Citation Nr: 20006876 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 10-36 959 DATE: January 28, 2020 ORDER Entitlement to a compensable rating for right foot degenerative joint disease of the metatarsal phalangeal joint with osteophyte formation of the plantar aspect to the calcaneus with plantar fasciitis (right foot disability) prior to March 17, 2008, is denied. Entitlement to a disability rating in excess of 10 percent for a right foot disability, from March 17, 2008 to June 22, 2017, is denied. Entitlement to a compensable rating for left foot degenerative joint disease of the metatarsal phalangeal joint with osteophyte formation of the plantar aspect to the calcaneus with plantar fasciitis (left foot disability) prior to August 14, 2009, is denied. Entitlement to a disability rating in excess of 10 percent for a left foot disability from August 14, 2009 to June 22, 2017, is denied. Entitlement to a disability rating in excess of 50 percent for degenerative joint disease of the metatarsal phalangeal joint with osteophyte formation of the plantar aspect to the calcaneus with plantar fasciitis, left foot and right foot (bilateral foot disability) from June 22, 2017, is denied. REMANDED The issue of entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. FINDINGS OF FACT 1. Prior to March 17, 2008, the Veteran’s right foot disability was not manifested by moderate symptoms. 2. From March 17, 2008 to June 22, 2017, the Veteran’s right foot disability was no worse than moderate. 3. Prior to August 14, 2009, the Veteran’s left foot disability was not manifested by moderate symptoms. 4. From August 14, 2009 to June 22, 2017, the Veteran’s left foot disability was no worse than moderate. 5. From June 22, 2017, the Veteran’s bilateral foot disability, has been manifested by extreme tenderness of the plantar surfaces and pain on use not improved with orthopedic shoes or appliances. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable rating prior to March 17, 2008, for right foot disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 2. The criteria for entitlement to a rating in excess of 10 percent, from March 17, 2008 to June 22, 2017, for right foot disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 3. The criteria for entitlement to a compensable rating prior to August 14, 2009, for left foot disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 4. The criteria for entitlement to a rating in excess of 10 percent, from August 14, 2009, to June 22, 2017, for left foot disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 5. The criteria for entitlement to a rating in excess of 50 percent, from June 22, 2017, for bilateral foot disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1973 to July 1975. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a May 2006 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in December 2015, March 2017, and April 2018. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case has been returned to the Board for review. The Board notes that the issue of entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) was separately adjudicated during the course of the appeal. In this regard, in September 2010, the Veteran perfected an appeal regarding the denial of entitlement to TDIU. Although a claim for TDIU is considered part of an increased rating claim when such claim is raised by the record, a claim for TDIU may also be pursued as a separate claim, as in this case. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In addition, the Board notes that the presence of a 100 percent disability rating does not necessarily render the issue of TDIU moot. In Bradley v. Peake, 22 Vet. App. 280, 293-94 (2008), the Court determined that a separate TDIU rating predicated on one disability (although perhaps not ratable at the schedular 100 percent level) when considered together with another disability separately rated at 60 percent or more could warrant special monthly compensation (SMC) under 38 U.S.C. § 1114 (s). Thus, the Court reasoned, it might benefit the Veteran to retain a TDIU rating, even where a 100 percent schedular rating has also been granted. Nevertheless, in the present case, the Veteran withdrew his claim for TDIU in December 2015, and the issue has not since been raised by the Veteran or the record. Therefore, given the specific procedural background in this case, a claim for TDIU is not deemed to be a component of the current appeal. In September 2018, the Veteran reported that he desired to file a claim for entitlement to special monthly compensation (SMC) based on the need for aid and attendance. In light of the Veteran’s assertion and the other evidence of record, the Board finds that the issue of entitlement to SMC based on the need for aid and attendance is reasonably raised by the record and is part and parcel of the increased rating claims. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (stating that the issue of entitlement to SMC is part and parcel of a claim for increased compensation and does not require submission of a separate claim); 38 C.F.R. § 3.155(d)(2). Increased Ratings Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating 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. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 1. Entitlement to a Compensable Rating for Right Foot Disability Prior to March 17, 2008 2. Entitlement to a Rating in Excess of 10 Percent for Right Foot Disability from March 17, 2008, to June 22, 2017 3. Entitlement to a Compensable Rating for Left Foot Disability Prior to August 14, 2009 4. Entitlement to a Rating in Excess of 10 Percent for Left Foot Disability from August 14, 2009 to June 22, 2017 5. Entitlement to a Rating in Excess of 50 Percent for Bilateral Foot Disability from June 22, 2017 The Veteran seeks higher ratings for his service-connected bilateral foot disability. His service-connected right foot disability is rated as noncompensable prior to March 17, 2008 and 10 percent disabling from March 17, 2008 to June 22, 2017, under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5284. The Veteran’s service-connected left foot disability is rated as noncompensable prior to August 14, 2009 and 10 percent disabling from August 14, 2009 to June 22, 2017, under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5284. From June 22, 2017, the Veteran’s bilateral foot disability is rated as 50 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Veteran’s increased rating claim was received on November 22, 2005. Therefore, the relevant rating period is from November 23, 2004, one year prior to receipt of the claim, through the present. See, 38 C.F.R. § 3.400(o)(2). Hyphenated diagnostic codes signify that the rating for a service-connected disability is based upon how another disability would be rated. 38 C.F.R. § 4.27. The diagnostic code for the service-connected disability is after the hyphen. 38 C.F.R. § 4.72, Diagnostic Code 5284 pertains to other injuries of the foot. A moderate disability warrants a 10 percent rating, a moderately severe disability warrants a 20 percent rating, and a severe disability warrants a 30 percent rating. Actual loss of the foot warrants a 40 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5284. The terms “mild,” “slight,” “moderate,” and “severe” are not defined in VA regulations, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6. Under Diagnostic Code 5276, a 50 percent rating is warranted when there is bilateral plantar fasciitis that is pronounced, with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. Turning to relevant evidence of record, the Veteran was provided a VA examination in April 2006. The Veteran reported that since his discharge from active duty he has never required any treatment for his heels. He also reported never using orthotics or shoe inserts. The Veteran reported pain in the posterior heel, which is precipitated by prolonged weightbearing. The Veteran did not report weakness or stiffness in the feet or heels. The VA examiner noted that the Veteran demonstrated normal weightbearing and balance with a normal gait. Upon examination, the VA examiner noted there were no abnormalities of the heels visible or redness present to palpation of the heels. Palpation of the Veteran’s Achilles tendon was normal with no tenderness or hypertrophy. There was no evidence of any painful motion in the feet or the ankles. The Veteran demonstrated full range of motion of both ankles without any complaints of pain. The Veteran did not demonstrate crepitus or instability. The Veteran was provided a VA examination in April 2008. The Veteran reported constant bilateral heel pain characterized by burning, aching and cramping. He further reported that pain can be elicited by physical activity and is relieved by rest. Upon examination, the Veteran did not demonstrate tenderness, painful motion, weakness, edema, atrophy or disturbed circulation of the bilateral feet. Additionally, the Veteran demonstrated active motion in the metatarsophalangeal joint and his gait was within normal limits. The Veteran did not demonstrate pes planus, pes cavus, hammer toe, Morton’s metatarsalgia, hallux valgus, or hallux rigidus. He did not have any limitation with standing and walking and he did not require any type of shoe support. The Veteran was provided a VA examination in September 2009. The Veteran reported constant bilateral foot pain that can be exacerbated by physical activity and stress. He further reported pain, weakness, stiffness and fatigue while standing or walking. Upon examination, the Veteran demonstrated painful motion and tenderness. The Veteran did not demonstrate edema, disturbed circulation, weakness, atrophy of the musculature, heat, redness or instability of the feet. He demonstrated palpation of the plantar surfaces. The Veteran did not demonstrate pes planus, pes cavus, hammer toes, Morton’s metatarsalgia, hallux valgus, or hallux rigidus. The Veteran did not require orthopedic shoes, corrective shoes, arch support, or foot supports. X-rays showed small bilateral plantar heel spurs. A September 2009 VA treatment record reflects that the Veteran was provided an x-ray of his bilateral feet that demonstrated bilateral tiny plantar calcaneal spurs. Additionally, the x-ray reflects that the bones and joints of the Veteran’s right foot were intact without evidence of fracture, dislocation, or osseous mass lesion. There were minimal degenerative changes noted at the metatarsophalangeal joint great toe without evidence of hallus valgus. The Veteran was provided a VA examination in October 2010. The Veteran reported pain with prolonged walking, standing and rest. He further reported stiffness, swelling, heat and redness. The Veteran denied flare-ups of his bilateral feet. He reported the use of bilateral shoe inserts. Upon examination, the feet were negative for joint deformity. No calluses formed. The Veteran’s Achilles alignment was within normal limits and he denied pain to palpation. The Veteran demonstrated pain to palpation along the bilateral plantar arches. He had normal range of motion of the toes and ankles. There was no change in function with repetition. The Veteran was provided a VA examination in October 2014. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported constant pain in both feet, made worse with walking. He further reported that he needs to rest after walking 200 yards due to pain. The VA examiner pes planus with pain on use of the bilateral feet and pain on manipulation of the bilateral feet. The Veteran was provided a VA examination in January 2016. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported there was no change in his bilateral foot condition since the 2014 VA examination. He reported constant bilateral foot pain made worse with walking. The Veteran further reported that he needs to rest after walking 200 yards. Upon examination, the Veteran demonstrated bilateral pes planus that causes pain on use and manipulation of the foot. The Veteran demonstrated pain on movement, pain on weight-bearing, pain on nonweight-bearing, interference with standing and lack of endurance. The Veteran did not demonstrate decreased longitudinal arch height, marked deformity of the feet, marked pronation, inward bowing of the Achilles tendon, Morton’s neuroma, hammer toe, hallux valgus or hallux rigidus. The VA examiner described the severity of the Veteran’s left foot disability as mild and the severity of his right foot disability as moderate. The Veteran was provided a VA examination in July 2017. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported “unbearable” pain of the bilateral feet. He had bilateral pain on use of the feet and bilateral pain on manipulation of the feet. The Veteran used bilateral arch supports that did not improve tenderness. He did not demonstrate decreased longitudinal arch height, marked deformity, marked pronation, inward bowing of the Achilles tendon, marked inward displacement of the Achilles tendon, or hallux valgus. The VA examiner described the Veteran’s bilateral foot disability as moderately severe. The Veteran was provided a VA examination in November 2018. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported chronic bilateral foot pain. The Veteran reported intermittent and chronic flare-ups that worsen while walking. The Veteran demonstrated bilateral pes planus pain that is accentuated on use and manipulation of the feet. The Veteran did not demonstrate Morton’s disease, hammer toe, hallux valgus, hallux rigidus, or claw foot. The VA examiner described the severity of the Veteran’s bilateral foot disability as moderate. Upon examination, the Veteran demonstrated bilateral functional loss and limitation of motion of the bilateral feet, including excess fatigability, incoordination, pain on movement, pain on weight-bearing, instability of station, disturbance of locomotion and interference with standing. The Veteran was provided an addendum opinion in June 2019. The VA examiner was requested to comment as to whether range of motion measurements for active motion, passive motion, weight-bearing, and/or nonweight-bearing could be estimated for the other VA examinations conducted during the appeal period. The June 2019 VA examiner reviewed the record and opined that there is no reasonable medical basis for a calculation of range of motion for the foot on passive or active movement. As rationale, the VA examiner explained that a retrospective range of motion estimate is not possible given the limitations of a normal foot exam. The VA examiner further explained that mechanics and physiological process for measuring range of motion required for ambulation and weight bearing is performed with an assessment of the ankle, not the foot. Having reviewed the complete record, the Board finds that the evidence does not support the criteria for a compensable rating, prior to March 17, 2008, for the Veteran’s service-connected right foot disability or for a compensable rating, prior to August 14, 2009, for his service-connected left foot disability under Diagnostic Code 5284. At the April 2006 VA examination the Veteran reported never using orthotics or shoe inserts. He reported pain in the posterior heel, which is precipitated by prolonged weightbearing but did not report weakness or stiffness in the feet or heels. The April 2006 VA examiner noted that the Veteran demonstrated normal weightbearing and balance with a normal gait. Upon examination, the VA examiner noted there were no abnormalities of the heels visible or redness present to palpation of the heels. A compensable rating for the Veteran’s service-connected right foot disability prior to March 17, 2008 or his service-connected left foot disability prior to August 14, 2009, requires a moderate foot disability. While the Veteran reported pain on his posterior heels, he did not report weakness or stiffness of the bilateral foot or heel. Additionally, the Veteran demonstrated normal weightbearing and balance with a normal gait. Accordingly, the Board finds that prior to March 17, 2008, the Veteran’s right foot disability was not manifested in moderate symptoms and does not meet the criteria for a compensable rating under Diagnostic Code 5284. Prior to August 14, 2009, the Veteran’s left foot disability was not manifested in moderate symptoms and does not meet the criteria for a compensable rating under Diagnostic Code 5284. The Board further finds that from March 17, 2008 to June 22, 2017, the evidence does not support the criteria for a rating in excess of 10 percent for the Veteran’s service-connected right foot disability or a rating in excess of 10 percent from August 14, 2009 to June 22, 2017, for his service-connected left foot disability under Diagnostic Code 5284. At the September 2009, October 2010, and October 2014 VA examinations, the Veteran reported pain, weakness, stiffness and fatigue while standing or walking. He did not report flare-ups of his bilateral feet and there was no evidence of fracture, dislocation, or osseous mass lesion. At the October 2016 VA examination, the Veteran reported there was no change in his bilateral foot condition since the 2014 VA examination. The Veteran demonstrated pain on movement, pain on weight-bearing, pain on nonweight-bearing, interference with standing and lack of endurance. The January 2016 VA examiner described the severity of the Veteran’s left foot disability as mild and the severity of his right foot disability as moderate. A disability rating in excess of 10 percent from March 17, 2008 to June 22, 2017 for the Veteran’s right foot disability and in excess of 10 percent from August 14, 2009 to June 22, 2017, for his left foot disability requires a moderately severe foot disability. While the Veteran complained of bilateral foot pain and had difficulty walking or standing for extending periods of time, he reported that his bilateral foot disability remained constant and that he did not experience flare-ups. Additionally, the January 2016 VA examiner described the severity of the Veteran’s bilateral foot disability as, at worst, moderate. Accordingly, the Board finds that from March 17, 2008 to June 22, 2017, the Veteran’s right foot disability was not manifested in moderately severe symptoms and does not meet the criteria for a rating in excess of 10 percent under Diagnostic Code 5284. From August 14, 2009 to June 22, 2017, the Veteran’s left foot disability was not manifested in moderately severe symptoms and does not meet the criteria for a rating in excess of 10 percent under Diagnostic Code 5284. The Board has also considered whether increased ratings prior to June 22, 2017 are warranted under other diagnostic codes pertaining to the foot. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, as the evidence does not reflect diagnoses of weak foot, claw foot, anterior metatarsalgia, hallux rigidus, hammer toe, or malunion of the tarsal or metatarsal bones an increased evaluation is not warranted under those diagnostic codes. See 38 C.F.R. § 4.71a, Diagnostic Codes 5277, 5278, 5279, 5280, 5281, 5282, 5283, 5284. Additionally, an increased rating greater than 50 percent is not warranted for the Veteran’s bilateral foot disability from June 22, 2017 under Diagnostic Code 5276. In that regard, the award of a 50 percent evaluation under Diagnostic Code 5276 constitutes the maximum schedular evaluation available under the pertinent diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Board has considered entitlement to an increased rating greater than 50 percent under other diagnostic criteria for the feet; however, a rating greater than 50 percent is not warranted for any disability of the foot. See 38 C.F.R. § 4.71a, Diagnostic Codes 5277, 5278, 5279, 5280, 5281, 5282, 5283, 5284. The evidence does not establish functional loss not contemplated by the rating assigned by this decision. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). In that regard, the VA examiners did not report additional limitation of range of motion of either foot from pain, fatigue, weakness, lack of endurance, incoordination, repetitive use, or during flare-ups. Furthermore, the effects of painful motion and other factors are not for consideration because plantar fasciitis does not encompass motion of a joint. See 38 C.F.R. §§ 4.40, 4.59; see also DeLuca, 8 Vet. App. at 205-206. Moreover, pain on use or pain on manipulation is explicitly considered by the rating criteria in this case and the record reflects the Veteran experienced such. There is no evidence to suggest that the Veteran’s bilateral foot disability causes additional functional loss not contemplated in the currently assigned ratings at any point during the appeal period. In making its determinations in this case, the Board has carefully considered the Veteran’s contentions with respect to the nature and severity of his service-connected bilateral foot disability at issue, and notes that his lay testimony is competent to describe certain symptoms associated with this disability. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and are noted to be contemplated by the criteria for the disability rating for which the Veteran has been found entitled by the Board. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disability at issue. As such, while the Board accepts the Veteran’s statements with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected conditions at issue. The Board therefore finds that the criteria for a compensable rating prior to March 17, 2008, and in excess of 10 percent from March 17, 2008 to June 22, 2017, for the Veteran’s service-connected right foot disability have not been met. The Board further finds that the criteria for a compensable rating prior to August 14, 2009, and in excess of 10 percent from August 14, 2009 to June 22, 2017, for the Veteran’s service-connected left foot disability have not been met. Additionally, the Board finds that a rating in excess of 50 percent, from June 22, 2017, for the Veteran’s service-connected bilateral foot disability have not been met. Accordingly, there is no basis for additional staged ratings of the Veteran’s bilateral foot disability pursuant to Fenderson, 12 Vet. App. at 126-27, and higher ratings must be denied. As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). The Board has also considered whether extraschedular ratings may be warranted. 38 C.F.R. § 3.321. The Court has set out a three-part test, based on the language of 38 C.F.R. § 3.321(b)(1), for determining whether a veteran is entitled to an extraschedular rating: (1) the established schedular criteria must be inadequate to describe the severity and symptoms of the claimant's disability; (2) the case must present other indicia of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization; and (3) the award of an extraschedular disability rating must be in the interest of justice. Thun v. Peake, 22 Vet. App. 111 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). 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. The Board finds that the rating criteria contemplate the Veteran's service-connected foot disabilities. Critically, a comparison between the level of severity and symptomatology of the Veteran's assigned ratings with the established criteria found in the rating schedule shows that the rating criteria reasonably describe the Veteran's disability level and symptomatology. Because the rating criteria reasonably describe the claimant's disability level and symptomatology, the Veteran's disability picture is contemplated by the Rating Schedule, such that the assigned schedular noncompensable evaluation is, therefore, adequate, and no referral is required. Thun, 22 Vet. App. at 115-116; VAOPGCPREC 6-96. The evidence does not show anything unique or unusual about the Veteran's foot disabilities that would render the schedular criteria inadequate. REASONS FOR REMAND 1. Entitlement to an SMC In a September 2018 report of general information, the Veteran reported that he seeks entitlement to SMC based on the need for aid and attendance. However, the medical evidence of record is not clear as to whether the Veteran’s service-connected disabilities result in him being so helpless as to be in need of regular aid and attendance. Therefore, the Veteran should be provided an opportunity to report for a VA examination to ascertain whether he is so helpless as to be in need of regular aid and attendance of another person due to his service-connected disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA aid and attendance examination to address whether the following are present as a result of his service-connected disabilities: (1) inability to dress or undress himself or to keep himself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this does not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacking at the back, etc.); (3) inability to attend to the wants of nature; (4) inability to feed himself through loss of coordination of the upper extremities or through extreme weakness; or (5) incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment. The examiner should limit his or her consideration to the effects of the Veteran’s service-connected disabilities and should disregard the effects of the Veteran’s nonservice-connected disabilities. 2. After completion of the above, review the expanded record, including the evidence entered since the most recent statement of the case, and determine whether SMC for regular aid and attendance may be granted. If the benefit sought remains denied, furnish the Veteran and his representative with a supplemental statement of the case. The appropriate period should be allowed for response before the appeal is returned to the Board. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. G. LeMoine The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.