Citation Nr: 0720828 Decision Date: 07/12/07 Archive Date: 07/25/07 DOCKET NO. 06-14 747 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to an increased rating for service-connected chronic low back strain, currently evaluated as 10 percent disabling. 2. Entitlement to a compensable evaluation for service- connected residuals of fatty liver, also claimed as digestive condition. 3. Entitlement to a compensable evaluation for service- connected residuals of right lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars. 4. Entitlement to a compensable evaluation for service- connected residuals of left lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Tanya A. Smith, Counsel INTRODUCTION The veteran had active service from January 1979 to January 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In March 2007, the veteran testified via videoconference before the undersigned Acting Veterans Law Judge. FINDINGS OF FACT 1. The veteran has been notified of the evidence necessary to substantiate his claims, and all relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. The medical evidence shows that the veteran's service- connected low back disability does not restrict forward flexion of the lumbar spine to a point not greater than 60 degrees (but rather allows for flexion to 80 degrees), nor does it result in a combined range of motion of the lumbar spine not greater than 120 degrees; the low back disorder does not cause muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, and it is not productive of associated objective neurological abnormalities. 3. The medical evidence of record shows that the veteran's service-connected liver disability is not currently productive of residuals. 4. The medical evidence of record shows that the veteran's service-connected residuals of lower extremities compartment syndrome, post-operative fasciotomy, are productive of no more than slight muscle disabilities; the superficial scars are not painful on examination or unstable and do not measure an area of 144 square inches (929 sq. cm.). CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 10 percent for service-connected chronic low back strain have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.27, 4.40-4.46, 4.59, 4.71a, Diagnostic Code 5237 (2006). 2. The criteria for a compensable rating for service- connected residuals of fatty liver, also complained as digestive condition have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.27, 4.114, Diagnostic Code 7399-7345 (2006). 3. The criteria for a compensable rating for service- connected residuals of right lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.27, 4.56, 4.73, 4.118, Diagnostic Codes 5312, 7802, 7803, 7804, 7805 (2006). 4. The criteria for a compensable rating for service- connected residuals of left lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.159, 4.1-4.14, 4.27, 4.56, 4.73, 4.118, Diagnostic Codes 5312, 7802, 7803, 7804, 7805 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000, Pub. L. No. 106- 475, 114 Stat. 2096 (2000) (VCAA) redefines the obligations of VA with respect to the duty to assist and includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2005); 38 C.F.R. § 3.159 (2006). VA is required to provide the claimant with notice of what information or evidence is to be provided by the Secretary and what information or evidence is to be provided by the claimant with respect to the information and evidence necessary to substantiate the claim for VA benefits. Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). In regard to VA's enhanced duty to notify under the VCAA, the Board notes that in correspondence dated in January 2004 and October 2006, the RO advised the veteran of VA's duties under the VCAA and the delegation of responsibility between VA and the veteran in procuring the evidence relevant to the claims, including which portion of the information and evidence necessary to substantiate the claims was to be provided by the veteran and which portion VA would attempt to obtain on behalf of the veteran. Quartuccio, 16 Vet. App. at 187. The VCAA notices advised the veteran of what the evidence must show to establish entitlement to an increased evaluation for service-connected disability. Finally, the October 2006 VCAA notice specifically requested that the veteran provide any evidence in his possession that pertained to his claims. 38 C.F.R. § 3.159(b)(1) (2006). During the course of this appeal, the United States Court of Appeals for Veterans Claims (Court) handed down Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). In Pelegrini II, the Court reaffirmed that the enhanced duty to notify provisions under the VCAA should be met prior to an initial unfavorable agency of original jurisdiction decision on the claim. In the instant appeal, the Board finds that any defect with respect to the timing of the VCAA notice requirement was harmless error. While the notice provided to the veteran in October 2006 was not given prior to the first RO adjudication of the claims, he was provided additional time within which to submit additional evidence concerning his appeal. The veteran has been provided with every opportunity to submit evidence and argument in support of his claims and to respond to VA notices. Also during the course of this appeal, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. In the instant appeal, the veteran was provided with notice of the type of evidence necessary to establish an effective date for the service-connected disabilities in correspondence dated in March 2006. The Board further observes that the RO provided the veteran with a copy of the April 2004 rating decision, October 2004 rating decision, March 2006 Statement of the Case (SOC), and June 2006 Supplemental Statement of the Case (SSOC), which included a discussion of the facts of the claims and the laws and regulations as well as notification of the bases of the decisions and a summary of the evidence used to reach the decisions. The Board concludes that the requirements of the notice provisions of the VCAA have been met, and there is no outstanding duty to inform the veteran that any additional information or evidence is needed. Quartuccio, 16 Vet. App. at 187. In regard to VA's duty to assist, the Board notes that the RO obtained VA treatment records. The RO afforded the veteran VA examinations in August 2004 and June 2006, which addressed the severity of the service-connected disabilities. At the March 2007 video conference hearing, the veteran affirmed that his disabilities had worsened since his last exam, but the veteran did not specify how the disabilities had worsened, and there is no objective medical evidence of record that shows or suggests that the VA examinations the veteran underwent in June 2006 are insufficient to evaluate his disabilities. Therefore, the Board finds that a new VA examination is not warranted. The veteran has not made the RO or the Board aware of any other evidence relevant to his appeal that needs to be obtained. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the veteran in developing the facts pertinent to his claims. Accordingly, the Board will proceed with appellate review. Increased Ratings In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41, 4.42 (2004) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board also reviewed all evidence of record pertaining to the history of the service-connected disabilities discussed below. The Board has found nothing in the historical record that would lead to the conclusion that the current evidence of record is not adequate for rating purposes. The Board is of the opinion that this case presents no evidentiary considerations that would warrant an exposition of remote clinical histories and findings pertaining to these disabilities. Chronic Low Back Strain In a November 1995 rating decision, the RO granted service connection for chronic low back strain and assigned a noncompensable evaluation under former Diagnostic Code 5295, effective February 1, 1995, the day following the veteran's discharge from service. On January 7, 2004, the veteran filed the instant claim for an increased rating. In the appealed rating decision of October 2004, the RO increased the disability rating to 10 percent under new Diagnostic Code 5237, effective January 7, 2004. The 10 percent rating has remained in effect. Records from Lexington Medical Center IRMO include a March 2003 record that showed that the veteran complained of lower back pain on the right side. He believed he strained his back at work and reported that he did this approximately one to two times per year. He usually received no treatment other than pain medications, and he indicated that the pain usually resolved within a couple of days. A December 2003 VA treatment record noted that an examination revealed full range of motion in all planes. A straight-leg raising test was negative bilaterally. The August 2004 VA joints examination report shows that the veteran complained of back pain that radiated to his hips and thighs. He also complained that he experienced numbness in his lower legs with prolonged sitting. He denied any history of spine surgery. He complained of back spasms and flare-ups of back pain. He was currently employed as a maintenance person. He missed 95 days per year secondary to several disabilities, which included his back disability. He was able to walk and fish but not participate in any other recreational activities. The physical examination of his lumber spine revealed mild tenderness to palpation in the midline. There were no contour abnormalities. He had full range of motion with minimal pain. Motor testing of his lower extremities was 5/5. The examiner reported that radiographs were reviewed and showed no disk space narrowing and no acute abnormalities. The examiner concluded that based on the veteran's history, examination, and diagnostic tests, it was less likely than not that the range of motion measured above was additionally limited by pain, fatigue, weakness, or lack of endurance following repetitive use. The August 2004 neurological examination report shows that the examiner reported that there was no evidence of any low back problem. The examiner reported that x-rays of the lumbar spine were normal and that the neurological and orthopedic examinations of the lumbar spine were negative. The June 2006 VA muscles examination report shows that the examiner reviewed the claims files. The veteran continued to complain of chronic low back pain and occasional pain in his lower extremities after being on his feet all day. Precipitating factors included weightbearing activities, but most symptoms were relieved by elevation of his legs. He had several epidural injections that provided moderate pain relief. He had physical therapy off and on for six or seven months, which provided good pain relief. He was currently employed as a state maintenance supervisor; he had to use sick and vacation days because of back pain. Prolonged standing, lifting, bathing, and sitting, and weather changes aggravated his back pain. He had two incapacitating episodes in the past year for which a physician prescribed bedrest for two to three days. He had flare-ups of back pain approximately four times a year that lasted for two to three days to the point of incapacitation for which he needed bedrest. The physical examination of the lumbosacral spine revealed 80 degrees of flexion and 25 degrees of extension, "both within the range of pain present." Lateral flexion to the right was measured at 40 degrees and 30 degrees to the left, both without pain present. Bilateral rotation was measured at 30 degrees without pain present. The range of motion measured was not additionally limited by pain, fatigue, or weakness, following repetitive use. There was no spasm present; however, there was tenderness along the lumbosacral junction. Right leg, straight-leg raising elicited low back pain but the left leg did not. Motor strength was 5/5 bilaterally. The sensory exam was normal. Deep tendon reflexes were 2+ bilaterally, and his gait was normal. The examiner reported that a July 2005 magnetic resonance image (MRI) study of the lumbar spine was essentially negative. In an addendum, it was noted that the veteran was diagnosed with lumbosacral strain. A March 2005 VA treatment record noted that an examination revealed point tenderness of the lumbosacral spine. Deep tendon reflexes were 2+, and the straight leg raising test was positive. The examiner noted an assessment of low back pain. At the March 2007 RO hearing, the veteran claimed that his back had worsened since the 2006 VA examination, but he did not explain how. He continued to work as a maintenance man. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumber spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243 (2006). Any associated objective neurologic abnormalities, including, but not limited to bowel or bladder impairment are to be evaluated separately under an appropriate diagnostic code. Intervertebral disc syndrome is to be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. For purposes of evaluations under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The medical evidence shows that the veteran's low back disability does not meet the minimum loss of motion associated with a 20 percent rating. The veteran demonstrated full range of motion and 80 degrees of flexion on VA examination in August 2004 and June 2006. Also, the combined range of motion of the lumbar spine demonstrated on the VA examinations was greater than 120 degrees. According to the VA examiners, the demonstrated range of motion is not additionally limited by such factors as pain, fatigue, weakness, or lack of endurance. In addition, the medical evidence of record shows that the veteran's low back disability is not productive of muscle spasm or guarding resulting in an abnormal gait or spinal contour. Thus, the veteran is not entitled to the next higher rating of 20 percent under the general rating formula for rating spine disabilities with respect to the orthopedic manifestations of his low back disability. While the veteran complained of back pain that radiated to his legs at the August 2004 VA examination and he had a positive straight leg raise test at the June 2006 VA examination, the VA examinations show that there are currently no ratable neurological manifestations associated with the low back disability. Radiographs and the July 2005 MRI show that the veteran does not have degenerative disc disease of the lumbar spine, and his low back disability is not characterized as being productive of intervertebral disc syndrome. Consequently, no consideration need be made to the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes notwithstanding the veteran's contention that he suffers from incapacitating episodes of low back pain. Moreover, VA treatment records do not document any physician prescribed bed rest in connection with any complaints of low back pain. Accordingly, the Board concludes that the veteran is not entitled to an increased rating in excess of 10 percent for service-connected chronic low back strain. Residuals of Fatty Liver, Also Complained as Digestive Condition In a November 1995 rating decision, the RO granted service connection for fatty liver and assigned a noncompensable evaluation under Diagnostic Code 7399-7345, effective February 1, 1995. On January 7, 2004, the veteran filed the instant claim for an increased rating. The noncompensable evaluation has remained in effect. At the March 2007 RO hearing, the veteran associated fatigue, anxiety, and gastrointestinal problems with his liver disability. He also claimed he was on a special diet for this disability. Records from Lexington Medical Center IRMO noted that the veteran had a past medical history significant for gastroesophageal reflux disease (GERD). VA treatment records include a January 2004 record that noted that the veteran was trying to lose weight with dietary and increased exercise efforts. Another January 2004 record noted that the veteran had no further complaints of left lower quadrant pain, which had been determined to be secondary to diverticular disease. It was noted that the veteran was diagnosed with diverticulosis, GERD, and peptic ulcer disease (PUD). A March 2005 record showed that the veteran was counseled on eating healthy to control his GERD. The June 2006 VA examination report shows that the examiner reviewed the claims files. The veteran complained of persistent gastrointestinal complaints described as pain in the left lower quadrant that had been intermittent over the years. He complained of bloating and gas at times, and occasional nausea and vomiting. He also experienced chronic fatigue. He had gained about 10 pounds over the last year. He usually ate about two meals a day with snacks in between. The examiner described the veteran as obese. The physical examination revealed mild tenderness to palpation in the left lower quadrant only. The examiner reported that the laboratory data revealed a full liver panel. The examiner noted that at the present time, the veteran had a diagnosis of fatty liver from a previous liver biopsy that was done well over a decade ago. The examiner maintained that this was related to the veteran being obese and possibly having some early nonalcoholic steatohepatitis back at that time. The examiner reported that the veteran currently had a normal liver function test and normal pancreatic enzymes, and he had no reported history of any kind of chronic liver condition. The examiner maintained that he found no findings consistent with liver cirrhosis or any liver abnormality. The examiner indicated that the veteran's complaints of left lower quadrant pain and some other gastrointestinal complaints might be consistent with a form of irritable bowel syndrome but not of any kind of liver cirrhosis or other liver damage. The examiner explained that typically nonspecific fatty liver was a benign process that in a small percentage of people over many years did lead to cirrhosis, but presently there were no findings of this in the veteran. The veteran's service-connected liver disability is rated by analogy to chronic liver disease without cirrhosis under Diagnostic Code 7345. Under Diagnostic Code 7345, a noncompensable evaluation is provided for nonsymptomatic liver disease. A 10 percent evaluation is prescribed where liver disease is productive of intermittent fatigue, malaise, and anorexia, or where there are incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks during the previous 12 month period. A 20 percent evaluation is prescribed where liver disease is productive of daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication; or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. 38 C.F.R. § 4.114, Diagnostic Code 7345 (2006). For purposes of evaluating conditions under Diagnostic Code 7345, "incapacitating episode'" means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Id. According to the June 2006 VA examiner and the other medical evidence of record, there are no residuals associated with the service-connected liver disability. Clinical testing revealed no liver abnormality. The VA examiner indicated that the veteran's gastrointestinal complaints might be due to a nonservice-connected disorder. The clinical findings noted in the VA and private treatment records similarly show that many of the veteran's complaints are attributable to nonservice-connected disorders. As the veteran's service- connected liver disability is not currently productive of compensable residuals, the Board finds that the veteran is not entitled to a compensable evaluation under Diagnostic Code 7345. Residuals of Right and Left Lower Extremity Compartment Syndrome, Post-Operative Fasciotomy, Claimed as Shin Splints and Scars In a November 1995 rating decision, the RO granted service connection for bilateral compartment syndrome (shin splints), status post bilateral fasciotomy and assigned a noncompensable evaluation under Diagnostic Code 5312, effective February 1, 1995. On January 7, 2004, the veteran filed the instant claim for an increased rating. The noncompensable evaluations have remained in effect, but the disabilities are assigned to Diagnostic Codes 5312-7805. At the March 2007 RO hearing, the veteran affirmed that his scars were tender and painful, and that he experienced a burning sensation. He also complained of numbness and weakness in his legs when he stood for prolonged periods. A March 2004 VA treatment record showed that the veteran complained of pain, tenderness, and numbness on the bottom of both of his feet. The August 2004 VA joints examination report shows that the veteran complained of numbness in his feet and legs. The June 2006 VA muscles examination report shows that the examiner reviewed the claims files. The veteran complained of bilateral foot numbness between his first and second toes on the plantar surface and along the medial shins with paresthesias. He also experienced some pain in his lower extremities with prolonged standing. The physical examination of the lateral lower extremities revealed a left- sided incisional scar that measured 12.3 by 0.6 cm and a right-sided incisional scar that measured 11.4 by 0.4 cm. There were no adhesions, tendon damage, bone, joint, or nerve damage. His muscle strength was 5/5 bilaterally. There was no muscle herniation, loss of muscle function, or tumors of the muscle. The examiner related that the veteran complained of easy fatigability in both lower extremities. In an addendum, it was noted that the veteran was diagnosed with bilateral lower extremity compartment syndromes treated with bilateral fasciotomies. Scars may be rated on limitation of function of the part affected. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2006). Injuries to Muscle Group XII are evaluated under Diagnostic Code 5312. The muscles involved in Muscle Group XII are the anterior muscles of the leg, which are the (1) tibialis anterior, (2) extensor digitorum longus, (3) extensor hallucis longus, and (4) peroneus tertius. The function of this muscle group is dorsiflexion (1), extension of the toes (2), and stabilization of the arch (3). A slight injury to this muscle group is evaluated as noncompensable. A moderate injury to this muscle group is evaluated as 10 percent disabling. 38 C.F.R. § 4.73, Diagnostic Code 5312 (2006). The cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue- pain, impairment of coordination, and uncertainty of movement. Slight muscle disability is found where there has been a simple wound of the muscle without debridement or infection. There are no cardinal signs or symptoms of muscle disability. Objective findings of a slight muscle disability include minimal scar, no evidence of fascial defect, atrophy, or impaired tonus, and no impairment of function or metallic fragments retained in muscle tissue. Moderate muscle disability is found where there has been a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. There is a record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability. Objective findings of a moderate muscle disability include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissues. Also, some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56 (2006). Other than rating on limitation of function of the part affected under Diagnostic Codes 5312-7805, a scar may also be assigned a 10 percent rating if it is painful on examination and superficial. A superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2006). A 10 percent rating is prescribed for superficial unstable scars. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7803 (2006). A 10 percent rating is prescribed for scars, other than on the head, face, or neck, that are superficial, that do not cause limited motion, and measure an area or areas of 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118, Diagnostic Code 7802 (2006). The service medical records show that the veteran underwent bilateral lower leg anterior and lateral compartment fasciotomies under general anesthesia in March 1994. The narrative summary indicated that the operation was uncomplicated. The veteran has only recently complained that his scars are tender and painful, and manifest a burning sensation. The VA examination reports and treatment records show that the veteran's earlier complaints had been centered on pain and numbness in his feet and legs. Service connection is already in effect for peroneal nerve neuropathy of the lower extremities secondary to the service-connected compartment syndrome disabilities for which each lower extremity has been assigned a 10 percent disability rating. Notwithstanding testimony from the veteran, his scars were not demonstrably painful on VA examination. From the June 2006 VA examiner's description, the scars are superficial, stable, and do not measure an area of 144 square inches (929 sq. cm.). While the veteran complained of fatigue, the examination revealed no weakness in muscle strength and the VA examiner indicated that the veteran had no loss of muscle function. Thus, the medical evidence shows that the veteran does not have a moderate muscle disability. For these reasons, the Board finds that the veteran is not entitled to a compensable evaluation under Diagnostic Codes 5213-7805 and 7802 to 7804. Other Considerations An increased rating may also be granted on an extraschedular basis when it is demonstrated that the particular disability presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (2006). The Board finds no evidence that the veteran's service-connected disabilities presented such an unusual or exceptional disability picture at any time so as to require consideration of an extraschedular evaluation pursuant to the provisions of 38 C.F.R. § 3.321(b)(1) (2006). The schedular rating criteria are designed to compensate for average impairments in earning capacity resulting from service-connected disability in civil occupations. 38 U.S.C.A. § 1155 (West 2002). Generally, the degrees of disability specified in the rating schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2006). Consequently, the Board concludes that referral of this case for consideration of an extraschedular rating is not warranted. Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). As the preponderance of the evidence is against all of the claims, the "benefit of the doubt" doctrine is not applicable, and the claims must be denied. 38 U.S.C.A. 5107(b) (West 2002); 38 C.F.R. § 3.102 (2006); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER An increased rating in excess of 10 percent for service- connected chronic low back strain is denied. A compensable rating for service-connected residuals of fatty liver, also complained as digestive condition is denied. A compensable rating for service-connected residuals of right lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars is denied. A compensable rating for service-connected residuals of left lower extremity compartment syndrome, post-operative fasciotomy, claimed as shin splints and scars is denied. ____________________________________________ DENNIS F. CHIAPPETTA Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs