.F.R. § 3.321(b)(1). See Thun v. Peake, 22 Vet. App. 111, 115 (2008); Bagwell v. Brown, 9 Vet. App. 337, 338- 39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). ORDER Service connection for a right hand disorder is denied. Service connection for residuals of a left ankle injury is dismissed. A 10 percent rating for residuals of a sprained ulnar collateral ligament of the right thumb is granted, subject to the regulations controlling disbursement of VA monetary benefits. A rating in excess of 10 percent for the service-connected right knee arthritis is denied. A separate 20 percent rating for a lateral meniscus tear of the right knee is granted, subject to the regulations controlling disbursement of VA monetary benefits. REMAND In a March 2010 rating decision, the RO granted service connection for status post old sprain injury of the right ankle and assigned an initial noncompensable rating, effective March 14, 2006. In an April 2010 letter, the RO notified the Veteran of the determination. In a statement dated in May 2010 and filed at VA that same month, the Veteran challenged the initial noncompensable evaluation. The Board accepts the Veteran's May 2010 statement as a Notice of Disagreement (NOD) with the March 2010 rating decision. See 38 C.F.R. § 20.201 (2010). To date, however, the RO has not issued him a Statement of the Case (SOC) with respect to this claim. Under the circumstances, the Board has no discretion and is obliged to remand this issue to the RO for the issuance of an SOC. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999); Holland v. Gober, 10 Vet. App. 433, 436 (1997). Similarly, in an October 2009 rating decision, the RO denied service connection for PTSD. Later that month, the RO notified the Veteran of the determination. In a statement dated in March 2010 and filed at VA later that month, the Veteran stated, "I would like to appeal my claim for PTSD." The Board accepts the Veteran's March 2010 2003 statement as an NOD with the October 2009 rating decision. See 38 C.F.R. § 20.201. To date, however, the RO has not issued him an SOC with respect to this claim. Under the circumstances, the Board has no discretion and is obliged to remand this issue to the RO for the issuance of an SOC. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999); Holland v. Gober, 10 Vet. App. 433, 436 (1997). With regard to the Veteran's "PTSD" claim, the Board notes that the Veteran has been diagnosed as having numerous psychiatric disabilities, and the United States Court of Appeals for Veterans Claims (Court) has held that the scope of a service connection claim should be construed based on the reasonable expectations of a non-expert, self-represented claimant, and the evidence developed during the claims process. The factors to consider are the Veteran's description of his claim, the symptoms he describes; and all the information he submits or VA obtains in support of the claim. Therefore, if a Veteran claims service connection for a specific disorder, any disorder reasonably encompassed by the Veteran's claim must be considered. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In light of these considerations, and consistent with the Veteran's assertions, the Board finds that the scope the present claim is not limited to a claim of service connection for PTSD alone, but also encompasses a claim of service connection for a psychiatric disorder(s) other than PTSD. Accordingly, the case is REMANDED for the following action: The RO must issue the Veteran an SOC with respect to his claims seeking a higher initial rating for his right ankle disability and to service connection for a psychiatric disability, to include PTSD, to include notification of the need to timely file a Substantive Appeal to perfect his appeal on this issue. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ STEVEN D. REISS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs