Citation Nr: 18152218 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 17-53 752 DATE: November 21, 2018 ORDER Service connection for an acquired psychiatric disorder, not to include major depression, is granted. A rating in excess of 70 percent for a psychiatric disability, characterized as major depression, is denied. A rating in excess of 20 percent from April 3, 2016 to April 2, 2017, and as of August 1, 2017, is denied. A rating in excess of 10 percent for a left thumb scar is denied. A rating of 20 percent, but no more, for left lower extremity radiculopathy is granted. A rating of 20 percent, but no more, for right lower extremity radiculopathy is granted. FINDINGS OF FACT 1. It is at least as likely as not that the Veteran’s psychiatric disorder, not to include major depression, had its onset during service and/or is otherwise etiologically related to service. 2. Throughout the period on appeal, the Veteran’s service-connected psychiatric disability was manifested by no more than occupational and social deficiencies in most areas; there was no showing of total occupational and social impairment. 3. Throughout the period on appeal, the Veteran’s back disorder has been characterized by pain and limitation of motion; forward flexion of the thoracolumbar spine less than 30 degrees, favorable ankylosis of the entire thoracolumbar spine, or intervertebral disc syndrome with incapacitating episodes for at least 6 weeks during the past 12 months, have not been shown. 4. Throughout the entire period on appeal, the evidence is at least in equipoise that the Veteran’s bilateral lower extremity radiculopathy was characterized by “moderate” incomplete paralysis of the sciatic nerve. 5. The Veteran’s left thumb scar was small, linear, and painful; a scar that was deep and nonlinear with a total area of at least 12 sq. in. (77 sq. cm) but less than 72 sq. in. (465 sq. cm), and/or unstable have not been shown. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder, not to include major depression, are met. 38 U.S.C. 1131, 5107(b); 38 C.F.R. 3.102, 3.303(a), 3.304, 3.307, 3.309. 2. The criteria for a rating in excess of 70 percent for a psychiatric disorder, characterized as major depression, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code (DC) 9434. 3. The criteria for a rating in excess of 20 percent for a back disorder prior to April 3, 2017, and in excess of 20 percent as of August 1, 2017, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5242. 4. The criteria for a rating of 20 percent, but no more, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 5. The criteria for a rating of 20 percent, but no more, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 6. The criteria for a rating in excess of 10 percent for a left thumb scar have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.14, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has active service from October 2004 to July 2007. The Board observes that in August 2017, the Regional Office (RO) increased the Veteran’s assigned disability rating for his service-connected back disorder to 40 percent from April 3, 2017 to July 31, 2017, and then reduced it to 20 percent thereafter. However, as these staged ratings were assigned by the RO in the same rating decision, the procedural protections of 38 C.F.R. § 3.105(e) do not apply. Further, in his August 2017 notice of disagreement, the Veteran stated that he wanted a 40 percent rating his back disability. Therefore, with respect to the Veteran’s increased claim for a back disorder, the Board finds that this is a full grant of the benefits sought on appeal for this time period. Cf. AB v. Brown, 6 Vet. App. 35 (1993). The Board acknowledges that the Veteran filed a claim of entitlement to service connection for a psychiatric disorder. However, a service connection claim which describes only one particular psychiatric disorder should not necessarily be limited to that disorder. Therefore, as reflected herein, VA should consider the claim as one for any psychiatric disability that may reasonably be encompassed by evidence of record, not including major depression (as the Veteran is already service-connected for major depression). Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board acknowledges the Veteran assertions that his August 2017 VA back examination was inadequate because the examiner was only a nurse practitioner and that she did not use a goniometer to measure his range of motion. However, the Board has reviewed the examination report and finds that the examiner reviewed the Veteran’s past medical history, recorded his current complaints and history, conducted appropriate evaluations and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. Moreover, with respect to the use of a goniometer (or lack thereof), the Board finds that this general assertion is insufficient to overcome the presumption of regularity applying to government officials, such as VA examiners conducting compensation examinations. See Ashley v. Derwinski, 2 Vet. App. 307, 308 (1992); see also Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009). Therefore, the VA examination report is adequate for the purpose of rendering a decision on appeal. 38 C.F.R. § 4.2; Barr v. Nicholson, 21 Vet. App. 303 (2007). Additionally, recognition is given to the Veteran’s claim that his back symptoms have increased in severity since his most recent VA examination. However, despite the Veteran’s contentions to the contrary, there is no objective evidence indicating that there has been a material change in the severity of the Veteran’s service-connected back disorder since his last VA examination. In fact, the Board specifically notes that it appears the Veteran has not received regular treatments or examinations for his back disorder. Therefore, a new VA examination is not warranted on this basis. Increased Ratings The Veteran is seeking increased ratings for his service-connected psychiatric disability, left thumb scar, back disability, and bilateral lower extremity radiculopathy. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 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. See 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436 (2002); Massey v. Brown, 7 Vet. App. 204, 208 (1994). Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder, not to include major depression The Veteran asserts that his psychiatric disorder, not including major depression, is related to active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. After a review of the evidence, the Board concludes that the Veteran’s current psychiatric disorder (other than depression) had its onset during service and/or is otherwise etiologically related to an in-service injury, event, or disease. 38 U.S.C. 1131; 38 C.F.R. 3.303, 3.304, 3.307, 3.309. As an initial matter, the Board takes notice of the fact that the Veteran is already service-connected for major depression that had its onset during service. Next, the post-service medical evidence indicates that the Veteran has a diagnosis of other psychiatric disorders, including PTSD and anxiety. Further, the evidence, including the Veteran’s April 2017 private opinion, reflects that the symptoms of his anxiety and PTSD overlap with his depression. Moreover, he opined that the Veteran’s anxiety and PTSD were related to the Veteran’s service, to include his documented in-service episode of depression. The Board notes that the negative medical evidence includes VA examinations prior to the period on appeal from March 2007 and March 2014, which reflect that the Veteran does not have any diagnosed psychiatric disorders, other than depression. Nevertheless, given that the Veteran was recently evaluated by his treating physician in April 2017, in conjunction with the lack of recent VA examinations during the period on appeal, the Board finds that the evidence is in relative equipoise to support service connection. Additionally, the Board notes that while it is granting service connection for a separate psychiatric disorder, the rating criteria for the Veteran’s service-connected psychiatric disorders are identical under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. As such, to the extent the Veteran’s psychiatric symptoms overlap, he will not be entitled to separate ratings. 38 C.F.R. § 4.14; see also Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009). Therefore, service-connection for an acquired psychiatric disorder, other than major depression, is warranted. Increased Ratings 2. Entitlement to a rating in excess of 70 percent for a psychiatric disability, characterized as major depression Throughout the period on appeal, the Veteran’s psychiatric disorder has been assigned a disability rating of 70 percent under 38 C.F.R. § 4.130, DC 9434. In order to warrant the next higher 100 percent rating, the evidence must demonstrate total occupational and social impairment due to such symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place; and/or memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9434. After a review of the evidence of record, the Board determines that a rating in excess of 70 percent is not warranted for any period on appeal. Indeed, the Board observes that during the period on appeal, the Veteran’s symptoms did not arise to the level of total occupational and social impairment, and in fact were not of the severity to meet many of the criteria listed for a 70 percent rating. Specifically, in an April 2016 treatment evaluation, while the Veteran reported that his insomnia was worsening, his medical provider noted that his depression was under “good therapeutic control.” Further, on examination, he was “nicely dressed,” displayed normal speech with linear and goal directed thoughts. Moreover, his thought content was normal with good insight and judgment, and he did not exhibit suicidal or homicidal ideations. Similarly, in a March 2017 treatment evaluation, while the Veteran reported worsening moods and social interactions, his treating medical provider stated his depression “remains under excellent control,” and that his insomnia was “under good therapeutic control.” On examination, he was noted be appropriately dressed and groomed. His judgment/insight was good with linear and goal oriented thoughts. There was no evidence of suicidal/homicidal ideations, psychosis, or a thought disorder. Further, the Veteran’s psychiatric symptoms continued to be more consistent with a rating of 70 percent in an April 2017 treatment evaluation. Here, while the Veteran had symptoms of depression, panic attacks, anxiety, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing effective work and social relationships, and some problems with verbal reasoning, his speech, thought process, and behaviors were essentially normal. Moreover, there was no evidence of suicidal ideations, thought disorder, or psychosis. As such, his treating physician opined that his symptoms only caused occupational and social impairment with reduced reliability and productivity. Additionally, the Board observes that the Veteran’s symptoms appeared to have improve in June 2017. Specifically, the Veteran’s treating physician noted that his symptoms were under “good control.” He appeared appropriately dressed and groomed. His motor activity, speech, and thought content were all normal. Further, his affect was congruent and he displayed good insight and judgment. There was no evidence of delusions, hallucinations, more than weekly panic attacks, obsessive/ritualistic behaviors, suicidal/homicidal thoughts, psychosis, or a thought disorder. In view of these clinical evaluations, the Board determines that a rating in excess of 70 percent is not warranted - especially in light of the Veteran’s clear, logical, and goal oriented speech and thought processes, without any signs of a psychosis, suicidal ideations, obsessive rituals, thought disorder, hallucinations, or delusions. Indeed, some of the symptoms listed in the diagnostic code for a higher rating have not been shown at all, including grossly inappropriate behavior, persistent danger of hurting self or others, and disorientation to time or place. Additionally, to the extent the Veteran has reported symptoms of a higher rating, the Board determines that these statements are less probative given that they are inconsistent with the medical evidence. Further, while the Veteran is competent to report symptoms, he is not competent to determine if his disorders cause total occupational and social impairment. Next, the Board has also considered the extent to which there are other indications of total occupational and social impairment, such as gross impairment of the thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place. See Mauerhan, 16 Vet. App. 436, 444 (2002). In this regard, while the Veteran’s disorder reflects a significant impact on his social and occupational functioning, the evidence does not indicate that a rating in excess of 70 percent is warranted. Here, at his April 2017 treatment examination, the Veteran reported that he was still married and had a close relationship with his son. He also noted that he was “emotionally close” with his mother and brothers. Moreover, he indicated that he sometimes goes to church. Therefore, he did not display total social and occupational impairment even when factoring in other relevant criteria outside of the rating code. Mauerhan, 16 Vet. App. 436, 444. 3. Entitlement to a rating in excess of 20 percent for a back disorder prior to April 3, 2017, and in excess of 20 percent as of August 1, 2017 As a preliminary matter, the Board notes that as discussed, the period from April 3, 2017 to July 31, 2017 is no longer on appeal. However, the period prior to April 3, 2017 is still on appeal as the effective date for an increased rating will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, provided a claim is received within one year from such date; otherwise, the effective date for an increased rating will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o). Nevertheless, the record does not contain, nor has the Veteran asserted, that there is any objective evidence, including the December 2016 VA treatment records, to demonstrate that his back disability increased in severity in the year prior to the submission of his claim on appeal. As a result, the Board finds that the evidence of record is not sufficient to support an increased rating prior to September 8, 2014. As of August 1, 2017, the Veteran has been in receipt of a 20 percent rating for his back disorder under 38 C.F.R. § 4.71a, DC 5243 (addressing IVDS). As a preliminary matter, the Board observes that the Veteran would receive a higher rating based upon separate ratings for limitation of motion and neurological impairments (i.e., lower extremity radiculopathy), respectively, in comparison to a single rating for IVDS under DC 5243 - which does not allow for separate ratings for limitation of motion and neurological impairments. See 38 C.F.R. § 4.71a. Therefore, based upon the medical evidence, the Board is reassigning the Veteran’s 20 percent rating to DC 5242 (addressing degenerative arthritis). See Butts v. Brown, 5 Vet. App. 532 (1993). A rating in excess of 20 percent is warranted for a lumbar spine disability when the evidence shows: • Forward flexion of the thoracolumbar spine to 30 degrees or less (40 percent); • Favorable ankylosis of the entire thoracolumbar spine (40 percent); or, • Intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months (60 percent) (The Board notes that the 40 percent rating for IVDS is not applicable given that the Veteran, as discussed below, has two separate 20 percent ratings for bilateral lower extremity radiculopathy). 38 C.F.R. § 4.71a, DC 5242. Based on the evidence of record, a rating in excess of 20 percent is not warranted during this period. Specifically, at an August 2017 VA examination, the Veteran reported worsening “constant” back pain that does not improve with pain medication and interferes with his activities of daily living. Nevertheless, on examination, the Veteran displayed forward flexion to 90 degrees with no loss of function or range of motion due to pain or repetitive use. Further, while the Veteran reported flare-ups, the examiner determined that the flare-ups did not cause any additional functional loss or loss of range of motion. Moreover, no ankylosis or incapacitating episodes of IVDS were observed. There was also no evidence in the Veteran’s treatment records to support a rating in excess of 20 percent based upon limitation of motion or incapacitating episodes of IVDS. Therefore, a rating in excess of 20 percent is not for application. When considering these ratings, the Board has considered the impact of functional loss in the Veteran’s back due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 206 -07 (1995). In this case, the Veteran has complained that he is limited in performing activities of daily living due to fatigue, pain, flare-ups, and weakness. Moreover, he has indicated that his pain and flare-ups cause additional functional loss. However, while the Veteran experiences the aforementioned symptoms, overall, it does not appear that these symptoms result in additional and significant functional loss, and his complaints are adequately contemplated in the ratings he currently receives. See Sharp v. Shinseki, 29 Vet. App. 26 (2017); Mitchell v. Shinseki, 25 Vet. App. 32, 37-43 (2011) (pain must affect some aspect of the normal working movements of the body such as strength, speed, coordination or endurance). Here, the August 2017 VA examiner specifically did not find any additional loss of motion or functioning after flare-ups, repetitive testing, or weight bearing that would warrant a higher rating. Next, when evaluating the extent of the Veteran’s back disability, the Board is required to consider whether a separate evaluation is warranted for any associated neurological abnormality including, but not limited to, bowel or bladder impairment, neurological impairment in the extremities or other such disorders, which are to be evaluated under the appropriate diagnostic code. See 38 C.F.R. § 4.71(a). Here, the Veteran is service-connected for bilateral lower extremity radiculopathy and the severity of those disorders are discussed below. Further, with respect to any other neurological abnormalities, the medical evidence does not document any other associated neurological impairments related to his lumbar spine disability during the period on appeal. Specifically, the Veteran’s August 2017 VA examination did not reveal any other neurological impairments related to his service-connected back disability that would warrant a separate rating, nor has the Veteran asserted otherwise. 4. Entitlement to a rating in excess of 10 percent for left lower extremity radiculopathy 5. Entitlement to a rating in excess of 10 percent for right lower extremity radiculopathy Throughout the period on appeal, the Veteran has been in receipt of two separate 10 percent ratings for his bilateral lower extremity radiculopathy under DC 8520 (addressing impairment to the sciatic nerve). As an initial matter, the Board assigns separate 20 percent ratings for the Veteran’s bilateral lower extremity radiculopathy given that the evidence is at least in equipoise that his radiculopathy is characterized by moderate impairment of the sciatic nerve. Specifically, in an April 2017 evaluation, the Veteran’s treating physician stated that the Veteran has partial paralysis of his sciatic nerve. Further, he stated that the Veteran cannot walk more than 100 feet “before having to stop and rest out of weight bearing or risk of a dangerous fall.” Moreover, he opined that the Veteran has “50% or more” loss and use and function of the lower extremities. Therefore, while the Board acknowledges the August 2017 VA examiner’s opinion that the Veteran’s bilateral lower extremity disorder is characterized by “mild” impairment, the Board finds that the evidence is at least in equipoise that his bilateral lower extremity radiculopathy is characterized by “moderate” impairment of the sciatic nerve. Additionally, the Board notes that in the Veteran’s August 2017 notice of disagreement, he stated that he wanted separate 20 percent ratings for his bilateral lower extremity radiculopathy. Therefore, the Board finds that the herein assignment of two separate 20 percent ratings for his bilateral lower extremity radiculopathy is a full grant of the benefits sought on appeal with respect to these issues. Cf. AB v. Brown, 6 Vet. App. 35 (1993). 6. Entitlement to a rating in excess of 10 percent for a left thumb scar The Veteran’s service-connected left thumb scar has been assigned a 10 percent rating under 38 C.F.R. § 4.118, DC 7804. In order to warrant a rating in excess of 10 percent for a scar, the evidence must show a scar that is: • Deep and nonlinear and total area or areas of at least 12 sq. in. (77 sq. cm) but less than 72 sq. in. (465 sq. cm) (20 percent under DC 7801); • Three or four in number that are unstable or painful (20 percent under DC 7804); or, • One or two scars that are both unstable and painful (20 percent under DC 7804, Note (2)). 38 C.F.R. § 4.118. After review of the evidence of record, a rating in excess of 10 is not warranted. Specifically, in an August 2017 VA examination, the Veteran presented with 1.9 cm scar on the plantar/medial aspect of his left thumb. The Veteran complained of “itching and stinging.” On examination, there was no evidence of instability, pain, skin ulceration, or breakdown. Further, the Veteran’s medical treatment records do not reflect evidence of a larger scar size and/or instability that would warrant a higher rating. As such, a rating in excess of 10 percent for a left thumb scar is not for application. The Board has also considered whether a higher rating is warranted under DC 7805 for “other” scars, which are to be rated based on limitation of function of the part affected. However, the August 2017 VA examiner did not report any evidence of nerve or muscle damage associated with the scar. Further, there is no evidence of other disabling effects that would warrant a higher and/or additional rating. Therefore, a rating under DC 7805, or any other relevant Diagnostic Code is not warranted. In considering the appropriate disability ratings, the Board has also considered the statements from the Veteran that his service-connected disorders are worse than the ratings he currently receives, including that his disabilities cause impairment with his activities of daily living. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his service-connected disabilities according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s psychiatric, scar, back, and lower extremity disorders has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. The Board also finds that consideration for an extraschedular evaluation, a component of a claim for an increased rating, is not warranted. 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). In considering whether an extraschedular rating may be warranted, VA must first determine whether the available applicable schedular rating criteria are inadequate because they do not contemplate the Veteran’s level of disability and symptomatology. If the rating criteria are inadequate, VA must then determine whether the Veteran exhibits an exceptional disability picture indicated by other related factors such as marked interference with employment or frequent periods of hospitalization. If such related factors are exhibited, then referral must be made to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the evidence does not indicate that the Veteran’s disability picture could not be adequately contemplated by the applicable schedular rating criteria discussed above. Specifically, the Board has reviewed all of his relevant symptoms related to the issue on appeal, including pain, radiculopathy, depression, and other psychiatric symptoms that causes limitations to his activities of daily living, and concludes that there are no symptoms that were not able to be addressed by the applicable diagnostic codes. See Mittleider v. West, 11 Vet. App. 181 (1998). As such, the Veteran’s symptoms are not which are so unusual that they are outside the schedular criteria. Therefore, given that the applicable schedular rating criteria are more than adequate in this case, the Board need not consider whether the Veteran’s disability picture includes exceptional factors, and referral for consideration of the assignment of a disability evaluation on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board also acknowledges the holding in Rice v. Shinseki, 22 Vet. App. 447 (2009), that a total rating based on individual unemployability due to service-connected disability (TDIU) claim is part of a claim for a higher rating when such claim is raised by the record or asserted by the Veteran. However, the Veteran has not asserted and the record does not indicate that the Veteran is unemployable due to the disorders on appeal. As such, Rice is inapplicable in this appeal. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Meyer, Associate Counsel