Citation Nr: 1035236 Decision Date: 09/17/10 Archive Date: 09/21/10 DOCKET NO. 06-10 735 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an initial compensable disability rating for traumatic residuals of a right ankle fracture. 2. Entitlement to a compensable disability rating for bilateral plantar fasciitis prior to May 20, 2009. 3. Entitlement to a disability rating in excess of 10 percent for bilateral plantar fasciitis since May 20, 2009. 4. Entitlement to an initial compensable disability rating for right third finger fracture. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. Purdum, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1979 to August 2005. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Waco, Texas, Department of Veterans Affairs (VA) Regional Office (RO). A December 2005 rating decision, in pertinent part, granted the Veteran's claims of entitlement to service connection and assigned initial noncompensable disability ratings for traumatic residuals of a right ankle fracture, bilateral plantar fasciitis, anal fissure, right third finger fracture, and left ear hearing loss. By an August 2006 service connection for anal fissure was severed. In April 2009, the Board denied the Veteran's claim of entitlement to an initial compensable disability rating for left ear hearing loss and determined that the Veteran was not eligible for a retroactive increase in benefits because basic entitlement to service connection for anal fissure had been severed. The Board remanded the remaining issues of entitlement to initial compensable disability ratings for traumatic residuals of a right ankle fracture, bilateral plantar fasciitis, and right third finger fracture for additional development. The file has now been returned to the Board for further consideration. By a May 2010 rating decision, the disability rating assigned to the Veteran's bilateral plantar fasciitis was increased to 10 percent, effective May 20, 2009. As the 10-percent evaluation is less than the maximum available rating, and there remains a time period for which a noncompensable disability rating was in place, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The issue of entitlement to vocational rehabilitation is raised by the record. Associated with the claims file currently before the Board is a January 2006 claim of entitlement to vocational rehabilitation. To date, it does not appear that the agency of original jurisdiction (AOJ) has addressed this issue; however, the Board notes that there may exist a separate vocational rehabilitation folder indicating that the Veteran's claim was indeed addressed. In the event that the Veteran's claim of entitlement to vocational rehabilitation has not been addressed, the Board refers such to the AOJ for appropriate action. FINDINGS OF FACT 1. During the appellate period, the Veteran's traumatic residuals of a right ankle fracture were manifested by tenderness to palpation of the talar joint and full range of motion, and subjective complaints of pain, weakness, stiffness, and lack of endurance. 2. Prior to May 20, 2009, the Veteran's bilateral plantar fasciitis was manifested by full range of motion of both feet; tenderness to palpation where the plantar fascia inserts to the calcaneus, bilaterally; and subjective complaints of pain, weakness, stiffness, and lack of endurance. 3. Since May 20, 2009, the Veteran's bilateral plantar fasciitis was manifested by normal bilateral Achilles alignment; non- painful bilateral manipulation; mild bilateral pronation; very mild swelling at the lateral malleolus of the right foot; bilateral weight-bearing line medial to great toe; and subjective complaints of pain and heat. 4. During the appellate period, the Veteran's right third finger fracture was manifested by full range of motion. CONCLUSIONS OF LAW 1. The criteria for an initial compensable disability rating for traumatic residuals of a right ankle fracture have not been met at any time during the appellate period. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b) (1), 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5271 (2009). 2. The criteria for a compensable disability rating for bilateral plantar fasciitis have not been met prior to May 20, 2009. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b) (1), 4.6, 4.20, 4.27, 4.71a, DCs 5276, 5284 (2009). 3. The criteria for a disability rating in excess of 10 percent for bilateral plantar fasciitis have not been met since May 20, 2009. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b) (1), 4.6, 4.20, 4.27, 4.71a, DCs 5276, 5284 (2009). 4. The criteria for an initial compensable disability rating for right third finger fracture have not been met at any time during the appellate period. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b) (1), 4.20, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5226, 5229 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist the Appellant VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326 (2009). The Veteran's claims of entitlement to increased disability ratings for traumatic residuals of a right ankle fracture, bilateral plantar fasciitis, and right third finger fracture arise from his disagreement with the initial evaluations assigned following the grant of service connection. Once service connection is granted, the claim is substantiated, additional notice is not required and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). The Board notes here that while not required due to the nature of his initial increased rating claims, the Veteran, as part of the Benefits Delivery at Discharge program (BDD), was provided pre- adjudicatory notice at the time he filed his original claim in March 2005. As to VA's duty to assist, the Veteran was afforded VA examinations in May 2005 and May 2009. The Veteran has not indicated that he was seen regarding the disabilities on appeal by any provider or at any time other than the treatment reflected in the current records on file. The Board notes that by a March 2008 letter, the Veteran asked the RO to consider additional medical evidence. Copies of medical evidence were attached to the letter and are currently associated with the claims file. The Veteran submitted an additional letter in May 2008 and again referred to additional medical evidence. He attached a copy of the RO's most recent communication to his May 2008 letter. However, no additional medical evidence was attached to the May 2008 letter or associated with the claims file. Review of the claims file reveals that the evidence to which the Veteran referred to in his May 2008 letter appears to be the evidence attached to the March 2008 letter. To the extent that such inconsistency raises the issue of whether VA lost or misplaced the medical evidence the Veteran referred to in his May 2008 letter, there is no evidence of such. There is a presumption of regularity under which it is presumed that government officials "have properly discharged their official duties." United States v. Chem. Found., Inc., 272 U.S. 1, 14-15 (1926); Mindenhall v. Brown, 7 Vet. App. 271, 274 (1994) (VA need only mail notice to the last address of record for the presumption to attach). This presumption of regularity in the administrative process may be rebutted by "clear evidence to the contrary." Schoolman v. West, 12 Vet. App. 307, 310 (1999). If there was indeed medical evidence attached to the May 2008 letter, such would presumably have been associated with the claims file. Without evidence to the contrary and with the presumption of regularity of the official acts of public officers, the Board must conclude that any and all attachments to the May 2008 letter were associated with the claims file. See Marciniak v. Brown, 10 Vet. App. 198, 200 (1998). Thus, the Board finds that there is no assertion or evidence sufficient to rebut the presumption of regularity in the administrative process. Therefore, all identified and authorized post-service treatment records available and relevant to the issues on appeal have been requested or obtained. Based upon the above, the Board finds that VA has satisfied its duty to assist and that no additional assistance is required. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Additionally, the Board finds there has been substantial compliance with its April 2009 remand directives. The Board notes that the U.S. Court of Appeals for Veterans Claims (Court) has recently held that "only substantial compliance with the terms of the Board's engagement letter would be required, not strict compliance." See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268) violation when the examiner made the ultimate determination required by the Board's remand.) The record indicates that the Appeals Management Center (AMC) provided the Veteran a VA examination in May 2009 and report of such indicates that the examiner provided sufficient detail to allow the Board to address all applicable diagnostic criteria. Thus, the Board finds that the May 2009 VA examinations were adequate for rating purposes. The AMC later issued a supplemental statement of the case in May 2010. Based on the foregoing, the Board finds that the AMC substantially complied with the mandates of its remand. See Stegall, supra, (finding that a remand by the Board confers on the appellant the right to compliance with its remand orders). Therefore, in light of the foregoing, the Board will proceed to review and decide the claims based on the evidence that is of record consistent with 38 C.F.R. § 3.655 (2009). Increased Ratings Ratings for service-connected disabilities are determined by comparing a veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4 (2009). When rating a service- connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2009). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination upon which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervations, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40 (2009). Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss in light of 38 C.F.R. § 4.40, taking into account any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions regarding the avoidance of pyramiding do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare ups. 38 C.F.R. § 4.14 (2009). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 (2009), however, should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59 (2009). With respect to the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: (a) less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); (b) more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); (c) weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); (d) excess fatigability; (e) incoordination, impaired ability to execute skilled movements smoothly; and (f) pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing and weight-bearing are related considerations. 38 C.F.R. § 4.45. The words slight, moderate, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. 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). It should also be noted that use of terminology such as severe by VA examiners and others, although an element 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 (2009). Traumatic Residuals of a Right Ankle Fracture The Veteran's traumatic residuals of a right ankle fracture are currently rated as noncompensably disabling under DC 5271, effective September 1, 2005. DC 5271 contemplates limited motion of the ankle. 38 C.F.R. § 4.71a, DC 5271 (2009). In considering the applicability of other diagnostic codes related to the ankle, the Board finds that DC 5003, contemplating degenerative arthritis; DC 5010, contemplating traumatic arthritis; DC 5262, contemplating impairment of the tibia and fibula; DC 5270, contemplating ankylosis of the ankle; DC 5272, contemplating ankylosis of the subastralgar or tarsal joint; DC 5273, contemplating malunion of the os calcis or astralgus; and DC 5274, contemplating astralgalectomy, are not applicable as the medical evidence of record is silent for evidence of such. Accordingly, these DCs may not serve as bases for an initial compensable disability rating in this case. 38 C.F.R. § 4.71a, DCs 5003, 5010, 5262, 5270, 5272, 5273, 5274 (2009). The Board now turns to the relevant medical evidence of record. On VA examination May 2005, the Veteran complained of constant and daily pain, weakness, stiffness, and lack of endurance related to his claimed musculoskeletal disabilities, precipitated by physical activity and inclement weather and alleviated by rest and medication. He reported that he had difficulty navigating stairs, walking or running long distances, or standing for a long period of time. Physical examination revealed tenderness to palpation over the talar joint and full range of motion, without pain on motion. No change in motion was detected during repetitive movement. The Veteran did not exhibit swelling of the right ankle or an abnormal gait. The examiner opined that the Veteran's claimed musculoskeletal disabilities interfered with his ability to fully enjoy recreational activities and that such disability may potentially interfere with employment in an occupation requiring vigorous activity. The examiner opined that the Veteran's musculoskeletal disabilities did not interfere with his ability to complete the activities of daily living. The Veteran was diagnosed with traumatic residuals, right ankle fracture. On VA examination in May 2009, the Veteran complained of pain and weakness of the right ankle. The Veteran rated his right ankle pain as two or three on a ten-point pain scale. He denied the following symptoms: deformity; giving way; instability; stiffness; incoordination; decreased speed of joint motion; episodes of dislocation, subluxation, or locking; inflammation; effusions; or problems with the motion of the joint. The Veteran described flare-ups of his disability as moderate and reported that such occurred every two to three weeks and lasted for hours. The Veteran reported that his flare-ups were precipitated by overuse with prolonged standing and walking and relieved by over- the-counter medication, elevation, and rest. The Veteran reported that when his right ankle pain was extreme, such was rated as a six or seven on a ten-point pain scale. The examiner reported that the Veteran's impression was that his right ankle pain, when flaring up, had no effect on his range of motion or functional impairment. Report of physical examination in May 2009 indicates that the examiner found no evidence of the following: constitutional symptoms, inflammatory, or incapacitating episodes of arthritis; evidence of abnormal weight-bearing; loss of bone or part of a bone; gait abnormality; ankle instability; tendon abnormality; angulation; or joint ankylosis. The Veteran presented without the use of assistive devices. The examiner reported that the Veteran was unable to stand for more than a few minutes, and that he is able to walk one-fourth of one mile. He demonstrated range of motion of the right ankle to include 20 degrees dorsiflexion and 45 degrees plantar flexion, without objective evidence of pain with motion or additional limitation with repetitive motion. The Veteran was diagnosed with fracture, right ankle, remote history. An addendum to the May 2009 VA examination report includes results of the Veteran's right ankle x-ray examination, wherein his right ankle was described as within normal limits. No fracture was found. During examination in May 2009, the Veteran reported that he was currently employed full-time and that he missed one week of work due to medical appointments during the past year. The examiner opined that there were no significant effects on the Veteran's usual occupation and no effects on the activities of daily living. The Board now turns to the applicable diagnostic criteria. DC 5271 provides for a 10 percent rating where there is moderate limitation of motion of the ankle, and for a maximum 20 percent evaluation for marked limitation of motion of the ankle. 38 C.F.R. § 4.71a, DC 5271. For VA purposes, normal plantar flexion of the ankle is from 0 to 45 degrees and normal dorsiflexion of the ankle is from 0 to 20 degrees. 38 C.F.R. § 4.71a, Plate II (2009). Here, on VA examinations in May 2005 and May 2009, the Veteran demonstrated full range of motion. There is no medical evidence of record to support the conclusion that the Veteran demonstrates moderate limitation of motion of the right ankle, as is required by DC 5271 for a compensable disability rating. Thus, the Board concludes that the Veteran's traumatic residuals of a right ankle fracture do not include moderate limitation of motion, and that DC 5271 may not serve as a basis for an initial compensable disability rating. 38 C.F.R. § 4.71a, DC 5271. In considering the provisions of DeLuca v. Brown, the Board notes that the Veteran has complained of pain as to his right ankle and described such pain during flare-ups. However, the Board finds that even if the Veteran does experience flare-ups of his right ankle disability, it is unlikely, and there is no evidence which suggests that, on repetitive use, the Veteran's traumatic residuals of a right ankle fracture would be restricted such that the requirement for an increased rating would be met. Specifically, as discussed above, on VA examination in May 2005, the Veteran demonstrated full range of motion, without pain. At that time, the examiner reported that there was no change in motion detected on repetitive movement. On VA examination in May 2009, the examiner reported that the Veteran's impression was that his right ankle pain, when flaring up, had no effect on his range of motion or functional impairment. At that time, the Veteran demonstrated full range of motion without objective evidence of pain with motion or additional limitation with repetitive motion. Thus, the Board finds that even considering the effects of pain on use, there is no probative evidence that the Veteran's traumatic residuals of a right ankle fracture causes such limitation that the requirements for an increased rating are met. 38 C.F.R. §§ 4.40, 4.45, 4.59; see DeLuca, 8 Vet. App. at 202. Bilateral Plantar Fasciitis The Veteran's bilateral plantar fasciitis was rated as noncompensably disabling, effective September 1, 2005, and is rated as 10 percent disabling, effective May 20, 2009, under DCs 5299-5276. DC 5299 is used to identify musculoskeletal disorders that are not specifically listed in the schedule, but are rated by analogy to similar disabilities under the schedule. See 38 C.F.R. §§ 4.20, 4.27. DC 5276 contemplates acquired flatfoot. 38 C.F.R. § 4.71a, DC 5276 (2009). Additional applicable regulatory criteria include DC 5284, contemplating other foot injuries. 38 C.F.R. § 4.71a, DC 5284 (2009). In considering the applicability of other diagnostic codes related to the feet, the Board finds that DC 5030, contemplating degenerative arthritis; DC 5010, contemplating traumatic arthritis; DC 5277, contemplating weak foot; DC 5278, contemplating claw foot; DC 5279 contemplating Morton's disease; DC 5280, contemplating unilateral hallux valgus; DC 5281, contemplating severe unilateral hallux rigidus; DC 5282, contemplating hammer toe; or DC 5283, contemplating malunion or nonunion of the tarsal or metatarsal bones, are not applicable as the medical evidence of record is silent for evidence of such. Accordingly, these DCs may not serve as bases for an initial compensable disability rating in this case. 38 C.F.R. § 4.71a, DCs 5003, 5010, 5277, 5278, 5279, 5280, 5281, 5282, 5283 (2009). The Board now turns to the relevant medical evidence of record. On VA examination in May 2005 the Veteran complained of constant and daily pain, weakness, stiffness, and lack of endurance related to his claimed musculoskeletal disabilities, precipitated by physical activity and inclement weather and alleviated by rest and medication. He reported that he had difficulty navigating stairs, walking or running long distances, or standing for a long period of time. The Veteran presented without inserts and reported that such were minimally useful. On physical examination the Veteran's arch was present and well-formed, and he demonstrated a normal gait and full range of motion of both feet, without pain. The Veteran demonstrated tenderness to palpation where the plantar fascia inserts to the calcaneus, bilaterally. The examiner opined that the Veteran's musculoskeletal disabilities interfered with his ability to fully enjoy recreational activities and that such disability may potentially interfere with employment in an occupation requiring vigorous activity. The examiner opined that the Veteran's musculoskeletal disabilities did not interfere with his ability to complete the activities of daily living. The Veteran was diagnosed with bilateral plantar fasciitis. VA treatment records dated in July 2008 indicate that the Veteran complained of left knee pain. At that time, physical examination included findings of asymptomatic plantar fasciitis. On VA examination in May 2009 the Veteran complained of burning in the arches, especially in the morning. He reported that his job requires a lot of walking, that he cannot walk constantly, and that he must sit down. He reported that his feet hurt more at the end of the day. The Veteran complained of pain and heat in the arches and heels of his feet while standing, walking, and at rest. He reported that he was unable to stand for more than a few minutes and was able to walk one-fourth of one mile. He denied swelling, redness, stiffness, fatigability, weakness, and lack of endurance. No flare-ups of a foot joint disease were noted. The Veteran presented without the use of assistive devices. On physical examination in May 2009 there was no evidence of painful motion, tenderness, instability, weakness, or abnormal weight-bearing. The Veteran demonstrated normal Achilles alignment and arch on weight-bearing and non-weight-bearing, bilaterally. There was no arch on weight-bearing, bilaterally. The Veteran exhibited bilateral forefoot malalignment, not correctable with manipulation, without midfoot malalignment. Bilateral manipulation was not painful. He demonstrated mild pronation, bilaterally, and very mild swelling at the lateral malleolus of the right foot, without swelling of the left foot. Physical examination was silent for the following: an abnormal gait; muscle atrophy; varus/valgus angulation of the os calcis; skin or vascular abnormalities; pes cavus; or malunion or nonunion of the tarsal or metatarsal bones. Left heel valgus was zero degrees. Location of the weight-bearing line, bilaterally, was medial to great toe. The Veteran demonstrated mild angulation without stiffness of the metatarso-phalangeal joint, bilaterally. X-ray examination revealed a small bone spur at the plantar aspect of calcaneus in the left foot, described as possible early plantar calcaneal spur. The Veteran was diagnosed with bilateral plantar fasciitis. During examination in May 2009, the Veteran reported that he was currently employed full-time and that he missed one week of work due to medical appointments during the past year. The examiner opined that there were significant effects on the Veteran's usual occupation, due to decreased mobility and pain, and no effects on the activities of daily living. An addendum to the May 2009 VA examination report includes results of the Veteran's right foot x-ray examination, wherein an old healed fracture involving the right fifth proximal phalanx was noted. The Board notes here that while degenerative changes were found at the right first metatarsophalangeal joint, the Veteran is not service-connected for a right toe disability and there is no evidence of record upon which to base the conclusion that his degenerative changes of the right toe are related to his acquired bilateral plantar fasciitis. The Board now turns to the applicable diagnostic criteria and considers the Veteran's symptomatology related to his bilateral plantar fasciitis prior to May 20, 2009, and since May 20, 2009. Under DC 5276, mild flatfoot, with symptoms relieved by built-up shoe or arch support, is rated noncompensably disabling. Moderate flatfoot, with weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet, bilaterally or unilaterally, is rated as 10 percent disabling. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities, is rated 20 percent disabling for unilateral disability, and 30 percent disabling for bilateral disability. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and a maximum 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a, DC 5276. Prior to May 20, 2009, the evidence of record does not support a compensable disability rating for bilateral plantar fasciitis under DC 5276. Specifically, there is no evidence that the Veteran demonstrated moderate symptoms marked by weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, or pain on manipulation, as to either foot. It is significant that on VA examination in May 2005, the Veteran demonstrated a present well-formed arch and full range of motion of both feet, without pain on motion. Though the Veteran reported pain on use of the feet and demonstrated tenderness on physical examination, such does not raise the level of the disability to moderate, as contemplated by DC 5276, in the absence of evidence showing that the other criteria for a compensable percent rating are met. Thus, the Board concludes that the Veteran's bilateral plantar fasciitis does not more nearly approximate moderate symptoms contemplated by DC 5276, as is required for a compensable disability rating and that DC 5276 may not serve as a basis for a compensable disability rating for the period prior to May 20, 2009. 38 C.F.R. § 4.71a, DC 5276. Since May 20, 2009, the evidence of record does not support a disability rating in excess of 10 percent for bilateral plantar fasciitis under DC 5276. Specifically, on VA examination in May 2009, the Veteran demonstrated weight-bearing line over or medial to great toe and reported pain on use, bilaterally. Thus, his bilateral plantar fasciitis more nearly approximates moderate symptoms contemplated by DC 5276 and such may serve as a basis for a 10 percent disability rating. However, there is no evidence that the Veteran's pronation was considered a marked deformity, as such was described as mild. The Veteran did not demonstrate painful manipulation or characteristic callosities. Though the Veteran reported pain on use of the feet and demonstrated very mild swelling of the left foot, such does not raise the level of the disability to severe, as contemplated by DC 5276, in the absence of evidence showing that the other criteria for an increased disability rating are met. Thus, the Board concludes that the Veteran's bilateral plantar fasciitis does not more nearly approximate severe symptoms contemplated by DC 5276, as is required for a disability rating in excess of 10 percent and that DC 5276 may not serve as a basis for a disability rating in excess of 10 percent since May 20, 2009. 38 C.F.R. § 4.71a, DC 5276. Under DC 5284, moderate residuals of other foot injuries warrant a 10 percent rating. A 20 percent rating requires moderately severe residuals. A maximum 30 percent rating requires severe residuals. 38 C.F.R. § 4.71a, DC 5284. Prior to May 20, 2009, bilateral tenderness to palpation where the plantar fascia inserts to the calcaneus was the only physical abnormality found on VA examination in May 2005. At that time, he demonstrated full range of motion, without pain. There is no evidence that the Veteran's gait was abnormal. In July 2008, the Veteran demonstrated asymptomatic plantar fasciitis. While the Veteran reported bilateral foot pain, there is no evidence that he demonstrated moderate symptomatology or that any treatment provider described his bilateral plantar fasciitis as moderate in degree. Thus, the Board concludes that prior to May 20, 2009, the Veteran's bilateral plantar fasciitis was not moderate in degree and DC 5284 may not serve as a basis for a compensable disability rating. 38 C.F.R. § 4.71a, DC 5284. Since May 20, 2009, it is significant that on VA examination in May 2009, the Veteran's swelling of the left foot was described as very mild, his bilateral pronation was described as mild, and his bilateral angulation was described as mild, without stiffness. At that time, he demonstrated full range of motion, without pain. There is no evidence that the Veteran's gait is abnormal. The Veteran demonstrated weight-bearing line over or medial to great toe and tenderness. While the Veteran reported pain on use, there is no evidence that the he demonstrated moderately severe symptomatology or that any treatment provider described his bilateral plantar fasciitis as moderately severe in degree. Thus, the Board concludes that since May 20, 2009, the Veteran's bilateral plantar fasciitis is not moderately severe in degree and DC 5284 may not serve as a basis for a disability rating in excess of 10 percent. 38 C.F.R. § 4.71a, DC 5284. In considering the provisions of DeLuca v. Brown, during both time periods, the Board notes that as the diagnostic criteria pertaining to the Veteran's bilateral plantar fasciitis do not contain criteria based on limitation of motion, the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment, are not applicable. See Johnston, 10 Vet. App. 80, 84-5 (1997). Right Third Finger Fracture The Veteran's right third finger fracture is currently rated as noncompensably disabling under DCs 5299-5229, effective September 1, 2005. DC 5299 is used to identify musculoskeletal disorders that are not specifically listed in the schedule, but are rated by analogy to similar disabilities under the schedule. See 38 C.F.R. §§ 4.20, 4.27. DC 5229 contemplates limited motion of the index or long finger. 38 C.F.R. § 4.71a, DC 5229 (2009). Additional applicable regulatory criteria include DC 5226, contemplating ankylosis of the long finger. 38 C.F.R. § 4.71a, DC 5226 (2009). The Board now turns to the relevant medical evidence of record. On VA examination in May 2005, the Veteran complained of and was examined for musculoskeletal disabilities other than his right third finger. He reported that he had fractured his right middle finger during service. The Veteran reported that he was treated with splinting and that such had fully resolved. The examiner noted that no further history or examination was necessary for the resolved condition. On VA examination in May 2009, the Veteran reported that he was right-hand dominant. He reported that his finger was fine, without any problem. He reported that there was not an overall decrease in hand strength or dexterity. The Veteran reported that there were no hand symptoms or history of flare-ups. Specific to the long finger, on physical examination the Veteran demonstrated normal extension of the distal interphalangeal, proximal interphalangeal, and metacarpal phalangeal joints, as his finger aligned with his hand. He did not demonstrate a gap between the index finger and proximal transverse crease of the hand on maximal flexion of the finger. The Veteran demonstrated full normal range of motion of all additional digits of the right hand, without a gap between the index finger and the palm or the thumb and the palm. There was no objective evidence of pain or additional limitation of motion on repetitive motion of any digit. There was no amputation, ankylosis, or deformity of any digit. There was no decreased strength for pushing, pulling, and twisting, or decreased dexterity for twisting, probing, writing, touching, and expression. The Veteran was diagnosed with fracture, right third finger, remote history. During examination in May 2009, the Veteran reported that he was currently employed full-time and that he missed one week of work due to medical appointments during the past year. The examiner opined that there were no significant effects on the Veteran's usual occupation and pain, and no effects on the activities of daily living. The Board now turns to the applicable diagnostic criteria. Under the rating criteria for limitation of motion of individual digits, the only available compensable rating pertinent to the long finger, or third finger, is that of a maximum 10 percent for limitation of motion with a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or with extension limited by more than 30 degrees. 38 C.F.R. § 4.71a, DC 5229. On VA examination in May 2009, the Veteran demonstrated normal extension of all joints of the third finger. He did not demonstrate extension of the finger limited by more than 30 degrees or a gap of one inch or more between the fingertip and the proximal transverse crease of the palm on maximal flexion of the finger, as is required by DC 5229 for a compensable disability rating. Thus, the Board concludes that the Veteran's right third finger fracture does not include compensable limitation of motion, and that DC 5229 may not serve as a basis for an initial compensable disability rating. 38 C.F.R. § 4.71a, DC 5229. In the alternative, a maximum 10 percent rating is also available for ankylosis of the long finger, whether favorable or unfavorable. Under DC 5226, it is also for consideration whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. 38 C.F.R. § 4.71a, DC 5226. On VA examination in May 2009, the examiner reported that ankylosis was not found. Further, there is no evidence that there was resulting limitation of motion of other digits or interference with overall function of the hand, as the Veteran demonstrated full range of motion in all digits and did not demonstrate any hand abnormalities. Thus, the Board concludes that the Veteran's right third finger fracture does not include ankylosis or resulting limitation of motion of other digits or interference with overall function of the hand, and that DC 5226 may not serve as a basis for an initial compensable disability rating. 38 C.F.R. § 4.71a, DC 5226. In considering the provisions of DeLuca v. Brown, the Board notes that the Veteran, on VA examination in May 2005, reported that his right third finger fracture had fully resolved. On VA examination in May 2009, the Veteran reported that he finger was fine, without any problem. At that time, the Veteran did not demonstrate pain or additional limitation of motion on repetitive motion of any digit of the right hand. Thus, the Board finds that the Veteran's right third finger fracture does not cause any limitation that meets the requirements for an increased rating. 38 C.F.R. §§ 4.40, 4.45, 4.59; see DeLuca, 8 Vet. App. at 202. Conclusion The Veteran's disability picture, related to his traumatic residuals of a right ankle fracture, bilateral plantar fasciitis, and right third finger fracture are not so unusual or exceptional in nature as to warrant referral of his case to the Director or Under Secretary for review for consideration of an extraschedular evaluation. 38 C.F.R. § 3.321(b)(1) (2009). Here, as discussed above, the rating criteria for the disabilities on appeal reasonably describe the Veteran's disability level and symptomatology. Thus, as the Veteran's disability picture is contemplated by the rating schedule, the assigned schedular evaluations are adequate, and no referral for extraschedular evaluation is required. Thun v. Shinseki, 573 F.3d 1366 (Fed. Cir. 2009). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim of entitlement to a total disability rating based on individual unemployability (TDIU) is part of an increased rating claim when such claim is raised by the record. The Court further held that when evidence of unemployability is submitted at the same time that the Veteran is appealing the initial rating assigned for a disability, the claim for TDIU will be considered part and parcel of the claim for benefits for the underlying disability. Id. In this case, the Board finds that a claim for a TDIU is not raised by the record as the evidence of record fails to show that the Veteran is unemployable. In this regard, the Board notes that the Veteran is currently employed. Therefore, the Board finds that no further consideration of a TDIU is warranted. In sum, the weight of the credible evidence demonstrates that the Veteran's traumatic residuals of a right ankle fracture and right third finger fracture do not warrant initial compensable disability ratings. Further, the weight of the credible evidence demonstrates that the Veteran's bilateral plantar fasciitis does not warrant a compensable disability rating prior to May 20, 2009, or a disability rating in excess of 10 percent since May 20, 2009. As the preponderance of the evidence is against the claims for increased disability ratings for traumatic residuals or a right ankle fracture, bilateral plantar fasciitis, and right third finger fracture, the appeals must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49, 50 (1990). ORDER An initial compensable disability rating for traumatic residuals of a right ankle fracture is denied. A compensable disability rating for bilateral plantar fasciitis prior to May 20, 2009 is denied. A disability rating in excess of 10 percent for bilateral plantar fasciitis since May 20, 2009 is denied. An initial compensable disability rating for right third finger fracture is denied. ____________________________________________ C. TRUEBA Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs