Citation Nr: 1320254 Decision Date: 06/24/13 Archive Date: 07/02/13 DOCKET NO. 09-45 767 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to an increased rating for lumbar strain with mild spondylosis, currently rated 20 percent disabling. 2. Entitlement to an initial separate rating in excess of 10 percent for right S1 radiculopathy, including prior to October 19, 2009. 3. Entitlement to an initial separate rating in excess of 10 percent for left S1 radiculopathy, including prior to February 23, 2010. 4. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S.J. Janec, Counsel INTRODUCTION The Veteran had active military service from June 1982 to May 1986. This matter comes before the Board of Veterans' Appeals (Board) from a March 2009 rating decision of the Indianapolis, Indiana, Regional Office (RO) of the Department of Veterans Affairs (VA) that denied a rating in excess of 20 percent for the service-connected lumbar strain with mild spondylosis. The Veteran filed a notice of disagreement with the determination in June 2009 and he was provided a statement of the case in October 2009. He perfected an appeal in November 2009. In his VA Form 9, the Veteran checked that he wanted a personal hearing before a Veterans Law Judge at the RO. However, in an accompanying statement, he clarified that he wanted a personal hearing before RO personnel. Such hearing was conducted in February 2010. In an October 2010 rating decision, the RO granted service connection for right S1 radiculopathy and assigned a 10 percent rating effective October 19, 2009; and granted service connection for left S1 radiculopathy and assigned a 10 percent rating effective February 23, 2010. The Board notes that service connection for lumbar strain with mild spondylosis was granted in a rating decision dated August 22, 2007 which was mailed to the Veteran under cover letter dated August 30, 2007. He did not file a notice of disagreement with the rating assigned for his back disability (he did file a notice of disagreement with other denials of service connection included in the August 2007 rating decision), and his current claim for an increased rating was received on September 15, 2008, more than one year after the mailing of notice of the original grant and award of a 20 percent rating. Hence, it cannot be accepted as a timely notice of disagreement with the August 2007 rating decision. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. §§ 20.302, 20.1103 (2012). Moreover, the Veteran did not submit additional evidence pertaining to his low back during the one-year period following notice of the allowance. Accordingly, the Board finds that the August 2007 rating decision became final and the Veteran's new claim was appropriately developed as an increased rating claim. See Buie v. Shinseki, 24 Vet. App. 242 (2011) (per curiam). Because the bilateral S1 radiculopathy is a manifestation of the low back disorder, and considering the Veteran's contentions, the Board has taken jurisdiction of these initial rating matters. In a November 2008 rating decision, the RO granted service connection for right and left knee disabilities; and in an April 2008 rating decision, the RO granted service connection for a right shoulder disability. These represented a full grant of the benefits sought on appeal pursuant to the Veteran's September 2007 notice of disagreement, and the issues are consequently no longer in appellate status. The issue of entitlement to a total disability rating based on individual unemployability due to service-connected disability is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, D.C. VA will notify the appellant if additional action is required on his part. FINDINGS OF FACT 1. The Veteran's lumbar strain with mild spondylosis is characterized by limited motion with pain on motion that causes functional impairment. 2. The Veteran's right S1 radiculopathy was initially documented clinically on October 19, 2009 and is characterized by symptoms that are compatible with no more than mild, incomplete paralysis of the sciatic nerve. 3. Complaints related to the Veteran's left S1 radiculopathy were initially documented at his hearing on February 23, 2010 and clinically manifest subsequent to that date; the disability is characterized by symptoms that are compatible with no more than mild, incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for lumbar strain with mild spondylosis have not been met during the appeal period. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.159, 3.321(b), 4.71a, Diagnostic Code 5237 (2012). 2. The criteria for an initial higher rating for right S1 radiculopathy have not been met during the appeal period, including prior to October 19, 2009. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.159, 3.321(b), 4.124a, Diagnostic Code 8520 (2012). 3. The criteria for an initial higher rating for left S1 radiculopathy have not been met during the appeal period, including prior to February 23, 2010. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.159, 3.321(b), 4.124a, Diagnostic Code 8520 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002) redefined VA's duty to assist the veteran in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Duty to Notify The notice requirements of the VCAA require VA to notify the veteran of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). In a January 2009 letter, the Veteran was provided notice regarding what information and evidence is needed to substantiate a claim for an increased rating, as well as what information and evidence must be submitted by the Veteran, and what information and evidence will be obtained by VA. He was also advised of how disability ratings and effective dates are assigned. The Board also observes the holding of the United States Court of Appeals for Veterans Claims (Court) in Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), which focuses on VCAA notice requirements in an increased rating case. However, this case has been overturned in part by the United States Court of Appeals for the Federal Circuit. See Vazquez-Flores v. Shinseki, 580 F.3d. 1270 (2009). Hence, it need not be further discussed in this decision. Consequently, the Board finds that the duty to notify provisions have been satisfactorily met, and neither the Veteran nor his representative has pointed out any deficiencies that require corrective action. Duty to Assist The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran. Specifically, the information and evidence that have been associated with the claims file include the Veteran's service treatment records, private and VA treatment reports, lay statements, the Veteran's statements and February 2010 personal hearing testimony, and VA examination reports, including the most recent examination in March 2010 generated in response to the Veteran's assertion that his disability increased in his November 2009 substantive appeal. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that a veteran was entitled to a new evaluation after a two year period between the last VA examination and the veteran's contention that his disability has increased in severity) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered "contemporaneous"). The Board notes that the relevant VA examination reports reflect that the examiners reviewed the Veteran's past medical history, documented the current medical conditions, and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record, and with supporting rationale. Nieves-Rodriguez v. Peake, 22 Vet App 295 (2008). Consequently, the Board concludes that the medical examinations are adequate for evaluation purposes. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). As such, the Board finds that VA's duty to assist has also been met. Analysis Laws and Regulations Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4 (2012). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2012). In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2012). Consideration of the recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (2012); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, consideration must be given as to whether staged ratings may be assigned to compensate entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). When rating disabilities using Diagnostic Codes which provide a rating on the basis of loss of range of motion, VA must consider, to the extent possible, the degree of additional range of motion loss due to pain, weakened movement, excess fatigability, or incoordination. DeLuca v. Brown, 8 Vet. App. 202 (1995), 38 C.F.R. §§ 4.40, 4.45 (2012). After careful consideration of the evidence, any reasonable doubt remaining should be resolved in favor of the veteran. 38 C.F.R. §§ 3.102, 4.3 (2012). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran's service-connected lumbar strain with mild spondylosis is currently rated 20 percent pursuant to Diagnostic Code 5237. The regulations governing the rating of back disabilities provide a general rating formula for evaluating diseases and injuries of the spine, including vertebral fracture or dislocation under Diagnostic Code 5235, lumbosacral strain under Diagnostic Code 5237, spinal stenosis under Diagnostic Code 5238, degenerative arthritis of the spine under Diagnostic Code 5242, and intervertebral disc syndrome under Diagnostic Code 5243. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243 (2012). The Rating Formula provides a schedule of ratings for spine disabilities with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Unfavorable ankylosis of the entire spine warrants a 100 percent rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine warrants a 40 percent rating. Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine warrants a 30 percent rating. Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis warrants a 20 percent rating. 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 the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, the 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 warrants a 10 percent rating. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine (2012). The rater is instructed to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1) (2012). 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 normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71, 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2) (2012). Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (4) (2012). In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3) (2012). 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 or more of the following: difficulty walking because of a 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 (0 degrees) always represents favorable ankylosis. Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5) (2012). Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6) (2012). Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. 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 Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, and a 20 percent rating is warranted with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. The 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note (1). 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2012). The Veteran's service-connected right and left S1 radiculopathy associated with lumbar strain with mild spondylosis are each rated 10 percent pursuant to Diagnostic Code 8520. In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124(a) (2012). When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. The ratings for peripheral nerves are for unilateral involvement; when bilateral, they are combined with application of the bilateral factor. Id. The use of terminology such as "mild," "moderate," and "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. 38 C.F.R. §§ 4.2, 4.6 (2012). The Veteran's service-connected right and left S1 radiculopathy are each currently rated 10 percent disabling under Diagnostic Code 8520, which pertains to neuritis of the sciatic nerve. Under Diagnostic Codes 8520, 8620, and 8720 (paralysis, neuritis and neuralgia of the sciatic nerve, respectively), disability ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis of the sciatic nerve which is mild, moderate or moderately severe in degree, respectively. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. 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. 38 C.F.R. § 4.124a, Diagnostic Code 8520 (2012). Diagnostic Codes 8620 and 8720 address the criteria for evaluating neuritis and neuralgia of the nerve, respectively and the criteria are consistent with those for evaluating degrees of paralysis as set forth above. 38 C.F.R. § 4.124a, Diagnostic Codes 8620, 8720 (2012). Factual Background Social Security Administration (SSA) records indicate that the Veteran was determined to be disabled due to a knee disability. In a January 2009 statement, a friend related that the Veteran had back problems for some time and he had difficulty bending down and tying his shoes. He missed a couple of weeks at the fitness center and had to adjust to the pain on his job by alternating sitting and standing. At a February 2009 VA contract examination, the Veteran reported that his pain began in 1983. The pain was located in the lumbar area of his back and it did not travel to other locations. He also reported stiffness, weakness, and flare-ups. He was able to walk 3/4 of a mile and he did not use any ambulatory aids. He walked with a normal gait and his posture was normal. Clinical evaluation showed that curvature, symmetry and rhythm of spinal motion were all normal. There was no pain, painful motion, spasm, effusion, instability, weakness, fatigue, lack of endurance, redness or heat. There was some abnormal movement and tenderness. Range of motion was flexion from 0 degrees to 60 degrees; extension from 0 degrees to 15 degrees; lateral flexion from 0 degrees to 15 degrees, bilaterally; and lateral rotation from 0 degrees to 15 degrees, bilaterally. Pain was present at the end points. Repetition of range of motion exercises were the same. There was no additional pain, fatigue, weakness, lack of endurance or incoordination. Straight leg raise was positive but there were no signs of intervertebral disc syndrome. Lower extremity motor function was normal. Lower extremity sensory function was normal. There was no bladder or bowel dysfunction; and no incapacitating episodes in the past 12 months. The assessment was lumbar strain with mild spondylosis. Modification of activities of daily living was necessary. At a personal hearing before a hearing officer at the RO in February 2010, the Veteran testified that he had continued symptoms of low back pain with pain that sometimes shot into his buttocks and legs. Sometimes, his legs would go numb. He has experienced stiffness. He currently used a TENS unit to help with his symptoms. Upon VA contract examination in March 2010, the Veteran reported pain, numbness, stiffness, and weakness in his back most of the time. The pain also traveled to his buttocks, legs and feet. He was able to walk 3-4 blocks and he did not use any ambulatory aids. He walked with a normal gait and his posture was normal. Clinical evaluation showed that curvature, symmetry and rhythm of spinal motion were all normal. There was pain and painful motion, but no spasm, effusion, instability, weakness, fatigue, tenderness, lack of endurance, redness or heat. There was no abnormal movement. Range of motion was flexion from 0 degrees to 42 degrees; extension from 0 degrees to 16 degrees; lateral flexion from 0 degrees to 15 degrees, bilaterally; and lateral rotation from 0 degrees to 10 degrees, bilaterally. Pain was present at the end points. Repetition of range of motion exercises was the same. There was no additional pain, fatigue, weakness, lack of endurance or incoordination. Straight leg raise was negative, bilaterally. Lower extremity motor function was normal. Lower extremity sensory function was normal. There was no bladder or bowel dysfunction; and no incapacitating episodes in the past 12 months. The assessment was chronic lumbar strain with mild spondylosis. The examiner noted that the Veteran appeared mildly affected by his condition. VA outpatient treatment reports dated from March 2009 through October 2010 show that the Veteran was seen for treatment of low back pain. In March 2009, an assessment noted a history of minimal degenerative changes of the lumbosacral spine and low back pain. In August 2009, he was seen for complaints of back pain that had been aggravated with gym activities. It was localized and he denied any incontinence or paresthesias. He had full range of motion without any restriction. There were no areas of warmth, erythema; but there was minimal paraspinal tenderness on the left side. Gait was slow and steady, he was able to walk on tip toes, and heels to squat. L1-S1 was intact. On October 19, 2009, he complained of increased pain with possible episodes of right lumbar radiculopathy. He exhibited gait dysfunction due to his right knee disability. He was provided with a TENS unit. In December 2009, he was seen for complaints of pain radiating to the right posterior thigh and calf. X-rays in September 2009 were noted to be unremarkable, but an MRI in December 2009 showed an L5-S1 small annular tear and superimposed small central disc protrusion contacting the traversing S1 nerves bilaterally. There was also a mild disc bulge. Bowel and bladder impairment were denied. In August 2010, he was seen for complaints of low back pain with radiating pain across the area, including paresthesias that radiated down the posterior aspect of both thighs and calves. He denied bowel or bladder dysfunction. In October 2010, he received a steroid injection for pain. Lumbar Strain with Mild Spondylosis In considering the evidence of record, including the Veteran's assertions, the Board finds that the Veteran's increased rating claim must be denied. Throughout the appeal period, the Veteran's low back disability has been clinically manifest by limited range of motion of the thoracolumbar spine and complaints of pain and functional impairment - which is required for the 20 percent rating currently assigned. To warrant the next higher 40 percent rating, the evidence must show that the Veteran has forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Neither of these findings were reported on the clinical examination detailed above. The criteria for ratings in excess of a 40 percent rating are also not met. Moreover, the Board finds that there are no additional factors demonstrated in the clinical evaluations to warrant the assignment of a higher rating, such as muscle spasms, abnormal gait (due to back issues rather than a knee problem), or additional loss of range of motion due to weakness, fatigue, incoordination, etc. See 38 C.F.R. §§ 4.40, 4.45, DeLuca, supra. The Board acknowledges that the Veteran is competent to report symptoms he experiences, such as pain and limited motion. Charles v. Principi, 16 Vet. App. 370 (2002); see also, e.g., Layno v. Brown, 6 Vet. App. 465, 469 (1994) (a veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses). However, he is not competent to attribute a specific symptom to a specific disability. Id. Disorders of the lumbosacral spine are complex in nature and require specialized training for a determination as to diagnosis and causation, and are not susceptible of lay opinions. As a result, his assertions cannot constitute competent medical evidence that his lumbar strain with spondylosis has increased in severity so as to warrant a higher evaluation. As such, the Board concludes that the medical findings on examination are of greater probative value than his or other lay allegations regarding the severity of the disability as well as the other symptoms that may be attributed to it. The Board concludes that the Veteran's objective symptoms related to his low back disability continue to more nearly approximate the criteria for the 20 percent rating assigned. Moreover, there are no additional clinical findings found on examination that warrant separate compensable ratings (other than those already assigned for the lower extremity radiculopathy addressed below). Accordingly, the preponderance of the evidence is against a finding that the Veteran's low back disability met the criteria for higher ratings at any time during the appeal period, or that additional separate ratings are warranted. Therefore, the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Alemany, supra; Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right and Left S1 Radiculopathy In considering the medical evidence, as well as the Veteran's statements and personal hearing testimony, the Board finds that his service-connected right and left S1 radiculopathy are compatible with mild, incomplete paralysis of the sciatic nerve throughout the appeal period. Hence, an initial rating in excess of 10 percent is not warranted for either extremity. Additionally, the Board observes that the 10 percent rating has been awarded from the earliest date it was factually ascertainable that these neurological symptoms were present due to the service-connected lumbosacral strain with mild spondylosis. As detailed in the Factual Background above, on August 19, 2009, the Veteran presented with increased pain and the assessment was right lumbar radiculopathy. The Veteran first reported similar symptoms on the left side at his personal hearing on February 23, 2010, and clinical findings supporting this assertion were made shortly thereafter upon clinical evaluation in March 2010. There is no indication in the clinical reports that such neurological symptoms or complaints were shown prior to these dates. In fact, upon VA contract examination in February 2009, the Veteran denied radiating pain and motor and sensory evaluations were within normal limits. From the times indicated above, the Veteran has complained of numbness and radiating pain in both extremities, and clinical evaluations have shown evidence of decreased sensation. There was no evidence of gait changes or difficulty ambulating due to the S1 radiculopathy that would be indicative of a higher level of disability. There was also no evidence of muscle wasting or atrophy. The Board acknowledges that the Veteran is competent to report symptoms he experiences, such as pain and numbness. Charles v. Principi, 16 Vet. App. 370 (2002); see also, e.g., Layno v. Brown, 6 Vet. App. 465, 469 (1994) (a veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses). However, he is not competent to attribute a specific symptom to a specific disability. Id. Here, the clinical evidence pertaining to the Veteran's radiculopathy is more probative for the purposes of assigning current ratings in conjunction with the relevant rating criteria - and the Board finds that the symptoms identified have been appropriately considered in assigning the current ratings. Consequently, the Board finds more severe symptomatology necessary for higher ratings for either extremity has not been demonstrated at any time during the appeal period, including prior to the effective dates assigned. The Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. Alemany, supra, Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the claims for entitlement to initial ratings in excess of 10 percent for right and left S1 radiculopathy are denied. Extraschedular Consideration The Board has considered whether extraschedular consideration is warranted. 38 C.F.R. § 3.321(b) (2012); Barringer v. Peake, 22 Vet. App. 242 (2008). The threshold factor for extraschedular consideration is a finding that the evidence presents such an exceptional disability picture that the available schedular rating for the service-connected low back disability with accompanying radiculopathy is inadequate. There must be a comparison between the level of severity and symptomatology of the service-connected disabilities with the established criteria. If the criteria reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Rating Schedule, and the assigned schedular rating is adequate, and no referral is required. Thun v. Peake, 22 Vet. App. 111 (2008). Here, the record does not establish that the rating criteria are inadequate for rating the Veteran's service-connected low back disability and accompanying radiculopathy. The competent medical evidence of record shows that his spine disability is primarily manifested by pain and some limited motion, as well as radiating pain in the extremities, symptoms that are specifically contemplated by the rating criteria utilized. Therefore, the Board finds that the effects of the Veteran's disability have been fully considered and referral for an extraschedular rating is unnecessary at this time. Furthermore, the evidence does not show marked interference with employment or frequent hospitalization due to a back disability with accompanying radiculopathy. Therefore, the Board finds that referral for consideration of an extraschedular rating is not warranted. 38 C.F.R. § 3.321(b) (2012). ORDER A rating in excess of 20 percent for lumbar strain with mild spondylosis is denied. An initial separate rating in excess of 10 percent for right S1 radiculopathy, including a compensable rating prior to October 19, 2009, is denied. An initial separate rating in excess of 10 percent for left S1 radiculopathy, including a compensable rating prior to February 23, 2010, is denied. REMAND In a June 2009 statement in support of his claim, the Veteran essentially raised the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities. The Court has held that a request for a total disability rating based on individual unemployability due to service-connected disability is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or, if a disability upon which entitlement to a total disability rating based on individual unemployability due to service-connected disability is based has already been found to be service connected, as part of a claim for increased compensation. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). If the claimant or the record reasonably raises the question of whether the veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether a total rating based on individual unemployability as a result of that disability is warranted. Id. at 455. Since the Veteran is alleging that his service-connected disabilities, including his back disability, prevent him from working, the Board finds that the claim for entitlement to a total disability rating based on individual unemployability due to service-connected disabilities must be addressed by the RO in the first instance. Ongoing VA medical records and any additional evidence to support the claims should be also obtained. 38 U.S.C.A. § 5103A(c) (West 2002); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). The Veteran is advised that failure to report for a VA examination, if one is scheduled for him, without good cause, may have adverse consequences on his claim. See 38 C.F.R. § 3.655 (2012). Accordingly, the case is REMANDED for the following action: 1. Provide the Veteran with a letter satisfying VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) to notify and assist him in substantiating the total disability rating based on individual unemployability due to service-connected disability claim. Afford the Veteran an appropriate period in which to respond to the VCAA notice. 2. Contact the Veteran and request that he provide, or identify, any relevant personnel or other records from any previous employers as to the reasons for his termination(s). Any authorization necessary to obtain such records should be obtained from the Veteran. Afford the Veteran an appropriate period in which to provide any relevant information or personnel records. 3. Obtain the names and addresses of all medical care providers who treated the Veteran for his service-connected disabilities since March 2010. After securing the necessary release(s), the RO should obtain any outstanding records. 4. After the above has been accomplished, schedule the Veteran for a VA examination to ascertain the current severity his service-connected disabilities and his ability to engage in substantially gainful employment. The claims folder must be made available to the examiner for review in conjunction with the examination. The examiner should examine the Veteran, review the Veteran's claims folder and provide all necessary clinical factors required in an appropriate examination worksheet. All necessary special studies or tests are to be accomplished. The examiner must elicit from the Veteran and record a full work and educational history. Based on a review of the case, the examiner must opine as to whether, without regard to the Veteran's age or the impact of any non service-connected disabilities, it is at least as likely as not that his service-connected disabilities alone render him unable to secure or follow a substantially gainful occupation. If the examiner opines that the Veteran's service-connected disabilities do not render him unemployable, the examiner should suggest the type or types of employment in which the Veteran would be capable of engaging, given his current skill set and educational background. A complete rationale for any opinion expressed and conclusion reached should be set forth in a legible report. 5. Then, adjudicate the Veteran's claim for entitlement to a total disability rating based on individual unemployability due to service-connected disability. If the benefit sought is denied, the Veteran and his representative must be furnished a supplemental statement of the case and be given an opportunity to respond before the case is returned to the Board. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs