Citation Nr: 1306263 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 10-01 694 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a right foot disorder. 2. Entitlement to an initial rating in excess of 10 percent for lumbar strain. 3. Entitlement to an initial compensable rating for left meralgia paresthetica, as due to lumbar strain. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESSES AT HEARING ON APPEAL Veteran and D.E. ATTORNEY FOR THE BOARD J. Connolly, Counsel INTRODUCTION The Veteran served on active duty from April 1974 to April 1977. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, in which the RO granted service connection and assigned an initial noncompensable (0 percent) rating for lumbar strain with left meralgia paresthetica, effective January 17, 2008. The RO also denied service connection for a bilateral foot condition. In November 2011, the Veteran testified before the undersigned Veterans Law Judge during a videoconference hearing. A transcript of that hearing is of record. In February 2012, the Board remanded this case. At that time, the Board noted that although, in his January 2008 claim for service connection, the Veteran indicated that he was seeking service connection for a condition of his bilateral feet; during a June 2008 VA examination to evaluate his claimed disability of the feet, the Veteran clarified that he was only seeking service connection for his right foot, as he had no complaints regarding his left foot. In his March 2009 notice of disagreement (NOD), the Veteran stated that, as regards his bilateral foot condition, the claim should have read "foot condition" and went on to discuss his claimed right foot disability. Further, during his November 2011 hearing, the Veteran again clarified that he was only seeking service connection for a right foot disorder, as he had no problems with his left foot. Accordingly, the Board recharacterized this issue on appeal as being service connection for a right foot disability, only. In an October 2012 rating decision, the RO granted separate service connection for left meralgia paresthetica which was assigned a non-compensable rating effective January 17, 2008, as well as a higher 10 percent rating for lumbar strain, also from January 17, 2008. The Board notes that the United States Court of Appeals for Veterans Claims (the Court) has held that a rating decision issued subsequent to a notice of disagreement which grants less than the maximum available rating does not "abrogate the pending appeal." AB v. Brown, 6 Vet. App. 35, 38 (1993). Consequently, the matter of a higher rating for lumbar strain remains in appellate status. In addition, since the Veteran initially appealed the rating assigned for both lumbar strain and left meralgia which were originally rated together, the matter of a higher rating for both disabilities remains under appeal. FINDINGS OF FACT 1. The Veteran does not have a right foot disorder which is attributable to service. 2. Prior to June 11, 2012, the Veteran's low back disability did not result in forward flexion of the thoracolumbar spine which was greater than 30 degrees, but not greater than 60 degrees; combined range of motion of the thoracolumbar spine was greater than 120 degrees but not greater than 235 degrees; muscle spasm or guarding was not severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; and there is no intervertebral disc syndrome with associated neurological impairment such as bowel or bladder impairment. 3. As of June 11, 2012, the Veteran's low back disability resulted in painful flexion at 25 degrees, but did not cause unfavorable ankylosis; or intervertebral disc syndrome with associated neurological impairment such as bowel or bladder impairment. 4. During the entire appeal period, the Veteran's left meralgia paresthetica resulted in mild to moderate, but not severe impairment. CONCLUSIONS OF LAW 1. A right foot disorder was not incurred or aggravated in active service. 38 U.S.C.A. §§ 1101, 1110, 1131 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.304, 3.306 (2012). 2. Prior to June 11, 2012, the criteria for a rating in excess of 10 percent for lumbar sprain, are not met. 38 U.S.C.A § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.1-4.16, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5237 (2012). 3. From June 11, 2012, the criteria for a 40 percent rating, but no more, for lumbar sprain, are met. 38 U.S.C.A §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.1-4.16, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5237 (2012). 4. The criteria for a compensable rating for left meralgia paresthetica are not met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.3, 4.31, 4.124, 4.124, 4.124a, Diagnostic Code 8729 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) 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; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the Veteran and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim, including apprising him or her of the information and evidence he or she is responsible for providing versus the information and evidence VA will obtain for him or her. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). These notice requirements apply to all five elements of a service-connection claim: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). So this notice must include information that a "downstream" disability rating and an effective date for the award of benefits will be assigned if service connection is granted. Id., at 486. Ideally, this notice should be provided prior to an initial unfavorable decision on a claim by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II). If, however, for whatever reason it was not, or the notice provided was inadequate, this timing error can be effectively "cured" by providing any necessary notice and then readjudicating the claim - including in a statement of the case (SOC) or supplemental SOC (SSOC), such that the intended purpose of the notice is not frustrated and the Veteran is given an opportunity to participate effectively in the adjudication of the claim. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Mayfield IV); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U.S. Supreme Court has made clear that VCAA notice errors are not presumptively prejudicial, rather, must be determined on a case-by-case basis, and that, as the pleading party attacking the agency's decision, the Veteran, not VA, bears this burden of proof of establishing there is a VCAA notice error and, moreover, above and beyond this, that the error is unduly prejudicial, meaning outcome determinative of the claim. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of the claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir., 2004). VCAA letters were sent in February 2008 and June 2012. The Veteran was informed of the type of evidence and information needed to substantiate the claims and apprised the Veteran of the Veteran's and VA's respective responsibilities in obtaining this supporting evidence. The February 2008 letter also notified the Veteran that a "downstream" disability rating and an effective date for the award of benefits would be assigned if service connection was granted, in compliance with Dingess. With regards to the claim for a higher initial rating for low back and left meralgia disabilities, the Veteran is challenging the initial evaluations assigned following the granting of service connection for this disability. In Dingess the Court held that in cases, as here, where service connection has been granted and an initial disability rating and effective date assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose the notice is intended to serve has been fulfilled. Id., at 490-91. Thereafter, once a notice of disagreement (NOD) has been filed contesting a "downstream" issue such as the initial rating assigned for the disability, the notice requirements of 38 U.S.C. §§ 5104 and 7105 regarding a rating decision and SOC control as to the further communications with the appellant, including as to what evidence is necessary to establish a more favorable decision with respect to the downstream element of the claim. See Goodwin v. Peake, 22 Vet. App. 128 (2008). Here, in the NOD, the Veteran took issue with the initial disability rating assigned to both disabilities, and it is presumed he is seeking the highest possible rating or maximum benefits available under the law. Id.; see also AB. Therefore, VA complied with the procedural statutory requirements of 38 U.S.C.A. §§ 5104(b) and 7105(d), as well as the regulatory requirements in 38 C.F.R. § 3.103(b). See also Dunlap v. Nicholson, 21 Vet. App. 112 (2007) and VAOPGCPREC 8-2003 (Dec. 22, 2003). The Veteran has been afforded a hearing before a Veterans Law Judge (VLJ) in which he presented oral argument in support of his claim. Here, during the hearing, the VLJ asked specific questions directed at identifying whether the Veteran had symptoms meeting the schedular criteria for a higher rating as well as for service connection. The Veteran also volunteered his treatment history and his pertinent symptoms. The hearing focused on the elements necessary to substantiate the claims, and the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claims. Regarding the duty to assist, VA also satisfied this obligation in terms of obtaining all potentially relevant evidence concerning these claims. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Veteran's service treatment records (STRs), VA medical treatment records, and identified private medical records were obtained, to the extent available. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. There is no indication that any additional evidence, relevant to these claims, is available and not part of the claims file. The Veteran also was provided VA compensation examinations, including for medical nexus opinions concerning the etiology of the claimed right foot disorder and its potential relationship with military service, as the Board directed when remanding these claims in February 2012. 38 U.S.C.A. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4). See also McLendon v. Nicholson, 20 Vet. App. 79 (2006). The medical opinions obtained are responsive to the determinative issues at hand, so additional examinations and opinions are not needed. 38 C.F.R. § 4.2. See also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that once VA undertakes the effort to provide an examination for a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (VA's duty to assist includes providing an adequate examination when such an examination is indicated). As regarding the higher rating matters, the Veteran additionally was examined to assess the severity of the low back and left lower extremity disabilities. See Caffrey v. Brown, 6 Vet. App. 377 (1994); Olsen v. Principi, 3 Vet. App. 480, 482 (1992); Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992); and Allday v. Brown, 7 Vet. App. 517, 526 (1995). The examinations of record are adequate to address all pertinent concerns, as the claims file was reviewed for the relevant medical and other history, the Veteran examined, the findings reported in sufficient detail, and there was discussion of the underlying medical rationale, which is where most of the probative value of an opinion is derived. See Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The VA examination reports are thorough and supported by the record. The records taken as a whole satisfy 38 C.F.R. § 3.326. Furthermore, in obtaining this additional medical comment, the Board is satisfied there was compliance with this remand directive. See Stegall v. West, 11 Vet. App. 268 (1998) (indicating the Veteran is entitled, as a matter of law, to compliance with a remand directive and that the Board, itself, commits error in failing to ensure this compliance). See also Dyment v. West, 13 Vet. App. 141, 146-47 (1999); and D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (discussing situations when it is acceptable to have "substantial", though not "exact", compliance with a remand directive). In summary, the Board finds that "it is difficult to discern what additional guidance VA could have provided to the Veteran regarding what further evidence he should submit to substantiate his claims." See Livesay v. Principi, 15 Vet. App. 165, 178 (2001) (en banc) (observing that "the VCAA is a reason to remand many, many claims, but it is not an excuse to remand all claims."); Reyes v. Brown, 7 Vet. App. 113, 116 (1994); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (both observing circumstances as to when a remand would not result in any significant benefit to the Veteran). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.304, 30306. Establishing entitlement to direct service connection generally requires: (1) competent and credible evidence confirming the Veteran has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. In addition, arthritis will be presumed to have been incurred in or aggravated by service if it had become manifest to a degree of 10 percent or more within one year of a veteran's separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may be established either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Other diseases initially diagnosed after service also may be service connected if the evidence, including that pertinent to service, shows the diseases were incurred in service. 38 C.F.R. § 3.303(d). If however chronicity (permanency) of disease or injury in service is not shown, or legitimately questionable, then a showing of continuity of symptomatology following service is required to support the claim. 38 C.F.R. § 3.303(b). See also Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). Under § 3.303(b), an alternative method of establishing the second and third Shedden/Caluza elements is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Savage v. Gober, 10 Vet. App. 494-97 (1997); Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet. App. at 495-96; see Hickson, 12 Vet. App. At 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection). To establish a showing of chronic disease in service, or within a presumptive period per § 3.307, a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic," is required. 38 C.F.R. § 3.303(b). Subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. Id. In-service notation of a condition does not require medical evidence where "the condition is of a type as to which a lay person's observation is competent." Savage, 10 Vet. App. at 497. However, although prong (3) does not require medical nexus evidence, "because it would not necessarily follow that there is a relationship between any present disability and the continuity of symptomatology demonstrated, medical evidence is required to demonstrate such a relationship unless such a relationship is one as to which a lay person's observation is competent." Id (citations omitted). A layperson is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff'd sub nom. Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied, 119 S. Ct. 404 (1998). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran's present condition (e.g., whether the Veteran's present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). Savage, 10 Vet. App. 488, 494-97. When, for example, a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C.A. § 1154(a). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). As held in Davidson, section 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. See also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence" such as actual treatment records). The Veteran is competent to report the Veteran can observe and feel through the senses. See Layno. When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage, 10 Vet. App. at 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether the evidence also is credible, as only then does it ultimately have probative value. See Layno (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")); Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, whereas credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons or bases for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). To this end, the Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court), citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the Court similarly has declared that, in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing when he/she has testified. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza, aff'd per curiam, 78 F.3d 604(Fed. Cir. 1996). See, too, Macarubbo v. Gober, 10 Vet. App. 388 (1997) (similarly holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). The determination as to whether these requirements for service connection are met is based on an analysis of all the relevant evidence of record, medical and lay, and the evaluation of its competency and credibility to determine its ultimate probative value in relation to other evidence. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Reasonable doubt concerning any matter material to the determination is resolved in the Veteran's favor. 38 U.S.C.A. § 5107 (b); 38 C.F.R. § 3.102. In written correspondence and at his Board hearing, the Veteran asserted that he began having blisters on his feet during service due to his boots rubbing against his feet. He reported that he has had problems with his right foot due to calluses/blisters since that time. The STRS revealed that the Veteran was having lower leg pain and that x-rays showed a small transverse line of increased density in the medullary area. The impression was compression stress of the tibia with ostitis. No abnormality specific to the feet was identified. In another notation, it was further noted that the Veteran complained of having arch pain in April 1976. It was noted that the Veteran had been lacing his boots too tightly. A foot series x-ray was performed to rule out flat feet. A July 1976 x-rays to determine if the Veteran had flat feet were negative. In August 1976, the Veteran reported having arch and lower leg pain. The impression was probable arch strain and posterior tibialis strain and cramps. The February 1977 discharge examination reflected that the Veteran reported having foot trouble, but the physical examination revealed only normal findings pertaining to the feet. Post-service, private medical records reflected treatment for his right foot. In April 1997, the Veteran was treated for an ingrown toenail on his right foot. In August 1999, the Veteran was seen for calluses and corns of his right foot. It was noted that the Veteran had corns beneath his 4th metatarsal as well as proximal phalanx of the great toe. He also had a very large callus between the second and third metatarsal heads. In March 2000, the Veteran was seen for a verruca of the right fourth toe. Private records further noted that in May 2002, the Veteran had an ingrown toenail as well as hallux nails, bilaterally, not infected. He also had a significantly painful hyperkeratosis of the second metacarpophalangeal joint of the right foot. VA records showed that in January 2005 showed a painful callus of the 4th metatarsal head which was debrided. In June 2007, it was noted that the Veteran had a callus on the bottom of his right foot. In December 2007, he was noted to have a callus and ingrown toenail of the right foot. In March 2008, the Veteran reported having painful calluses on the right foot. He said that he had had calluses since he was in the Army. In June 2008, the Veteran was afforded a VA examination. At that time, the Veteran stated that he was only claiming service connection for his right foot and he had no complaints with regard to the left foot. The Veteran complained of right foot metatarsalgia and gave a history of hyperkeratosis, which both he and a private physician had resected in the past. It was noted that the Veteran walked on the lateral borders of his right foot to prevent pressure over his metatarsals. A heavy, tender, rounded, raised, hyperkeratotic lesion of the head of the second metatarsal of the right foot was noted. There was no pes planus. The examiner indicated that the Veteran complained once during service of having pain on his arches and calf. During military duties with military boots, x-rays were ordered to "rule out" flat feet. No diagnosis of flat feet was given. The Veteran was advised to use shoe inserts. There were no complaints of right metatarsalgia. The Veteran's present metatarsalgia of the right foot, secondary to hyperkeratotic lesion at the head of the second metatarsal, was not related to pain on the arches and calves during service. In February 2012, the Board remanded this case for additional development, including procuring records and obtaining a VA examination. The Board noted that the Veteran reported that he had a right foot callus/blister since service and he was competent to make this type of assessment. See Charles v. Principi, 16 Vet. App. 370 (2002). The Board recognized that the June 2008 VA examination examiner did not consider or address the Veteran's report of a continuity of symptomatology. Moreover, the examiner did not provide any rationale for his opinion that the Veteran's present metatarsalgia of the right foot, secondary to a hyperkeratotic lesion at the head of the second metatarsal head, was not related to pain on his arches and calves in service. Therefore, with regard to the examination, an opinion was requested as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current right foot disorder was incurred or aggravated as a result of active service. The examiner was asked to specifically consider and address the Veteran's reports of having a callus/blister of the right foot since service. In June 2012, another VA examination was performed. The Veteran's inservice history of a callus during service was noted. Currently, the examiner indicated that the Veteran did not have Morton's neuroma, metatarsalgia, hammertoes, hallux valgus, hallux rigidus, claw foot, malunion or nonunion of tarsal or metatarsal bones, weak foot, or scarring. The Veteran reported having foot pain, but he could not let it affect his work because he needed to pay his bills. The current diagnoses were callus of the right foot located between the first and second toe, measuring approximately 1 centimeter, as well as hyperkeratosis. The examiner cited to a definition of callus which essentially indicated that the callus was the result of repeated friction or pressure, as well as a definition of hyperkeratosis, which the examiner noted was similar. The examiner cited to the Veteran's past diagnoses of callus/corn/hyperkeratosis conditions. The examiner opined that the Veteran's ongoing callus was most likely due to foot wear as each examination showed a different location due to different areas of friction. As already explained, competent lay evidence may establish the presence of observable symptomatology and, in certain circumstances, it may provide a basis for establishing service connection. See Barr. Although claimants may be competent to provide the diagnoses of simple conditions, such as a broken leg, they are not competent to provide evidence on more complex medical questions beyond simple observations. Jandreau; see Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia aggravated his diabetes and hypertension was not of sufficient weight to trigger the Secretary's duty to seek a medical opinion on the issue). Indeed, even if lay testimony is competent, should VA find it to be mistaken or lacking credibility, the Board may reject it as unpersuasive and, thus, not ultimately probative. Buchanan; see also Rucker and Layno. The Board may find a lack of credibility in, for example, conflicting medical statements or witness biases. Buchanan at 1337. The lack of contemporaneous medical evidence is also relevant; however, the mere lack of such evidence may not constitute the sole basis for discrediting the lay evidence. Id. The Veteran is competent in this case to report his symptoms regarding calluses/corns of the right foot, but nothing in the record demonstrated that he has received any special training or acquired any medical expertise in evaluating and determining causal connections for the claimed conditions. Therefore, a medical expert opinion is more probative regarding the causation question in this case. King v. Shinseki, No. 2011-7159 (Fed. Cir. Dec. 5, 2012). The Board finds that the most recent VA examination report is particularly probative. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez. The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ( "[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In this case, the June 2012 examiner was aware of the Veteran's medical history, provided a fully articulated opinion, and also furnished a reasoned analysis. He essentially indicated that the Veteran has calluses, corns, hyperkeratosis lesions because of friction from his footwear. However, these skin problems have historically occurred in different places on his right foot. Thus, he felt that while the Veteran has ongoing callus problems, this was most likely due to his footwear issue, and was less likely due to service. He noted that the STRs did not document any right foot callus or similar foot problem, but he also acknowledged the Veteran's report of right foot callus since 1974. In sum, the Veteran is competent to state that he has had calluses, corns, of hyperkeratotic lesions on his right foot since service. However, the evidence shows that this has been an ongoing problem due to foot wear, but not a chronic disease process that was due to service. Each callus, corn, or lesion, essentially, is a separately diagnosed condition, rather than a chronic condition, due to wear from his shoes. The VA examiner clearly attributed his currently diagnosed right foot callus and hyperkeratosis condition to his current footwear, and not to service. The Board therefore attaches significant probative value to this opinion, and the most probative value in this case, as it is well reasoned, detailed, consistent with other evidence of record, and included an access to the accurate background of the Veteran. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). This medical opinion, by a medical professional who examined the Veteran, is simply more probative than the Veteran's statements on their own. Accordingly, service connection for a right foot disorder is not warranted. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The preponderance is against the Veteran's claim, and it must be denied. Higher Ratings In written correspondence and at his Board hearing, the Veteran asserted that his low back felt tight, sore, and stuff. He stated that he was taking pain medication. He reported that after work, he would return home and could not do much. His friend stated that he observed the Veteran not being able to do much because he could not get up because of his back and that he was referred to as the "old man." Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Before proceeding with its analysis of the Veteran's claim, the Board finds that some discussion of Fenderson v. West, 12 Vet. App 119 (1999) is warranted. In that case, the Court emphasized the distinction between a new claim for an increased evaluation of a service-connected disability and a case (such as this one) in which a veteran expresses dissatisfaction with the assignment of an initial disability evaluation where the disability in question has just been recognized as service-connected. VA must assess the level of disability from the date of initial application for service connection and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim-a practice known as "staged rating." See also Hart v. Mansfield, 21 Vet. App. 505 (2007). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. However, the evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C.A. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, if a veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Recently, the Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board notes that the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Board further notes that the provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45, should only be considered in conjunction with the Diagnostic Codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). The Board observes that the Court has stated that when rating spine disabilities, the Board must discuss any additional limitation of motion that a Veteran has due to pain, weakness, or fatigue. See Cullen v. Shinseki, 24 Vet. App. 74, 85 (2010). Under the General Rating Formula as applicable to the Veteran's back disability, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or there is 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 requires forward flexion of the thoracolumbar spine limited to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. These ratings are warranted if the above-mentioned manifestations are present, 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. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. The rating criteria under the General Formula for Diseases and Injuries of the Spine also, in pertinent part, provide the following Notes: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, 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 combined normal range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of the spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. Note (3) states that in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors note the result of the disease or injury of the spine, the range of motion of the spine in particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4) indicates that each range of motion measurement should be rounded to the nearest 5. Note (5) provides that for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one of more of the following: difficulty walking because of the limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6) provides that VA should separately evaluate disability of the thoracolumbar and cervical spine segments, except whether there is unfavorable ankylosis of both segments, which will be rated as a single disability. Under the criteria governing disabilities of the lumbar spine, 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. This formula provides a rating of 20 percent for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent rating for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a (2010). An incapacitating episode is defined as 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. See 38 C.F.R. § 4.71a, Note (1). The Veteran has been afforded three VA examinations. In June 2008, the Veteran was afforded the first of the three VA examinations. The Veteran described having pain across the lumbar area which radiated to his left thigh, anterolaterally, as tingling or numbing, when he stood up too long. The Veteran reported that the pain intensity was 8/10 on a scale of 1-10 with 10 being worse. The Veteran denied having flare-ups, but indicated that the pain was worse with standing and subsided when he would sit down. There were no associated bladder, bowel, or erectile dysfunction issues. He was able to walk unaided. The Veteran was employed as a security officer. The low back disability did not affect his work or daily living activities, but he could not play sports. Range of motion testing revealed forward flexion to 90 degrees, extension to 30 degrees, left and right lateral flexion both to 30 degrees, and left and right lateral rotation both to 30 degrees. Pain was not shown. Repeated testing did not decrease motion or function. There was no ankylosis. There were no spasms or guarding. Lumbar lordosis was preserved. There were no postural abnormalities. Motor strength was normal, reflexes were normal, Lasegue's sign was negative, and there were no vertebral fractures. With regard to neurological involvement, intervertebral disc disease was not diagnosed. There was a slight decrease to touch sensation with paresthesia of the left thigh. The diagnoses were lumbar strain and left meralgia paresthetica. The examiner indicated that the low back disorder was related to service. In February 2010, the Veteran was afforded another examination by the same VA examiner. He described having pain across the lumbar area since service as well as meralgia paresthetica over the left thigh, anterolaterally, for the past 5-8 years. The Veteran reported that the pain intensity was 8/10 on a scale of 1-10 with 10 being worse. The Veteran denied having flare-ups, but rather indicated that the pain was constant. There were no associated bladder, bowel, or erectile dysfunction issues. He was able to walk unaided. The Veteran was employed as a security officer and did not lose time from work due to his disability. There was also no effect on his usual daily activities. There was mild tenderness over the lumbar areas, but there were no spasms or guarding. Lumbar lordosis was preserved. Posture was normal. Range of motion testing revealed forward flexion to 90 degrees, extension to 30 degrees, left and right lateral flexion both to 30 degrees, and left and right lateral rotation both to 30 degrees. Pain was noted at the end of forward flexion. Repeated testing did not decrease motion or function. There was no ankylosis. Motor strength was normal, reflexes were normal, Lasegue's sign was negative, and there were no vertebral fractures. With regard to neurological involvement, intervertebral disc disease was not diagnosed. There was subjective tingling of the left thigh anterolaterally. In addition, there were other neurological problems related to diabetes. X-rays revealed degenerative changes at L5-S1. The diagnoses were low back strain, underlying early degenerative joint disease at L5-S1 as well as meralgia paresthetica, which this examiner did not feel was related to the low back. In June 2012, the Veteran was afforded the third VA examination. At that time, range of motion testing revealed flexion to 90 degrees with pain at 25 degrees; extension to 30 degrees with no pain; right and left lateral flexion to 30 degrees with pain at 10 degrees each; and right and left lateral rotation to 30 degrees with pain at 15 degrees each. The Veteran was able to perform repetitive testing and there were no additional limitations or loss of function after the repetitive testing. The Veteran did not have any localized tenderness or pain to palpation. His overall strength was 5/5. There was no muscle atrophy. Reflexes were 2+ in the knees and ankles. Sensory examination was normal in the upper anterior thighs, lower thighs and knees, foot/toes, and strength leg raising was normal. The Veteran did not have any radicular pain or other signs of symptoms due to radiculopathy. No nerve roots were involved. The examiner stated that the Veteran did not have intervertebral disc syndrome. The Veteran regularly used a walker. The Veteran's function was not so diminished that an amputation with prosthesis would serve equally well. The Veteran had no scarring. The Veteran had no vertebral fractures, but did have arthritis. Degenerative disc disease was shown by x-ray at L5-S1; also, osteoarthritis changes were shown. The Veteran reported that he could not let his disability affect his work. The examiner indicated that left meralgia was not found on the current examination. The examiner felt that the Veteran's range of motion was normal; however, he had symptoms of pain on motion, as indicated. Thereafter, private electromyography (EMG) results were received which were abnormal with regard to the tibial nerve. The report indicated that the distal amplitude was reduced. All other findings were normal. The impression notation indicated that it did not evaluate the anterior thigh or femoral nerve. Sciatic neuropathy was noted to be a possibility, but the examiner stated that the peroneal nerve was more likely to cause sciatic neuropathy than the distal nerve. This report, however, was dated November 18, 2003, prior to when service connection was established. As such, although the Board considers this evidence when viewing the Veteran's disability in an historical context, the current findings are more pertinent to the current nature of his disability and the level of severity. Under the criteria for range of motion, the Veteran does not meet the criteria for a higher rating based on his range of motion prior to June 11, 2012, the date of his last VA examination. The two prior examinations do not reflect forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine being 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. The Veteran has significantly greater motion of his spine; in fact, the range of motion criteria for a 10 percent rating were not even met, even considering DeLuca and subsequent Court directives, including those set forth in Cullen . In addition, there were no muscle spasms or postural deformities. However, on the most recent VA examination, dated June 11, 2012, the examiner indicated that the Veteran had pain on forward flexion at 25 degrees. Although the examiner indicated that the Veteran otherwise had normal motion, the Board is required to consider at what point pain, as well as other factors, limit movement. The examiner reported that this point was 25 degrees. A 40 percent rating requires forward flexion of the thoracolumbar spine limited to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Since the Veteran has movement to only 25 degrees when pain starts, the Board finds that, in light of DeLuca and Cullen, and in resolving all reasonable doubt in the Veteran's favor, that his disability warrants a 40 percent rating under the general schedule for evaluating spine disorders. A higher rating is not warranted since the Veteran does not have unfavorable ankylosis of the spine. A rating pursuant to the criteria for intervertebral disc syndrome is not for application at any time since the VA examination reports uniformly reported that the Veteran does not have intervertebral disc syndrome. The Veteran also does not have bowel, bladder, or other associated neurological impairment, other than the nerve issue addressed below. With regard to the Veteran's service-connected left meralgia paresthetica, the Veteran has been assigned a noncompensable rating under Diagnostic Code8729. Neuralgia of the external cutaneous nerve of the thigh is rated under Diagnostic Code 8729. Under Diagnostic Code 8729, a disability rating of zero percent is assignable for incomplete paralysis which is mild to moderate and a disability rating of 10 percent is assignable for incomplete paralysis which is severe to complete (complete paralysis) in degree. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When involvement is wholly sensory, the rating should be for mild, or at most, moderate degree. See Note preceding Code 8510. 38 C.F.R. § 4.124a. In this case, the Veteran has reported subjective findings of tingling as well as a slight decrease to touch sensation. The most recent examiner indicated that the Veteran did not have any current symptoms. Under the applicable code, incomplete paralysis which is mild to moderate warrants a noncompensable finding. Only severe symptoms warrant a 10 percent, compensable rating. The findings on the examinations do not reveal severe impairment. As such, a higher rating is not warranted at any time. In determining whether a higher rating is warranted for service-connected disability, VA must determine whether the evidence supports the Veteran's claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107(a); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, a preponderance of the evidence is against a rating in excess of 10 percent for lumbar strain prior to June 11, 2012, but the evidence supports a 40 percent rating as of June 11, 2012. Also, a preponderance of the evidence is against a compensable rating for left meralgia paresthetica at any time during the appeal period. In considering the claims for higher ratings, the Board also has considered whether the Veteran is entitled to a greater level of compensation on an extra-schedular basis. Ordinarily, the VA Schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). In a recent case, the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. See Thun v. Peake, 22 Vet. App. 111 (2008). First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the C&P Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extraschedular rating. The symptoms associated with the Veteran's low back and left lower extremity impairment are not shown to cause any impairment that is not already contemplated by the relevant diagnostic codes, as cited above, and the Board finds that the rating criteria reasonably describe his disabilities. The Veteran has not been hospitalized and reports that he does not let his disabilities affect his work. Therefore, referral for consideration of an extraschedular rating is not warranted. ORDER Service connection for a right foot disorder is denied. Prior to June 11, 2012, a rating in excess of 10 percent for lumbar sprain is denied. From June 11, 2012, a 40 percent rating for lumbar sprain, is granted, subject to the law and regulations governing the payment of monetary benefits. A compensable rating for left meralgia paresthetica is denied. ____________________________________________ K. PARAKKAL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs