Citation Nr: 18148083 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 14-35 464 DATE: November 6, 2018 ORDER The issue of a rating in excess of 30 percent prior to July 21, 2017, and in excess of 70 percent thereafter, for pain disorder associated with psychological factors, is dismissed. A rating in excess of 20 percent for fracture of the right ankle, post-traumatic arthritis, is denied. From April 23, 2010, a separate 20 percent rating, but not higher, for recurrent right ankle instability is granted. Service connection for a right knee disorder, to include as secondary to service-connected disability, is denied. Service connection for a left knee disorder, to include as secondary to service-connected disability, is denied. Service connection for a left ankle disorder, to include as secondary to service-connected disability, is denied. From July 21, 2017, a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. REMANDED Prior to July 21, 2017, a TDIU based on extraschedular basis is remanded.   FINDINGS OF FACT 1. In September 2018, prior to the promulgation of a Board decision, the Veteran requested withdrawal of the appeal of the issue of increased ratings for his service-connected psychiatric disability. 2. The Veteran’s right ankle disability is manifested by marked limitation of motion, but not ankylosis. 3. From April 23, 2010, the Veteran’s right ankle disability has caused moderate recurrent instability. 4. The right knee disorder was not caused or aggravated by a service-connected disability. 5. The left knee disorder was not caused or aggravated by a service-connected disability. 6. A left ankle disorder is not shown. 7. From July 21, 2017, the Veteran has been prevented from securing and following substantially gainful employment as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the issue a rating in excess of 30 percent prior to July 21, 2017, and in excess of 70 percent thereafter, for pain disorder associated with psychological factors, have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.204. 2. The criteria for a rating in excess of 20 percent for the right ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5271. 3. From April 23, 2010, the criteria for a separate rating of 20 percent, but not higher, for recurrent right ankle instability, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5262. 4. The criteria for service connection for a right knee disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. From July 21, 2017, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1960 to August 1964, and from October 1964 to November 1965. He also had service in the Army National Guard from March 1958 to September 1958. The case is on appeal from May 2010 and September 2012 rating decisions. The claims came before the Board in May 2017 and were remanded for further development. At the outset of this analysis, the Board notes it has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Withdrawn Claim Under 38 U.S.C. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. An appeal may be withdrawn by the Veteran or representative on the record at a hearing, or in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. In September 2018, the Veteran indicated he was withdrawing the issue of increased ratings for his service-connected psychiatric disability. He reported that the April 2018 rating decision increased his psychiatric rating to 70 percent and he is satisfied with such rating. He stated, “I would like at this time to withdraw my formal appeal since VARO has assigned a favorable rating.” The Board finds that the withdrawal of the appeal is “explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the claimant.” DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see also Acree v O’Rourke, 891 F.3d 1009 (Fed. Cir. 2018). The September 2018 correspondence was an express statement by the Veteran withdrawing the claim for an increased psychiatric rating. Therefore, there remain no allegations of errors of fact or law for appellate consideration with regard to the issue on appeal. Accordingly, the Board does not have jurisdiction to review the increased rating psychiatric issue and it is dismissed. Increased Rating General Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. 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. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 1. A rating in excess of 20 percent for the right ankle disability. The Veteran contends the severity of his right ankle disability warrants a rating greater than 20 percent. His right ankle has been rated at 20 percent under DC 5271 throughout the appeal period. The Veteran’s right ankle disability is currently rated under DC 5271 which provides for a maximum schedular rating of 20 percent for marked limitation of range of motion. 38 C.F.R. § 4.71a, DC 5271. However, the Board notes under DC 5270, a 30 percent rating compensates for ankylosis of the ankle when plantar flexion is between 30 degrees and 40 degrees or the dorsiflexion is between 0 degrees and 10 degrees. A 40 percent rating is warranted when the plantar flexion is more than 40 degrees or the dorsiflexion at more than 10 degrees or with abduction, adduction, inversion, or eversion deformity. 38 C.F.R. § 4.71a, DC 5270. VA defines favorable ankylosis as fixation of a joint in a neutral position and unfavorable ankyloses as fixation of a joint in flexion or extension that results in significant functional impairment. VA’s Adjudication Procedure Manual, M21-1, III.iv.4.A.2.n. The question for the Board is whether the Veteran’s disability has been manifested by a disability level involving at least ankylosis of the ankle when plantar flexion is between 30 degrees and 40 degrees or the dorsiflexion is between 0 degrees and 10 degrees. The Board finds that this next-higher disability level is not more nearly approximated. The Veteran was afforded an April 2010 VA examination in which significant ankle symptoms were reported, including pain, weakness, stiffness, swelling, heat, redness, instability, giving way, fatigability and lack of endurance. He reported severe pain, including 10 out of 10. Right ankle dorsi-flexion was limited to 20 degrees and plantar flexion to 40 degrees. The examiner found there was no ankylosis of the right ankle. The examiner indicated severe traumatic joint disease with moderate instability was found and loss of full weight bearing capacity. A May 2010 x-ray indicated an intense uptake of the right ankle suggestive of significant posttraumatic changes. The Veteran was afforded a July 2010 VA examination in which the examiner noted similar symptoms, including pain reported at 10 out of 10. The examiner also indicated no ankylosis was present. A September 2012 examination was provided in which the examiner indicated plantar flexion to 35 degrees and dorsiflexion to 10 degrees. Similar to the prior examiners, the September 2012 examiner noted no ankylosis present. Private treatment records were submitted thereafter. In an October 2016 record, the Veteran reported constant right ankle pain of a 10/10 severity. The Veteran indicated that his right ankle pain had progressed to the point where it was difficult to walk. His range of motion measurements (plantar flexion) had worsened. A January 2017 medical record noted limited range of motion of the right ankle with pain and crepitation and an ankle fusion or possible replacement was considered. The Board remanded the claim in May 2017 due to potential worsening of the condition. The Veteran was afforded a July 2017 VA examination and significantly, no ankylosis was found in the right ankle. Range of motion measurements indicated dorsiflexion to 10 degrees and plantar flexion to 15 degrees. Instability was also indicated and severe pain. The Board finds the preponderance of the evidence is against the claim for a rating of the right ankle disability in excess of 20 percent. Given that a 20 percent rating is the highest available rating pursuant to DC for 5271, an increased rating for limited motion is not indicated. The Board has also considered whether a rating higher than 20 percent may be awarded pursuant to any of the other ankle impairment rating criteria. The only ankle ratings higher than 20 percent are awarded pursuant to DC 5270 based on evidence of ankle ankylosis. However, all the evidence of record, including four VA examinations, have indicated there is no ankylosis present in the right ankle. While the Board does not doubt the severity of the Veteran’s right ankle pain and other symptoms, without the presence of ankylosis, a rating in excess of 20 percent is not assignable. Based on the foregoing, the Board concludes that a rating in excess of 20 percent for the right ankle disability is not warranted. There is no ankylosis present, and as such, the preponderance of the evidence is against the claim. Therefore, a rating in excess of 20 percent is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 2. A separate rating for right ankle instability. The Board finds that after a thorough review of the evidence, a separate rating of 20 percent is warranted due to moderate right ankle instability, under DC 5262. This rating is warranted from April 23, 2010, the date of the VA examination. Under DC 5262 for impairment of the tibia and fibula, a 40 percent rating is assigned with nonunion, with loose motion, requiring brace. With malunion, 30, 20, and 10 percent ratings are warranted if there is marked, moderate, or slight knee or ankle disability, respectively. As noted above, the Veteran was afforded an April 2010 VA examination. The Veteran reported instability and giving way. Objective testing revealed right ankle instability, moderate in severity. An August 2011 statement was submitted in which the Veteran reported worsening right ankle symptoms, including that his right ankle gives way frequently causing him to fall. He stated he requires a cane in order to walk with any stability and he has barely any movement in the ankle. Additionally, the July 2017 VA examiner noted right ankle instability and diagnosed the Veteran with moderate to severe degenerative joint disease (DJD) of the posterior subtalar joint. Given the Veteran’s reports, as well as the medical evidence, indicating recurrent ankle instability, falls, and “giving way” of the ankle, the Board finds that a separate rating of 20 percent should be assigned for the right ankle disability from April 23, 2010, independent of the current rating for limitation of motion. As the diagnostic codes relating to the ankles do not contain an appropriate diagnostic code to account for all of these symptoms, the Board finds it appropriate to rate these symptoms by analogy using DC 5262, which is usually used to rate impairment of the tibia and fibula and contemplates corresponding disability of the knee or ankle. See 38 C.F.R. § 4.71a, DC 5262. The Board finds that a 20 percent rating, but not higher, for the right ankle is warranted under DC 5262 from April 23, 2010, the date of the VA examination in which instability was first noted on objective examination. The Board finds his instability is most accurately described as moderate based on the medical and lay evidence. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 3. Service connection for bilateral knee disorder. The Veteran contends that his right and left knee disorders were caused or aggravated by his service-connected right ankle and/or psychiatric disability. In an August 2011 statement, the Veteran indicated due to the pain and instability of his right ankle, he is forced to walk with an altered gait, causing pain in both his knees. He stated his knees lock up or give way and cause him to fall. He further stated his knees get swollen and cause daily pain and discomfort. The Veteran was afforded a September 2012 VA examination in which the examiner diagnosed him with DJD of the bilateral knees. The examiner concluded the bilateral knee conditions are less likely than not proximately due to or the result of a service-connected condition. He stated that medical literature supports that osteoarthritis in weight-bearing joints is present in almost all persons of 45 years. He indicated further that radiographic evidence supports up to 85 percent of persons older than 65 years age have osteoarthritis. Thus, he indicated the arthritis found in the Veteran’s knee is due to the aging process and not the right ankle disability. The Board remanded the claims in May 2017 for an additional VA examination which was afforded to the Veteran in July 2017. The examiner determined the Veteran’s knee disorders suggest mild degenerative disease, consistent with age-related degenerative changes. He stated examination revealed no evidence of significant leg length discrepancy and the degenerative changes in the knees are bilateral and symmetrical which is suggestive of age-related degeneration. He noted there is no evidence of inflammatory arthritis. Moreover, he stated, although the Veteran has an altered gait due to his right ankle disorder, it is very unlikely to account for the bilateral symmetrical knee degenerative changes, as there is no evidence of leg length discrepancy. With regard to potential aggravation, the examiner indicated the current examination and x-ray findings do not suggest aggravation of the Veteran’s knees beyond the natural progression, as there is no abnormality found and no evidence of inflammatory arthritis. The VA Regional Office (RO) obtained an addendum opinion in March 2018. The examiner similarly indicated the right and left knee disorders were not caused or aggravated by the service-connected disabilities. He stated prior radiographic evidence was reviewed which supports minimal degenerative changes. He noted there is a lack of sufficient orthopedic clinical evidence to support the right ankle disability or pain disorder caused or aggravated the bilateral knee disorders. In consideration of the medical and lay evidence of record, the Board determines service connection for right and left knee disorders, as related to a service-connected disability, is not warranted. The Veteran has provided consistent lay statements that his right ankle disability caused limping and an altered gait leading to his knee disorders. However, he is a lay person with background, training, or expertise in medical matter. As such, he has not shown that he has specialized training sufficient to render an adequate medical opinion related to the etiology of his bilateral knee arthritis. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In this regard, the etiology of knee arthritis is a matter not capable of lay observation and requires medical expertise to determine. Specifically, the question of causation extends beyond an immediately observable cause-and-effect relationship. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Veteran portions of medical articles address antalgic gait and how foot problems may affect the knee. These generalized articles indicate that foot problems can affect the knees. But, the VA examiners’ opinions explain why such is not the case here. Rather, the Board finds the VA examiner’s opinions from July 2017 and March 2018 the more probative evidence of record. The VA examiners’ opinions are highly persuasive as to the etiology of the knee disorders. The examiners considered particular circumstances of this Veteran’s case, including the radiographic evidence, and provided complete rationales relying on and citing to the records reviewed. These examiners offered clear conclusions with supporting data, as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). The Board notes there are no other medical opinions of record supporting that the Veteran’s bilateral knee disorders were caused or aggravated by his right ankle and/or psychiatric disorders. In sum, the preponderance of the evidence is against the claim; the benefit-of-the-doubt doctrine is not applicable; and the claims of service connection for right and left knee disorders, including as related to service-connected right ankle and/or psychiatric pain disorder, must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Service connection for a left ankle disorder. The Veteran contends that he has a left ankle disorder which was caused or aggravated by his service-connected right ankle and/or psychiatric disability. He indicated in August 2011 that due to an altered gait caused by his right ankle disability, he had to put pressure on his left ankle, resulting in pain, swelling, and some limitation of movement in the ankle. During the September 2012 VA examination, the examiner indicated there was no left ankle disability found. He stated there was no arthritis seen on the left ankle x-ray. However, he also indicated the left ankle arthritis is due to the aging process. Following the May 2017 Board remand, the Veteran was afforded a July 2017 VA examination in which the examiner indicated July 2017 x-rays revealed normal findings of the left ankle. He noted the Veteran does not have a left ankle disability, x-rays did not reveal abnormal findings, and the left ankle condition does not rise to the level of a disability. A March 2018 examiner similarly indicated there was no left ankle disability. He noted there was prior mild soft tissue swelling of the medial left ankle, although there was no significant osseous or joint abnormality. Thus, he stated, there is no clinical and/or radiographic pathology of the left ankle and the left ankle is deemed normal. The Board finds that due to the lack of a current diagnosis for the left ankle, service connection for a left ankle condition is not warranted. All service connection claims require a finding of a current disability as one of the elements. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). When the record contains a recent diagnosis of disability prior to the veteran’s filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). While the Board acknowledges the Veteran’s reports of left ankle pain and discomfort, and that such symptoms are related to an altered gait caused by his right ankle, the preponderance of the evidence supports he has no current left ankle disability. Moreover, three VA examination reports, from September 2012, July 2017 and March 2018, have concluded that there is no left ankle pathology to allow for a current diagnosis. Thus, the current disability element of the claim is not substantiated for the left ankle. Further, no medical evidence of record confirms that the Veteran has an established left ankle diagnosis. In the absence of proof of a present disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Further, the Veteran has not been shown to have the training or credentials needed to provide a diagnosis of a left ankle disorder, to include a diagnosis that is secondary to a service-connected disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In sum, the preponderance of the evidence weighs against the claim, as there is no competent and credible evidence of a current left ankle diagnosis. As the preponderance of the evidence is against the claim, service connection for a left ankle disorder, as related to service-connected disability, is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 5. Entitlement to a TDIU. A TDIU may be assigned where the schedular rating is less than total and when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. § 4.16(a). A veteran need not show 100 percent unemployability in order to be entitled to a TDIU. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). Marginal employment is not considered substantially gainful employment and is deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment also may be held to exist on a facts-found basis when earned annual income exceeds the poverty threshold. Such situations may include, but are not limited to, employment in a protected environment such as a family business or sheltered workshop. 38 C.F.R. § 4.16(a). If the percentage requirements of 38 C.F.R. § 4.16(a) are not met, then a TDIU may still be granted on an extraschedular basis in cases when a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b). However, the Board cannot grant an award of a TDIU on an extraschedular basis under 38 C.F.R. § 4.16(b) in the first instance because that regulation requires that the RO first submit the claim to the Director of the Compensation Service (Director) for extraschedular consideration. See Wages v. McDonald, 27 Vet. App. 233 (2015). The Veteran contends his two service-connected disabilities, the right ankle and psychiatric disabilities, prevent him from securing and following any substantially gainful occupation. He reported in the TDIU application that he last worked full time in 1998 as a security guard. During an April 2010 VA examination, the Veteran reported severe pain and instability. He indicated symptoms of pain, weakness, stiffness, swelling, heat, redness, instability, giving way, fatigability and lack of endurance. With regard to occupational capacity, the examiner indicated the Veteran was “unable to do much,” could not meet any work obligations and was unemployable unless the ankle pain and impairment could be resolved. The September 2012 examiner indicated the right ankle did not impact the Veteran’s ability to work; however, the July 2017 examiner indicated the Veteran’s ankle related work restrictions include avoidance of prolonged exertion, no heavy lifting, and no heavy carrying of excess poundage. With regard to the psychiatric disability, an August 2012 VA examiner indicated the Veteran had a diagnosed mental disorder, but the symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. However, a July 2017 examiner indicated significant worsening, including that the Veteran suffers from total occupational and social impairment. He reported the Veteran was experiencing suicidal thoughts, as well as sleep difficulties and weight loss. The Board finds that, from July 21, 2017, the Veteran’s service-connected psychiatric and right ankle disorders, preclude him from securing or following a substantially gainful occupation. This is so particularly when reasonable doubt is resolved in his favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The record reflects that the Veteran is eligible for TDIU consideration on a schedular basis from July 21, 2017. From that date, the Veteran is service-connected for the psychiatric disorder, rated at 70 percent. 38 C.F.R. § 4.16(a). However, as further discussed in the remand section below, prior to July 21, 2017, the Veteran’s combined rating do not meet the schedular requirement under 38 C.F.R. § 4.16(a). Thus, a TDIU is assignable by the Board only since July 21, 2017. REASONS FOR REMAND A remand of the claim for a TDIU prior to July 21, 2017, is warranted. The Board notes that during the appeal period prior to July 21, 2017, the Veteran’s service-connected disabilities included pain disorder, 30 percent from August 25, 2011; and right ankle disability, 20 percent throughout the appeal period. Thus, prior to July 21, 2017, the combined disability rating was 40 percent from August 25, 2011 to July 20, 2017, and 20 percent prior to that date. Therefore, review of entitlement to a TDIU is necessary for the period prior to July 21, 2017, because the schedular requirement under 38 C.F.R. § 4.16(a) were not met even with the combination exceptions in the regulation. A TDIU prior to July 21, 2017, may still be granted on an extraschedular basis if the Veteran was unable to secure and follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b). Although the Veteran’s service-connected disabilities did not meet the schedular criteria for a TDIU prior to July 21, 2017, the evidence supports that he was still unemployable, including from the April 2010 VA examination of his right ankle disability. Although only rated as 20 percent disabling, the evidence supports the Veteran’s right ankle disability rendered him unemployable from April 23, 2010, as he had severer difficulty standing and walking. As noted above, the Board is prohibited from granting an award of a TDIU under 38 C.F.R. § 4.16(b) in the first instance. See Wages v. McDonald, 27 Vet. App. 233 (2015) (Board is authorized to award extraschedular TDIU after obtaining the Director’s decision). Therefore, the RO must first refer the claim for a TDIU on an extraschedular basis to the Director to determine whether the Veteran is entitled to an extraschedular TDIU prior to July 21, 2017, under 38 C.F.R. § 4.16(b). The matter is REMANDED for the following action: Pursuant to 38 C.F.R. § 4.16(b), refer the claim for a TDIU to the Director for extraschedular consideration, for the time period on appeal, prior to July 21, 2017. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel