Citation Nr: 1329263 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 07-26 307 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an initial compensable rating for left ear hearing loss. 2. Entitlement to an initial compensable rating for bilateral pes planus. 3. Entitlement to an initial compensable rating for pseudofolliculitis barbae (PFB). 4. Entitlement to an initial compensable rating for residuals of a chemical burn with loss of thumb print of the right hand. 5. Entitlement to an initial compensable rating for residuals, including a scar, of an umbilical hernia repair. 6. Entitlement to an initial compensable rating for a right knee strain. 7. Entitlement to an initial compensable rating for a left knee strain. 8. Entitlement to an initial compensable rating for hemorrhoids. 9. Entitlement to an initial rating higher than 10 percent for vertigo. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD C. Kedem, Counsel INTRODUCTION The Veteran served on active duty from August 1984 to December 2005. This appeal to the Board of Veterans' Appeals (Board/BVA) is from an August 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO granted service connection for left ear hearing loss, bilateral pes planus, PFB, residuals of a chemical burn with loss of thumb print of the right hand, residuals of an umbilical hernia repair with scar, right and left knee strains, hemorrhoids, and vertigo. The RO assigned an initial 10 percent rating for the vertigo and 0 percent (so noncompensable) ratings for the other eight disabilities. The Veteran's appeal is for higher initial disability ratings. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999) (indicating that, when a Veteran timely appeals an initial rating, VA must consider whether to "stage" the rating to compensate him for times since the effective date of his award when the disability may have been more severe than at other times during the course of his appeal). In April 2011, the Board remanded the claims for further development and consideration, which since has been accomplished satisfactorily, at least as concerning the claims being decided in this decision. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (another remand not required under Stegall v. West, 11 Vet. App. 268, 271 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). But the claims of entitlement to initial compensable ratings for the PFB and residuals, including a scar, of the umbilical hernia repair require still further development before being decided on appeal. So the Board is again remanding these claims to the RO via the Appeals Management Center (AMC) in Washington, DC. FINDINGS OF FACT 1. The Veteran has no more than Level I hearing loss in his left ear, and it is presumed the hearing acuity in his non- service-connected right ear also is Level I. 2. His bilateral pes planus is manifested by no more than mild symptoms without the need for a built-up shoe or arch support. 3. The residuals of the chemical burn with loss of thumb print of his right hand do not cause functional limitation or pain. 4. His right and left knee strains are not manifested by any particular symptoms other than some stiffness. 5. His hemorrhoids have frequent recurrences and involve thrombosis. 6. His vertigo causes no more than occasional dizziness. CONCLUSIONS OF LAW 1. The criteria are not met for an initial compensable rating for the left ear hearing loss. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.85, Diagnostic Code 6100 (2013). 2. The criteria are not met for an initial compensable rating for the bilateral pes planus. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5276 (2013). 3. The criteria are not met for an initial compensable rating for the residuals of the chemical burn with loss of thumb print of the right hand. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Code 7805 (effective from August 30, 2002 to August 22, 2008). 4. The criteria are not met for initial compensable ratings for the right and left knee strains. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.27, 4.71a, Diagnostic Code 5299-5024 (2013). 5. The criteria are met, however, for a higher 10 percent initial rating, though no greater rating, for the hemorrhoids. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.114, Diagnostic Code 7336 (2013). 6. But the criteria are not met for a rating higher than 10 percent for the vertigo. 38 U.S.C.A. § 1155, 5107 (West 2002); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.27, 4.87, Diagnostic Code 6299-6204 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000), redefined VA's obligations in terms of its duties to notify and assist claimants with claims for VA benefits upon receipt of a complete or substantially complete application. The VCAA was codified as amended at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126, and the implementing VA regulations were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). These particular claims at issue, however, arise from the Veteran's disagreement with the initial ratings assigned for these disabilities following the granting of service connection for them. And the courts have held that once service connection is granted the claim as it arose in its initial context has been substantiated, so proven, meaning the intended purpose of the notice has been served. VA therefore does not have to provide additional VCAA notice in this circumstance concerning the "downstream" disability rating and effective date elements of the claim. See Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007); VAOPGCPREC 8- 2003, 69 Fed. Reg. 25180 (May 5, 2004). Rather, according to the holding in Goodwin v. Peake, 22 Vet. App. 128 (2008), and this line of precedent cases and General Counsel Opinion, instead of issuing an additional VCAA notice letter in this situation concerning the downstream disability rating and effective date elements of the claim, the provisions of 38 U.S.C.A. § 7105(d) require VA to issue a statement of the case (SOC) if the disagreement is not resolved, and this occurred in this particular instance. The Veteran was provided this required SOC, also since has been provided a supplemental SOC (SSOC), citing the applicable statutes and regulations governing the assignment of disability ratings, including initial ratings, and containing discussion of the reasons or bases for not assigning higher initial ratings. So he has received all required notice concerning his claims. The VCAA also requires that VA make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim, unless there is no reasonable possibility that such assistance would aid in the substantiation of the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to the claim, regardless of whether the records are in the custody of a Federal department or agency, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). To this end, VA has obtained the Veteran's service treatment records (STRs), and the file also contains the reports of his VA compensation examinations. He has not cited any other medical evaluation or treatment, either from VA or a private source, which is relevant to these claims. Regarding his VA compensation examinations, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA findings obtained in this case are adequate, as they are predicated on a full reading of the medical records in his claims file, so consider his pertinent medical history. The VA examiners considered all of the pertinent evidence of record, including his STRs, the results of his comprehensive examinations, his personal statements and those of his representative. Accordingly, the Board finds that VA's duty to assist with respect to obtaining VA examinations or opinions regarding the claims being decided has been met. 38 C.F.R. § 3.159(c)(4). Standard of Review After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C.A. § 7104(a) (West 2002). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of a matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3 (2013) (reasonable doubt to be resolved in Veteran's favor). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) held that "a Veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Increased Ratings Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as here, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). And if there has been variance in the severity of the disability, VA is required to "stage" the rating to compensate the Veteran for this change. The Court also since, incidentally, has extended this practice even to cases that do not involve initial ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 38 C.F.R. § 4.27 provides that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and "99." 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. A VA regulation also provides that, when a disability not specifically provided for in the rating schedule is encountered, it will be rated under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. The Court additionally has held that, if the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether a total disability rating based on individual unemployability (TDIU) as a result of that disability is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). Left Ear Hearing Loss The Veteran's service-connected left ear hearing loss has been rated a 0-percent disabling, so noncompensable, under the provisions of 38 C.F.R. § 4.85, Diagnostic Code 6100. Hearing loss is evaluated under this code, which provides that numeric designations are assigned based on a mechanical (so nondiscretionary) use of the tables found in 38 C.F.R. § 4.85, based on puretone thresholds and speech discrimination; there consequently is no room for subjective interpretation. See, e.g., Lendenmann v. Principi, 3 Vet. App. 345 (1992). Under Table VI, a Roman numeral designation (I through XI) for hearing impairment is found based on a combination of the percent of speech discrimination scores and the puretone threshold average. 38 C.F.R. § 4.85(b). Table VIA will be used alternatively, which assigns a Roman numeral designation solely on the puretone threshold average, when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. 38 C.F.R. § 4.85(c). Table VIA also may be used when there is an exceptional pattern of hearing impairment. The regulation is applicable where testing shows the Veteran had puretone thresholds of 55 decibels or more in each of the specified frequencies (1000, 2000, 3000 and 4000 Hertz ) or when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 or more decibels at 2000 Hertz. 38 C.F.R. § 4.86(a) and (b). The Table yeilding the better result for the Veteran is to be selected. But no exceptional pattern is shown here. The puretone threshold average is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. 38 C.F.R. § 4.85(d). The Roman numeral designations determined using Table VI or Table VIA are combined using Table VII to find the percentage evaluation to be assigned for the hearing impairment. Unlike in his left ear, the Veteran does not have service- connected hearing loss in his right ear. If, as here, impaired hearing is service connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman numeral designation for hearing impairment of I. 38 C.F.R. § 4.85(f). However, if hearing impairment in the service- connected ear is compensable to a degree of 10 percent or more, compensation is payable for hearing impairment in both the service-connected and non-service-connected ears if hearing impairment in the non-service-connected ear is a ratable disability by VA standards, meaning according to the threshold minimum requirements of 38 C.F.R. § 3.385. 38 C.F.R. § 3.383(a)(3). This also is not shown here, however, as the hearing loss in the Veteran's service-connected left ear is not compensable to a degree of 10 percent or more; instead, it is noncompensable, i.e., 0-percent disabling. So he is not entitled to the benefit of 38 C.F.R. § 3.383(a)(3). Therefore, for all intents and purposes, the Board must consider the hearing impairment in his non-service-connected right ear as Level I. On May 2006 VA audiologic examination, left ear hearing was as follows: HERTZ 1000 2000 3000 4000 Average LEFT 5 5 15 40 16 Speech audiometry revealed speech recognition ability of 100 percent in the left ear. The results of that evaluation correlate to Level I hearing loss in his left ear. In May 2011, he had another VA audiologic examination to reassess the severity of his hearing loss. His left ear hearing acuity was as follows: HERTZ 1000 2000 3000 4000 Average LEFT 5 10 25 40 20 Speech audiometry revealed speech recognition ability of 98 percent in his left ear. So even the results of this more recent testing continue to show he has just Level I hearing loss in his left ear. In an addendum to that May 2011 VA examination report issued in June 2011, the examiner indicated the claims file was reviewed and that the type of hearing loss experienced by the Veteran was not the type that would pose challenges to either occupational or daily activities. So in this supplemental comment this VA examiner specifically addressed the functional effects caused by the Veteran's left ear hearing loss disability, by explaining that it would neither affect his current employment nor his social and daily activities. See Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). Therefore, for the entire rating period at issue, the Veteran's left ear hearing loss has been no worse than Level I. 38 C.F.R. § 4.85, Table VI. And, to reiterate, because service connection has been granted only for left ear hearing loss, the nonservice-connected right ear will be assigned a Roman numeral designation for hearing impairment of Level I, since the provisions of 38 C.F.R. § 3.383 are not shown to apply. As the right ear is not independently compensable, the paired organ rule is not triggered. 338 C.F.R. § 3.383 (2013). Level I hearing loss in both ears warrants no more than a zero percent evaluation. 38 C.F.R. § 4.85, Table VII. There also has not been any fluctuation in the Veteran's left ear hearing loss disability since the effective date of the grant of service connection for this disability, so the Board cannot "stage" this rating, either. See Fenderson, 12 Vet App. at 125-26. Finally, in making this determination not to increase the rating, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 4.3, but there is not such a state of approximate balance of positive versus negative evidence to otherwise warrant a favorable decision. Bilateral Pes Planus The Veteran's bilateral pes planus also has been rated as zero-percent disabling, but instead under 38 C.F.R. § 4.71a, Diagnostic Code 5276. Under Diagnostic Code 5276, a 0 percent rating is awarded for mild symptoms relieved by built-up shoe or arch support. A 10 percent rating contemplates moderate disability with weight-bearing over or medial to the great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet, bilateral or unilateral. A higher evaluation of 30 percent is assigned for severe bilateral acquired flatfoot, with objective evidence of marked deformity, pain on manipulation and use accentuated an indication of swelling on use, and characteristic callosities. A maximum 50 percent evaluation is assigned for pronounced bilateral acquired flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. During his May 2006 VA general medical examination, the Veteran reported some aching sensations in his feet two to three weeks at a time approximately twice a year. The reported aching did not prevent him from continuing his normal activities without restrictions. Inspection of his feet showed no inflammation or tenderness to palpation. And although the examiner observed flat feet, there was no associated pathology involving the Achilles tendons. An X- ray of the feet also showed no significant abnormality. The diagnosis was simply pes planus. During a more recent June 2011 VA examination of the feet, the Veteran indicated that the course of his pes planus disability had been stable since its onset, so unchanging. There was no pain, pain on motion, or pain on manipulation. There was no tenderness, instability, swelling, heat, redness, stiffness, fatigability, weakness, lack of endurance, or abnormal weight bearing. There were no fare- ups, limitations on standing, or limitations on walking. The condition also did not require assistive devices. There was no forefoot malalignment. There was no midfoot malalignment. The Veteran's gait was antalgic. The examiner diagnosed pes planus and indicated it had no significant occupational impact. Indeed, the Veteran was employed on a full-time basis, and in the previous 12 months he had not lost any time from work because of this disability. The Veteran's bilateral pes planus disability has been characterized as mild. In fact, the symptoms are few, and he does not even require built-up shoe or arch supports. It follows that the criteria for a higher 10 percent rating are not met, much less the requirements for an even greater rating. A 10 percent rating requires a moderate disability picture with such symptoms as abnormal weight bearing, pain on manipulation and use of the feet, or inward bowing of the Achilles tendon. These symptoms are either largely or completely absent. Indeed, to the extent he experiences pain, it is only for a few weeks out of the year. He therefore does not have the level of impairment required for a 10 percent or greater rating and has not at any time since the effective date of his award, precluding the staging of the rating. 38 C.F.R. § 4.71a, Diagnostic Code 5276; Fenderson, supra. The Board has considered other schedular provisions concerning disabilities affecting the feet. Diagnostic Code 5277 applies to bilateral weak foot, Diagnostic Code 5278 pertains to pes cavus, Diagnostic Code 5279 concerns metatarsalgia, Diagnostic Code 5280 relates to unilateral hallux valgus, Diagnostic Code 5281 applies to unilateral severe hallux rigidus, Diagnostic Code 5282 concerns hammertoes, Diagnostic Code 5283 pertains to malunion or nonunion of the metatarsal or tarsal bones, and Diagnostic Code 5284 relates to other injuries of the foot. 38 C.F.R. § 4.71a. But these other codes are inapplicable, either because the Veteran does not suffer from these other types of foot disabilities or the level of impairment he has does not correspond with what is required for a higher rating under these other codes. It equally should be noted that, when evaluating disabilities of the musculoskeletal system that are at least partly rated based on the extent there is consequent limitation of motion, 38 C.F.R. § 4.40 (2013) allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected in range-of-motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 (2013) provides that consideration also be given to weakened movement, premature or excess fatigability, and incoordination. No further compensation is warranted under these provisions in this particular instance, however, because the manifestations described does not suggest the Veteran has additional disability, including on account of his pain. The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered in conjunction with the Diagnostic Codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Although 38 C.F.R. § 4.40 does not require a separate rating for pain, it does provide guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. Painful motion is an important factor of disability, and it is the intention of the Rating Schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 CF.R. § 4.59. See also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. 4.59 is not just limited to cases where there is arthritis). Functional loss due to pain is rated at the same level as functional loss where motion is impeded. Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Pursuant to 38 C.F.R. § 4.59, painful motion should be considered limited motion, even though a range of motion may be possible beyond the point when pain sets in. See Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995). A finding of functional loss due to pain, however, must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; see also Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Moreover, although pain may cause a functional loss, pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell, at 43, quoting 38 C.F.R. § 4.40. In short, no more than a noncompensable rating is warranted for the bilateral pes planus. 38 C.F.R. § 4.71a, Diagnostic Code 5276; Fenderson, supra. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 4.3, but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision. Residuals of the Chemical Burn with Loss of Thumb Print of the Right Hand This disability has been rated as zero-percent disabling under 38 C.F.R. § 4.118, Diagnostic Code 7899-7813 (effective from August 30, 2002 to August 22, 2008). See also 38 C.F.R. §§ 4.20, 4.27. The applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were amended effective August 30, 2002 and again in October 2008. The October 2008 revisions are applicable to applications for benefits received by the VA on or after October 23, 2008. 73 Fed. Reg. 54708 (September 23, 2008). But the Veteran filed his claim in March 2006, and VA has not received a request from him to be rated under the revised criteria that took effect in October 2008. Therefore, only the post-August 2002 and pre-October 2008 version of the schedular criteria, set out immediately below, is applicable. Diagnostic Code 7805 pertains to scars, other than as examples on the head and face. 38 C.F.R. § 4.118, Diagnostic Code 7805 (effective from August 30, 2002 to August 22, 2008). They are to be rated based upon limitation or function of the affected part. During the May 2006 VA general medical examination, the examiner noted that, following a chemical burn of the right thumb in 1994, the Veteran had noticed a loss of right thumb prints. He voiced no other complaints regarding this thumb, and the examiner affirmed no other right thumb condition was present. The diagnosis was loss of right thumb print secondary to chemical burn. During the more recent VA examination in June 2011, the examiner indicated that the Veteran was right handed. There was no impairment of strength or dexterity of the right hand. There was no angulation, ankylosis, or amputation of any right hand digits. There was no thumb disorder. There was no gap between any finger and the proximal transverse crease of the hand on maximal flexion of the finger. The examiner diagnosed residuals of a chemical burn of the right thumb with loss of finger print. There were no resultant occupational or work problems due to this diagnosis, and there was no impact on the usual daily activities. Indeed, the Veteran was employed on a full-time basis and was not absent from work in the previous 12 months. During the scars portion of the examination, the examiner indicated that the area of the firth right thumb scar was .1 cm in width and .5 cm in length. The area covered was less than six square inchers (39 sq cm). There was no pain or skin breakdown. The burn scar with superficial and did not entail inflammation, edema, keloid formation, or other disabling effects. It had no occupational impact and no impact upon the activities of daily living. The second right thumb scar was .2 cm wide and .6 cm long. It covered an area of less than six square inches (39 sq cm). There was no pain or skin breakdown. The burn scar with superficial and did not entail inflammation, edema, keloid formation, or other disabling effects. It had no impact occupational impact and no impact upon the activities of daily living. The Veteran was employed on a full-time basis and lost no time from work in the previous 12 months. The applicable version of Diagnostic Code 7805 states that scars should be rated based upon limitation or function of the affected part. 38 C.F.R. § 4.71a, Diagnostic Code 7805 (effective from August 30, 2002 to August 22, 2008). A compensable evaluation under the Schedular criteria for disabilities of the fingers is not warranted. Disabilities of the fingers are evaluated based on the degree of ankylosis or limitation of motion of the digits. See 38 C.F.R. § 4.71a, Diagnostic Codes 5216 through 5230 (2012). Here, the Veteran's loss of right thumb print is essentially asymptomatic. The function of the thumb is not limited or affected in any way. Thus, no more than a zero percent evaluation could be assigned under any of the foregoing provisions. Id.; see also 38 C.F.R. § 4.31 (2013) (where the criteria for a compensable rating under a diagnostic code are not met, and the schedule does not provide for a 0 percent evaluation, a zero percent rating will be assigned when the required symptomatology is not shown). Other potentially applicable provisions would not yield a compensable evaluation, either. Diagnostic Code 7801 concerns scars, other than the head, face, or neck, which are deep or that cause limitation of motion. 38 C.F.R. § 4.118, Diagnostic Code 7801 (effective from August 30, 2002 to August 22, 2008). A 10 percent evaluation under this provision would require that the service-connected scar area exceed 6 square inches (39 sq. cm.). The Veteran's right thumb print region does not cover an area of that size or even nearly so. Thus, an increased rating under Diagnostic Code 7801 would not yield a compensable evaluation for the Veteran's service-connected residuals of a chemical burn with loss of thumb print of the right hand. Diagnostic Code 7802 deals with scars, other than the head, face, or neck, that are superficial and that do not cause limitation of motion. 38 C.F.R. § 4.118, Diagnostic Code 7802 (effective from August 30, 2002 to August 22, 2008). The maximum evaluation under this provision is 10 percent for qualifying scars that cover an area of at least 144 square inches (929 square centimeters). The Board cannot award a 10 percent evaluation under the applicable version of Diagnostic Code 7802 because the service-connected residuals of a chemical burn with loss of thumb print of the right hand do not cover an area of at least 144 square inches. Under Diagnostic Code 7803, superficial unstable scars are rated 10 percent disabling. That is the maximum rating available under Diagnostic Code 7803. 38 C.F.R. § 4.118, Diagnostic Code 7803 (effective August 30, 2002 to October 22, 2008). The Veteran's service- connected residuals of a chemical burn with loss of thumb print of the right hand do not entail an unstable scar. Thus, compensation under the applicable version of Diagnostic Code 7803 is precluded. Diagnostic Code 7804 deals with scars that are superficial and painful on examination. 38 C.F.R. § 4.118, Diagnostic Code 7804 (effective from August 30, 2002 to August 22, 2008). The maximum rating under Diagnostic Code 7804 is 10 percent. A compensable evaluation under this provision is not warranted for the service-connected residuals of a chemical burn with loss of thumb print of the right hand because the disability did not cause pain on examination. As apparent from the foregoing discussion, the Board has examined all potentially applicable schedular provisions, but there is no means by which to assign a compensable evaluation for the service-connected residuals of a chemical burn with loss of thumb print of the right hand at any time during the appeal period. See Fenderson, supra. Finally, in making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision. Right and left knee strain The Veteran's service-connected right knee strain has been rated zero percent disabling by the RO under the provisions of Diagnostic Code 5099-5024. 38 C.F.R. §§ 4.20, 4.27, 4.71a. The Veteran's service-connected left knee strain has been rated zero percent disabling by the RO under the provisions of Diagnostic Code 5099-5024. 38 C.F.R. §§ 4.20, 4.27, 4.71a. Diagnostic Code 5024 pertains to tenosynovitis. 38 C.F.R. § 4.71a. The diseases under Diagnostic Codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under Diagnostic Code 5002. Standard motion of a knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II (2013). Limitation of leg motion is governed by Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 concerns limitation of leg flexion. A 10 percent evaluation is for application where flexion is limited to 45 degrees. A 20 percent evaluation is for application where flexion is limited to 30 degrees, and a 30 percent rating applies where flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, diagnosis 5260 (2013). Diagnostic Code 5261 pertains to limitation of leg extension. Under that Diagnostic Code, a 10 percent evaluation is for application where extension is limited to 10 degrees. A 20 percent evaluation is for application where extension is limited to 15 degrees. A 30 percent rating applies where extension is limited to 20 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261 (2013). On VA examination in May 2006, the Veteran indicated that his knees were asymptomatic. On objective examination, the knees were stable. Range of motion of the knees was normal bilaterally with no decrease in range of motion on repetitive motion. The diagnosis was of bilateral knee strain. On VA examination in June 2011, the Veteran reported bilateral knee stiffness. There was no crepitation, clicks, snaps, grinding, instability, patellar abnormality, meniscus abnormality, abnormal tendons or bursae, or other abnormality regarding either knee. Knee range of motion was from zero to 135 degrees bilaterally. There was no objective evidence of pain following repetitive motion. There were no additional limitations after three repetitive range of motion exercises. There was no joint ankylosis regarding either knee. An X-ray study of the knees revealed no significant abnormalities. The Veteran was employed on a full-time basis and lost no time from work during the previous 12 months. The examiner indicated that the knees had no significant effects on occupational functioning or on the activities of daily living. The diagnosis was of right knee strain and of left knee strain. Right and left knee range of motion is from zero to 135 degrees. Thus a compensable evaluation is not warranted for either knee under Diagnostic Code 5260 or 5261. The Board has considered other provisions related to the knees. Diagnostic Code 5256 is inapplicable because it pertains to knee ankylosis, which is not present. 38 C.F.R. § 4.71a. Diagnostic Code 5257 pertains to other impairment of the knee, recurrent subluxation or lateral instability. Id. Since the bilateral knee disability is productive of minimal impairment and because recurrent subluxation and lateral instability have not been shown, an evaluation under Diagnostic Code 5257 need not be considered further. Diagnostic Codes 5258 and 5259 pertain to the semi lunar cartilage. Id. Because the semi lunar cartilage is not part of either the right or left knee disability, the Board need not discuss these provisions further. Diagnostic Code 5262 pertains to impairment of the tibia or fibula. Id. These are not impaired in the Veteran's case, and the Board need consider Diagnostic Code 5262 no further. Finally, Diagnostic Code 5263 pertains to genu recurvatum. Id. This is not present, and the Board need not consider Diagnostic Code 5263 any further. In the present case, it should also be noted that when evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca, supra. Further, 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability, and incoordination. No further compensation is warranted under these provisions because functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements has not been shown regarding either knee and because weakened movement, excess fatigability, and incoordination are not present bilaterally. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision with respect to either knee. Hemorrhoids The Veteran's service-connected hemorrhoids have been rated zero percent disabling by the RO under the provisions of Diagnostic Code 7336. 38 C.F.R. § 4.114. Diagnostic Code 7336 pertains to hemorrhoids, external or internal. A zero percent evaluation is assigned for mild or moderate hemorrhoids. A 10 percent evaluation is assigned for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent rating is warranted when there is persistent bleeding with secondary anemia or fissures. There is no higher rating. 38 C.F.R. § 4.114, Diagnostic Code 7336. On VA examination in May 2006, the Veteran indicated that he experienced discomfort in the anal area approximately six times a year, lasting a day or two. On rectal examination, the examiner noted mild internal hemorrhoids without bleeding or masses. There was no pain on evaluation. The diagnosis was of internal hemorrhoids. On VA examination in June 2011, the Veteran indicated that his hemorrhoid disability was becoming progressively worse. He was receiving no current treatment. Objectively, the examiner noted that the hemorrhoids were external without bleeding. There was evidence of thrombosis and prolapse. The diagnosis was of hemorrhoids that posed no occupational difficulties and that had no impact upon the activities of daily living. The Veteran was working on a full-time basis and missed no time from work during the previous 12 months. As stated, under Diagnostic Code 7336, a 10 percent evaluation is assigned for hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. 38 C.F.R. § 4.114, Diagnostic Code 7336. When viewing the evidence in the light most favorable to the Veteran, a 10 percent evaluation is warranted throughout the appeal period. Id.; Fenderson, supra. The May 2006 VA examination report indicated that the Veteran experienced symptoms six times a year, which, in the Board's view, amounts to frequent recurrences. The June 2011 examination report reveals that the hemorrhoids are thrombosed, which also militates in favor of a 10 percent evaluation for the service-connected hemorrhoids. Again, therefore, a 10 percent evaluation for hemorrhoids is assigned for the entire appeal period. Id. A 20 percent evaluation is not warranted at any time during the appeal period because persistent bleeding with secondary anemia or fissures has not been shown. Id. The Board notes that there is no provision in the Schedule that is more fitting for the evaluation of the service- connected hemorrhoids. Thus, the Board will consider no provision other than Diagnostic Code 7336. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant an even more favorable decision. Vertigo The Veteran's service-connected vertigo has been rated 10 percent disabling by the RO under the provisions of Diagnostic Code 6299-6204. 38 C.F.R. §§ 4.20, 4.27, 4.87. Peripheral vestibular disorders are evaluated under Diagnostic Code 6204. 38 C.F.R. § 4.87. Under Diagnostic Code 6204, a 10 percent evaluation is warranted for peripheral vestibular disorders with occasional dizziness. A 30 percent evaluation will be assigned with dizziness and occasional staggering. A note to Diagnostic Code 6204 explains that objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under Diagnostic Code 6204 and that hearing impairment with suppuration is to be separately rated and combined. On May 2006 VA general medical examination, the Veteran felt sensations of movement around him when he moved his head fast, and he avoided sudden movements of his head. He was on no specific medication. Symptoms occurred approximately three times a year and lasted for a few days. During symptomatic periods, the Veteran had to avoid moving his head, running, or performing activities requiring moving the head. The diagnosis was of benign positional vertigo. On VA examination in June 2011, the Veteran reported intermittent symptoms of vertigo. The last episode occurred six month previously. His vertigo was intermittent with remissions. The Veteran denied receiving treatment for vertigo. The examiner diagnosed intermittent vertigo and indicated that the disability had no impact upon occupational or daily activities and that the Veteran had missed no time from work during the previous 12-month period. The Board finds that a 30 percent evaluation is not warranted for vertigo at any time during the appeal period because dizziness and occasional staggering has never been shown. 38 C.F.R. § 4.87, Diagnostic Code 6204. Indeed, the Veteran's vertiginous symptoms are intermittent. Moreover, the Veteran has not claimed, and the evidence does not reflect, that the service-connected vertigo has ever been productive of staggering. Absent such symptoms, a 30 percent evaluation under Diagnostic Code 6204 is denied for the entire appeal period. Id.; Fenderson, supra. The Board notes that there is no scheduler provision that is better suited to rating the service-connected vertigo than Diagnostic Code 6204. Diagnostic Code 6205 pertains to Maniere's disease, which involves some symptoms experienced by the Veteran. The Board need not consider an evaluation under Diagnostic Code 6205, however, because Maniere's disease has never been Diagnostic Code. 38 C.F.R. § 4.87, Diagnostic Code 6205. In making this determination, the Board has considered the provisions of 38 U.S.C.A. § 5107(b), but there is not such a state of approximate balance of the positive evidence with the negative evidence to otherwise warrant a favorable decision. Rice v. Shinseki The Court held that if the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether a total disability rating based on individual unemployability (TDIU) as a result of that disability is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board finds that a claim for a TDIU is not raised by the record. Specifically, the evidence of record fails to show that the Veteran is unemployable. Therefore, the Board finds that no further consideration of a TDIU is warranted. Rice, supra. Extrascedular Consideration In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321 (2013). 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 the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant'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"). When the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has 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 for completion of the third step-a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. Id. In Mittleider v. West, 11 Vet. App. 181 (1998), the Court held that the benefit of the doubt applies to determinations of whether a symptom should be attributed to a service- connected condition. Id. at 182. Here, the Board has considered Mittleider and has attributed all potentially service-connected symptoms to one service-connected condition or another, before considering if the Veteran is entitled to an extraschedular rating herein. Concerning the issue of an increased rating for left ear hearing loss, in Martinak, 21 Vet. App. at 455, the Court held that, relevant to VA audiological examinations, in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. The Court also noted, however, that even if an audiologist's description of the functional effects of the Veteran's hearing disability was somehow defective, the Veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination. In this regard, the May 2006 and May 2011 VA examiners, when taking into account the June 2011 addendum, specifically addressed the functional effects caused by the Veteran's left ear hearing loss disability. The Board, therefore, finds that the evidence of record is sufficient for the Board to consider whether referral for an extraschedular rating for left ear hearing loss is warranted under 38 C.F.R. § 3.321(b) . The Board notes that the Court's rationale in requiring an examiner to consider the functional effects of a Veteran's hearing loss disability involves the potential application of 38 C.F.R. § 3.321(b) in considering whether referral for an extra-schedular rating is warranted. Specifically, the Court noted that, unlike the rating schedule for hearing loss, 38 C.F.R. § 3.321(b) does not rely exclusively on objective test results to determine whether a referral for an extra-schedular rating is warranted. VA's policy requiring VA audiologists to describe the effect of a hearing disability on a Veteran's occupational functioning and daily activities facilitates such determinations by requiring VA audiologists to provide information in anticipation of its possible application. Martinak, 21 Vet. App. at 455. In this Veteran's case, the Board notes that the Veteran's left ear hearing loss is no more than mild. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss, including exceptional hearing patterns which are not demonstrated in this case, and as measured by both audiological testing and speech recognition testing. Speech recognition testing is a schedular rating criterion that recognizes such an inability to understand certain words in conversation. For these reasons, the Board finds that the schedular rating criteria in this case are adequate to rate the Veteran's left ear hearing loss disability. Concerning the issue of a higher initial rating for the Veteran's pes planus, the Board finds that the schedular rating criteria contemplate the limitations and impairment caused by that disability. The rating criteria specifically provide for ratings based on the presence of such symptoms as pain on use, swelling, and characteristic callosities. As for the issue of a higher initial rating for the Veteran's residuals of a right thumb chemical burn with loss of finger print, the Board finds that the schedular rating criteria contemplate all potential symptoms associated with scarring to include limitation of function. Thus, the schedular rating criteria are adequate to rate the Veteran's service-connected residuals of a right thumb chemical burn with loss of thumb print. Regarding the service-connected right and left knee disabilities, the Board finds that the schedular rating criteria contemplate these disabilities. The knee rating criteria specifically provide for ratings based on the presence of arthritis, and limitation of motion (including due to pain and other orthopedic factors; see 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca. Because the schedular rating criteria are adequate to rate the Veteran's service- connected right and left knee disabilities, there is no exceptional or unusual disability picture to render impractical the application of the regular schedular standards. Turning to the service-connected hemorrhoids, the evidence in this case does not show such an exceptional disability picture that the available schedular criteria for the service-connected hemorrhoid disability are inadequate. The rating assigned under Diagnostic Code 7336 is based on the average impairment of earning capacity resulting from such symptoms as size of the hemorrhoid, whether the hemorrhoid was thrombosed, whether the hemorrhoid was reducible, whether there was excessive redundant tissue, and on the frequency of recurrences. The record contains no indication that the Veteran's hemorrhoid disability causes him greater difficulty than that contemplated by the 10 percent initial rating that has been assigned. Having reviewed the evidence and the rating assigned, the Board finds that the evidence does not show such an exceptional disability picture to render the schedular evaluation assigned for the hemorrhoid disability to be inadequate to rate the Veteran's service- connected hemorrhoid disability. The Board also finds that the symptomatology and impairment caused by the Veteran's vertigo is specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. The rating assigned under Diagnostic Code 6299-6204 is based on the average impairment of earning capacity resulting from occasional dizziness. The record contains no indication that the Veteran's vestibular disorder causes him greater difficulty than that contemplated by the 10 percent rating assigned. Therefore, having reviewed the evidence and the rating assigned, the Board finds that the evidence does not show such an exceptional disability picture to render the schedular evaluation assigned for the vestibular disorder to be inadequate to rate the Veteran's service-connected vertigo. In this case, the problems reported by the Veteran are specifically contemplated by the criteria discussed above, including the effect on daily life. In the absence of exceptional factors associated with the disabilities at issue herein, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER A compensable evaluation for left ear hearing loss is denied. A compensable evaluation for bilateral pes planus is denied. A compensable evaluation for residuals of a chemical burn with loss of thumb print of the right hand is denied. A compensation evaluation for right knee strain is denied. A compensation evaluation for left knee strain is denied. A 10 percent evaluation for hemorrhoids is granted subject to the law and regulations governing the payment of veterans' benefits. An evaluation in excess of 10 percent for service-connected vertigo is denied. REMAND A remand is required in this case to assist the Veteran with his claim. VA has a duty to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claim for the benefits sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A(a); 38 C.F.R. § 3.159(c), (d). PFB In its April 2011 remand, in connection with the claim of entitlement to a compensable initial rating for service- connected PFB, the Board asked that the RO schedule a VA examination. The Board asked the following: Concerning PFB, the examiner should describe the degree of disfigurement, distortion, or asymmetry; and address whether any of the following are present: (1) a scar of five or more inches (13 or more cm.) in length; (2) a scar of at least one- quarter inch (0.6 cm.) wide at the widest part; (3) surface contour of the scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper- pigmented in an area exceeding six square inches (39 sq. cm.); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). The examination must include color photographs of the condition. On May 2006 VA general medical examination, the Veteran indicated that he had symptoms of PFB since the onset of the condition in service. The condition was present when he shaved. The examiner observed some small bumps on the lower part of the face and neck. The diagnosis was of pseudofolliculitis. On VA examination in June 2011, the examiner observed a rash on the face. There were no systemic symptoms. The examiner described multiple hypopigmented papules on the face and chin and occipital area. There was a small area of scarring in the occiput that was 1 cm in width and 1.5 cm in length that was not tender or erythematous but slightly raised. It was not fixated to the underlying skin. The diagnosis was of PFB. The examiner did not indicate whether the above mentioned scar was a component of the service-connected PFB. Clearly, the examiner did not answer the specific questions posed in the April 2011 remand to include the total area covered, and photographs were not included. Thus, a remand for corrective action is required. See Stegall 11 Vet. App. at 271 (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). In addition, the Board will ask whether the occipital scar observed on examination in June 2011 is a component of the service-connected PFB or of unrelated origin. Residuals, including scar, of an umbilical hernia repair In April 2011, the Board asked that a general medical examination be scheduled to, in pertinent part, evaluate the severity of the residuals, including scar, of an umbilical hernia repair. Specifically, the Board asked the following: concerning the scar from the umbilical hernia repair ...the examiner should describe any associated symptoms, including any pain and limitation of function of the affected parts. On May 2006 VA general medical examination, the Veteran reported a herniorrhaphy in approximately 1989. The Veteran was reportedly doing well and was asymptomatic. On objective examination, there were two scars around the umbilical area. One was three inches long, and the other was four inches long. They were healed with no sign of inflammation. There was no tenderness to palpation. The diagnosis was of umbilical hernia status-post herniorrhaphy. On June 2011 VA medical examination, there was no hernia present. There was no abnormal guarding, and bowel sounds were normal. The examiner, however, described only one scar in the umbilical area, which was .3 cm wide and 5.5 cm long. The area of the scar was less than six square inches (39 sq cm). The scar was not painful, involved no skin breakdown, was superficial, and entailed no inflammation, edema, keloid formation, and had no other disabling effects. The June 2011 examiner did not describe a second scar in the umbilical area. Thus, clarification is necessary due to the discrepancy between the two examination reports (the first indicating the presence of two scars and the second reflecting the presence of just one). Accordingly, the case is REMANDED to the RO/AMC for the following action: 1. Schedule a VA examination concerning the service-connected PFB. The examiner should describe the degree of disfigurement, distortion, or asymmetry; and address whether any of the following are present: (1) a scar of five or more inches (13 or more cm.) in length; (2) a scar of at least one-quarter inch (0.6 cm.) wide at the widest part; (3) surface contour of the scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); (6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); (7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and (8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). The examination must include color photographs of the condition. The examiner must also state whether the scar observed on the occiput is part of the service-connected PFB disability or of unrelated origin. The examiner should comment upon the impact of the Veteran's PFB upon employability, and any occupational impact should be detailed. The examiner must review all pertinent documents in the claims file in conjunction with the examination, and the examination report must indicate whether the requested review of the file took place. A rationale for all opinions and conclusions must be provided. 2. Schedule a VA examination for a clear picture of any residuals associated with the hernia repair. The examiner must state the number of scars resulting from the hernia repair and describe all scars resulting from the umbilical hernia repair. The examiner should describe any associated scar symptoms, including any pain and limitation of function of the affected parts. The examiner should comment upon the impact of the Veteran's residuals of a hernia repair upon employability and any occupational impact should be detailed. The examiner must review all pertinent documents in the claims file in conjunction with the examination, and the examination report must indicate whether the requested review of the file took place. A rationale for all opinions and conclusions must be provided. 3. After completion of the above development, the remaining claims should be readjudicated. If the determination remains adverse to the Veteran, he and his representative should be furnished with a Supplemental Statement of the Case, and should be given an opportunity to respond. The Veteran has the right to submit additional evidence and argument on the or matters 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). ______________________________________________ Keith W. Allen Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs