Citation Nr: 1305080 Decision Date: 02/12/13 Archive Date: 02/21/13 DOCKET NO. 10-27 616A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to a schedular rating in excess of 10 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, prior to February 27, 2009. 2. Entitlement to a schedular rating in excess of 20 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, for the period from February 27, 2009, through January 6, 2010. 3. Entitlement to a schedular rating in excess of 30 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, from January 7, 2010. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James R. Siegel, Counsel INTRODUCTION The Veteran served on active duty from April 1982 to September 1984, and from October 2004 to January 2006. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). By rating action dated March 2009, the RO confirmed the 10 percent evaluation in effect for the Veteran's service-connected cervical spine disability. In a rating decision dated June 2010, the RO assigned a 20 percent evaluation for his neck disorder, effective February 27, 2009. Thereafter, the RO assigned a 30 percent evaluation for small disc bulge of the cervical spine, effective January 7, 2010. The Board points out that a temporary total rating under the provisions of 38 C.F.R. § 4.30 (2012) was assigned for various periods during the course of the Veteran's claim. This determination only addresses the schedular evaluations in effect during the pendency of the Veteran's claim. In a December 2012 statement, the Veteran's representative waived RO consideration of medical records added to the Virtual VA paperless claim processing system after the most recent supplemental statement of the case. The issue of entitlement to an increased rating for ulnar neuropathy of each hand has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. Prior to February 27, 2009, the Veteran's cervical spine disability was manifested by slight limitation of motion without evidence of painful motion. 2. From February 27, 2009, through January 6, 2010, the Veteran's cervical spine disc disease was manifested by limitation of motion and pain. 3. The Veteran's disability of the cervical spine is manifested by painful motion, without evidence of ankylosis. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, prior to February 27, 2009, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5242, 5243 (2012). 2. The criteria for a rating in excess of 20 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, for the period from February 27, 2009, through January 6, 2010, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5242, 5243 (2012). 3. The criteria for a rating in excess of 30 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, from January 7, 2010, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5242, 5243 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Notice and Assistance VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). See also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). In an increased rating claim, VA must notify the Veteran to submit evidence showing (1) a worsening or increase in severity of the disability and (2) the effect that worsening has on the claimant's employment. Vazquez-Flores v. Shinseki, 24 Vet. App. 94 (2010). The duties to notify and assist were met in this case. Notice was provided in letters dated May and November 2008. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the appellant. Specifically, the information and evidence that have been associated with the claims file include private and VA medical records, VA examination reports, Social Security Administration records, and the testimony of the Veteran at a hearing before the undersigned Veterans Law Judge. VA clinical examinations with respect to the current claim have been obtained. 38 C.F.R. § 3.159(c) (4). The Board finds that the VA clinical examinations obtained in this case are more than adequate, as they are predicated on a full reading of the medical records in the Veteran's claims file. As appropriate, clinical findings pertinent to the schedular criteria for rating the disability at issue were obtained. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c) (4). Analysis The Board has reviewed all the evidence in the appellant's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board acknowledges that a claimant may experience multiple degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40 (2009); see also 38 C.F.R. §§ 4.45, 4.59 (2009). Under the General Formula, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, unfavorable ankylosis of the entire cervical spine warrants a 40 percent evaluation. Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine warrants a 30 percent evaluation. Forward flexion greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 warrants a 20 percent evaluation. Forward flexion greater than 30 degrees but not greater than 40 degrees; or, the combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasms, 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 warrants a 10 percent evaluation. Any associated objective neurologic abnormalities including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. For VA compensation purposes, normal forward flexion of the cervical spine is 0 to 45 degrees; extension is 0 to 45 degrees; left and right lateral flexion are 0 to 45 degrees; and left and right lateral rotation are 0 to 80 degrees. See Plate V. 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 combined range of motion range of motion of the cervical spine is 340 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, General Rating Formula, Note (2). A 60 percent evaluation may be assigned for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months, a 40 percent evaluation may be assigned. With incapacitating episodes having a total duration of at leasdt 2 weeks but less than 4 weeks during the past 12 months, a 20 percent evaluation may be assigned. With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months, a 10 percent evaluation may be assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5243. 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. Id. at Note 1. As indicated above, service connection has been established for ulnar neuropathy of each upper extremity. This determination is limited to the claim for an increased rating for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7. Private medical records disclose the Veteran underwent surgery on his neck in January 2008. He had a history of chronic back pain and radicular left arm pain. The operation report indicates that previous studies showed cervical spondylosis and degenerative bulging discs at C5-6 and C6-7. A C-6 and C6-7 anterior microdiscectomy with bilateral foraminotomies and C5-8 and C6-7 anterior body fusion was performed. The diagnoses were neck pain and cervical radiculopathy secondary to cervical degenerative disc disease. The Veteran was seen in a private facility in December 2008. An examination revealed normal palpation of the neck, but he had limited range of motion with neck extension. Flexion appeared to be adequate. Rotation was limited to about 30 degrees, bilaterally. The Veteran was afforded a VA examination in December 2008. He reported constant burning at the base of his neck, and this was exacerbated by driving or extending his left arm forward or above his head. There was no paravertebral tenderness or spasms on examination. The Veteran complained of discomfort with deep palpation at the base of the cervical spine. He demonstrated exaggerated lordosis of the cervical spine. Flexion and extension were to 48 degrees, lateral flexion was to 40 degrees, bilaterally, and rotation was to 70 degrees, bilaterally. After repetitive exercise, flexion was to 40 degrees, extension was to 60 degrees, lateral flexion was to 40 degrees, bilaterally, and rotation was to 80 degrees on the right and to 64 degrees on the left. No neurological abnormalities were found. No painful motion, spasms, weakness and/or tenderness were found, except as noted. It was reported the Veteran had not experienced incapacitating episodes in the preceding 12 months. The diagnosis was C5-6 and C6-7 anterior microdiscectomy and anterior body fusion. Private medical records disclose the Veteran was seen in March 2008 and it was noted he was doing reasonably well from his neck. He had some burning pain in the mid thoracic region. The examiner stated the Veteran could return to light duty work. The Veteran described stabbing pain at the base of his neck going to the left trapezius area in December 2008. This was aggravated when he turned his head to the left. The Veteran was neurologically intact on examination. The Veteran reported radicular pain in the left trapezius and supra scapula area in January 2009. He stated he had some neck pain at the base of his neck. The examiner noted the Veteran's symptoms were in a C8 dermatome, and additional studies were recommended. Additional private medical records reveal the Veteran was seen on February 27, 2009. An examination disclosed flexion of the cervical spine was to 30 degrees and extension was to 20 degrees. Lateral side bending was diminished bilaterally. Spurling's sign gave the Veteran "radiating going into the C8 dermatome on the left." It was noted a repeat cervical myelogram was essentially unremarkable. The Veteran was seen at another private facility in March 2009 and an examination demonstrated he had significant myofascial tenderness and pain over the left trapezius region, approximately near the rhomboid. VA outpatient treatment records disclose the Veteran reported in March 2009 that he had pain that seemed to radiate from his neck to his left scapular area. In September 2009, he stated he continued to have stiffness in his neck. An examination revealed restriction of flexion, extension and rotation. When seen at a private facility in December 2009, the Veteran complained of a stinging, burning sensation at the base of his skull to the upper part of his back. It was noted he used a cervical collar. The examiner stated that if the Veteran truly could not stand his neck pain, he recommended additional surgery. The Veteran was afforded a VA examination on January 7, 2010. He related he was scheduled to have surgery on his cervical spine two days later. He reported constant burning in his neck, with shooting pain to the left shoulder and left shoulder blade. An examination showed tenderness at C7-T1, but no other paravertebral tenderness or spasm. Flexion was to 25 degrees; extension was to 50 degrees; lateral flexion was to 0 degrees to the right and to 30 degrees to the left; and rotation was to 50 degrees to the right and to 60 degrees to the left. After repetitive exercise, flexion was to 10 degrees; extension was to 40 degrees; lateral flexion was to 10 degrees to the right and to 20 degrees to the left; and rotation was to 25 degrees to the right and to 40 degrees to the left. No neurological abnormalities were found. There was no objective evidence of painful motion, spasms, weakness, tenderness, atrophy or guarding. It was indicated the Veteran had not had any incapacitating episodes in the previous 12 months. The diagnosis was status post anterior cervical discectomy and fusion at C5-6 and C6-7. The Veteran underwent a left C5-6 and C6-7 laminotomy and foraminotomy and bilateral internal fixation and fusion at a private facility later in January 2010. The clinical history noted he had had previous cervical spine surgery, but persisted with chronic neck pain, particularly to the left trapezius. The postoperative diagnosis was pseudoarthrosis at C5-6 and C6-7 with residual left-sided radiculopathy. Private medical records associated with a Social Security Administration determination reflect treatment for neck symptoms from 2008 to 2010. In December 2008, it was noted that the Veteran had normal palpation of the neck, but limited range of motion with extension of the neck. The following month, he reported his symptoms included stabbing and burning on the left side of his neck to the shoulder blade. The pain was rated as 8/10 consistently, with flares to 10/10. He stated he was doing pretty well in February 2010, and said he only had a little bit of neck soreness. On VA examination in May 2010, the Veteran denied symptoms of stiffness, fatigue, spasms, weakness, decreased motion, numbness and paresthesias. It was asserted there had been no incapacitating episodes in the previous 12 months. He reported flare-ups were 7-8/10, and lasted only a few minutes. He stated he had to really watch the movements of his neck. An examination revealed the musculature of his neck and upper back was normal. There was tenderness on palpation, but no spasms were noted. Forward flexion was to 28 degrees; extension was to 30 degrees; lateral flexion was to 10 degrees bilaterally; and rotation was to 40 degrees on the left and to 44 degrees on the right. There was pain with all movements. The examiner indicated the Veteran declined to do repetitive movements, stating it would start a terrible headache. No muscle atrophy was noted. Strength was 4/5, and sensation was normal, except involving a scar. No other painful motion, spasms, weakness and/or tenderness was found. The examiner added there would be change in active or passive range of motion during repeat testing against resistance, with most likely an additional 10 percent loss in range of motion would be expected due to painful motion, weakness, impaired endurance, fatigue, flare-ups or incoordination. The Veteran was again examined by the VA in October 2010. He denied any impairment in the activities of daily living, except he needed assistance with bathing because he could not reach backwards. He also needed assistance for any clothing that he needed to pull over his head. On examination, no spasms were appreciated. There was tenderness to palpation of the paraspinal muscles of the cervical spine, worse on the left than right. Flexion was decreased from 0 to 35 degrees times three with pain at 20 degrees; extension was decreased from 0 to 30 degrees, with pain at 25 degrees; lateral flexion was decreased from 0 to 25 degrees, bilaterally, with pain at onset at 0 degrees; rotation was decreased from 0 to 50 degrees, bilaterally, with pain at 40 degrees on the left and at 35 degrees on the right. The diagnosis was degenerative disc disease of the cervical spine with bilateral intermittent radiculopathy and decreased range of motion. When examined by the VA in December 2011, the Veteran described his daily pain as 6/10, with flares to 8-9/10. Forward flexion of the cervical spine was to 40 degrees, with pain at 30 degrees; extension was to 30 degrees, with pain at 25 degrees; lateral flexion was to 35 degrees, bilaterally, with pain at 30 degrees, bilaterally; rotation was to 50 degrees, bilaterally, with pain at 30 degrees, bilaterally. The Veteran was able to perform three repetitions, with no additional limitation in the range of motion of the cervical spine. It was also indicated he had pain on movement after repetitive use. There was no guarding or muscle spasm of the cervical spine. The examiner stated the Veteran had not experienced any incapacitating episodes in the preceding 12 months due to his cervical spine disability. She also stated the Veteran was not able to quickly look up or down and that he had limited range of motion of the neck. VA outpatient treatment records in Virtual VA show the Veteran was seen for complaints involving neck pain from 2010 to 2012. In December 2011, he described mostly left-sided neck pain that traveled to his shoulder blade. No weakness was reported. The Veteran had limited range of motion. The Board will initially address whether a rating in excess of 10 percent is warranted prior to February 27, 2009. As noted above, the December 2008 VA examination reflects the Veteran had limitation of motion of the cervical spine. Forward flexion was to 48 degrees, and the combined range of motion was 316 degrees. After repetition, flexion was reduced to 40 degrees, and the combined range of motion was greater than 170 degrees. There was no tenderness or spasms. These findings support the 10 percent evaluation that has been assigned. The next matter is whether a rating in excess of 20 percent is warranted for the period from February 27, 2009, through January 6, 2010. The 20 percent evaluation was assigned based on the findings recorded when the Veteran was seen at a private facility on February 27, 2009. That examination disclosed the Veteran had flexion to 30 degrees, and there were findings suggestive of involvement of the C8 dermatome on the left. The Board notes that the remaining medical records during this period, while indicating the Veteran has limitation of motion, do not show the specific range of motion of the Veteran's cervical spine. The VA examination conducted on January 7, 2010 establishes forward flexion of the cervical spine was to 25 degrees, with additional limitation of motion following repetitive testing; flexion to 10 degrees. Thus, the RO assigned a 30 percent evaluation for the Veteran's cervical spine disorder from that date. Prior to this examination, the findings did not support a rating in excess of 20 percent for degenerative disc disease of the cervical spine as there was no evidence of forward flexion to 15 degrees or less. Finally, the Veteran asserts a rating in excess of 30 percent is warranted from January 7, 2010. As noted above, in order to assign a higher rating for the cervical spine based on range of motion, the evidence must show unfavorable ankylosis of the entire cervical spine. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's [Illustrated Medical Dictionary], at 86 [(27th ed. 1988]). Coyalong v. West, 12 Vet. App. 524, 528 (1999). The Board observes that all medical findings of record establish the Veteran has some range of motion of the cervical spine. Thus, a determination that he has ankylosis is precluded. The Board has also considered whether a higher rating is warranted for each period on appeal under Diagnostic Code 5243. Although the Veteran claims he experiences incapacitating episodes, by regulation, bed rest must be prescribed by a physician. Such has not been demonstrated in this case. The Board points out that the examinations of December 2008, January 2010, and December 2011 specifically indicate he had not had any such episodes. Contrary to his current allegations, the October 2010 VA examination reveals the Veteran specifically denied having had bed rest prescribed by a doctor. Thus, there is no basis on which a higher rating may be assigned under Diagnostic Code 5243. The Board has considered whether factors including functional impairment and pain as addressed under 38 C.F.R. §§ 4.10, 4.40 and 4.45 would warrant a higher rating for the Veteran's cervical spine disability. See Spurgeon v. Brown, 10 Vet. App. 194 (1997); and DeLuca v. Brown, 8, Vet. App. 202 (1995). The Board acknowledges that the December 2008 and January 2010 VA examinations reveal some additional limitation of motion of the cervical spine following exercise and the Board has considered those findings. During the May 2010 VA examination, the Veteran refused to perform repetitive testing, and the examiner estimated he would have additional limitation of motion due to pain, the Board finds that any pain the Veteran experiences is contemplated in the evaluations that have been assigned. The Board concedes the Veteran is competent to report symptoms he experiences, such as pain, and the Board finds him to be credible in this regard. However, the Veteran is not competent to provide an opinion requiring medical knowledge, or a clinical examination by a medical professional, such as an opinion addressing the severity of those symptoms or whether a service-connected disability satisfies specific rating criteria. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007) (noting, in a footnote, that sometimes a layperson will be competent to identify the condition where the condition is simple, for example, a broken leg, and sometimes not, for example a form of cancer). As a result, his assertions cannot constitute competent medical evidence that his cervical spine disability has increased in severity, so as to warrant a higher rating during any period on appeal. As such, the Board concludes that the medical findings on examination are of greater probative value than the Veteran's allegations regarding the severity of degenerative disc disease of the cervical spine. Accordingly, the Board finds the preponderance of the evidence is against the claims for a schedular rating in excess of 10 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7 prior to February 27, 2009; a rating in excess of 20 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, for the period from February 27, 2009, through January 6, 2010; and a rating in excess of 30 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, from January 7, 2010. Finally, the Board has considered whether extraschedular consideration is warranted. The discussion above reflects that the symptoms of the Veteran's cervical spine disability (mainly pain, tenderness and limitation of motion) are contemplated by the applicable rating criteria. The effects of pain and functional impairment have been taken into account and are considered in applying the relevant criteria in the rating schedule. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. 202. The effects of the Veteran's disability have been fully considered and are contemplated in the rating schedule; hence, referral for an extraschedular rating is unnecessary at this time. Consideration of whether the Veteran's disability picture exhibits other related factors such as those provided by the regulations as "governing norms" is not required and referral for an extraschedular rating is unnecessary. Thun v. Peake, 22 Vet. App. 111 (2008). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Total Rating for Compensation Based on Individual Unemployability (TDIU) TDIU is an element of all appeals of an initial rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). Entitlement to TDIU is raised where a Veteran : (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability. Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). In an April 2012 rating decision, TDIU was granted based on consideration of the Veteran's service-connected cervical and lumbar spine disabilities. The grant was effective April 1, 2009, the date he first met the schedular requirements. The Veteran has not argued, and the record does not otherwise reflect, that his service-connected cervical spine disability rendered him totally unemployable prior to that date. Accordingly, consideration of TDIU prior to April 1, 2009, is not before the Board. ORDER A schedular rating in excess of 10 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, prior to February 27, 2009, is denied. A schedular evaluation in excess of 20 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, for the period from February 27, 2009, through January 6, 2010, is denied. A schedular rating in excess of 30 percent for small disc bulge and disc protrusion of the cervical spine, C5-6 and C6-7, from January 7, 2010, is denied. ____________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs