Citation Nr: 1317962 Decision Date: 06/03/13 Archive Date: 06/11/13 DOCKET NO. 07-17 117 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to an evaluation in excess of 20 percent for service-connected lumbosacral strain. 2. Entitlement to an evaluation in excess of 10 percent for service-connected post arthroscopic surgery of the right knee with mild degenerative changes. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD T. Hal Smith, Counsel INTRODUCTION The Veteran served on active duty from April 1981 to March 1990. These matters are before the Board of Veterans' Appeals (Board) on appeal from an April 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. In January 2011, the Board remanded the claim for additional evidentiary development, and it has now been returned for further appellate consideration. The following determinations are based on review of the Veteran's claims file in addition to his Virtual VA "eFolder." FINDINGS OF FACT 1. The Veteran's lumbar spine is manifested by range of motion (ROM) to include flexion to 70 degrees with pain; there was tender to palpation over the paraspinal musculature diffusely. He was sensate to light touch from L2 to S2 dermatomes and had 1+ patellar tendon reflexes. 2. The Veteran has exhibited mild incomplete paralysis of the sciatic nerve of the lower extremities; moderate or severe incomplete paralysis, or complete paralysis has not been demonstrated. 3. The Veteran's right knee is manifested by ROM from 0 degrees of extension to flexion of 120 degrees with pain from 100 to 120 degrees. There was stable varus and valgus stress at 0 and 30 degrees. X-ray examination of the knee revealed right knee patellofemoral arthritis. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for lumbosacral strain have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237 (2012). 2. Resolving all doubt in the Veteran's favor, the criteria for a separate 10 percent disability evaluation for associated incomplete paralysis of the sciatic nerves of the lower extremities is met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.27, 4.40, 4.124a, DC 8520 (2012). 3. The criteria for an evaluation in excess of 10 percent for status post arthroscopic surgery of the right knee with mild degenerative changes have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.71a, DCs 5010, 5257, 5260, 5261 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented at 38 C.F.R. § 3.159, amended VA's duties to notify and assist a claimant in developing the information and evidence necessary to substantiate a claim. First, VA has a duty under the VCAA to notify a claimant and any designated representative of the information and evidence needed to substantiate a claim. In this regard, letters to the Veteran from the RO (to include letters in August 2005, September 2005, November 2005, and February 2011) specifically notified him of the substance of the VCAA, including the type of evidence necessary to establish entitlement to service connection on a direct and presumptive basis, and of the division of responsibility between the Veteran and the VA for obtaining that evidence. Consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), VA essentially satisfied the notification requirements of the VCAA by way of these letters by: (1) informing the Veteran about the information and evidence not of record that was necessary to substantiate his claims; (2) informing the Veteran about the information and evidence VA would seek to provide; and (3) informing the Veteran about the information and evidence he was expected to provide. The United States Court of Appeals for Veterans Claims (Court) held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, to specifically include that a disability rating and an effective date will be assigned if service connection is awarded. Dingess v. Nicholson, 19 Vet. App. 473 (2006). In the present appeal, the Veteran was provided with notice of this information in letters dated in the February 2011 letter mentioned above. Second, VA has made reasonable efforts to assist the Veteran in obtaining evidence necessary to substantiate his claims. 38 U.S.C.A. § 5103A (West 2002 & Supp. 2012). The information and evidence associated with the claims file consist of his service treatment records (STRs), VA medical treatment records, private post-service medical treatment records, VA examinations, and statements from the Veteran and his representative. There is no indication that there is any additional relevant evidence to be obtained by either VA or the Veteran. In January 2011, the Board remanded these matters to the RO directing that additional treatment records be requested and that a contemporaneous examination be conducted to determine the severity of the Veteran's low back and right knee disabilities. Additional records were added to the file and a VA examination was conducted in February 2011. A March 2011 addendum was added to the exam. Accordingly, the directives of the board's January 2011 remand have been accomplished. See Stegall v. West, 11 Vet. App. 268 (1998). Moreover, the Board finds the examination report to be thorough and consistent with contemporaneous medical records. The examination in this case is adequate upon which to base a decision with regards to these claims. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (defining adequacy with respect to medical examinations and opinions as those providing sufficient detail so that the Board can perform a fully informed evaluation of the claim). Overall, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. Increased Ratings - In General Disability evaluations are based upon the average impairment of earning capacity as determined by a schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. Part 4 (2012). Separate rating codes identify the various disabilities. 38 C.F.R. Part 4. In determining the current level of impairment, the disability must be considered in the context of the whole-recorded history, including STRs. 38 C.F.R. §§ 4.2, 4.41 (2012). The determination of whether an increased evaluation is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). An evaluation of the level of disability present also includes consideration of the functional impairment of the veteran's ability to engage in ordinary activities, including employment, and the effect of pain on the functional abilities. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59 (2012); DeLuca v. Brown, 8 Vet. App. 202, 204-06 (1995). Under the laws administered by VA, the Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.3 (2012). Historical Background as to the Lumbar Spine and Right Knee In the Board's January 2011 remand, summarization of pertinent records on file at that time was provided in regards to the lumbar spine and right knee. This summarization included detailed description of 2006 treatment records and VA examination in April 2007. For purposes of efficiency, the Board will not repeat those findings here, but they have been reviewed and considered in this decision. Additional VA treatment records were added to the file subsequent to the Board's January 2011 remand decision. These records, dated through 2012, reflect continued treatment for the low back and right knee condition. When examined by VA in February 2011, the Veteran reported that his back pain had worsened over the years. His pain increased with activity and sometimes he felt radiating pain and tingling down his left buttock and down into his calf. He felt weak from time to time and stated that he could only walk 15 minutes or 50 feet. He described flare-ups that were worse than usual with walking and standing. He had had physical therapy and injections. His back problems affected his ability to work as a prison counselor because he was unable to run for fire drills and use stairs. He had been on bedrest and on medication for bowel or bladder dysfunction. On examination, the lumbar spine was tender to palpation over the paraspinal musculature diffusely. His active ROM was to 70 degrees of forward flexion with pain. He could extend 15 degrees with pain, and could laterally bend and laterally deviate 20 degrees with pain. After repetitive ROM, neither his pain nor ROM was changed. He had 5/5 strength in his hip flexors, quadriceps, hamstrings, and tibialis anterior. He was sensate to light touch from L2 to S2 dermatomes. He had a negative straight leg test. He had 1+ patellar tendon reflexes. X-rays of the lumbar spine were normal. (The Board notes that previous X-rays of the lumbar spine in 2007 were unremarkable, but in 2005, they showed minor osteophytes at the T12 location, and there were small marginal osteophytes at L4.) Regarding his right knee, the Veteran said that ever since his anterior cruciate ligament (ACL) reconstruction surgery, he had had anterior knee pain. It was worse when he walked up and down stairs, or when he kept his knee bent in a flexed position. The pain was described as 10 out of 10. He did use a cane which helped him minimally. He was limited in walking to less than 15 minutes or a 1/4 mile. He described flare-ups that were worse than usual with climbing and standing. He had had physical therapy injections, and medications, all without relief. He said that this affected his daily activities by limiting his ability to run and stand. On exam, his skin was intact. His right knee incision was well-healed. His active ROM was from 0 degrees of extension to flexion of 120 degrees with pain from 100 to 120 degrees. After repetitive ROM, neither his pain nor ROM was changed. He had a negative Lachman, negative posterior drawer sign, and negative McMurry. He was stable varus and valgus stress at 0 and 30 degrees. X-rays showed patellofemoral arthritis. Lumbar Spine Service connection has been established for lumbosacral strain. The RO has evaluated the Veteran's disability under DC 5237 as 20 percent disabling based on painful or limited motion of the lumbar spine. 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 2. Currently, spinal disabilities are primarily evaluated under a general rating formula. Under the formula, a 10 percent evaluation is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235; or, muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is assigned for forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Higher evaluations are assigned for unfavorable ankylosis of the entire spine, or the entire thoracolumbar spine, which are not relevant to the Veteran's claim. 38 C.F.R. § 4.71a, DCs 5235-5243 (2012). Alternatively, intervertebral disc syndrome is evaluated (preoperatively or postoperatively) either on the basis of incapacitating episodes over the past 12 months, or under the general rating formula (which provides the criteria for rating orthopedic disability, and authorizes separate evaluations of its chronic orthopedic and neurologic manifestations), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25 (2012). A 10 percent rating is warranted for incapacitating episodes having a total duration of at least one week, but less than two weeks, during the past 12 months. A 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks, but less than four weeks, during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks, but less than six weeks, during the past 12 months. A maximum, 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, DC 5243 (2012). The notes following revised DC 5243 define an incapacitating episode 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. "Chronic orthopedic and neurologic manifestations" means orthopedic and neurologic signs and symptoms resulting from intervertebral disc syndrome that are present constantly, or nearly so. The notes following DC 5243 further provide that, when evaluating on the basis of chronic manifestations, VA should evaluate orthopedic disabilities using evaluation criteria for the most appropriate orthopedic diagnostic code or codes; and evaluate neurologic disabilities separately using evaluation criteria for the most appropriate neurological diagnostic code or codes. Where intervertebral disc syndrome is present in more than one spinal segment, and provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurological manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003 (2012). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate DCs, a rating of 10 percent is for application for each major joint or groups of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. In general, the rating criteria take into account pain and other symptoms. In the case of spine disabilities, pain is often the primary factor limiting motion and is almost always present when there is muscle spasm. Therefore, an evaluation based on pain alone would not be appropriate, unless there is specific nerve root pain, for example, that could be evaluated under the neurological sections of the rating schedule. Schedule for Rating Disabilities; The Spine, 68 Fed. Reg. 51,454 (Aug. 27, 2003) (See 38 C.F.R. § 4.71a, DCs 5235-5243) (2012). Based on the evidence of record, a rating in excess of 20 percent is not warranted for the Veteran's lumbosacral strain pursuant to DC 5237. 38 C.F.R. § 4.71a, General Rating Formula. At no point during the pendency of this claim does the evidence of record demonstrate forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. As noted above, the 2011 examination revealed forward flexion to 70 degrees. Moreover, the combined ROM exhibited on the exam was greater than 120 degrees. The Board also notes that while private magnetic resonance imaging (MRI) in 2006 showed disc herniation at L2 and L3 and degenerative changes at L5-S1, subsequently dated X-rays have not shown degenerative changes. Still, the Board further notes that there is no record of doctor-prescribed bed rest. Thus, the evidence does not show incapacitating episodes. Hence, there is no basis for a disability evaluation in excess of 20 percent for the Veteran's low back disability pursuant to intervertebral disc regulations. DC 5003, 5252, 5243 (2012). As such, the Board finds that a rating in excess of 20 percent for the Veteran's service-connected lumbar strain is not warranted under the General Rating Formula. Id. In making this determination, the Board has considered whether there was any additional functional loss not contemplated in the 20 percent evaluation for the Veteran's orthopedic manifestations of his service-connected lumbar strain. See38 C.F.R. §§ 4.40, 4.49 (2012); see DeLuca, supra. Next, in rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120 (2012). Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123 (2012). DC 8520 provides the rating criteria for paralysis of the sciatic nerve, and therefore neuritis and neuralgia of that nerve. Complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Disability ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis which is mild, moderate or moderately severe in degree, respectively. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. 38 C.F.R. § 4.124a, DC 8520. DC 8620 refers to neuritis of the sciatic nerve, and DC 8720 refers to neuralgia of the sciatic nerve. In this case, the Board finds that the Veteran is entitled to a separate 10 percent rating for mild incomplete paralysis of the sciatic nerve of the lower extremities. In so determining, it is noted that at the time of the 2011 examination, the Veteran was sensate to light touch from L2 to S2 dermatomes and he had 1+ patellar tendon reflexes. Moreover, he reported radiating pain and tingling into the lower extremities. Therefore, because the Veteran suffers from radiating neurological symptoms in the lower extremities and that condition has been medically linked to the low back disability, the Board finds that a separate 10 percent rating for neurological manifestations of the lower back disability in the lower extremities is warranted. However, the Board finds that a rating higher than 10 percent is not warranted in the lower extremities because the Veteran's symptoms have been predominately sensory in nature, with no evidence of muscle atrophy and no evidence of loss of reflexes or sensory disturbances more than mild in degree. Moreover, the neurological symptoms have not been described as constant, but instead occur on flare-up. Right Knee Service connection is in effect for post arthroscopic surgery of the right knee with mild degenerative changes. During the appeal process, a temporary total rating was assigned based on convalescence for ACL surgery performed in March 2006. Following a period of convalescence the disability rating was returned to 10 percent which had been in effect since service connection was initially granted upon rating decision in 2003. This rating was assigned pursuant to DC 5010-5257. Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27 (2012). DC 5010 is used in rating traumatic arthritis. 38 C.F.R. § 4.71a, DC 5010 (2012). Traumatic arthritis is to be rated as degenerative arthritis under DC 5003, which in turn, states that the severity of degenerative arthritis, established by x-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. 38 C.F.R. § 4.71a, DC 5003 (2012). When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. Id. A noncompensable evaluation is contemplated for knee flexion limited to 60 degrees. 38 C.F.R. § 4.71a, DC 5260 (2012). A 10 percent disability evaluation is assigned when flexion of the knee is limited to 45 degrees, and a 20 percent disability evaluation is warranted when flexion is limited to 30 degrees. Id. A 30 percent disability evaluation is assigned when knee flexion is limited to 15 degrees, which is the maximum evaluation available under DC 5260. Id. A noncompensable evaluation is assigned for knee extension limited to 5 degrees, and a 10 percent disability evaluation is contemplated for extension limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5261 (2012). When there is limitation of extension of the knee to 15 degrees, a 20 percent disability evaluation is warranted. Id. A 30 percent rating will be assigned for knee extension limited to 20 degrees, and a 40 percent rating is contemplated for limitation of extension to 30 degrees. Id. A 50 percent disability evaluation is warranted for extension of the knee limited to 45 degrees. Id. A separate rating for limitation of extension and for limitation of flexion may be assigned. VAOPGCPREC 9-2004; see also VAOPGCPREC 23-97; 62 Fed. Reg. 63604 (1997) (arthritis and instability of the knee may be rated separately under DCs 5003 and 5257, provided that any separate rating is based upon additional disability); VAOPGCPREC 9-98; 63 Fed. Reg. 56704 (1998) (if a Veteran has a disability rating under DC 5257 for instability of the knee, and there is x-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59). In this case, the Veteran's right knee exhibits a ROM consisting of flexion to 120 degrees and extension to 0 degrees. The Veteran has reported complaints of pain, inability to use stairs and difficulty with walking and standing. Objectively, the Veteran's right knee exhibited pain on motion, but after repetitive ROM there was no change in pain or ROM. The 2011 X-ray examination of the knee confirmed patellofemoral arthritis. Under these circumstances, the ROM exhibited by the Veteran's right knee has not been shown to have met the criteria for a compensable rating under DCs 5260 or 5261. Thus, even with full consideration of pain and functional loss, an evaluation in excess of the currently assigned 10 percent rating is not warranted. 38 C.F.R. §§ 4.40, 4.45; see also DeLuca, supra. A separate rating based upon limitation of extension of the right knee is not warranted. The knee has consistently been shown to exhibit extension to 0 degrees, and that would not warrant a noncompensable rating under DC 5261. 38 C.F.R. § 4.71a, DC 5261 (2012). While the Board has considered whether an increased evaluation would be in order under other relevant DCs, such as that governing ankylosis, dislocated semilunar cartilage, removal of semilunar cartilage, and impairment of the tibia and fibula, the Board finds that the criteria for a rating in excess of 10 percent for the service-connected right knee disorder are not met. See 38 C.F.R. § 4.71a, DC 5256, 5258, 5259, 5262 (2012). The medical evidence of record does not show the Veteran to have ankylosis, dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint or the removal of semilunar cartilage. In addition, there is no evidence of impairment of the tibia and fibula, and the Veteran has not asserted otherwise. Extraschedular Considerations 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 91993). According to the regulation, an extraschedular disability rating is warranted upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See 38 C.F.R. § 3.321(b)(1) (2012); Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111, 115 (2008), there is a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, 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 level of disability and symptomatology and is found to be inadequate, the Board must then determine whether the claimant's 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 VA Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran's disability picture requires the assignment of an extraschedular rating. The Veteran has not expressly raised the matter of entitlement to an extraschedular rating. His contentions have been limited to those discussed above, i.e., that his low back and right knee are more severe than is reflected by the currently assigned rating. See Brannon v. West, 12 Vet. App. 32, 35 (1998). Moreover, the Veteran has not identified any factors which may be considered to be exceptional or unusual with respect to his service-connected back or knee and the Board has been similarly unsuccessful. The record does not show that the Veteran has required any hospitalizations for his service-connected low back or knee. There is no unusual clinical picture presented, nor is there any other factor, which takes the disability outside the usual rating criteria. In short, the evidence does not support the proposition that the Veteran's back or knee presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards and warrant the assignment of an extraschedular rating under 3.321(b)(1) (2012). [Continued on Next Page] ORDER A rating in excess of 20 percent for lumbosacral strain is denied. A separate 10 percent disability for associated mild, incomplete paralysis of the sciatic nerve of the lower extremities is granted, subject to the regulations governing the award of monetary benefits. A rating in excess of 10 percent for status post arthroscopic surgery of the right knee with mild degenerative changes is denied. ____________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs