Citation Nr: 1322981 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 08-13 153 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an evaluation in excess of 10 percent for right ankle sprain with arthritis. 2. Entitlement to an evaluation in excess of 10 percent for left ankle sprain with arthritis. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Kristi L. Gunn, Counsel INTRODUCTION The Veteran served on active duty from May 1963 to May 1966. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2007 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In March 2012, the Board remanded the claims for additional development and adjudicative action. The Board has reviewed the Veteran's Virtual VA file and notes that a June 2013 Written Brief Presentation from the Veteran's representative has been associated with the electronic file. This document has also been associated with the Veteran's claims file. FINDINGS OF FACT 1. Prior to April 2, 2012, the evidence of record demonstrates that the Veteran's service-connected bilateral ankle disabilities are characterized by dorsiflexion to 15 degrees and plantar flexion to 40 degrees with degenerative joint disease. 2. As of April 2, 2012, the evidence of record demonstrates that the Veteran's service-connected bilateral ankle disabilities are characterized by dorsiflexion to 5 and 10 degrees and plantar flexion to 20 and 25 degrees with degenerative joint disease. CONCLUSIONS OF LAW 1. Prior to April 2, 2012, the criteria for an evaluation in excess of 10 percent for right ankle strain with arthritis have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & West Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.17a, Diagnostic Codes (DCs) 5010, 5271 (2012). 2. Prior to April 2, 2012, the criteria for an evaluation in excess of 10 percent for left ankle strain with arthritis have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & West Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.17a, Diagnostic Codes (DCs) 5010, 5271 (2012). 3. As of April 2, 2012, the criteria for a 20 percent evaluation, and no higher, for right ankle strain with arthritis have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & West Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.17a, Diagnostic Codes (DCs) 5010, 5271 (2012). 4. As of April 2, 2012, the criteria for a 20 percent evaluation, and no higher, for left ankle strain with arthritis have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & West Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.17a, Diagnostic Codes (DCs) 5010, 5271 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA's Duty to Notify and Assist Review of the claims folder reveals compliance with the Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. § 5100 et seq. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The duty to notify was accomplished by way of the VCAA letter from the RO to the Veteran dated in March 2007. The letter effectively satisfied the notification requirements of the VCAA consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) by: (1) informing him about the information and evidence not of record that was necessary to substantiate his increased rating claims; (2) informing him about the information and evidence the VA would seek to provide; and (3) informing him about the information and evidence he was expected to provide. See also Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The March 2007 VCAA notice letter also contained the information regarding the assignment of ratings and effective dates required by Dingess v. Nicholson, 483 F.3d 1311 (2007). With respect to the duty to assist, the RO has secured the Veteran's service treatment records (STRs) and records from the Social Security Administration (SSA). He did not respond to efforts to obtain his private records from Christopher Rush, M.D. The RO provided him with two VA medical examinations to rate the current severity of his service-connected bilateral ankle disabilities. See 38 C.F.R. § 3.327(a); Palczewski v. Nicholson, 21 Vet. App. 174, 182-83. The examinations were provided in March 2007 and April 2012. These examinations are adequate, and a new VA examination to rate the severity of his service-connected disabilities is not warranted. Additionally, the Veteran has not indicated that his service-connected bilateral ankle disabilities have worsened in severity. Finally, the Veteran has submitted personal statements and representative argument. The Appeals Management Center (AMC) also substantially complied with the Board's March 2012 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). See also D'Aries v. Peake, 22 Vet. App. 97 (2008) (finding that only substantial compliance, rather than strict compliance, with the terms of a Board engagement letter requesting a medical opinion is required). The AMC contacted the Veteran and requested that he provide the names and addresses of all physicians/medical care providers that have provided treatment for his service-connected ankle disabilities. See the March 2012 AMC letter. The AMC also provided him with a VA examination for his increased rating claims in April 2012. See the April 2012 VA examination report. Thus, RO/AMC has substantially complied with the Board's instructions. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). The duty to assist has therefore been satisfied and there is no reasonable possibility that any further assistance to the Veteran by VA would be capable of substantiating his claims. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. II. Decision The Veteran contends that his service-connected bilateral ankle disabilities are worse than is contemplated by the currently-assigned ratings, and asserts that higher ratings are warranted. The Veteran filed increased rating claims in March 2007. The Veteran's entire history is reviewed when assigning a disability evaluation per 38 C.F.R. § 4.1. However, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Court has held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). That is to say, the Board must consider whether there have been times when his lumbar spine disability has been more severe than at others, and rate it accordingly. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran's service-connected bilateral ankle disabilities have been rated at 10 percent disabling each under Diagnostic Codes (DCs) 5010-5271. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Under DC 5010, arthritis due to trauma, which is substantiated by X-ray findings, will be rated as degenerative arthritis under DC 5003. Under DC 5003, degenerative arthritis, when substantiated by X-rays, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Under DC 5271, limited motion of the ankle warrants a 10 percent disability evaluation if moderate and a 20 percent evaluation if marked. 38 C.F.R. § 4.71a, DC 5271. The Board observes that the words "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the degree that its decisions are "equitable and just." See 38 C.F.R. § 4.6 (2012). It should also be noted that use of descriptive terminology such as "mild" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 U.S.C.A. § 7104(a) (West 2002); 38 C.F.R. §§ 4.2, 4.6 (2012). The Board notes that normal ankle dorsiflexion is zero to 20 degrees and normal plantar flexion is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate II (2012). When evaluating musculoskeletal disabilities, VA must consider granting a higher rating in cases in which the veteran experiences functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination (to include during flare-ups or with repeated use), and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Recently, the Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath, 1 Vet. App. at 592. Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The Board has reviewed all of the evidence in the Veteran's claims file, including the VA examination reports, SSA records, and statements submitted in support of his claims. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, all of the extensive evidence of record. Indeed, it has been held that while the Board must review the entire record, it need not discuss each piece of evidence in rendering a decision. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board's analysis will focus specifically on the evidence that is needed to substantiate the Veteran's claims for increased ratings for his service-connected bilateral ankle disabilities. Specifically, the Board will focus on the evidence of record that describes the severity of his service-connected bilateral ankle disabilities. In March 2007, the Veteran was afforded a VA examination for his service-connected bilateral ankle disabilities. He reported that the ankles are bilaterally equal and denied having any surgery, physical therapy, or injections for the ankles. He has not sought medical care since the military for his ankle disabilities and takes no medication. He complained of daily bilateral lateral and medial malleolar aching pain with occasional sharp pains and rated it between a 5 and 7 out of 10 in terms of intensity, and admitted that the pain improved throughout the day. The Veteran denied having any significant flare-ups, locking, subluxing, or dislocating. Physical examination testing revealed a normal posture, gait, toe walking, heel walking, and heel-to-toe walking, with no orthotics, prosthetics, or ambulatory devices. There was no atrophy, hypertrophy, palpable spasms or tenderness. Strength testing was +5/5 to gravity and resistance bilaterally. There was normal and bilateral equal strength to resistance in inversion and eversion for age. Range of motion testing reflected dorsiflexion to 15 degrees bilaterally and plantar flexion to 40 degrees bilaterally, both limited by difficulty. There was no discomfort or difficulty with range of motion testing or effusion, edema, erythema, tenderness, palpable deformities, or instability. The VA examiner noted that additional limitation due to flare-ups could not be determined without resorting to mere speculation. Diagnostic testing revealed degenerative joint disease in both ankles with the left ankle being greater than the right. The VA examiner diagnosed the Veteran with bilateral ankle traumatic arthritis with residual functional limitation. In support of his claim, the Veteran submitted a letter from a private physician, Christopher Rush, M.D., dated in April 2008, indicating that the Veteran's pain had become more intense and chronic in nature. Dr. Rush specifically noted that the Veteran's ankle pain had clinically worsened. On remand, the RO attempted to obtain the Veteran's actual treatment records from Dr. Rush; however, the Veteran did not submit the records or provide a release so that VA could obtain the records. See VA letter to the Veteran, dated March 19, 2012. In April 2012, the Veteran was afforded a second VA examination for his service-connected bilateral ankle disabilities. He admitted to daily constant bilateral pain associated with his ankles, and rated it at a 5 out of 10 in terms of severity, flaring up to an 8 out of 10. He explained that the pain usually lasts for an hour or so and is often aggravated by standing or walking. The Veteran indicated that he regularly uses both a cane and braces as assistive devices as a normal mode of locomotion because his ankles have a tendency to give way. Physical examination testing showed localized tenderness or pain on palpation of the joints/soft tissues of both ankles. Muscle strength testing was 4/5, denoting active movement against some resistance involving plantar flexion and dorsiflexion of both ankles. The VA examiner noted the presence of anklyosis of the ankles, subtalar, and or tarsal joints due to plantar flexion of both ankles being less than 30 degrees; dorsiflexion of both ankles between 0 and 10 degrees; abduction, adduction, inversion or eversion deformity in both ankles; good weight-bearing position in both ankles; and poor weight-bearing position in both ankles. Range of motion testing revealed plantar flexion to 20 degrees for the right ankle and 25 degrees for the left ankle. Dorsiflexion was to 5 degrees in the right ankle and 10 degrees in the left ankle. The examiner noted that objective evidence of painful motion began at 20 degrees for right ankle plantar flexion, 5 degrees for right ankle dorsiflexion, 25 degrees for left ankle plantar flexion, and 10 degrees for left ankle dorsiflexion. The VA examiner indicated that the Veteran was able to perform repetitive-use testing with three repetitions. At that time, range of motion testing showed right ankle post-test plantar flexion to 20 degrees, right ankle post-test dorsiflexion to 5 degrees, left ankle post-test plantar flexion to 25 degrees, and left ankle post-test dorsiflexion to 10 degrees. Although there was no additional limitation in range of motion of the ankles following repetitive-use testing, there was functional loss and/or functional impairment of the ankles. The VA examiner noted that the contributing factors to such functional loss and/or functional impairment was less movement than normal for both ankles, weakened movement in both ankles, incoordination with an impaired ability to execute skilled movements smoothly in both ankles, pain on movement in both ankles, instability of station in both ankles, disturbance of locomotion in both ankles, and interference with sitting, standing and weight-bearing in both ankles. Diagnostic testing revealed degenerative or traumatic arthritis of both ankles, and the Veteran was diagnosed with bilateral ankle degenerative joint disease. In carefully reviewing the evidence of record, the Board finds that the criteria for a 20 percent rating is warranted for both service-connected right and left ankles as of April 2, 2012 under DC 5271. As previously stated, range of motion testing at the April 2012 VA examination revealed right ankle plantar flexion to 20 degrees, right ankle dorsiflexion to 5 degrees, left ankle plantar flexion to 25 degrees, and left ankle dorsiflexion to 10 degrees. Such findings are at least half of what is considered normal ankle dorsiflexion and normal plantar flexion according to 38 C.F.R. § 4.71a, Plate II (2012) and is reflective of marked limitation of motion. Accordingly, the Veteran's service-connected right and left ankle disabilities have more closely approximated the criteria for 20 percent ratings under DC 5271 as of April 2, 2012. The Board notes that a 20 percent rating is the highest rating available for limitation of motion of the ankle under DC 5271. See Id. As the Veteran is now assigned the maximum disability rating available from April 2, 2012, forward, based on symptomatology that includes limitation of motion, it is not necessary to consider whether 38 C.F.R. §§ 4.40, 4.45 are applicable during this period. Johnston v. Brown, 10 Vet. App. 80 (1997). The Board finds that increased ratings are not warranted for the Veteran's service-connected bilateral ankle disabilities prior to April 2, 2012, under DC 5271. As mentioned above, at the March 2007 VA examination, range of motion findings showed bilateral plantar flexion to 40 degrees and bilateral dorsiflexion to 15 degrees. The Board notes that normal ankle dorsiflexion is zero to 20 degrees and normal plantar flexion is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate II (2012). Such findings are indicative of only a moderate limitation of motion and increased ratings are not warranted prior to April 2, 2012, under DC 5271. The Board also finds that increased ratings are not warranted under DC 5010. Although the Veteran has been diagnosed with bilateral ankle degenerative joint disease as noted in the April 2012 VA examination report, he is not entitled to a separate or increased rating under DC 5010 because the Veteran is in receipt of compensable ratings under a diagnostic code predicated upon limitation of motion (DC 5271). Thus, higher ratings for the Veteran's service-connected bilateral ankle disabilities are not warranted. The Board has evaluated the Veteran's bilateral ankle disabilities under all other potentially applicable diagnostic codes to determine whether he can be rated higher than 10 percent disabling, prior to April 2, 2012, and 20 percent thereafter. Under the criteria of Diagnostic Code 5270, ankylosis of the ankle in plantar flexion, between 30 and 40 degrees, or in dorsiflexion, between zero and 10 degrees warrants a 30 percent disability rating; and ankylosis of the ankle in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion or eversion deformity warrants a 40 percent disability rating. The Board notes that ankylosis is immobility and consolidation of a joint. See Dorland's Illustrated Medical Dictionary 86 (28th ed., 1994). The Board acknowledges the April 2012 VA examiner's findings of anklyosis, but finds that it is inconsistent with the range of motion findings, as the Veteran demonstrated dorsiflexion and plantar flexion of both ankles at the March 2007 and April 2012 VA examinations. As there cannot be both range of motion and ankylosis of a joint, the Board finds that the examiner's indication that the Veteran had ankylosis of his ankles is not credible as it is inconsistent with the reported range of motion findings. It appears that the finding of ankylosis was reported in error, and that the examiner intended to indicate that the Veteran had plantar flexion less than 30 degrees and dorsiflexion between 0 and 10 degrees (as would be consistent with the range of motion findings recorded in the examination report). Therefore, a higher rating for either ankle under DC 5270 is not warranted. In addition, the Veteran has never been diagnosed with malunion of the os calcis or astragalus and never underwent astragalectomy, thus, DCs 5273 and 5274 are not for application in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5272, 5273, 5274 (2012). For the time period prior to April 2, 2012, the Board has also considered whether a higher rating is warranted based on functional loss due to pain, weakness, excess fatigability, and incoordination causing additional disability beyond that reflected on range of motion measurements. See 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); Johnson v. Brown, 9 Vet. App. 7 (1996) (holding that the provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 should only be considered in conjunction with the diagnostic codes predicated on limitation of motion). In this case, the Board does not find an increase due to functional loss is warranted. On VA examination in March 2007, the Veteran complained of daily bilateral lateral and medial malleolar aching pain with occasional sharp pains and rated it between a 5 and 7 out of 10 in terms of intensity. However, he admitted that the pain improved throughout the day and denied having any significant flare-ups, locking, subluxing, or dislocating. The examiner noted a normal posture, gait, toe walking, heel walking, and heel-to-toe walking, with no orthotics, prosthetics, or ambulatory devices. There was no atrophy, hypertrophy, palpable spasms or tenderness, and strength testing was +5/5 to gravity and resistance bilaterally. There was no discomfort or difficulty with range of motion testing or effusion, edema, erythema, tenderness, palpable deformities, or instability. The VA examiner also noted that additional limitation due to flare-ups could not be determined without resorting to mere speculation. Thus, higher ratings are not warranted under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Veteran is competent to report his symptoms, and the Board does not doubt the sincerity of the Veteran's belief that his service-connected bilateral ankle disabilities have worsened. However, the objective clinical findings do not support his assertions for the reasons stated above. As the preponderance of the evidence is against the Veteran's claims for increased ratings in excess of 10 percent for his service-connected bilateral ankle disabilities, prior to April 2, 2012, the benefit-of-the-doubt doctrine is not for application, and an increased rating must be denied. See 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet. App. at 55. As of April 2, 2012, the Board concludes that the evidence supports increased ratings of 20 percent for the Veteran's service-connected bilateral ankle disabilities, and not higher, under DC 5271. The Board has also considered whether referral for an extraschedular rating is appropriate. In this regard, the Board notes that ratings are generally based on average impairment, and that the rating schedule represents, as far as is practicable, the average impairment of earning capacity. See 38 C.F.R. § 3.321(a), (b) (2012). However, to afford justice in exceptional situations, an extraschedular rating can be provided. 38 C.F.R. § 3.3211 (b) (2012). 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. First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Id. at 115-16. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, and is therefore found to be inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as 'governing norms.' Id. Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. Id. As noted above, the Veteran's bilateral ankle disabilities primarily involve pain, and limited motion. Such impairment is specifically contemplated by the rating criteria. See 38 C.F.R. § 4.40, 4.45, 4.71a, DC 5271. Accordingly, the Board finds that the Veteran does not present such an exceptional or unusual disability picture that the available schedular evaluations for his bilateral ankle disabilities are inadequate. Therefore, the Board concludes that referral for consideration of an extraschedular rating is not warranted in this case. See Floyd v. Brown, 9 Vet. App. 88, 95 (1996); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). ORDER Entitlement to an evaluation in excess of 10 percent prior to April 2, 2012, for right ankle sprain with arthritis is denied. Entitlement to an evaluation in excess of 10 percent prior to April 2, 2012, for left ankle sprain with arthritis is denied. Entitlement to a 20 percent evaluation, and no higher, as of April 2, 2012, for right ankle sprain with arthritis is granted. Entitlement to a 20 percent evaluation, and no higher, as of April 2, 2012, for left ankle sprain with arthritis is granted. ____________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals `` ` Department of Veterans Affairs