92 Decision Citation: BVA 92-20610 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-27 064 ) DATE ) ) ) THE ISSUES 1. Entitlement to accrued compensation benefits based on a claim for service connection for residuals of a fracture of the left tibial plateau including osteomyelitis. 2. Entitlement to accrued compensation benefits based on a claim for service connection for diabetes mellitus. 3. Entitlement to accrued compensation benefits based on a claim for service connection for a heart disorder. 4. Entitlement to accrued compensation benefits based on a claim for an evaluation in excess of 70 percent for nonunion of the midshaft of the left humerus with shortening and limitation of motion of the elbow and atrophy of the biceps and triceps muscles with retained metallic foreign bodies. 5. Entitlement to accrued compensation benefits based on a claim for an evaluation in excess of 10 percent for a scar, bone graft donor site, right tibial diaphysis. 6. Entitlement to accrued compensation benefits based on a claim for an evaluation in excess of 10 percent for a scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in the medullary canal and metallic foreign body in the calf muscle. 7. Entitlement to accrued compensation benefits based on a claim for a temporary total disability rating based upon convalescence beyond May 25, 1987. 8. Entitlement to accrued compensation benefits based on a claim for a total disability rating based upon individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD F. H. Ayer, Counsel INTRODUCTION The veteran had active military service from June 1943 to June 1946. This case came before the Board of Veterans' Appeals, hereinafter the Board, on appeal from rating decisions of the Phoenix, Arizona, Regional Office. The notice of disagreement was received in September 1988. The statement of the case was issued in December 1988. The substantive appeal was received in January 1989. A supplemental statement of the case was issued in May 1989. The veteran died on November [redacted], 1989. In a rating action dated in March 1990, the current claims as to the appellant were denied. A supplemental statement of the case was issued in April 1990. The case was received and docketed at the Board in July 1990. The claims file was then referred to the appellant's accredited representative, Disabled American Veterans, and that organization presented additional written argument to the Board in October 1990. In a decision of the Board dated in April 1991, the case was remanded to the regional office for additional action. A supplemental statement of the case was issued in May 1991. The case was received and docketed at the Board in July 1991. The claims file was then referred to the appellant's accredited representative, Disabled American Veterans, and that organization submitted additional written argument to the Board in August 1991. In a decision of the Board dated in October 1991, the case was remanded to the regional office for additional action. A supplemental statement of the case was issued in November 1991. The appeal was received and docketed at the Board in March 1992. The claims file was then referred to the appellant's accredited representative, Disabled American Veterans, and that organization presented additional written argument to the Board in March 1992. The case is now ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the veteran should have been service connected for left tibial plateau fracture residuals to include osteomyelitis. She maintains that the removal of the bone from the left tibia weakened it and thereby made it more susceptible to subsequent fracture. The same contentions are alleged with respect to the development of osteomyelitis. It is also contended that service connection is warranted for diabetes mellitus because the initial manifestations of this disorder had their inception during the veteran's active military service. It is also alleged that the inservice traumatic injuries brought about the development of the veteran's diabetes. She points out that medical literature acknowledges that diabetes is found in increased prevalence in individuals exposed to transfusions or trauma. It is also contended that service connection is warranted for a heart disorder because the veteran's heart problems were brought about by his service-connected disabilities. It is also contended that higher evaluations are warranted for the veteran's left arm disability and right and left leg disabilities. She maintains that the veteran's left arm was essentially useless and both legs were weak due to the bone grafts and rendered him unable to stand or walk. She alleges that the nature and severity of the veteran's service-connected disabilities rendered him unable to obtain or retain any form of substantially gainful employment. The appellant also contends that convalescent benefits pursuant to 38 C.F.R. § 4.30 are warranted beyond May 25, 1987, because the veteran continued to wear an arm brace. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C. § 7104 (1992), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that accrued compensation benefits based on a claim for entitlement to service connection for residuals of a fracture of the left tibial plateau including osteomyelitis, a claim for entitlement to service connection for diabetes mellitus, a claim for entitlement to service connection for a heart disorder, a claim for entitlement to accrued compensation benefits based on a claim for entitlement to an evaluation in excess of 10 percent for a scar, bone graft donor site, right tibial diaphysis, a claim for entitlement to an evaluation in excess of 10 percent for a scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in the medullary canal and metallic foreign body in the calf muscle, a claim for entitlement to a temporary disability rating based upon convalescence beyond May 25, 1987, and a claim for entitlement to a total disability rating based upon individual unemployability are not assignable. Accrued compensation benefits for an evaluation of 80 percent for nonunion of the midshaft of the left humerus with shortening and limitation of motion of the elbow and atrophy of the biceps and triceps muscles with retained metallic foreign bodies are assignable. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained. 2. Inservice bone grafts were harvested from the left and right tibial crests. 3. A left tibial plateau fracture first occurred in 1982. This fracture is unrelated to the bone removed from the left tibial crest for bone grafting during service or to any other incidents of service. 4. Diabetes mellitus is not shown during the veteran's active military service or for many years thereafter and is unrelated to service. 5. Prior to the veteran's death in November 1989, service connection was in effect for nonunion of midshaft of left humerus with shortening and limitation of motion of elbow, atrophy of biceps and triceps muscles with retained metallic foreign bodies; scar, bone graft donor site, right tibial diaphysis; scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in medullary canal, and metallic foreign body in calf muscle; and right wrist fracture. 6. Diabetes mellitus is unrelated to any of the veteran's service-connected disabilities. 7. Heart pathology is not shown during the veteran's active military service or for many years thereafter and is unrelated to service. 8. Heart pathology is unrelated to the veteran's service-connected disabilities. 9. There was nonunion of the left humerus at the midthird with gross movement. The left arm was functional only with use of an external brace. 10. Left elbow range of motion was from approximately 45 degrees to 110 degrees with good pronation and supination. Left hand function was good. 11. There was biceps and triceps atrophy of the left arm and muscle damage affecting Muscle Groups V and VI. 12. There was essentially loss of use of the left arm. The veteran would have been just as well served were the left arm to have been amputated at an appropriate level. If an amputation of the left arm were to have been performed, it likely would have been done at or above the insertion of the deltoid. 13. A bone graft was taken from the right tibial diaphysis. The only residual disability was a scar approximately 19 centimeters' long and 1/2- to 1 1/4-inch wide. The scar was tender and adherent but not functionally limiting. 14. A bone graft was taken from the left tibial diaphysis. Residual disability included a scar approximately 7 1/2-inches long by 1/4-inch wide, two small metallic fragments in the medullary space of the tibia, and a fairly large metallic fragment posterior in the left calf within the gastrocnemius muscle. The scar was tender and adherent but not functionally limiting. Injury to the gastrocnemius muscle, a component of Muscle Group XI, was not more than slight in degree. 15. The veteran refractured his left humerus on May 26, 1986. A total disability rating based upon convalescence was granted for a period of one year. Left arm disability due to this refracture was essentially static in May 1987. 16. The veteran had a high school education and work experience as a reservations supervisor for an airline. He reportedly last worked in August 1968. 17. Nonservice-connected disabilities included osteomyelitis of the left tibia, fracture of the left tibial plateau with open reduction and internal fixation, below-the-knee amputation of right lower extremity, a heart disorder, diabetes mellitus, and a stomach disorder. 18. The veteran was not unemployable due solely to service-connected disabilities. 19. The appellant is the veteran's surviving spouse. The veteran died in November 1989. CONCLUSIONS OF LAW 1. Accrued compensation benefits based on a claim for service connection for a left tibial plateau fracture, including osteomyelitis, are not assignable. 38 U.S.C. §§ 1110, 5107, 5121 (1992); 38 C.F.R. § 3.310(a) (1992). 2. Accrued compensation benefits based on a claim for service connection for diabetes mellitus are not assignable. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107, 5121 (1992); 38 C.F.R. §§ 3.307, 3.309, 3.310(a) (1992). 3. Accrued compensation benefits based on a claim for service connection for a heart disorder are not assignable. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107, 5121 (1992); 38 C.F.R. §§ 3.307, 3.309, 3.310(a) (1992). 4. Accrued compensation benefits for an evaluation of 80 percent for left humerus fracture residuals are assignable. 38 U.S.C. §§ 1155, 5107, 5121 (1992); 38 C.F.R. §§ 4.20, 4.25, 4.40, 4.47, 4.55, 4.56, 4.68 and Part 4, Codes 5121, 5200, 5202, 5205, 5206, 5207, 5305, 5306, 5307, 5308, 5309 (1992). 5. Accrued compensation benefits based on a claim for an evaluation in excess of 10 percent for scar, bone graft donor site, right tibial diaphysis are not assignable. 38 U.S.C. §§ 1155, 5107, 5121 (1992); 38 C.F.R. §§ 3.321(b)(1), 4.50, 4.51, 4.56 and Part 4, Codes 5311, 7803, 7804, 7805 (1992). 6. Accrued compensation benefits based on a claim for an evaluation in excess of 10 percent for scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in medullary canal, and metallic foreign body in calf muscle are not assignable. 38 U.S.C. §§ 1155, 5107, 5121 (1992); 38 C.F.R. §§ 3.321(b)(1), 4.56 and Part 4, Codes 5311, 7803, 7804, 7805 (1992). 7. Accrued compensation benefits based on a claim for a total disability rating based on convalescence beyond May 25, 1987, are not assignable. 38 U.S.C. §§ 5107, 5121 (1992); 38 C.F.R. § 4.30 (1992). 8. Accrued compensation benefits based on a claim for a total disability rating based upon individual unemployability are not assignable. 38 U.S.C. §§ 1155, 5107, 5121 (1992); 38 C.F.R. §§ 3.340, 3.341, 4.16 (1992). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant's claims are well-grounded within the meaning of 38 U.S.C. § 5107(a). That is, we find that she has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed and no further assistance is required to comply with the duty to assist as mandated by 38 U.S.C. § 5107(a). The veteran died in November 1989. At the time of his death, he had perfected appeals as to those disabilities encompassed by issues 1 through 8 as noted on the cover sheet of this decision. The appellant has continued to pursue these issues for accrued benefits purposes. Upon the death of a veteran, periodic monetary benefits to which he was entitled on the basis of evidence in the file at date of death, and due and unpaid for a period of not more than one year prior to death, may be paid to his surviving spouse. 38 U.S.C. § 5121. The appellant is shown to be the veteran's surviving spouse. I. Fracture of the Left Tibial Plateau Including Osteomyelitis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The evidence of record reveals that a fracture of the left tibial plateau and osteomyelitis did not occur during the veteran's active military service or for many years thereafter. Furthermore, neither the veteran nor the appellant contend that this disorder was so incurred. Rather, it is alleged that this fracture and resulting osteomyelitis resulted from service-connected disability, specifically, the removal of bone from the left tibia for bone grafting purposes. The bone removed from the tibia during service for bone grafting purposes was harvested from the left tibial crest. The post service fracture in 1982 occurred at the left tibial plateau. These sites are well removed from each other and the removal of bone from the tibial crest is not shown to have weakened the tibial plateau in any way so as to make it more susceptible to subsequent fracture. The osteomyelitis which developed after the left tibial plateau fracture did so as a result of that fracture and not as a result of the inservice removal of bone for grafting purposes. Shortly before his death, the veteran was specially examined by the Department of Veterans Affairs (VA) for the purpose of determining whether a relationship existed between the service-connected disorder and the subsequent fracture of the left tibial plateau with associated osteomyelitis. The opinion was that there was no such relationship. It is noted that other medical treatment records indicate no relationship, including the contemporaneous hospital records of 1982. Accordingly, service connection is not warranted on either a direct or secondary basis. II. Diabetes Mellitus Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. In addition, where a veteran served continuously for ninety (90) days or more during a period of war and diabetes mellitus becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The service medical records reveal no signs or symptoms of diabetes mellitus during the veteran's active military service nor is diabetes shown within one year following the veteran's separation from service. In fact, diabetes was not shown until decades after service separation. Furthermore, we find nothing persuasive in current medical literature to support the contentions advanced that the veteran's diabetes originated due to inservice trauma and transfusions. 2 Cecil, Textbook of Medecine, 1360-1381 (18th ed. 1988). Accordingly, service connection on a direct or secondary basis is not warranted. III. A Heart Disorder Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. In addition, where a veteran served continuously for ninety (90) days or more during a period of war and a heart disorder becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Additionally, service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The evidence of record reveals no signs or symptoms of heart disease during the veteran's active military service or for many years thereafter nor is it contended that heart disease began during service or within close proximity thereto. Rather, it is contended that the veteran's heart disorder was caused by his service-connected disabilities. However, such a causal connection is not shown and none of the examiners who have examined the veteran have indicated that such a causal relationship exists. Accordingly, service connection is not warranted. IV. Left Humerus Fracture Residuals Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Historically, the veteran received injuries to his left humerus due to an explosion while engaged in naval action aboard ship. He sustained a large deep laceration of the lateral side of the left arm extending to the bone. There were also several small wounds scattered on his body and extremities. X-rays revealed a comminuted fracture of the middle third of the humerus with anterior displacement of the proximal end of the distal fragment. Several minute metallic foreign bodies were also seen. The left arm wound was debrided, a vaseline gauze dressing applied, and a plaster splint (shoulder to hand) applied. In November 1944, the cast was removed. At that time there was crepitus and hypermobility of the midthird of the humerus. X-rays revealed a comminuted fracture of the left humerus with overriding and displacement. The wound was dressed and a hanging cast applied. He later developed a secondary infection. The wound was cleaned and skin grafting performed. In January 1945, it was noted there was definite nonunion. A bone graft was then taken from the right tibia and applied to the left humerus. Following this surgical procedure, the fractured fragments were in excellent anatomical position. The arm was casted. In May 1945, faulty union continued to be demonstrated. In June 1945, the old graft was broken, the hardware was removed, and a graft was obtained from the left tibia. His postoperative condition was poor due to shock. In October 1945, the veteran underwent additional bone grafting reutilizing the former tibial graft and obtaining additional graft material from the right ilium. In April 1946, he underwent revision of the left humeral scar. The following month, a medical survey board found him unfit due to acquired deformity of the left humerus. It was then noted that the fracture was well united and the wound scar well healed and nontender. A 2-inch shortening of the left upper extremity was noted and range of motion was only from 63 degrees to 115 degrees. On VA examination in May 1948, it was noted the veteran had definite awkwardness in the use of his left arm. which was deformed. He maintained it in a semi-flexed condition and was able to extend it fully. He was able to adduct his left arm at about 60 degrees in overhead flexion. Circumduction was restricted about 60 percent on the left and external rotation of the left shoulder was almost totally limited. Internal rotation was moderately good. There were multiple scars on the left arm due to surgery and shrapnel injuries and two of the longer scars were indented and adherent to the underlying tissue. The other scars were moderately superficial and well healed. The scars involved Muscle Groups V and VI. There was minimal restriction of supination and pronation of the left forearm, radial deviation and ulnar deviation of the left wrist was minimal, and flexion and extension of the hand and fingers were normal. However, there was about a 40 percent loss of strength in the left hand. A 50 percent evaluation was assigned, effective June 1946. The veteran was not again examined until September 1968. This examination was conducted by the VA and it was then noted that the scars of the left arm were healed but somewhat adherent to the triceps muscles with some loss of tissue and muscle substance of both Muscle Groups V and VI. The left biceps was almost 1 1/2-inch smaller than the right. There was good motion at the shoulder but the extremes of arm movements above shoulder level produced discomfort. There was limitation of motion of the left elbow which lacked 45 degrees of full extension and 25 degrees of full flexion. Pronation of the left forearm was restricted about 10 degrees and supination, about 30 degrees. There was good motion at the left wrist which was restricted not more than 10 degrees in dorsiflexion and palmar flexion. Extremes of movement produced discomfort. Radial and ulnar flexion were asymptomatic and unrestricted. He could make a normal fist and his finger spread was unimpaired. The grip of the left hand was good but about half that of the right. The right hand was noted to be his major extremity. The midforearm on the left was 1-inch smaller than the right and the left palm was 1/4-inch smaller than the right. There was about a 1 1/2-inch shortening of the left arm between the shoulder and elbow. In May 1986, the veteran sustained a refracture of the left humerus. Despite treatment, the fracture site remained ununited. VA physical therapy and rehabilitation findings of March 1989 indicate that the veteran had been instructed in a course of strengthening exercises for the extremities, except for the left upper extremity which at most had passive range of motion. On VA examination later in 1989, there was gross movement of the left humerus at the junction at approximately the middle third and some pain on movement. The proximal glenohumeral joint had a flexion contracture of 25 degrees and there was 3/4 of an inch of true shortening although functional shortening was greater because of the nonunion. Elbow range of motion was from 45 degrees to 110 degrees and there was good pronation and supination. The gross movement of the left upper extremity could only be made functional with the use of an external brace. There was biceps and triceps atrophy and the forearm was essentially normal with good hand function. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Through-and-through wounds and other wounds of the deeper structures almost invariably destroy parts of muscle groups and bring about intermuscular fusion and binding by cicatricial tissue and adherence of muscle sheath. 38 C.F.R. § 4.47. When rating muscle injuries in the same anatomical region, i.e. (1) shoulder girdle and arm (2) forearm and hand, the ratings will not be combined, but instead, the rating for the major group will be elevated from moderate to moderately severe, or from moderately severe to severe, according to the severity of the aggregate impairment of function of the extremity. Two or more severe muscle injuries affecting the motion about a single joint may be combined but not in combination receive more than the rating for ankylosis of that joint at an "intermediate" angle, except that when severe injuries involving the shoulder girdle and arm, the combination may not exceed the rating for unfavorable ankylosis of the scapulohumeral joint. 38 C.F.R. § 4.55. A 20 percent evaluation is warranted for favorable ankylosis of the scapulohumeral articulation of the minor upper extremity. Ankylosis is considered to be favorable when abduction is possible to 60 degrees and the individual can reach his or her mouth and head. Ankylosis of the scapulohumeral articulation of the minor upper extremity which is intermediate between favorable and unfavorable ankylosis warrants a 30 percent evaluation. A 40 percent evaluation requires unfavorable ankylosis. Ankylosis is considered to be unfavorable when abduction is limited to 25 degrees from the side. 38 C.F.R. Part 4, Code 5200. Slight disability of muscles is usually found in injury involving a simple wound of muscle without debridement, infection or effects of laceration. Moderate disability is normally found with injury involving through-and-through or deep penetrating wounds of relatively short tract by single bullet or a small shell or shrapnel fragment and absence of explosive-effective high velocity missile and of residuals of debridement or prolonged infection. Moderately severe disability is contemplated with injury such as through-and-through or deep penetrating wound by high velocity missile of small size or a large missile of low velocity, with debridement or with prolonged infection or with sloughing of soft parts, intermuscular cicatrization. Severe disability is contemplated by injury such as through-and-through or deep penetrating wound due to high velocity missile, or large or multiple low velocity missiles, or explosive-effective high velocity missile, or shattering bone fracture with extensive debridement or prolonged infection and sloughing of soft parts, intermuscular binding and cicatrization. 38 C.F.R. 4.56. A 50 percent evaluation is warranted for nonunion of the humerus of the minor upper extremity (a false, flail joint). A 70 percent evaluation requires loss of the head of the humerus (flail shoulder). 38 C.F.R. Part 4, Code 5202. A noncompensable evaluation is warranted when flexion of the forearm of the minor upper extremity is limited to 110 degrees or more. A 10 percent evaluation requires that flexion be limited to 100 degrees. 38 C.F.R. Part 4, Code 5206. A 10 percent evaluation is warranted when extension of the forearm of the minor upper extremity is limited to 45 degrees. A 20 percent evaluation requires that extension be limited to 75 degrees. 38 C.F.R. Part 4, Code 5207. A noncompensable evaluation is warranted for slight injury to Muscle Group V (flexor muscles of the elbow) of either the major or minor upper extremity. A 10 percent evaluation requires moderate injury of the minor upper extremity. A 20 percent evaluation requires moderately severe injury. A 30 percent evaluation requires severe injury. 38 C.F.R. Part 4, Code 5305. A noncompensable evaluation is warranted for slight injury to Muscle Group VI (extensor muscles of the elbow) of the minor upper extremity. A 10 percent evaluation requires moderate injury. A 20 percent evaluation requires moderately severe injury. A 30 percent evaluation requires severe injury. 38 C.F.R. Part 4, Code 5306. The evidence in this case reveals that the veteran clearly merited a 50 percent rating pursuant to 38 C.F.R. Part 4, Code 5202 due to nonunion of the left humerus. A 70 percent evaluation under that rating code is not warranted because there was no loss of the head of the humerus. In addition, the veteran had additional disability of the left upper extremity in the form of limitation of flexion of the forearm. However, since flexion was only limited to 110 degrees, a noncompensable evaluation would apply pursuant to 38 C.F.R. Part 4, Code 5206. He also had limitation of extension of the forearm which was limited to 45 degrees. Under 38 C.F.R. Part 4, Code 5207, a 10 percent evaluation is clearly warranted. The veteran also had muscle injury involving Muscle Groups V and VI. The Board is of the opinion, that, given the nature of the wounds sustained, the injury to both muscle groups would have to be considered severe in degree. Pursuant to 38 C.F.R. § 4.55, two or more severe muscle injuries affecting the motion about a single joint may be combined. 38 C.F.R. Part 4, Codes 5305 and 5306 provide for individual 30 percent ratings for severe muscle injury. The combined rating pursuant to 38 C.F.R. § 4.25 would be 51 percent. However, since 38 C.F.R. § 4.55 provides that the combination may not exceed the rating for unfavorable ankylosis of the scapulohumeral joint, and since 38 C.F.R. Part 4, Code 5200 provides for a 40 percent evaluation for unfavorable ankylosis of the scapulohumeral articulation of the minor upper extremity, the combined 51 percent evaluation must be reduced to 40 percent. Any additional impairment of the left upper extremity essentially involved the veteran's inability to use his hand for grasping. Although he was reported to have good hand function and an essentially normal forearm, there was some limitation of function of the forearm and the left hand had been described as having only about half of the grip strength of the right hand. Loss of grip strength connotes weakness of the musculature of the hand. The schedule for rating disabilities does not contain specific criteria for the evaluation of such weakness. When an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. The closest analogy that can be made would be for muscle injury. This would involve consideration of the criteria set forth for evaluating Muscle Groups VII, VIII, and IX. Applicable rating criteria is set forth in 38 C.F.R. Part 4, Codes 5307, 5308, and 5309. It seems clear to the Board that the demonstrated weakness would equate to moderate injury therby warranting a 10 percent evaluation. Thus, the combined rating for the veteran's left upper extremity disability would be rounded up to at least 80 percent (50 plus 40 plus 10 plus 10 equals 76 percent which rounds up to 80 percent). 38 C.F.R. § 4.25. At this juncture, the Board need delve no further into any additional possible disability because of the amputation rule which provides that 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. In this case, if the veteran's left upper extremity were to be amputated, given the location of the fracture site, it is probable that the amputation would have to take place either at or above the insertion of the deltoid. 38 C.F.R. Part 4, Code 5121 provides for a maximum 80 percent evaluation for amputation of the minor arm at that level. While it is possible that amputation might be accomplished below the insertion of the deltoid, the evidence currently available to the Board is at least evenly divided as to where the exact amputation point would occur. Accordingly, pursuant to 38 U.S.C. § 5107(b), the benefit of the doubt must be given to the claimant. Since the veteran was previously only in receipt of a 70 percent evaluation for disability attributable to the left upper arm, and since the Board herein finds a basis upon which to grant an 80 percent evaluation, accrued compensation benefits are assignable to this extent. Consideration has been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). The 1945 Schedule for Rating Disabilities will be used for evaluating the degree of disabilities in claims for disability compensation, disability and death pension, and in eligibility determinations. Those provisions represent, as far as can practicably be determined, the average impairment in earning capacity in civil occupations resulting from disability. In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities may be approved provided 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. 38 C.F.R. § 3.321(b)(1). Given the nature of the debilitation, it cannot be said that the case presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. Therefore, an extraschedular evaluation is inapplicable. In view of the foregoing, accrued benefits are not assignable beyond the extent previously indicated. V. Right Tibial Bone Graft Bone graft material was surgically removed from the right tibia in January 1945. The tibial donor site produced drainage through March 1945. When examined by the VA in May 1948, the scar over the right tibial crest was found to be indented and adherent to the underlying tibia. However, the veteran was able to perform a full deep knee bend with no limitation of motion at the knee or ankle. When he was next examined by the VA in September 1968, he was still able to squat well without difficulty although he did complain of discomfort in the right leg. The scar was healed but sensitive on palpation and there was an area on the right leg where it was adherent to the tibia for about 4 inches, an area which was very tender on palpation. There was no impairment of ankle function and no evidence of inflammation or drainage. A 10 percent evaluation was then assigned. Similar findings have since been demonstrated and continued through the veteran's death. The veteran's 10 percent evaluation had been assigned pursuant to 38 C.F.R. Part 4, Code 7804 which provides such an evaluation for superficial scars which are tender and painful on objective demonstration. Scars may also be evaluated on the basis of any related limitation of function of the body part which they affect. 38 C.F.R. Part 4, Code 7805. In this case, the only functional limitation which the right tibial crest scar could possibly contribute to would be functional limitation of the knee or ankle. Such functional limitation has not been objectively demonstrated by the evidence of record. The veteran had no right lower extremity below the knee due to amputation but this was occasioned due to complications from his nonservice-connected diabetes mellitus. Prior thereto, no functional limitation of the knee or ankle was shown. The Board is also cognizant of the adherent nature of the scar but, as noted above, this also did not occasion any functional limitation and any muscle injury cannot be said to be more than slight in degree. Slight injury to Muscle Group XI warrants only a noncompensable evaluation. 38 C.F.R. §4.50, 4.51, 4.56 and Part 4, Code 5311. Consideration has been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath. In particular, the evidence discussed above does not suggest that this disorder presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards, so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. 3.321(b)(1). For example, the disability had not required frequent periods of hospitalization, nor did it present significant interference with employment. Accordingly, since a higher evaluation is not warranted, accrued compensation benefits are not assignable. VI. Left Tibial Bone Graft Bone graft material was surgically harvested from the left tibial crest in June 1945. When examined by the VA in May 1948, the scar was noted to be well healed, superficial, and 7 1/2-inches long by 1/4-inch wide. There was no limitation of motion at the knee or ankle. X-rays showed slight deformity of contour, two minute metallic foreign bodies retained within the medullary canal close to the internal cortex just below the junction of the proximal and middle third, and a larger metallic foreign body within the calf muscle. On VA examination in September 1968, the scar was healed and sensitive on palpation. The knee and ankle had normal motion without restriction but the veteran did complain of discomfort on extreme ankle movement. There was no evidence of inflammation or drainage. A 10 percent evaluation was assigned pursuant to 38 C.F.R. Part 4, Code 7804 which provides for the assignment of such an evaluation on the basis of superficial scars which are tender and painful on objective demonstration. Scars may also be evaluated on the basis of any related limitation of function of the body part which they affect. 38 C.F.R. Part 4, Code 7805. However, in this case, the donor site scar did not produce any functional limitation. The Board is cognizant of the knee impairment demonstrated on examination in 1989. However, this impairment is shown to be due to a left tibial plateau fracture in 1982 which required surgical intervention with open reduction and internal fixation and produced subsequent osteomyelitis. The nonservice-connected nature of such disability was more fully discussed in Subsection I above. The Board is also cognizant of the large metallic fragment which was contained within the gastrocnemius muscle. This muscle constitutes part of Muscle Group XI. A noncompensable evaluation is warranted for slight injury to Muscle Group XI while a 10 percent evaluation requires moderate injury. 38 C.F.R. Part 4, Code 5311. The Board is of the opinion that the evidence in this case demonstrates that any injury to this muscle was not more than slight in degree. The wound was simple, did not require debridement, there was no infection, and no effects of the laceration have been shown. See 38 C.F.R. § 4.56. Accordingly, there is no basis upon which to assign an evaluation in excess of that currently in effect. Consideration has been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the appellant, as required by Schafrath. In particular, the evidence discussed above does not suggest that this disorder presented such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards, so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). For example, the disability had not required frequent periods of hospitalization, nor did it present significant interference with employment. Therefore, accrued compensation benefits are not assignable. VII. A Temporary Total Convalescent Rating Beyond May 25, 1987 In May 1986, the veteran refractured his left humerus. He was subsequently granted a temporary total disability rating pursuant to 38 C.F.R. § 4.30 which was paid through May 1987. The law provides that such a total rating will be assigned following hospital discharge, effective from the date of hospital admission and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge if the hospital treatment of the service-connected disability resulted in: (1) Surgery necessitating post hospital convalescence. The initial grant of a total rating will be limited to one month, with 1 or 2 extensions of periods of one month each in exceptional cases. (2) Surgery with severe postoperative residuals shown at hospital discharge, such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of wheelchair or crutches (regular weight bearing prohibited). Initial grants may be for 1, 2, or 3 months. (3) Immobilization by cast, without surgery, of one major joint or more shown at hospital discharge or performed on an outpatient basis. Initial grants may be for 1,2, or 3 months. Extensions of periods of 1, 2, or 3 months beyond the initial three months may be made under subparagraph (1)(2) or (3). In addition, approval may be obtained for an extension of up to six months beyond the initial six-month period under subparagraph (2) or (3). 38 C.F.R. § 4.30. In this case, the veteran's hospital discharge took place in May 1986 and he subsequently received the maximum 12 months of convalescent benefits pursuant to 38 C.F.R. § 4.30 which were paid through May 1987. 38 C.F.R. § 4.30 does not provide a basis for a continuation of benefits assigned under that section in excess of 12 months. Moreover, by May 1987, the disorder had stabilized and further convalescence was not in order. The evidence in this case shows that in June 1986, the veteran's left arm was placed in a posterior plaster splint. Later, a new Sarmiento sleeve was applied. In August 1986, good callous formation was noted but it was also determined that there was still motion present. In September 1986, the veteran continued to be immobilized in the Sarmiento sleeve. By November 1986, a stimulator was put in place in an attempt to assist in callous formation. It was then noted that there was some lateral fracture displacement since prior examinations. In December 1986, no sign of increased callous formation was found. In January 1987, no significant change was noted. There was a minimal periosteal reaction at the fracture site. In February 1987, it was noted that three surgical staples had been removed since the previous month. There was a slight increase in callous formation. In March 1987, no significant change was noted. In April 1987, minimal increase in callous formation at the ununited fracture site was seen. In May 1987, the splint arrangement was removed due to skin problems and the veteran was referred to prosthetics. A jacket prosthesis was fitted. In June 1987, it was noted that the prosthetic device had provided good support but he complained that he could not use it because of excessive sweating. In December 1987, it was indicated there was no sign of change since examinations in March and April 1987. It also appears from the evidence that, since the termination of the convalescent rating in May 1987, the veteran had worn a brace or device of some sort on his left upper extremity which was removed only for sleeping and bathing. It appears to the Board that, by May 1987, the veteran's left arm disability had reached a point where it was unlikely to significantly improve further and, by the same token, was essentially stabilized. Given the nature of the disability, it is evident that severe debilitation would continue. However, the rating criteria could then be adequately applied as a need for further convalescence no longer existed. Accordingly, such benefits are not payable beyond May 1987. VIII. Total Disability Rating Based Upon Individual Unemployability The law provides that, before a total disability rating based upon individual unemployability may be granted, it must be shown that the veteran is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. With respect to the laws and regulations pertaining to the VA, neither the United States Code nor the Code of Federal Regulations offers a definition for "substantially gainful employment" or "substantially gainful occupation." The VA Adjudication Manual, M21-1, Section 50.55(8) defines "substantially gainful employment" as "that which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." The veteran's service-connected disabilities included nonunion of midshaft of left humerus with shortening and limitation of motion of elbow, atrophy of biceps and triceps muscles with retained metallic foreign bodies; scar, bone graft donor site, right tibial diaphysis; scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in medullary canal, and metallic foreign body in calf muscle; and right wrist fracture. The veteran also had significant nonservice-connected disabilities to include osteomyelitis of the left tibia, left tibial plateau fracture with open reduction and internal fixation, a below-the-knee amputation of the right lower extremity, a heart disorder, diabetes mellitus, and a stomach disorder. These nonservice-connected disabilities were of such severity as to cause the veteran's death in November 1989. The nonservice-connected disabilities principally contributing to his death were his diabetes mellitus and heart disorders. Indeed, on autopsy protocol, the examiner commented that, in evidence of the diabetes mellitus, the autopsy found bilaterally enlarged kidneys, nodular glomerulosclerosis of the kidneys, and arteriolonephrosclerosis. Islets of Langerhans in the pancreas were decreased in number. The veteran also had arteriosclerotic cardiovascular disease in which the left anterior descending coronary artery was 95 percent stenotic and the right coronary artery was approximately 75 percent. He had an old myocardial infarction with an aneurysm of the left cardiac ventricle and septum in an anterolateral location measuring 6 centimeters by 3 centimeters. Diabetes mellitus was also the probable cause for his foot amputation and history of hypertension. The veteran had previously been in a nursing home primarily due to his nonservice-connected disabilities. Regarding the veteran's service-connected disabilities, the veteran, at worst, had no use of the left (minor) arm, had no residual disability attributable to the right wrist fracture, and had relatively minimal disability of both lower extremities because of bone grafts which had been harvested from both tibial crests. Although the veteran's service-connected disabilities precluded heavy or medium work, they most probably did not preclude light work and clearly did not preclude sedentary work. Although neither light work nor sedentary work is defined for VA benefits purposes, regulations applicable to the Social Security Administration do define them, and we find these definitions to be helpful. Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even if the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. 20 C.F.R. § 404.1567(b). Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. 20 C.F.R. § 404.1567(a). Given the veteran's high school education and previous supervisory experience, light and sedentary work exist which he would have been capable of performing. Although it is clear that the veteran was unable to perform any kind of work prior to his death, it was not due solely to his service-connected disabilities. It is clear to the Board that, had he been totally free of debilitation due to his nonservice-connected disabilities, he would have been able to perform a substantially gainful occupation. Accordingly, a total disability rating based upon individual unemployability due to service-connected disabilities was not warranted and accrued benefits are not assignable. ORDER Accrued compensation benefits based on a claim for service connection for residuals of a fracture of the left tibial plateau including osteomyelitis, a claim for service connection for diabetes mellitus, a claim for service connection for a heart disorder, a claim for an evaluation in excess of 10 percent for scar, bone graft donor site, right tibial diaphysis, a claim for an evaluation in excess of 10 percent for scar, bone graft donor site, left tibial diaphysis with two minute metallic foreign bodies in the medullary canal and metallic foreign body in the calf muscle, a claim for a temporary total disability rating based upon convalescence beyond May 25, 1987, and a claim for a total disability rating based upon individual unemployability are not assignable. The appellant's appeal as to these issues is denied. Accrued compensation benefits for an evaluation of 80 percent for nonunion of the midshaft of the left humerus with shortening and limitation of motion of the elbow and atrophy of the biceps and triceps muscles with retained metallic foreign bodies are assignable. To this extent, the accrued benefits sought on appeal are granted. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * M. SABULSKY J. U. JOHNSON *38 U.S.C. § 7102(a)(2)(A) (1992) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional Member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1992), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.