Citation Nr: 21003099 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 06-35 648 DATE: January 19, 2021 ORDER Entitlement to an initial evaluation of 30 percent, and no greater, prior to November 2, 2006, for a right-hand disability is granted. Entitlement to an evaluation in excess of 10 percent beginning November 2, 2006, for a right-hand disability is denied. REMANDED Entitlement to a TDIU on an extraschedular basis prior to November 2, 2006, and from January 15, 2010, to May 24, 2017, is remanded. FINDINGS OF FACT 1. Prior to November 2, 2006, the Veteran’s right-hand disability prevented full use of his thumb and ring and little fingers, affecting his ability to grip and hold objects. 2. Beginning November 2, 2006, the Veteran’s right-hand disability manifested in pain, some limitation of motion, and decreased grip strength. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation of 30 percent, and no greater, prior to November 2, 2006, for a right-hand disability have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1-4.10, 4.71a, Diagnostic Code 5299-5223. 2. The criteria for an evaluation in excess of 10 percent beginning November 2, 2006, for a right-hand disability have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1-4.10, 4.71a, Diagnostic Code 5299-5223. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from July 1956 to November 1957. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in May 2014. This case was previously before the Board most recently in August 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When there is a question as to which of two ratings apply, VA will assign the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Disabilities must be viewed in relation to their entire history. 38 C.F.R. § 4.1. VA is required to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. VA is also required to evaluate functional impairment on the basis of lack of usefulness and the effects of the disabilities upon the claimant’s ordinary activity. 38 C.F.R. § 4.10; see generally Schafarth v. Derwinski, 1 Vet. App. 589 (1991). 1. Entitlement to an initial evaluation in excess of 10 percent for a right-hand disability The Veteran is currently in receipt of a 10 percent evaluation throughout the appeal period under Diagnostic Code (DC) 5299-5223 for Dupuytren’s contracture of the right hand. The record reflects the Veteran is right-hand dominant. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The hyphenated diagnostic code here indicates that the Veteran is service connected for a disability of the musculoskeletal system rated by analogy to disabilities involving favorable ankylosis of multiple digits. Diagnostic Code 5223 governs favorable ankylosis of two digits. For the dominant hand, a 10 percent evaluation is assigned for favorable ankylosis affecting the long and ring fingers, the long and little fingers, or the ring and little fingers. A 20 percent evaluation is assigned for favorable ankylosis affecting the index and long fingers, the index and ring fingers, or the index and little fingers. A 30 percent evaluation is assigned for favorable ankylosis affecting the thumb and any finger. The normal range of motion for the second through fifth digits (the index, long, ring, and little fingers) is zero degrees in extension, 90 degrees in flexion at the metacarpophalangeal (MCP) joint, 100 degrees in flexion at the proximal interphalangeal (PIP) joint, and 70 degrees in flexion at the distal interphalangeal (DIP) joint. For the first digit (the thumb), the normal range of motion is zero degrees in extension, 100 degrees in flexion at the MCP joint, and 90 degrees in flexion at the interphalangeal (IP) joint. The Board first notes the Veteran’s VA treatment records do not contain treatment for his right hand disability, aside from one treatment note in November 2006, where the Veteran requested help in strengthening his right hand. The occupational therapist instructed the Veteran in therapeutic exercises and issued an ergonomic hand helper. No follow-up treatment is documented in the VA treatment records. The Veteran submitted a September 2003 opinion letter written by a private physician, who noted difficulty in making a fist with the right hand. The physician noted flexion contractures of the right fourth and fifth MCP joints, which is a fixed tightening of the ring and little fingers in flexion at the joint where the finger meets the hand. An MRI demonstrated degenerative changes, mostly at the first MCP joint, and x-rays revealed degenerative changes at the first, second (index finger), and fifth MCP joints. The physician opined that the right-hand disability interfered with the Veteran’s activities of daily living. At a March 2004 VA examination, the examiner identified Dupuytren’s contracture in the right hand, with contracture of the fourth and fifth finger into the palm. Decreased grip strength of 4 out of 5 was noted in the Veteran’s right hand. In June 2004, the Veteran sought treatment with another private physician for increasing instability and decreasing grip strength in his right hand. He reported he was having increasing difficulty holding onto items with his right hand, particularly if he had to use his thumb. The Veteran also complained of occasional moderate pain in the right thumb. The physician estimated that the Veteran had 50 percent functionality in his right hand, and was only able to use the long and ring fingers, with a partially unstable thumb and Dupuytren’s contracture of the ring and pinky fingers. In June 2005, the Veteran had surgery with the same private physician to release the Dupuytren’s contracture. In July 2005, the physician noted the Veteran was able to extend his fingers fully. In November 2005, the Veteran was noted to have 100 percent improved mobility in the right hand, and he reported no numbness or tingling. Some induration was noted, but the Veteran was able to straighten the fingers out “pretty much all the way,” and a good grip was noted as well. In August 2006, a full range of motion was noted, with full extension and complete flexion. On November 2, 2006, the physician noted the Dupuytren’s contracture was basically corrected to within a reasonable degree of ability. At a February 2009 follow-up with the private physician, a full range of motion was noted in the right hand, and the strength was noted to be 5 out of 5. The Veteran denied pain, numbness, and tingling in the right hand and fingers. In December 2011, the Veteran attended another VA examination. He reported intermittent pain in the right hand, which was aggravated when grabbing objects. The right thumb MCP joint was tender to palpation, and the right thumb range of motion was measured to be 30 degrees in flexion, with a full range of extension. Pain was noted throughout this range of motion. The right thumb IP joint had a range of motion of zero degrees in extension and 40 degrees in flexion. After three repetitions, the ranges of motion and associated pain did not change. Regarding the right hand, the examiner noted a well-healed surgical scar over the palm with very mild thickening of the fibrous tissue under the skin near the base of the fourth finger. The examiner noted no curled fingers. The range of motion of the second and third fingers was measured to be zero degrees in extension and 75 degrees in flexion at the MCP joint; zero degrees in extension and 70 degrees in flexion at the PIP joint, with pain at the end of the range of motion; and zero degrees in extension and 40 degrees in flexion at the DIP joint. After three repetitions, the ranges of motion and associated pain did not change. The range of motion of the fourth and fifth fingers was measured to be zero degrees in extension and 85 degrees in flexion at the MCP joint; zero degrees in extension and 75 degrees in flexion at the PIP joint; and zero degrees in extension and 40 degrees in flexion at the DIP joint. No pain was noted on examination, and after three repetitions, the ranges of motion did not change. No evidence of fatigue, weakness, or lack of endurance was noted in any of the joints. A gap of more than one inch was noted between the fingertips and the proximal transverse crease of the palm in attempting to touch the palm with the fingertips. Muscle strength was noted to be 5 out of 5, though the Veteran had difficulty making a fist due to the limitations of motion noted on the examination. In May 2014, the Veteran testified at the Board hearing that he had difficulty holding objects with his right hand because he could not sustain the grip strength to prevent dropping items or complete tasks requiring manipulation of tools with his right hand. He also testified that he was unable to lift or carry heavy items with his right hand. The Veteran testified to regularly experiencing pain in his right hand, and occasional numbness in it in cold weather. In May 2016, the Veteran attended another VA examination, at which he reported pain at the base of the right thumb. The examiner identified diagnoses of Dupuytren’s contracture and degenerative arthritis in the right hand and fingers. The Veteran did not endorse flare-ups of the disability. The second, third, fourth, and fifth fingers of the right hand were all measured to have a full range of motion. The range of motion in the thumb was measured to be zero degrees in extension and 100 degrees in flexion at the MCP joint, and zero degrees in extension and 45 degrees at the IP joint. Pain was noted on examination in all ranges of motion but did not cause functional loss, and after three repetitions, the ranges of motion did not change. There was no gap noted between the thumb pad and the fingers or between the fingers and the proximal transverse crease of the hand, and grip strength was measured to be normal. At a January 2017 VA examination, the Veteran reported pain in his right hand with a weak grip; he did not endorse flare-ups. The range of motion of the second finger of the right hand was measured to be zero degrees in extension and 80 degrees in flexion at the MCP joint; zero degrees in extension and 90 degrees in flexion at the PIP joint; and zero degrees in extension and 70 degrees in flexion at the DIP joint. The range of motion of the third finger of the right hand was measured to be zero degrees in extension and 75 degrees in flexion at the MCP joint; zero degrees in extension and 80 degrees in flexion at the PIP joint; and zero degrees in extension and 60 degrees in flexion at the DIP joint. The range of motion of the fourth finger of the right hand was measured to be zero degrees in extension and 75 degrees in flexion at the MCP joint; zero degrees in extension and 85 degrees in flexion at the PIP joint; and zero degrees in extension and 60 degrees in flexion at the DIP joint. The range of motion of the fifth finger of the right hand was measured to be zero degrees in extension and 80 degrees in flexion at the MCP joint; zero degrees in extension and 75 degrees in flexion at the PIP joint; and zero degrees in extension and 60 degrees in flexion at the DIP joint. The range of motion in the thumb was measured to be zero degrees in extension and 75 degrees in flexion at the MCP joint, and zero degrees in extension and 70 degrees at the IP joint. No pain was noted on the examination, and there was no additional limitation to the ranges of motion after three repetitions. There was no gap noted between the thumb pad and the fingers or between the fingers and the proximal transverse crease of the hand. The Board notes that it previously found this examination to be incomplete as to passive range of motion testing; the ranges of motion and associated pain noted here are in active motion. In August 2017, the Veteran was afforded another VA examination. He again reported pain at the base of his thumb, and did not endorse flare-ups of the disability. The examiner identified diagnoses of Dupuytren’s contracture and degenerative arthritis in the right hand and fingers. The second, third, fourth, and fifth fingers of the right hand were all measured to have a full range of motion. The range of motion in the thumb was measured to be zero degrees in extension and 100 degrees in flexion at the MCP joint, and zero degrees in extension and 45 degrees at the IP joint. No pain was noted upon both active and passive range of motion testing, and there was no additional limitation after three repetitions. Grip strength in the right hand was measured to be normal, and there was no gap noted between the thumb pad and the fingers or between the fingers and the proximal transverse crease of the hand. The Veteran attended another VA examination in April 2019, but the Board has previously found this examination to be internally inconsistent regarding the clinical findings relevant to the Veteran’s right hand. Therefore, the Board will not consider evidence from this examination report. In September 2020, the Veteran attended another VA examination, at which he reported pain in the hand that increases after prolonged use. He also reported a weakened grip, in that he is unable to hold and grip heavy objects, open jars, and perform certain fine motor skills with his right hand. The second and third fingers of the right hand were measured to have a full range of motion. The range of motion of the fourth and fifth fingers of the right hand was measured to be zero degrees in extension and 90 degrees in flexion at the MCP joint; zero degrees in extension and 80 degrees in flexion at the PIP joint; and zero degrees in extension and 70 degrees in flexion at the DIP joint. The range of motion in the thumb was measured to be zero degrees in extension and 100 degrees in flexion at the MCP joint, and zero degrees in extension and 75 degrees at the IP joint. Pain was noted in flexion in the fingers, and there was no additional limitation to the ranges of motion after three repetitions. The examiner estimated the Veteran would lose an additional ten degrees of flexion at the PIP joint in the ring and little fingers, as well as ten degrees of flexion at the IP joint in the thumb, after repeated use over time. Grip strength in the right hand was measured to be a 4 out of 5. There was no gap noted between the thumb pad and the fingers or between the fingers and the proximal transverse crease of the hand. The examiner opined that the identified degenerative arthritis in the right hand was likely not caused by the history of Dupuytren’s contracture, but the symptoms of both disabilities overlapped and therefore cannot be differentiated. The Board will therefore consider the effects of the non-service-connected arthritis alongside symptoms of the service-connected Dupuytren’s contracture. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (where effects of service-connected disabilities and non-service-connected disabilities cannot be distinguished, they will all be attributed to the service-connected disabilities). After careful review of the record, the Board finds that an increase is warranted for the period prior to the Veteran’s corrective surgery and subsequent recovery. Prior to the surgery, the Veteran’s private physician noted he had only 50 percent functionality in the right hand, with a partially unstable thumb and Dupuytren’s contracture of the ring and pinky fingers. Another private physician opined that the right-hand disability interfered with his activities of daily living, and a VA examiner noted decreased grip strength of 4 out of 5. As functional impairment in the Veteran’s right hand is clearly demonstrated by the evidence of record, the Board finds that, prior to November 2, 2006, when the treating physician noted the Dupuytren’s contracture was corrected to a reasonable degree of ability, a 30 percent evaluation is appropriate under DC 5299-5223. The Veteran’s right-hand function was impaired during this period such that he only had full use of two fingers, which is a greater impairment than limitation limited solely in the thumb, as contemplated by the 20 percent evaluation under DC 5228. It is likewise a greater limitation than that presented by favorable ankylosis of the index finger and another finger, as contemplated by the 20 percent evaluation under DC 5223. However, it is not as extreme a limitation as favorable ankylosis of the thumb and any two fingers as contemplated by the 40 percent evaluation for ankylosis of three digits under DC 5222; albeit with weak grip strength, the Veteran was still able to make a fist during this period. Beginning November 2, 2006, the Board finds an increase under DC 5223 is not warranted. The private treatment records reflect full extension and flexion on November 2, 2006, and the limitation of motion of the digits noted in the VA examinations after this date does not approximate favorable ankylosis of the index finger and another finger, required by the criteria for a 20 percent evaluation under DC 5223. Further, flare-ups approximating ankylosis of the index finger or the thumb are not reported at any point in the record. Although the Veteran consistently reported pain at the base of his right thumb and variously reported pain on motion of the fingers, this pain is already compensated in his current 10 percent evaluation. The Board has also considered evaluating the Veteran’s right-hand disability under other diagnostic codes as well, but none will afford the Veteran a higher rating. Limitation of motion of the fingers is governed by DCs 5228 through 5230, which contemplate limited motion of the thumb (DC 5228), the index or long finer (DC 5229), and the ring or little finger (DC 5230). The evidence here shows limitation of motion of each finger and the thumb at different points throughout the appeal period. Diagnostic Code 5230 only provides for a noncompensable evaluation for limitation of motion of the ring and little finger. Rating the disability under DC 5228 would not yield a higher evaluation, as this diagnostic code considers limitation of motion resulting in a gap between the thumb and finger pads, which is not demonstrated at any point throughout the period on appeal. Further, although the December 2011 VA examination indicated a gap of more than inch between the fingertips and the proximal transverse crease of the palm, as contemplated by DC 5229, this diagnostic code provides for a maximum of 10 percent rating, so a higher evaluation is not available. The Board has considered evaluations under the other codes governing ankylosis. Diagnostic Codes 5224 through 5227 consider ankylosis of individual digits, and include a note that directs consideration be given to whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand when ankylosis is present. Here, combining two such evaluations would not result in a higher rating, as the Veteran’s ring and little fingers are involved in the disability, which each would only render a noncompensable evaluation under DC 5227; when combined with an evaluation for favorable ankylosis of any other digit, the highest available rating is 10 percent. Further, the functional impairment shown in the record, both by clinical findings and the Veteran’s own testimony, is decreased grip strength, and not the inability to use one or more digits. Thus, the Board does not find that the evidence of record during the period beginning November 2, 2006, approximates ankylosis of any digit of the right hand, nor is rating by analogy to amputation appropriate. Because of the finding of degenerative arthritis in the Veteran’s right hand, the Board has also considered evaluation under DC 5003, which allows for a 20 percent rating where there is involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Multiple involvements of the interphalangeal, metacarpal, and carpal joints of the upper extremities are considered a minor joint group. 38 C.F.R. § 4.45(f). However, the record does not reflect occasional exacerbations causing incapacitation of the right hand, as the Veteran consistently denied flare-ups. Finally, the Board has also considered whether the service-connected scars of the right hand warrant a compensable evaluation in order to compensate for decreased grip strength in the right hand. The record does not reflect the scars are painful or unstable, or that the scars have contributed to functional loss in any way, such as by limiting motion in the hand. Therefore, an increased evaluation for the right-hand scars is not warranted. In conclusion, the Board finds that a 30 percent evaluation, and no greater, is warranted for the period prior to November 2, 2006, and a rating in excess of 10 percent is not warranted thereafter for the Veteran’s right-hand disability. TDIU VA will grant entitlement to TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing and following “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The sole fact that the Veteran was or is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the Board must evaluate whether there are circumstances in the Veteran’s case, apart from any non-service-connected conditions and advancing age, which would justify a total rating based on individual unemployability due solely to the service-connected conditions. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993); see also Blackburn v. Brown, 5 Vet. App. 375 (1993). Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). Marginal employment includes occupation incapable of producing income that is more than marginal, Ortiz-Valles v. McDonald, 28 Vet. App. 65, 71 (2016), and occupation where earned annual income exceeds the poverty limit but is done so in a protected environment such as a family business or sheltered workshop, 38 C.F.R. § 4.16(a). The regulations provide that if there is only one service-connected disability impeding employability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the above purposes. 38 C.F.R. § 4.16(a). Because it is established VA policy that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled, the Board will submit to the Director of Compensation (Director) for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the above percentage standards. 38 C.F.R. § 4.16(b). The Board cannot assign an extraschedular rating in the first instance, but must specifically adjudicate whether to refer a case to the Director for consideration of an extraschedular rating under section 4.16(b) when the issue is either raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008) (citing Thun v. Peake, 22 Vet. App. 111, 115 (2008)). Section 4.16 of VA’s regulations does not require a finding that the schedular ratings are inadequate to compensate for the average impairments in earning capacity caused by particular disabilities, but requires only a finding that the service-connected disabilities render a particular veteran unemployable. VAOPGCPREC 6-96 (August 16, 1996). 2. Entitlement to a TDIU prior to May 25, 2017 The Veteran has been awarded a TDIU from May 25, 2017. Accordingly, the Board will address whether a TDIU is warranted prior to May 25, 2017. Currently, the Veteran’s combined evaluation prior to May 25, 2017, does not meet the schedular requirements for a TDIU. Therefore, the Board will examine whether his case should be referred to the Director for extraschedular consideration. As noted above, referral is merited in cases where the evidence suggests a Veteran is unable to obtain and maintain substantially gainful employment by virtue of his service-connected disabilities. In December 2011, the Veteran submitted a VA Form 21-8940 indicating that he last worked from January 1, 2005, to March 2, 2005, as a laborer, and prior to that for a grocery store. He reported he was let go from the grocery store because he was unable to do the work. The Veteran later testified that he worked stocking shelves and was unable to keep up with unloading boxes of groceries from pallets and refilling the shelves. Information from the grocery store indicates the Veteran worked there on a part-time basis from December 23, 2004, to January 13, 2005. On a March 2010 VA Form 21-8940, the Veteran reported that prior to these two jobs, he last worked full-time as a driver until 2002, prior to the period on appeal. The Veteran reported that he completed high school and that he has had no subsequent education or training. Throughout the period on appeal, the Veteran is service connected for only the right-hand disability until December 17, 2007, when he was awarded service connection for posttraumatic stress disorder (PTSD). Then, effective January 31, 2008, he was awarded service connection for tinnitus and bilateral hearing loss; and service connection for the scars of the right-hand effective December 3, 2011. Prior to November 2, 2006, as discussed above, the Board finds the Veteran’s right-hand disability manifested in significant functional impairment, including decreased range of motion and grip strength. The Veteran’s testimony further indicates that this functional impairment directly affected his ability to complete light labor. As the Veteran is right-hand dominant, it appears the Veteran was likely precluded from securing and following gainful occupation during this period, as he was unable to lift or carry heavy objects and he was unable to manipulate tools or perform other fine motor skill tasks. Therefore, the Board will remand the issue of a TDIU for this period for referral to the Director for extraschedular consideration. From November 2, 2006, to December 17, 2007, the Veteran’s only service-connected disability was the right-hand disability. The only evidence of record during this period is the November 2, 2006, private treatment note, which indicated a full range of motion and a reasonable degree of ability with the right hand. This evidence does not indicate an effect on the Veteran’s ability to secure and follow gainful employment, as he was able to use his right hand in the ways he previously was unable to do. Therefore, a referral for extraschedular TDIU consideration is not warranted for this period. Beginning December 17, 2007, the effects of the Veteran’s PTSD symptoms on his employability may also be considered. May 2008 and July 2008 VA treatment notes document symptoms of depression, nightmares, and sleep impairment, but no psychotic symptoms or suicidal or homicidal ideation. Until January 15, 2010, the only PTSD treatment in the Veteran’s VA treatment records is group therapy, which notes do not record any additional symptoms. The evidence in this period likewise does not indicate any impairment in the Veteran’s ability to secure and follow gainful employment, as his hand retained a useful range of motion and there is no evidence his PTSD symptoms were having a significant impact on aspects of employment such as building and maintaining relationships, interacting with others in a transactional setting, or maintaining focus on tasks. Therefore, a referral for extraschedular TDIU consideration is not warranted. At a January 15, 2010, VA mental health treatment visit, the Veteran reported episodes of anxiety lasting several hours where he felt overwhelmed and unable to concentrate on anything. In March 2010, the Veteran was hospitalized for approximately six days in a psychiatric unit; he reported hearing voices, feeling depressed, and experiencing suicidal and homicidal ideation. Outpatient treatment notes in June 2010, September 2010, and June 2011 document vague paranoid thinking, and the Veteran’s psychiatrist noted chronic paranoid thinking in August 2011, which was also noted in May 2012 and October 2012 mental health notes, with increasing focus on the Veteran’s neighbors and apartment complex security guards. In January 2013, the Veteran’s psychiatrist prescribed medication to target paranoid delusions and thought process disturbance. At a February 2013 VA psychiatric examination, the examiner opined that the Veteran would require assistance in managing his finances, as he reported that he frequently forgets to pay his electric bill and loses electric service. In October 2014, the Veteran called the VA suicide hotline and reported that he was afraid to leave his apartment, as he believed people in his apartment complex would attack him. In January 2015, the Veteran was again hospitalized; he reported to the VA hospital after experiencing homicidal ideation toward his apartment building superintendent in order to prevent himself from physically attacking the superintendent. In November 2015, the Veteran reported being in a confrontation with two people at the apartment building; the police were called, and an eviction notice was issued to the Veteran, although it does not appear from the record that he was evicted. In March 2017, the Veteran reported that he attacked a building security guard, and eviction proceedings were again implemented against the Veteran. The Board also notes that, throughout this period, the record repeatedly reflects the Veteran’s non-compliance with his medications. Based on this evidence, the Board finds that for the period from January 15, 2010, to May 24, 2017, referral for extraschedular consideration of TDIU is appropriate. The documented paranoid ideation indicates an inability to get along with others and maintain effective relationships outside of a social setting. Further, the Veteran’s inability to consistently pay his electricity bill and his non-compliance with medication indicate an inattention to detail and poor judgment and decision-making skills. Therefore, the Board will remand the issue of a TDIU for this period for referral to the Director for extraschedular consideration. REASONS FOR REMAND 1. Entitlement to a TDIU prior to November 2, 2006, and from January 15, 2010, to May 24, 2017, is remanded. There is evidence of unemployability due to service-connected disabilities in the period prior to November 2, 2006, and the period from January 15, 2010, to May 24, 2017. However, the Veteran does not meet the schedular requirements for a TDIU during these two periods. As discussed above, the Board finds this case should be referred to the Director, Compensation Service, for extraschedular consideration of entitlement to a TDIU for these two periods. (Continued on the next page)   The matter is REMANDED for the following action: Refer the claim to the Director, Compensation Service, for consideration of whether a TDIU is warranted on an extraschedular basis prior to November 2, 2006, and from January 15, 2010, to May 24, 2017. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Josey, 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.