Citation Nr: 1007222 Decision Date: 02/26/10 Archive Date: 03/05/10 DOCKET NO. 08-13 890 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for a neck disorder, to include as secondary to lumbosacral strain. 2. Entitlement to service connection for a bilateral knee disorder, to include as secondary to lumbosacral strain. 3. Entitlement to service connection for a bilateral foot disorder, to include as secondary to lumbosacral strain. 4. Entitlement to an initial evaluation in excess of 20 percent for lumbosacral strain. 5. Entitlement to an initial compensable evaluation for radiculopathy symptoms of the bilateral lower extremities. 6. Entitlement to an initial evaluation in excess of 10 percent for depressive disorder. REPRESENTATION Appellant represented by: John S. Berry, Attorney at Law ATTORNEY FOR THE BOARD David S. Ames, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1970 to December 1971. This matter comes properly before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office in Lincoln, Nebraska (RO). FINDINGS OF FACT 1. The medical evidence of record does not show that the Veteran's currently diagnosed neck disorder is related to military service or to a service-connected disability. 2. The medical evidence of record does not show that the Veteran's currently diagnosed bilateral knee disorder is related to military service or to a service-connected disability. 3. The medical evidence of record does not show that the Veteran's currently diagnosed bilateral foot disorder is related to military service or to a service-connected disability. 4. The medical evidence of record shows that the Veteran's lumbosacral strain is manifested by back pain and limitation of motion to 40 degrees of flexion, 10 degrees of extension, 15 degrees of left lateral flexion, 15 degrees of right lateral flexion, 15 degrees of left rotation, and 15 degrees of right rotation. 5. The medical evidence shows that the Veteran's radiculopathy symptoms of the right lower extremity are manifested by leg pain without objective findings. 6. The medical evidence shows that the Veteran's radiculopathy symptoms of the left lower extremity are manifested by leg pain without objective findings. 7. The medical evidence of record shows that the Veteran's depressive disorder is manifested by sleep impairment, nightmares, a constricted affect, depressed mood, and psychomotor activity. CONCLUSIONS OF LAW 1. A neck disorder was not incurred in, or aggravated by, active military service, nor is it proximately due to, or aggravated by, a service-connected disability. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2009). 2. A bilateral knee disorder was not incurred in, or aggravated by, active military service, nor is it proximately due to, or aggravated by, a service-connected disability. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 3. A bilateral foot disorder was not incurred in, or aggravated by, active military service, nor is it proximately due to, or aggravated by, a service-connected disability. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2009). 4. The criteria for an initial rating in excess of 20 percent for lumbosacral strain have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2009). 5. The criteria for an initial evaluation of 10 percent, but no more, for radiculopathy symptoms of the right lower extremity have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. §§ 4.26, 4.124a, Diagnostic Code 8520 (2009). 6. The criteria for an initial evaluation of 10 percent, but no more, for radiculopathy symptoms of the left lower extremity have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. §§ 4.26, 4.124a, Diagnostic Code 8520 (2009). 7. The criteria for an initial rating in excess of 10 percent for a depressive disorder have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9434 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS With respect to the Veteran's claims, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2009). Prior to initial adjudication, letters dated in June 2007, July 2007, and December 2007 satisfied the duty to notify provisions with respect to the original claims. Additional letters were also provided to the Veteran in May 2008, after which the claims were readjudicated, and July 2008. See 38 C.F.R. § 3.159(b)(1); Overton v. Nicholson, 20 Vet. App. 427 (2006); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran's service treatment records, VA medical treatment records, and indicated private medical records have been obtained. Adequate VA examinations were provided to the Veteran in connection with his claims. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). There is no indication in the record that additional evidence relevant to the issues decided herein is available and not part of the claims file. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman, 19 Vet. App. 473. Further, the purpose behind the notice requirement has been satisfied because the Veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claims, to include the opportunity to present pertinent evidence. Simmons v. Nicholson, 487 F.3d 892, 896 (Fed. Cir. 2007); Sanders v. Nicholson, 487 F.3d 881, 889 (Fed. Cir. 2007) (holding that although VCAA notice errors are presumed prejudicial, reversal is not required if VA can demonstrate that the error did not affect the essential fairness of the adjudication). Neck Disorder, Bilateral Knee Disorder, Bilateral Foot Disorder Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In addition, service connection may be granted for any disease diagnosed after discharge, when all the evidence including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by a service connected disability or (b) aggravated by a service connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 488 (1995) (en banc). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). For certain chronic disorders, including arthritis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309. The Veteran's service treatment records are negative for any complaints or diagnosis of a neck disorder, knee disorder, or foot disorder. After separation from military service, in an August 2002 outpatient medical report, the Veteran complained of chronic knee pain. On physical examination, there was crepitus in both knees. In a December 2004 VA outpatient medical report, the Veteran reported that "he wrenched his neck 3 months ago and aggravated it on a trip to Sturgus, [South Dakota]." On physical examination, the Veteran held his head stiffly to the right and had limited range of motion of the cervical spine. The impression was cervicalgia. The medical evidence of record shows that a neck disorder has been consistently diagnosed since December 2004. In a March 2007 VA outpatient medical report, the Veteran reported that "[a]fter several months of construction [he] developed severe worsening neck and back pain." In an August 2007 VA spine examination report, the Veteran denied experiencing any incapacitating episodes due to cervical spine symptoms over the previous 12 months. On physical examination, there were no objective abnormalities of the cervical spine. December 2007 VA feet and joints examination reports stated that the Veteran's service treatment records and post-service medical records had been reviewed. The Veteran complained of bilateral knee and foot pain related to his service-connected back disorder. He reported that the foot pain began in 1994. After physical and radiographic examinations, the diagnoses were bilateral podalgia associated with prolonged standing/walking, bilateral calcaneal spurs, and bilateral knee musculoligamentous strain with mild bilateral degenerative changes. The examiner opined that the Veteran's bilateral knee and foot disorders were less likely as not (less than 50/50 probability) caused by or a result of his lumbosacral strain. . . . It is unlikely that the [V]eteran's lumbar spine condition can be implicated as causing the bilateral foot and knee condition. It is also unlikely to be aggravating these conditions. Both these conditions are far more likely due to age, occupational history, mechanical strain over many years and would likely present regardless of the [V]eteran's back condition. A February 2008 VA spine examination report stated that the Veteran's claims file and medical records had been reviewed. The Veteran complained of neck pain which he stated began approximately 10 years before. After physical, radiographic, and neurologic testing, the diagnosis was mechanical cervical muscle strain and osteoarthritis of the mid to lower cervical spine. The examiner opined that [c]oncerning his lower neck pain and stiffness, I cannot find any specific reason or mechanism why his neck pains would be specifically due to his lower back. There is just no medical nexus that would support this. He does have osteoarthritic change[s] in the neck, so this is likely the cause of his neck pains. Therefore, I cannot find any reason why his neck pains would be secondary to his lower back, for reasons and bases stated as above. . . . I cannot find any aggravation issues either. The medical evidence of record does not show that the Veteran's currently diagnosed neck, bilateral knee, and bilateral foot disorders are related to military service or to a service-connected disability. The Veteran's service treatment records are negative for any complaints or diagnoses of any neck, knee, and foot disorders. After separation from military service, there is no medical evidence of record that a knee disorder was diagnosed prior to August 2002, 31 years after separation from military service, that a neck disorder was diagnosed prior to December 2004, 33 years after separation from military service, and that a foot disorder was diagnosed prior to December 2007, 36 years after separation from military service. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that VA did not err in denying service connection when the Veteran failed to provide evidence which demonstrated continuity of symptomatology, and failed to account for the lengthy time period for which there is no clinical documentation of his low back condition). In addition, there is no medical evidence of record that relates the Veteran's currently diagnosed neck, bilateral knee, and bilateral foot disorders to military service or to a service-connected disability. The only medical reports of record which provide etiological opinions as to these disabilities are the December 2007 VA feet and joints examination reports and the February 2008 VA spine examination report. These reports concluded that the Veteran's neck, bilateral knee, and bilateral foot disorders were not related to military service and were not aggravated by the Veteran's service-connected lumbosacral strain. The Veteran's statements alone are not sufficient to prove that his currently diagnosed neck, bilateral knee, and bilateral foot disorders are related to military service or to a service-connected disability. Medical diagnosis and causation involve questions that are beyond the range of common experience and common knowledge and require the special knowledge and experience of a trained physician. As he is not a physician, the Veteran's statements are not competent evidence that his currently diagnosed neck, bilateral knee, and bilateral foot disorders are related to military service or to a service-connected disability. Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Accordingly, there is no competent medical evidence of record that relates the Veteran's currently diagnosed neck, bilateral knee, and bilateral foot disorders to military service or to a service-connected disability. As such, service connection for a neck disorder, a bilateral knee disorder, and a bilateral foot disorder is not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as there is no competent medical evidence of record that relates the Veteran's currently diagnosed neck, bilateral knee, and bilateral foot disorders to military service or to a service-connected disability, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Initial Evaluations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4 (2009). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2009). In resolving this factual issue, the Board may only consider the specific factors as are enumerated in the applicable rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2009). Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where an increase in the disability rating is at issue, the present level of the Veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board notes, however, that the rule articulated in Francisco does not apply to the Veteran's lumbosacral strain, radiculopathy symptoms of the bilateral lower extremities, and depressive disorder claims, because the appeal of these issues is based on the assignment of initial evaluations following initial awards of service connection for these disabilities. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Instead, evidence contemporaneous with the claims and the initial rating decisions are most probative of the degree of disability existing when the initial ratings were assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson, 12 Vet. App. at 126. If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial ratings, staged ratings may be assigned for separate periods of time. Id. Lumbosacral Strain Service connection for lumbosacral strain was granted by a September 2007 rating decision and a 20 percent evaluation was assigned under 38 C.F.R. § 4.71a, Diagnostic Code 5237, effective March 28, 2007. In a March 2007 VA outpatient medical report, the Veteran complained of severe back pain. He reported that it was very difficult for him to engage in construction work and he was considering other professions. On physical examination, the Veteran had low back stiffness and discomfort on motion, but with a normal range of motion. The impression was degenerative joint disease and spinal stenosis. In an August 2007 VA outpatient medical report, the Veteran complained of muscle spasm in the lumbar back region. After physical examination, the assessment was that the Veteran's muscle spasms did not have an organic cause. The Veteran was referred for a psychiatric consultation. In an August 2007 VA spine examination report, the Veteran complained of lumbar spine pain for which he took oxycodone daily. The Veteran denied experiencing any bowel or bladder symptoms. He denied fatigue, but reported experiencing decreased motion, stiffness, weakness, and spasms. He reported that he experienced pain in the low back on a daily basis which was moderate in severity and lasted for hours at a time. The Veteran reported experiencing flare-ups on a weekly basis which were severe in nature and lasted for hours at a time. The precipitating factors included bumpy roads, jarring, lifting, and long walks, and the alleviating factor was rest. The Veteran reported experiencing incapacitating episodes of low back pain for approximately 3 days over the previous 12 month period. On physical examination, there was no spasm, atrophy, guarding, or weakness. The Veteran had pain with motion and tenderness of the spine, bilaterally. The Veteran had normal posture, head position, and gait type and the spine was symmetrical in appearance. There was no gibbus, kyphosis, list, lumbar flattening, lumbar lordosis, scoliosis, or reverse lordosis. There were no motor, sensory, or reflex abnormalities noted. On range of motion testing, the Veteran had flexion to 45 degrees, with pain at 40 degrees, extension to 20 degrees, with pain at 10 degrees, and bilateral lateral flexion and rotation to 20 degrees in all movements, with pain at 15 degrees in all movements. There was no additional limitation of motion on repetitive use. The Veteran was not positive for Lasegue's sign. After radiographic and computed tomography examinations, the diagnoses were (1) mild multilevel degenerative changes with facet hypertrophy and marginal osteophytes; mild spinal stenosis at L4-5, and foraminal narrowing on the left at L3-4, and bilaterally at L4-L5 and L5-S1, and (2) lumbosacral strain. The examiner stated that the disability caused minor impairment with chores, bathing, dressing, toileting, and grooming, moderate impairment with traveling, severe impairment with exercise and recreation, and prevented sports. In a September 2007 VA outpatient mental health report, the Veteran complained of back pain. In an October 2007 VA outpatient medical report, the Veteran complains of low back pain and muscle spasms. On physical examination, the Veteran had muscle spasms and decreased flexion of the lower back. A February 2008 VA spine examination report stated that on physical examination, the Veteran had normal posture, head position, and symmetry in appearance. The Veteran's gait was stiff. There was no gibbus, kyphosis, list, lumbar flattening, lumbar lordosis, scoliosis, or reverse lordosis. After muscle and nerve examination, the examiner stated that the Veteran's muscle spasms were "unusual and bizarre," and it was felt that the Veteran should be referred for psychiatric examination. The Veteran's service-connected chronic lower back sprain is rated under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5237. A 20 percent evaluation is warranted 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. A 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237. The medical evidence of record shows that the Veteran's lumbosacral strain is manifested by back pain and limitation of motion to 40 degrees of flexion, 10 degrees of extension, 15 degrees of left lateral flexion, 15 degrees of right lateral flexion, 15 degrees of left rotation, and 15 degrees of right rotation. There is no medical evidence of record that the Veteran's thoracolumbar spine has ever been limited to 30 degrees or less of forward flexion or that it has been ankylosed, either favorably or unfavorably. Furthermore, the Veteran's lumbosacral strain cannot be rated under Diagnostic Code 5243 as the medical evidence of record does not show that the Veteran has a current diagnosis of intervertebral disc syndrome or manifestations thereof. While the Veteran claims to have experienced incapacitating episodes as a result of his lumbosacral strain, there is no medical evidence of record that the Veteran was ever prescribed bed rest by a physician. Accordingly, any such episodes do not qualify as incapacitating episodes for the purposes of Diagnostic Code 5243. See 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2009). The medical evidence of record shows that the Veteran experiences bilateral leg radiculopathy related to his service-connected lumbosacral strain, and the evaluation assigned for that disability is discussed separately below. The Veteran has reported low back pain on use, a contention which is substantiated by the evidence of record. However, the medical evidence of record does not show that this results in additional limited in range of motion due to pain. Pain was taken into account by the limitation of motion described in the August 2007 VA spine examination report. Accordingly, there is no medical evidence of record that the Veteran currently experiences pain which causes additional limitation of motion beyond that contemplated by the assigned evaluation. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2009); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). As such, a rating in excess of 20 percent is not warranted for the Veteran's lumbosacral strain. As this issue deals with the rating assigned following the original claim for service connection, consideration has been given to the question of whether staged ratings would be in order. Fenderson, 12 Vet. App. at 126. However, the evidence of record shows that the symptoms of the Veteran's service-connected lumbosacral strain have remained largely unchanged since the time of his initial evaluation. Accordingly, there is no basis for staged ratings with respect to this claim. Generally, evaluating a disability using either the corresponding or analogous diagnostic codes contained in the Schedule is sufficient. See 38 C.F.R. §§ 4.20, 4.27 (2009). However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual Veteran's circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. In exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b) (2009). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Thun v. Peake, 22 Vet. App. 111, 115 (2008); see also Fisher v. Principi, 4 Vet. App. 57, 60 (1993). Therefore, initially, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability with the established criteria found in the Schedule for that disability. Thun, 22 Vet. App. at 115. If the criteria under the Schedule reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Schedule, and the assigned schedular evaluation is adequate, and no referral is required. See VAOGCPREC 06-96, 61 Fed. Reg. 66749 (1996) (when service- connected disability affects employment "in ways not contemplated by the rating schedule[,]" § 3.321(b)(1) is applicable). The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render his disabilities rating for lumbosacral strain inadequate. The Veteran's lumbosacral strain was evaluated under to 38 C.F.R. § 4.71a, Diagnostic Code 5237, the criteria of which is found by the Board to specifically contemplate the Veteran's level of disability and symptomatology. As noted above, the Veteran's lumbosacral strain is manifested by back pain and limitation of motion to 40 degrees of flexion, 10 degrees of extension, 15 degrees of left lateral flexion, 15 degrees of right lateral flexion, 15 degrees of left rotation, and 15 degrees of right rotation. When comparing this disability picture with the symptoms contemplated by the Schedule, the Board finds that the Veteran's symptoms are more than adequately contemplated by the disabilities rating for his lumbosacral strain. A rating in excess of the currently assigned rating is provided for certain manifestations of back disorder, but the medical evidence reflects that those manifestations are not present in this case. The criteria for a 20 percent rating for the Veteran's lumbosacral strain more than reasonably describe the Veteran's disability level and symptomatology and, therefore, the currently assigned schedular evaluation is adequate and no referral is required. See VAOGCPREC 06-96, 61 Fed. Reg. 66749 (1996); see also 38 C.F.R. § 4.71a, Diagnostic Code 5237. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as the medical evidence of record does not show findings that meet the criteria for a rating in excess of 20 percent, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); see also Massey, 7 Vet. App. at 208. Radiculopathy Symptoms of the Bilateral Lower Extremities Service connection for radiculopathy symptoms of the bilateral lower extremities with bilateral buttock pain (muscle group XVII) as a result of the Veteran's service-connected lumbosacral strain was granted by a March 2008 rating decision and a noncompensable evaluation was assigned under 38 C.F.R. § 4.73, Diagnostic Code 5317-8520, effective March 28, 2007. In the selection of code numbers assigned to disabilities, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With injuries and diseases, preference is to be given to the number assigned to the injury or disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. 38 C.F.R. § 4.27 (2009). The hyphenated diagnostic code in this case indicates that impairment of muscle group XVII, under Diagnostic Code 5317, was the service-connected disorder, and paralysis of the sciatic nerve, under Diagnostic Code 8520, was a residual condition. In a March 2007 VA outpatient medical report, the Veteran complained of pain radiating down both legs which had improved over time. In an August 2007 VA spine examination report, the Veteran complained of back pain. On physical examination, no lower extremity abnormalities were noted on motor, sensory, or reflex examination. In an August 2007 VA outpatient medical report, the Veteran complained of muscle spasms in the legs. After physical examination, the assessment was that the Veteran's muscle spasms did not have an organic cause. The Veteran was referred for a psychiatric consultation. In an August 2007 VA outpatient neurological report, the Veteran complained of muscle spasms in the legs. On physical examination, no lower extremity abnormalities were noted in muscle strength, tone, movement, or atrophy. Sensation to touch, pinprick, vibration, and proprioception was normal, bilaterally. The Veteran had abnormal bilateral knee reflexes. The examiner stated that the Veteran's abnormal reflexes "seem voluntary" and were "difficult to be explained by any organic neurological cause." In an October 2007 VA outpatient medical report, the Veteran complained of low back pain, which radiated to both legs. In a February 2008 VA muscles examination report, the Veteran complained of buttock and leg pain. On physical examination, no lower extremity abnormalities were noted. The diagnosis was radiculopathy symptoms, both legs, likely due to back disease. The examiner stated that the disability caused moderate impairment with chores, shopping, recreation, and traveling, and prevented exercise and sports. The Schedule provides that assignment of a 10 percent evaluation is warranted for incomplete paralysis of the sciatic nerve to a mild degree. A 20 percent evaluation is warranted for incomplete paralysis of the sciatic nerve to a moderate degree. A 40 percent rating is warranted for incomplete paralysis of the sciatic nerve to a moderately- severe degree. A 60 percent rating is warranted for incomplete paralysis of the sciatic nerve to a severe degree with marked muscular atrophy. 38 C.F.R. § 4.124a, Diagnostic Code 8520. With respect to diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis for a particular nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. When the involvement is bilateral, the ratings should be combined with application of the bilateral factor. 38 C.F.R. § 4.124a. The medical evidence shows that the Veteran's radiculopathy symptoms of the bilateral lower extremities are manifested by bilateral leg pain without objective findings. The medical evidence of record shows that the Veteran's lower extremity radiculopathy is wholly sensory in nature, as manifested by bilateral leg and buttock pain. In addition, while the Veteran has repeatedly complained of this pain, no lower extremity sensory abnormalities have ever been noted on physical or neurological examinations. Without objective findings of sensory impairment, the Veteran's lower extremity radiculopathy cannot be described as anything other than mild in severity. Accordingly, an initial 10 percent evaluation for the right leg and an initial 10 percent evaluation for the left leg due to neurological symptoms of the Veteran's lumbosacral strain are warranted under Diagnostic Code 8520. In addition, as the Veteran's disabilities impact both of his legs, application of the bilateral factor is warranted. 38 C.F.R. § 4.26 (2009) As this issue deals with the rating assigned following the original claim for service connection, consideration has been given to the question of whether staged ratings would be in order. Fenderson, 12 Vet. App. at 126. However, the evidence of record shows that the symptoms of the Veteran's service-connected lower extremity radiculopathy have remained largely unchanged since the time of his initial evaluation. Accordingly, there is no basis for staged ratings with respect to this claim. The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render the disability ratings for radiculopathy symptoms of the bilateral lower extremities inadequate. The Veteran's radiculopathy symptoms of each lower extremity were evaluated under to 38 C.F.R. § 4.124a, Diagnostic Code 8520, the criteria of which is found by the Board to specifically contemplate the Veteran's level of disability and symptomatology. As noted above, the Veteran's radiculopathy symptoms of the bilateral lower extremities are manifested by bilateral leg pain without objective findings. When comparing this disability picture with the symptoms contemplated by the Schedule, the Board finds that the Veteran's symptoms are more than adequately contemplated by the disability ratings for radiculopathy symptoms of the right and left lower extremities. A rating in excess of the currently assigned rating is provided for certain manifestations of nerve disorders, but the medical evidence reflects that those manifestations are not present in this case. The criteria for a 10 percent rating for the Veteran's radiculopathy symptoms of each lower extremity more than reasonably describe the disability level and symptomatology and, therefore, the currently assigned schedular evaluation is adequate and no referral is required. See VAOGCPREC 06- 96, 61 Fed. Reg. 66749 (1996); see also 38 C.F.R. § 4.124a, Diagnostic Code 8520. Accordingly, an initial evaluation of 10 percent, but no more, for radiculopathy symptoms of the right lower extremity and an initial evaluation of 10 percent, but no more, for radiculopathy symptoms of the left lower extremity is warranted. However, as the preponderance of the evidence is against the claim of entitlement to an initial evaluation in excess of 10 percent for radiculopathy symptoms of each lower extremity, the doctrine is not for application. Gilbert, 1 Vet. App. at 54; see also Massey, 7 Vet. App. at 208. Depressive Disorder Service connection for a depressive disorder was granted by a March 2008 rating decision and a 10 percent evaluation was assigned under 38 C.F.R. § 4.130, Diagnostic Code 9434, effective November 13, 2007. In an August 2003 VA outpatient medical report, the Veteran complained of feeling stress, depression, and panic attacks. On examination, the Veteran was extremely anxious. The impression was anxiety/depression. In an August 2004 VA outpatient medical report, the Veteran reported that he had a religious experience earlier in the year and was no longer depressed or anxious. After examination, the impression was anxiety/depression, resolved. In an August 2006 VA outpatient psychiatry note, the Veteran denied experiencing a depressed mood. He reported frustration over financial issues and anxiety about disabilities. The Veteran reported suicidal ideation, but stated that he would never act on it. He reported sleep impairment and nightmares, but denied psychotic symptoms and homicidal ideation. The report stated that the Veteran lived with his wife and owned his own business. On mental status examination, the Veteran appeared fairly well groomed and appeared his stated age. He had shoulder tics and cried during the examination. The Veteran's attitude was cooperative and his speech was fluent, with some stuttering. His mood was "fine," and his affect was constricted. The Veteran's thought process was linear and he denied suicidal ideation, homicidal ideation, delusions, audio hallucinations, and visual hallucinations. His concentration was intact and he was oriented to time, place, person, and object. The Veteran's insight and judgment were poor. The Axis I diagnosis was posttraumatic stress disorder (PTSD), anxiety disorder not otherwise specified, and rule out major depressive disorder. The examiner assigned a Global Assessment of Functioning (GAF) score of 60, which contemplates moderate symptoms, such as flat affect, circumstantial speech, or occasional panic attacks, or moderate difficulty in social, occupational, or school functioning, such as few friends and conflicts with peers or co-workers. See QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM THE DSM-IV, 46-47 (1994). An August 2007 VA outpatient PTSD report stated that on objective examination, the Veteran was casually attired, hyperverbal, and significantly over-inclusive in his details. The Veteran's thought process was goal directed and there were no signs of response to internal stimuli. The Veteran denied suicidal or homicidal ideation. The diagnosis was mood disorder due to medical condition. A January 2008 VA mental disorders examination report stated that the Veteran's claims file and medical records had been reviewed. The Veteran reported that he had been married to his wife for 18 years and had 2 children and 5 grandchildren. He reported that his relationships with his wife and children were good. The Veteran reported that due to the location of his home, his neighbors "are blocks away" and his only friends were in his church. He reported that he was a Deacon with a former congregation and was waiting to be nominated as a Deacon with his current congregation. The Veteran reported that he attended church every week and had only missed attending 2 to 3 times over the previous 4 years. He reported having "a ton" of hobbies and interests but that he couldn't do them anymore. These included motorcycle riding, owning a welding shop, fixing antique clocks, collecting music boxes, and collecting antique swords. He reported that he owned a motorhome and went to a lake for 2 to 3 days at a time. The Veteran denied suicide attempts, but reported that he had assaulted his first wife once when she had tried to wake him up. The Veteran denied alcohol or other substance use problems. On psychiatric examination, the Veteran was clean, neatly groomed, and casually dressed. The Veteran had psychomotor activity in the form of a jerking tic. His speech was unremarkable and spontaneous. The Veteran appeared to accentuate the negative, minimize the positive, and made himself look more pathological than would be the case for someone in a similar circumstance. His affect was bland and his mood was depressed. The Veteran's attention and orientation to person, time, and place were intact. His thought process was evasive and his thought content was unremarkable. The Veteran did not have any delusions, understood the outcome of behavior, and had insight into his problems. The Veteran had sleep impairment, but denied hallucinations and did not have inappropriate behavior. The Veteran interpreted proverbs appropriately and did not have obsessive or ritualistic behavior or panic attacks. There was no suicidal or homicidal ideation and he had good impulse control. The Veteran was able to maintain minimal personal hygiene, had no problems with activities of daily living, and his memory was normal. The Axis I diagnosis was depressive disorder due to a general medical condition. The examiner assigned a GAF of 70, which contemplates some mild symptoms, such as depressed mood and mild insomnia, or some difficulty in social, occupational, or school functioning, such as occasional truancy, or theft within the household, but generally functioning pretty well, with some meaningful interpersonal relationships. Id. The examiner specifically listed the criteria listed in the General Rating Formula for Mental Disorders and indicated that the Veteran met the criteria listed for a 10 percent evaluation, but did not meet the criteria for 30 percent, 50 percent, 70 percent, and 100 percent evaluations. The report specifically stated that the Veteran's psychiatric disorder "is such that there would be a mild decrease in work efficiency and ability to perform occupational tasks only during periods of significant stress." The Schedule provides that assignment of a 10 percent evaluation is warranted for mental disorders with occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent evaluation is warranted for mental disorders with 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, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9434. The medical evidence of record does not support an initial evaluation in excess of 10 percent for a depressive disorder. The medical evidence of record shows that the Veteran's depressive disorder is manifested by sleep impairment, nightmares, a constricted affect, depressed mood, and psychomotor activity. In addition, there is no medical evidence that the Veteran's depressive disorder has anything other than a mild impact on occupational and social activities. The Veteran reported having a good relationship with his family and had friends in his church group. While the Veteran was not friends with his neighbors, this was reported to be due to distance between houses, not a psychiatric disorder. In addition, while the evidence of record shows that the Veteran is unemployed and does not participate in many of his former hobbies, the medical evidence of records shows that these changes are due to his physical disabilities, not his depressive disorder. Indeed, the general picture created by the medical evidence of record is one of a well-adjusted individual that has little to no psychiatric impairment in occupational and social functioning and whose predominant psychiatric manifestations are depression and pessimism as a result of limitations imposed on his life due to his physical disabilities. The examiner who wrote the January 2008 VA mental disorders examination report also reported that the Veteran met the criteria for a 10 percent evaluation under the General Rating Formula for Mental Disorders, but not the criteria for a higher rating. As such, an initial evaluation in excess of 10 percent for a depressive disorder is not warranted. As this issue deals with the rating assigned following the original claim for service connection, consideration has been given to the question of whether staged ratings would be in order. Fenderson, 12 Vet. App. at 126. However, the evidence of record shows that the symptoms of the Veteran's service-connected depressive disorder have remained largely unchanged since the time of his initial evaluation. Accordingly, there is no basis for staged ratings with respect to this claim. The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render his disabilities rating for a depressive disorder inadequate. The Veteran's depressive disorder was evaluated under to 38 C.F.R. § 4.130, Diagnostic Code 9434, the criteria of which is found by the Board to specifically contemplate the Veteran's level of disability and symptomatology. As noted above, the Veteran's depressive disorder is manifested by sleep impairment, nightmares, a constricted affect, depressed mood, and psychomotor activity. When comparing this disability picture with the symptoms contemplated by the Schedule, the Board finds that the Veteran's symptoms are more than adequately contemplated by the disabilities rating for his depressive disorder. A rating in excess of the currently assigned rating is provided for certain manifestations of psychiatric disorders, but the medical evidence reflects that those manifestations are not present in this case. The criteria for a 10 percent rating for the Veteran's depressive disorder more than reasonably describe the Veteran's disability level and symptomatology and, therefore, the currently assigned schedular evaluation is adequate and no referral is required. See VAOGCPREC 06-96, 61 Fed. Reg. 66749 (1996); see also 38 C.F.R. § 4.130, Diagnostic Code 9434. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as the medical evidence of record does not show findings that meet the criteria for a rating in excess of 10 percent, the doctrine is not for application. Gilbert, 1 Vet. App. 49; see also Massey, 7 Vet. App. at 208. ORDER Service connection for a neck disorder is denied. Service connection for a bilateral knee disorder is denied. Service connection for a bilateral foot disorder is denied. An initial evaluation in excess of 20 percent for lumbosacral strain is denied. An initial disability evaluation of 10 percent, but no more, for radiculopathy symptoms of the right lower extremity is granted, subject to the laws and regulations governing the payment of monetary benefits. An initial disability evaluation of 10 percent, but no more, for radiculopathy symptoms of the left lower extremities is granted, subject to the laws and regulations governing the payment of monetary benefits. An initial evaluation in excess of 10 percent for a depressive disorder is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs