Citation Nr: 1323287 Decision Date: 07/22/13 Archive Date: 08/01/13 DOCKET NO. 07-17 706 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUES 1. Entitlement to an initial rating in excess of 10 percent for bilateral pes planus with status post hammertoe deformity and bunions. 2. Entitlement to an initial compensable rating for left little finger deformity. 3. Entitlement to an initial compensable rating for a Muscle Group XIV defect, claimed as right thigh deformed hamstring. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD Shauna M. Watkins, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1973 to May 2003. These matters come before the Board of Veterans' Appeals (Board) on appeal from September 2004 and April 2007 rating decisions by the Baltimore, Maryland Regional Office (RO) of the U.S. Department of Veterans Affairs (VA). An October 2010 letter informed the Veteran that his requested Board hearing was scheduled in February 2011. Although the hearing notification was not returned by the U.S. Postal Service as undeliverable, the Veteran failed to report for the scheduled hearing, and has not requested rescheduling of the hearing. As such, his hearing request is deemed withdrawn. See 38 C.F.R. § 20.704(d) (2012). In March 2011, the Board remanded this appeal to the RO via the Appeals Management Center (AMC), in Washington, DC, for further development. The appeal has now been returned to the Board for appellate disposition. The Veteran's Virtual VA paperless claims file has been reviewed in preparing this decision, along with his paper claims file. The issue of entitlement to an initial rating in excess of 10 percent for bilateral pes planus with status post hammertoe deformity and bunions is REMANDED to the RO via the AMC in Washington, DC. VA will notify the Veteran if further action is required. FINDINGS OF FACT 1. Throughout the appeal, the Veteran's left little finger deformity has not been manifested by ankloysis, but has interfered with the overall function of the left hand and fingers. 2. Throughout the appeal, the Veteran's Muscle Group XIV defect, claimed as right thigh deformed hamstring, has been manifested by a moderately severe disability. CONCLUSIONS OF LAW 1. The criteria for a 10 percent initial disability rating, but no higher, for the left little finger deformity has been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5227, 5230 (2012). 2. The criteria for a 30 percent initial disability rating, but no higher, for the Muscle Group XIV defect, claimed as right thigh deformed hamstring, has been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.55, 4.56, 4.73, DC 5314 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). I. VA's Duties to Notify and Assist Under applicable law, 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. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, 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 notice from VA 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. This notice must be provided prior to an initial unfavorable decision on a claim by the Agency of Original Jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The RO sent the Veteran an initial duty-to-assist letter in July 2004. This letter addressed the Veteran's underlying claims of service connection for the disorders currently on appeal. The increased rating claims flows downstream from a September 2004 rating decision, which initially established service connection for the disorders on appeal. The United States Court of Appeals for Veterans Claims (Court) held, in Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 490-91(2006), that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering 38 U.S.C.A. § 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Thus, because the notice provided before service connection was granted was legally sufficient, VA's duty to notify in this case is satisfied. See also Dunlap v. Nicholson, 21 Vet. App. 112 (2007); Goodwin v. Peake, 22 Vet. App. 128 (2008). VA also has a duty to assist the Veteran in the development of the claims. This duty includes assisting the Veteran in the procurement of service treatment records (STRs) and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Here, the Board finds that all relevant facts have been properly developed, and that all evidence necessary for equitable resolution of the issues has been obtained. His STRs and post-service VA and Army treatment records have been obtained. The AMC also sent the Veteran a letter in March 2011 requesting the names and addresses of his private treatment providers. The Veteran did not respond to this letter and thus the records could not be obtained. The claims file does not present evidence that the Veteran is currently receiving disability benefits from the Social Security Administration (SSA) for the disabilities currently on appeal. Therefore, the Board does not need to make an attempt to obtain these records. The Veteran's Virtual VA records were also reviewed and considered in preparing this decision. The Board does not have notice of any additional relevant evidence that is available but has not been obtained. He was afforded the opportunity for a personal hearing with a Decision Review Officer (DRO), and this conference report has been included in the claims file. He has also been provided VA examinations, and the reports of those evaluations contain all findings needed to properly evaluate his disabilities. 