Citation Nr: 21028144 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 13-11 742 DATE: May 10, 2021 ISSUES 1. Entitlement to disability rating in excess of 10 percent for bilateral pes planus and plantar fasciitis prior to August 27, 2020. 2. Entitlement to disability rating in excess of 60 percent for epilepsy. ORDER 1. Entitlement to disability rating in excess of 10 percent for bilateral pes planus and plantar fasciitis prior to August 27, 2020 is denied. 2. Entitlement to a disability rating in excess of 60 percent for epilepsy is denied. FINDINGS OF FACT 1. For the period prior to August 27, 2020, the Veteran's bilateral foot pes planus and plantar fascitis was moderate, manifested by pain on the use of both feet with weight-bearing line over or medial to the great toe. It did not manifest in severe symptoms, and it did not result in any marked deformity, pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. 2. For the period on appeal, the Veteran's seizure disability has been manifested by at least one major seizure in four months over the last year; a seizure disorder manifested by at least one major seizure in three months over the last year or more than 10 minor seizures weekly has not been shown. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent prior to August 27, 2020, for bilateral pes planus and plantar fasciitis have not been met or approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 5276 (2018). 2. The criteria for a disability rating in excess of 60 percent, for service-connected epilepsy have not been met or approximated. 38 C.F.R. §§ 3.102, 3.159, 4.124a, Diagnostic Code 8910. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1993 to October 1996 and April 2008 to January 2011. This case comes before the Board of Veterans' Appeals (Board) from a rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah, which at that time handled paperless claims for the Western and Central areas of the Veterans Benefits Administration. The Veteran resides in North Carolina and the RO in Winston-Salem currently has jurisdiction of the file. In March 2017, a videoconference hearing was held before a different Veterans Law Judge (VLJ) than the judge issuing this decision. A transcript of that proceeding is of record. The Veteran was afforded an opportunity for re-hearing after the first hearing judge retired. (See BVA Letter, March 16, 2021). However, the Veteran did not respond within 30 days and as such, the Board will proceed to consider his appeal. By way of background, this case was before the Board in February 2018. In that February 2018 decision, the Board, in pertinent part, remanded the Veteran's claims for additional evidentiary development, including a VA examination to assess the severity and manifestations of the Veteran's epilepsy, to include whether the Veteran has a memory loss that at least as likely as not was either caused or aggravated by his service-connected epilepsy. Additionally, the Veteran was to be afforded a VA examination was to assess the severity of the Veteran's epilepsy, and specifically, the frequency and severity of his seizures. Finally, a VA examination was to be afforded to the Veteran to assess the current severity of his bilateral pes planus and plantar fasciitis. The Board observes that in an October 2020 rating decision, the Veteran was granted service connection for memory loss, combined with the already service-connected major depressive disorder with psychotic features. Therefore, this issue (memory loss secondary to service-connected epilepsy) is no longer before the Board and has been resolved. See October 19, 2020 Rating Decision. In this same rating decision, the Veteran's disability rating for bilateral pes planus and plantar fascitis, was increased from 10 percent to 50 percent, effective August 27, 2020. As 50 percent is considered the maximum schedular evaluation and the 50 percent award represents a partial grant of the benefits sought on appeal, the issue remaining with the Board is whether the Veteran is entitled to a rating in excess of 10 percent for the period prior to August 27, 2020. Additionally, the Board observes that the Veteran was also granted service connection for left and right foot hallux valgus at a 10 percent disability rating; however the Veteran has not yet expressed disagreement with this rating and as such, the Bord will not address the propriety of these recently assigned ratings. The matter of (1) entitlement to a disability rating in excess of 10 percent for bilateral foot pes planus and plantar fasciitis prior to August 27, 2020 and (2) entitlement to a disability rating in excess of 60 percent for epilepsy have returned to the Board for appellate review. The Board is satisfied that there has been substantial compliance with the Board's February 2018 remand directives. Thus, no further action is required. See Stegall v. West, 11 Vet. App. 268 (1998). Disability Ratings Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2018). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 3.321 (a), 4.1 (2018). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficient characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2018). Where there is a question as to which of two ratings shall be applied, the higher rating 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 (2018). The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14 (2018). However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). In all claims for an increased disability rating, VA has a duty to consider the possibility of assigning staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. Entitlement to a disability rating in excess of 10 percent for bilateral pes planus and plantar fasciitis prior to August 27, 2020 The Veteran asserts that he is entitled to a higher disability rating for his bilateral pes planus and plantar fasciitis. At his March 2017 Board Hearing, the Veteran testified that he has pain on the bottom of the foot when walking without support. With support, the Veteran testified that the pain is a little less. The Veteran testified that he has some swelling on the feet and that it is worse when he is on his feet. The Veteran testified that he cannot stand for more than 20 minutes before he has to sit down to rest. The Veteran testified that he does not have swelling on the feet when he has not been standing for 6-8 hours. The Veteran testified that he does not have callouses at the bottom of his feet, just in the toes. The Veteran indicated that he was not certain if he is walking with a limp, but asserts that he has a posture problem because of his bilateral pes planus and plantar fasciitis disability. See March 14, 2017, Board Hearing testimony, pgs. 32-39. The Veteran's bilateral pes planus and bilateral plantar fasciitis is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, which specifically addresses flat feet. As noted in the introduction of this decision, the Veteran has been granted a 50 percent maximum schedular rating for his bilateral pes planus and plantar fasciitis from August 27, 2020. Prior to August 27, 2020, the Veteran's bilateral pes planus and bilateral plantar fasciitis is assigned a 10 percent disability rating. Therefore, the Board will examine whether the Veteran is entitled to a rating in excess of 10 percent for the period prior to August 27, 2020. Under Diagnostic Code 5276, a noncompensable rating is assigned for mild flatfoot with symptoms relieved by built-up shoe or arch support. A 10 percent rating is assigned for moderate flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the tendo-Achillis, pain on manipulation and use of the feet, bilateral or unilateral. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities warrants a 30 percent rating when bilateral. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, that is not improved by orthopedic shoes or appliances, warrants a 50 percent rating when bilateral. 38 C.F.R. § 4.71a, Diagnostic Code 5276. 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, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different "staged" ratings may be warranted for different time periods. Where the question for consideration is the propriety of the initial evaluation assigned after the granting of service connection, separate ratings may also be assigned for separate periods of time based on facts found, i.e. "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). The Board has reviewed all the evidence in the Veteran's claim file, but will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claim file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Discussion During the course of this appeal, the Veteran has been afforded VA examinations in April 2011, July 2018 and August 2020. In his April 2011 VA examination, the examiner noted the Veteran's medical history: The Veteran states that since 1993 on entry into service he has had daily chronic plantar pain in the arches of his feet. He was treated with inserts while on active duty. They helped very little. The examiner recorded that the Veteran notes that standing longer than ten minutes and walking greater than half-a-mile tends to increase the pain in his feet. The pain also increased during periods of physical training while on active duty. He currently has no pain at rest. This only occurs with standing. See April 19, 2011 VA examination, pg. 12. The April 2011 VA examiner recorded that the Veteran's gait at the time of the examination is normal. The examiner recorded that there is no evidence of painful motion, edema, instability, or weakness noted. He does have tenderness over the entirety of the plantar arch on both the left and the right foot. The examiner recorded that there are no calluses or skin breakdown on either the left or right foot. There is no unusual shoe-wear pattern on either the left or the right foot. The examiner recorded that there is no skin or vascular changes on either the left or the right foot. There are no hammertoes, high arch, claw foot, or other deformity with the singular exception of moderate pes planus, which is present on both the left and right foot. Both weightbearing and non-weightbearing alignment of the Achilles tendon is normal bilaterally. There is no valgus deformity of either the left or the right foot. There is no forefoot or midfoot malalignment noted on either the left or the right foot. There is no hallux valgus noted on either the left or the right foot. The active range of motion of the MP joints of both the left and the right foot is normal. Repetition of those ranges of motion time three does not increase pain, fatigue, weakness, lack of endurance, or incoordination. Id. at 13. In his July 2018 Foot Conditions examination, the Veteran was diagnosed with flat foot and hallux valgus. The Veteran described his overall functional impairment as no walking or running. See July 18, 2018 Foot Condition's Examination, pgs. 7-8. The July 2018 VA examiner found pain on the use of both feet. There was no pain on manipulation of the bilateral feet. The examiner recorded that arch supports are used for both feet, effecting relief of symptoms. The examiner recorded that the Veteran had decreased longitudinal arch height of one or both on weight-bearing. The weight-bearing line falls over or medial to the great toe for both. The examiner recorded that there was no indication of swelling on use, or characteristic callosities. The examiner recorded that the Veteran does not have extreme tenderness of plantar surfaces on one or both feet. There was no objective evidence of marked pronation or marked deformity of one or both feet. There was no lower extremity deformity other than pes planus causing alteration of the weight bearing line. Id. at pgs. 9-10. Analysis After assessing the totality of the evidence (lay and medical), the Board finds that the Veteran's symptoms of his bilateral pes planus and bilateral plantar fasciitis do not warrant a rating in excess of 10 percent prior to August 27, 2020. Lay assertions: The Board acknowledges the Veteran's March 2017 testimony that he has some swelling on the feet and that it is worse when he is on his feet. The Board further acknowledges the Veteran's testimony that he does not have callouses at the bottom of his feet, just in the toes. See March 2017 Board Hearing transcript, pgs. 32-39. The Board notes that during the April 2011 VA examination, the examiner recorded that there was no evidence of painful motion, edema, instability, or weakness noted. The examiner recorded that the Veteran does have tenderness over the entirety of the plantar arch on both the left and the right foot. The examiner recorded that there are no calluses or skin breakdown on either the left or right foot. See April 2011 VA examination, pg. 13. Further, the Board observes that in the July 2018 VA Foot Conditions examination, the VA examiner recorded that there was no indication of swelling on use, or characteristic callosities. The examiner recorded that the Veteran does not have extreme tenderness of plantar surfaces on one or both feet. There was no objective evidence of marked pronation or marked deformity of one or both feet. See July 2018 VA Foot Conditions examination, pgs. 9-10. Here the medical evidence prior to August 27, 2020 does not document objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. Rather, the Veteran's primary symptom documented was pain on the use of both feet. Physical examination revealed weight-bearing over or medial to great toe. See July 2018 VA Foot Conditions Examination, pgs. 9-10. This is contemplated by the 10 percent rating. As a result, an evaluation in excess of 10 percent for this period is not warranted under Diagnostic Code 5276. In summary, the Board finds that for the period prior to August 27, 2020, the Veteran's bilateral foot pes planus and plantar fascitis is moderate, manifested by pain on the use of both feet, with weight-bearing over or medial to great toe. It did not manifest in severe symptoms, and it did not result in any marked deformity, pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. The Board has considered whether the Veteran may be entitled to a higher rating under any other diagnostic code. Diagnostic Codes 5277, 5278, 5279, 5281, 5282 and 5283 however are not for application because the medical evidence does not indicate weak foot, claw foot, hallux rigidus, hammer toe, or malunion or nonunion of tarsal or metatarsal bones. Lastly, as the Veteran's disability is flat feet, which is specifically contemplated by DC 5276, evaluation under the general category of Diagnostic Code 5284 for other foot injuries is inappropriate. See Copeland v. McDonald, 27 Vet. App. 333 (2015) (holding that when a condition is specifically listed in the Schedule, it may not be rated by analogy). The Veteran has not raised any other issues, and no other issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant ... on appeal). Entitlement to a disability rating in excess of 60 percent for epilepsy. The Veteran contends that he is entitled to a higher disability rating for his service-connected epilepsy. The Veteran testified that he believed his medications are keeping the frequency of his seizures in check, but that the side effects of the medications has affected his quality of life. Specifically, the Veteran states that the medications the Veteran takes for his condition has caused him to loss significant weight. See March 14, 2017 Board Hearing testimony, pgs. 19-20 & 22-24. Epilepsy The Veteran's epilepsy, grand mal, is currently rated as 60 percent disabling from January 28, 2011 under 38 C.F.R. § 4.124a, Diagnostic Code 8910, which provides ratings for epilepsy, grand mal. Under the General Formula, a 20 percent rating is warranted for at least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months. A 40 percent rating is warranted for at least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly. A 60 percent rating is warranted for an average of at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week. An 80 percent rating is warranted for an average of at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly. A 100 percent rating is warranted for an average of at least 1 major seizure per month over the last year. 38 C.F.R. § 4.124a. During the course of this appeal, the Veteran has been afforded VA examinations in March 2011, July 2018 and August 2020. In the March 2011 examination, the VA examiner recorded that the Veteran first developed epilepsy before Korea in 2009. The Veteran was admitted to a Hospital five times for seizures. The examiner recorded that the Veteran started out with anti-convulsive medications. He took Dilantin. He is now weaned off Dilantin and is now on Keppra twice a day. The examiner noted that the Veteran's seizures are usually grand mal seizures. The March 2011 examiner noted that the Veteran's last grand mal seizure was four months ago. The examiner described the Veteran's seizures noting that he drops to the ground with shaking of all four extremities. No biting of the tongue. There are no other residuals or complaints. He has had no brain surgery. See March 25, 2011 VA examination, pgs. 5-6. Pursuant to the Board's February 2018 Remand, the Veteran was afforded VA Seizure Disorder examinations in July 2018 and August 2020 for the purpose of determining the frequency and severity of the Veteran's seizure condition. In the July 2018 Seizure Disorder examination, the examiner reviewed the Veteran's medical history, including progress notes from the Neurodiagnostic-Epilepsy Clinic depicting the nature and severity of this Veteran's seizure disorder. See July 16, 2018 VA Seizure Disorders examination, pgs. 1-2. The examiner determined a diagnosis of psychomotor epilepsy (complex partial seizures, temporal lobe seizures). Id. at pg. 6. The examiner recorded the Veteran's history of illness: Beginning in 2008, the Veteran reports driving a car which he wrecked due to his first seizures. He was seen by a neurologist then and placed on medication. The Veteran cannot recall the frequency or severity then. Had EEG done in 2008-2009. The Veteran reports being diagnosed with epilepsy (2008-2009). The examiner reported that the Veteran has seizures once a year. He was last seen in emergency department for seizures in October 2017. He was not admitted. The examiner recorded that the Veteran is seen by a neurologist every 6 months. The Veteran cannot recall having an EEG done since 2008/2009. The examiner recorded that the Veteran is not on any restrictions for seizures. Id. at 6. The examiner recorded that the Veteran has signs or symptoms attributable to a seizure disorder: generalized tonic-clonic convulsion. Id. Severity and Frequency. The examiner recorded that the Veteran's last seizure was in October 2017. The examiner recorded that the Veteran has not had minor seizures. (The examiner recorded that the Veteran has had at least 1 minor seizure in the past 2 years.) Average frequency of major seizures: The examiner recorded that the Veteran has had less than 1 major seizure in the past 6 months. Id. at 7. The examiner recorded that the Veteran has had a major psychomotor seizure, at least 1 in the past 2 years. Average frequency of major psychomotor seizures: less than 1 in the past 6 months. Id. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms related to any condition listed on examination. Id. at pgs. 8. The Veteran was afforded an August 2020 Seizure Disorder examination. The examiner noted review of all available records and confirmed a diagnosis of tonic-clonic seizures or grand mal epilepsy. See August 27, 2020 Seizure Disorder examination, pgs. 1-2. The examiner noted the details of onset and history of illness: Per the Veteran, he was given required shots before his deployment to Bosnia. He doesn't remember what shots and soon after he got the shots, he develops seizure. He was seen by a neurologist. His last seizure was in May 2020, triggered during exercise. He developed generalized muscle pain, headaches, and memory problem after seizure episode. The examiner recorded that the course of the condition since onset has stayed the same. Id. at pg. 2. Severity and Frequency. The examiner recorded that the Veteran's most recent seizure activity was in May 2020. The examiner recorded that the Veteran has not had minor seizures. The examiner record that the Veteran has had at least 2 major seizures in the past two years. Average frequency of major seizures: At least 1 in 4 months over the past year. Id. at pg. 4. The examiner recorded that the Veteran has never had minor psychomotor seizures characterized by brief transient episodes of random motor movements; nor has the Veteran ever had major psychomotor seizures (major psychomotor seizures are characterized by automatic states and/or generalized convulsions with unconsciousness)? hallucinations, perceptual illusions, abnormalities of thinking, memory or mood, or autonomic disturbances). The examiner recorded that the Veteran has never had epilepsy associated with a nonpsychotic organic brain syndrome. Id. Analysis The Board notes that the Veteran is currently rated at 60 percent. A 60 percent rating is warranted for an average of at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week. The March 2011 examiner noted that the Veteran's last grand mal seizure was four months ago. See April 2011 VA examination, pgs. 5-6. The July 2018 VA examiner recorded that Veteran has had less than 1 major seizure in the past 6 months. See July 2018 Seizure Disorders' examination, pg. 7. The August 2020 examiner recorded that the average frequency of the Veteran's seizures was at least 1 in 4 months over the past year. See August 2020 Seizure Disorder's examination, pg. 4. The Board notes that the next higher rating level 80 percent requires an average of at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly. 38 C.F.R. § 4.124a, Diagnostic Code 8910. Additionally, as referenced above in this decision, the Veteran has not asserted that the frequency of his seizures is higher than what has been depicted in the examination reports. The Veteran testified at his March 2017 Board Hearing that his seizures are pretty much controlled by his medications. See March 2017, Board Hearing transcript, pgs. 18-22. Based on a review of the lay and medical evidence of record, there is no evidence to substantiate the weekly seizure threshold or the requisite number of major seizures for the next higher rating. In sum, during the entire period on appeal, the Veteran's epilepsy (seizure disorder) has been manifested by at least one major seizure in four months over the last year; a seizure disorder manifested by at least one major seizure in three months over the last year or more than 10 minor seizures weekly has not been shown. Thus, the Board denies the Veteran's claim for entitlement to a disability rating in excess of 60 percent for epilepsy. Extraschedular As a final point, the Board has also examined whether the Veteran's seizure disorder represents an exceptional disability picture to warrant extraschedular consideration based on his March 2017 testimony that his epilepsy medications has caused him to lose weight. The Board notes that in exceptional circumstances, where the schedular evaluations are found to be inadequate, 38 C.F.R. § 3.321(b) (1) provides that a veteran may be awarded a rating higher than that encompassed by the schedular criteria. Under the regulation, an extraschedular disability rating is warranted upon a finding that "the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." If exceptional circumstances are found, the matter must be referred to the Under Secretary for Benefits or the Director of the Compensation Service for consideration of assignment of an extraschedular evaluation. See id. Here, the Board finds that extraschedular based on an exceptional disability picture for the Veteran's epilepsy is not warranted for the appellate period. The Board observes that the Veteran was afforded a July 2018 Nutritional Deficiency examination in July 3, 2018 VA to evaluate the Veteran's contention regarding weight loss symptoms as a result of his anti-epileptic medications. See July 3, 2018 VA examination. The July 2018 VA examiner noted that the Veteran has never been diagnosed with a nutritional deficiency. See July 3, 2018 Nutritional Deficiency examination, pg. 1. After review of the Veteran's claim's file and review of pertinent diagnostic testing, the VA examiner concluded that medical records do not reflect current weight and appetite loss related to epilepsy. The examiner recorded the Veteran's current height at 71"; Wt- 156.8 lbs. (after shoes/clothes - 2.5 lbs.). The examiner found that according to BMI, the Veteran is a healthy weight with a BMI of ~ 22. The examiner recorded that the Veteran's weight has been stable from 2013 to present, ranging from 152 to 157 lbs. The examiner recorded that 2018 Lab studies are normal. Medical records are negative for current diagnosis or symptoms of appetite and weight loss. The examiner noted that in 2013, a Psychologist evaluation noted that in 2012 that the Veteran developed symptoms of depressed mood, anhedonia, hopelessness, chronic sleep impairment, decreased appetite with significant weight loss of ~ 28 lbs. in 30 days. The examiner reported that these symptoms were related to untreated depression, adjustment disorder, anti-epileptic medication side effects and Veteran's fear of anti-epileptic medications. The examiner noted that once the Veteran was treated for depression, his weight normalized. There examiner concluded that there was no evidence of current appetite and weight loss secondary to epilepsy or treatment of condition. No chronic diagnosis for appetite and weight loss condition secondary to epilepsy. Id. at pg. 4. The Board underscores that the July 2018 VA examiner concluded that there was no evidence of current appetite and weight loss secondary to epilepsy or treatment for the condition. Because the Veteran's seizure disability is capable of evaluation by conventional means, it cannot be deemed exceptional. Here, the Veteran has reported seizures of various frequency and severity due to epilepsy, and the schedular rating criteria assigns disability ratings due to the severity and frequency of epileptic seizures. See also, March 2011 VA examination, pgs. 5-7; July 2018 VA Seizure Disorders examination, pg. 7; August 2020 VA Seizure Disorders examination, pgs. 4-5. As such, the rating criteria is adequate to evaluate the Veteran's epilepsy, and referral for consideration of an extraschedular rating is not warranted. The Board concludes that the preponderance of the evidence is against the appeal for a rating in excess of 60 percent for epilepsy and referral for extraschedular consideration is not warranted. In denying the claim, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.