Citation Nr: 20081198 Decision Date: 12/28/20 Archive Date: 12/28/20 DOCKET NO. 15-36 884 DATE: December 28, 2020 ORDER Entitlement to an initial compensable rating for hepatitis C prior to September 21, 2016, is denied. Entitlement to an initial 20 percent rating, but no higher, for hepatitis C, from September 21, 2016, to April 15, 2019, is granted. Entitlement to an initial rating for hepatitis C in excess of 20 percent from September 21, 2016, to December 4, 2019, and entitlement to an initial compensable rating, thereafter, is denied. FINDINGS OF FACT 1. Prior to September 21, 2016, the Veteran’s hepatitis C had not resulted in intermittent fatigue, malaise, and anorexia; or incapacitating episodes requiring bed rest and treatment by a physician. 2. From September 21, 2016, to December 4, 2019, hepatitis C has manifested at most as daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication. 3. From December 4, 2019, hepatitis C has not resulted in intermittent fatigue, malaise, and anorexia; or incapacitating episodes requiring bed rest and treatment by a physician. CONCLUSIONS OF LAW 1. Prior to September 21, 2016, the criteria for an initial compensable rating for hepatitis C have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, Diagnostic Code (DC) 7354. 2. From September 21, 2016, to December 4, 2019, the criteria for an initial 20 percent rating, but no higher, for hepatitis C have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, DC 7354. 3. From December 4, 2019, the criteria for an initial compensable rating for hepatitis C have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.114, DC 7354. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from February 1970 to October 1972. This case is before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the November 2011 rating decision, the Veteran was awarded service connection for hepatitis C and assigned a noncompensable rating. The Veteran expressed disagreement with the rating assigned and perfected an appeal to the Board. In August 2018, the claim was remanded for further development. On remand, in a June 2019 rating decision, the Agency of Original Jurisdiction (AOJ), assigned a 20 percent rating, effective from April 15, 2019. The claim was remanded again in October 2019, for further development. The AOJ issued another rating decision in July 2020, which reduced the Veteran’s 20 percent rating for hepatitis C to a noncompensable rating effective December 4, 2019. The Board notes, the assignment of a staged rating which includes a higher evaluation followed by a lower evaluation does not require application of the reduction notice rule. The procedural protections regarding reduction of stabilized rating under 38 C.F.R. § 3.344 only apply to prospective rating reductions and are inapplicable to retroactively assigned staged ratings that are assigned as part of an initial rating, such as in the case here before the Board. Thus, the provisions of 38 C.F.R. § 3.344 do not apply to reductions in staged ratings. See Singleton v. Shinseki, 23 Vet. App. 376 (2010); Reizenstein v. Shinseki, 583 F.3d 1331 (Fed. Cir. 2009). Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. While a veteran’s entire history is reviewed when assigning a disability evaluation, 38 C.F.R. § 4.1, where service connection 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. Francisco v. Brown, 7 Vet. App. 55 (1994). The United States Court of Appeals for Veterans Claims (Court) has held that, in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran contends that his service-connected hepatitis C should be assigned a higher rating. In his February 2012 statement, the Veteran reported that he was affected by the disease even though he didn’t show active symptoms of the disease and he asserted that the disease affected every day of his life. As noted above, the Veteran’s disability is rated as noncompensable prior to April 15, 2019, as 20 percent disabling from April 15, 2019, and as noncompensable from December 4, 2019. Hepatitis C is rated under 38 C.F.R. § 4.114, Diagnostic Code 7354, when there is serologic evidence of hepatitis C infection and the following signs and symptoms due to hepatitis C infection. A noncompensable rating is assigned for non-symptomatic Hepatitis C. A 10 percent rating is assigned for intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. A 20 percent rating is warranted if the disease is productive of daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past twelve-month period. Id. A 40 percent disability rating is warranted if the disease is productive of daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. A 60 percent rating is assigned for daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. Finally, a 100 percent rating is warranted for near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). Following the criteria, Note (1) indicates that sequelae, such as cirrhosis or malignancy of the liver, are to be evaluated under an appropriate diagnostic code, but should not be based on the same signs and symptoms as the basis for evaluation under Diagnostic Code 7354. In addition, Note (2) provides that, for purposes of evaluating conditions under Diagnostic Code 7354, an “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Under 38 C.F.R. § 38 C.F.R. § 4.112, “minor weight loss” means a weight loss of 10 to 20 percent of the individual’s baseline weight, sustained for three months or longer. The term “substantial weight loss” means a loss of greater than 20 percent of the individuals’ baseline weight, sustained for three months or longer. “Baseline weight” means the average weight for the two-year period preceding the onset of the disease. Prior to September 21, 2016 The Veteran’s medical treatment records reveal that he was diagnosed with hepatitis in May 1973, and hospitalized for six days in May 1973 due to symptoms of jaundice. The Veteran reported feeling tired and weak for the last few weeks, and came to the hospital after his doctor told him he had hepatitis. The examiner noted that the Veteran did not seem interested in coming to the hospital and that he had come because of his mother. In a February 2004 VA treatment record, the Veteran reported fatigue, but no nausea, vomiting, or abdominal pain. The Veteran underwent several examinations in April, August, and September of 2004 which revealed that the Veteran’s hepatitis C was asymptomatic. During a July 2005 private examination conducted by M.K. (initials used to protect privacy), the Veteran reported that he was told his hepatitis was dormant and not causing any difficulty, and the examiner noted no appreciable hepatosplenomegaly. In an August 2005 VA treatment record, the examiner reported tiredness, which the examiner noted was likely secondary to hepatitis C, however in a subsequent August 2005 VA treatment record, the Veteran denied having nausea, vomiting, and abdominal pain. He reported having an episode of abdominal pain, but it only lasted a few hours. No further episodes were noted. He also denied having weight loss of 10 pounds or more in a September 2005 self-assessment. An October 2006 VA treatment record noted right upper and left lower abdominal pain and fatigue, however the Veteran denied having nausea, vomiting, and diarrhea. The examiner questioned whether there was a potential enlargement of the liver, and also noted that weight gain was progressive. An echogram of the abdomen was done in November 2006 to follow up with the Veteran’s reports of right upper quadrant and left lower quadrant pain. The echogram revealed no abnormalities, and no focal masses were identified on the liver. In a November 2006 Physical Residual Functional Capacity Questionnaire, the Veteran was noted to have several diagnoses and reported having symptoms of fatigue and weakness. During an October 2007 Decision Review Officer Hearing, the Veteran testified that he was not taking any medication for his hepatitis. He also indicated that his hepatitis C was dormant and that his liver was fine at the moment, but could potentially flare up. In a November 2008 VA general examination, the Veteran reported having a recent loss of appetite in the past two weeks, but denied having any unexpected weight loss. He reported fatigue associated with poor sleep, and denied having persistent nausea, vomiting, and chronic abdominal pain. The Veteran was noted to have a normal liver function and mild hepatomegaly during an examination in May 2009. The Veteran received a VA examination in November 2010. At that time, the Veteran reported no vomiting, hematemesis, melena, or abdominal pain. Additionally, he had no sequeles of hepatitis C. Further, the examiner stated that a review of the record does not show any significant history of abdominal pain requiring hospitalization. In his August 2015 Form 9, the Veteran reported that he had daily fatigue, and nausea and malaise on a regular basis. He also reported having pain in his liver, in his upper right abdominal quadrant, that lasted weeks at a time for the last few years. In a February 2016 statement, the Veteran reported having pain over his liver and kidney for years, and that he received X-rays which showed that pain was caused by his hepatitis C. February 2016, August 2016 and September 2016 VA treatment records reveal complaints of fatigue, however examiners noted that the Veteran did not have any liver problems such as cirrhosis. In September 2016, a VA treatment record documented that the Veteran started an 8-week treatment course for chronic hepatitis C where he was prescribed medication, and had to undergo regular lab work. In a November 2016 VA treatment record, the examiner noted that after reviewing the Veteran’s labs, his treatment had ended. In an April 2017 VA examination for diabetes mellitus, the Veteran reported that he experienced profound unintentional weight loss due to his diabetes mellitus. Further, in a May 2017 VA treatment record, the Veteran denied weight loss, profound fatigue, abdominal pain, nausea, and vomiting. In an April 2018 brief, the Veteran’s representative asserted that he should be entitled to a higher rating due to flare-ups that intermittently present as fatigue, nausea, vomiting, and pain. Based on the evidence of record and resolving reasonable doubt in favor of the Veteran, the Board concludes that a rating of 20 percent is warranted from September 21, 2016, the date on which he started taking daily medication for his hepatitis C. However, prior to September 21, 2016, assignment of a compensable rating is not warranted. The evidence does not demonstrate that, prior to September 21, 2016, the Veteran had intermittent fatigue, malaise, and anorexia, or any incapacitating episodes. Rather the medical evidence of record shows that the Veteran has never had an incapacitating episode during the period on appeal, nor has there been any malaise or anorexia noted in his records. In fact, for the majority of the appeal period, the Veteran denied having any weight loss, except for the April 2017 VA treatment record which noted unintentional weight loss. However, this was attributed specifically to the Veteran’s diabetes mellitus, and not to his hepatitis C. Moreover, the Veteran frequently denied having any nausea and vomiting. While he did report having right quadrant abdominal pain, subsequent follow up testing confirmed that his liver was normal. Although the Veteran has reported fatigue at times throughout the appeal period, these reports are inconsistent, and at times, it appears that the fatigue may be due to another cause. For example, during the November 2008 VA examination, the Veteran reported that his fatigue was due to poor sleep. In addition, in the November 2006 Physical Residual Functional Capacity Questionnaire, the Veteran indicated that he had several diagnoses when reporting his symptoms of fatigue and weakness. Moreover, in VA treatment records from August 2011 through February 2016, the Veteran’s reports of fatigue were associated with his diabetes and heart disability. For example, in a February 2016 VA treatment record, the Veteran reported fatigue and nocturia in relation to his glycemic control. In an August 2011 VA treatment record, the examiner noted fatigue was a symptom of hyperglycemia. In a September 2015 VA cardiology consult, the Veteran reported having chest pain, along with fatigue, shortness of breath, and diaphoresis. Thus, the preponderance of the evidence does not demonstrate that the Veteran meets the criteria for a 10 percent rating or higher, prior to September 21, 2016. The Board acknowledges the Veteran’s assertions that he experiences flare-ups, that he has daily fatigue, and that he experiences nausea, pain, and malaise regularly. While he is competent to report his observable symptoms, he is not competent to provide a diagnosis for his symptoms. Moreover, as noted above, the Veteran’s reports of fatigue have been inconsistent throughout the appeal period, and the medical evidence of record does not show that he experienced pain, nausea, and malaise regularly. In fact, in a May 2017 VA treatment record, the Veteran denied having weight loss, profound fatigue, abdominal pain, nausea, and vomiting. Furthermore, multiple VA treatment records, in addition to the Veteran’s own October 2007 DRO hearing testimony, indicate that the Veteran is asymptomatic. Thus, the weight of the evidence is against a finding that the Veteran demonstrates intermittent fatigue, malaise, and anorexia, or incapacitating episodes with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and upper right quadrant pain, prior to September 21, 2016. In sum, the weight of the evidence is against a finding that the Veteran’s hepatitis C was symptomatic, prior to September 21, 2016. While the Veteran has reported certain symptoms that he believes are attributable to his hepatitis C, the medical evidence establishes that the Veteran was asymptomatic prior to that date. Regarding the Veteran’s assertion that he had symptoms of hepatitis C prior to September 21, 2016, the Board finds that this assertion is outweighed by the more probative findings from VA examiners who have examined the Veteran and documented his symptoms. Contrary to the Veteran, these medical professionals have specialized knowledge and are competent to ascertain whether the Veteran had any symptoms at the time. Based on their competent medical findings, the Board finds that the probative and competent evidence does not tend to show that the Veteran manifested symptoms of hepatitis C prior to September 21, 2016. As the Veteran’s hepatitis C was asymptomatic prior to that date, he does not meet the criteria for a compensable rating under the applicable diagnostic code for rating hepatitis C. In conclusion, as the Veteran’s symptoms meet the criteria for a 20 percent rating, but no higher, from September 21, 2016, the Veteran’s claim for an increased rating is granted to that extent. However, the preponderance of evidence weighs against the Veteran’s claim of entitlement to a compensable initial disability rating for hepatitis C prior to September 21, 2016. From September 21, 2016, to December 4, 2019 As noted above, the Board finds that the Veteran is entitled to a 20 percent rating for his hepatitis C effective from September 21, 2016. In a June 2019 rating decision, the Veteran was assigned a rating of 20 percent effective from April 15, 2019. In a July 2020 rating decision, the Veteran was assigned a noncompensable rating from December 4, 2019. The Board finds that the preponderance of the evidence does not warrant a rating in excess of 20 percent from September 21, 2016, to December 4, 2019. The Veteran underwent a VA examination in April 2019, where he made vague complaints of abdominal pressure all over, not associated with eating or bowel movements, and occasional loose stools. He reported no bleeding and continuous medication was not required. The examiner noted the Veteran’s symptoms of daily fatigue and weakness. However, she stated that the Veteran had several co-morbid conditions that could also cause fatigue and malaise. The Veteran did not suffer from incapacitating episodes or exhibit signs or symptoms attributable to cirrhosis of the liver. Based on the evidence of record, the Board finds that a disability rating in excess of 20 percent is not warranted for hepatitis C from September 21, 2016, to December 4, 2019. The evidence only demonstrates that the Veteran has daily fatigue and weakness, which are contemplated in the 20 percent rating assigned. Notably, the evidence does not demonstrate that the Veteran exhibited daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes. Thus, the criteria for a rating in excess of 20 percent for hepatitis C have not been met during the appeal period from September 21, 2016, to December 4, 2019. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). From December 4, 2019 As noted above, the Veteran’s hepatitis C was reduced to a noncompensable rating in a July 2020 rating decision, effective December 4, 2019. In a February 2018 VA radiology report, the examiner noted that the Veteran’s liver appeared slightly high in attenuation, which could reflect underlying cirrhotic change or metal deposition. A prominent portcaval lymph node was noted to be most likely reactive. In a September 2020 brief, the Veteran’s representative asserted that the Veteran experiences additional disabilities associated with his hepatitis C, to include fatigue, right upper quadrant pain, and nausea on a regular basis. During a December 2019 VA examination, the Veteran reported that since completing his treatment for hepatitis C in November 2016, he has had an undetectable viral load after testing done in May 2017. The Veteran reported symptoms of intermittent fatigue and intermittent right upper quadrant pain with no incapacitating episodes. The examiner noted no signs or symptoms attributable to cirrhosis of the liver, biliary cirrhosis, or cirrhotic phase of sclerosing cholangitis. Further, the examiner noted that there was no evidence of active infection, as the viral load is undetectable and that there was no evidence of any other chronic liver disease. Instead, the examiner noted that the Veteran’s fatigue was more likely due to his other underlying comorbidities of obstructive sleep apnea, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, and hyperthyroidism. The examiner also indicated the Veteran’s right upper quadrant pain was more likely due to a recent reported fall, as the Veteran has had discomfort in the lower ribs/upper abdomen since that time, and there is no evidence active hepatitis C based upon the undetectable viral load, as well as the lack of evidence of any chronic liver disease. Based on the evidence of record, the Board concludes that a compensable rating is not warranted from December 4, 2019. The evidence does not demonstrate that the Veteran has had intermittent malaise, and anorexia, or any incapacitating episodes with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain. While the Veteran did report intermittent fatigue and upper right quadrant pain on the December 2019 VA examination, the examiner clearly indicated that this was more likely than not due to other comorbidities and injuries, as the Veteran did not have active hepatitis C. Thus, the Veteran has not met the criteria for a compensable rating for hepatitis C for the appeal period starting from December 4, 2019. The Board acknowledges the Veteran’s assertions that he experiences fatigue, nausea, and right upper quadrant pain on a regular basis. Again, as previously stated, while he is competent to report his observable symptoms, he is not competent to provide a diagnosis for his symptoms. Moreover, as noted above by the December 2019 VA examiner, his symptoms of fatigue and right upper quadrant pain are more likely than not due to other disabilities or injuries. The December 2019 VA examination also did not note any symptoms of daily nausea, nor do VA treatment records document any complaints of this. The Board also notes that while the February 2018 VA examination noted possible cirrhosis of the liver, the December 2019 VA examiner reviewed the report and specifically concluded that the Veteran did not have any signs or symptoms attributable to cirrhosis of the liver, and the Veteran did not have any chronic liver disease. Thus, a separate rating for cirrhosis or malignancy of the liver is not warranted. Accordingly, the Board finds that the Veteran’s hepatitis C does not more nearly approximate a 10 percent disability rating for the appeal period starting from December 4, 2019. Thus, the preponderance of the evidence is against the claim for a compensable rating for hepatitis C from December 4, 2019, and it is, therefore, denied. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Extraschedular Consideration The Board acknowledges the contention made by the Veteran’s representative in a September 2019 brief, that the schedular rating may be inadequate in this case, and that referral for an extraschedular rating may be appropriate in this case. The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Thun v. Peake, 22 Vet. App. 111 (2008). In this regard, 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. If the criteria reasonably describe the claimant’s disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule and the assigned schedular evaluation is therefore adequate, and no extraschedular referral is required. Id.; see also VAOGCPREC 6-96 (Aug. 16, 1996). Otherwise, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, VA must determine whether the claimant’s exceptional disability picture exhibits other related factors, such as those provided by the extraschedular regulation (38 C.F.R. § 3.321(b)(1)) as “governing norms” (which include marked interference with employment and frequent periods of hospitalization). As previously noted, the Veteran’s is assigned a noncompensable rating prior to September 21, 2016, a 20 percent rating from September 21, 2016, to December 4, 2019, and a compensable rating thereafter for his service-connected hepatitis C pursuant to DC 7354. The Board finds that evidence does not show such an exceptional disability picture that the available schedular evaluation for hepatitis Cis inadequate. 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. The Veteran’s representative asserted that the Board should consider the impact of pain when assigning a rating, however, pain is already contemplated in the rating criteria and does not give rise to entitlement to an extraschedular referral. Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017). Indeed, the Board notes that for hepatitis C, under DC 7354, the rating schedule specifically contemplates arthralgia and upper quadrant pain. Thus, given that the rating schedule specifically contemplates pain, the Board finds that the schedular criteria reasonably describe the Veteran’s disability picture in this case. Thus, it cannot be said that the available schedular evaluations for this disability are inadequate, and the first element of extraschedular consideration has not been met. See Thun v. Peake, 22 Vet. App. 111 (2008). In addition, neither the Veteran nor his representative has alleged any other symptoms, manifestations, or treatment that warrant extraschedular consideration. Nor is there any evidence that the Veteran’s disability picture includes any symptoms, manifestations, or treatment not adequately contemplated by the rating schedule. The medical evidence of record shows symptoms no more severe than daily fatigue and daily weakness. Based on the foregoing, the Board finds that the requirements for an extraschedular evaluation for the Veteran’s service-connected hepatitis C under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995); Thun v. Peake, 22 Vet. App. 111 (2008). J. SAIKH Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vample, 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.