Citation Nr: 20059948 Decision Date: 09/11/20 Archive Date: 09/11/20 DOCKET NO. 17-57 463 DATE: September 11, 2020 ORDER The appeal for entitlement to an effective date earlier than December 21, 2001 for the award of service connection and assignment of initial rating for migraine/atypical headaches has been withdrawn. Entitlement to higher staged initial ratings for migraine/atypical headaches, rated 30 percent from December 21, 2001 and 50 percent from August 22, 2015 is denied. Entitlement to an increased evaluation for status post osteotomy, left foot, depressed second metatarsal with corn, currently rated 20 percent (except for a period of a temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30, from November 10, 2004 through January 31, 2005) is denied. Entitlement to an increased evaluation for right foot hallux valgus, status post arthroplasties, currently rated 10 percent (except for periods of a temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30) denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. At the November 2019 hearing, prior to the promulgation of a decision in the appeal, the Veteran requested withdrawal of the issue of entitlement to an effective date earlier than December 21, 2001 for the award of service connection and assignment of initial rating for migraine/atypical headaches. 2. The most probative evidence of record shows that, prior to August 22, 2015, the Veteran's migraine/atypical headaches were manifested by characteristic prostrating attacks occurring on an average of once a month over the last several months, and the 50 percent rating assigned from August 22, 2015 is the maximum schedular rating assignable for migraines. 3. Throughout the rating period on appeal, the Veteran’s status post osteotomy, left foot, depressed second metatarsal with corn, was not manifested by severe symptoms. 4. The Veteran’s right foot hallux valgus, status post arthroplasties is manifested by significant pain with standing and walking. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to an effective date earlier than December 21, 2001 for the award of service connection and assignment of initial rating for migraine/atypical headaches have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 2. The criteria for higher staged initial ratings for migraine/atypical headaches, rated 30 percent from December 21, 2001 and 50 percent from August 22, 2015, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321 (b), 4.124a, Diagnostic Code 8100. 3. The criteria for an increased rating for status post osteotomy, left foot, depressed second metatarsal with corn, rated 20 percent, (except for a period of temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30 from November 10, 2004 through January 31, 2005) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284 (2019). 4. The criteria for a disability evaluation in excess of 10 percent for right foot hallux valgus, status post arthroplasties, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276-5284 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1979 to August 1984. These matters come before the Board of Veterans' Appeals (Board) on appeal from April 2002 (left foot and right foot) and April 2016 (migraine/atypical headaches) rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The April 2002 rating decision continued a 10 percent rating for right foot hallux valgus, status post arthroplasties with history of atrophy of the heel fat pad, and continued a 10 percent rating for status post osteotomy of the left foot for depressed 2nd metatarsal with corn, pursuant to an increased rating claim received on December 21, 2001. The Veteran filed a NOD in June 2002, a SOC was issued in October 2002 and the Veteran filed a substantive appeal in May 2003. During the pendency of the appeal, a March 2005 rating decision awarded a temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30, from November 10, 2004 through January 31, 2005, and a 20 percent rating effective from February 1, 2005, for the Veteran’s service-connected left foot disability. In February 2007, the Board denied the claims for increased ratings for the Veteran's right and left foot disabilities. The Veteran appealed the February 2007 Board decision to the United States Court of Appeals for Veterans Claims (Court). In an April 2009 Memorandum Decision, the Court vacated the Board's denial of these claims, and remanded the matters to the Board for further proceedings consistent with the Memorandum Decision. In September 2009, the Board remanded the claims for action pursuant to the Memorandum Decision. In an October 18, 2013 rating decision code sheet, the rating for the service-connected status post osteotomy of the left foot for depressed 2nd metatarsal with corn was adjusted to award a 20 percent rating effective from September 1, 1998, with continuation of the temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30 from November 10, 2004 through January 31, 2005, and a 20 percent rating effective from February 1, 2005. Notice of this adjustment in the rating assigned was issued in a letter dated November 29, 2013. Although a December 2017 Board remand characterized the left foot disability appeal as entitlement to an increased evaluation for status post osteotomy, left foot, depressed second metatarsal with a corn, in excess of 10 percent prior to November 11, 2004, and in excess of 20 percent as of February 1, 2005, the left foot increased rating claim is properly characterized as on the title page of this decision, as a 20 percent rating has been in effect since the beginning of the rating period on appeal (except for the assignment of a temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30 from November 10, 2004 through January 31, 2005) pursuant to the adjustment in rating made in the October 18, 2013 rating decision code sheet. The April 2016 rating decision on appeal granted service connection for migraine/atypical headaches, and assigned staged initial ratings of 30 percent effective from December 21, 2001 and 50 percent from August 22, 2015. The Veteran filed a notice of disagreement (NOD) in January 2017 as to the effective date and staged initial ratings assigned, and a statement of the case (SOC) was issued in September 2017. The Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals (Board)) in October 2017. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a November 2019 in person hearing. A transcript of that hearing is of record. Further, in Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that a TDIU claim is part of an increased rating claim when such claim is raised by the record. During the pendency of the claims for an increased rating for migraine headaches, and left and right foot disabilities, specifically during the November 2019 Board hearing, the Veteran's representative raised the issue of entitlement to a TDIU as part and parcel of these increased rating claims, while noting that “even though she is “working” it doesn’t necessarily mean that she should be or that she actually can, although she is not 100%.” Thus, the Board concludes that the Court's holding in Rice is applicable, and the TDIU claim is properly before the Board. Issue Withdrawn 1. Entitlement to an effective date earlier than December 21, 2001 for the award of service connection and assignment of initial rating for migraine/atypical headaches The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 39 U.S.C. §7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. The Veteran properly appealed an April 2016 rating decision which granted service connection for migraine/atypical headaches, and assigned an initial rating, effective from December 21, 2001. An appeal including as to the effective date assigned for the award of service connection and assignment of initial rating was certified to the Board. At the November 2019 Board hearing, prior to promulgation of a decision by the Board, the Veteran requested that the appeal for entitlement to an effective date earlier than December 21, 2001 for the award of service connection and assignment of initial rating for migraine/atypical headaches, be withdrawn from appellate consideration. The repercussions of withdrawal of the issue was explained to the Veteran by the undersigned VLJ, and the Veteran expressed understanding as to the repercussions. As such, the withdrawal was 1) explicit, 2) unambiguous, and 3) done with a full understanding of the consequences of such action by the appellant. Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018). Therefore, there remains no allegation of error of fact or law for appellate consideration as to this issue. Accordingly, the Board does not have jurisdiction to review that issue on appeal and it is dismissed.   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). 2. Entitlement to higher staged initial ratings for migraine/atypical headaches, rated 30 percent from December 21, 2001 and 50 percent from August 22, 2015 The Veteran seeks higher staged initial ratings for her service-connected migraine/atypical headaches. The Veteran's service-connected migraine/atypical headaches are rated 30 percent from December 21, 2001 and 50 percent from August 22, 2015 under 38 C.F.R. § 4.124a, Diagnostic Code 8100. The applicable rating period is from December 21, 2001, the effective date for the award of service connection for migraine/atypical headaches. See 38 C.F.R. § 3.400. Under Diagnostic Code 8100 a 10 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once in 2 months over the last several months; a 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months; and a maximum 50 percent schedular rating is warranted for migraines with very frequent completely prostrating and prolonged attacks, productive of severe economic inadaptability. The rating criteria do not define "prostrating." By way of reference, the Board notes that DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1531 (32nd Ed. 2012), defines "prostration" as "extreme exhaustion or powerlessness." In addition, regarding the criteria for a schedular 50 percent rating under Diagnostic Code 8100, the term "productive of" can be read as meaning "producing" or "capable of producing." See Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). Furthermore, the term "inadaptability" is not defined in title 38 of the Code of Federal Regulations. However, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work to qualify for a 50 percent rating. See id. at 446. Therefore, the phrase "severe economic inadaptability" does not mean a complete inability to work. Turning to the relevant evidence of record, the Veteran's medical treatment records do not include all findings relevant to the criteria for rating the Veteran's migraine headaches under Diagnostic Code 8100. They reflect that the Veteran endorsed migraines and atypical headaches, however, they do not indicate or suggest whether the migraines/atypical headaches included prostrating attacks, or the degree of any economic impact. In her December 2001 initial claim for migraine headaches, the Veteran complained of an increase in migraine headaches due to medication required by her service connected disabilities. The Veteran was provided a VA examination in February 2002. The Veteran reported recurrent migraine headaches with nausea and phonophobia. The examiner stated that the Veteran had an MRI of her brain done in June of 2001 that was read as normal. No frequent, completely prostrating and prolonged attacks were reported. In a March 2002 letter the Veteran reported that her headaches/migraines have increased due to the medication that she takes primarily for her service-connected condition. A May 2002 VA treatment record note referred to the Veteran’s daily headaches. A July 2004 letter from a VA doctor states that the Veteran is seen in the neurology service for her two types of headaches, the most severe of which is a migraine headache. The Veteran was provided a VA examination in September 2012. The Veteran reported migraine headaches every other week. She reported pain on both sides of the head, nausea, and sensitivity to light. The Veteran further reported the duration of typical head pain is more than two days. The VA examiner noted that the Veteran has characteristic prostrating attacks of migraine headache pain less than once every two months. In a letter received by the VA in May 2013, the Veteran reported that she suffers terribly from the pain caused by the migraines and they have rendered her totally incapacitated during periods when she is taking medications that cause the migraines. The Veteran was provided a VA examination in August 2015. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. Describing the history of the Veteran’s migraines including migraine variants, the examiner stated that the Veteran started to have intermittent headaches 30 years ago. She had two types of headache. One was severe throbbing bilateral headache associated with photophobia, phonophobia, nausea or vomiting, which lasted for hours. She had similar headaches 2-3 times per week 30 years ago and she had similar headaches up to now. Her second type of headache was mild to moderate pressure like daily headache up to now. The headaches last less than one day with characteristic prostrating attacks once every month including very prostrating and prolonged attacks. The examiner reported that the Veteran’s headache condition impacts her ability to work and she has to call in sick days 2-3 times per week. At a November 2019 hearing, the Veteran testified that prior to 2015 she was having migraines three to four times a week and that they were very incapacitating. The migraines were worse in 2001, 2005 and 2010 because she was being treated for sarcoidosis. The Veteran also stated that migraines prior to 2015 were accompanied by nausea, vomiting and light sensitivity and she was having a migraine that lasted over a day during which she did not want to be touched, talked to or moved and she was sensitive to noise. The Veteran also reported missing 2-3 days from work because of migraines for the entire time that she has had migraines. See, November 2019 Board hearing transcript. The Veteran is competent to report headaches and accompanying symptoms such as pain, nausea, vomiting, phonophobia, and photophobia. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Board does not find that she is credible in this regard as to a prostrating nature of the headaches, and frequency, prior to August 2015. There is evidence in the record that impugns her statements as to the nature and frequency of her headaches prior to August 22, 2015. In this regard, on VA examination in February 2002, in a May 2002 VA treatment record note, and in a July 2004 letter from a VA doctor, no frequent, completely prostrating and prolonged attacks were reported. Further, on VA examination in September 2012, the VA examiner noted that the Veteran has characteristic prostrating attacks of migraine headache pain less than once every two months. Although, in a letter received by the VA in May 2013, the Veteran reported that she suffers terribly from the pain caused by the migraines and that they have rendered her totally incapacitated during periods when she is taking medications that cause the migraines, such is not consistent with the preponderance of the evidence dated prior thereto. Additionally, the Veteran has not been shown to have the requisite expertise and medical knowledge to be deemed competent to opine as to whether the manifestations of her service-connected disability meet specific rating criteria under Diagnostic Code 8100 of the Schedule for Rating Disabilities. To be entitled to a 50 percent rating under Diagnostic Code 8100, the Veteran must experience very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The August 2015 VA examiner noted that the Veteran experiences prostrating headaches more than once per month and that she has experienced them since she was diagnosed with migraine headaches in 1999. The Board finds that such statement is based on no more than the Veteran’s subjective report of medical history since 1999, and that such is inconsistent with the contemporaneous objective evidence of record prior to August 2015. It was also noted as medical history that, since that time, she has consistently reported to her treatment providers and medical examiners that she has multiple headaches each month, that the headaches are manifested by a number of symptoms in addition to pain, and that during the headaches she experiences photophobia and phonophobia. This is contemplated by the current 30 percent rating in effect prior to August 22, 2015. The Board also finds that the Veteran's headaches have not been shown to be very frequently prostrating and productive of “severe” economic inadaptability prior to August 22, 2015, simply because they sometimes require her to lie down. As noted above, on VA examination in September 2012, the VA examiner noted that the Veteran had characteristic prostrating attacks of migraine headache pain less than once every two months. The Board acknowledges that the record shows that the Veteran continues to work. The Board also acknowledges that a veteran need not be totally unemployable for the headaches to be productive of severe economic inadaptability. See Pierce, 18 Vet. App. at 446. The Veteran has indicated that, when she had headaches prior to August 2015, she couldn’t go to work when she was experiencing nausea and vomiting. The fact that the headaches resulted in days off is not sufficient to establish “severe” economic inadaptability as the fact that the Veteran is service-connected for disability rated 30 percent prior to August 22, 2015 contemplates impact on occupational functioning. In other words, the Veteran’s headaches have not been shown by objective competent evidence to have resulted in extreme exhaustion or powerlessness on a very frequent basis so as to prevent her from performing work or activities of daily living resulting in “severe” economic inadaptability, albeit they impact his occupational functioning. This conclusion is consistent with the August 2015 VA examiner’s conclusion that the Veteran's migraine headaches and non-migraine headaches prior to August 22, 2015 were prostrating. In summary, the record reflects that, prior to August 22, 2015, the Veteran's migraine headaches have not been shown to have manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Board therefore finds that prior to August 22, 2015, the criteria for an initial rating of 50 percent for migraine headaches have not been met. A 50 percent rating is the highest schedular rating available under 38 C.F.R. § 4.124a, Diagnostic Code 8100. As a 50 percent rating is currently in effect from August 22, 2015, discussion as to a higher schedular rating from August 22, 2015 has been rendered moot. Where, as in this case, a Diagnostic Code specific to the disability at issue exists, assignment of a rating by analogy to a different Diagnostic Code is not appropriate. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015); 38 C.F.R. § 4.20. 3. Entitlement to an increased evaluation for status post osteotomy, left foot, depressed second metatarsal with corn, in excess of 20 percent (except for a period of a temporary total (100 percent) convalescence rating pursuant to 38 C.F.R. § 4.30, from November 10, 2004 through January 31, 2005) The Veteran’s service-connected status post osteotomy, left foot, depressed second metatarsal with corn, is currently rated 20 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5284 for other foot injuries. Under Diagnostic Code 5284, a 20 percent rating is assigned for moderately severe foot injury, and a 30 percent rating is assigned for severe foot injury. In addition, if there is actual loss of use of the foot, a 40 percent evaluation is assigned. In October 1983 the Veteran underwent an operation to trim her left foot callouses. In December 1983 she had an osteotomy of the left foot second metatarsal neck and dorsal wedge displacement to prevent callous recurrence. In November 2004 the Veteran underwent another second metatarsal osteotomy and first and 5th osteotomies with pinning of the first. The July 1992 VA examiner found that the Veteran had occasional pain from the left foot. The July 1995 examiner stated that the Veteran reported recurrent corns on her left second metatarsal requiring trimming every few months by a podiatrist. The surgical scar on the dorsal surface of the second metatarsal head was well healed and there was a 1 cm corn on the planar surface of the left great toe overlying the metatarsal. The examiner also reported a 0.5 cm callous on the plantar aspect of the left great toe on the plantar surface of the very distal fat pad, and no atrophy of the left heel pad. In a December 2001 statement in support of claim, the Veteran reported a desire to reopen her disabilities claims, in part, because of recurring lesions on the left foot. In a September 2004 VA treatment record, a physician reported that an examination of the Veteran’s left foot showed a sub-first lesion of the left foot and multiple BB pellets projecting at the left foot. The Board remanded the Veteran’s foot claims in June 2012 to obtain an assessment as to whether the Veteran’s service-connected foot disabilities present an exceptional or unusual disability picture. The Board also directed the examiner to consider related factors such as the specific nature and degree of interference with her employment or the nature and frequency of hospitalization and outpatient medical care as it affects attendance and capability for employment and daily activities. Further, the Board directed that a prior examiner provide this opinion; if a prior examiner was not available, the Board directed the RO to arrange for the Veteran to undergo a new VA examination. The claim was returned to the Board and in a December 2017 decision, the Board again remanded the Veteran’s foot disability claims as not all questions posed by the Board were adequately addressed with sufficient rationale for the Board to decide whether the Veteran’s foot disorders manifested with an exceptional or unusual disability picture with such related factors as interference with employment or frequent hospitalization or medical care. The April 2019 VA examiner referenced a March 2016 examination noted no calluses on the left second MTP joint. The examiner opined that the Veteran had many calluses on the bottoms of both feet and they are very tender to palpation. It was opined that this would cause significant pain with standing and walking and would keep her from doing activities that require these activities. However, she could do her job if she had a motorized scooter for these activities. When considering the evidence of record in total, the Board finds that a rating in excess of 20 percent, for the Veteran's service-connected left foot disability, is warranted at any time during the rating period. The Board acknowledges the Veteran's lay reports of symptoms and that there is functional loss due to pain, weakened movement, and excess fatigability. However, the VA examiners noted that the Veteran's left foot disability had a moderate effect on the Veteran’s ability to complete daily life activities and work. As such, the medical evidence of record supports a finding that the Veteran’s left foot disability was manifested in no worse than moderately severe symptoms. Even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the evidence would not result in symptoms more nearly approximating severe foot injury. Further, the record does not demonstrate functional impairment comparable to actual loss of use of the left foot so as to warrant assignment of a 40 percent evaluation. The Board therefore finds that the criteria for a rating of in excess of 20 percent, for the Veteran's service-connected left foot disability, is not warranted. The preponderance of the evidence is against a rating for her service-connected left foot disability higher than or in addition to that currently assigned. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board has considered whether evaluation under criteria for an alternative diagnostic code (DC). However, a higher schedular evaluation is not for assignment under DC 5277 for weak foot, under DC 5279 for anterior metatarsalgia (Morton’s disease), under DC 5280 or 5281 for hallux valgus or rigidus, or under DC 5282 for hammer toe. Further, the claims file does not demonstrate a diagnosis or clinical findings more consistent with the diagnostic code criteria contemplated under DC 5276 for flat foot, under DC 5278 for claw foot, or under DC 5283 for malunion of the tarsal or metatarsal bones. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 4. Entitlement to an increased evaluation for right foot hallux valgus, status post arthroplasties, in excess of 10 percent The Veteran contends that she should be assigned a rating higher than 10 percent for right foot hallux valgus, status post arthroplasties, because of pain and recurring lesions on her right foot. The Veteran’s service-connected right foot hallux valgus is currently rated under DC 5280, for rating unilateral hallux valgus. A 10 percent rating is the maximum schedular rating assignable under that diagnostic code. The 10 percent rating contemplates unilateral hallux valgus that has been operated with resection of the metatarsal head, or severe hallux valgus if equivalent to amputation of the great toe. Where, as in this case, a Diagnostic Code specific to the disability at issue exists, assignment of a rating by analogy to a different Diagnostic Code is not appropriate. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015); 38 C.F.R. § 4.20. Nevertheless, the Board notes that DC 5277 for weak foot, DC 5279 for anterior metatarsalgia (Morton’s disease), DC 5281 for rating severe unilateral hallux rigidus, and DC 5282 for hammer toe, do not provide for a higher schedular rating. Additionally, the record does not support a finding that referral for assignment of a higher evaluation on an extraschedular basis is warranted as DC 5280 contemplates the manifestations of, and functional impairment due to, the service-connected disability, to include complaints of pain and resultant functional impairment comparable to amputation of the great toe. As such, the Board does not find that the claims file contains clinical manifestations productive of functional impairment more consistent with the diagnostic code criteria contemplated under DC 5276 for flat foot, under DC 5278 for claw foot, under DC 5283 for malunion of the tarsal or metatarsal bones, or under DC 5284 so as to warrant referral for consideration of an extraschedular rating. Under DC 5284 for rating other foot injury, a 20 percent evaluation is warranted for moderately severe foot injury, and a 30 percent evaluation is warranted for severe foot injury. In addition, if there is actual loss of use of the foot, a 40 percent evaluation is assigned. 38 C.F.R. § 4.71a. The words "mild," "moderate," "moderately severe," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. The Veteran's treatment records contain multiple notations related to right foot pain. An April 2019 VA examination noted that the Veteran has many calluses on the bottoms of both feet and they are tender to palpation. The examiner opined that this would cause significant pain with standing or walking and keep her from doing activities that require these activities. However, she could do her job if she had a motorized scooter for these activities. The January 2020 examiner conducted an in-person foot conditions examination and reviewed the Veteran’s claims file. The examiner continued the diagnosis of right foot hallux valgus. The Veteran reported pain of the foot and described sharp aching pain. No flare-ups are reported. The Veteran reported functional loss because she cannot stand or walk for a long time. Of the Veteran’s right foot hallux valgus, the examiner stated that the symptoms are mild or moderate in severity. However, the examiner also opined that the Veteran’s foot pain is severe and that she is unable to stand or walk for a long time and functional loss when the foot is used repeatedly over a period of time. In this regard, it is again noted that the 10 percent rating assigned under the provisions of DC 5280 contemplate severe hallux valgus if equivalent to amputation of the great toe. The January 2020 examiner reported that the Veteran does not use assistive devices as a normal locomotion mode, although the Veteran’s current employment status is impacted by her right foot condition because she is unable to walk over a quarter of a mile. The fact that the Veteran is service-connected for the disability at issue with the assignment of a 10 percent rating contemplates that the disability at issue impacts his occupational functioning. The examiner noted that there is objective evidence of pain on active and passive range of motion testing of the right foot; and objective evidence of pain on weight bearing and non-weight bearing testing on the right foot. Nevertheless, the January 2020 examiner noted that the Veteran’s foot condition did not result in functional impairment such that no effective functions remained other than that which would be equally well served by an amputation with prosthesis. The Veteran testified in her November 2019 hearing that she had her bilateral foot pain has increased in intensity and has gotten so bad that there are times when walking is very hard and she has to see a podiatrist to shave callouses on both feet to make it manageable. The Veteran also testified that parts of her foot have become so painful that on a recent visit, her podiatrist suggested additional surgery on her foot. It was not specified in the testimony as to which foot was referenced. The Veteran further stated that to manage the pain in her feet, she has to shave her feet down every other day and the process is time consuming and costly when she does it instead of having a VA podiatrist do it. The Veteran testified that her bilateral foot pain is 4 out of 10, 10 being the most painful. The bilateral foot pain has reportedly gotten worse over the last 15 years. The Board notes that in a December 2019 letter to the Veteran, the VA requested private treatment records that the Veteran referenced which may include medical evidence related to the Veteran’s foot disability claims. There is no response to that letter in the Veteran’s claims file. As noted above, ,the Veteran’s complaints of pain on weight-bearing which actually interferes with walking and standing, albeit not enough to be recorded as the cause of the limp and need for a cane, has been contemplated in the current rating assigned. As such, the preponderance of the evidence is against a higher rating for the service-connected right foot hallux valgus, status post arthroplasties. As such, the appeal is denied. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). VA's Duty to Notify and Assist With respect to the Veteran's claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156 (a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015).   REASONS FOR REMAND 1. Entitlement to a TDIU As noted above, the issue of entitlement to a TDIU has been raised as part and parcel to the Veteran's claims for higher ratings for the disability at issue. See Rice, 22 Vet. App. 447. In this regard, as noted above, at the November 2019 Board hearing, the Veteran’s representative asserted that it was felt a TDIU claim was appropriate as “even though she is “working” it doesn’t necessarily mean that she should be or that she actually can, although she is not 100%.”As the RO has not yet considered whether the Veteran is entitled to a TDIU, the issue must be remanded to the RO for appropriate development and initial adjudication. The matter is REMANDED for the following action: 1. Send the Veteran a notification letter with respect to her claim for entitlement to a TDIU. The letter should include a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, and a VA Form 21-4142, Authorization and Consent to Release Information to VA, for completion and return to VA. 2. Complete any necessary development in view of the Veteran's response to the above notification letter, to   include the scheduling of any additional VA examinations deemed warranted. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.J. Smith, Associate Counsel 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.