Citation Nr: 0000533 Decision Date: 01/07/00 Archive Date: 01/11/00 DOCKET NO. 98-06 215 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for right elbow disability. 2. Entitlement to service connection for arthritis. 3. Entitlement to service connection for mycosis fungoides. 4. Entitlement to service connection for skin disability, variously assessed. 5. Entitlement to an increased (compensable) rating for scars, residuals of a shell fragment wound, right leg. 6. Entitlement to an increased rating for post-traumatic stress disorder (PTSD), currently rated as 30 percent disabling. 7. Entitlement to a total rating based on unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Michael P. Vander Meer, Counsel INTRODUCTION The veteran served on active duty from June 1967 to August 1971. In October 1994, the Board of Veterans' Appeals (Board) denied entitlement to service connection for right elbow disability. This case is before the Board on appeal from rating decisions, the earliest of which was entered in October 1997, of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The appeal was docketed at the Board in 1998. FINDINGS OF FACT 1. In October 1994, the Board denied entitlement to service connection for right elbow disability. 2. The additional evidence received since the October 1994 Board denial of service connection for right elbow disability is, in its entirety, cumulative to that previously of record and is not so significant that it must be considered in order to fairly decide the claim. 3. The claims for service connection for arthritis, mycosis fungoides, and skin disability, variously assessed, are, in each instance, not plausible. 4. The veteran's scars, residual of a shell fragment wound, right leg, are in each instance asymptomatic; no related limitation of function, relative to any affected part, is shown. 5. Current manifestations of the veteran's service-connected PTSD include the experiencing of continued Vietnam-related flashbacks, with clear and coherent speech, normal mood and mildly depressed affect, productive, collectively, of not more than definite overall impairment. 6. The veteran's combined rating for service-connected disabilities is 30 percent. 7. The veteran has completed four years of high school and was employed until January 1997 as a supervisor for a food company. 8. The veteran's service-connected disabilities are not of such severity as to preclude him from securing or following a substantially gainful occupation consistent with his educational and occupational experience. CONCLUSIONS OF LAW 1. Evidence received since the October 1994 Board denial of service connection for right elbow disability is not new and material and the claim is not reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). 2. The claims for service connection for arthritis, mycosis fungoides, and skin disability, variously assessed, are, in each instance, not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The criteria for a compensable rating for scars, residual of a shell fragment wound, right leg, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.31 and Part 4, Diagnostic Code 7805 (1999). 4. The criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.7 and Part 4, Diagnostic Code 9411, as promulgated in 38 C.F.R. § 4.132 (in effect through November 6, 1996) and 38 C.F.R. § 4.130 (1999). 5. The criteria for a TDIU have not been met. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the final three issues listed on the title page are, in each instance, well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the Board finds that these claims are plausible. The Board is also satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 4.1, 4.10 (1999). Service connection is in effect for PTSD, for which the RO has assigned a 30 percent rating in accordance with the provisions of Diagnostic Code 9411 of the Rating Schedule; and for scars, residuals of a shell fragment wound, right leg, rated noncompensable under Diagnostic Code 7805. In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 and 4.42 (1999), and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of each disability for which entitlement to an increased rating is asserted. The Board has found nothing in the historical record which would lead it to conclude that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical histories and findings pertaining to these disabilities. I. New and Material Evidence, Right Elbow Disability Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §1110 (West 1991). The October 1994 Board denial of service connection for right elbow disability is final, based upon the evidence then of record. 38 U.S.C.A. § 7104 (West 1991). However, if new and material evidence is submitted, a previously denied claim must be reopened. 38 U.S.C.A. § 5108. Therefore, the issue for appellate determination is whether the evidence received since the October 1994 decision is new and material under the provisions of 38 C.F.R. § 3.156(a). In accordance with 38 C.F.R. § 3.156(a), "[n]ew and material evidence means evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim." In denying service connection for right elbow disability in October 1994, the Board, after observing that service medical records were negative for any reference to an injury involving the veteran's right elbow in service, determined that his then shown right elbow disability did not originate in service. Evidence in the Board's possession in October 1994 included the veteran's service medical records. The report of his November 1966 pre-induction medical examination reflects notation that the veteran had in the past sustained a fracture of his right "forearm". When he was examined for service separation purposes in August 1971, his upper extremities were clinically evaluated as normal. Also in the Board's possession in October 1994 was a report pertaining to the veteran's examination by VA in August 1990, on which occasion he indicated that he had injured his right elbow (in "1972" though presumably he meant during service) when striking it on an ammunition case. He further alluded to injuring the elbow in a post-service work-related mishap "in 1974", in the aftermath of which a metal screw was surgically inserted into the joint. Additionally included of record in October 1994 was a December 1991 statement from Dr. John M. Cook, to whom the veteran had related having injured his right elbow in service as well as having, subsequent to service, undergone reconstructive surgery involving his right elbow joint; the statement reflects an assessment of arthritis involving such joint. Evidence added to the record since October 1994 includes a report pertaining to the veteran's examination by VA in January 1997, on which occasion he related having injured his right elbow in service and undergoing surgery in response to the same "in 1969". The pertinent examination impression, following X-ray examination which revealed a "screw" in the right elbow joint, was arthritis in the right elbow. Also recently added to the record was a report pertaining to a VA evaluation afforded the veteran in 1981 which was, however, apparently not previously of record. The report reflects that the veteran had at that time related having undergone surgery on his right elbow in 1976 and 1978. He had also complained of soreness and swelling in his right elbow, which he related to his period of service. The veteran contends, in essence, that he presently has right elbow disability which is of service origin. In considering whether new and material evidence has been submitted to reopen his related claim for service connection for right elbow disability, the Board has determined that the evidence added to the record since October 1994 is not new and material. In reaching such conclusion, the Board is constrained to point out that inasmuch as the recently received items of evidence reflect the veteran's assertion of having injured his right elbow in service and undergoing surgery involving such joint subsequent to service, the items convey information of which the Board was aware in October 1994. As such, the information reflected on the items is 'cumulative' to that of which the Board was cognizant in October 1994, and thus this evidence, in accordance with the related aspect of 38 C.F.R. § 3.156(a), is not 'new'. The same consideration attaches relative to the arthritis revealed on the January 1997 VA examination, inasmuch as the same pathology was reflected on the 1991 statement from Dr. Cook which was in the Board's possession in 1994. Finally, while the report reflecting the veteran's evaluation by VA in 1981 was apparently not in the Board's possession in 1994, VA at that time had notice of the pertinent information reflected therein, i.e., that the veteran had undergone post- service surgery involving his right elbow, and thus the report is not pertinently 'new'. In light of the above observations, then, it is concluded that no item of 'new and material' evidence, in accordance with the above-cited provisions of 38 C.F.R. § 3.156(a), has been submitted in conjunction with the veteran's attempt to reopen his claim for service connection for right elbow disability. Therefore, such claim is not reopened. 38 U.S.C.A. § 5108; 38 C.F.R. § 3.156(a). II. Arthritis III. Mycosis Fungoides IV. Skin Disability, Variously Assessed The threshold question to be answered concerning the veteran's claims for service connection for each disability included in issues II through IV is whether he has presented, with respect to each disability, evidence of a well grounded claim, that is, one which is plausible and meritorious on its own or capable of substantiation. 38 U.S.C.A. § 5107(a); see Tirpak v. Derwinski, 2 Vet. App. 609 (1992). If a claimant does not submit evidence of a well grounded claim, VA is under no duty to assist him in developing facts pertinent to such claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990). For the reasons set forth below, the Board finds that the veteran has not met his burden of submitting evidence to support a belief by a reasonable individual that his claims for service connection for the disabilities included in issues II through IV are, in any instance, well grounded. Regarding his claim for service connection for arthritis, the veteran asserts that he presently has arthritis involving a number of joints. He contends, in essence, that such pathology is of service origin. In this regard, however, service medical records are negative for any reference to arthritis. Such pathology, involving the veteran's right elbow and knee, was apparently initially assessed in the early 1990's, as reflected on the above-cited December 1991 statement from Dr. Cook. However, this is many years after the veteran's separation from service, which consideration negates any notion of affording him presumptive service connection for arthritis in accordance with the provisions of 38 U.S.C.A. §§ 1110, 1112 (West 1991) and 38 C.F.R. §§ 3.307, 3.309 (1999). There is, in addition, no evidence otherwise relating such pathology to the veteran's period of service, which consideration precludes any notion of according inferred service connection for the same pursuant to the provisions of 38 C.F.R. § 3.303(d) (1999). In view of the foregoing, then, the Board is constrained to conclude that a plausible claim for service connection for arthritis is not presented. Therefore, such claim, as was determined by the RO, is not well grounded. 38 U.S.C.A. § 5107(a). Concerning his claim for service connection for mycosis fungoides, the veteran contends, in substance, that he has the same owing to service. In this regard, service medical records are negative for any reference to such condition, which was apparently initially assessed, under non-VA auspices, in the mid-1990's. However, there is no evidence relating the mycosis fungoides to the veteran's period of service, which consideration renders his claim for service connection therefor implausible. See Grottveit v. Brown, 5 Vet. App. 91 (1993). Accordingly, such claim, as was determined by the RO, is not well grounded. 38 U.S.C.A. § 5107(a). With respect to his claim for service connection for skin disability, variously assessed, the veteran contends, in essence, that he acquired such disability in service. In this regard, service medical records are negative for any reference to a skin condition and, when he was examined for service separation purposes in August 1971, the veteran's skin was clinically evaluated as normal. Subsequent to service, the record, dated exclusively in the 1990's, reflects assessments inclusive of tinea versicolor, parapsoriasis and "dermatitis-xerosis". However, with respect to each of the foregoing, there is no evidence relating the same to the veteran's period of service. Given such consideration, a plausible claim for service connection for skin disability, variously assessed, is not presented, see Grottveit, supra, and such claim is, therefore, as was determined by the RO, not well grounded. 38 U.S.C.A. § 5107(a). Finally, as pertinent to each of the latter three above- addressed issues, the Board is of the opinion that its discussion above bearing on each issue is sufficient, as to each respective disability for which service connection is claimed, to inform the veteran of the elements necessary to complete his application for a claim for service connection relative to each corresponding disability. See Robinette v. Brown, 8 Vet. App. 69 (1995). V. Increased Rating, Scars, Residual of Shell Fragment Wound Pursuant to Diagnostic Code 7805, scarring is evaluated on the basis of limitation of function of any affected part. In accordance with the provisions of Diagnostic Code 7804, a 10 percent rating is assignable for scarring which is objectively tender and painful. Under Diagnostic Code 7803, a 10 percent rating is warranted for scarring which is characterized by repeated ulceration and is, in addition, superficial and poorly nourished. However, pursuant to 38 C.F.R. § 4.31, where the minimum schedular evaluation requires residuals and the schedule does not provide for a noncompensable rating, a noncompensable rating will be assigned where the required residuals are not shown. When he was examined by VA in August 1990, the veteran was found to have small scars in the area of his right knee. A report reflecting the veteran's award of a combat decoration denoted that he had sustained "several fragment wounds in his right leg" in Vietnam when a vehicle he was driving was hit by enemy artillery fire. Based on the foregoing, service connection for scars, residual of a shell fragment wound, right leg, was established in a rating decision entered in October 1990, at which time a noncompensable evaluation was assigned in accordance with the provisions of Diagnostic Code 7805. In conjunction with his claim for an increased rating for scars, residual of a shell fragment wound, right leg, the veteran was pertinently examined by VA in October 1997. He was found to have four scars in the area of his right knee, each being "about 2.0 cm." in dimension. A photograph of the skin surface of the veteran's right knee, taken under VA auspices in September 1997, is also of record. The foregoing evidence, however, reflects no indication of any impaired function traceable to the right leg scars, as is necessary for any consideration of entitlement to a compensable rating in accordance with the provisions of Diagnostic Code 7805. There is, in addition, no evidence reflecting that any of the scars is, as is required for an award of a compensable rating under Diagnostic Code 7804, objectively tender and painful. Further, while under Diagnostic Code 7803 a 10 percent rating is warranted for scarring which is characterized by repeated ulceration and is, in addition, superficial and poorly nourished, there is no evidence demonstrative of the same. In view of the foregoing, then, the Board is of the opinion, in accordance with the above-stated provisions of 38 C.F.R. § 4.31, that the veteran's present noncompensable rating for scars, residual of a shell fragment wound, right leg, is wholly appropriate. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.31 and Part 4, Diagnostic Codes 7805, 7803-7804. VI. Increased Rating, PTSD Pursuant to Diagnostic Code 9411, prior to November 7, 1996, the evaluation of the veteran's service-connected PTSD turns on the severity of his overall social and industrial impairment. A 30 percent rating is warranted where such impairment is of definite severity; a 50 percent rating is warranted where such impairment is considerable. 38 C.F.R. § 4.132. In Hood v. Brown, 4 Vet. App. 301 (1993), the United States Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." In addition, effective November 7, 1996, VA has revised the criteria for diagnosing and evaluating psychiatric disabilities. See 61 Fed. Reg. 52, 695 (1996). Pursuant to Diagnostic Code 9411 under the revised criteria, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events); a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130. With respect to his claim for an increased rating for his service-connected PTSD, the veteran complains of experiencing Vietnam-related flashbacks and contends, in substance, that his PTSD is more severely disabling than presently rated. In this regard, when he was examined by VA in January 1997, the veteran, in addition to alluding to experiencing Vietnam- related flashbacks, indicated that his sleep was often interrupted when he would dream about combat in Vietnam. He also related that, earlier that same month, he had been put "on sick leave" at his place of employment, a food company, owing to bleeding he was experiencing due to a skin disorder. Findings on mental status examination included orientation in all spheres, speech which was "relevant and coherent", and "normal" mood, affect and judgment; his memory for recent and remote events was described as being "good". The pertinent examination diagnosis was PTSD, and a score of 80 was assigned as being representative of his Global Assessment of Functioning (GAF). Most recently, when he was examined by VA in August 1998, the veteran again alluded to experiencing flashbacks related to Vietnam as well as experiencing nightmares which would frequently wake him up. He also indicated that his employment had been terminated in January 1997 due to skin disorder-related problems he had been experiencing. He related that he associated with people in his church and that once a month he participated as a member of a choir which would entertain patients. His overall socialization was described as being "good". On mental status examination, his speech was described as being "clear, coherent and relevant"; his affect was described as being "mildly depressed"; his concentration was described as being "poor at times"; he was oriented in three spheres, and had no impairment of either short or long term memory. The pertinent examination diagnosis was PTSD, and a GAF score of 50 was assigned. In considering the veteran's claim for an increased rating for his service-connected PTSD, the Board is of the opinion, in light of the reasoning advanced hereinbelow, that an increased disability evaluation therefor, at least in accordance with the above-stated criteria in effect prior to November 1996, is not warranted. In reaching such conclusion, the Board is constrained to point out that the veteran's PTSD is not shown, at least per se, to be productive of the requisite considerable social impairment necessary for the assignment of a 50 percent rating under such criteria. In this regard, the Board observes that, based on the report of his August 1998 VA examination, the veteran apparently mingles easily with members of his church, where he participates in a singing group, and his general level of socialization was described by the VA examiner as being 'good'. Further, impairment related to the veteran's PTSD would not appear to occasion the requisite considerable industrial inadaptability necessary for the assignment of a 50 percent rating under the above-stated criteria in effect prior to November 1996. In this regard, as related by the veteran in conjunction with the two above-addressed VA examinations, the discontinuation of his employment at a food company in January 1997 was, as opposed to being related to his PTSD, occasioned by bleeding associated with a skin disorder. Since the veteran's duties involved handling food, the company felt that he should no longer do the same owing to his skin problems. In addition, the Board cannot overlook the consideration that the lower of the two GAF scores assigned him on the foregoing VA examinations was still 50. Since a GAF of 55-60 is (at least pursuant to DSM-III-R criteria) indicative of only "moderate" industrial impairment, see Carpenter v. Brown, 8 Vet. App. 240, 243 (1995), the Board is of the view that a slightly lower GAF of 50 would still not equate with more than "definite" industrial impairment (since 'definite' is itself, in light of O.G.C. Prec. 9-93, supra, 'more than moderate'), the latter being characteristic of pertinent disability commensurate with the veteran's presently assigned 30 percent rating. In view of the foregoing observations, then, the Board is of the view that an increased rating for the veteran's service-connected PTSD, at least under the criteria contained in Diagnostic Code 9411 which was in effect through November 6, 1996, is not warranted. The Board is, in addition, of the opinion that entitlement to a rating in excess of 30 percent for the veteran's service- connected PTSD is not warranted pursuant to the revised above-addressed criteria that became effective November 7, 1996. In reaching this conclusion, the Board would point out that, when the veteran was most recently examined by VA in August 1998, his speech was described as being 'clear, coherent and relevant', in contradistinction to the requisite circumlocutory or stereotypical speech which (if present) would otherwise be characteristic of disability warranting a 50 percent rating under the above-cited revised criteria. In addition, the veteran's mood was described as being 'normal' on the January 1997 VA examination and even a depressed mood (though not in fact shown) would still only comprise a manifestation of pertinent disablement warranting a 30 percent rating (the veteran's present pertinent evaluation). Moreover, while flattened affect (if evident) would comprise a characteristic independently representative of disability warranting a 50 percent rating under the revised criteria, the veteran's affect was specifically described as being 'normal' on the January 1997 VA examination, though 'mildly depressed' on the latter examination. Further, while the experiencing of panic attacks more than once a week would comprise evidence of pertinent disablement warranting a 50 percent rating, the panic attacks reported by the veteran on the more recent examination are apparently of lesser frequency, occurring only "a couple of times a month". Finally, while the veteran indicated on each examination that he experienced disruptive sleep, even if his problematic sleep constituted sleep impairment of chronic derivation, it would still only be independently characteristic of pertinent disablement commensurate with a 30 percent rating, identical to the veteran's present pertinent evaluation. In light of the foregoing observations, then, the Board is persuaded that, under the above-cited revised criteria that became effective on November 7, 1996, a disability rating in excess of the 30 percent evaluation presently assigned for the veteran's PTSD is not in order. 38 C.F.R. § 4.130. Finally, in each aspect of the foregoing disposition (comprising the Board's separate discussion bearing on each temporal promulgation of pertinent rating criteria), the Board has given consideration to the provisions of 38 C.F.R. § 4.7, which provide that, where there is a question as to which of two evaluations should be assigned, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. However, the record does not show, with respect to either temporal aspect of the disposition set forth immediately hereinabove, that the actual manifestations of the veteran's service- connected PTSD more closely approximate those required for the higher rating. 38 C.F.R. § 4.7. VII. TDIU The veteran's service-connected PTSD and scars, residual of a shell fragment wound, right leg, comprise the only disabilities for which service connection is in effect. His combined rating for his service-connected disabilities is 30 percent. The pertinent clinical evidence bearing on these disabilities was, in each instance, addressed in the Board's related increased rating dispositions set forth hereinabove and will, therefore, not be rearticulated for purposes of the Board's adjudication of the current claim for a TDIU. A total compensation rating may be assigned where the schedular rating is less than total when it is found that the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16. The veteran's March 1998 application for a TDIU (VA Form 21- 8940) reflects that he has completed four years of high school and that he was most recently employed, as a food company supervisor, until January 1997. Following its review of the pertinent evidentiary record, to specifically include the findings cited in the preceding sections V and VI which were obtained in the course of several VA examinations, the Board is of the opinion that entitlement to a TDIU is not warranted. In reaching the foregoing conclusion, the Board is constrained to point out that the veteran's service-connected shell fragment wound- related scarring is not shown to be productive of any ascertained impairment. As is indicated above, the veteran's service-connected PTSD comprises his lone compensable service-related condition. However, owing to the reasoning advanced by the Board in its related analysis above bearing on the veteran's PTSD, such condition does not occasion more than 'definite' industrial impairment. Moreover, while the veteran is apparently unemployed at the present time, the Board would stress the salient consideration that being unemployed gives no rise, in any event, to any inference that one is unemployable. While the Board does not, to be sure, dispute that the veteran may be somewhat hindered by disablement traceable to PTSD in engaging in certain fields of employment, e.g., those necessitating extensive social interaction, such consideration is irrelevant to entitlement to a TDIU. Rather, as noted above, the criteria set forth in the VA Rating Schedule, supra, specifically contemplate, and provide compensation for, any impairment of earning capacity in civil occupations. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. The Board is aware that any unfavorable determination it renders on a claim for a TDIU must include an analysis bearing on how the claimant's employability status is impacted by service-connected disablement in comparison with the impact occasioned by conditions for which service connection is not in effect. See Cathell v. Brown, 8 Vet. App. 539, 544-545 (1996). In this regard, in his March 1998 application for a TDIU, the veteran cited a "skin condition" as being the major factor on which he predicated his asserted unemployability. Such disorder, however, is not service- connected. The fact, however, that the veteran identified the same as significantly inhibiting his ability to work leads to the conclusion that, at least in the veteran's own mind, his nonservice-related skin condition plays a predominant role in whatever extent the veteran's employability is impaired. In addition, the Board would further observe that there is no evidence of record reflecting that the veteran is unable to secure employment of a substantially gainful nature due to service-connected disablement, which consideration further militates against entitlement to a TDIU. See Gary v. Brown, 7 Vet. App. 229, 231 (1994). Finally, there would appear to be no exceptional or unusual disability factors warranting extraschedular consideration and the veteran does not, in any event, meet the schedular criteria for a TDIU under 38 C.F.R. § 4.16. Given the considerations addressed in the preceding paragraph, as well as the additional reasoning advanced by the Board thereabove in its analysis bearing on this aspect of the appeal, it is readily concluded that the preponderance of the evidence is against the veteran's claim for a TDIU. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16. ORDER New and material evidence not having been submitted, the application to reopen a claim for service connection for right elbow disability is denied. Evidence of well grounded claims not having been submitted, the appeal for service connection for arthritis, mycosis fungoides, and skin disability, variously assessed, is, in each instance, denied. An increased rating for scars, residual of a shell fragment wound, right leg, is denied. An increased rating for PTSD is denied. A total rating based on unemployability due to service- connected disabilities is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals