Citation Nr: 21073017
Decision Date: 12/07/21	Archive Date: 12/07/21

DOCKET NO. 18-38 604A
DATE: December 7, 2021

ORDER

An initial rating in excess of 10 percent for psoriasis, prior to August 1, 2014, and in excess of 60 percent thereafter is denied.

An initial compensable rating for psoriatic arthritis bilateral feet, ankles, wrists, hands, fingers, toes, prior to June 16, 2021, and in excess of 10 percent thereafter for psoriatic arthritis of the cervical spine, is denied.

FINDINGS OF FACT

1. Prior to August 1, 2014, the Veteran's psoriasis did not affect 20 to 40 percent of his entire body, or 20 to 40 percent of exposed areas. It was treated using several different topical medications, but did not require the use of intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, or intensive light therapy, UVB, PUVA, or electronic beam therapy. It was not manifested by scarring or disfigurement. 

2. For the period beginning August 1, 2014, the Veteran's psoriasis was treated with constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs during a 12-month period. There was no evidence of scarring or disfigurement related to the service-connected psoriasis.

3.  Prior to September 16, 2021, the Veteran's psoriatic arthritis bilateral feet, ankles, wrists, hands, fingers, toes was manifested by painful joints, but no X-ray evidence of arthritis and no limitation of joint motion.

4. For the period beginning September 16, 2021, the Veteran's psoriatic arthritis cervical spine has not been manifested by forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

CONCLUSIONS OF LAW

1. Prior to August 1, 2014, the criteria for a rating in excess of 10 percent for psoriasis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.20, 4.118, Diagnostic Codes 7800-7805.

2. For the period beginning August 1, 2014, the criteria for a rating in excess of 10 percent for psoriasis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.20, 4.118, Diagnostic Codes 7800-7805.

3. Prior to September 16, 2021, the criteria for a compensable rating for psoriatic arthritis bilateral feet, ankles, wrists, hands, fingers, toes have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5002, 5003, 5009.

4. For the period beginning September 16, 2021, the criteria for a rating in excess of 10 percent for psoriatic arthritis cervical spine have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1995 to August 1995, from February 1996 to May 1996, from February 2003 to June 2003, and from September 2012 to August 2013.

The Veteran testified before the Board at a May 2021 hearing. A transcript of that hearing is of record.

In August 2021, the Board remanded the case for further development by the originating agency. The case has been returned to the Board for further appellate action.

In an October 2021 rating decision, the RO granted an increased rating of 60 percent for the service-connected psoriasis, effective August 1, 2014. The RO also recharacterized the Veteran's service-connected psoriatic arthritis, bilateral feet, ankles, wrists, hands, fingers, toes) as psoriatic arthritis of the cervical spine, and granted an increased evaluation of 10 percent, under Diagnostic Code 5242, effective September 16, 2021. The issues of an increased rating for psoriasis and an increased rating for psoriatic arthritis cervical spine (previously rated as psoriatic arthritis, bilateral feet, ankles, wrists, hands, fingers, toes), remain on appeal. AB v. Brown, 6 Vet. App. 35 (1993) (where a claimant has filed a notice of disagreement as to a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal).

In the same rating decision, the RO also granted service connection and separate evaluations for psoriatic arthritis of left foot, and psoriatic arthritis of right foot, with separate 20 percent evaluations, effective September 16, 2021. The RO also granted service connection for psoriatic arthritis of left ankle, psoriatic arthritis of right ankle, psoriatic arthritis of left elbow, psoriatic arthritis of right elbow, psoriatic arthritis of left forearm, psoriatic arthritis of right forearm, psoriatic arthritis of left hip, psoriatic arthritis of right hip, psoriatic arthritis of left index finger, psoriatic arthritis of right index finger, psoriatic arthritis of left knee, psoriatic arthritis of right knee, psoriatic arthritis of left long finger, psoriatic arthritis of right long finger, psoriatic arthritis of left thumb, psoriatic arthritis of right thumb, psoriatic arthritis of left wrist, psoriatic arthritis of right wrist, psoriatic arthritis of left little finger, psoriatic arthritis of right little finger, psoriatic arthritis of left ring finger, psoriatic arthritis of right ring finger, and psoriatic arthritis of thoracolumbar spine. Separate 10 percent evaluations were assigned, effective September 16, 2021. The Veteran has not appealed these ratings.

GENERAL LEGAL CRITERIA FOR INCREASED RATING

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2019). The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § § 4.21 (2019).

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § § 4.14. However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

In both initial rating claims and normal increased rating claims, the Board must discuss whether any "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

In accordance with 38 C.F.R. § §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disabilities at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to these disabilities.

1. An initial rating in excess of 10 percent for psoriasis, prior to August 1, 2014, and in excess of 60 percent thereafter

In an August 2014 rating decision, the RO granted service connection for psoriasis. A 10 percent evaluation was assigned, effective August 30, 2013. The Veteran appealed this initial rating. In an October 2021 rating decision, the RO granted an increased rating of 60 percent for the service-connected psoriasis, effective August 1, 2014. The Veteran has continued to appeal this rating.

DC 7816 provides ratings for psoriasis. Psoriasis that affects less than 5 percent of the entire body or exposed areas, and requires no more than topical therapy during the previous 12 month period, is rated noncompensably (0 percent) disabling.

A 10 percent evaluation is warranted where at least 5 percent but less than 20 percent of the entire body, or at least 5 percent but less than 20 percent of exposed areas are affected, or where intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the previous 12 month period.

A 30 percent evaluation is warranted where 20 to 40 percent of the entire body, or 20 to 40 percent of exposed areas are affected, or where intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the previous 12 month period.

Finally, a maximum 60 percent evaluation is warranted where more than 40 percent of the entire body, or more than 40 percent of exposed areas are affected, or where constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the previous 12 month period.

DC 7816 also indicates that psoriasis can be evaluated as disfigurement of the head, face, or neck (DC 7800), or scars (DC's 7801 through 7805), depending upon the predominant disability.

Effective October 23, 2008, the Schedule for rating criteria that addresses the evaluation of scars was revised. See 73 Fed. Reg. 54,708 (Oct. 23, 2008) (to be codified at 38 C.F.R. pt. 4). These new criteria apply to applications for benefits received on or after October 23, 2008, or upon request from a Veteran who was rated under the applicable criteria before this date. Id.

Diagnostic Code 7800 is for evaluation of scars of the head, face, or neck.  Diagnostic Codes 7801 and 7802 provide criteria to evaluate scars other than of the head, face, or neck. Under current Diagnostic Code 7801, scars, other than of the head, face, or neck, that are deep or that cause limited motion warrant a 10 percent rating when the scars cover an area or areas exceeding 6 square inches (39 sq. cm.). A 20 percent rating is warranted when the area or areas exceed 12 square inches (77 sq. cm.). A 30 percent rating requires an area or areas exceeding 72 square inches (465 sq. cm.), while a 40 percent rating requires an area or areas exceeding 144 square inches (929 sq. cm.).

Under the current Diagnostic Code 7802, scars, other than of the head, face or neck, that are superficial and that do not cause limited motion warrant a 10 percent rating when the scars cover an area or areas of 144 square inches (929 sq. cm.) or greater.

Under the current Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent evaluation; three or four scars that are unstable or painful warrant a 20 percent evaluation; five or more scars that are unstable or painful warrant a 30 percent evaluation. 38 C.F.R. § 4.118. If one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. at Note (2). Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. Id. at Note (3).

Diagnostic Code 7805 directs that any other disabling effects of a scar not described in Code 7802 or 7804, are to be evaluated under an appropriate Diagnostic Code. Id.

Period Prior to August 1, 2014

The evidence of record does not show that prior to August 1, 2014, 20 to 40 percent of the Veteran's entire body, or 20 to 40 percent of his exposed areas were affected by his psoriasis. Nor does it show that he required systemic therapy (administered orally or intravenously), such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, for twelve months during this period. See treatment records from Carl R. Darnall Medical Center, Columbia St. Mary's, and Dr. J.W., MD at Peachtree Dermatology. Accordingly, a rating in excess of 10 percent is not warranted under DC 7816 during this period.

There is also no evidence during this period showing that the Veteran had scars of the head, face or neck, or any other affected area of the body, that were deep, superficial, unstable, painful, or otherwise disabling, due to his psoriasis. There is also no evidence of disfigurement of the head, face, or neck, as a result of the Veteran's psoriasis. 

Accordingly, the Board finds that a rating in excess of 10 percent, under Diagnostic Codes 7800-7805, is also not warranted during this period.

Period Beginning August 1, 2014

For the period beginning August 1, 2014, the Veteran's psoriasis is rated as 60 percent disabling under DC 7816, based on evidence of treatment with the immunosuppressive drugs, including Methotrexate and Humira 40 mg since August 1, 2014 for his psoriasis. See private treatment records from Dr. J.W. at Peachtree Dermatology, dated August 1, 2014 and August 2014 VA examination report. This is the maximum schedular rating allowable under this diagnostic code.

The Board has again considered the application of Diagnostic Codes 7800, 7801, 7802, 7803, and 7804, for scars. Only DC 7800, pertaining to disfiguring scars of the head, face, or scalp, would provide a basis for a higher schedular rating, specifically, an evaluation of 80 percent.

The medical evidence of record for this period, including a September 2021 VA scars/disfigurement examination, does not show that the Veteran's psoriasis is manifested by gross distortion or asymmetry of three or more features or paired sets of features, or six or more characteristics of disfigurement. Accordingly, the Board finds that a rating in excess of 60 percent, under Diagnostic Code 7800, is also not warranted during this period.

The Board has also considered other medical evidence of record, including VA and private treatment records. None of these records contains evidence showing that the Veteran's psoriasis is manifested by symptoms that meet the criteria for an increased rating at any time during the appeal period.

Consideration under 38 C.F.R. §§ 3.321 (b)(1) has not been specifically sought by the Veteran or reasonably raised by the facts found by the Board. As such, there is no basis for extraschedular discussion in this case. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016).

2. An initial compensable rating for psoriatic arthritis of the cervical spine, prior to September 16, 2021 and in excess of 10 percent thereafter

In an August 2014 rating decision, the RO granted service connection for psoriatic arthritis, bilateral feet, ankles, wrists, hands, fingers, toes. A noncompensable (0 percent) evaluation was assigned, effective August 30, 2013. The Veteran denied this initial rating, contending that the disability should have also encompassed his knees, elbows, neck, and back. See December 2014 notice of disagreement (NOD). In an October 2021 rating decision, the RO recharacterized the disability as psoriatic arthritis of the cervical spine, and granted an increased rating of 10 percent, under Diagnostic Code 5242, effective September 16, 2021. The Veteran continues to appeal these ratings.

 

Period Prior to September 16, 2021

Prior to September 16, 2021, the Veteran's service-connected psoriatic arthritis, bilateral feet, ankles, wrists, hands, fingers, toes was rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5009, which provides that other types of arthritis will be rated as rheumatoid arthritis under Diagnostic Code 5002.

For active rheumatoid arthritis, a 20 percent rating is assigned for one or two exacerbations a year in a well-established diagnosis; a 40 percent rating is assigned with symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year. A 60 percent rating is assigned where manifestations are less than commensurate with the criteria for a 100 percent rating but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods. A 100 percent rating is assigned with constitutional manifestations associated with active joint involvement, totally incapacitating. 38 C.F.R. § 4.71a, Diagnostic Code 5002.

Chronic residuals of rheumatoid arthritis are to be rated on the basis of limitation of motion or ankylosis of the specific joints affected. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5002. A Note to the Code provides that the rating for active process cannot be combined with that for residuals based on limitation of motion or ankylosis; the higher rating is to be assigned.

Degenerative arthritis established by X-ray findings will also be rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003.

The Board finds that prior to September 16, 2021, a compensable rating for psoriatic arthritis, bilateral feet, ankles, wrists, hands, fingers, toes is not warranted. In this regard, the Veteran complained of joint pain due to his psoriatic arthritis. However, there was no evidence on VA examination in August 2014 or in any private or VA treatment records of degenerative arthritis, confirmed by X-ray, in the joints affected or evidence of limitation of joint motion attributable to the Veteran's arthritis condition.  Accordingly, the Board finds that prior to September 16, 2021, a compensable rating under  diagnostic codes 5002 is not warranted.

Period Beginning September 16, 2021

As noted above, in an October 2021 rating decision, the RO recharacterized the Veteran's psoriatic arthritis disability as psoriatic arthritis of the cervical spine, and granted an increased rating of 10 percent, under Diagnostic Code 5242, effective September 16, 2021.

Under the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain, whether or not it radiates, stiffness, or aching in the area of the spine affected by the residuals of injury or disease, a 10 percent evaluation is warranted when there is forward flexion of the cervical spine greater than 30 degrees, but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height.

A 20 percent evaluation is warranted when there is forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

A 30 percent evaluation is warranted when there is forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine.

Unfavorable ankylosis of the entire cervical spine is evaluated as 40 percent disabling.

Unfavorable ankylosis of the entire spine is evaluated as 100 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5237.

Note (1) permits the evaluation of any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

For VA compensation purposes, normal forward flexion of the cervical spine is 0 to 45 degrees, extension is 0 to 45 degrees, and left and right lateral rotation are 0 to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Each range of motion measurement should be rounded to the nearest five degrees. See Plate V, 38 C.F.R. § 4.71 and 38 C.F.R. § 4.71a, Notes (2) and (4).

In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a, Note (3).

For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphasia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, Note (5).

Diagnostic Code 5243 for intervertebral disc syndrome is rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25.

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. A 10 percent rating for intervertebral disc syndrome requires incapacitating episodes having a total duration of one week but less than 2 weeks during the past 12 months. The 20 percent rating for intervertebral disc syndrome, requires incapacitating episodes of at least 2 weeks but less than 4 weeks during the past 12 months. With incapacitating episodes having a total duration of 4 weeks but less than 6 weeks during the past 12 months, a 40 percent rating is warranted. Finally, with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5243.

An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. § §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § § 4.59.

During this period, there is no evidence of forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine 170 degrees or less; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. In this regard, on VA examination in August 2021, the examiner noted that the Veteran has polyarthralgia of multiple joints, including the cervical spine. However, there was no indication of any limitation of motion. Furthermore, there is no evidence of any neurological abnormalities, or any IVDS with incapacitating episodes of at least 2 weeks but less than 4 weeks in a 12-month period. In this regard, on VA examination in August 2021, the Veteran reported incapacitating exacerbations of his arthritis of 1-2 weeks in the previous 12 months, which he described as episodes of severe symptoms once every 1-2 months that require treatment with an oral Medrol dose pack and/or steroid infusions. The definition of an incapacitating episode under Diagnostic Code 5243 is a period of acute signs and symptoms due to intervertebral disc syndrome (IVDS) that requires bed rest prescribed by a physician and treatment by a physician. The Board notes that the Veteran has not been diagnosed with IVDS, and there is no evidence that he has been prescribed bedrest by a physician to treat his psoriatic arthritis. As such, the Board finds that a rating in excess of 10 percent is not warranted for the cervical spine disability during this period on appeal under the General Rating Formula or Diagnostic Code 5242.

The Board has considered whether there is any other schedular basis for granting a higher rating other than that discussed above, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim for a higher schedular rating. 38 U.S.C. § 5107 (b); 38 C.F.R.  §§ 4.7, 4.21.

With regard to functional impairment, during this period, the Veteran reported that he can't exercise due to polyarthralgia, burning pain, paresthesias, numbness, tingling and stiffness, and chronic fatigue, and as a result, he has gained weight. He also reported that he regularly uses a wheelchair, and that he lost 2-4 weeks from his job as a nurse anesthetist, in a year. Notwithstanding the Veteran's reports, as noted, there is no evidence of limitation of motion of the cervical spine due to the Veteran's psoriatic arthritis. Painful motion can equate to limitation of motion. Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). However, pain alone does not constitute a functional loss under VA regulations that evaluate disability based upon range-of-motion loss. Mitchell v. Shinseki, No. 09-2169 (U.S. Vet. App. Aug. 23, 2011). The Board finds that any functional impairment the Veteran experienced during this period was already considered with the assignment of the current 10 percent rating. Therefore, the Board finds that a rating in excess of 10 percent, based on functional impairment, is also not warranted. 38 C.F.R. § §§ 4.40, 4.45, and 4.59.

Consideration under 38 C.F.R. § § 3.321 (b)(1) has not been specifically sought by the Veteran or reasonably raised by the facts found by the Board. As such, there is no basis for extraschedular discussion in this case. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016).	 

 

KELLI A. KORDICH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	F. Yankey, 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.