BVA9502054 DOCKET NO. 91-43 436 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to a permanent and total disability rating for pension purpose from January 1990 to July 1991. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD K. J. Alibrando, Associate Counsel INTRODUCTION The veteran served on active duty from March 1967 to June 1968. This appeal arises from a July 1990 rating decision in which the RO denied non-service connected pension benefits. The Board remanded the case in April 1992 for additional development of the evidence. By rating action of December 1993, the RO granted service connected pension benefits effective in September 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he was permanently precluded from performing any substantially gainful employment due to multiple physical disabilities from January 1990 to July 1991. He states that he has been employed since July 1991 and is not seeking non- service connected pension benefits after July 1991. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence is against the claim for a permanent and total disability rating for pension purpose from January 1990 to July 1991. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Glaucoma was manifested by visual loss equivalent to anatomical loss of one eye in the left eye with visual acuity of 20/40 in the right eye; the disability was 40 percent disabling. 38 C.F.R. Part 4, Code 6066. 3. The veteran's cervical spine disability was manifested by x- ray evidence of moderately advanced spondylosis; and its manifestations are analogous to moderate limitation of motion; the disability was 20 percent disabling under Code 5290 4. The veteran's paresthesia of the right arm and hand was manifested by numbness of the tips of the fingers, the index and middle finger and the thumb of the right hand with a normal range of motion of the wrists, hands and elbows and well-preserved grip strength; the disability was rated at 10 percent under Code 8515. 5. The evidence shows a history of schizophrenia; the disability was rated at 0 percent under Code 9210. 6. The veteran's left shoulder disability was manifested by a normal range of motion of the left shoulder with mild dipping of the shoulder. The disability was periodically symptomatic, and was 10 percent disabling by analogy to Code 5203. 7. The veteran's fistula in ano was manifested by a one and 1/2 year history of perianal abscess and no complaints or findings of slight leakage or occasional moderate leakage; the disability was noncompensable under Code 7335. 8. The veteran's hepatitis was manifested by a diagnosis of infectious hepatitis on the basis of the results of serum antigen and antibody tests, no jaundice, no enlargement of the liver or any other demonstrable liver damage and no mild gastrointestinal disturbance attributed to hepatitis; the disability was rated noncompensable under Code 7345. 9. The veteran's atrophy of the left testicle was rated noncompensable under Code 7523. 10. The veteran's scars of the abdomen and chest were manifested by well-healed, nontender scars; the disability was noncompensable under Code 7805. 11. The veteran was born in February 1946, has a 12th grade education, and worked as a maintenance worker. The veteran secured employment in July 1991 and is currently employed as an elevator operator. 12. The veteran's permanent disabilities were not so severe that they precluded him from following all types of substantially gainful employment for the period from January 1990 to July 1991. CONCLUSION OF LAW The veteran was not permanently and totally disabled with the meaning of governing law and regulations for the period from January 1990 to July 1991. 38 U.S.C.A. § § 1155, 1502, 1521, 5107(a) (West 1991); 38 C.F.R. § § 3.321(b)(2), 3.340(b), 3.342, 4.1, 4.2, 4.7, 4.10, 4.15,4.16, 4.17, 4.20, 4.31, 4.40, Codes 6066, 5290, 8515, 9210, 5201, 5203, 7335, 7345, 7523, 7805 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. 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.A. § 5107(a). The law authorizes the payment of pension to a veteran of a war who has the requisite service and who is permanently and totally disabled. 38 U.S.C.A. § § 1502, 1521. If his disability is less than 100 percent, he shall be considered permanently and totally disabled if unemployable as a result of disability reasonably certain to continue throughout the person's life, or is suffering from disability which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.321, 3.340, 3.342, and Part 4. The provisions of 38 C.F.R. § 4.15 provide further criteria with respect to total disability ratings, which will be discussed subsequently. In determining whether an assignment of a permanent and total disability rating is warranted, the veteran's disabilities must be reviewed and separately evaluated. Roberts v. Derwinski, 2 Vet.App. 387 (1992) 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.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Moreover, the VA has a duty to acknowledge and consider all regulations which are potentially applicable to the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history and that there be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.2 requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.7 provides that where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. Also, 38 C.F.R. § 4.10 provides that, in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory, and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the function affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in part of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and functional loss, with respect to all of these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structure, or the 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. Some of basic facts are not in dispute. The veteran was born February 1946 and is 48 years old, has a 12th grade education, and work experience as a maintenance worker. He had no service connected disabilities. By rating action of July 1990, the RO evaluated the veteran's permanent disabilities as follows: no light perception of the left eye, residuals of glaucoma, assigned a 30 percent evaluation under the provisions of 38 C.F.R. Part 4, Code 6070; spondylosis of the cervical spine, assigned a 10 percent evaluation under Code 5290; paresthesia of the right arm and hand, median nerve pathology, evaluated as 10 percent disabling under Code 8515; schizophrenia, competent, assigned a 10 percent rating under Code 9210; history of rotator cuff injury of the left shoulder, evaluated as noncompensable under Code 5203; postoperative fistula in ano, assigned a noncompensable evaluation under Code 7335; hepatitis, evaluated as noncompensable under Code 7345; atrophy of the left testicle, assigned a noncompensable evaluation under Code 7523 and stab wound of the abdomen, assigned a noncompensable evaluation under Code 7805. The combined disability evaluation was 50 percent. The veteran filed an application for VA compensation or pension in March 1990. An April 1990 VA abbreviated medical record shows findings of a deviated septum and bony pyramid with an initial impression of traumatic nasal deformity. The veteran underwent septorhinoplasty. The final diagnosis was traumatic nasal deformity. On VA general medical examination of April 1990, the veteran reported difficulty with arthritis on the right side in the hand and upper arm. He was right handed. He indicated experiencing cramps in the arm in the morning and during sleep, which he noticed more in the wintertime. The veteran had a laceration scar on the right side of his scalp which he reported was from being cut. He reported that he was stabbed in the abdomen in 1968 and 1969 and was treated for those injuries. He indicated he had current discomfort in the right side described as knots in the lower abdomen. He stated he had not received treatment for this problem as it usually resolved. He also reported having surgery on his right shoulder for a tumor in February 1990 and a growth was removed. He indicated it was healing normally. He stated he had a rotator cuff injury on the left shoulder and if he lifted too much weight it caused difficulty. He reported having six months of therapy for that injury. He indicated that he was not taking any medications. He stated that his normal occupation was maintenance and the main reason for unemployment at the present time was because he was laid off. Examination revealed a well-healed 12 inch scar on the upper abdomen and a drain scar in the upper right quadrant. The examiner indicated that these scars represented treatment for the liver or abdominal injury reported by the veteran. There was also an inch long scar alone the spine, at about the T5 and another one and 1/2 inch scar over the scapula. There was a slight "coving down" of the left shoulder when compared to the right which the examiner stated was probably due to the rotator cuff injury. The examiner noted that the veteran had a normal walk and posture, disrobed easily and that he saw nothing remarkable about the right shoulder. The examiner indicated that he found no evidence of arthritis in the upper extremities. The range of motion of the wrists, hands, elbows, and shoulders were all well within normal limits. He indicated that grip strength was as well-preserved in the right hand as in the left hand. The examiner stated that the veteran could throw the shoulders back and forward and elevate them with no difficulty and showed no impairments of the right upper extremity. The examiner stated that on questioning the veteran, it appeared that his history resembled more of a neuropathy rather than arthritis in that he had numbness of the tips of the fingers, the index finger and middle finger, and the thumb, on the right hand and also at times over the lateral aspect of the arm. The examiner noted that there was a lymph node in the right supraclavicular triangle which the veteran was aware of and indicated that it had been there for a long time. There was also folliculitis in the pubic hair above the penis and atrophy of the left testicle. The examiner stated that the stab wounds to the abdomen resulted in muscle injuries and the veteran reported that a laparotomy was done in the past. The range of motion of the left shoulder was reported as normal. The examiner indicated that he could not pull the shoulder down to any degree in attempting to show the rotator cuff injury and grip strength was well-preserved. A chest x-ray showed no infiltrate. The heart size was upper limits of normal with prominence of the left ventricle and pulmonary vasculature was within normal limits. An x-ray of the cervical spine showed that the cervical disc spaces were narrowed, such as C2-C3, C3-C4, C5-C6 and C6-C7. It was noted that between some of the spaces there was also bridging osteophytosis and the intervertebral foramina were also narrowed. The radiological impression was moderately advanced spondylosis. The final diagnoses were arthritis of the right upper extremity claimed, with no evidence of arthritic changes found; paresthesia, right arm and hand, secondary to median nerve pathology, periodically symptomatic; stab wounds to the abdomen, well-healed, with no changes of a surgical nature second to said wounds found; history of rotator cuff injury, left shoulder, with mild dipping as the only finding noted, periodically symptomatic. An April 1990 VA special internal medicine examination noted that the veteran's claims file was not available for review and that the examination would be confined to the veteran's reported hepatitis. The veteran reported that in 1968, when he attempted to sell blood, he was told he had antibodies indicating that he had previous hepatitis. He indicated that beginning in 1971 he abused intravenous narcotics and alcohol. He reported numerous hospitalizations for detoxification but that he had abstained from using alcohol and intravenous narcotics since 1984. He also reported that he was stabbed in 1968 or 1969 and that his gallbladder was removed and a laceration of the liver was repaired. He indicated that he also suffered a stab wound in the back of left upper chest and was cut over the back of the head in separate incidents. He indicated that currently, he was not under regular medical care and was not taking any medications. He reported nausea approximately three times per month and that he sometimes brought up some clear slimy mucoid-type juices, usually a few minutes after breakfast. The examiner indicated that the veteran had a superb muscular development due to weight lifting and was overweight at 222 pounds. The veteran reported that his minimum weight during the past year had been 221 and his maximum weight had been 230. He denied chronic diarrhea but reported six occasions in the past year of a peristaltic rush with rectal incontinence. He denied passing any clay-colored stools, cream-colored stools or tarry stools. The veteran stated that he worked in maintenance as a janitor in a condominium but had been laid off in December 1989 because the building management have indicated that he was not qualified for the type of work for which he was hired. Physical examination revealed a very superbly-muscled, superbly developed mildly obese male. There was no fetor, uremic odor or acetone odor on the breath. There was no cyanosis of the lips or clubbing of the fingers. There was a healed stab wound scar on the left upper chest near the spine that was nontender with no keloiding. The breath sounds were normal bilaterally throughout the chest with no lung rales, lung rhonchi or asthmatic wheezing heard. There was no cardiomegaly. The cardiac rhythm was regular with no premature beats or pulse deficits. There were no murmurs, palpable thrills, pericardial friction rub or bruit on auscultation. The abdomen was flat, soft, nontender and nonrigid. There was a 10 inch healed surgical scar running down the midline and around the umbilicus. There was a healed drainage scar in the right lateral chest. The examiner noted that all scars were well-healed and intact, with no keloiding, herniation or retraction. There was no enlargement of the liver or the spleen. There were no abdominal masses or ascites. The blood pressure readings were 124/84 in the left arm and 120/82 in the right arm. The examiner indicated that a laboratory workup of the veteran would include a CBC, urinalysis, Chemistry 1 and Chemistry 2 series and titer for Hepatitis-B antigen, Hepatitis-B surface and core antibodies, and Hepatitis-A antibody. The final diagnoses included history of previous multi-substance abuse intravenously, history of periods alcohol abuse, hepatitis- B hepatitis acquired via intravenous drug abuse. There was no enlargement of the liver and no ascites or jaundice The examiner also noted that testing showed positive titers for hepatitis-B surface antigen; positive titer for hepatitis B Core antibody and negative titer for hepatitis B surface antibody. He stated that the veteran was infectious to others. He also indicated that an EKG and chest x-ray were normal and that the physical examination showed normal cardiovascular findings and normal blood pressure. An April 1990 VA eye examination shows that the veteran reported that the vision in his left eye was "out" for 97 days. He reported a history of being hit in the left eye and having that eye stuck with a fork. On examination, his vision was 20/40 in the right eye and no light perception in the left eye. The assessment was end stage glaucoma of the left eye greater than the right eye. On follow-up examination in April 1990, vision testing showed vision of 20/40 in the right eye and no light perception in the left eye. The intraocular pressure was 20 on the right and 44 on the left. The right lens was normal and the left lens showed a mature cataract with a view of the fundus. The examiner indicated that medications had improved the intraocular pressure, however it remained too high on the right and the veteran was instructed to return in ten days for a follow-up examination. An April 1990 VA discharge summary shows that the veteran reported a 1 1/2 year history of perianal abscess, which intermittently drained pus but with no purulent discharge or pain in the past several weeks. The veteran was admitted for an elective examination under anesthesia and probable fistulotomy. The veteran reported a history of glaucoma and left eye surgery in 1989 and a psychiatric history of schizophrenia. On rectal examination, there were no masses, the prostate was normal and the examination was heme-negative. There was a small indurated area in the posterior midline with an external opening evident of the posterior midline. There was no purulence or fluctuance noted, and the area was nontender. The electrocardiogram showed an incomplete right bundle branch block and sinus bradycardia, as well as a possible inferior wall myocardial infarction, age indeterminate. The chest x-ray was reported as normal. The examiner indicated that the veteran was scheduled for surgery for examination under anesthesia and possible fistulotomy which was not done due to scheduling problems and emergencies. VA outpatient treatment records developed for the period between May 1990 and January 1991 show that the veteran was seen in May 1990 for end stage chronic open angle glaucoma. He reported a history of glaucoma for seven months with treatment for one month. On examination his vision was 20/30 in the right eye with pin hole vision of 20/25. There was no light perception in the left eye. The intraocular pressure was 24 in the right eye and 43 in the left eye. The assessment indicated that the intraocular pressure was too high in the right eye. The outpatient records include numerous entries between May 1990 and January 1991 which show treatment of end stage glaucoma. In June 1990 his vision was 20/40+1 in the right eye and no light perception in the left eye. In September 1990, the examiner indicated that the veteran's vision was 20/40 in the right eye and no light perception in the left eye with intraocular pressure of 24 in the right eye and 42 in the left eye. The assessment was chronic end stage glaucoma, advanced, uncontrolled on maximum medical therapy. In October 1990, the veteran's vision was 20/40+2 in the right eye and no light perception in the left eye. Intraocular pressure readings between 8:40 and 4:25 showed pressures between 17 and 26 in the right eye and 39 to 47 in the left eye. The assessment was chronic open angle glaucoma, intraocular pressure too high on the right, range 17-26. In December 1990, field of vision testing showed progressive vision field changes with increased intraocular pressure and the plan was to schedule the veteran for a right eye trabeculectomy. A January 1991 VA hospital summary shows that the veteran had a history of open angle glaucoma, on maximal therapy, with continued visual field loss with a cup-to-disk ration of .95. The examiner indicated that the intraocular pressures where considered to be too high, in the high teen and low twenties. A trabeculectomy of the right eye was performed in January 1991 and on the first postoperative day vision in the right eye was 20/40. It was noted that on postoperative day four, his vision was stable, yet he was complaining of a painful right eye with a foreign body sensation. The cornea revealed diffuse 1-2+ coarse SVK and a central epithelial deft, thought to be secondary to toxicity through the concentrated solution of 5-Fluorouracil. A collagen shield was placed to protect the cornea. The veteran continued to improve on postoperative day seven. Examination of the conjunctiva revealed a fairly avascular bleb superiorly with a a small inferior subconjunctival hemorrhage. The cornea revealed continued epithelial defect centrally and coarse SVK paracentrally. The anterior chamber was deep and quiet. The pressure was 11. The lens was clear. The iris was well dilated and a PI was present and patent superiorly. The final diagnosis was open angle glaucoma. On discharge, his intraocular pressure and clinical status were stable. A February 1991 Application for Medical Care shows that the veteran requested follow-up dental work. On VA psychiatric examination in 1993, there was no recent history of psychosis or psychiatric history. There was no evidence of psychosis and no psychiatric diagnosis apart from history of substance abuse. Scars may be evaluated on the basis of any related limitation of function of the body part which they effect. 38 C.F.R. Part 4, Code 7805. Based on a review of the record, the current clinical findings show that a compensable rating for stab wound scars of the abdomen and chest are not warranted. Examination in April 1990 showed that the veteran had stab wound scars located on the left upper chest near the spine and on the abdomen which were well-healed and intact with no keloiding, herniation or retraction. The medical evidence was negative for complaints, findings or diagnoses of any limitation of function of the chest or abdomen as a result of the scars which would warrant a compensable evaluation. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran reported that the scars had marked interference with his employment and he had no hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the scars of the abdomen and chest is not warranted. 38 C.F.R. § 3.321(b)(1). A 10 percent evaluation is warranted for slight limitation of motion of the cervical spine. A 20 percent evaluation is warranted for moderate limitation of motion of the cervical spine. A 30 percent evaluation is warranted for severe limitation of motion of the cervical spine. 38 C.F.R. Part 4, Code 5290. Based on a review of the record, the Board concludes that a 20 percent rating for spondylosis of the cervical spine was warranted. On examination in April 1990, the veteran made no complaints of neck pain. An X-ray revealed narrowing of the cervical disc spaces with bridging osteophytosis. The radiological impression was moderately advanced spondylosis. Although no findings of functional impairment due to the cervical spine disability were recorded during the period at issue, we accept the radiologic assessment as a measure of the degree of disability, that is, we find that there was moderate disability. Accordingly, the cervical spine disability more closely resembled the criteria for a 20 percent rating under the provisions of 38 C.F.R. Part 4, Code 5290 during the period at issue. It should be added, however, that the requirements for a 30 percent rating have not been met as there were no findings of severe disability of the cervical spine. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran reported that a back disability caused marked interference with the veteran's employment and he had no hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the spondylosis of the cervical spine is not warranted. 38 C.F.R. § 3.321(b)(1). Blindness in one eye (anatomical loss of the eye) warrants a 40 percent evaluation, in addition to special monthly compensation, when corrected visual acuity in the other eye is 20/40 (6/12) A 50 percent evaluation requires corrected visual acuity in the other eye of 20/50 (6/21). 38 C.F.R. Part 4, 4.75 and Code 6066. Based on a review of the record, the clinical findings show in April 1990, the veteran reported that he had lost vision in his left eye and on examination, his vision was reported as 20/40 in the right eye and no light perception in the left eye. The assessment was end stage glaucoma of the left eye greater than the right eye. Subsequent VA records from May 1990 to January 1991 show that the veteran was treated for glaucoma with abnormal intraocular pressure in the right eye which required corrective surgery in January 1991. The January 1991 VA hospital summary shows that a trabeculectomy of the right eye was performed and postoperatively vision in the right eye was 20/40. The clinical evidence does not show that corrected visual acuity in the right eye of 20/50 which would warrant a 50 percent evaluation. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran reported that his visual disability had marked interference with his employment and other than the hospitalization for the corrective surgery in January 1991, he was not hospitalized for that disability. Thus, the Board finds that an extraschedular evaluation for the veteran's visual disability is not warranted. 38 C.F.R. § 3.321(b)(1). A 10 percent evaluation is warranted for mild incomplete paralysis of the median nerve of the major upper extremity. A 30 percent evaluation requires moderate incomplete paralysis. 38 C.F.R. Part 4, Code 8515. Based on a review of the record, those clinical findings show that a rating in excess of 10 percent for paresthesia of the right arm and hand is not warranted. On examination in April 1990, the veteran reported numbness of the tips of the fingers, the index and middle finger and the thumb of the right hand. There was a normal range of motion of the wrists, hand and elbows. Grip strength was well-preserved. The findings do not show moderate incomplete paralysis which would warrant a 30 percent rating. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show demonstrable functional impairment due to the disability, and, therefore, we do not find marked interference with his employment. The veteran had no hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the paresthesia of the right arm and hand is not warranted. 38 C.F.R. § 3.321(b)(1). A noncompensable evaluation is warranted for psychosis in full remission. A 10 percent evaluation requires slight impairment of social and industrial adaptability. A 30 percent evaluation requires definite impairment of social and industrial adaptability. 38 C.F.R. Part 4, Code 9210. Based on a review of the record, the clinical evidence shows that a compensable rating for schizophrenia is not warranted. The clinical evidence shows that the veteran received no psychiatric treatment during the period of time he contends that he was permanently disabled. The only evidence of a psychiatric disorder is included in an April 1990 VA discharge summary which simply noted a history of schizophrenia. As for the subsequent psychiatric examination, this also revealed no recent history or, for that matter, findings of psychosis. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran asserted that schizophrenia had marked interference with his employment and he had no hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the history of schizophrenia is not warranted. 38 C.F.R. § 3.321(b)(1). Malunion of the clavicle or scapula, or nonunion without loose movement, warrants a 10 percent evaluation. A 20 percent evaluation requires nonunion with loose movement or dislocation. These disabilities may also be rated on the basis of impairment of function of the contiguous joint. 38 C.F.R. Part 4, Code 5203. A 20 percent evaluation (the lowest rating provided under Code 5201) is warranted for limitation of motion of minor arm when motion is limited to shoulder level and to midway between the side and shoulder level. A 30 percent rating is warranted where motion of the minor arm is limited to 25 degrees from the side. 38 C.F.R. Part 4, Code 5201. Based on a review of the record, the clinical findings show that a compensable rating for rotator cuff injury of the left shoulder injury is warranted under Code 5201. On examination in April 1990, there was a normal range of motion of the left shoulder. The examiner indicated that the veteran was able to throw the shoulders back and forward and elevate them with no difficulty. However, there was mild dipping of the shoulder which was described as periodically symptomatic. In the Board's judgment, the disability is equivalent to malunion of the scapula without loose movement based on analogous anatomical localization and symptomatology. The findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran reported that his left shoulder disability had marked interference with his employment and he has had no hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the history of left shoulder rotator cuff injury is not warranted. 38 C.F.R. § 3.321(b)(1). A noncompensable evaluation is warranted for healed or slight impairment of the rectal and anal sphincter without leakage. A 10 percent evaluation requires constant slight leakage or occasional moderate leakage. 38 C.F.R. Part 4, Code 7332. Fistula in ano is evaluated as for impairment of sphincter control under the provisions of 38 C.F.R. Part 4, Code 7332. 38 C.F.R. Part 4, Code 7335. Based on a review of the record, the clinical findings show that a compensable rating for fistula in ano is not warranted. The clinical evidence shows that in April 1990 the veteran reported a one and 1/2 year history of perianal abscess. He was admitted for an elective examination and possible fistulotomy, which was not performed. The remainder of the medical evidence is negative for complaint or finding of slight leakage or occasional moderate leakage which would warrant a compensable rating. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran contended that the fistula in ano had marked interference with his employment and other than the April 1990 hospitalization for elective surgery, he had no recent hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for fistula in ano is not warranted. 38 C.F.R. § 3.321(b)(1). Healed, nonsymptomatic infectious hepatitis warrants a noncompensable evaluation. A 10 percent evaluation is warranted for infectious hepatitis manifested by demonstrable liver damage with mild gastrointestinal disturbance. 38 C.F.R. Part 4, Code 7345. Based on a review of the record, the clinical findings show that a compensable rating for hepatitis is not warranted. The April 1990 internal medical examination shows a diagnosis of infectious hepatitis on the basis of the results of serum antigen and antibody tests. Examination showed that the veteran had no jaundice, enlargement of the liver or any other demonstrable liver damage. He complained of nausea three times per month but this was not attributed to the hepatitis. The evidence does not show demonstrable liver damage with mild gastrointestinal disturbance which would warrant a compensable evaluation. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that any treatment was required for hepatitis or that the veteran made any complaints that hepatitis had a marked interference with his employment. There is no evidence of hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the hepatitis is not warranted. 38 C.F.R. § 3.321(b)(1). A noncompensable evaluation is warranted for complete atrophy of one testis. A 20 percent evaluation requires complete atrophy of both testis. 38 C.F.R. Part 4, Code 7523. Based on a review of the record, the clinical findings show that a 20 rating for atrophy of the left testicle is not warranted. The clinical evidence is negative for evidence of complete atrophy of both testes. Further, the findings do not present 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. In this regard, the Board notes that evidence does not show that the veteran complained that the atrophy of the left testicle had a marked interference with his employment and he had hospitalizations for that disability. Thus, the Board finds that an extraschedular evaluation for the atrophy of the left testicle is not warranted. 38 C.F.R. § 3.321(b)(1). As discussed above, the Board concluded that a 20 percent evaluation for spondylosis of the cervical spine is warranted. The combined rating for the veteran's permanent disabilities is 60 percent. The veteran does not have at least one disability rated at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Therefore, the veteran does not meet the schedular requirements for assignment of a permanent and total disability rating under 38 C.F.R. § § 4.16 and 4.17. Accordingly, in this case, in order to grant a permanent and total disability rating for pension purposes, it must be concluded that the veteran meets the requirements for pension on an extraschedular basis. Under the applicable criteria, where the evidence of record establishes that an applicant for pension who is basically eligible fails to meet the disability requirements based on the percentage standards of the rating schedule but is found to be unemployable by reason of his or her disabilities, age, occupational background and other related factors, a permanent and total disability rating on an extraschedular basis may be approved. 38 C.F.R. § 3.321 (b)(2). In this case, the veteran has work experience as a maintenance worker. He has asserted, in effect, that he was permanently precluded from performing any substantially gainful employment due to multiple physical disabilities from January 1990 to July 1991. He asserts that he has been employed since July 1991 and is not seeking non-service connected pension benefits after July 1991. He was born in February 1946 and was 44 years old in 1990. He has a high school education. The record shows that he reported that he was laid of work was a maintenance worker in December 1989 due to being unqualified for the that position. He has also reported that he resumed working in July 1991. As noted above, the veteran is entitled to pension benefits only if he is permanently and totally disabled. During the period at issue, the veteran was undergoing evaluation and treatment principally for continued right visual field loss due to glaucoma (with no light perception in the left eye). However, notwithstanding the continued unacceptably high intraocular pressures, requiring surgical intervention in January 1991, he did not experience significant loss of visual acuity on the right, and, in any event, the disability was surgically corrected and, therefore, not permanent. As to the remaining disabilities, functional impairment was no more than minimal and should not have precluded substantially gainful employment. These principally involve the periodically symptomatic minor shoulder disability; the mild sensory, but not motor changes, of the major hand and arm; the occasional gastrointestinal symptoms; the anal fistula, not symptomatic during the period at issue; and the schizophrenia apparently in full remission. Based on these findings, the Board concludes that an extraschedular evaluation is not warranted. Additionally, he did not have permanent loss of use of the hands or feet, or of one hand and one foot, or loss of sight of both eyes. He was not permanently helpless or permanently bedridden. Consequently, he did not meet the criteria of 38 C.F.R. § 4.15. The Board finds that veteran was not unemployable by reason of his disabilities, age, and occupational background from January 1990 to July 1991. ORDER A permanent and total disability rating for pension purposes from January 1990 to July 1991 is denied. NANCY I. PHILLIPS Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), 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.