38 C.F.R. § 4.2 (2012). The Board is also satisfied as to substantial compliance with its March 2011 remand directives. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). This included sending the Veteran a letter in March 2011 and requesting the names and addresses of his private treatment providers. The Veteran did not respond to this letter. The remand also included scheduling the Veteran for an additional VA examination, which was provided in April 2011. Finally, as directed by the remand, the RO/AMC readjudicated the Veteran's claims in the May 2012 Supplemental Statement of the Case (SSOC). Thus, the Board finds that there has been substantial compliance with its remand directives. Id. For the foregoing reasons, the Board concludes that all reasonable efforts were made by the VA to obtain evidence necessary to substantiate the Veteran's claims. Therefore, no further assistance to the Veteran with the development of evidence is required. II. Analysis A. General Regulations and Statutes Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity in civil occupations. Separate DCs identify the various disabilities. See 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4 (2012). Where a Veteran appeals the initial rating assigned for a disability at the time that service connection for that disability is granted, evidence contemporaneous with the claim and with the initial rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous . . . ." See Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. B. Left Little Finger The Veteran is currently in receipt of a noncompensable (0 percent) disability rating under 38 C.F.R. § 4.71a, DC 5230, for his left little finger deformity. He seeks an increased rating. The Veteran is left-hand dominant (as stated at his recent April 2011 VA examination). Under DC 5230, a maximum 0 percent rating is assigned for any limitation of motion of the ring or little finger (whether on the major (dominant) or minor (non-dominant) hand). 38 C.F.R. § 4.71a , DC 5230 (2012). The Board notes that for digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion. Id., Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand, Note (1). The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2012). A disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4.40. Consideration is to be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse, instability of station, or interference with standing, sitting, or weight bearing. For the purpose of rating disability from arthritis, multiple involvements of the metacarpal and carpal joints of the upper extremities are considered groups of minor joints ratable on a parity with major joints. 38 C.F.R. § 4.45. VA must consider "functional loss" of a musculoskeletal disability separately from consideration under the diagnostic codes; "functional loss" may occur as a result of weakness, fatigability, incoordination or pain on motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). VA must consider any part of the musculoskeletal system that becomes painful on use to be "seriously disabled." Under 38 C.F.R. §§ 4.40 and 4.45, a Veteran's pain, swelling, weakness, and excess fatigability must be considered when determining the appropriate evaluation for a disability using the limitation of motion diagnostic codes. See Johnson v. Brown, 9 Vet. App. 7, 10 (1996). The Court held in DeLuca that all complaints of pain, fatigability, etc., shall be considered when put forth by a Veteran. Therefore, consistent with DeLuca and 38 C.F.R. § 4.59, the Veteran's complaints of pain have been considered in the Board's review of the DCs for limitation of motion. Since the Veteran is in receipt of the maximum disability rating available under DC 5230, the Board also will consider other potentially applicable DCs in the Rating Schedule. Under DC 5227, a maximum 0 percent rating is assigned for favorable or unfavorable ankylosis of the ring or little finger (whether on the major (dominant) or minor (non-dominant) hand). 38 C.F.R. § 4.71a , DC 5227. A Note to DC 5227 provides that evaluation as amputation should be considered, and whether an additional evaluation is warranted for any resulting limitation of motion of other digits or interference with the overall function of the hand. Id. Thus, the Veteran is also in receipt of the maximum disability rating under DC 5227. Higher schedular ratings are not available under these Codes. Although the Board recognizes that the Veteran currently is in receipt of the maximum 0 percent disability rating, the Note to DC 5227 states that an amputation evaluation should also be considered, particularly where ankylosis is present. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992) (memorandum decision); see Nix v. Brown, 4 Vet. App. 462, 465 (1993); see also Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Here, there is no competent evidence suggesting that the Veteran experiences anklylosis in his left little finger. 38 C.F.R. § 4.71a, DC 5227. Specifically, at the August 2004 and April 2011 VA examinations, and in the treatment records, anklyosis of the left little finger was not documented. Thus, the Board concludes that an increased rating is not warranted via the amputation codes because the asymptomatic nature of the Veteran's service-connected left little finger disability, coupled with the absence of ankylosis, leads the Board to conclude that his left little finger disability is not analogous to amputation. Id. The Board recognizes the Veteran's lay statements of pain in his left little finger. However, the VA examinations, and the treatment records, do not establish that the Veteran's pain has caused his left little finger to be ankloysed at any period during the appeal. At the August 2004 VA examination, the Veteran had full range of motion of his left little finger. At the April 2011 VA examination, the examiner found that the Veteran did not have anklyosis of his finger. Further limitation of motion does not entitle the Veteran to a higher disability rating. The Veteran is already in receipt of the maximum schedular disability rating available for limitation of motion of the left little finger under DC 5230. Instead, as previously mentioned, the Veteran's left little finger must demonstrate ankloysis to warrant a compensable disability rating. Thus, even when considering the Veteran's pain, the requirements for a compensable disability rating for the left little finger are not met. Accordingly, the Board finds the current evaluation assigned adequately compensates the Veteran for the pain and functional impairment caused by his service-connected left little finger deformity. DeLuca, 8 Vet. App. at 202; 38 C.F.R. §§ 4.40, 4.59. The Note to DC 5227 also states that an additional evaluation is warranted for any resulting limitation of motion of other digits or interference with the overall function of the hand due to the service-connected right little finger. Here, there is competent evidence in the April 2011 VA examination that the Veteran's left little finger has interfered with the overall function of the left hand, such that a separate evaluation is warranted under the Note to DC 5227. 38 C.F.R. § 4.71a, DC 5227. Specifically, at the April 2011 VA examination, the VA examiner determined that the Veteran's left little finger is interfering with the function of the left hand and the other digits of that hand. The examiner stated that the Veteran is not able to assume the position of function of the left hand, as the left little finger cannot be abducted and rotated so that it can face the thumb. The examiner found that there was a decrease in strength of the left hand for pushing, pulling, and twisting. There was also a loss of dexterity in the left hand for twisting, writing, and touching. The examiner indicated that the major impact of the left little finger was due to the incoordination. The Veteran also reported difficulty typing because of the deformity and locking of the left little finger. Similarly, in VA outpatient treatment dated in December 2009, the Veteran reported locking of his left little finger. At the August 2004 VA examination, the VA examiner found that the Veteran had instability at the proximal interphalangeal joint (PIP) joint of the left little finger, giving him hyperextension of 10 degrees. The examiner indicated that this hyperextension caused the Veteran to have limitation in using the keyboard. Thus, the Board finds that this evidence establishes that the Veteran's left little finger has interfered with the overall function of the left hand, such that a separate evaluation is warranted under the Note to DC 5227. 38 C.F.R. § 4.71a, DC 5227. The Board finds that the evidence is in equipoise, and thus the Veteran is entitled to the benefit of the doubt. An increased evaluation of 10 percent is assigned for impairment of the overall function of the left hand due to the service-connected left little finger deformity. See 38 C.F.R. § 4.71a, DC 5227. Here, in assigning a 10 percent disability rating for impairment in the overall function of the hand, the Board has taken into account the Veteran's limitations due to pain and decreased grip strength. Therefore, the Board finds that a disability rating in excess of 10 percent under DeLuca is not warranted. Indeed, as the Veteran is already receiving the maximum schedular rating based on symptomatology that includes limitation of motion under DC 5230, an increased rating under 38 C.F.R. §§ 4.40 and 4.45 is not available. See Johnston, 10 Vet. App. at 85. The Board has also considered whether any separate evaluations might be assigned under other applicable DCs. See Esteban v. Brown, 6 Vet. App. 259 (1994) (holding that evaluations for distinct disabilities resulting from the same injury can be combined so long as the symptomatology for one disability is not "duplicative or overlapping with the symptomatology" of the other disability). Specifically, the Board has considered whether a separate compensable evaluation is warranted based on any neurologic dysfunction of the finger or hand. As the August 2004 and April 2011 VA examinations noted no neurological abnormalities, and the medical evidence is otherwise negative for neurological abnormalities, a separate rating based on neurologic impairment is not warranted. Furthermore, the Veteran's symptoms do not appear to have changed significantly during this initial rating period so as to warrant a staged rating. Fenderson, 12 Vet. App. at 126. The Board notes that in adjudicating a claim, the competence and credibility of the Veteran must be considered. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board acknowledges that the Veteran is competent to give evidence about what he observes or experiences. For example, he is competent to report that he experiences certain symptoms, such as pain, and he is credible in this regard. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran's competent and credible belief that his disability is worse than the assigned rating, however, is outweighed by the competent and credible medical examinations that evaluated the true extent of impairment based on objective data coupled with the lay complaints. The VA examiners have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the physical examination findings. Also, as stated above, the rating criteria are specific in indicating that some of the criteria must be objectively demonstrated. In sum, the schedular criteria for a disability rating of 10 percent, but no higher, for the Veteran's service-connected left little finger deformity, has been met since the effective date of service connection. The preponderance of the evidence is against the assignment of a rating in excess of 10 percent for the service-connected left little finger deformity at any time during the appeal period. Thus, an initial 10 percent rating is assigned since the effective date of service connection, and a claim of entitlement to an initial disability rating higher than 10 percent for his left little finger deformity is denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49 (1990). C. Right Thigh The Veteran is currently in receipt of a noncompensable (0 percent) disability rating under 38 C.F.R. § 4.73, DC 5314 for his Muscle Group (MG) XIV defect, claimed as right thigh deformed hamstring. He seeks an increased rating. VA regulations provide principles of combined ratings for muscle injuries, including that a muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. 38 C.F.R. § 4.55(a). For rating purposes, the skeletal muscles of the body are divided into 23 MGs in 5 anatomical regions: 6 MGs for the shoulder girdle and arm (DCs 5301 through 5306); 3 MGs for the forearm and hand (DCs 5307 through 5309); 3 MGs for the foot and leg (DCs 5310 through 5312); 6 MGs for the pelvic girdle and thigh (DCs 5313 through 5318); and 5 MGs for the torso and neck (DCs 5319 through 5323). 38 C.F.R. § 4.55(b). DC 5314 is applicable to MG XIV, which is the anterior thigh MG. The functions of this MG are: extension of the knee; simultaneous flexion of hip and flexion of the knee; tension of fascia lata and iliotibial (Massiat's) band, acting with MG XVII in postural support of the body; and, acting with hamstrings in synchronizing hip and knee. The involved muscles include: the Sartorius; the rectus femoris; the vastus externus; the vastus intermedius; the vastus internus; and, the tensor vaginae femoris. Under DC 5314, a slight disability warrants a 0 percent rating. A moderate disability warrants a 10 percent rating. A moderately severe disability warrants a 30 percent rating. A severe disability warrants a 40 percent rating. A 40 percent rating is the maximum schedular rating available under DC 5314. 38 C.F.R. § 4.73. A moderate disability of the muscles may result from a through and through wound, or deep penetrating wounds of relatively short track by single bullet or small shell or shrapnel fragment. The absence of the explosive effect of high velocity missile or of the residuals of debridement or of prolonged infection is also considered moderate. The history of the disability should be considered, including service department records or other sufficient evidence of hospitalization in service for treatment of the wound. Records in the file of consistent complaints on record from the first examination forward of one or more of the cardinal symptoms of muscle wounds, particularly fatigue and fatigue-pain after moderate use, and an effect on the particular functions controlled by the injured muscles should be noted. Objective evidence of a moderate disability includes entrance and (if present) exit scars which are linear or relatively small and so situated as to indicate relatively short track of missile through muscle tissue, signs of moderate loss of deep fascia or muscle substance or impairment of muscle tonus, and of definite weakness or fatigue in comparative tests. 38 C.F.R. § 4.56(b). A moderately severe disability of the muscles may result from a through and through wound or a deep penetrating wound by high velocity missile of small size or large missile of low velocity, with debridement or with prolonged infection or with sloughing of soft parts, intermuscular cicatrization. The history of the disability should be considered including service department record or other sufficient evidence showing hospitalization for a prolonged period in service for treatment of wound of severe grade. Record in the file of consistent complaint of cardinal symptoms of muscle wounds should also be noted. Evidence of unemployability because of inability to maintain work requirements is to be considered, if found to be present. Objective evidence of a moderately severe disability includes entrance and (if present) exit scars relatively large and so situated as to indicate track of missile through important muscle groups. Indications on palpation of moderate loss of deep fascia, or moderate loss of muscle substance or moderate loss of normal firm resistance of muscles compared with sound side. Tests of strength and endurance of muscle groups involved (compared with sound side) give positive evidence of marked or moderately severe loss. 38 C.F.R. § 4.56(c). A severe muscle disability usually results from a through and through wound, or deep penetrating wounds as a result of high velocity missiles, or large or multiple low velocity missiles, or shattering bone fracture with extensive debridement, or sloughing of soft parts, or intermuscular binding and cicatrization. Ordinarily, this results in extensive ragged, depressed and adherent scars of the skin so situated as to indicate wide damage to muscle groups in the track of the missile(s). Palpation should indicate moderate or extensive loss of deep fascia or of muscle substance. Affected muscles do not swell and harden normally during contraction. 38 C.F.R. § 4.56(d). The general regulations governing the evaluation of muscles disabilities further provide that a through and through injury with muscle damage shall be evaluated as no less than a moderate injury for each muscle group affected. 38 C.F.R. § 4.56(b). The corresponding level of severity of a service-connected muscle injury is determined to a significant extent by the presence or absence of cardinal signs and symptoms of muscle disability, which consist of loss of power, lowered threshold of fatigue, weakness, pain, impairment of coordination and uncertainty of movement. 38 C.F.R. § 4.56(c). The criteria of 38 C.F.R. § 4.56 are only guidelines for evaluating muscle injuries from gunshot wounds or other trauma, and the criteria are to be considered with all factors in the individual case. Robertson v. Brown, 5 Vet. App. 70 (1993). The Veteran's STRs reflect that the Veteran injured his right thigh muscle in July 1994 while playing softball. He tore the quadriceps muscle of his right leg while running to first base. He was found to have moderate swelling and tenderness over the anterior aspect of the right thigh. He was treated with medicine, ice, a cane, and splints. The Veteran was not hospitalized for this injury, or placed on a permanent profile. He was not medically discharged from the military for this injury. Three days later, the Veteran was again seen for treatment of his right thigh injury. At that time, it was noted that the Veteran's swelling and pain had worsened. The right thigh was tender. The Veteran was diagnosed with a contusion, and prescribed bed rest. In July 1994, X-rays of the right hip and right thigh were taken, which revealed no significant abnormality. In July 2002, the Veteran was seen again for a persistent quadriceps deformity with increased pain with running over the past year. X-rays were taken, which revealed a normal femur. The Veteran's active military service ended in May 2003. Based on the evidence of record, the Board finds that the Veteran has a moderately severe disability of MG XIV. Specifically, at the August 2004 VA examination, the VA examiner found that the Veteran had a defect on the proximal aspect of the right quadriceps muscle, which seemed to have detached from his proximal attachment partially. The examiner determined that the Veteran had a muscle defect of his quadriceps anteriorly, which caused him discomfort in running, jogging, and climbing stairs. At the April 2011 VA examination, the examiner diagnosed the Veteran with avulsion of the right quadriceps muscle, proximal, and found that the muscle involved was the quadriceps muscle of the right proximal thigh. The examiner noted that the Veteran had a 13 centimeter (cm) defect in the right proximal quadriceps muscle, and the quadriceps muscle was very prominent anteriorly at the mid-portion. Upon reviewing the Veteran's STRs, the examiner determined that the Veteran had an avulsion of the quadriceps muscles from the proximal insertion. The examiner found that the Veteran's disability of the muscle was secondary to the avulsion that occurred in 1994, as there are no other abnormalities to explain the right thigh disability. The examiner then determined that the right quadriceps disability was best characterized as "moderately severe." The examiner reasoned that the avulsion of the proximal end of the right quadriceps muscle has caused weakness, pain, and lack of endurance of the muscle. At the examination, the Veteran also complained of involuntary jerking, pain, and easy fatigability of the right quadriceps muscle. The Veteran's muscle strength was 4/5. The examiner found that the Veteran had additional functional loss due to pain, weakness, and lack of endurance after repetitive use. The major impact was due to the lack of endurance. The post-service treatment records do not provide contrary evidence to that obtained at the VA examinations. Therefore, based on this evidence and in giving the Veteran the benefit of the doubt, the Board finds that the Veteran has displayed a moderately severe disability of MG XIV throughout the entire appeal period, which warrants a 30 percent rating under DC 5314. 38 C.F.R. § 4.73. In this regard, the Board reiterates that the corresponding level of severity of a service-connected muscle injury is determined to a significant extent by the presence or absence of cardinal signs and symptoms of muscle disability, which consist of loss of power, lowered threshold of fatigue, weakness, pain, impairment of coordination and uncertainty of movement. 38 C.F.R. § 4.56(c). As determined by the recent VA examination, the Veteran manifests these symptoms, and thus the Board finds that the Veteran's service-connected disability is best rated as 30 percent disabling for the moderately severe disability. 38 C.F.R. § 4.73, DC 5314. However, the Board finds that the Veteran is not entitled to rating higher than 30 percent, since his Muscle Group XIV defect, claimed as right thigh deformed hamstring, is not a severe disability under DC 5314. 38 C.F.R. § 4.73. The August 2004 examiner found that there was no evidence of further limitation due to further loss of motion, incoordination, weakness, or flare-up, or additional limitation following repetitive use. At the examination, the Veteran also denied impact on his usual occupation or activities of daily living. He did not use an assistive device. A VA X-ray in August 2007 found no definite abnormality of the right femur. The April 2011 VA examiner found that there was no associated bone, nerve, or vascular injuries, or muscle tremor, in connection with the service-connected disability. The Veteran was able to perform the activities of daily living, to include his usual occupation. The examiner stated that the initial injury was not due to any missile, and there were no entry or exit wounds. There were also no adhesions, muscle herniationsm, or tendon damage. The Veteran's muscle strength was 4/5. Similarly, at the August 2004 VA examination, the VA examiner found that the Veteran's quadriceps muscle strength was 5/5. There was no evidence of atrophy at the examination. Additionally, the Veteran has not been hospitalized or required surgical repair for this injury. Thus, based on this evidence, the Board finds that the Veteran's service-connected disability is best rated as moderately severe, and not severe. Furthermore, the Veteran's service-connected Muscle Group XIV defect, claimed as right thigh deformed hamstring, has not been manifested by the suggested, enumerated symptoms for a severe muscle disability, to include: a through and through wound; deep penetrating wounds as a result of high velocity missiles, or, large or multiple low velocity missiles; shattering bone fracture with extensive debridement; sloughing of soft parts; intermuscular binding and cicatrization; extensive ragged, depressed and adherent scars of the skin so situated as to indicate wide damage to muscle groups in the track of the missile(s); or, moderate or extensive loss of deep fascia or of muscle substance. 38 C.F.R. § 4.56(d). Accordingly, the Veteran is not entitled to a disability rating in excess of 30 percent for his service-connected Muscle Group XIV defect, claimed as right thigh deformed hamstring, under DC 5314. 38 C.F.R. § 4.73. The Board notes that 38 C.F.R. §§ 4.40 and 4.45 are not applicable because DCs 5314 and 5315 do not contemplate limitation of motion based upon a joint abnormality (as opposed to limitation of motion based upon a muscle injury). See Johnson, 9 Vet. App. at 7; see also DeLuca, 8 Vet. App. at 202; VAOPGCPREC 9-98 (August 1998). Moreover, symptoms such as weakness, loss of power, fatigue-pain, etc., are specifically contemplated by DC 5314. See 38 C.F.R. § 4.56(c). Additionally, the April 2011 VA examiner found that the service-connected disability did not lead to any scar formation or nerve injury. Contrary findings were not provided at the August 2004 VA examination, or in the treatment records. Thus, a separate disability rating for associated scar formation or neurological deficits is not warranted. Furthermore, the Veteran's symptoms do not appear to have changed significantly during this initial rating period so as to warrant a staged rating. Fenderson, 12 Vet. App. at 126. The Board notes that in adjudicating a claim, the competence and credibility of the Veteran must be considered. See Buchanan, 451 F.3d at 1331; Washington, 19 Vet. App. at 368-69. The Board acknowledges that the Veteran is competent to give evidence about what he observes or experiences. For example, he is competent to report that he experiences certain symptoms, such as pain, and he is credible in this regard. See, e.g., Layno, 6 Vet. App. at 465. The Veteran's competent and credible belief that his disability is worse than the assigned rating, however, is outweighed by the competent and credible medical examinations that evaluated the true extent of impairment based on objective data coupled with the lay complaints. The VA examiners have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the physical examination findings. In sum, the schedular criteria for a disability rating of 30 percent, but no higher, for the Veteran's service-connected Muscle Group XIV defect, claimed as right thigh deformed hamstring, has been met since the effective date of service connection. The preponderance of the evidence is against the assignment of a rating in excess of 30 percent for the service-connected Muscle Group XIV defect, claimed as right thigh deformed hamstring, at any time during the appeal period. Thus, an initial 30 percent rating is assigned since the effective date of service connection, and a claim of entitlement to an initial disability rating higher than 30 percent for his Muscle Group XIV defect, claimed as right thigh deformed hamstring, is denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see Gilbert, 1 Vet. App. at 53. III. Extraschedular and TDIU Consideration The above determination is based on application of provisions of the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2012). However, the regulations also provide for exceptional cases involving compensation. Pursuant to § 3.321(b)(1), the VA Under Secretary for Benefits or the Director of the Compensation and Pension Service is authorized to approve an extraschedular evaluation if the case "presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." 38 C.F.R. § 3.321(b)(1). The question of an extraschedular rating is a component of a claim for an increased rating. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). If the evidence raises the question of entitlement to an extraschedular rating, the threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of a Veteran's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). If the criteria reasonably describe the claimant's disability level and symptomatology, then a Veteran's disability picture is contemplated by the rating schedule. The assigned schedular evaluation is, therefore, adequate, and no referral is required. In the second step of the inquiry, however, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology, and is found 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." 38 C.F.R. 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). Here, because the schedular ratings for the service-connected disabilities on appeal fully address his symptoms, which include mainly pain and weakness, referral to the VA Under Secretary for Benefits or the Director of Compensation and Pension Service for consideration of extraschedular evaluations is not warranted. The evidence of record does not establish, and the Veteran does not contend, that the service-connected disabilities on appeal prevent him from being employed or require frequent hospitalizations. Thus, there is no evidence that the Veteran's service-connected disabilities cause impairment that is not contemplated by the schedular rating criteria or that render impractical the application of the regular schedular standards. See Thun, 22 Vet. App. at 111. Accordingly, referral of this case for consideration of extraschedular ratings is not warranted. Id.; see also Bagwell v. Brown, 9 Vet. App. 337 (1996); Floyd v. Brown, 9 Vet. App. 88 (1996). Finally, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), a claim for a TDIU is considered part and parcel of an increased rating claim when the issue of unemployability is raised by the record. In this case, the issue of unemployability is not raised by the record. At all of the VA examinations, the Veteran reported that his service-connected disabilities do not impact his usual occupation, and he denied any absence from work due to his service-connected disabilities. There is no allegation in the record that the service-connected disabilities currently on appeal have resulted in unemployment. Therefore, consideration of a TDIU is not warranted. (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial disability rating of 10 percent, but no higher, for the left little finger deformity is granted, subject to the statutory and regulatory provisions governing the payment of monetary benefits. Entitlement to an initial disability rating of 30 percent, but no higher, for the Muscle Group XIV defect, claimed as right thigh deformed hamstring, is granted, subject to the statutory and regulatory provisions governing the payment of monetary benefits. REMAND Inasmuch as the Board regrets the additional delay of this appeal, a remand is required before the remaining pes planus claim can be properly adjudicated. In March 2011, the Board remanded this claim so that the Veteran could be afforded a VA examination to ascertain the current severity of his bilateral pes planus with status post hammertoe deformity and bunions. The Veteran was afforded this VA examination in April 2011. In the examination report, the VA examiner requested X-rays of the Veteran's feet. The examiner then stated in the examination report that X-rays of the feet would be forthcoming. To date, these X-rays of the feet have not been associated with the claims file. The Board finds that, as the examiner found these X-rays were necessary to the examination, these X-rays must be obtained before the claim can be decided on the merits. Upon remand, these X-rays must be associated with the claims file. See 38 U.S.C.A. § 5103A(a)(1), (b)(1), (c)(1); Loving v. Nicholson, 19 Vet. App. 96, 101-03 (2005). Accordingly, the case is REMANDED for the following actions: 1. Obtain and associate the X-rays of the feet from the April 2011 VA examination with the claim file, as described in the examination report. If X-rays of the feet were never taken at the April 2011 VA examination, schedule the Veteran for X-rays of his feet. Once the X-rays of the feet have been associated with the claims file, return the claims file to the April 2011 VA examiner (or another VA examiner if he is unavailable) for a VA addendum medical opinion concerning the current severity of the Veteran's bilateral pes planus with status post hammertoe deformity and bunions. 2. After the above action has been completed, readjudicate the Veteran's claim of entitlement to an initial rating in excess of 10 percent for bilateral pes planus with status post hammertoe deformity and bunions. If the claim remains denied, issue to the Veteran and his representative a Supplemental Statement of the Case (SSOC). Afford them the appropriate period of time within which to respond thereto. The Veteran 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 or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ____________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs