Citation Nr: 21073848 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 14-13 227 DATE: December 10, 2021 ORDER Entitlement to a disability rating in excess of 30 percent for bilateral open angle glaucoma with bilateral dry eye syndrome associated with type II diabetes mellitus with nephropathy and erectile dysfunction is denied. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the right lower extremity with radiculopathy associated with type II diabetes mellitus with nephropathy and erectile dysfunction is denied. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the left lower extremity with radiculopathy associated with type II diabetes mellitus with nephropathy and erectile dysfunction is denied. FINDINGS OF FACT 1. The Veteran's bilateral open angle glaucoma with bilateral dry eye syndrome manifests as impaired visual acuity to no worse than 20/40 bilaterally; impaired visual fields with an average concentric contraction of no less than 31 degrees bilaterally; without diplopia nor incapacitating episodes. 2. The Veteran's peripheral neuropathy of the bilateral lower extremities with radiculopathy is manifest by no more than mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 30 percent for bilateral open angle glaucoma with bilateral dry eye syndrome have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.75-4.79, Diagnostic Code 6013, Diagnostic Code 6066, Diagnostic Code 6080. 2. The criteria for a disability rating in excess of 20 percent for peripheral neuropathy of the right lower extremity with radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 3. The criteria for a disability rating in excess of 20 percent for peripheral neuropathy of the left lower extremity with radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1966 until his honorable discharge in July 1968. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). These matters come before the Board of Veterans' Appeals (Board) on appeal from the August 2014 and January 2015 rating decisions by the Guaynabo, Puerto Rico and San Diego, California Regional Offices (ROs) of the United States Department of Veterans Affairs (VA). In March 2018, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the record on appeal. In September 2018 and April 2020, the Board remanded the case to the RO for further development. Specifically, Board directed in the most recent remand for the RO to obtain the most recent results pertaining to the Veteran's eye disability and to obtain an opinion if the Veteran has radiculopathy secondary to his service-connected lumbar strain. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The 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. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. 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 any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 1. Entitlement to a disability rating in excess of 30 percent for bilateral open angle glaucoma and dry eye syndrome associated with type II diabetes mellitus with nephropathy and erectile dysfunction The Veteran asserts that he is entitled to a higher disability rating. As a preliminary matter, the Board finds that a change in the Veteran's assigned Diagnostic Code is warranted. The Board notes that the Court has held that the selection of a particular Diagnostic Code "is a determination that is completely dependent upon the facts of a particular case," and the Board has discretion in determining the appropriate Diagnostic Code. Butts v. Brown, 5 Vet. App. 532, 538 (1993) (applying the more deferential "arbitrary, capricious" standard, rather than de novo review, to the Board's determination of the appropriate Diagnostic Code). The Veteran is currently assigned a 30 percent disability rating under Diagnostic Code 6080 for bilateral open angle glaucoma. Diagnostic Code 6080 provides disability ratings for impairment of the visual field. Accordingly, the Veteran is currently being rated for impairment of the visual field for his bilateral open angle glaucoma. However, the Veteran's VA examinations demonstrated that the Veteran has glaucoma. Therefore, the Board finds that a rating under Diagnostic Code 6080 is not the appropriate Diagnostic Code to rate the Veteran's disability. The evidence does show that the Veteran has glaucoma and is service-connected for glaucoma. As such, the Board finds that a rating under Diagnostic Code 6013 for open angle glaucoma is the more appropriate Diagnostic Code. Accordingly, the Board finds that the appropriate Diagnostic Code for the Veteran's disability is Diagnostic Code 6013. The Board further notes that the Veteran's current disability has been rated under Diagnostic Code 6080 for 12 years and is afforded protection under 38 U.S.C. § 1159. However, the Board finds that a change in the Diagnostic Code will not result in a reduction of the current disability rating or severance of service connection. Therefore, the Board finds that a change in the Diagnostic Code does not violate the Veteran's rights under 38 U.S.C. § 1159. In contrast, the change in Diagnostic Code affords evaluation under the General Rating Formula for Diseases of the Eye, which considers incapacitating episodes, impairment of central visual acuity, and impairment of the visual field. Finally, the Board notes that the Veteran's eye disabilities are only service-connected for open-angle glaucoma, and as will be addressed in greater detail below, now also includes dry eye syndrome. The Veteran's additional eye disabilities, including but not limited to refractive error (hypermetropia, astigmatism, presbyopia), bilateral pseudophakia, degenerative retinal drusen are not service connected. Evaluations of defective vision from noncompensable to 100 percent based on organic impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. §§ 4.76(a), 4.79. The examination for visual impairment must be conducted by a licensed optometrist or by a licensed ophthalmologist and the examiner must identify the disease, injury, or any other pathologic found. 38 C.F.R. § 4.76(b). Examination of visual fields or muscle function will be conducted only when there is a medical indication of disease or injury that may be associated with visual field defect or impaired muscle function. Id. Unless medically contraindicated, the fundus must be examined with the Veteran's pupils dilated. Id. Unless otherwise directed, evaluate diseases of the eye under the General Rating Formula for Diseases of the Eye. 38 C.F.R. § 4.79, Diagnostic Codes 6000 through 6009. Impairment of Visual Acuity is rated under Diagnostic Codes 6061 through 6066. Impairment of Visual Fields is rated under Diagnostic Codes 6080 through 6081. Diagnostic Code 6013 provides that open-angle glaucoma is to be evaluated under the General Rating Formula for Diseases of the Eye with a minimum evaluation of 10 percent if continuous medication is required. 38 C.F.R. § 4.79, Diagnostic Code 6013. During the pendency of the Veteran's appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that address the organics of special sense and schedule of ratings-eye. 83 Fed. Reg. 15316 (April 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Under both the former and revised criteria, a 10 percent disability rating is warranted for localized scars, atrophy, or irregularities of the retina, unilateral or bilateral, that are centrally located and that result in an irregular, duplicated, enlarged, or diminished image. Both versions of the criteria also provide for an alternative basis for the evaluation if it results in a higher disability rating. Under the former criteria, the alternative evaluation is based on the General Rating Formula for Diseases of the Eye. The General Rating Formula for Diseases of the Eye instructs to evaluate the disability based on visual impairment or its rating criteria for incapacitating episodes. Thus, the primary difference between the former and revised criteria is consideration of incapacitating episodes. Prior to the May 13, 2018 changes, the criteria under the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. 38 C.F.R. § 4.79. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent disability rating is warranted. A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. Id. From May 13, 2018; the criteria under the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. 38 C.F.R. § 4.79. Where documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition in the past 12 months, a 10 percent disability rating is warranted. Where documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition in the past 12 months, during the past 12 months, a 20 percent disability rating is warranted. Where documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition in the past 12 months, during the past 12 months, a 40 percent disability rating is warranted. Where documented incapacitating episodes requiring 7 or more treatment visits for an eye condition in the past 12 months, during the past 12 months, a 60 percent disability rating is warranted. The Board also notes that the May 2018 changes also included a change to the Note(s) under General Rating Formula for Diagnostic Codes 6000 through 6009. Specifically, prior to the May 2018 changes, the Note provided "For VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider." However, subsequent to the May 2018 changes, there are now three notes under General Rating Formula for Diagnostic Codes 6000 through 6009. Note: (1) provides "For the purposes of evaluation under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note: (2) provides "examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions." Note: (3) provides for the purposes of evaluating visual impairment due to the particular condition, refer to 38 C.F.R. §§ 4.75 through 4.78 and 4.79, Diagnostic Codes 6061-6091. The Board notes that the Veteran does not assert, nor does the evidence reflect, that the Veteran has had any incapacitating episodes under either the former nor current criteria. Therefore, the evaluation shall be done on the basis of visual impairments due to the Veteran's service-connected disabilities. Examinations of visual acuity must include the central uncorrected and corrected visual acuity for distance and near vision using Snellen's test type or its equivalent. 38 C.F.R. § 4.76(a). Evaluation of central visual acuity on the basis of corrected distance vision with central fixation, even if a central scotoma is present. 38 C.F.R. § 4.76(b). However, when the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, evaluate the visual acuity of the poorer eye using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. Id. For evaluations of restrictions in visual field(s), the examiner must use either Goldmann kinetic perimetry or automated perimetry using Humphrey Model 750, Octopus Model 101, or later versions of these perimetric devices with simulated kinetic Goldmann testing capability. 38 C.F.R. § 4.77. Determination of the average concentric contraction of the visual field of each eye by measuring the remaining visual field (in degrees) at each of the eight principal meridians 45 degrees apart, adding them, and dividing the sum by eight. 38 C.F.R. § 4.77(b). To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of 38 C.F.R. § 4.25. A May 2014 VA examination reveals that the Veteran had bilateral pseudophakia, bilateral open-angle glaucoma (requiring continuous medication), and dry eye. 05.06.2014 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/25 20/20 20/50 20/20 LEFT 20/30 20/20 20/40 20/20 The May 2014 VA examination also revealed that the Veteran has a documented visual field defect, specifically a contraction of the visual field. Normal Right Left Up 45 28 24 Up Temporally 55 35 30 Temporally 85 42 45 Down Temporally 85 61 58 Down 65 41 33 Down Nasally 50 38 39 Nasally 60 39 40 Up Nasally 55 35 28 The Veteran's average concentric contraction of the visual field of each eye results in a right eye contraction of 39.875 degrees and left eye contraction of 37.125 degrees. Based on the evidence above, a rating in excess of 30 percent for the Veteran's loss of visual acuity and visual field is not warranted. The Veteran's visual acuity of 20/20 corrected distance bilaterally warrants a noncompensable disability rating. Additionally, the Veteran's average contraction of the visual field of 31 to 45 degrees bilaterally warrants a 30 percent disability rating. Combining the Veteran's results for visual acuity disability rating of a noncompensable disability rating and contraction of visual field disability rating of 30 percent results in a combined disability rating of 30 percent disabling. A December 2014 VA examination reveals that the Veteran had bilateral open angle glaucoma, bilateral dry eye syndrome, bilateral pseudophakia, bilateral pinguecula, corneal arcus, and corneal scars from cataract surgery. 12.30.2014 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/50 20/40 or better 20/200 20/40 or better LEFT 20/50 20/40 or better 20/200 20/40 or better The December 2014 VA examination also revealed that the Veteran has a documented visual field defect, specifically a contraction of the visual field. Normal Right Left Up 45 38 38 Up Temporally 55 50 52 Temporally 85 72 74 Down Temporally 85 68 68 Down 65 55 50 Down Nasally 50 40 35 Nasally 60 57 50 Up Nasally 55 42 45 The Veteran's average concentric contraction of the visual field of each eye results in a right eye contraction of 52.75 degrees and left eye contraction of 51.50 degrees. The Board notes that the December 2014 VA examiner opined that the Veteran's impairment of visual acuity and impairment of visual fields are not related to his service-connected open-angle glaucoma. Based on the evidence above, a disability rating in excess of 30 percent for the Veteran's loss of visual acuity and visual field defects is not warranted. The Veteran's visual acuity of 20/40 or better corrected distance bilaterally warrants a noncompensable disability rating. Additionally, the Veteran's average contraction of the visual field of 46 to 60 degrees bilaterally warrants a 10 percent disability rating (if the impairment of the visual field was related to the Veteran's service-connected open-angle glaucoma). Combining the Veteran's results for visual acuity disability rating of a noncompensable disability rating and contraction of visual field disability rating of 10 percent results in a combined disability rating of 10 percent disabling (if the impairment of the visual field was related to the Veteran's service-connected open-angle glaucoma). However, although the December 2014 VA examiner opined that the Veteran's loss of visual acuity and visual field are not related to his service-connected glaucoma, the Veteran would still be entitled to a disability rating of 10 percent as a minimum disability rating for open-angle glaucoma requiring continuous medication. An April 2019 VA examination reveals that the Veteran had bilateral open angle glaucoma, bilateral pingueculae, bilateral pseudophakia, bilateral corneal arcus, and bilateral dry eye syndrome. 04.08.2019 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/40 20/20 or better 20/50 20/20 or better LEFT 20/50 20/20 or better 20/40 20/20 or better The April 2019 VA examination also revealed that the Veteran has a documented visual field defect, specifically a contraction of the visual field. Normal Right Left Up 45 42 35 Up Temporally 55 49 55 Temporally 85 75 75 Down Temporally 85 70 70 Down 65 60 58 Down Nasally 50 50 45 Nasally 60 60 60 Up Nasally 55 54 53 The Veteran's average concentric contraction of the visual field of each eye results in a right eye contraction of 57.5 degrees and left eye contraction of 56.375 degrees. Based on the evidence above, a disability rating in excess of 30 percent for the Veteran's loss of visual acuity and visual field is not warranted. The Veteran's visual acuity of 20/20 corrected distance bilaterally warrants a noncompensable disability rating. Additionally, the Veteran's average contraction of the visual field of 46 to 60 degrees bilaterally warrants a 10 percent disability rating. Combining the Veteran's results for visual acuity disability rating of a noncompensable disability rating and contraction of visual field disability rating of 10 percent results in a combined disability rating of 10 percent disabling. A December 2020 VA examination reveals that the Veteran had bilateral open-angle glaucoma, bilateral dry eye syndrome, posterior chamber intraocular lenses, pinguecula bilateral nasal and temporal. 12.15.2020 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/70 20/20 or better 20/100 20/20 or better LEFT 20/70 20/20 or better 20/100 20/20 or better The December 2020 VA examination also revealed that the Veteran no longer had a documented visual field defect. Based on the evidence above, a disability rating in excess of 30 percent for the Veteran's loss of visual acuity is not warranted. The Veteran's visual acuity of 20/20 corrected distance bilaterally warrants a noncompensable disability rating. Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a disability rating in excess of 30 percent for a loss of visual acuity and impairment of visual field. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the right lower extremity with radiculopathy associated with type II diabetes mellitus with nephropathy and erectile dysfunction 3. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the left lower extremity with radiculopathy associated with type II diabetes mellitus with nephropathy and erectile dysfunction Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below. The Veteran asserts that he is entitled to a higher rating for his peripheral neuropathy of the bilateral lower extremities with radiculopathy. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123 Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124.] Regarding impairment of motor functions, the Veteran has normal muscle functions. Regarding trophic changes, the Veteran has bilateral shin loss of hair and skin darkening. Regarding sensory disturbance, the Veteran has decreased light touch in the left ankle/lower leg and bilateral feet/toes. Regarding loss of reflexes, the Veteran has decreased deep tendon reflexes in his left knee and left ankle. Regarding pain, the Veteran reports moderate intermittent pain (usually dull), numbness, and paresthesias and/or dysesthesias in his bilateral lower extremities. Regarding muscle atrophy, the Veteran does not have muscle atrophy. Regarding complete paralysis, the Veteran does not have complete paralysis. In contrast, the Veteran has mild incomplete paralysis of his bilateral sciatic nerves. Based on the above, the Board finds that the disability is primarily manifest by trophic changes, sensory disturbance, loss of reflexes, pain, and incomplete paralysis. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, muscle atrophy, nor complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis. The Board acknowledges that the Veteran uses an assistive device due to his peripheral neuropathy of the bilateral lower extremities with radiculopathy. However, 38 C.F.R. § 4.120 "contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker." Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). The Board acknowledges the Veteran's assertion that his symptoms are not contemplated under the schedular criteria. However, given the broad nature of § 4.120, finding symptoms not contemplated by 'impairment of motor, sensory or mental function' language presents quite a challenge." Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Deemer, 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.