Citation Nr: 21011974 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 00-01 083 DATE: March 3, 2021 ORDER A rating of 20 percent, but no higher, for right lower extremity peripheral neuropathy is granted. A total disability rating based on individual unemployability (TDIU) is granted. A rating in excess of 40 percent for a right ankle disability on an extraschedular basis is denied. FINDINGS OF FACT 1. The competent and probative evidence is at least in equipoise as to whether the Veteran’s right lower extremity peripheral neuropathy is manifest by moderate incomplete paralysis of the peroneal nerve. 2. The competent and probative evidence is at least in equipoise as to whether the impairment caused by the Veteran’s service-connected disabilities precluded substantially gainful employment. 3. The competent and probative evidence is against finding that the Veteran’s right ankle disability presented an exceptional disability picture or resulted in marked interference with employment, socialization, or frequent hospitalizations. CONCLUSIONS OF LAW 1. The criteria for a rating of 20 percent, but no higher, for right lower extremity peripheral neuropathy, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code (DC) 8521. 2. The criteria for a TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. 3. The criteria for a rating over 40 percent for a right ankle disability on an extraschedular basis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5003-5270. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1966 to November 1970. This case is before the Board of Veterans’ Appeals (Board) on appeal from a June 1999 and January 2000 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In February 2002, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) who is no longer at the Board. The transcript of the hearing has been associated with the record. In a June 2002 decision, the Board denied the claim of rating in excess of 40 percent for a right ankle disability and a TDIU. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (CAVC). In a February 2003 Order, the CAVC granted a Joint Motion for Remand (JMR), vacated the Board’s June 2002 decision, and remanded for further development. The Board remanded this case for further development in February 2004 and October 2011. In January 2017, VA had advised the Veteran that the VLJ he testified before is no longer with the Board and offered him a hearing before a new VLJ. In February 2017, the Veteran responded that he did not wish to appear at another Board hearing and requested that his claim be considered on the evidence of record. In July 2017, the Board remanded the issue of TDIU and denied the claim of a rating in excess of 40 percent for the Veteran’s right ankle disability and assigned a separate 10 percent rating for incomplete paralysis of the anterior tibial nerve associated with the service-connected right ankle disorder. In June 2018, the Court granted a joint motion for partial remand (JMPR), vacated the Board’s decision, and remanded the matter for action consistent with the JMPR. In June 2019, the Board remanded all issues on appeal. This claim was referred to the Director of Compensation and Pension Service for consideration in the first instance of an extraschedular rating. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating 1. Right lower extremity peripheral neuropathy. The Veteran contends that he is entitled to a 20 percent evaluation for his right lower extremity peripheral neuropathy. 10/03/2017, NOD. The record also contains an argument that the Veteran has lost the use of his right foot. See 01/16/2004, Correspondence. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, VA will assign the higher evaluation if the disability picture more nearly approximates the criteria required for that rating. Otherwise, it will assign the lower rating. 38 C.F.R. § 4.7. VA resolves any reasonable doubt regarding the degree of disability in favor of the Veteran. 38 C.F.R. § 4.3. In the case of an initial rating, the entire evidentiary record from the time of a veteran’s claim for service connection to the present is of importance in determining the proper evaluation of the disability. Fenderson v. West, 12 Vet. App. 119 (1999). Where a claimant appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). In evaluating a disability, the current examination reports in light of the whole recorded history are considered to ensure that the current rating accurately reflects the severity of the disorder. The medical, as well as industrial history, is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder is not duplicative of the symptomatology of the other disorder. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Veterans are competent to report observable symptoms in the realm of their personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information, including lay and medical evidence, of record in a case. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). The higher evaluation will be assigned when two disability evaluations are potentially applicable, and the disability picture more nearly approximates the criteria for the higher rating. 3 8 C.F.R. § 4.7. VA has an independent obligation to consider all potentially applicable provisions of law and regulation and to apply the diagnostic criteria in a manner that maximizes benefits. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); Bradley v. Peake, 22 Vet. App. 280 (2008). The Veteran’s right lower extremity peripheral neuropathy is rated at 10 percent disabling under DC 8523. The Veteran was diagnosed as having peroneal neuropathy in November 1991. See 08/14/2006, Medical Treatment Record (MTR)–Non-Government Facility (NGF). An electromyography (EMG) demonstrates the peroneal neuropathy affects the Veteran’s deep peroneal (anterior tibial) nerve and external popliteal (common peroneal) nerve. Diseases affecting the nerves are rated based on the degree of paralysis, neuritis, or neuralgia under 38 C.F.R. §§ 4.123, 4.124, and 4.124a. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, can receive a maximum rating of severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuritis not characterized by organic changes can receive a maximum rating of moderate, incomplete paralysis. Id. Neuralgia characterized usually by a dull and intermittent pain, of typical distribution can receive a maximum rating of moderate incomplete paralysis. 38 C.F.R. § 4.124. Under DC 8523 for paralysis of the anterior tibial nerve, mild incomplete paralysis is noncompensable. Moderate incomplete paralysis is rated as 10 percent disabling. Severe incomplete paralysis is rated as 20 percent disabling. Complete paralysis is rated as 30 percent disabling and is manifest by loss of dorsal flexion of the foot. 38 C.F.R. § 4.124a, DC 8523. Neuritis and neuralgia of the common peroneal nerve are evaluated under DC 8621 and DC 8721. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 disabling. C.F.R § 4.124a. Under DC 8521 for paralysis of the common peroneal nerve, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis is rated as 40 percent disabling and is manifest by loss of dorsal flexion of the foot, as well as foot drop and slight droop of the first phalanges of all toes, dorsal flexion of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes. 38 C.F.R. § 4.124a, DC 8521. Loss of dorsal flexion of the foot is also a consideration under DC 5270, in which the Veteran has a separate service-connected disability under the maximum rating available for complete ankylosis. The loss of dorsal flexion will not be considered in the rating of the right peroneal neuropathy to avoid pyramiding as it is duplicative of the symptomatology of the service-connected right ankle disability. See Esteban, 6 Vet. App. at 262. 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 assigned based on 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 levels 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 the 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). After reviewing the relevant medical and lay evidence and applying the above laws and regulations, a disability rating of 20 percent, but no higher, for a right foot disability is warranted. The record demonstrates the Veteran uses a cane to walk and has done so throughout the period on appeal, except the period he was recovering from his non-service-related meningoencephalitis in 2008 and 2009. See 12/09/2017, CAPRI. A private March 2000 treatment note indicates the Veteran has numbness in the foot that travels to the leg, decreased sensation in his toes, moderate discomfort with hindfoot and midfoot motion, a dysesthetic Tinel’s over his tarsal tunnel, weak pulses, and skin intact. 08/14/2006, MTR–NGF. A January 2001 VA foot evaluation describes foot numbness but no pain, burning, or tingling. 09/10/2002, CAPRI. In a February 2003 diabetic foot examination, the examiner noted abnormal findings of corn, callus, thickened or ingrown nails, dry and cracking skin, and diminished or absent bilateral dorsalis and posterior pedal pulse. 12/09/2017, CAPRI. A private examiner observed the Veteran has atrophy of his right leg muscle. 01/26/2004, MTR, NGF. A June 2004 VA examiner noted the Veteran felt a stabbing pain in his foot and toes, was unable to flex his first three toes, and wore a right leg and foot brace. 06/02/2004, VA Examination. In a February 2005 diabetic foot examination, the examiner noted abnormal findings of thickened or ingrown nails, diminished or absent right posterior pedal pulse, and partially decreased sensation in each foot. 12/09/2017, CAPRI. A private November 2005 treatment note contains complaints of the foot feeling asleep and numbness and tingling from toes to thighs. The physician observed a four-centimeter girth difference in the thigh muscles (atrophy), a slight movement in the midfoot, no active motion of the great toe, very slight toe extension, and great toe passive extension limited to about 20 degrees. The November 2005 note mentioned that a collapse of the foot caused the Veteran to fall in March 2000. 08/14/2006, MTR–NGF. In a June 2006 VA examination, the Veteran stated his walking is very limited by a heart condition, but he can walk around the block twice each day even though it is a bit slow. The Veteran said he could not move his toes; however, the examiner noted they could move the toes for the Veteran, and he was able to resist movement in the toes, so some active function of those muscles is present. The examiner found sensory function was good in all areas. 06/20/2006, VA examination. In a May 2007 diabetic foot examination, the examiner noted abnormal findings of a partially insensate foot inspection and decreased dorsalis pedal pulse bilaterally. 12/09/2017, CAPRI. In a July 2009 diabetic foot examination, foot sensory, foot inspection, and foot pulse were normal. Id. In a February 2011 diabetic foot examination, the examiner noted a partially insensate foot inspection but normal nail pathologies and foot pulse. Id. In a July 2014 VA examination, the Veteran stated he does not have a foot condition other than neuropathy. The VA examiner determined the Veteran had moderate incomplete paralysis of the anterior tibial (deep peroneal) nerve; however, no EMG study was performed. A sensory examination of the foot and toes (L5) was normal; however, the examiner noted severe numbness of the right lower extremity. The trophic change of lower extremity hair loss was also observed. 07/25/2014, C&P Exam. A February 2019 VA examination notes moderate constant and intermittent pain, moderate paresthesia/dysesthesia, and moderate numbness in the right lower extremity. The examiner observed no muscle atrophy. The sensory examination demonstrated normal sensation in the thigh and knee but decreased sensation in the lower leg, ankle, foot, and toes. The examiner observed trophic changes of hair loss and scaly skin. An EMG was performed, and the examiner found moderate incomplete paralysis of the right common peroneal nerve and right deep peroneal nerve. The February 2019 VA examiner explained the findings were indicative of a right peroneal neuropathy but no definite electrophysiological evidence of right medial or lateral plantar neuropathy. 02/07/2019, C&P Exam. The Veteran underwent many fall risk screenings during the period on appeal, and he consistently denied feeling unsteady when standing or walking, with exception to the November 2005 treatment note referring to a March 2000 fall and the period he was recovering from his non-service related meningoencephalitis in 2008 and 2009. See 01/17/2020, MTR–GF; 07/03/2019, CAPRI; 02/20/2019, CAPRI; 12/09/2017, CAPRI; 08/14/2006, MTR–NGF. An evaluation of the foot in December 2019 showed no visual abnormalities, normal pulse, normal and present sensory check using monofilament, and normal and intact sensory to monofilament. 01/17/2020, MTR–GF. Based on the above, the peroneal neuropathy throughout the entire period on appeal is primarily manifest by hair loss, moderate constant and intermittent pain, moderate paresthesia/dysesthesia, moderate to severe numbness, some loss in the range of motion of toes and foot, and at times slight atrophy of the right leg. The most probative evidence of record is against a finding that the disability is manifest by foot drop and slight droop of the first phalanges of all toes, dorsal flexion of proximal phalanges of toes lost, abduction of foot lost, adduction weakened; anesthesia covering entire dorsum of foot and toes. The impairment level is most analogous to moderate incomplete paralysis as the evidence does not demonstrate a consistent manifestation of severe symptoms or complete paralysis; indeed, many times throughout the appeal period right foot sensory has been found normal. The lay assertions of complete loss of use of the right foot have been considered; however, during the period on appeal, the evidence of record demonstrates the right foot is intact, retains some sensation and motion, and is fit for walking. The competent and probative evidence is at least in equipoise as to whether the Veteran has moderate incomplete paralysis of the common peroneal nerve. Under DC 8521, a rating of 20 percent, but no higher, is warranted. The Veteran’s reports of constant pain and numbness support a finding that the symptoms more closely approximate moderate incomplete paralysis of the common peroneal nerve. Moderate constant pain, moderate paresthesias/dysesthesias, moderate numbness, decreased sensation to light touch, and atrophy are contemplated by the ratings for moderate incomplete paralysis of the common peroneal nerve. All other potentially applicable Diagnostic Codes have been considered, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves or a musculoskeletal disability that has not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. Schafrath, 1 Vet. App. 589. TDIU 2. Entitlement to TDIU. VA may grant a total disability rating where the schedular rating is less than 100 percent, and the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16. Generally, to be eligible for TDIU, a percentage threshold must be met. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If there is only one service-connected disability, or two or more with the same etiology or affecting the same body system, the disability rating must be 60 percent or more. 38 C.F.R. § 4.16(a). If there are two or more disabilities, there shall be at least one disability rated at 40 percent or more and sufficient additional disabilities to bring the combined rating to 70 percent or more. The Veteran’s service-connected disabilities include depression (50 percent from March 7, 2003, and 70 percent from December 15, 2017), right ankle disability (40 percent from March 3, 1999), left shoulder tendonitis (20 percent from June 11, 2007), right lower extremity peripheral neuropathy (20 percent from March 3, 1999), left ankle degenerative joint disease (10 percent from September 1, 1999), right shoulder degenerative joint disease (10 percent from August 2002), bilateral carpal tunnel syndrome (10 percent each from June 11, 2007), residuals of a right index finger injury (noncompensable from November 28, 1970), residuals of a left little finger fracture (noncompensable from August 9, 2002), right shoulder scar (noncompensable from August 9, 2002), and right carpal tunnel scar (noncompensable from June 11, 2007). The combined evaluation is noncompensable from November 28, 1970, 60 percent from March 3, 1999, 70 percent from September 1, 1999, 90 percent from March 7, 2003, and 100 percent from June 11, 2007. The percentage threshold for schedular TDIU was met as of September 1, 1999. See 38 C.F.R. § 4.25. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. The question is whether the veteran can perform the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). The Board must, therefore, evaluate whether there are circumstances, apart from any non-service-connected conditions and advancing age, which would justify a total rating based on unemployability. See id.; see also 38 C.F.R. § 4.16(b). In making this determination, consideration may be given to his or her level of education, special training, and previous work experience, but not to his or her age or occupational impairment caused by non-service-connected disabilities. Marginal employment or employment provided on account of disability or special accommodation is not substantially gainful. See 38 C.F.R. §§ 3.341, 4.16, 4.18, 4.19 (2017); Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992); Faust v. West, 13 Vet. App. 342 (2000). An individual’s particular circumstance is the basis for entitlement to TDIU. Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Veterans are competent to report observable symptoms in the realm of their personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). 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(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). After resolving all reasonable doubt in favor of the Veteran, a review of the record demonstrates the competent and probative evidence is at least in equipoise as to whether the Veteran’s service-connected disabilities render him unable to secure and maintain substantially gainful employment. The record demonstrates that the Veteran’s highest level of education is three years of junior college, and the Veteran worked as a letter carrier for the U.S. Postal Service (USPS), sorting and delivering mail, for about 27 years. See 08/03/2018, Medical Opinion; 12/09/2017, CAPRI. The exact date of the Veteran’s retirement is inconsistent in the record, noting dates from 1988 to 2000. The evidence demonstrates the Veteran has had an antalgic and slow gait due to his lower extremity disabilities since at least 1986, which would not allow for effective mail delivery. A July 2014 VA examiner opined the Veteran’s shoulder disability would impede physical activities requiring the use of arms above his head and mainly physical labor, and his depression results in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or symptoms controlled by medication. See 07/10/2014, C&P Exam. A July 2018 private vocational expert opined, considering the Veteran’s highest level of education being the completion of high school and his employment history at USPS, that the Veteran’s unemployability due to his physical problems began in 2002 when he became service-connected for his right shoulder disability. The vocational expert noted the Veteran also separately became unemployable in 2003 due to his service-connected depression. 08/03/2018, Medical Opinion. The July 2018 private vocational expert opinion was based on inaccurate information regarding the Veteran’s educational history. Compare 08/03/2018, Medical Opinion with 12/09/2017, CAPRI. Considering the above, the competent and probative evidence is at least in equipoise as to whether the Veteran’s service-connected disabilities render him unable to secure and maintain gainful employment. Specifically, the functional impairment resulting from his service-connected upper and lower extremity disabilities, when taken in conjunction with the Veteran’s service-connected depression and occupational history, preclude gainful employment as of March 27, 2003. Extraschedular Rating 3. Right ankle disability. The Veteran and his representative contend the Veteran is entitled to an extraschedular rating for his right ankle disability during the period on appeal for the following reasons: the loss of his right foot function, the several hospitalizations and surgeries for his right ankle, atrophy of the right leg, and the inability to drive his car because of the right ankle disability. 12/27/2018, Correspondence; 07/08/2011, Correspondence; 01/16/2004, Correspondence Regarding the contention that an extraschedular rating is warranted due to the loss of his right foot function, the issue of entitlement to special monthly compensation (SMC) based on the loss of use of the right foot is pending. Further, the Veteran’s right foot disability, which as noted by the Veteran is manifest exclusively by peripheral neuropathy, is service connected as secondary to the right ankle disability with a disability rating under DC 8521, as discussed above. See also 07/25/2014, C&P Exam. Right ankle numbness and atrophy are also symptoms covered under DC 8521 for peripheral neuropathy of the common peroneal nerve. Regarding the contention that an extraschedular rating is warranted due to several hospitalizations and surgeries of the right ankle, the Veteran does not note any specific ankle-related surgeries or hospitalizations during the appeal period, and the record does not contain any evidence of any ankle-related surgeries or hospitalizations during the period on appeal. The Veteran has had right ankle surgeries prior to the period on appeal, but as those were before the period on appeal, only the manifestations of residuals of the surgeries during the period on appeal can be considered in determining the Veteran’s right ankle disability picture for the period on appeal. Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran’s disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant’s symptoms to the rating criteria, while the second addresses the effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran’s disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. Indeed, the Board did refer this case to the Director of Compensation Services. The Director’s advisory opinion determined an extra-schedular evaluation for the service-connected residuals of an old fracture of the right ankle and right lower extremity peripheral neuropathy is not warranted. 10/27/2020, VA Memo. Regarding the first element, a comparison of the Veteran’s symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The record shows that he has complaints and findings of pain and ankylosis. DC 5003-5270 does not specifically list the Veteran’s symptoms of pain; however, the Rating Schedule specifically contemplates factors such as weakened movement, excess fatigability, pain on movement, disturbance of locomotion, and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). The schedular criteria for musculoskeletal disabilities contemplate a wide variety of functional loss manifestations, and pain is a common and wholly considered manifestation of functional loss. Because the Rating Schedule was purposely designed to compensate for such functional effects of the Veteran’s disabilities in all spheres of his daily life, including at work, at home, and driving a car, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the schedular rating criteria reasonably describe the Veteran’s disability picture, including his difficulties driving his car. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. During the period, the Veteran’s right ankle symptoms are not so severe, alone, as to cause marked interference with employment or frequent hospitalizations. Notably, the Veteran continues to go on walks daily and has had no ankle-related hospitalizations during the period on appeal. See 02/20/2019, CAPRI; 12/09/2017, CAPRI. The Veteran’s disability picture does not exhibit other related factors such as marked interference with employment or frequent periods of hospitalization that would warrant further extraschedular consideration. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Costa, 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.