Citation Nr: 0211310 Decision Date: 09/04/02 Archive Date: 09/09/02 DOCKET NO. 93-13 287 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an evaluation in excess of 40 percent for degenerative arthritis of the lumbar spine. 2. Entitlement to a certificate of eligibility for financial assistance in acquiring specially adaptive housing. 3. Entitlement to a certificate of eligibility for financial assistance in acquiring special home adaptations. 4. Entitlement to financial assistance in the purchase of an automobile or other conveyance and/or adaptive equipment. (The claims for an increased evaluation for service-connected ischemic heart disease with angina and hypertension, and the payment or reimbursement of unauthorized medical expenses incurred during a period of hospitalization and treatment on December 23, 1998 will be the subjects of separate decisions which will be promulgated at a later date.) REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The appellant and his spouse ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The veteran retired in 1981 after approximately 20 years active service. This case comes before the Board of Veterans' Appeals (Board) on appeal of various decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, and was previously before the Board in March 1995, July 1997, and February 1999, on which occasions it was remanded for additional development. The case is now, once more, before the Board for appellate review. At the time of its February 1999 remand, the Board issued a decision granting a 40 percent evaluation for the veteran's service-connected degenerative joint disease of the cervical spine. That issue is no longer before the Board for appellate review. The Board wishes to make it clear that it is undertaking additional development with respect to the issues of an increased evaluation for service-connected ischemic heart disease with angina and hypertension, and the payment or reimbursement of unauthorized medical expenses incurred during a period of hospitalization and treatment on December 23, 1998, pursuant to authority granted by 67 Fed. Reg. 3,009, 3,104 (Jan. 23, 2002) [codified at 38 C.F.R. § 19.9(a)(2)]. When the requested development is completed, the Board will provide notice of the development as required by Rule of Practice 903 (67 Fed. Reg. 3,009, 3,105 (Jan. 23, 2002) [codified at 38 C.F.R. § 20.903 (2002)]. After giving notice and reviewing the veteran's response to that notice, the Board will prepare and promulgate separate decisions addressing those issues. FINDINGS OF FACT 1. The veteran's service-connected degenerative arthritis of the lumbar spine is currently productive of no more than a severe limitation of motion of the lumbar segment of the spine, accompanied by pain. 2. Service connection is currently in effect for degenerative arthritis of the lumbar spine, evaluated as 40 percent disabling; degenerative joint disease of the cervical spine, evaluated as 40 percent disabling; ischemic heart disease with angina and hypertension, evaluated as 30 percent disabling; arthritis of the left knee, evaluated as 10 percent disabling; arthritis of the right knee, evaluated as 10 percent disabling; and for otitis media, tinnitus, duodenal ulcer disease, hemorrhoids, laceration of the left lower back, and a sebaceous cyst of the neck, each evaluated as noncompensably disabling. The combined evaluation currently in effect for the veteran's service- connected disabilities is 80 percent. The veteran is additionally in receipt of a total disability rating based upon individual unemployability, effective from November 1, 1991. 3. The veteran is not shown to suffer from a permanent and total service-connected disability due to the loss or loss of use of both lower extremities so as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; or the loss or loss of use of one lower extremity, together with the residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 4. The veteran is not shown to have permanent and total service-connected disability which is due to blindness in both eyes, with 5/200 or less visual acuity, or which includes the anatomical loss or loss of use of both hands. 5. The veteran does not currently suffer from a loss or permanent loss of use of one or both feet, or one or both hands, or permanent impairment of vision of both eyes to the required specified degree, that is, central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200, if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; nor does he currently exhibit ankylosis of one or both knees or one or both hips. CONCLUSIONS OF LAW 1. An evaluation in excess of 40 percent for degenerative arthritis of the lumbar spine is not warranted. 38 U.S.C.A. § 1155 (West 1991 & Supp. 2002); 38 C.F.R. §§ 4.40, 4.59, and Part 4, Codes 5003, 5292 (2001). 2. The criteria for a certificate of eligibility for financial assistance in acquiring specially adapted housing are not met. 38 U.S.C.A. § 2101(a) (West 1991 & Supp. 2002); 38 C.F.R. § 3.809 (2001). 3. The criteria for a certificate of eligibility for financial assistance in acquiring special home adaptations are not met. 38 U.S.C.A. § 2101(b) (West 1991 & Supp. 2002); 38 C.F.R. § 3.809a (2001). 4. Financial assistance in the purchase of an automobile or other conveyance and specially adapted automotive equipment is not warranted. 38 U.S.C.A. §§ 3901, 3902 (West 1991 & Supp. 2002); 38 C.F.R. § 3.808 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background During the course of VA outpatient treatment in April 1991, it was noted that the veteran exhibited a functional range of motion of both his upper and lower extremities, with good strength. Additionally noted was that the veteran was able to ambulate a distance of 100 feet while using a cane. At the time of a period of VA hospitalization during the months of August and September 1991, the veteran stated that he had gotten to the point "where his legs often gave out on him and he felt that he couldn't control them." A CT of the veteran's lumbar spine conducted during his period of hospitalization was consistent with diffuse disc bulging at the level of the 3rd and 4th, and 4th and 5th lumbar vertebrae, and at the level of the 5th lumbar vertebra and 1st sacral segment, most prominently involving the 4th and 5th lumbar vertebrae. There was no evidence of neural foraminal narrowing at the levels of the 3rd and 4th, or 4th and 5th lumbar vertebrae, or the level of the 5th lumbar vertebra and 1st sacral segment. Nor was there any evidence of a herniated disc at any of those levels. In March 1992, a VA neurologic examination was accomplished. At the time of examination, the veteran stated that, since the time of a previous cervical laminectomy, he had experienced pain at the base of his neck, across his left shoulder, and down the posterior aspect of his left arm. He had, however, experienced "tremendous improvement" in his myelopathy, in that, while prior to surgery, he was wheelchair-bound due to frequent falls, he was currently able to ambulate with a cane. On physical examination, there was evidence of normal muscle tone. Strength was 5/5, with the exception of the veteran's grip, which was 5-/5 bilaterally. Sensory examination was normal in all primary modalities, including pinprick, touch, vibration, and proprioception. The veteran's gait was slow, and revealed a stooped posture, with greatly limited mobility, but without shuffling, or any evidence of a spastic or ataxic gait. Basically, the veteran exhibited what could best be described as a "cautious gait." On VA orthopedic examination in April 1992, the veteran described episodes of numbness and tingling involving the ring and little fingers of his left hand. Additionally noted was a long history of low back pain. According to the veteran, his pain was "constant," but varying in severity. The veteran denied numbness or tingling in his lower extremities, and stated that he utilized two Canadian crutches in order to ambulate. On physical examination, the veteran moved about the room without the aid of his crutches, though somewhat slowly and cautiously, and with a limp, which was greater on the right. The veteran was able to stand erect, though he appeared to have bilateral paravertebral muscle spasm and tenderness to palpation in the midline of the lower lumbar region. Range of motion of the lumbar spine showed flexion to 60 degrees, with extension to 20 degrees, and right and left lateral bending to 20 degrees. The veteran performed a fair heel- and-toe walk as long as he was allowed to hold onto surrounding objects for balance. The veteran was able to squat farther than approximately one-third of the way down, and arise again. The pertinent diagnosis was degenerative arthritis/disc disease of the lumbar spine. During the course of an RO hearing in January 1993, the veteran and his spouse offered testimony regarding the severity of his various service-connected disabilities, and their impact upon his daily activities. In February 1993, an additional VA orthopedic examination was accomplished. At the time of examination, the veteran complained of pain radiating into both legs, accompanied by numbness and tingling in both feet. On physical examination, the veteran was described as ambulatory with the aid of two Canadian crutches. The veteran exhibited some difficulty in standing erect, and, in fact, lacked 15 degrees from being able to stand completely erect. The veteran displayed more than 35 degrees of flexion, accompanied by complaints of pain on motion. Further examination revealed a generalized tenderness to palpation over the lower lumbar region, though with no definite spasm. Both reflexes and sensation appeared to be intact in the veteran's upper and lower extremities. Radiographic studies of the veteran's lumbar spine revealed no evidence of any significant abnormality. The pertinent diagnosis was chronic lumbar syndrome with degenerative disease. In a rating decision of April 1993, the RO granted a 40 percent evaluation for the veteran's service-connected degenerative arthritis of the lumbar spine. In that same decision, the RO granted entitlement to a total disability rating based upon individual unemployability. During the course of a VA rehabilitative medicine consultation in April 1995, the veteran demonstrated functional mobility and strength in his upper extremities. The veteran was observed propelling his wheelchair down the hall, and indicated that he was able to walk short distances with forearm crutches. Noted at the time was that, inasmuch as the veteran was mobile with a wheelchair, and ambulatory for short distances, he did not meet the qualifications for a power cart. On VA neurologic examination in May 1995, the veteran gave a history of C2-C6 laminectomy, following which he had reportedly experienced worsened neck and shoulder pain, as well as numbness in his arms. According to the veteran, he had derived no benefit from his operation, and still utilized a wheelchair most of the time. According to the veteran's wife, he (i.e., the veteran) ambulated less than 1 hour per day with his cane. In the past, the veteran had reportedly used forearm crutches on an intermittent basis. Additional complaints included chronic pain in the lumbar spine area radiating down the back of both lower extremities, persistent tingling in the 3rd, 4th and 5th digits of both upper extremities, and numbness around the ankles of both feet. On physical examination, there was normal muscle bulk and tone in the upper extremities, with apparent normal tone in the lower extremities. This was, however, somewhat difficult to formally assess, inasmuch as it was physically impossible to move the veteran from his wheelchair to a flat table. At the time of examination, the veteran's strength appeared to be 5/5 throughout. There was, however, some notable giveway in the veteran's lower extremities attributable to pain. Sensory examination revealed normal light touch, pinprick, vibration, and proprioception throughout. Noted at the time of examination was that the veteran was unable to ambulate without assistance. Deep tendon reflexes were Grade II in the right biceps, and absent in the left biceps, with Grade II triceps jerks bilaterally, Grade III knee jerks bilaterally, and Grade II+ ankle jerks with toes downgoing, but no evidence of clonus. Radiographic studies of the veteran's lumbar spine conducted as part of his orthopedic examination were consistent with mild degenerative joint disease of the lumbar spine, but no other abnormality. The pertinent diagnosis was degenerative joint disease. On VA orthopedic examination in June 1995, it was noted that the veteran's claims folder was available, and had been reviewed. Additionally noted was that the veteran was primarily a "wheelchair ambulator." While the veteran previously had been able to walk with the aid of two Canadian crutches, he no longer used these crutches, and currently did most of his ambulation either in a wheelchair, or on a three-wheel motorized scooter. According to the veteran, he utilized a cane to make transfers. On physical examination, the veteran was able to get out of his chair only with some difficulty, and to force himself onto the adjacent desk. Examination of the veteran's back revealed some tenderness to palpation in the lower back region. Range of motion measurements of the lumbar spine showed flexion to 55 degrees, with 15 degrees of extension. At the time of examination, the veteran was unable to heel- and-toe walk, or squat. On private orthopedic evaluation in August 1996, the veteran gave a history of pain from his spine to his right buttock, and down to his right ankle. When further questioned, the veteran complained of "some muscle spasm" in his low back which had lasted "all night." On physical examination, the veteran walked and moved in a "very guarded" manner. There was some tenderness in the right lower back and along the sciatic nerve, and into the sciatic notch. The veteran exhibited positive seated straight leg raising at about 45 degrees. Deep tendon reflexes were +2 to +3 bilaterally in both the patella and Achilles. Radiographic studies of the veteran's lumbar and cervical spine showed evidence of marked degenerative changes, but no acute injury. The clinical assessment was degenerative arthritis; sciatica. Private magnetic resonance imaging of the veteran's lumbar spine conducted in February 1997 was consistent with a small ventral disc protrusion in the area of the 5th lumbar vertebra and 1st sacral segment, as well as a left paracentral disc protrusion at the level of the 4th and 5th lumbar vertebrae, accompanied by fluid in the facet joints bilaterally at the level of the 4th and 5th lumbar vertebrae, consistent with facet arthritis. In January 1998, an additional VA orthopedic examination was accomplished. At the time of examination, it was noted that the veteran utilized a scooter "most all of the time," though he used forearm braces "to get to the table," and a cane to get back from the table, and into his scooter. On physical examination, the veteran stayed seated in his scooter, and made no effort to get out in order to facilitate the examination. Noted at the time was that the veteran had not brought either his forearm crutches or his cane to the examination. Range of motion measurements of the veteran's lumbar spine conducted with him sitting in his scooter but leaning forward showed flexion to 12 degrees, extension to 14 degrees, left lateroflexion to 12 degrees, and right lateroflexion to 11 degrees. Noted at the time of examination was that it was "impossible" to determine the degree of impairment of function in the veteran's upper and lower extremities, inasmuch as he could not get out of his scooter, and did not bring his crutches or cane. In the opinion of the examiner, it appeared that the veteran was "bound" to his scooter, and needed it for locomotion. On VA neurologic evaluation in May 1999, the veteran complained of numbness in his upper extremities, though with no accompanying pain or weakness. Additionally noted was low back pain, which was "not progressive" insofar as the veteran could determine. When further questioned, the veteran described his pain as a dysesthesia beginning in the center of his lower back, and radiating bilaterally down the posterior aspects of his thighs, continuing along the posterior aspects of his calves, and terminating diffusely in the plantar surfaces of his feet. On physical examination, muscle strength was 5/5, with normal bulk, tone and power throughout, though with some limitation due to pain on occasion, especially in the lower extremities. At the time of evaluation, no involuntary movements were in evidence. Sensory examination was intact for light touch, vibration, proprioception, and temperature in all four extremities. The veteran exhibited globally decreased sensation to pinprick from about the level of the 4th cervical to the 1st lumbar vertebra, and in all extremities, though there were small, irregular patches of normal sensation. Deep tendon reflexes were 2 and symmetrical, with upgoing toes bilaterally. The veteran's station and gait were antalgic, and the Romberg test was negative. In October 1999, an additional VA neurologic examination was accomplished. At the time of examination, the veteran complained of "instability and an inability to walk." According to the veteran, he had to "hoist himself" along handrails, and use the support of his vehicle in order to enter. When further questioned, the veteran reported numerous falls from his three-wheeled scooter, both on level ground, as in a grocery store or commissary, and in his yard. On physical examination, there was no evidence of any drift. Muscle bulk was within normal limits, and muscle tone was "normal times four." Upper extremity strength was 5/5 at the biceps, triceps, wrist extensors, flexors, grasps, and deltoids, "Grade IV with give-away." The veteran's lower extremities showed iliopsoas of 5 bilaterally, with hamstrings of grade 4 on the right, and 4- on the left, with give-away, and quadriceps of 5/5 on the left, and 5-/5 on the right, with 5/5 anterior tibialis and gastrocnemius "symmetric." On sensory examination, the veteran denied any pin sensation in all four extremities. Vibratory sensation was present in a diminished fashion in the left arm only. Reflexes were symmetrical in both the upper and lower extremities. At the time of examination, the veteran was "unable to advance," though he was able to stand. When grasping the examiner's shoulders, the veteran demonstrated no truncal sway. Additionally noted was that the veteran was able to turn and dismount from his scooter. At the time of examination, the veteran was unable to stand on his toes, and showed difficulty in leaning back on his heels. In the opinion of the examiner, the only finding of give-away weakness inconsistent with the veteran's ability to stand was his hamstring weakness. On VA orthopedic examination, conducted in conjunction with the aforementioned neurologic examination in October 1999, it was noted that the veteran's claims folder was available, and had been reviewed. The veteran presented for examination in his scooter, stating that he had driven to the examination in his pickup truck with his wife. When further questioned, the veteran stated that, on those occasions when he and his wife would go to the grocery store, he brought "all of the groceries in his scooter." Current complaints consisted of pain, weakness, stiffness, fatigability, and a lack of endurance. According to the veteran, he was in a scooter because pressure on his wheelchair caused his blood pressure to increase. The veteran stated that he was unable to walk "because of his sciatic nerve being pinched," and could therefore "only shuffle." Additional complaints included shoulder and arm pain, radiating into the veteran's middle, ring, and little fingers. Reportedly, because of this, the veteran was unable to hold a cup of coffee or a glass, instead finding it necessary to use a mug. On physical examination, the veteran stayed in his scooter "all of the time," except when getting up for range of motion measurements of his lumbar spine. At the time of examination, the musculature of the veteran's back was described as good. Deep tendon reflexes were active and equal, with the exception of the biceps, which was absent on the left. Knee jerks were "active and equal." Range of motion measurements of the veteran's lumbar spine showed right flexion to 24 degrees, with left flexion to 16 degrees, and forward flexion to 36 degrees. Backward extension was to 8 degrees. In the opinion of the examiner, the veteran was not "totally incapacitated," or he would have been unable to drive his pickup truck to the examination, or to go to the grocery store and pick up groceries. The veteran was, however, "certainly disabled and in pain." During the course of VA occupational therapy in January 2000, it was noted that the veteran required minimal assistance with the activities of daily living. Additionally noted was that the veteran was able to ambulate in his trailer with the support of furniture, and that he utilized a scooter "for mobility." On VA orthopedic examination in January 2000, it was noted that the veteran had driven himself from Huntsville (Alabama). Additionally noted was that the veteran used a scooter to transport himself from his vehicle to the floor, or to go any distance other than about his room. While the veteran did not bring his crutches to the examination, he was able to ambulate to the bathroom, which was a distance of approximately 10 to 15 feet by holding onto various objects, such as chairs and tables. According to the veteran, at home, he utilized a cane. On physical examination, range of motion of the veteran's lower extremities appeared to be full, though accompanied by crepitus, and complaints of knee and low back pain. Regarding functional assessment, the veteran appeared to be limited with any extensive walking, and required an assistive device, such as a cane or rolling walker, as well as handholds for stability while moving through his home. Analysis Regarding the issue of an increased evaluation for service- connected degenerative arthritis of the lumbar spine, the Board notes that disability evaluations, in general, are intended to compensate for the average impairment of earning capacity resulting from a service-connected disability. They are primarily determined by comparing objective clinical findings with the criteria set forth in the rating schedule. 38 U.S.C.A. § 1155 (West 1991 & Supp. 2002); 38 C.F.R. Part 4 (2001). In evaluating the severity of a particular disability, it is essential to consider its history. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1, 4.2 (2001). However, where 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. Though a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). As noted above, the veteran in this case seeks an increased evaluation for degenerative arthritis of the lumbar spine. In that regard, degenerative arthritis established by X-ray findings is to be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Such limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. Part 4, Code 5003 (2001). In the present case, over the course of the veteran's rather lengthy appeal, there has been demonstrated what could best be described as significant limitation of motion of the lumbar spine. However, the 40 percent evaluation currently in effect contemplates the presence of just such "severe" limitation of motion. 38 C.F.R. Part 4, Code 5292 (2001). In order to warrant an increased evaluation, there would, of necessity, need to be demonstrated the presence of unfavorable ankylosis of the lumbar spine [see 38 C.F.R. Part 4, Code 5289 (2001)], or, in the alternative, findings consistent with pronounced intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy (i.e., with characteristic pain, demonstrable muscle spasm and an absent ankle jerk or other neurological findings appropriate to the site of the diseased disc) and little intermittent relief. [See 38 C.F.R. Part 4, Code 5293 (2001)]. As is clear from the above, the veteran has at no time exhibited unfavorable ankylosis of his lumbar spine. Nor has it been demonstrated that, as a result of his service- connected low back disability, he suffers from either demonstrable muscle spasm or an absent ankle jerk. In point of fact, while on VA orthopedic examination in February 1993, there was evidence of generalized tenderness to palpation over the lower lumbar region, no definite muscle spasm was in evidence. As of the time of a recent VA outpatient neurological evaluation in May 1999, motor strength was 5/5 throughout, with normal bulk, tone, and power, though admittedly, on occasion, somewhat limited by pain. Deep tendon reflexes were 2 and symmetrical, while sensory examination was intact to light touch, vibration, proprioception, and temperature in all four of the veteran's extremities. The Board acknowledges that it is the intent of the Schedule for Rating Disabilities (Part 4) to recognize painful motion with joint or periarticular pathology as productive of disability. 38 C.F.R. § 4.59 (2001). This is to say that, even absent a definable limitation of motion, where there is functional disability due to pain, supported by adequate pathology, additional compensation may be warranted. 38 C.F.R. § 4.40 (2001). However, in the present case, it is apparent that, notwithstanding the veteran's complaints of pain, the clear weight of the evidence is to the effect that he currently suffers from no more than severe impairment of the lumbar spine. At no time has it been demonstrated that the veteran exhibits the unfavorable ankylosis and/or pronounced intervertebral disc pathology requisite to the assignment of an increased evaluation. Accordingly, the veteran's claim for such an evaluation must be denied. In addition to the above, the veteran seeks financial assistance in acquiring either specially adapted housing or special home adaptations, as well as financial assistance in the purchase of an automobile or other conveyance, and/or adaptive equipment. In pertinent part, it is argued that, as a result of the veteran's various service-connected disabilities, he has suffered the "loss of use" of both of his legs. Regarding the veteran's entitlement to financial assistance in acquiring specially adaptive housing, the Board notes that such assistance is available to a veteran who has a permanent and total service-connected disability due to: (1) the loss, or loss of use, of both lower extremities, such as to preclude locomotion without aid of braces, crutches, canes, or a wheelchair; or (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; or (3) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; or (4) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affects the function of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 38 U.S.C.A. § 2101(a) (West 1991 & Supp. 2002); 38 C.F.R. § 3.809 (2001). Financial assistance in acquiring special home adaptations is available to a veteran who, though not entitled to a certificate of eligibility for assistance in acquiring specially adaptive housing, is entitled to compensation for permanent and total disability which (1) is due to blindness in both eyes, with 5/200 or less visual acuity, or (2) includes the anatomical loss or loss of use of both hands. 38 U.S.C.A. § 2101(b) (West 1991 & Supp. 2002); 38 C.F.R. § 3.809a (2001). A certificate of eligibility for assistance in the purchase of one automobile or other conveyance is provided any eligible veteran or service member whose service-connected disability includes one of the following: (1) loss or permanent loss of use of one or both feet; or (2) loss or permanent loss of use of one or both hands: or (3) permanent impairment of the vision of both eyes to the required specified degree, that is, central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200, if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) for adaptive equipment eligibility only, ankylosis of one or both knees or one or both hips, with the term adaptive equipment meaning generally that equipment which must be part of or added to a conveyance manufactured for sale to the general public in order to make it safe for use by the claimant and to assist him or her in meeting the applicable standards of licensure of the proper licensing authority. 38 U.S.C.A. §§ 3901, 3902 (West 1991 & Supp. 2002); 38 C.F.R. § 3.808 (2001). In the case at hand, there exists no evidence that the veteran suffers permanent impairment of vision of both eyes, ankylosis of one or both knees or hips, or loss or loss of use of his upper extremities, including his hands. Nor is it otherwise alleged. Rather, as noted above, the veteran argues that, due solely to his service-connected disabilities, he suffers from a complete loss of use of both lower extremities. In that regard, the Board observes that, while over the course of this appeal, there has been demonstrated significant disability of the veteran's lower extremities, that disability has never risen to the level of "loss of use." More specifically, while at the time of a VA neurologic examination in October 1999, the veteran was "unable to advance," he was nonetheless able to stand. Motor examination of the veteran's lower extremities showed normal muscle bulk and tone, and vibratory sensation was normal in all but the veteran's left arm. On VA orthopedic examination, likewise conducted in October 1999, the veteran stated that he had driven to the examination in his pickup truck from Huntsville, Alabama. Musculature of the veteran's back was described as "good," and deep tendon reflexes were, for the most part, active and equal. In the opinion of the examiner, the veteran was "not totally incapacitated," or he would have been unable to drive his pickup truck to the examination, or go to the grocery store "and pick up groceries in his scooter." The Board acknowledges that, as a result of the veteran's lower extremity disabilities, he initially made use of Canadian crutches, progressing to a wheelchair, and, currently, to a 3-wheel scooter. The Board further acknowledges that, at the time of the aforementioned VA orthopedic examination, the veteran was described as "disabled, and in pain." However, at no time has it been demonstrated that, as a result of the veteran's service- connected disabilities, he suffers from a complete loss of use of one or both lower extremities. More to the point, notwithstanding the current severity of the veteran's various service-connected disabilities, he is presently able to walk, although slowly, while holding onto furniture or other objects, and, in so doing, move about his trailer and various other facilities. Under such circumstances, financial assistance in acquiring specially adapted housing, special home adaptations, or an automobile or other conveyance and/or adaptive equipment must be denied. In reaching the above determinations, the Board has given due consideration to the provisions of the recently-passed Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), and its implementing regulations, as that law and those regulations redefine the obligations of the VA with respect to the duty to assist, and the enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. However, in the case at hand, it is clear that the VA has met its "duty to assist" the claimant in the development of all facts pertinent to his claims. To that end, the veteran has been afforded numerous VA examinations, and medical opinions have been obtained. Accordingly, the Board is of the opinion that no further duty to assist the veteran exists in this case. ORDER An increased evaluation for degenerative arthritis of the lumbar spine is denied. A certificate of eligibility for financial assistance in acquiring specially adapted housing is denied. A certificate of eligibility for financial assistance in acquiring special home adaptations is denied. Financial assistance in the purchase of an automobile or other conveyance, and/or adaptive equipment is denied. D. C. Spickler Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you. Error! Not a valid link.