Citation Nr: 0002434 Decision Date: 01/31/00 Archive Date: 02/02/00 DOCKET NO. 95-35 324 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUES 1. Entitlement to an increased rating for a right hip disability, currently evaluated as noncompensable. 2. Entitlement to an increased rating for a right shoulder disability, currently evaluated as 10 percent disabling. WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD L. A. Mancini, Associate Counsel INTRODUCTION The veteran had active duty from February 1991 until July 1991, with evidence of prior service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1994 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) located in Salt Lake City, Utah. On October 26, 1998, the veteran testified at a hearing held at the RO before Holly E. Moehlmann, who is the Board Member making this decision. The transcript of the hearing is associated with the veteran's claims folder. FINDINGS OF FACT 1. The veteran's right hip disability is manifested by complaints of pain at full abduction and internal rotation but by full range of motion and normal strength. 2. The veteran's right shoulder disability is manifested by pain beyond 90 degrees of adduction and some tenderness over the acromioclavicular joint but with normal range of motion and strength; dislocation is very infrequent. CONCLUSIONS OF LAW 1. The schedular criteria for a compensable rating for a right hip disability have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.71a, Diagnostic Code 5252 (1999). 2. The schedular criteria for a rating in excess of 10 percent for a right shoulder disability have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.71a, Diagnostic Code 5003-5010 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking an increased rating for a right hip disability, currently evaluated as noncompensable, and an increased rating for a right shoulder disability, currently evaluated as 10 percent disabling. In the interest of clarity, the Board will initially discuss pertinent law and VA regulations. The factual background of this case will then be reviewed. Finally, the Board will analyze the veteran's claim and render a decision. Relevant law and VA regulations pertinent to increased ratings Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities ("Schedule"), 38 C.F.R. Part 4 (1999). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent, as far as practicably can be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon 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, 592 (1991). Governing regulations to include 38 C.F.R. §§ 4.1, 4.2 (1999) require evaluation of the complete medical history of the veteran's condition. Where, as in this case, entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 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. 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 (1999). The provisions of 38 C.F.R. §§ 4.45 and 4.59 (1999) consider whether there is crepitation, more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. It is the intent of the Schedule to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) ("the Court") held in DeLuca v. Brown, 8 Vet. App. 202 (1995), that where evaluation is based on limitation of motion, the question of whether pain and functional loss are additionally disabling must be considered. See 38 C.F.R. §§ 4.40, 4.45, 4.59. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3 (1999). In Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, supra, 1 Vet. App. at 54. Entitlement to an increased rating for a right hip disability Relevant law and VA regulations Full range of motion on flexion of the hip is zero to 125 degrees and on abduction is zero to 45 degrees. 38 C.F.R. § 4.71, Plate II (1999). The veteran's right hip disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5252 as zero percent disabling based on limitation of motion. Limitation of motion is evaluated under 38 C.F.R. § 4.71a, Diagnostic Codes 5251 (1999) (limitation of extension), 38 C.F.R. § 4.71a, 5252 (limitation of flexion), and 38 C.F.R. § 4.71a, 5253 (1999) (limitation of abduction, adduction, or rotation). Diagnostic Code 5251 provides that a 10 percent rating will be assigned with limitation of extension to 5 degrees. There are no higher ratings provided under Diagnostic Code 5251. Diagnostic Code 5252 provides that a 10 percent rating will be assigned with flexion limited to 45 degrees. A 20 percent rating contemplates flexion limited to 30 degrees. Flexion limited to 20 degrees warrants a 30 percent rating, and flexion limited to 10 degrees warrants a 40 percent rating. Diagnostic Code 5253 provides for evaluation of impairment of the thigh manifested by limitation of abduction, adduction, or rotation. Limitation of rotation such that the individual cannot toe out more than 15 degrees warrants a 10 percent evaluation. Limitation of adduction so that the legs cannot be crossed warrants a 10 percent evaluation. Limitation of abduction, with motion lost beyond 10 degrees, warrants a 20 percent evaluation. 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 (1999). Factual background Service medical records, dated in May 1991 and June 1991, show that the veteran twisted his right hip and complained of persistent pain. Objective findings were full range of motion and mild tenderness, and the diagnosis was right hip strain. An x-ray of the right hip was within normal limits. A December 1991 VA examination report noted that the veteran developed right hip pain when he stumbled while playing softball in April 1991. He reportedly had pain in his hip at that time, but indicated that it was somewhat better at the time of the examination. He reportedly had aching only with cold weather. The examination of the right hip, including flexion, extension, abduction, adduction, and internal and external rotation, were all completely normal. The VA examiner found no crepitation with motion, and diagnosed arthralgia of the right hip, secondary to muscular tenderness strain with only minimal symptomatology at the present time. The veteran underwent a VA joints examination in June 1994 with complaints of right hip pain. He reported a slow, but progressive increase in right hip pain over the last few years. On examination, the veteran had essentially symmetric range of motion of the hip joint. Internal rotation was about 15-20 degrees and external rotation was 30-35 degrees bilaterally. Flexion was noted to be slightly asymmetrical, as the veteran flexed his right hip to approximately 125-130 degrees; whereas, he flexed his left hip to 135-140 degrees. Extension was approximately 50 degrees bilaterally. Quadriceps strength and hamstring strength were 5/5 bilaterally. The examiner noted that the veteran had perhaps a very mild weakness of hip flexion strength, perhaps 5-/5 on the right and 5/5 on the left. The veteran reported mild hip pain with that maneuver. Extension of the hips was 5/5 bilaterally. Straight leg raising was negative. The examiner opined that the veteran's complaints of right hip pain seemed to be focused on the concerns about re-dislocation and the apprehension the veteran experienced when he found himself in certain positions. The veteran underwent a VA joints examination in September 1998, with complaints of intermittent right hip pain, aggravated by walking 8 blocks or over. He reportedly had no problems with prolonged standing, ascending or descending stairs; however, he indicated that he was no longer able to run or jog over one block without aggravating the right hip pain. On examination, the veteran ambulated without a limp and could easily walk on his heels and toes. The examiner noted no definite palpable tenderness over the right hip. Range of motion revealed adequate flexion at 125 degrees with no onset of pain at that level, and backward extension to 30 degrees with no onset of pain. Adduction at 25 degrees was also painless, but abduction at 45 degrees revealed right hip pain at full abduction. External rotation to 60 degrees was painless and adequate, but internal rotation at 40 degrees produced pain in the right hip. Strength was 5/5. The examiner diagnosed arthralgia of the right hip with intermittent pain, normal range of motion with onset of pain at full abduction and full internal rotation. The veteran had pelvis and lateral hip x-rays taken at the VA in September 1998. Bone density was reportedly normal and joint spaces were symmetric. Femoral heads were spherical and symmetric. No fracture, subluxation, or dislocation was apparent. Sacroiliac joints were intact. The examiner diagnosed normal films. In October 1998, the veteran testified at a Travel Board hearing held at the RO before a member of the Board. The veteran indicated that his right hip did bother him but stated that he had nothing to add. He indicated that it was "just a weak hip." See Transcript, page 2. When asked whether his hip was getting worse, the veteran responded that he could not tell. He then stated, "it's going to get worse, that's the reason that, you know, as you age things weaken you know and I anticipate that. I anticipate that it will, it will weaken proportionately as I get older." See Transcript, p. 6. The veteran indicated that his hip was weak at the time of the hearing. He stated that when the hip was weak, he would try to walk and he put up with the pain. He further stated,"It's not a big pain. I'm in the process of losing some so I figure it's going to help, you know, that. However, it's just there, bothersome. I don't like to call it a pain 'cause it's always there. It's like an ache." See Transcript, page 7. Analysis Initial matter-well groundedness of claim and duty to assist Initially, the Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). When a veteran is awarded service connection for a disability and appeals the RO's initial rating determination, the claim continues to be well grounded as long as the claim remains open and the rating schedule provides for a higher rating. See Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). Upon the submission of a well-grounded claim, the VA has a duty to assist the veteran in developing the facts pertinent to his claim. 38 U.S.C.A. § 5107(a). In the instant case, there is ample medical evidence of record regarding the veteran's right hip, the veteran has been provided several VA examinations, and there is no indication that there are additional records that have not been obtained and which would be pertinent to the present claim. Moreover, the veteran testified at a personal hearing in October 1998 and presented the facts of his claim. Thus, no further development is required in order to comply with VA's duty to assist as mandated by 38 U.S.C.A. § 5107(a). Application of VA Schedule for Rating Disabilities The veteran's right hip disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5252 as zero percent disabling based on limitation of motion. That code provides that a 10 percent rating will be assigned with flexion limited to 45 degrees. The Board has carefully reviewed the evidence of record, which has been reported in detail above. VA examinations consistently have shown normal or essentially normal flexion of the right hip, but not limitation of flexion as required for a compensable disability rating under Diagnostic Code 5252. Examinations in 1994 and 1998 showed right hip flexion at 125 degrees or better, significantly higher than the limitation of flexion required for a compensable rating under Diagnostic Code 5252. In addition, the more recent examinations show essentially full rotation, adduction and abduction, and limitation of any of those movement as to meet the requirement for a compensable rating under Diagnostic Code 5253, cited above, is not shown. The evidence does not show limitation of extension of the thigh to 5 degrees, and the requirement for a compensable evaluation under Diagnostic Code 5251 is not met. Therefore, the Board concludes that the preponderance of the evidence is against a compensable rating under Diagnostic Code 5251, 5252 or 5253, the codes pertinent to rating his disability. DeLuca considerations Where a diagnostic code is predicated on loss of motion, VA must also consider 38 C.F.R. § 4.40, regarding functional loss due to pain, and 38 C.F.R. § 4.45, regarding more or less movement than normal, weakness, excess fatigability, incoordination, pain on movement of a joint, swelling, deformity or atrophy. See DeLuca, supra, 8 Vet. App. at 204- 207. The Board begins by noting that there is no evidence of excess fatigability, incoordination, swelling, deformity, or atrophy of the right hip. Regarding weakness, the veteran testified at his hearing that he had a weak hip. However, the medical evidence of record is either silent on this issue or indicates either minimal weakness or more recently normal strength. More specifically, in June 1994, a VA examiner noted that the veteran perhaps had a very mild weakness of hip flexion strength. In fact, during a September 1998 VA examination, the veteran indicated that he had no problems with prolonged standing, ascending or descending stairs. With respect to pain, the Board notes that the veteran has essentially normal range of motion and can move the right hip region with either no pain, mild pain, or with pain only at full abduction and rotation. In June 1994, the veteran complained of progressive right hip pain. The VA examiner noted that the veteran reported mild hip pain during a hip flexion maneuver. However, there is no indication that the veteran experienced pain during any other part of the hip examination. In his most recent VA medical examination of record, dated in September 1998, the veteran complained of intermittent right hip pain, aggravated by walking 8 blocks or more. He also indicated that he was not able to run or jog over one block without aggravating the right hip pain. However, on examination he experienced either no pain or pain only at the fullest level of abduction and rotation, and there was no indication of additional loss of motion due to pain. He ambulated without a limp and could easily walk on heels and toes. From a review of the evidence the Board concludes that the veteran has not demonstrated any significant additional functional loss to warrant an increased evaluation based on 38 C.F.R. §§ 4.40 and 4.45. Entitlement to an increased rating for a right shoulder disability Initial matter The veteran's right shoulder disability was originally evaluated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5203 (1999), for impairment of the clavicle or scapula. In a February 1999 rating decision, the RO increased the rating to 10 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5010, for arthritis due to trauma (to be rated as degenerative arthritis). Relevant law and VA regulations The regulations define normal range of motion for the shoulder as forward flexion from zero to 180 degrees, abduction from zero to 180 degrees, external rotation to 90 degrees, and internal rotation to 90 degrees. With forward elevation (flexion) and abduction, range of motion for the arm is from the side of the body (zero degrees) to above the head (180 degrees) with the mid-point of 90 degrees where the arm is held straight out from the shoulder. 38 C.F.R. § 4.71, Plate I (1999). Traumatic arthritis is rated as degenerative arthritis on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint involved. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003 and 5010. When, however, the limitation of motion for the specific joint involved is noncompensable under the appropriate diagnostic code, a rating of 10 percent is to be applied for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, degenerative arthritis is evaluated at 10 percent where there is x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, and is evaluated at 20 percent where there is x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. Diagnostic Code 5003-5010. The Diagnostic Code pertaining to limitation of motion of the arm provides that such limitation at shoulder level warrants a 20 percent rating for either the major or minor extremity. Limitation of motion midway between the side and shoulder level warrants a 30 percent evaluation for the major extremity and 20 percent for the minor extremity. Limitation of motion to 25 degrees from the side of the major extremity warrants a 40 percent rating, with a 30 percent evaluation for the minor extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (1999). Pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5202, recurrent dislocation of the scapulohumeral joint with infrequent episodes and guarding of movement only at the shoulder level warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5202 (1999). Pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5203, impairment of the clavicle or scapula, malunion warrants a 10 percent evaluation. Nonunion of the clavicle or scapula without loose movement warrants a 10 percent evaluation. The maximum evaluation available under Diagnostic Code 5203 is 20 percent, and that rating requires either nonunion of the clavicle or scapula with loose movement or dislocation of the clavicle or scapula. Factual background Service medical records, including those related to annual periods of training duty, show that the veteran injured his right shoulder in August 1988 and complained of recurrent shoulder pain. Subsequent assessments included recurrent inferior subluxation of the right shoulder. X-rays taken in June 1991 reveal post-traumatic or dystrophic ossification, caudal portion of the "conioclavicular ligament." Service medical records further reflect objective findings of full range of motion, 5/5 muscle strength, very slight tenderness, and slight crepitus. The veteran underwent a VA examination in December 1991 with complaints of "sore shoulder, limited movement, weak." The examination report noted that the veteran's shoulder was dislocated in 1988, and intermittently dislocated since then. On examination, there was no limitation of motion of the shoulder. Abduction was complete to 180 degrees, and forward elevation to 180 degrees. Internal and external rotation were noted to be completely normal and equal on both sides. There was some slight tenderness noted over the acromioclavicular joint and there was no obvious external deformity. The examiner diagnosed acromioclavicular joint arthritis with shoulder impingement syndrome with moderate symptomatology and no limitation of motion at this time. During the veteran's VA joints examination in June 1994, he reported that his shoulder caused him moderate pain at night, and occasionally felt that it may "pop out" when he rolled in certain positions while sleeping. On examination, the veteran had narrow atrophy of the deltoid on the right side and appeared to have symmetrical development of the musculature around the shoulder when comparing the right to the left. His range of motion was described as "excellent." The veteran had bilateral abduction to 180 degrees, bilateral extension to 50 degrees, bilateral flexion to 180 degrees, internal rotation to T6 level bilaterally, external rotation to approximately 80 degrees bilaterally. On the right side, he had a positive apprehension sign and slight pain with abduction to 90 degrees combined with external rotation. The veteran had no impingement sign bilaterally. Motor strength was 5/5 bilaterally and sensation appeared to be intact in the axillary nerve distribution. The examiner opined that the veteran's complaints of right shoulder pain seemed to be focused on the concerns about re-dislocation and the apprehension the veteran experienced when he found himself in certain positions. The veteran underwent a VA joints examination in September 1998, with complaints of chronic, but intermittent pain in the right shoulder, especially when working overhead. The pain was reportedly aggravated by bowling. The veteran reported dislocating his shoulder in 1988 and reducing the dislocation himself. The veteran further reported multiple dislocations since that time, all self-reduced, with the last recurring in 1993. On examination, the right shoulder revealed no obvious deformity. The veteran had some moderate tenderness over the acromial clavicular joint involving the right shoulder. The musculature was symmetrical as compared to the opposite shoulder. Range of motion was adequate to 180 degrees abduction and 180 degrees forward flexion with the onset of right shoulder pain at and beyond 90 degrees adduction. Internal and external rotation were painless and adequate at 90 degrees. The shoulder girdle muscle strength was adequate at 5/5. Adson's maneuver was negative. Sensory perception was intact over the entire right upper extremity. The examiner diagnosed "impingement syndrome of the right shoulder stage 2 with frequent of dislocations with onset of pain on flexion and abduction at 90 degrees and over with palpable tenderness over the achromic clavicular joint with a history of arthritis involving that joint." Right shoulder x-rays showed an ossific density projecting beneath the clavicle on the frontal views, of uncertain etiology. There was also an ossific projection off the superior aspect of the coracoid, which was of uncertain etiology, but which could be the result of prior trauma. In October 1998, the veteran testified at a Travel Board hearing at the RO held before a member of the Board. The veteran indicated that in the past two weeks he had dislocated his shoulder, and put it back. See Transcript, page 5. The veteran stated that he took Tylenol, but did not take any prescription medication for his shoulder. When asked whether he felt that his shoulder was worsening, he responded, "At the present time, it's worse but I - I kind of anticipate that it will build up. I started lifting weights, you know, little small weights to straighten it and I can't do it. Since I hurt it, I can't - haven't been able to do it." See Transcript, page 6. The veteran stated that he had pain in his right shoulder. He indicated that he could probably move it normally up to a point with no weight on it, but that pain was attached to it, not excruciating pain, but pain and discomfort. In November 1998, the veteran underwent magnetic resonance imaging (MRI) of the right shoulder which showed mild degenerative changes of the acromioclavicular joint; calcification of the coracoclavicular ligament; degeneration of the supraspinatus and infraspinatus tendons, consistent with tendinitis; question of partial-thickness tear of the supraspinatus tendon; and type III acromion. Analysis Initial matter-well groundedness of claim and duty to assist The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); See also Shipwash, supra. There is ample medical evidence of record regarding the veteran's right shoulder, the veteran has been provided several VA examinations, and there is no indication that there are additional records that have not been obtained and which would be pertinent to the present claim. Moreover, the veteran testified at a personal hearing in October 1998 and presented the facts of his claim. Thus, no further development is required in order to comply with VA's duty to assist as mandated by 38 U.S.C.A. § 5107(a). Application of VA Schedule for Rating Disabilities The veteran's right shoulder disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5010 as 10 percent disabling. Examinations in 1994 and 1998 show flexion and abduction to 180 degrees; therefore, arm motion is not limited to the shoulder level, and the veteran's right shoulder disability does not more nearly meet the requirements for the minimum 20 percent rating under Diagnostic Code 5201. As stated above, under Code 5010, when the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for the lesser limitation of motion shown but that limitation must be confirmed by findings of swelling, muscle spasm, satisfactory evidence of painful motion or similar such findings. Here, limitation of motion of the shoulder is not shown but there is satisfactory evidence of painful motion and some tenderness over the joint. Therefore, the veteran meets the criteria for a 10 percent disability rating pursuant to Diagnostic Code 5010. In order to be awarded a 20 percent evaluation under Diagnostic Code 5010, there would have to be involvement of two or more major joints or two or more minor joint groups, which is clearly not the situation in this case, since only the right shoulder is involved. The evidence does not show nonunion of the clavicle or scapula or chronic dislocation of the clavicle or scapula, and, therefore, a rating in excess of 10 percent would not be appropriate under Diagnostic Code 5203. DeLuca considerations As indicated above, where a diagnostic code is predicated on loss of motion, VA must also consider 38 C.F.R. § 4.40, regarding functional loss due to pain, 38 C.F.R. § 4.45, regarding more or less movement than normal, weakness, excess fatigability, incoordination, pain on movement of a joint, swelling, deformity or atrophy and 38 C.F.R. § 4.59, regarding painful motion with any form of arthritis. See DeLuca, supra, 8 Vet. App. at 204-207. The medical evidence of record fails to demonstrate excess fatigability, incoordination, swelling, or deformity. The veteran stated at his hearing that he had begun lifting small weights in an effort to strengthen his right shoulder but strength was normal on examination in 1994 and 1998. The Board acknowledges that the veteran has complained of limited movement and pain in his right shoulder. However, in June 1994, the VA examiner described the veteran's range of motion as excellent, and despite some pain evidenced on abduction in excess of 90 degrees on examination in September 1998, motion was full. Although there was also reference to frequent dislocation, it was also stated that the last dislocation occurred in 1993. The veteran also testified in 1998 that he had had a dislocation about two weeks prior to the hearing but that the dislocation prior to that had occurred in 1993. Thus, the dislocations are very infrequent. He also stated that he had pain in his right shoulder when carrying something, but not excruciating pain and more like discomfort. The evidence of painful motion was considered in assigning a 10 percent rating under Diagnostic Code 5010, and after reviewing the evidence, the Board believes that the medical evidence of record does not demonstrate any additional loss of motion or significant functional loss to warrant an increased evaluation based on 38 C.F.R. §§ 4.40, 4.45 and 4.59. Extraschedular rating The Board notes that the RO, in the Supplemental Statement of the Case in February 1999, concluded that an extraschedular evaluation was not warranted for the veteran's disabilities. The Board will, accordingly, consider the provisions of 38 C.F.R. § 3.321(b)(1) (1999). Ordinarily, the VA Schedule for Rating Disabilities will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extraschedular disability rating is warranted upon a finding that "the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards." 38 C.F.R. § 3.321(b)(1) (1999). The record fails to demonstrate that the veteran's service- connected disabilities have interfered with his employment. In fact, the evidence reflects that the veteran was unable to attend a previously scheduled personal hearing as a result of his mandatory attendance at a training conference in connection with his employment. The record also does not demonstrate that he has required any hospitalization for his service-connected right hip and right shoulder disabilities. The Board has been unable to identify any other factor consistent with an exceptional or unusual disability picture. Accordingly, an extraschedular evaluation is not warranted. In reaching its decision, the Board finds that the preponderance of the evidence is against the veteran's claims, and, therefore, the doctrine of reasonable doubt does not apply. ORDER Entitlement to a compensable rating for a right hip disability is denied. Entitlement to a rating in excess of 10 percent for a right shoulder disability is denied. HOLLY E. MOEHLMANN Member, Board of Veterans' Appeals