Citation Nr: 21025456 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-09 998 DATE: April 28, 2021 ORDER Prior to April 25, 2012, a separate rating of 20 percent for recurrent dislocation of the left shoulder disability, is granted, subject to the laws and regulations governing the award of monetary benefit. Entitlement to a rating higher than 10 percent for bilateral hearing loss is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), to include on an extraschedular basis pursuant to 38 C.F.R. § 4.16 (b), is remanded. FINDINGS OF FACT 1. Prior to April 25, 2012, the most probative evidence of record shows that the Veteran’s left shoulder disability was characterized by recurrent dislocation of the scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level. 2. The most probative evidence indicates the Veteran’s bilateral hearing loss disability has been manifested by loss of hearing acuity measured at no worse than Level III hearing in the right ear and Level VI hearing in the left ear. CONCLUSIONS OF LAW 1. Prior to April 25, 2012, the criteria for the assignment of a separate rating of 20 percent for recurrent dislocation of the scapulohumeral joint of the left shoulder have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5202. 2. The criteria for a rating higher than 10 percent for bilateral hearing loss have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.86, DC 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from October 1972 to September 1978. These matters are on appeal from October 2011 and January 2015 rating decisions. In August 2018, the Veteran testified at a Board hearing via videoconference before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is associated with the record. In a May 2019 decision, the Board denied the Veteran’s claim of entitlement to a rating higher than 30 percent prior to April 25, 2012, and a rating higher than 50 percent since May 1, 2014, for a left shoulder disability; granted a 100 percent temporary total evaluation for the left shoulder disability from December 1, 2012, to March 12, 2013, and remanded a claim of entitlement to a rating higher than 10 percent for bilateral hearing loss. The Board did not adjudicate the issue of entitlement to TDIU on the basis that the Veteran failed to appeal the RO’s January 2015, September 2015, September 2016, and January 2019 denials of entitlement to TDIU. The Veteran appealed the denial of the claim of entitlement to a rating higher than 30 percent prior to April 25, 2012, for a left shoulder disability and the Board’s finding that the TDIU claim was not on appeal, to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the portion of the May 2019 Board decision that denied entitlement to a rating higher than 30 percent prior to April 25, 2012, for a left shoulder disability and remanded the TDIU claim for adjudication, leaving undisturbed the portion of the Board’s decision that granted a 100 percent temporary total evaluation for the left shoulder disability from December 1, 2012, to March 12, 2013 and denied a rating higher than 50 percent for the left shoulder since May 1, 2014, and remanded the claim of entitlement to a rating higher than 10 percent for bilateral hearing loss for further development. Increased Rating Claims Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical and 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. 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. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. 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. At the time of an initial rating, separate ratings can be assigned for separate periods of time based on facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 1. Left shoulder disability Procedural History Before addressing the merits of this appeal, the Board must explain the procedural history of this case: The Board adjudicated the issue now before it in a May 2019 decision, in which the Board denied entitlement to a rating higher than 30 percent prior to April 25, 2012. In the July 2020 JMPR, the Parties found that the Board failed to set forth an adequate statement of reasons or bases that addressed whether a separate rating was warranted under Diagnostic Code 5202 for the period prior to April 25, 2012. In its May 2019 decision the Parties stated that the Board found that prior to April 25, 2012, the Veteran was in receipt of the maximum rating under Diagnostic Code 5201 and while he experienced recurrent dislocations, the Board found that he exceeded the maximum rating for the minor extremity under Diagnostic Code 5202. The Parties noted that it is possible for the Veteran to have separate manifestations from the same injury which would permit rating under several diagnostic codes. See Esteban, supra. The Parties found that the Board failed to explain whether a separate rating was warranted under Diagnostic Code 5202 based on a November 2010 VA examination in which the Veteran’s symptoms included episodes of dislocation or subluxation occurring one to three times a month with locking that either occurred daily or more frequently. In the instant decision, the Board endeavors to address precisely what the Parties found deficient in the now vacated portion of the May 2019 Board decision that denied a rating higher than 30 percent for a left shoulder disability, prior to April 25, 2012. The Board has left essentially unchanged those parts of the previous decision that the Parties did not address in the JMPR. Analysis When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, painful motion should be considered to determine whether a higher rating is warranted on such basis, whether or not arthritis is present. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). When determining the severity of musculoskeletal disabilities, which are at least partly rated on the basis of range of motion, VA must consider the extent of additional functional impairment a veteran may have above and beyond the limitation of motion objectively demonstrated due to pain, limited or excess movement, weakness, incoordination, and premature or excess fatigability, etc., particularly when symptoms “flare up,” to include periods of prolonged use, and assuming these factors are not already contemplated in the governing rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; Sharp v. Shulkin, 29 Vet. App. 26 (2017). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. The Veteran contends that his service-connected left shoulder disability is more severe than his 30 percent evaluation prior to April 25, 2012. would indicate. The evidence establishes the Veteran is right-hand dominant, so his left shoulder necessitates ratings for his non-dominant or minor, extremity. Prior to February 7, 2021, under Diagnostic Code 5202, other impairment of the minor extremity humerus warrants a 20 percent rating is warranted for recurrent dislocation of the humerus at the scapulohumeral joint with frequent or infrequent episodes and guarding of all arm movements or guarding of movement only at the shoulder level. A 20 percent evaluation may also be assigned for malunion of the humerus with deformity. A 40 percent rating is warranted if there is fibrous union of the humerus. A 50 percent rating is warranted for nonunion of the humerus (false flail joint). A 70 percent rating is warranted for loss of the humerus head (flail shoulder). 38 C.F.R. § 4.71a, Code 5202. Effective February 7, 2021, DC 5202 was revised to define movement only at shoulder level as “flexion and/or abduction at 90 degrees.” Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76462 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5202). However, since the period on appeal is prior to April 25, 2012, the Board will consider the Veteran’s claim under the old criteria prior to February 7, 2021. Normal forward flexion of the shoulder is 0 to 180 degrees; abduction is 0 to 180 degrees; and internal and external rotation are from 0 to 90 degrees. 38 C.F.R. § 4.71a, Plate I. Forward flexion and abduction to 90 degrees amounts to shoulder level. Turning to the evidence, the Veteran has evidenced recurrent dislocations. VA treatment records indicate complaints of chronic left shoulder pain. On November 2010 VA joints examination indicates that the Veteran had secondary surgery in 1974 secondary to recurrent shoulder dislocation status post Bristol repair. His symptoms included deformity, giving way, instability, pain, stiffness, weakness, incoordination, decrease speed of joint, and episodes of dislocation or subluxation one to three times a month. Locking episodes occurred daily or more frequently. Symptoms of inflammation were manifested by tenderness, but there were no effusions. However, there were recurrent shoulder dislocations with guarding of all movements of the left shoulder. Examination of the left shoulder indicated bony joint enlargement, crepitus, deformity, tenderness, pain at rest, weakness, abnormal motion, and guarding of movement. Range of motion of the left shoulder indicated 30 degrees flexion and abduction, 18 degrees internal and external rotation. Due to severe pain and restricted motion, repetitive motion was unable to be tested. During the examination the Veteran held his shoulder against his chest and stated that he was in severe pain. At that time, he was unemployed and stated that he retired in 2008 due to severe pain and restricted movement. The examiner diagnosed glenohumeral joint dislocation and A-C joint dislocation with secondary surgery and posttraumatic degenerative arthritis of the left shoulder. As far as the impact of the left shoulder disability on occupational activities, the Veteran had decreased dexterity, problems with lifting and carrying, difficulty reaching, and decreased strength and pain. When he was employed, he was assigned different duties to accommodate the left shoulder disability. The examiner indicated that the left shoulder disability had no effect on traveling, feeding, toileting, and feeding; a mild effect on bathing, dressing, and grooming; a moderate effect on shopping; a severe effect on chores, recreation; and prevented exercise, sports, and recreation. On November 2010 bones examination the Veteran presented with complaints of shoulder and clavicle pain. There was fracture site motion, and a history of deformity of the distal clavicle. There were no flare-ups of bone or joint disease. Diagnoses included left clavicle deformity and angulation of the bone. There was malunion and malunion of the distal clavicle, but there was no loss of bone or part of bone, false joint, or nonunion. VA treatment records indicate additional complaints of left shoulder pain and limited motion. After review of the evidence, the Board finds that the record reflects that Veteran is entitled to a separate 20 percent disability rating for recurrent dislocations of his left shoulder. On November 2010 VA examination the Veteran had recurrent shoulder dislocations with guarding of all movements of the left shoulder. Accordingly, the Board finds that a separate rating of 20 percent is warranted for recurrent dislocations of the left shoulder under Diagnostic Code 5202 prior to April 25, 2012. The Board has also considered the impact of functional loss on the Veteran’s range of motion of the left shoulder. However, the Veteran’s functional loss is already compensated in the 30 percent rating assigned for limitation of motion under DC 5201, so to utilize that symptomatology to award a 30 percent rating under DC 5202 would constitute prohibited pyramiding. See 38 C.F.R. § 4.71, DC 5201, 5202; 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). Moreover, the record does not show that he has any other disability listed under DC 5202 that would entitle him to a higher separate rating, such as flail shoulder, false flail joint, fibrous union, or malunion of the humerus with marked deformity. 2. Bilateral hearing loss The Veteran contends that his service-connected bilateral hearing loss is more severe than his 10 percent rating would indicate. Disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are made. Bruce v. West, 11 Vet. App. 405 (1998); Lendenmann v. Principi, 3 Vet. App. 345 (1992). The regulations set forth eleven auditory acuity levels, designated from Roman numerals I to XI, in escalating order of hearing impairment. 38 C.F.R. § 4.85. The appropriate auditory acuity level is determined based on a combination of the percentage of speech discrimination and the puretone threshold average. Additional considerations apply when exceptional patterns of hearing loss are demonstrated, which are defined as either a) puretone averages of 55 or greater at 1000, 2000, 3000, and 4000 Hertz, or; b) a puretone threshold of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86 (a). Once an acuity level is established for each ear, Table VII, Percentage Evaluations for Hearing Impairment, is used to determine the appropriate disability evaluation. The appropriate rating is determined based on a combination of the levels of hearing impairment established for each ear. Hearing loss disabilities are rated by application of a mechanical process that is explained here. Initially, VA must determine the Roman numerical designation for the degree of hearing impairment in each ear based upon a combination of the percent of speech discrimination and the pure tone threshold average. 38 C.F.R. § 4.85. In general, the Roman numerical designation is determined through application of 38 C.F.R. § 4.85 (h), Table VI. Under Table VI, the horizontal rows represent eight separate ranges of pure tone threshold averages, as demonstrated through audiometric testing for the frequencies at 1000, 2000, 3000, and 4000 Hertz. The average pure tone threshold is calculated by determining the sum of the pure tone thresholds demonstrated at the four aforementioned frequencies and dividing that sum by four. The vertical columns under Table VI represent nine separate ranges of speech discrimination percentage, as determined through Maryland CNC testing. The Roman numerical designation of impaired efficiency is determined for each ear by intersecting the horizontal row appropriate for the calculated pure tone threshold average and the vertical column appropriate for the demonstrated percentage of speech discrimination. 38 C.F.R. § 4.85 (b). Table VIA, which assigns a Roman numeral designation based solely on the puretone threshold average, is used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. 38 C.F.R. § 4.85 (c). In addition, where audiometric testing reveals an exceptional pattern of hearing impairment, Roman numerical designations may be determined under 38 C.F.R. § 4.85 (h), Table VIA. Pursuant to 38 C.F.R. § 4.86 , an exceptional pattern of hearing impairment exists where audiometric testing reveals either: (1) pure tone thresholds of 55 decibels or more at each of the frequencies at 1000, 2000, 3000, and 4000 Hertz; or (2) a pure tone threshold at 30 decibels or less at 1000 Hertz and 70 decibels or greater at 2000 Hertz. 38 C.F.R. §§ 4.85 (h); 4.86. After the Roman numerical designation has been determined for each ear, VA then determines the appropriate disability rating through application of 38 C.F.R. § 4.85 (h), Table VII. Table VII is applied by intersecting the appropriate horizontal row (which represents the Roman numerical designation for the poorer ear) with the appropriate vertical column (which represents the Roman numerical designation for the better ear). 38 C.F.R. § 4.85 (e). In Martinak v. Nicholson, 21 Vet. App. 447 (2007), the Court held that in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak, 21 Vet. App. at 455. The Court also noted, however, that even if an audiologist's description of the functional effects of the veteran's hearing disability was somehow defective, the veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination. Id. Turning to the evidence, on April 2013 VA hearing loss and tinnitus examination, puretone thresholds for the right ear, in decibels, at 1000, 2000, 3000, and 4000 Hz were as follows: 40, 45, 45, and 60 decibels; the average puretone decibel loss was 48 decibels. The pure tone thresholds for the left ear, in decibels, at 1000, 2000, 3000, and 4000 Hz as follows: 45, 55, 60, and 70 decibels; the average puretone decibel loss was 58 decibels. The CNC word list speech recognition score was 80% in the right ear and 76% in the left ear. The audiologist diagnosed bilateral sensorineural hearing loss which he opined impacted the ordinary conditions of daily life, including the ability to work. The Veteran stated that his service-connected tinnitus interfered with his hearing. Under Table VI, these audiometric findings correspond to Level III hearing loss in the right ear and Level IV hearing loss in the left ear. Those Roman numerical designations equate to a 10 percent disability rating under Table VII. On September 2014 VA hearing loss and tinnitus Disability Benefits Questionnaire (DBQ) examination, puretone thresholds for the right ear, in decibels, at 1000, 2000, 3000, and 4000 Hz were as follows: 40, 45, 40, and 65 decibels; the average puretone decibel loss was 48 decibels. The pure tone thresholds for the left ear, in decibels, at 1000, 2000, 3000, and 4000 Hz as follows: 45, 50, 60, and 70 decibels; the average puretone decibel loss was 56 decibels. The CNC word list speech recognition score was 80% in the right ear and 60% in the left ear. The audiologist diagnosed bilateral sensorineural hearing loss which he opined impacted the ordinary conditions of daily life, including the ability to work. The Veteran stated he had increased difficulty hearing his mother’s voice. Under Table VI, these audiometric findings correspond to Level III hearing loss in the right ear and Level VI hearing loss in the left ear. Those Roman numerical designations equate to a 10 percent disability rating under Table VII. Pursuant to the Board’s May 2019 remand, on November 2019 VA hearing loss and tinnitus DBQ examination, puretone thresholds for the right ear, in decibels, at 1000, 2000, 3000, and 4000 Hz were as follows: 50, 60, 60 and 75 decibels; the average puretone decibel loss was 61 decibels. The pure tone thresholds for the left ear, in decibels, at 1000, 2000, 3000, and 4000 Hz as follows: 60, 65, 70, and 80 decibels; the average puretone decibel loss was 69 decibels. The CNC word list speech recognition score was 96% in the right ear and 92% in the left ear. The audiologist diagnosed bilateral sensorineural hearing loss which he opined impacted the ordinary conditions of daily life, including the ability to work. The Veteran stated that his bilateral hearing loss disability was frustrating. Under Table VI, these audiometric findings correspond to Level II hearing loss, bilaterally. Those Roman numerical designations equate to a noncompensable (0 percent) disability rating under Table VII. Applying the relevant rating criteria, the Board notes that a rating higher than 10 percent, for the Veteran’s bilateral hearing loss is not warranted. The Board is mindful that an audiologist must provide a description of the functional effects caused by a hearing loss disability. Martinak v. Nicholson, 21 Vet. App. 447 (2007). On April 2013, September 2014, and November 2019 VA examination, the Veteran complained of difficulty hearing. The Board finds these comments are sufficient to comply with the applicable VA policies. Id. Additional considerations The Board notes that the Veteran is competent to report complaints such as left shoulder pain and instability and difficulty hearing as these observations come to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also acknowledges the Veteran’s belief that his symptoms are of such severity as to warrant a higher rating and has taken these contentions seriously. However, the Veteran is not competent to identify a specific level of disability of his left shoulder disability or bilateral hearing loss according to the appropriate diagnostic codes. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s left shoulder disability and bilateral hearing loss has been provided by the examining VA examiners who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly addresses the criteria under which these disabilities are evaluated. Finally, with the exception of the TDIU claim addressed in the remand below, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND TDIU In the JMPR the Parties found that remand of the TDIU claim was warranted because the Board erred when it found that the issue of entitlement to TDIU was not before it in the May 2019 decision. The Parties noted that the Veteran filed a claim for an increased rating for his left shoulder disability in October 2010 which was denied in October 2011 and that his claim of entitlement to TDIU was previously denied by the RO in January 2015, September 2015, September 2016, and January 2019 rating decisions. In the May 2019 decision, the Board found that the issue of entitlement to TDIU was no longer on appeal because the Veteran did not appeal the RO’s denials of TDIU and because the Veteran did not raise the issue of TDIU during his Board hearing. However, the Parties found that the Veteran’s TDIU claim is part and parcel of his claim of entitlement to an increased rating for his left shoulder disability and that remand was warranted to adjudicate the claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009) and Harper v. Wilkie, 30 Vet. App. 356 (2018). The Veteran does not meet the schedular requirements for consideration of a TDIU. 38 C.F.R. § 4.16 (a). The record, however, the medical records reflects the Veteran’s complaints of an inability to work due to his service-connected left shoulder disability. The Board may not assign an extraschedular rating in the first instance because the authority for doing so is vested in VA’s Director of Compensation Service. The Board may, however, consider whether remand to the RO for referral to the Director of Compensation Service is warranted. See 38 C.F.R. § 4.16 (b). Because there is evidence that the Veteran has been unable to work due to his service-connected left shoulder disability and he did not meet schedular criteria, the Veteran’s TDIU claim must be referred for extraschedular consideration of TDIU. See Wages v. McDonald, 27 Vet. App. 233, 236 (2015). The matters are REMANDED for the following action: After reviewing the record and conducting any additional development deemed necessary, in accordance with 38 C.F.R. § 4.16 (b), refer the issue of entitlement to a TDIU, to VA’s Director of Compensation Service for adjudication. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adams, 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.