Citation Nr: 1319316 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 11-23 209 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD). 2. Entitlement to an initial disability rating in excess of 20 percent for radiculopathy of the right lower extremity, secondary to service-connected lumbar spine disability. 3. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the left lower extremity, secondary to service-connected lumbar spine disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD C. D. Simpson INTRODUCTION The Veteran served on active duty from January 2004 to September 2005. His service awards include the Combat Infantry Badge (CIB). These matters initially came before the Board of Veterans' Appeals (Board) on appeal from October 2010 and July 2011 rating decisions by the RO in Lincoln, Nebraska. The United States Court of Appeals for Veterans Claims (Court) has held that a claim for service connection for PTSD or any other psychiatric disorder encompasses all diagnoses raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the issue has been recharacterized as service connection for an acquired psychiatric disorder, to include PTSD. The Veteran was afforded an April 2013 hearing before the Board at his local RO. A transcript is of record in the Virtual VA efolder. A review of the Virtual VA efolder shows that VA treatment records from July 2011 through April 2013 are of record. The RO has not considered these updated VA treatment records in the most recent adjudications in July and November 2011 Statements of the Case. The evidence from these records, however, is cumulative and redundant of treatment records previously reviewed by the RO. The Board may consider the updated VA treatment records in the first instance. 38 C.F.R. § 20.1304(c). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The most competent and probative evidence establishes that the Veteran does not meet the criteria for a current PTSD or related psychiatric diagnosis at any time during the claims period. 2. Since July 1, 2010, the effective date for the grant of service connection, the Veteran's peripheral neuropathy of the right lower extremity has been manifested by incomplete paralysis of the nerve with subjective symptoms of pain, numbness, vibration, tingling on use, loss of strength, and with objective findings of diminished sensation. Moderately severe symptoms such as trophic changes, motor loss, loss of reflexes or complete paralysis have not been shown on clinical examination. 3. Since July 1, 2010, the effective date for the grant of service connection, the Veteran's peripheral neuropathy of the left lower extremity has been manifested by incomplete paralysis of the nerve with subjective symptoms of pain, numbness, and tingling on use, with objective findings of diminished sensation. Moderate symptoms such as trophic changes, motor loss, loss of reflexes or complete paralysis have not been shown on clinical examination. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder, to include PTSD, have not been met. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2012); 75 Fed. Reg. 39843 (Jul. 13, 2010). 2. The criteria for a rating in excess of 20 percent for radiculopathy of the right lower extremity have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.321, 4.124a, Diagnostic Code 8520 (2012). 3. The criteria for a rating in excess of 10 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C.A. § 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.321, 4.124a, Diagnostic Code 8520 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b)(1) (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Pelegrini, the United States Court of Appeals for Veterans Claims (Court) held that VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. The Court has also held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include (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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). For the issues of higher initial ratings, the appeal arises from disagreement with the initial ratings following the grant of service connection. The courts have held that once service connection is granted, the claim is substantiated. Additional VCAA notice is not required, and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007); VAOPGCPREC 8-2003 (2003). Nevertheless, the record indicates that the Veteran was provided with adequate VCAA notice in September 2010. Specifically, the RO notified the Veteran of information and evidence necessary to substantiate his service connection claims, including assignment of a disability rating and effective date. He was notified of the information and evidence that VA would seek to provide and the information and evidence that he was expected to provide. The duty to notify has been met. The Board further concludes that the duty to assist has also been met. The Veteran's service treatment records (STRs), VA treatment records, and Vet Center records have been obtained, in addition to various written statements by the Veteran himself. The Board notes that the Veteran separation examination report is unavailable and he was appropriately notified. (See September 2010 Formal Finding of Unavailability and notice letter). Here, his in-service stressors are conceded, and he does not report having treatment for psychiatric problems or leg pain in service. (See July 2010 Veteran statement). The separation examination report is not clearly determinative to the appeal. In any event, the Board has considered its heightened obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The available VA treatment records include comprehensive VA Medical Center Omaha (VAMC Omaha) records from 2007 to 2013, including Grand Island records from 2007 to 2010. He was afforded appropriate VA examinations in July 2010 and June 2011, and relevant opinions have been obtained from the examiners after a review of the claims folder. There is no indication that his service-connected lower extremity radiculopathy has materially increased in severity since his most recent VA examination. The Veteran contends that the current VA examinations are inadequate. (See Veteran statements from August 2011 and January 2012). For the PTSD examination, he contended that the psychological testing was not sufficiently extensive. Review of the July 2010 VA PTSD examination shows that the examiner reviewed the pertinent mental health treatment history and conducted a thorough clinical interview and examination. The Board considers the July 2010 VA PTSD examination to be adequate. For the neurological examination, the Veteran contends that clinical testing performed on his right leg was not performed on his left leg. EMG studies show bilateral motor conduction and F-wave latency studies were performed for both legs. An EMG monopolar sample was taken of the right leg only. The examination report shows that the examiner reviewed the claims file and performed a thorough clinical interview and examination. Overall, the absence of an EMG monopolar sample for the left leg does not render the June 2011 VA neurology examination report inadequate for adjudication purposes. The Court has held that the provisions of 38 C.F.R. § 3.103(c)(2) (2012) impose two distinct duties on VA employees, including Board personnel, in conducting hearings. The duty to explain fully the issues and the duty to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010) (per curiam); see also 77 Fed. Reg. 23128-01 (April 18, 2012). At the April 2013 hearing, both during a prehearing conference and during the hearing, the undersigned identified the issues on appeal. The Veteran described his lower extremity symptoms. He provided testimony as to all mental health treatment received and, thereby, demonstrated actual knowledge of the ability to submit additional relevant evidence. The undersigned queried the Veteran about his psychiatric treatment history to ensure that no evidence remained outstanding. The duties imposed by Bryant were thereby met. There is no indication that there is any relevant evidence outstanding in these claims, and the Board will proceed with consideration of the Veteran's appeal. II. Service connection for an acquired psychiatric disorder, to include PTSD 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; 38 C.F.R. § 3.303. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present 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); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. For chronic disabilities listed under 38 C.F.R. § 3.309(a), which includes psychosis, an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology for chronic diseases recognized under 38 C.F.R. § 3.309(a) 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. Id. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 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"). Although the Veteran is competent in certain situations to identify a simple condition such numbness, he is not competent to provide evidence as to more complex medical questions such as a psychiatric diagnosis. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. Layno v. Brown, 6 Vet. App. 465, 469 (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")). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection for PTSD requires (1) medical evidence diagnosing PTSD in conformance with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; (2) a link, established by medical evidence, between a Veteran's present symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128, 139 (1997). If a medical professional diagnoses PTSD, VA must assume that the diagnosis meets the DSM-IV criteria relating to adequacy of the symptomatology and sufficiency of the stressor. See Cohen, 10 Vet. App. at 153. If a Veteran's claimed stressor relates to an event in which he engaged in combat with the enemy, his lay testimony, alone, is sufficient to verify the claimed in-service stressor. VAOPGCPREC 12-99, p. 4 (October 18, 1999); Gaines v. West, 11 Vet. App. 353 (1998). Establishing that the Veteran engaged in combat with the enemy requires objective, competent, and factual evidence of record. See id. The determination is made on a case-by-case basis and means that the Veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. VAOPGCPREC 12-99 (Oct. 18, 1999); see also Sizemore v. Principi, 18 Vet. App. 264, 273-74 (2004). Here, the Veteran is recognized as serving in combat as he earned a CIB and his lay reports are sufficient to show an in-service stressor. See also 38 C.F.R. § 3.304(f)(3). In relevant part, 38 U.S.C.A. 1154(a) (West 2002) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b). The Veteran contends that service connection is warranted for PTSD. Although PTSD or related psychiatric disorder was not shown in service, the record shows that he earned a CIB and his combat status is conceded. 38 C.F.R. § 3.304(f); Gaines, 11 Vet. App. 353 (1998). The pertinent issue is whether he currently has PTSD or an additional psychiatric disorder related to the in-service combat stressors. As an initial matter, the Board notes that the Veteran is competent to report on his psychiatric symptoms. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Unlike merely reporting psychiatric symptoms, however, diagnosing a psychiatric illness is a complex medical question beyond the capabilities of lay observation, and the Veteran is not shown to be a medical professional. Thus, his reports of any current psychiatric diagnosis are not competent evidence addressing this medical question and have no probative value. See Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77; Woehlaert, 21 Vet. App. at 456. The competent evidence supporting the claim consists of PTSD diagnoses made by treating clinicians. (See VA treatment records dated March 2007 through September 2011). In March 2007, the Veteran reported that his primary concern was ceasing marijuana use and obtaining anti-anxiety medication. He acknowledged having stressors from a recent broken engagement and inability to consistently maintain employment. The examiner, qualified as a certified physicians' assistant (PA-C) listed a diagnosis of "symptoms suggestive of PTSD, chronic; and substance abuse, marijuana." The following month, April 2007, the Veteran returned for individual counseling. He reported that his current stressors were more problematic than war memories. Mental status examination was unremarkable; however, the same examiner now provided a PTSD diagnosis. Vet Center records from September 2007 show that the Veteran presented with an unusual affect, but did not display symptoms sufficient for a diagnosis of depression or dysthymia. His problems revolved around current domestic stressors and continued marijuana abuse. Based upon clinical examination and reported symptoms, the examiner made an assessment of rule out PTSD and listed an adjustment disorder with depressed mood. She described the Veteran as having anger management issues and problems with marijuana abuse. In July 2010, the Veteran was afforded a VA PTSD examination. The examiner reviewed the claims folder, interviewed the Veteran, and provided a mental status examination. The overall mental status examination was unremarkable. The Veteran detailed his various stressors while serving in Iraq, including being targeted by mortar fire, improvised explosive devices (IEDs), and small arms fire. He denied any combat injury, but experienced fear and distress during much of his deployment. He stated that he had recurrent distressing dreams of combat, anger management problems, and exaggerated startle responses. He reported feeling uncomfortable in crowds and certain sounds or smells would trigger flashback type memories of Iraq. The examiner acknowledged that the Veteran had combat exposure stressors. He conducted a clinically administered PTSD scale diagnostic test. Based upon the record and clinical examination, he determined that the Veteran did not meet the DSM-IV PTSD criteria. He explained that the PTSD criterion C and F were not met. The Veteran did not have avoidance of stimuli associated with combat stressors and PTSD-type disturbances were not severe enough to result in clinically significant distress. VA treatment records through April 2013 do not show that any clinician has made a PTSD diagnosis based upon a detailed analysis of the DSM-IV PTSD criteria. They also do not show mental health treatment on any sustained basis. The competent evidence is conflicting on whether the Veteran currently has PTSD. When evaluating this evidence, the Board must analyze its credibility and probative value, account for evidence which it finds to be persuasive or unpersuasive, and provide reasons for rejecting any evidence favorable to the Veteran. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In evaluating medical opinions, the Board may place greater weight on one medical professional's opinion over another's depending on such factors such as reasoning employed by the medical professionals, and whether or not and to what extent they review prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 336 (1994). The Board initially notes that the treating clinicians diagnosing PTSD are not shown to have attained terminal degrees in psychiatry or psychology. Rather, the diagnosing clinicians hold physician assistants (PA-C) or general medical doctor (MD) credentials. More importantly, they did not detail how the Veteran met each of the six DSM-IV criteria necessary to establish a PTSD diagnosis. This omission heavily weighs against the probative value of these reports in showing a current PTSD diagnosis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion depends on its rationale and consideration of an accurate record). By contrast, the June 2010 VA examiner, a licensed clinical psychologist, carefully considered each reported stressor and queried the Veteran about his symptoms. He detailed the Veteran's symptoms in light of each DSM-IV PTSD criterion and determined that the Veteran did not meet the DSM-IV criteria for PTSD. He explained that although the Veteran was exposed to combat stressors during service, he did not respond by avoidance of stimuli associated with his stressors and the disturbance from the stressors does not cause clinically significant distress or impairment in occupational or social functioning. His report is plausible and consistent with the record. The opinion reflects familiarity with the Veteran's history and is accompanied by rationale that is supported by citation to reports made throughout the record and explanation of the significance of the Veteran's symptoms in the context of the DSM-IV PTSD diagnostic criteria. Id.; see Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board considers the June 2010 VA examination report to be highly persuasive. Id.; Gabrielson, 7 Vet. App. 336 (1994). In weighing the conflicting competent evidence, the Board concludes that the June 2010 VA examiner's opinion merits the greater probative weight. Gabrielson, 7 Vet. App. 336. The opinion reflects familiarity with the Veteran's history and is accompanied by rationale that is supported by citation to reports made throughout the record and explanation of the significance of the Veteran's symptoms in the context of the DSM-IV PTSD diagnostic criteria. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Nieves-Rodriguez, 22 Vet. App. 295. The competent evidence does not otherwise show that any additional psychiatric diagnosis has been made. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board notes that the Veteran on two occasions was assessed as having an adjustment reaction, but the assessment was made in light of personal relationship difficulties and continued recreational use of marijuana as opposed to in-service combat stressors. In summary, the weight of the probative evidence is against a finding that the Veteran currently has any current psychiatric disorder, to include PTSD, related to service. Service connection for an acquired psychiatric disorder, to include PTSD, is denied. See id.; 38 U.S.C.A. § 5107(a); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 3.307, 3.309. III. Increased initial ratings for radiculopathy of the lower extremities Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Because the Veteran is challenging the initially assigned disability rating, it has been in continuous appellate status since the original assignment of service connection. The evidence to be considered includes all evidence proffered in support of the original claim. Fenderson v. West, 12 Vet. App. 119 (1999). 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. Id. 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, atrophic changes, or sensory disturbances. 38 C.F.R. § 4.120. 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. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124 (2012). The Veteran's radiculopathy of the lower extremities is currently rated under Diagnostic Code (DC) 8520. 38 C.F.R. § 4.124, DC 8520. DC 8520 provides an 80 percent rating for complete paralysis of the sciatic nerve, contemplated by foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. Ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis that is mild, moderate or moderately severe in degree, respectively. Id. The Veteran underwent a VA neurology examination in June 2011. The examiner reviewed the claims folder. The Veteran reported having intermittent numbness and tingling in both lower extremities. Symptoms occurred three to four days per week and were worse on the right side. He also had constant sharp pain on the bottom of his right foot. He had not sought medical attention for these symptoms. Clinical examination showed normal reflexes. Sensory findings from electromyography (EMG) testing on both legs showed the L5 myotome consistent with radiculopathy with the right leg being greater than the left. Position sense and light tough remained normal for both legs. Motor examination was normal without evidence of any muscle atrophy, gait abnormality, imbalance, tremor, or muscle fasciculation. The examiner diagnosed L5 radiculopathy of both lower extremities. In August 2011, the Veteran reported that he had minimal feeling on the bottom of his right foot. Both legs tingled and occasionally vibrate. He had constant pain in his right leg. In January 2012, the Veteran acknowledged that his right leg symptoms were worse than his left leg symptoms. The symptoms included vibrating, tingling, and numbness. VA treatment records from June 2012 show that the Veteran complained about being unable to lift his right great toe and was recommended for magnetic resonance imaging (MRI) studies of his lumbar spine. Subsequent VA treatment records, however, do not include any additional clinical findings for radiculopathy symptoms. At the April 2013 hearing, the Veteran described his primary symptoms as numbness and tingling in both legs. He also had dermatological problems from excessively scratching his legs. His right leg continued to be more symptomatic and included numbness in the bottom of his foot. He alluded to difficulty lifting his right foot, but it occurred on an intermittent basis. For the left lower extremity, the record shows that the Veteran has sensory disturbances. His left leg radiculopathy has not been shown to pose additional impairment in activities of daily living. Left leg radiculopathy has not been productive of muscle atrophy, paralysis, diminished reflexes, or loss of strength in the left foot. It is limited to sensory disturbances. Without showing any clinical abnormalities beyond sensory disturbances, an initial rating in excess of 10 percent for mild radiculopathy of the left lower extremity is not warranted. 38 C.F.R. § 4.124a, DC 8520. For the right lower extremity, the record shows that the Veteran has sensory disturbances extending to his right foot; however, the clinical evidence does not show muscle atrophy, paralysis, or diminished reflexes. The Veteran had reported intermittent difficulty lifting in his right foot or toe. Nonetheless, the record does not show consistent loss of strength in his right foot to warrant a finding of moderately severe sciatic nerve impairment. (See April 2013 hearing transcript). Without showing more consistent loss of strength in addition to sensory disturbances, an initial rating in excess of 20 percent for moderate radiculopathy of the right lower extremity is not warranted. 38 C.F.R. § 4.124a, DC 8520. Extraschedular considerations The Board has also considered the potential application of other various provisions, including 38 C.F.R. § 3.321(b)(1), for exceptional cases where schedular evaluations are found to be inadequate. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board finds that the severity of the Veteran's service-connected radiculopathy of the lower extremities symptoms is fully contemplated by the rating criteria. They are productive of occasional pain, numbness, and weakness of the right foot. The Veteran has recently reported dermatological problems with his lower extremities. However, clinical records have not established any relationship to radiculopathy in his lower extremities. Furthermore, it is not shown that such dermatological symptoms could not be adequately rated by the pertinent dermatology disability rating criteria. In sum, there is nothing exceptional about the Veteran's bilateral lower extremity radiculopathy whether considered separately or in conjunction with the additional service-connected lumbar spine disability. Mittleider v. West, 11 Vet. App. 181 (1998). The degree of disability exhibited is contemplated by the rating schedule. Thus, the Board finds that the threshold test is not met for referral for extraschedular consideration. 38 C.F.R. § 4.16(b); Thun v. Peake, 22 Vet. App. 111 (2008). Total disability based upon individual unemployability (TDIU) A request for a TDIU whether expressly raised by a Veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability as part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). In other words, if the claimant or the evidence of record reasonably raises the question of whether the Veteran is unemployable due to a disability for which an increased rating is sought, then part and parcel with the increased rating claim is the issue of whether a TDIU is warranted as a result of that disability. Id. In this instance, the record does not show that the Veteran left employment due to lumbar pain and associated radiculopathy. (See June and August 2012 VA primary care records showing normal gait and no difficulty with mobility). He does not assert that radiculopathy was related to his decision to leave work. (See June 2011 VA neurology examination report). TDIU is not for further consideration at this time. ORDER Service connection for an acquired psychiatric disorder is denied. Initial rating in excess of 20 percent for radiculopathy of the right lower extremity is denied. Initial rating in excess of 10 percent for radiculopathy of the left lower extremity is denied. ____________________________________________ James L. March Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs