Citation Nr: 1321340 Decision Date: 07/03/13 Archive Date: 07/12/13 DOCKET NO. 06-17 759 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUES 1. What evaluation is warranted for a chronic lumbar strain prior to May 12, 2010? 2. What evaluation is warranted for a chronic lumbar strain since May 12, 2010? 3. What evaluation is warranted for coccydynia since May 12, 2004? 4. What evaluation is warranted for left foot plantar fasciitis since May 12, 2004? 5. What evaluation is warranted for right foot plantar fasciitis since May 12, 2004? 6. What evaluation is warranted for thoracic neuritis since May 12, 2004? 7. What evaluation is warranted for eczema prior to March 16, 2007? 8. What evaluation is warranted for eczema since March 16, 2007? 9. What evaluation is warranted for right deltoid bursitis/right shoulder supraspinatus tendonitis with limitation of motion since May 12, 2004? REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD T.S. Willie, Counsel INTRODUCTION The Veteran served on active duty from August 1997 to May 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. The issue of what evaluation is warranted for eczema since March 16, 2007 is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Prior to May 13, 2010, a chronic lumbar strain was manifested by scoliosis and muscle spasms but not by forward thoracolumbar flexion to 30 degrees or less. 2. Since May 13, 2010, the Veteran's lumbar strain has not been productive of unfavorable ankylosis of the entire thoracolumbar spine. 3. Prior to and since May 12, 2004, coccydynia was manifested by painful residuals. 4. Since May 12, 2004, left foot plantar fasciitis has been productive of moderate disability but not moderately severe disability. 5. Since May 12, 2004, right foot plantar fasciitis has been productive of moderate disability but not moderately severe disability. 6. Since May 12, 2004, thoracic neuritis has not been productive of incomplete moderate neuritis. 7. Since March 16, 2007, eczema has not been productive of at least 5 percent, but less than 20 percent of the entire body covered; or at least 5 percent, but less than 20 percent of exposed areas affected nor was intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, required for a total duration of less than six weeks during the past 12- month period. 8. Since May 12, 2004, right deltoid bursitis/right shoulder supraspinatus tendonitis has not been productive of limitation of motion of the arm to midway between side and shoulder level. CONCLUSIONS OF LAW 1. Prior to May 13, 2010, the criteria for a 20 percent rating, but not higher, for chronic lumbar strain were met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 and Supp. 2012); 38 C.F.R. §§ 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2012). 2. Since May 13, 2010, the criteria for a rating higher than 40 percent disabling for chronic lumbar strain have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 3. Since May 12, 2004, the criteria for a 10 percent rating, but not higher, for coccydynia have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5298 (2012). 4. Since May 12, 2004, the criteria for a 10 percent rating, but not higher, for left foot plantar fasciitis have been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284 (2012). 5. Since May 12, 2004, the criteria for a 10 percent rating, but not higher, for right foot plantar fasciitis have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 6. Since May 12, 2004, the criteria for a compensable rating for thoracic neuritis have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.7, 4.20, 4.124a, Diagnostic Codes 8311 (2012). 7. The criteria for a compensable rating for eczema prior to March 16, 2007 have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.118, Diagnostic Code 7806 (2012). 8. Since May 12, 2004, the criteria for a rating higher than 20 percent disabling for right deltoid bursitis/right shoulder supraspinatus tendonitis with limitation of motion have not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) As service connection, initial ratings, and effective dates have been assigned, the notice requirements of 38 U.S.C.A. § 5103(a) have been met. VA has fulfilled its duty to assist the Veteran in obtaining identified and available evidence needed to substantiate a claim, and as warranted by law, affording VA examinations. The Veteran was provided the opportunity to meaningfully participate in the adjudication of her claims and did in fact participate. See Washington v. Nicholson, 21 Vet. App. 191 (2007). Hence, there is no error or issue that precludes the Board from addressing the merits of this appeal. Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C.A. § 1155. Evaluation of a service-connected disorder requires a review of a veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1, 4.2 (2012); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply, 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. In Fenderson v. West, 12 Vet. App. 119 (1999), the United States Court of Appeals for Veterans Claims (Court) held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of staged ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Id. at 126-127; Hart v. Mansfield, 21 Vet. App. 505 (2007). Given that the Veteran has appealed the initial evaluations assigned, the severity of her disability is to be considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. Lumbar spine In the April 2005 rating decision at issue VA granted entitlement to service connection for chronic lumbar strain, and assigned a 10 percent evaluation. In a January 2013 rating decision, a 40 percent rating was assigned from May 13, 2010. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. In this appeal, the Board is presented with the issues of what evaluation is warranted for chronic lumbar strain prior to May 12, 2010 and since May 12, 2010. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40 and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Under the general rating formula for diseases and injuries of the spine, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is 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 rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Significantly, these criteria are for application with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a. In light of the evidence presented, the Board finds that a 20 percent rating for a chronic lumbar strain is warranted for the term prior to May 13, 2010. In this regard, service treatment records reveal complaints of back pain since 1998. The Veteran complained of low back pain in September 1998 after she attempted to pick up a wallet from the ground. Her gait was normal at that time. She denied weakness, tingling, and bowel and bladder changes. Low back pain was assessed. Muscle spasms were shown in January 2002. Degenerative disc disease was diagnosed in August 2002. During the January 2005 VA examination, the Veteran described lower sacral and coccyx, as well as upper lower back pain. She denied bowel or bladder symptomatology, and lower extremity radiculopathy. The Veteran denied weakness, lack of endurance and fatigability but claimed stiffness, back spasms and tenderness. She had no incapacitating episodes in the last 12 months but stated that her back pain was so severe at times she felt like she could not move. The Veteran's low back pain precluded any moderate to heavy lifting. Examination revealed mild tenderness to palpation of the upper lumbar musculature without spasm. There was excess lumbar lordosis and the soft tissues of the lower sacral area were tender without heat, redness or soft tissue swelling. Forward thoracolumbar flexion was to 90 degrees, extension to 30 degrees, bilateral rotation to 45 degrees and bilateral lateral flexion to 30 degrees with complaints of soreness of the muscles through all range of motion. She was not hesitant about doing the maneuvers. Her gait was normal. A chronic lumbar strain was diagnosed. There was no loss of motion due to pain or flare up of pain, but overall there was a 30 percent loss of functional capacity due to her unwillingness to perform certain activities because of said pain. In July 2005, the Veteran reported she was diagnosed with lumbar degenerative disc disease and that because of her lumbar disability she had a sciatic condition. Private examiner, Dr. Du, assessed low back pain with neuropathy in April 2006. In April 2006, the Veteran reported having daily back pain with periods of excruciating pain which prevented her from functioning for two to three days. She also related that she had nerve damage secondary to the lumbar spine. At a May 2007 VA examination, the Veteran reported that her low back pain increased in severity since her last VA examination. She reported a history of degenerative disc disease and pain that radiated to her buttocks and alternated from one leg to the other. She also felt weakness, stiffness, intermittent swelling, heat, instability, fatigue and lack of endurance due to mid to low back pain. Precipitating factors included long walks, lifting, excessive house chores or prolonged periods of sitting. She remained unemployed by choice. She denied incapacitating episodes due to severe mid to lower back pain during the prior 12 months prescribed by her doctor but she reported an incident in March 2007 which required her to go to the emergency room. She was placed on bed rest at that time and given three shots of morphine. Examination revealed no redness, swelling or spasm. There was increased lumbosacral lordosis, and mild thoracic kyphosis. The Veteran initially showed some hesitation to perform range of motion and stated that she was already in pain. With pain and grimacing, she flexed to 80 degrees with the onset of pain at 60 degrees, hyperextension was to 30 degrees with the onset of pain at 20 degrees, bilateral bending was to 30 degrees and bilateral rotation was to 30 degrees. The Veteran was unable to perform repetitive movements because of pain. Straight leg raises were negative while sitting down. Deep tendon reflexes were 1+ to 2+ bilaterally, motor strength was 5 on a 0 to 5 scale, and sensory function was intact to both lower extremities. X rays revealed mild levoconvex lumbar scoliosis with narrowing of the L3-L4 disc. The assessments were degenerative disk disease, scoliosis, right sacroiliac joint dysfunction in June 2008. At a December 2008 private examination, the Veteran presented with complaints of bilateral lumbosacral pain which radiated into the upper lumbar area paravertebrally and out over the posterior iliac crest bilaterally. No bowel or bladder problems were reported. Low back pain possible disk derangement with dysfunction and pain was assessed. Although the evidence shows forward thoracolumbar flexion greater than 30 degrees, and a combined range of the thoracolumbar motion greater than 120 degrees during this time, there were findings of an abnormal spinal contour such as scoliosis. To that end, x ray findings in May 2007 revealed mild levoconvex lumbar scoliosis with narrowing of the L3-L4 disc. The findings of scoliosis coupled with the complaints of muscle spasms justify a 20 percent evaluation for chronic lumbar strain prior to May 13, 2010. The Board finds, however, that entitlement to a rating higher than 20 percent disabling is not warranted prior to May 13, 2010. To that end, the functional equivalent of forward thoracolumbar flexion to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine was not shown during this period of time. Rather, even when accounting for pain, the Veteran retained the functional equivalent of forward flexion to 60 degrees during this time. There was never a showing of ankylosis. The above findings are consistent with the 20 percent evaluation but not higher. Furthermore, the Board finds that entitlement to a rating higher than 40 percent disabling for a chronic lumbar strain since May 13, 2010 is not warranted. At the May 2010 VA examination, the Veteran reported constant low back pain which did not radiate to the lower extremities. She denied lower extremity parestheisa, as well as any bowel or bladder dysfunction. She reported, however, that while walking on the treadmill her toes went numb at times but she was uncertain if it was related to her back pain. She denied being prescribed bed rest by a physician within the prior 12 months because of the back. She remained unemployed but remained independent in her basic activities of daily living despite her back disability except for some physical chores. Examination revealed a normal thoracolumbar alignment. Range of motion testing revealed forward flexion limited to 25 degrees because of pain, extension to 10 degrees, right lateral flexion to 15 degrees and left lateral flexion to 20 degrees. All ranges of motion were elicited by pain and after three repetitions there was no loss of excursion due to pain, fatigue, weakness and/or lack of endurance. The above evidence does not show unfavorable ankylosis of the entire thoracolumbar spine at any time since May 13, 2010. Rather, the Veteran retains the functional equivalent of forward flexion to 25 degrees. These findings are consistent with the 40 percent evaluation but not higher. The Board accepts that the Veteran has functional impairment, pain, and pain on motion. It must be recalled, however, that the rating criteria are binding regardless whether there is or is not pain. 38 C.F.R. § 4.71a. Neither the lay nor medical evidence, however, reflects the functional equivalent of the criteria required for the next higher rating. The Board has also considered whether the Veteran's service- connected lumbar spine disability would warrant a higher rating if rated on the basis of incapacitating episodes. Although the Veteran reported an incident in March 2007 which required her to go to the emergency room, she has not reported, and the objective evidence does not show any incapacitating episodes during either time frame in question. In light of the lack of evidence demonstrating any episodes requiring bed rest prescribed by a physician and treatment by a physician for an intervertebral disc syndrome, and indeed, in light of the lack any assertion on the part of the Veteran that the criteria for incapacitating episodes have been met, the Board finds that a higher rating under the formula for rating intervertebral disc syndrome based on incapacitating episodes is not warranted for any period during this appeal. Coccydynia In an April 2005 rating decision, VA granted entitlement to service connection for coccydynia, and assigned a noncompensable rating. In a January 2013 rating decision, a 10 percent rating was assigned from May 13, 2010. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. In this appeal, the Board is presented with the issues of what evaluation is warranted for coccydynia prior to May 13, 2010 and since May 13, 2010. The Veteran's disability is rated by analogy under diagnostic code 5298. 38 C.F.R. § 4.20. Diagnostic Code 5298 assigns a maximum 10 percent evaluation for partial or complete removal of the coccyx with painful residuals. A noncompensable rating is assigned for coccyx removal without painful residuals. 38 C.F.R. § 4.71a. In light of the evidence of record, the Board finds that a 10 percent rating is warranted for coccydynia prior to May 13, 2010. In this regard, service treatment records reveal complaints of coccyx pain since 2001. In May 2002, a one year history of a painful coccyx since a fall was given. Physical examination revealed moderate lower sacrum and coccyx tenderness. Tenderness was also found over the intervertebral soft tissues in February 2003. Dr. Scherrer found that there was mild to moderate coccygeal tenderness without significant coccygeal abnormality. In April 2004, the Veteran reported she was uncomfortable sitting and leaning back. During the January 2005 VA examination, the Veteran reported a tailbone injury while rollerblading on concrete. She described lower sacral and coccyx pain as well as upper lower back pain. According to the Veteran, her pain was so severe she could not go from sitting to a standing position. The pain was described as constantly severe. The Veteran related that she was unable to work because of her pain and injury to her coccyx. Examination revealed mild tenderness to palpation of the upper lumbar musculature without spasm. There was excess lumbar lordosis and soft tissues of the lower sacral area were tender without heat, redness or soft tissue swelling. The coccyx was immobile and was not anymore tender than the rest of the soft tissue areas. Coccydynia was diagnosed. There was no loss of motion due to pain or pain flare ups, but overall there was a 30 percent loss of functional capacity due to the unwillingness to perform certain activities because of pain. Dr. Hope stated in July 2005 that the Veteran had a classic case of pain in the buttock and pelvis region with sitting which would qualify fairly well with coccyodynia. In September 2005, Dr. Reiseck stated that due to the severe pain of the Veteran's coccyx she was unable to sit for periods greater than 10-15 minute intervals and that such was consistent with the examination. The Veteran reported in April 2006 that she had continual pain which prevents her from sitting and sometimes laying on her back. At a May 2007 VA examination, the Veteran reported her coccydynia was of the same frequency and severity of her back pain. Examination revealed the sacrum and coccyx revealed normal bone alignment and mineralization. The sacroiliac joints were well preserved. There was no acute fracture or bony destructive process identified. The impression was unremarkable plain films of the sacrum and coccyx. Coccydynia with no current malalignment or deformity was diagnosed. In the May 2010 VA examination, the Veteran expressed that her disability had increased in severity since the last VA examination. Examination revealed tenderness palpation of the coccyx area. Chronic coccydynia was diagnosed. The objective and subjective evidence summarized above demonstrates that the Veteran's coccydynia has been manifested by painful residuals since the initial grant of service connection to the present. The Board recognizes that objective evidence of record fails to demonstrate that the Veteran has had her coccyx removed. In light of the chronic nature of the Veteran's pain, however, and the grant of a 10 percent rating for coccydynia since May 13, 2010, the Board finds that uniform rating is warranted for the entire appellate term since May 12, 2004. The Board, however, finds that entitlement to a disability rating in excess of 10 percent is not warranted for any period of the claim. In this regard, the Veteran has been assigned the maximum disability evaluation under Diagnostic Code 5298 which requires painful residuals following partial or complete removal of the coccyx. While the Board acknowledges the subjective and objective medical evidence supporting her coccyx pain, the maximum rating available under Diagnostic Code 5298 is 10 percent. The Board has considered whether there is any other schedular basis for granting a rating higher than 10 percent but has found none. Plantar fasciitis In an April 2005 rating decision, VA granted entitlement to service connection for plantar fasciitis of the left and right foot, and assigned a noncompensable rating. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. In this appeal, the Board is presented with the issue of what evaluation is warranted for plantar fasciitis of the left and right feet. The Veteran's disability is rated under by analogy to diagnostic code 5284. 38 C.F.R. § 4.20. Diagnostic Code 5284 addresses foot injuries and provides that injuries of the foot other than those addressed by other diagnostic codes are rated at 10 percent if moderate, and 20 percent if moderately severe 38 C.F.R. § 4.71a, Diagnostic Code 5284. Service treatment records reveal complaints of bilateral foot pain. During the January 2005 VA examination, the Veteran related that she walked outside of her feet. The pain was occasional and her arches were tender to touch. Examination revealed no palpable tenderness to the arches of her feet or manipulation of the foot bones, Achilles or heels bilaterally. Her ankle had slightly reduced dorsiflexion to 10 degrees, as opposed to 20 degrees being normal. There was also slightly decreased eversion strength of her right ankle against resistance. Otherwise, examination of the ankles was normal. Bilateral plantar fasciitis was diagnosed. There was no loss of motion due to pain or flare ups, but there was a minor 10 percent loss of functional capacity due to repetitive weight-bearing activities. In July 2005, the Veteran reported continual pain in both feet which required her to purchase special insoles which did not provide relief. She stated that she believed her condition was moderate. In March 2007, the Veteran expressed that her foot disability affected her employability as she could not stand or walk longer than 30 minutes without throbbing pain in the ball and heel of her feet. She also stated that she could not walk very far, even with arch supports, without having shooting pain in her arches. At a May 2007 private examination, the Veteran complained of foot pain and fatigue off and on for several years. She related that the pain caused both difficulty walking and instability. With "prolonged force," (sic) the foot could be brought to a little less than 90 degrees to the leg at the ankle joint again with knees extended bilateral. With the knees flexed, the foot could move into perhaps one to two degrees in dorsiflexion bilaterally. There was normal subtalar joint motion bilaterally, and higher than normal arch structure bilaterally. There were no digital deformities but tenderness involving the anterior plantar medial aspect of both heels and tenderness along the course of the medial slip of the plantar fascia bilateral. Bilateral foot pain and plantar fasciitis were diagnosed. At a May 2007 VA examination, the Veteran expressed that her foot disability had increased in severity since the last VA examination. She noted some constant heel pain bilaterally, and continuing to feel a burning sensation at bedtime. She tried to use braces for her feet and ankles but without significant improvement. Shoe inserts were reportedly effective. Examination revealed normal arches and pedal pulses were 1+ to 2 + bilaterally. She was able to flex and extend all of her toes. There was mild tenderness to the heels and mid arches, bilateral feet. There was no redness or swelling, and no increase in tenderness with ankle dorsiflexion. Mild plantar fasciitis of the feet was diagnosed. The Veteran presented with considerable discomfort in her feet, even in non-weight and light-weight bearing situations at a June 2007 private examination. She described frequent burning pain in the ball of the foot, medial arch and heel at times. Examination showed the orthotics seemed to fit well. At the May 2010 VA examination, the Veteran reported that her foot disability had worsened since the last VA examination. She described constant foot pain, but offered that with increased pain medication the pain was less consistent. She did complain of pain at rest, upon standing, and with walking. Her foot condition reportedly limited her ability to stand for no more than five minutes. Walking was reportedly limited to a few feet on some days but on other days she could walk almost a mile. She denied swelling. There was no weakness but she complained of redness of the soles of her feet. Examination revealed low arches upon weight bearing with normal Achilles alignment. There were callosities at the level of both first toes, otherwise, no other skin lesions. The feet were not tender on examination. Bilateral plantar fasciitis was diagnosed. Based upon the record, the Board finds that separate 10 percent ratings for left and right plantar fasciitis are warranted. The objective and subjective evidence of record demonstrates continual foot pain and functional limitations caused by the Veteran's foot disability. The Veteran reports foot discomfort bilaterally during weight and nonweight bearing circumstances, as well as foot pain related limitations with standing and walking. She consistently reported constant pain and fatigue, although medications have helped reduce the degree of pain. The above evidence, to include her reports of pain, justifies a finding of moderate disability. Accordingly, 10 percent ratings for plantar fasciitis of each foot are warranted. The Board finds, however, that moderately severe disability is not shown by the record. While the evidence demonstrates that the Veteran's foot disability is productive of pain and functional limitations, she denied redness and swelling. She is also able to flex and extend her toes. At most, the evidence shows a moderate foot disability. The Board considered whether a higher rating is warranted under any other potentially applicable diagnostic code but has determined that the most appropriate diagnostic code for rating the disability is the diagnostic code assigned and that no reasonable basis exists for assigning a higher rating under another diagnostic code. The Veteran is not service connected for hallux valgus, pes planus, weak foot, claw foot, hammertoe, or malunion or nonunion of the tarsal or metatarsal bones, and her plantar fasciitis is not manifested by similar pathology. Hence, consideration of Diagnostic Codes 5276 to 5283 is not warranted. 38 C.F.R. § 4.20 (Conjectural analogies are to be avoided when rating a disorder.) Thoracic neuritis In an April 2005 rating decision, VA granted entitlement to service connection for thoracic neuritis, and assigned a noncompensable rating. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. In this appeal, the Board is presented with the issue of what evaluation is warranted for thoracic neuritis since May 12, 2004. The Veteran's disability is rated by analogy to diagnostic code 8311. 38 C.F.R. § 4.20. Diagnostic Code 8311 addresses neuritis of the 11th cranial nerve, with ratings dependent upon loss of motor function of the sternomastoid and trapezius muscles. A minimum 10 percent evaluation is assigned for incomplete moderate neuritis. A 20 percent evaluation is warranted in incomplete severe cases. In complete cases, a 30 percent evaluation is in assigned. 38 C.F.R. § 4.124a. Service treatment records reveal the Veteran complained of thoracic spine pain since 1998. In July 2000, it was determined that left thoracic back pain was most likely neurologic in origin. During the January 2005 VA examination, the Veteran reported symptoms dating back to May 2000. She reported pressure pain in the left thoracic area that radiates around her chest wall to the front which lasts about 15-20 minutes. She stated it occurred about once a month if she did not get regular massage therapy and about every three months with deep tissue massage therapy. Thoracic neuritis was diagnosed. In June 2005, the Veteran described low thoracic pain which radiated to the front for the prior one to two months. She described a burning like sensation running toward the front as if traveling along with her ribs. Lying down worsened the pain. There was mild tenderness with deep palpation in the thoracic region bilateral to the spine with minimal paresthesia. The Veteran reported in July 2005 that thoracic neuritis required spinal adjustments twice a day, three times per week. Without the above, she stated that her pain intensified greatly. In September 2005, Dr. Reiseck stated that thoracic dysfunction with associated myositis, costochondritis and intercostal neuritis caused the Veteran a great deal of pain, and was objectively elicited upon digital palpation and is consistent with her complaints. At the May 2007 VA examination, the Veteran expressed that her disability had increased in severity since the last VA examination. She described sharp but insidious pain. Thoracic neuritis mild, etiology unknown, was diagnosed. In the May 2010 VA examination, the Veteran stated that her disability had increased in severity since the last VA examination. She described flare ups of severe thoracic back pain intermittently throughout the day which were accompanied by severe chest pain that could last for hours and sometimes days. Examination revealed tenderness with palpation of the thoracic spine. There was also some paraspinal tenderness at the level of the thoracic muscles consistent with mild spasm. A chronic thoracic strain was diagnosed. The evidence summarized above preponderates against entitlement to a higher rating. The current level of disability does not demonstrate incomplete moderate neuritis of the eleventh cranial nerve. Rather, her disability has been described as mild by the VA examiner. Although the Veteran reports thoracic pain, there is no basis for finding incomplete moderate neuritis as would warrant a 10 percent evaluation under Diagnostic Code 8311. Accordingly, the claim is denied. Eczema An April 2005 rating decision, VA granted entitlement to service connection for eczema, and assigned a noncompensable rating. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. Initially, the Board is presented with the issue of what evaluation is warranted for eczema prior to March 16, 2007. The Veteran's disability is rated under Diagnostic Code 7806. Diagnostic Code 7806 provides that when the disorder covers less than 5 percent of the entire body or less than 5 percent of exposed areas are affected, and no more than topical therapy is required during the past 12- month period, a noncompensable rating is assigned. A 10 percent rating is assigned when at least 5 percent, but less than 20 percent of the entire body is covered; or at least 5 percent, but less than 20 percent of exposed areas are affected; or intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, are required for a total duration of less than six weeks during the past 12- month period. Service treatment records reveal that since April 2001 the Veteran complained of eczema of the eyelids. She was shown to have lichenified scaly pink plaques on her eyelids, a scaly plaque on her upper back and a small patch lower. During the January 2005 VA examination, a history was given of eyelid eczema diagnosed in 2002 with symptoms dating back to 2000. The eyelids demonstrated minimal dry scaliness only. Eczema of the eyelids was diagnosed. At a September 2005 private examination, hyperkeratotic lichenified plaques were seen on the eyelids. No gross lymphadenopathy appreciated. Lid eczema was diagnosed. The Veteran reported eczema like lesions on her hands and upper eyelids in November 2005. Examination revealed eczema like lesions on both upper eyelids. Contact dermatitis was diagnosed. The Veteran had a little breakout on the face and trunk in February 2007. Atopic dermatitis with possible secondary infection was assessed. Here, there is no evidence of a skin disability involving at least 5 percent, but less than 20 percent of the entire body is covered; or at least 5 percent, but less than 20 percent of exposed areas are affected. During the term addressed the Veteran did not require intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, for a total duration of less than six weeks during any 12- month period. Furthermore, the use of corticosteroids or other immunosuppressive drugs was not shown by objective evidence during the applicable time. The above findings do not warrant a compensable rating. Neither the pleadings, nor her reports to examiners provide a basis to assign a higher evaluation. Accordingly, the claim is denied. Right shoulder In an April 2005 rating decision, VA granted entitlement to service connection for a chronic right shoulder strain with recurrent instability, and assigned a 10 rating. In a February 2008 rating decision, a 20 percent rating was assigned since May 12, 2004. Given that the Veteran appeals the initial evaluation assigned, the severity of her disability is considered during the entire period from the initial assignment of the disability rating to the present. Fenderson. In this appeal, the Board is presented with the issue of what evaluation is warranted for a chronic right shoulder strain with recurrent instability. The Veteran's right shoulder disability is rated by analogy to Diagnostic Code 5201. 38 C.F.R. § 4.20. Diagnostic Code 5201 addresses limitation of motion of the arm. Limitation of motion of the arm to shoulder level merits a 20 percent evaluation for either arm. Limitation of motion of the arm to midway between side and shoulder level is evaluated as 30 percent for the major arm. 38 C.F.R. § 4.71a. Initially, the evidence shows that the Veteran is right shoulder disorder involves his major arm. Service treatment records reveal complaints of right shoulder pain since February 2002. Painful motion of the right shoulder was reported in January 2004. A February 2004 MRI revealed bursitis and mild tendinopathy associated with bursa. During the January 2005 VA examination, she reported that the onset of her right shoulder pain with bursitis was about three years prior after she restarted upper body weight training. She reported chronic recurring pain since 2001-2002. There was no swelling, redness, instability or locking. She reported that her shoulder fatigued easily and lacked endurance. She also alleged that lifting, typing, sitting, any kind of work with her arms, and reaching back and sideways at an angle exacerbated her pain. She described a constant burning and tight pain in the joint that varied throughout the day. According to the Veteran, she had no true loss of joint motion but she was limited by pain. The Veteran stated that she was unable to work because of her pain and overall multiple injuries. Examination revealed a full range of shoulder motion. She described mild discomfort over the dorsal aspect of the right shoulder with motion from 90-180 degrees. Right deltoid bursitis/right supraspinatus tendonitis was diagnosed. There was no loss of right shoulder motion due to pain or flare ups, but there was an overall 20 percent loss of functional capacity due to self imposed limitation of motion due to pain and flare up of pain with repetitive motion activities. A February 2005 private examination revealed active right shoulder elevation to 150 degrees, abduction to 120 degrees with pain, external rotation to 50 degrees with pain, and internal rotation thumb to the lower thoracic spine. Passive elevation was within normal limits. At that time, she complained of right shoulder pain anteriorly and posteriorly. The Veteran reported in July 2005 that she had continual pain with all shoulder movements, and that the radiating pain in her arm was mild to extreme burning near the shoulder blade anytime she used the shoulder. In April 2006, the Veteran reported constant pain at rest and with motion, excessive fatigability and weakness with repetitive use. At the May 2007 VA examination, the Veteran described daily pain to the right shoulder with pain levels ranging from 1 to 9 on a scale of 1 to 10. She also described weakness, stiffness, fatigue and lack of endurance. The pain was located over the deltoid region as well as posterior right shoulder. Examination revealed normal shoulder contour bilaterally. The Veteran was able to shrug both shoulders. There was no redness or swelling, but there was anterior and posterior shoulder tenderness, and right shoulder acromioclavicular joint tenderness. Range of motion testing showed some hesitation. She had difficulty raising her right shoulder, but was able to lift her arm to 90 degrees without pain but then pain started from 90 to 180 degrees. The Veteran was able to hyperextend and adduct to 50 degrees without pain. Internal and external rotation were to 90 degrees with pain. There was a 10 degree loss of abduction, forward flexion and external right shoulder rotation after three repetitive movements with such loss primarily due to pain. Chronic right shoulder bursitis was diagnosed. The Veteran was afforded a VA examination in May 2010. She, however, declined evaluation of her right shoulder. The VA examiner stated that she was not requesting an increase at that time. The Board finds that the above evidence is against entitlement to a rating higher than 20 percent disabling since May 12, 2004. In this regard, the Veteran's functional use is not limited to the arm to midway between the side and shoulder level. Rather, she is able to lift her arm 90 to 180 degrees with pain, and hyperextend and adduct to 50 degrees without pain. She lost 10 degrees in abduction, forward flexion and external rotation of the right shoulder after three repetitive movements with such loss primarily due to pain. Although the Veteran has reported right shoulder pain, such is considered in the current evaluation. See 38 C.F.R. § 4.59. The Board considered other diagnostic codes pertaining to the shoulder and arm. As there is no showing of ankylosis, however, Diagnostic Code 5200 is not for application. There is also no showing of impairment of the left humerus, or disability comparable therewith. Therefore, Diagnostic Code 5202 is inapplicable. Furthermore, there is no showing of dislocation of the clavicle or scapula and/or nonunion of the clavicle or scapula with loose movement as to warrant a higher rating under Diagnostic Code 5203. There are no other relevant diagnostic codes for consideration. All Claims The Board acknowledges the Veteran's assertions that her disabilities are more severe than evaluated. The Veteran is competent to report her symptoms to include pain and has presented credible testimony in this regard. The Board finds, however, that the objective evidence, which is more probative than the Veteran's lay statements, demonstrates that the criteria for the next higher evaluations have not been met, except where otherwise stated. The more probative evidence consists of that prepared by neutral skilled professionals, and such evidence demonstrates that the assigned ratings are warranted for the Veteran's disabilities. A claim of entitlement to a total disability rating based on individual unemployability has also been considered, however, that benefit was granted from May 12, 2004 to May 12, 2010. Since May 12, 2010, the appellant has been assigned a 100 percent schedular rating. Hence, there is no issue concerning unemployability to address here. The Board considered whether the Veteran's disabilities present an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of extra-schedular ratings is warranted. See 38 C.F.R. § 3.321(b)(1) ; Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). There are no exceptional or unusual factors with regard to the Veteran's disabilities. The threshold factor for extra-schedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluation for that service-connected disability is inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical.") Here, the rating criteria reasonably describe the Veteran's disability levels and symptomatology to include pain, and provide for consideration of greater disability and symptoms than currently shown by the evidence. Thus, her disability picture is contemplated by the rating schedule, and the assigned schedular evaluations are, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extra-schedular consideration is not warranted. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, except to the extent indicated the preponderance of the evidence is against assignment of a higher rating, and the doctrine is not otherwise applicable. See 38 U.S.C.A. § 5107(b). ORDER Entitlement to a 20 rating percent for a chronic lumbar strain since May 12, 2004 is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a rating higher than 40 percent disabling for a chronic lumbar strain since May 12, 2010 is denied. Entitlement to a 10 percent rating, but not more than 10 percent, for coccydynia since May 12, 2004, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a 10 percent rating for left foot plantar fasciitis since May 12, 2004, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a 10 percent rating for right foot plantar fasciitis since May 12, 2004, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a compensable rating for thoracic neuritis since May 12, 2004, is denied. Entitlement to a compensable rating for eczema prior to March 16, 2007 is denied. Entitlement to an increased rating for right deltoid bursitis/right shoulder supraspinatus tendonitis with limitation of motion since May 12, 2004, is denied. REMAND The Board finds that further development is needed for the remaining issue on appeal. To that end, on March 16, 2007, private examiner, Dr. Abangan, stated that the Veteran was well known to him with a long history of eczema. Examination revealed that her eyelids were completely cleared and that the roughness and eczema on the cheek resolved as had the eczema on the shoulder. The only residual lesion was a small portion of her middle finger on the plantar side of the hand. Clinically atopic dermatitis/eczema in good control because of good maintenance was assessed. During this examination, it was noted that the Veteran was using steroids for her skin. At a May 2007 VA examination, the Veteran reported intermittent itching, redness and dryness of the skin over her lower extremities and eyelids. She denied using steroid cream and/or functional loss due to eczema. Examination revealed no redness, dryness, scaling, crusting or swelling to the eyelids. She denied use of steroid cream for her condition. Eczema of the eyelids, currently asymptomatic, was diagnosed. During the January 2008 VA examination, the Veteran complained of a rash on her back, arms and breast which when present were flaky and itchy. Examination revealed the skin was clear and intact without apparent rashes on back, arms, breasts or abdomen. Eczema was diagnosed. The Veteran had an active eruption on her back in January 2008. Follicular eczema was diagnosed. In August 2009 the Veteran expressed that her condition was not limited to her eyelids but affected her face, neck, back, arms, hands, stomach and legs. She stated that her disability requires the use of corticosteroids. During the May 2010 VA examination, the Veteran claimed that her skin disability had worsened since the last VA examination. She described weekly chronic flare ups especially in cold and warm weather. Her eyelids were puffy and itchy. The rash was on her hands, and because of the cracked skin her hands become very painful and she cannot hold objects in her hands. The itching disrupted her sleep. Examination revealed a three by three centimeter patch of erythematous rash with minimal scales, otherwise, no inflammation. The rash was not disfiguring and represented three percent of the exposed body surface skin and less than one and a half percent of the total body surface skin. It was noted that the Veteran had been using flucionlone acetonide solution lotion which a steroid solution. Chronic eczematous dermatitis, percentage of body skin on examination today as described above, the Veteran does describe involvement of more than fifteen percent of her total body skin depending on the flare up was diagnosed. The Veteran reports steroid treatment for her skin disability, and the VA examination and private medical evidence indicates that the Veteran has been prescribed steroid treatment. The evidence, however, is unclear as to whether her treatment includes systemic therapy, such as corticosteroids or other immunosuppressive drugs. Accordingly, the Board finds that a remand is warranted to afford the Veteran a more recent examination and to address whether her skin disability has ever required the use of systemic therapy, such as corticosteroids or other immunosuppressive drugs, and if so since when and for how long. If the appellant's treatment involves the use of topical vs. systemic steroid treatment that fact should be noted. In view of VA's duty to assist obligations, which include the duty to obtain a VA examination or opinion when necessary to decide a claim, and based upon guidance from the United States Court of Appeals for Veterans Claims, remand for the purpose of obtaining a VA examination is required. Accordingly, the case is REMANDED for the following action: 1. Contact the Veteran to request information regarding any evaluation and/or treatment pertaining to her eczema since March 2007. Based on the Veteran's response to the above request, the RO/AMC should make efforts to obtain any outstanding treatment records. All records obtained should be associated with the claims file. If the RO/AMC cannot locate any records requested herein, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO/AMC must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for a VA dermatology examination to determine the severity of her eczema. Access to the Veteran's claims folders, and her Virtual VA file must be provided to the examiner. The examiner must address the medications prescribed to the Veteran and directly address whether intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, have ever been required for a total duration of less than six weeks during any 12-month period since March 16, 2007. The examiner must also review the May 2010 VA examination and private treatment records for the skin and document whether the Veteran's past medications were corticosteroids or other immunosuppressive drugs. A complete rationale must be provided for any opinion offered. 3. The Veteran is hereby notified that it is her responsibility to report for the examinations and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for the aforementioned examination, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. After the development requested has been completed, the RO should review the examination reports to ensure that it is in complete compliance with the directives of this REMAND. The AMC/RO must ensure that the examining physician documented their consideration of Virtual VA. If any report is deficient in any manner, the RO must implement corrective procedures at once. The appellant has the right to submit additional evidence and argument on the matter or matters 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). ___________________________________________ DEREK R. BROWN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs