Citation Nr: 21042696 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-38 786 DATE: July 13, 2021 ORDER An initial disability rating in excess of 70 percent for service-connected anxiety disorder is denied. A 10 percent disability rating for service-connected residuals, left index finger injury, is granted. A 10 percent disability rating for service-connected residuals, left middle finger injury, is granted. Entitlement to an initial compensable disability rating for service-connected residuals of broken left pinky finger is denied. Entitlement to an initial disability rating in excess of 20 percent for residual surgical scars, right ankle is denied. Entitlement to a disability rating in excess of 10 percent for service-connected residuals crushing injury, right ankle is denied. Entitlement to a disability rating in excess of 30 percent for right foot cold injury residuals is denied. Entitlement to a disability rating in excess of 30 percent for left foot cold injury residuals is denied. REMANDED Entitlement to a total disability rating based upon individual unemployability due to service-connected disability is remanded. FINDINGS OF FACT 1. The severity, frequency, and duration of the Veteran's psychiatric symptoms are not such as to result in disability more closely approximating total occupational and social impairment at any time during the relevant appeal period. 2. The Veteran experiences tingling of his left index finger, as well as intermittent pain and flare-ups of swelling with extended use of the hand. 3. The Veteran experiences intermittent pain in the left middle finger on use of the hand. 4. The Veteran has residual ache and discomfort with grasping from a previously-broken left pinky. 5. The Veteran has 3 service-connected right ankle scars that are painful. 6. For the entirety of the relevant appeal period, the Veteran is in receipt of the maximum combined disability rating for disabilities of the right ankle and right foot allowable by the amputation rule. 7. The Veteran's right foot cold injury residuals include mild intermittent tingling of the foot, darkened skin on top of the toes, aching in cold weather, and pain on use and manipulation of the foot. 8. The Veteran's left foot cold injury residuals include mild intermittent tingling of the foot, darkened skin on top of the toes, aching in cold weather, and pain on use and manipulation of the foot. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 70 percent for anxiety disorder, not otherwise specified have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9413. 2. The criteria for an initial 10 percent disability rating, but no greater, for service-connected residuals, left index finger injury have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.59, 4.71a, Diagnostic Code 5229. 3. The criteria for an initial 10 percent disability rating, but no greater, for service-connected residuals, left middle finger injury have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.59, 4.71a, Diagnostic Code 5229. 4. The criteria for an initial compensable disability rating for residuals of broken little finger, left hand have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.59, 4.71a, Diagnostic Code 5230. 5. The criteria for a disability rating in excess of 20 percent for right ankle surgical scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.25, 4.68, 4.71a, 4.118, Diagnostic Codes 5165, 7804. 6. The criteria for a disability rating in excess of 10 percent for service-connected residuals crushing injury, right ankle have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.20, 4.25, 4.68, 4.71a, Diagnostic Codes 5165, 5271. 7. The criteria for a disability rating in excess of 30 percent for right foot cold injury residuals have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.20, 4.25, 4.68, 4.71a, 4.104, Diagnostic Codes 5165, 7122. 8. The criteria for a disability rating in excess of 30 percent for left foot cold injury residuals have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.20, 4.25, 4.104, Diagnostic Code 7122. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from June 1994 to June 1998 and in the United States Army from July 1998 to October 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The appeals were previously remanded in January 2019 and October 2019. They have since been returned to the Board for further appellate review. Increased Ratings 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. An evaluation of the level of disability present must include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 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 a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd on other grounds, Moore v. Shinseki, 555 F.3d 1369 (2009). 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. The Board has reviewed all of the evidence in the claims file, with an emphasis on the evidence pertinent to the issues on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all contents of the extensive evidence of record. Indeed, the United States Court of Appeals for the Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. 1. Entitlement to a disability rating in excess of 70 percent for service-connected anxiety disorder, not otherwise specified is denied. The Veteran contends that his psychiatric symptoms warrant a 100 percent disability rating. Specifically, in a June 2021 brief, the Veteran's representative asserted that the February 2020 examination meets part of the criteria for the 100 percent level under the rating schedule, as the Veteran's judgment was described as poor, his insight was described as impaired, and the Veteran had attempted suicide. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent at any point during the relevant appeal period. The Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA treatment records, VA examinations from February 2020, October 2017, and April 2012, and the Veteran's lay statements demonstrate that the Veteran's anxiety disorder was manifested by symptoms associated with at worst, a 70 percent rating. At times, the Veteran has endorsed suicidal ideation and visualizing violent/destructive behavior or action, but not homicidal ideation. Symptoms including depressed mood, anxiety, chronic sleep impairment, disturbances in motivation and mood, difficulty in adapting to stressful circumstances, including work or a worklike setting, suspiciousness, flattened affect, impaired judgment, obsessional rituals which interfere with routine activities, and impaired impulse control, such as unprovoked irritability with periods of violence were noted on the later VA examination reports, and are all included among the symptoms listed for a 70 percent or lower evaluation. The Board notes that the Veteran has expressed suicidal ideation with intent/plan, which is similar to persistent danger of self-harm, contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records. While the record does reflect a suicide attempt in March 2013 and hospitalization for suicidal ideation in June 2017, such episodes of increased symptomatology are not found to be so frequent or prolonged as to represent a "persistent" danger of self-harm. Additionally, while the Board recognizes that at the time of the February 2020 examination, the Veteran was incarcerated and was awaiting trial for the murder of his girlfriend and her 10 year old son, the February 2020 examiner noted that the Veteran's daily routine while incarcerated involved eating breakfast, sitting and reading the bible or hanging out with his one friend, or going off by himself. The examiner noted that the Veteran noted being on edge, having trust issues, and avoidance of others daily due to his circumstances being imprisoned and trying to avoid trouble. Such is not found to reflect a persistent danger of hurting others. The Board also finds that the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 70 percent, rather than 100 percent rating. VA examiners in October 2017 and February 2020 concluded that the Veteran's level of occupational and social impairment was best characterized as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The February 2020 examiner noted that at the time the Veteran was incarcerated in late 2018, the Veteran had completed his master's degree in Human Resources Management and was making plans for the future, identifying work opportunities in administration or legal areas as he was a trained and experienced paralegal. The examiner noted that the Veteran's ability to understand and follow instructions and ability to sustain concentration to perform simple tasks was not considered impaired, but that his ability to sustain concentration to task persistence and pace, ability to respond appropriately to coworkers, supervisors, or the general public, and ability to respond appropriately to changes in the work setting was considered markedly impaired. The term "marked" was defined as serious limitation, substantial loss of ability to effectively function. However, none of the Veteran's occupational functions were noted by the examiner to be profound, defined on the report as a major limitation with no useful ability to function remaining. The Board therefore finds that the Veteran's overall symptom picture was not of such severity as to result in total occupational and social impairment. While the Veteran did experience some symptoms similar to those contemplated by a 100 percent rating, the evidence overall does not demonstrate that the danger the Veteran posed to himself or others was persistent or to a degree such that it would result in total occupational and social impairment. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent or higher rating are not met and the appeal must be denied, to that extent. A claim for a TDIU that is part and parcel of the Veteran's claim for an increased disability rating for service-connected anxiety disorder is addressed in the Remand section, below. 2. Entitlement to a 10 percent disability rating for service-connected residuals, left index finger injury is granted. 3. Entitlement to a 10 percent disability rating for service-connected residuals, left middle finger injury is granted. The Veteran is presently in receipt of service connection with noncompensable disability ratings for residuals of injuries to the left index and middle finger, under 38 C.F.R. § 4.71(a), Diagnostic Code 5229. Under DC 5229, limitation of motion of an index or long finger warrants a noncompensable disability rating if there is a gap of less than one inch (2.5 centimeters) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible and; extension is limited by no more than 30 degrees. A 10 percent rating is warranted for limitation of motion with a gap of one inch (2.5 centimeters) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. The Board notes that the rating criteria that are applicable to the Veteran's left index and middle finger disabilities are identical for the major (dominant) extremity and the minor (non-dominant) extremity. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. See id. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Range of motion testing was performed at VA examinations of the left hand and fingers throughout the appeal period. The April 2009 exam showed the left index and middle finger could be fully extended normally, with the Veteran able to make a fist easily without pain, weakness, fatigue, or lack of endurance. The August 2015 examination showed full extension for the left index and middle finger, and no gap was noted between the finger and proximal transverse crease of the hand on maximal finger flexion. The July 2017 examination showed full extension for the left index and long fingers, but did show a gap between the index finger and proximal transverse crease of the hand on maximal finger flexion of 7 centimeters, with no gap present for the middle/long finger. The February 2020 examination showed full extension for both fingers, and no gap between either finger and the proximal transverse crease of the hand on maximal finger flexion. When considering the evidence of record, the Board finds that awards of a 10 percent disability rating for residuals, left index finger injury and a 10 percent disability rating for residuals, left middle finger injury are warranted. The Veteran has consistently and credibly reported painful motion of the joints, particularly with repetitive use. Therefore, per 38 C.F.R. § 4.59, these painful joints resulting from healed injury are entitled to at least the minimum compensable rating for the joint. Under DC 5229, the minimum compensable rating for limited motion of the index or long/middle finger is 10 percent. The Board has also considered whether a higher evaluation is warranted at any time during the relevant appeal period, particularly considering that the July 2017 examination included objective findings for the index finger that correspond to the 10 percent criteria of DC 5229. However, a 10 percent evaluation is the highest rating assignable for limited motion of either the long or index finger. The Board further finds that the Veteran's reports at that time of achy and sharp shooting pain with occasional swelling of the knuckles and pain with gripping things is not of such severity as to approximate the level of impairment contemplated by a rating under DC 5223 for favorable ankylosis of the index and long finger of one hand. In this regard, the Veteran noted lifting weight of more than 30-35 lbs. and repetitive use of his fingers working as a paralegal (involving a lot of typing, carrying files, pulling cabinets, etc....) caused increased pain and resulted in less motion, but did not describe symptoms effectively precluding movement of the joint during flare-ups of symptoms or when used repeatedly. He reported that he used a heating pad on occasion and used over the counter medication as well as marijuana to ease the pain and retain functioning. While the ameliorative effects of medication are not to be considered when assigning disability ratings under DC 5229, the Board notes that the February 2020 examination did not indicate that the Veteran utilized medication for his continuing symptoms, and that he reported that even when the pain is at its worst and he has "occasional" swelling episodes lasting up to 12 hours, such symptoms do not prevent use of the hand. The Board therefore finds that the preponderance of the evidence supports the award of a 10 percent disability rating for residuals left index finger injury and a 10 percent disability rating for residuals left middle finger injury, but no higher. An award of increased evaluations is therefore warranted. 4. Entitlement to an initial compensable disability rating for service-connected residuals of broken left pinky finger is denied. The Veteran has asserted entitlement to a compensable rating for his service-connected residuals of broken left little finger. After careful review of the evidence the Board finds that a compensable rating is not warranted. The Veteran's left little finger disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. The Board notes that the rating criteria that are applicable to the Veteran's left little finger disability are identical for the major extremity and the minor extremity. Under Diagnostic Code 5230, limitation of motion of the ring or little finger, any limitation of motion is noncompensable. 38 C.F.R. § 4.71a. Diagnostic Code 5227, used for rating ankylosis, also assigns a noncompensable evaluation for ankylosis of the little finger. The evidence of record indicates that the Veteran experiences pain and limited motion of the left little finger. After reviewing all of the evidence and subjective complaints, the Board finds that the preponderance of the evidence shows that a compensable disability rating is not warranted. Specifically, under the applicable diagnostic criteria, any limitation of motion or ankylosis of the little finger of either hand is noncompensable. 38 C.F.R. § 4.71a, DCs 5227 and 5230. Moreover, although 38 C.F.R. § 4.59 provides that actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint, there is no compensable rating for limitation of motion or ankylosis of the little finger. Therefore, application of 38 C.F.R. § 4.59 does not assist the Veteran in this case. See Sowers v. McDonald, 27 Vet. App. 472 (2016). Thus, no compensable rating is available. Finally, as to rating the Veteran's left little finger disability under any other diagnostic code used to rate finger disabilities and/or as a wrist disability, the Board finds that, given the nature and location of his service-connected disorder, it is not ratable under any of the other criteria to rate finger disabilities and/or the wrist because these other criteria do not deal with his left little finger. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3, 4.71a, DCs 5215 to 5230. The claim must therefore be denied. 5. Entitlement to an initial disability rating in excess of 20 percent for residual surgical scars, right ankle is denied. 6. Entitlement to a disability rating in excess of 10 percent for service-connected residuals crushing injury, right ankle is denied. 7. Entitlement to a disability rating in excess of 30 percent for right foot cold injury residuals is denied. The Veteran filed a claim for increased disability ratings that was received on July 26, 2010. In an April 2012 rating decision, the RO continued the Veteran's 10 percent disability rating for residuals crushing injury, right ankle and increased the disability rating for right foot cold injury residuals to 20 percent, effective from July 26, 2010. In a November 2012 decision, the Agency of Original Jurisdiction (AOJ) granted service connection for a right ankle scar with a noncompensable evaluation. In a January 2019 rating decision, the RO granted a temporary 100 percent disability rating for right ankle surgery requiring convalescence, effective from September 28, 2018, with a 10 percent disability rating for the right ankle from November 1, 2018. Finally, in a June 2020 rating decision, the AOJ granted an increased 30 percent disability rating for right foot cold injury residuals, and assigned a 20 percent disability rating for painful residual surgical scars, right ankle, both effective from July 26, 2010. As a result, other than the period when he was in receipt of a temporary 100 percent for right ankle surgery necessitating convalescence, the Veteran is in receipt of a combined 50 percent disability rating for disability of the right lower extremity below the knee from July 26, 2010 and a combined 60 percent disability rating for disability of the right lower extremity below the knee from September 10, 2018, the effective date when service connection and a 20 percent disability rating was assigned for plantar fasciitis, right foot. See 38 C.F.R. §§ 4.25, 4.26. Under 38 C.F.R. § 4.68, the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. For a single extremity, the combined rating below the knee shall not exceed 40 percent, which is the rating assigned to amputation of the leg at a lower level, permitting prosthesis. 38 C.F.R. § 4.68, see also 38 C.F.R. § 4.71a, DC 5165. Thus, from July 26, 2010, the Veteran is presently in receipt of the maximum combined rating for the right ankle and foot that is allowed by the amputation rule. See 38 C.F.R. § 4.68. Assignment of greater or additional compensable disability ratings in this case for service-connected disability of the right ankle and/or foot from this date is therefore impermissible, as the combined rating for service-connected disability affecting the extremity "shall not" exceed this level. See 38 C.F.R. § 4.68. The Board has further considered whether additional compensation is warranted under the special monthly compensation provisions of 38 U.S.C. § 1114. However, the Veteran has not asserted, and the evidence of record does not otherwise demonstrate, that his service-connected disabilities have resulted in the loss or effective loss of use of his right foot. VA examination reports and treatment records throughout the relevant appeal period do not indicate that the Veteran has been rendered unable to make use of his foot or lower extremity for ambulation or to assist in balance. Entitlement to increased disability ratings for residual surgical scars, right ankle, crushing injury, right ankle with residuals, and right foot cold injury residuals is therefore denied. 8. Entitlement to a disability rating in excess of 30 percent for left foot cold injury residuals is denied. In a June 2020 rating decision, the AOJ increased the Veteran's rating for left foot cold injury residuals from 10 percent to 30 percent, effective from the date of claim, July 26, 2010. The Veteran's left foot cold injury residuals are evaluated under Diagnostic Code 7122. 38 C.F.R. § 4.104. That diagnostic code provides for a maximum 30 percent schedular disability rating for cold injury residuals with arthralgia or other pain, numbness, or cold sensitivity in the affected parts, plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis). Note (1) specifies that amputations of fingers or toes and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy are to be separately evaluated under other diagnostic codes. Other disabilities diagnosed as the residual effects of cold injury, such as Raynaud's phenomenon, muscle atrophy, etc., are to be separately evaluated unless they are used to support an evaluation under DC 7122. At the March 2020 VA examination, the Veteran reported that he gets tingling and minimal numbness in the toes of both feet when the weather gets cold, with the sensation more intense in the left foot vs. the right. He also stated that his toenails on the left foot are slightly darker than the right as well. He denied pain, swelling, skin breakdown, or loss of function of the feet. Under signs and symptoms, the left foot was noted to have cold sensitivity, locally impaired sensation, and nail abnormalities. As the Veteran is in receipt of the highest schedular rating for cold injury residuals of the left ankle, and there is no amputation of toes or complications such as peripheral neuropathy or squamous cell carcinoma or other diagnosed residuals to be rated separately, there is no basis to award a higher rating. As the Veteran already has the maximum schedular disability rating, and the evidence does not demonstrate extraordinary or unusual symptoms that would render the rating schedule inadequate, the appeal is denied. REASONS FOR REMAND Entitlement to a total disability rating based upon individual unemployability due to service-connected disability is remanded. The Veteran asserts that he is unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. While he is in receipt of a combined 100 percent disability rating, an award of a TDIU based on impairment from a single service-connected disability may qualify him for special monthly compensation at the statutory housebound rate. The issue of entitlement to a TDIU has thus not been rendered moot, and remains on appeal. The Veteran most-recently submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability in October 2010. An August 2018 Compensated Work Therapy initial assessment note indicates that the Veteran had worked as a paralegal from April 2017 to September 2017 at the Attorney General's Office and had worked from 2013-2017 with the South Carolina Supreme Court Administration. On remand, the Veteran should be asked to submit an additional VA Form 21-8940 with updated information concerning his employment during the appeal period. The AOJ should also seek to obtain information from the Veteran's prior employers concerning the circumstances of his leaving the job(s) and ensure the Veteran's complete vocational rehabilitation file is obtained and added to the electronic record. The matters are REMANDED for the following action: 1. Ask the Veteran to complete an updated VA Form 21-8940, Application for TDIU. Obtain all indicated employment information from the Veteran's employers. 2. Obtain and associate the Veteran's complete VA Vocational Rehabilitation file with the electronic record. 3. After completing the above, conduct any further development deemed needed then readjudicate the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disability. If the benefits sought are not granted to the Veteran's satisfaction, issue the Veteran and his representative a supplemental statement of the case and provide them with an opportunity to respond before returning the appeal to the Board, if in order. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Solomon, 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.