Citation Nr: 0003212 Decision Date: 02/09/00 Archive Date: 02/15/00 DOCKET NO. 96-41 147 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to an increased evaluation for bilateral pes planus, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Amanda Blackmon, Counsel INTRODUCTION The appellant served on active duty from December 1973 to July 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which granted an increased rating evaluation for the service- connected for bilateral pes planus from zero percent to 30 percent. The appellant filed a notice of disagreement with this rating decision in June 1996. A statement of the case was issued to the appellant later that month in June 1996. He thereafter filed a substantive appeal in this matter in August 1996. The record reflects that the appellant initially requested a hearing in this matter, but in correspondence dated in July 1997 withdrew his hearing request. The Board notes that a review of the record discloses that in June 1996, the appellant filed a claim for service connection for a disorder of the lower back, claimed as secondary to the service-connected bilateral pes planus. In an August 1996 rating decision, the RO denied the appellant's claim for benefits. The appellant filed a notice of disagreement with the denial of his claim for service connection for a low back disorder in July 1997. The record reflects that a statement of the case relative to the claimed low back disorder was issued to the appellant in September 1997. The appellant, however, has not filed a substantive appeal with respect to this issue. Accordingly, this issue is not properly before the Board for appellate consideration. With respect to the claimed low back condition, the Board further notes that the March 1998 remand referred a question concerning this aspect of the appellant's claim to the RO for consideration of the applicability of Allen v. Brown, 7 Vet. App. 439 (1995). Specifically, the RO was advised that the question of whether the service-connected bilateral foot condition aggravated the claimed low back disorder had been reasonably raised by the record. A review of the record discloses, however, that in subsequent rating actions in March and June 1999, the RO did not squarely address this question. Consequently, the Board again refers this particular question to the RO for the appropriate action. FINDINGS OF FACT 1. All available, relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained by the RO. 2. The evidence of record demonstrates that appellant's bilateral pes planus is currently manifested by objective of evidence of pathological pronation, pain and swelling on use of the feet, requiring use of arch supports, with objective evidence of a callus of the left fifth metatarsal, which is productive of no more than severe impairment. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for bilateral pes planus has not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.71a, Diagnostic Code 5276 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the provisions of 38 U.S.C.A. § 5107(a) have been met, in that the appellant's claim for increased evaluation for his service-connected bilateral pes planus is well grounded, and adequately developed. This finding is predicated upon the appellant's evidentiary assertions that his service-connected disability reflects a greater disability picture than currently assessed. Drosky v. Brown, 10 Vet. App. 215, 254 (1997) (citing Proscelle v. Derwinski, 1 Vet. App. 629 (1992)); King v. Brown, 5 Vet. App. 19 (1993). The Board is further satisfied that no further assistance to the appellant is required to comply with the duty to assist as mandated in 38 U.S.C.A. § 5107(a). Law and Regulations Under applicable criteria, 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. The VA has a duty to acknowledge and to consider all regulations which are potentially applicable through 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). It is essential that each disability be viewed in relation to its history, and that medical examinations are accurately and fully described emphasizing limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.1. Medical evaluation reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. 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. 38 C.F.R. § 4.7. 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 claimant. 38 U.S.C.A. § 5107(b). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (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 its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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. Functional loss 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. As regards the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to various considerations, including less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, and swelling. 38 C.F.R. § 4.45. Factual Background Service connection for bilateral pes planus was granted by rating action dated in February 1989. A noncompensable rating evaluation was initially assigned for this disability under Diagnostic Code 5276. The appellant underwent VA examination in April 1989. The medical examination report indicated that the appellant was evaluated for subjective complaints of constant pain and swelling of the feet, and fatigue. The examiner observed that the appellant had erect posture, with no abnormalities noted with respect to his carriage or gait. On examination of the feet showed small maceration of the skin of the fourth and fifth toes of both feet. The appellant was noted to be able to walk on his toes and heel freely. X-ray studies of the feet revealed mild pes planus deformity bilaterally. A diagnostic impression of athlete's foot, bilaterally, was noted. The appellant was seen in the podiatry clinic in May 1989. At that time, he reported a two year history of symptoms involving the feet, knee, and lower back. He also reported that his employment required a lot of standing. The appellant reported non-specific pain in the left leg, and around the plantar aspect of the feet and ankle. It was noted that the appellant had utilized arch supports, and taping for rehabilitation of arches due to plantar fasciitis. The appellant reported relief with use of arch supports, but indicated that he had not worn arch supports recently. The appellant indicated that he was presently without symptoms. Evaluation conducted at that time showed a hallux dorsiflexion of 65 degrees, bilaterally. It was noted that the appellant exhibited adequate extension and flexion of the lesser digits. Range of motion testing was accomplished without complaints of pain on motion, or crepitus. The assessment included findings of left gastrocnemius equinus causes abnormal pronotary compensation of the foot; hallux abducto valgus of both feet; plantar fasciitis, bilaterally; and flexible flatfeet. The examiner noted that this abnormal compensatory pronation contributed to the appellant's reported foot, leg, knee, and low back symptoms. It was noted that examination showed neurologic, vascular, dermatological evaluations to be grossly intact. Based upon this evidence, the RO determined that a higher rating evaluation was not warranted for the service-connected bilateral pes planus. An October 1995 private medical report noted that the appellant experienced a chronic callosity of the fifth metatarsal. The report indicated that the appellant's symptoms determine the frequency of his clinical visits. Limitations in standing along with use of orthotic devices were recommended. In November 1995, the appellant sought an increased evaluation for his service-connected disability. A March 1996 VA medical examination report indicated that the appellant presented with complaints of aggravation of pain in his knees with standing, despite type of footwear worn. He also reported pain associated with his back, arches, and across the metatarsal heads. The appellant reported that use of functional orthotics did not help alleviate his pain. He reported a history of callous development in approximately 1989, following service. It was noted that the appellant was presently employed as a postal worker, whose duties included standing for extended periods. The appellant reported that he experienced all types of postural problems and foot symptoms. On physical examination, there was a two centimeter tyloma on the left foot. Dorsalis pedis pulses were palpable, but posterior tibial pulses were not palpable bilaterally. The appellant was evaluated as neurologically intact. Motor strength of the feet was intact. On non- weight bearing activity, an arch was maintained, but decreased moderately upon weight bearing. Range of motion was evaluated as 85 degrees with dorsiflexion of the first metacarpal phalangeal joint on the right side, and 60 degrees on the left side. There was adequate extension and flexion of the lesser metacarpal phalangeal joints two through five, bilaterally. It was noted that metatarsal heads one through five were parallel in the transverse plane, bilaterally. There were no plantarly subluxed metatarsals. The examiner indicated that no hammertoes were detected. There was no intra-articular swelling of the joints of the thenar ankle detected. There was also no para-articular swelling detected. The appellant reported no pain or crepitus during range of motion studies of the feet or ankle. Evaluation of the feet showed hallux valgus in Stage I, bilaterally. The range of motion of the first ray was equal above and below the second metatarsals, bilaterally. Subtalar joint range of motion on the right side was evaluated at 30 degrees of inversion, and 5 degree eversion. The total range of motion of the subtalar joint on the left side was evaluated at 20 degrees inversion, and seven degrees eversion. The examiner noted that in a relaxed calcaneal stance, the appellant's heel was three degrees valgus on the left side, and one degree valgus on the right side. In a neutral stance, there was five degrees varus on the left side, and two degrees varus on the right side. In static stance, the subtalar joint was in pronator position, bilaterally, greater on the left side than the right side. The neutral subtalar joint was evaluated as seven degrees on the right side, and two degrees on the left side. X-ray studies of the feet revealed normal podiatry foot views, without radiographic evidence of pes planus. The diagnostic impression was hallux valgus Stage I, bilaterally; pathological pronation of the foot, greater on the left side than the right side; pes planus bilaterally, symptomatic; and limb length discrepancy, left side shorter than the right side. Based upon a review of his evidence, the RO granted an increased evaluation from zero percent to 30 percent for the appellant's bilateral pes planus condition. Clinical records, dated from December 1995 to July 1996, document intermittent treatment the appellant received. These treatment reports show that the appellant was seen in December 1995 for complaints of painful feet, particularly with pain reported in the heels and legs. Examination of the feet showed sub-five callus. The appellant was next seen in January 1996 for follow-up evaluation, at which time it was determined that the left fifth callus would be shaved, and control supports issued. It was noted that the appellant also reported pain in his knee and back with standing in excess of one half hour. During a March 1996 examination, the appellant reported subjective complaints of pain upon standing one half to one hour. He indicated that both feet bothered him across the metatarsals. The appellant was evaluated with a stable left nucleated tyloma. These reports further show that the appellant was evaluated in June and July 1996 for complaints of low back and knee pain. Radiographic evaluation conducted in conjunction with the June 1996 examination was negative for bilateral pes planus. It was noted that the appellant wore plastic heel cup inserts bilaterally. In correspondence, dated in June 1996, the appellant indicated that he was issued inserts for his foot complaints. He reported that use of the inserts caused his foot condition to increase in severity due to the development of calluses on the ball of the feet, with painful heels. In correspondence, dated in August 1996, the appellant indicated that he continued to utilize orthopedic appliances and shoes, without improvement after 10 months. He further reported that he had developed another callus under his large toe on the "same foot." In March 1998, the Board remanded this matter to the RO for further evidentiary development, to include association of addition medical evidence, and for completion of VA examination. In that context, the examiner was requested to provide information concerning the limitation of motion and functional loss due to pain, if any, associated with the appellant's service-connected disability. Private medical records, dated from December 1994 to October 1997, document intermittent clinical visits during this period for treatment of a callosity of the fifth metatarsal head. When evaluated in December 1994, the appellant presented with complaints of pain involving both feet. The appellant also reported his belief that his foot pain was related to the onset of his knee and back pain. The appellant reported that he was required to stand for prolonged periods in conjunction with his work duties. The clinical impression was callosity of the fifth metatarsal and pes planus. During a clinical visit in January 1995, the appellant reported that both feet were "doing ok." When seen later that month, the appellant reported that his left foot continued to bother him, but noted that the right foot was "ok." A computerized tomography (CT) scan of the feet was conducted in January 1995, and yielded normal findings relative to both feet. A subsequent CT scan of the left foot, conducted in February 1995, revealed a callus formation on the plantar aspect of the left foot. It was noted that studies showed no evidence of periosteal reaction. There was also no evidence of abnormal soft tissue calcification, or bone contour abnormality except for a small exostosis or a spur on the plantar aspect of the base of the head of the left fifth metatarsal bone. A March 1995 clinical report referenced an assessment of metatarsal callosity, but indicated that there was no pressure associated with the fifth metatarsal on either side shown on physical examination. In April 1995, an adjustment was made to the appellant's footwear. The treatment records reflect that the appellant underwent shaving of a callus in May 1995. He reported that his arch continued to bother him following this procedure. The physician noted that the appellant was symptomatologically better. The appellant was clinically authorized to return to work in December 1995, without restrictions. During an October 1996 evaluation, the appellant complained of trouble with his left foot callous, and back pain. Evaluation of the feet showed bilateral calluses. By December 1996, the appellant reported that he was more comfortable. When seen in March 1997, the appellant reported complaints of left heel pain. An assessment of calcaneal pain was indicated. In April 1997, the appellant was evaluated for callus pain, and assessed with calcaneal pain. An October 1997 clinical report indicated that the appellant reported his callus was a "little better." An assessment of plantar callosity was noted. The record reflects that private medical certification reports, dated from October 1995 to November 1997, were reviewed. In general, these reports consisted of a series of monthly evaluations conducted during this period relative to the appellant's light duty status. A review of these medical statements show that the appellant was evaluated for callosity of the fifth metatarsal. The appellant was noted to continue to have a weight lifting restriction of 50 pounds, and a standing limitation of four hours intermittently. It was noted that prolonged standing aggravated the appellant's fifth metatarsal callus. The physician opined that the estimated duration of the appellant's light duty status should continue for one year, unless use of orthotics, or surgical treatment could help. The appellant's weight bearing limitations were also designated as the "job required." It was noted that appellant utilized orthotics. A January 1998 private medical report indicated that the appellant was evaluated to assess his fitness for continued duty. It was noted that the appellant presented with a chief complaints of chronic left foot pain. It was noted that the appellant was privately treated following service, beginning in 1995, for a callus on his left foot. His treatment course reportedly consisted of use of a variety of orthotics, and shaving of a callus on the foot. Diagnostic studies performed during this period were noted to reveal a spur over the left fifth metatarsal head of the left foot. It was noted that surgical treatment had been offered as an alternative. The appellant indicated that his foot was "fine as long as he is able to move around and does not have to walk too much or stand in any one spot too long." The physician indicated that because the appellant's position at work, which he held for the previous 20 years, was abolished, the appellant was now assuming duties which required him to stand in one position for extended periods of time. The appellant reported an increase in symptoms due to prolonged standing. The appellant indicated that he was able to work, and that he had even worked overtime on several occasions, with his work schedule extending to seven days per week. The physician noted that there were no other medical problems which affected the appellant's ability to work. The appellant was also noted to be able to perform all of the normal activities associated with daily living without difficulty. The medical report reflects that on examination, the left foot was noted to have a well circumscribed callous formation over the fifth metatarsal head. There was slight tenderness to deep palpation over the metatarsal head. The physician noted an obvious bilateral pes planus. There was no obvious deformity of the metatarsals, or malalignment of the metatarsals. It was suspected that the appellant had a thin foot pad underlying his callus. In his assessment, the physician noted that his findings were predicated upon a review of the current clinical findings, in addition to a review of other private medical reports provided by the appellant. Based upon this evidence, the physician indicated that the appellant's condition resulted in the following permanent work restrictions: 1. The [appellant] should be assigned to a job which allows for sitting and standing; 2. The [appellant] should avoid positions which call for standing in one spot for greater than 30 minutes; and 3. Walking around within an office area would not be a problem, but prolonged walking, i.e., associated in a letter carrier position would not be recommended. The appellant was afforded VA examination in September 1998. The medical examination report indicated that the appellant reported a history of foot problems since service. It was noted that the appellant was employed as a postal worker. The examiner noted that the appellant had developed a sub- five callus of the left foot, for which he was currently being followed at the VA medical facility. His current treatment course was noted to consist of conservative care, to include manual debridement of the callus with arch supports. The examiner indicated that the appellant's calluses continued to reappear despite conservative treatment with emollient cream and orthosis. The appellant reported an onset of leg and back pain within the last eight year period. In this context, the appellant reported that the orthopedic surgeon who examined him determined that no pathology existed with respect to his lower back. The appellant reported subjective complaints of a six week history of numbness in his third and fourth toes when he was shod. The appellant reported relief from this symptom when he removes his shoes, or loosens his shoe strings. He also reported symptoms of numbness when he stands or places weight on his left extremity. It was reported that the appellant was treated for possible neuroma of the third intermetatarsal space of the left foot with orthosis with a neuroma plug, and with injections of Lidocaine, Cortisone, and vitamin B-12. It was noted that the appellant reported that his left extremity is shorter than the right extremity, and that he utilizes lifts in his left shoe. On physical examination, the examiner observed a 11/2 inch nucleated tyloma sub-five of the left foot with some swelling, and tenderness of the nucleated tyloma. The appellant's arches were noted to decrease with weight bearing. The appellant achieved a full range of motion of the joints of the feet and ankle. In the neutral calcaneal stance, the appellant's heels were in varus position. In relaxed calcaneal stance, the heels were perpendicular to the supporting structure. There was no intra-articular or peri- articular swelling detected. There was no evidence of crepitus noted during range of motion testing. The examiner noted that active range of motion was equal to passive range of motion of the joints of the feet. There were no abnormal findings associated with the dorsalis pedis or posterior tibial on vascular evaluation of the extremities. Muscle strength of the feet was evaluated as 5/5. There was no evidence of atrophy or hypertrophy detected. X-ray studies of the feet were normal. The diagnostic impression included findings of: 1. Pes planus with nucleated tyloma sub-five of the left; 2. Limb length discrepancy; 3. Compensated rear foot varus; 4. Numbers 1, 2, and 3, above, noted to contribute to the development of the callous sub-five of the left foot, recalcitrant to conservative treatment of orthosis and manual debridement of callous; and 5. Postural symptoms most likely related to a limb length discrepancy and secondary to body readjustment from the painful callous during ambulation. In a November 1998 addendum, the examiner indicated that the appellant's symptoms are greater on the left side than the right side, and that the severity of the appellant's symptoms are greater on the left side than the right side. It was noted that the appellant presented on examination with no symptoms relative to the right foot. There was no calluses noted on the right side. X-ray studies of the right foot were normal. In a second addendum, issued later that month, the examiner indicated that the appellant demonstrated full, stable and asymptomatic active and passive range of motion of the ankles and feet. In his assessment, the examiner noted that there was no clinical or radiographic evidence to suggest a loss of range of motion of the ankles or feet due to the painful callous confined under the fifth metatarsal head during ambulation, or during the periods prior to conservative treatment of manual debridement of the callous. It was noted, however, that an enlarged metatarsal head with a prominence noted by the surgical neck of the left fifth metatarsal was observed on the lateral view of radiographs of the left foot. It was the examiner's opinion that the prominent aggravating factors that contribute to the recurrent build up of the left sub-five callous, in spite of the appellant's continued use of emollients, orthosis, lifts and manual debridement were the appellant's limb length discrepancy (the left leg measured 39 4/8 inches, and the right leg measured 39 7/8 inches), and the enlarged prominent metatarsal head of the left fifth metatarsal. The flexible pes planus of the left foot was noted, to a much lesser degree, to contribute to the appellant's recurrent callus build up. In support of his opinion in this regard, the examiner pointed to the lack of symptoms and signs of right foot pes planus. It was noted that the appellant presented with mild asymptomatic pes planus of the right foot. In correspondence, dated in May 1999, the appellant generally reiterated his contention that his bilateral foot condition was more severe than currently assessed. He indicated that his foot condition had progressively increased in severity. He reported subjective complaints of numbness in the left foot and leg, which had developed into constant pain. He reported that he was in receipt of therapeutic treatment due to continued leg and back problems associated with this foot condition. The appellant described neurological impairment associated with this foot condition, to include daily nerve problems related to use of orthotics. The appellant indicated that his bilateral foot condition was manifested by daily symptoms of numbness in his toes, heel pain, and leg and lower back pain. With respect to the presently assigned rating evaluation, it was the appellant's contention that the rating evaluation did not reflect adequate consideration of the social and industrial impact of the service-connected disability. The appellant noted that he is unable to stand for prolonged periods, that he utilizes orthotic devices with no relief, and requires ongoing clinical treatment. In June 1999, the RO confirmed and continued the assigned rating evaluation for the service-connected disability. Analysis Under Diagnostic Code 5276, a 30 percent evaluation is warranted for severe bilateral acquired flatfoot (pes planus) manifested by marked deformity (pronation, abduction, etc.), accentuated pain on manipulation and use the feet, indications of swelling on use of feet, and characteristic callosities. A 50 percent evaluation is warranted for pronounced bilateral acquired flatfoot (pes planus) manifested by marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation which is no improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a. The Board has considered the full history of the appellant's bilateral pes planus. In this regard, the evidence demonstrates that service connection was granted for bilateral pes planus by a rating decision of 1989, which indicated that this foot disability was manifested (at that time) by subjective complaints of pain and swelling. Objective clinical findings on examination revealed no abnormalities in carriage or gait. Small maceration of the skin was detected at that time. Radiographs confirmed mild pes planus deformity. The medical records document intermittent treatment for continued complaints of left foot pain, evaluated as callus of the left fifth metatarsal, for which a conservative course of treatment was followed. The appellant also utilized orthotic devices. The treatment reports reflect that the appellant reported some periods of improvement associated with his left foot callus. The pertinent medical data of record, dated between 1994 and 1998, reveal that during VA examination in 1996, the appellant was evaluated with symptomatic bilateral pes planus manifested by pathological pronation of the feet, noted to be greater on the left side than the right side, with continued subjective complaints of chronic left foot pain. On private evaluation in 1998, the appellant's bilateral foot condition was noted to require permanent work restrictions, principally to prevent prolonged standing. Examination conducted at that time showed no obvious deformity or malalignment of the metatarsals. A well circumscribed callus formation was detected over the fifth metatarsal head, with subjective complaints of tenderness to deep palpation. On the most recent VA examination in 1998, the appellant exhibited a full range of motion of the feet and ankles. Examination showed no significant clinical or radiographic evidence of functional impairment. The examiner indicated that the appellant's foot condition was manifested by a callus confined to the fifth metatarsal. It was the examiner's opinion that the appellant's callus had not previously responded to conservative treatment of manual debridement, and use of emollients, orthosis, or lifts. However, the examiner indicated that the recurrent build up of the callus is largely attributable to a discrepancy in the appellant's leg lengths, and the prominence of the metatarsal head on his left fifth toe. The examiner particularly noted that the appellant's bilateral pes planus condition was not clinically significant with respect to cause of the recurring callous build up. The right foot was asymptomatic, and noted to be manifested by only mild pes planus. Thus, under diagnostic code 5276, a 50 percent evaluation requires evidence of marked pronation and inward displacement, extreme tenderness of feet, and severe spasm of the tendo Achilles, all of which must be productive of pronounced impairment, in addition to any findings which may indicate a lack of improvement by use of orthosis or lifts. See generally DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45. Therefore, in view of the foregoing, the Board determines that an increased evaluation for the appellant's bilateral pes planus is not warranted. Based upon a review of the evidence in this case, the Board finds no provision upon which to assign a higher rating for the service-connected bilateral foot disability. In that regard, the extent of symptomatology shown for the bilateral foot disability is currently adequately compensated by the assigned rating evaluation. The Board recognizes that there are circumstances in which the application of 38 C.F.R. §§ 4.40, 4.45, and 4.59 are warranted in order to evaluate the existence of any functional loss due to pain, or any weakened movement, excess fatigability, incoordination, or pain on movement of the appellant's joints. See DeLuca v. Brown, supra. In this case, however, the medical evidence does not demonstrate that the appellant is experiencing functional loss due to pain for which a higher rating evaluation is warranted. Following a careful and considered review of the evidence in this case, the Board concludes that the evidence demonstrates that the appellant's bilateral pes planus is no more than severe in degree. Accordingly, a higher rating evaluation is not warranted in this case. Pursuant to 38 C.F.R. § 3.321(b)(1), an extra-schedular rating is in order where there exists such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. However, the record does not reflect periods of hospitalization because of the appellant's service-connected bilateral pes planus, and there is no showing that this service-connected condition has significantly interfered with the appellant's employment status other than to result in work-related restrictions against prolonged standing. Thus, the record does not present an exceptional case where his currently assigned rating evaluation is found to be inadequate. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting the disability evaluation itself is recognition that industrial capabilities are impaired). Accordingly, the Board finds that the criteria for submission for assignment of an extra-schedular rating under 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER An increased evaluation for bilateral pes planus is denied. Deborah W. Singleton Member, Board of Veterans' Appeals