Citation Nr: 1322848 Decision Date: 07/17/13 Archive Date: 07/24/13 DOCKET NO. 09-24 242 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to a higher initial evaluation for a lumbar spine disability, rated as 0 percent disabling, effective from February 8, 2008 to April 26, 2013 (characterized as residuals of lumbar strain) and rated as 20 percent disabling from April 26, 2013 (characterized as intervertebral disc syndrome, previously rated as lumbar strain). 2. Entitlement to an evaluation higher than 10 percent for sinusitis, effective prior to April 26, 2013, and 50 percent, effective April 26, 2013. 3. Entitlement to an evaluation higher than 10 percent for residuals of a right ankle injury, effective prior to April 26, 2013, and 20 percent, effective April 26, 2013. 4. Entitlement to a compensable evaluation for allergic rhinitis. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Sarah Richmond, Counsel INTRODUCTION The Veteran had active military service from August 1994 to August 1997. This matter comes to the Board of Veterans' Appeals (Board) from an August 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas, which granted service connection for lumbar strain assigning a 0 percent rating, effective February 8, 2008, and denied increased ratings for sinusitis (rated as 10 percent disabling), residuals of a right ankle injury (rated as 10 percent disabling), and allergic rhinitis (rated as 0 percent disabling). In November 2012, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing at the RO. In January 2013, the Board remanded the claim finding that additional development was warranted; specifically VA examinations were necessary to rate the present severity of the disabilities on appeal. Subsequently, VA examinations were provided in April 2013. As a result of these examinations, the RO granted (in effect) a higher initial rating of 20 percent, effective April 26, 2013, for the lumbar spine disability, recharacterizing the disability as intervertebral disc syndrome; granted a separate rating of 40 percent, effective April 26, 2013, for radiculopathy of the right lower extremity associated with intervertebral disc syndrome; granted an increased rating of 20 percent, effective April 26, 2013, for the right ankle disability; and granted an increased rating of 50 percent, effective April 26, 2013, for sinusitis. The Veteran has not indicated that he is satisfied with the ratings assigned for the lumbar spine, right ankle, or the sinusitis. Thus, this claim is still before the Board. AB v. Brown, 6 Vet. App. 35 (1993). As noted in the previous Board remand, the issue of entitlement to service connection for sleep apnea has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. Prior to April 26, 2013, the Veteran's lumbar spine disability is manifested by tenderness on palpation of the lumbar paraspinous, x-ray findings of minimal degenerative changes at L4-5 and L5-S1, some functional impairment in daily activities during flare-ups, complaints of pain and numbness radiating to the right leg, and MRI findings of displacement of the thecal sac and impingement of the right descending L5 nerve root and likely the right S1 nerve root. 2. Effective April 26, 2013, the Veteran's lumbar spine disability is manifested by forward flexion to 45 degrees with no further decrease in motion after repetitive movement, severe intermittent pain, paresthesias and/or dysesthesias, and numbness in the right lower extremity involving the L4-5, S1, S2, and S3 nerve roots (sciatic nerve) on the right, and intervertebral disc syndrome with incapacitating episodes within the last 12 months for at least two weeks but less than four weeks. 3. Prior to April 26, 2013, the Veteran's right ankle disability is manifested by complaints of pain, weakness, and lack of endurance, with some functional impairment in daily activities during flare-ups, localized tenderness and pain on palpation of the soft tissue joints, and painful motion of the right ankle. 4. Effective April 26, 2013, the Veteran's right ankle disability is manifested by complaints of pain, weakness, and lack of endurance, with some functional impairment in daily activities during flare-ups, localized tenderness and pain on palpation of the soft tissue joints, and marked limitation of motion of the right ankle. 5. Prior to April 26, 2013, the Veteran's sinusitis is manifested by subjective complaints of constant symptoms of sinusitis, purulent discharge, bloody nose, sneezing, itchy nose, and headaches with non-incapacitating episodes and antibiotic treatment lasting four to six weeks, without a history of surgery for sinusitis, incapacitating episodes, nor objective findings of sinusitis on x-ray or CT examination; and it was medically determined that the Veteran's sinusitis was in remission. 6. Effective April 26, 2013, the Veteran's sinusitis is described as pansinusitis that is near constant and involves pain and tenderness of the affected sinus and seven or more non-incapacitating episodes over the past 12 months. 7. The Veteran's allergic rhinitis is manifested by 40 percent nasal obstruction on both sides, with no permanent hypertrophy of the nasal turbinates or nasal polyps. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating, but no higher, for service-connected lumbar spine disability have been met, effective prior to April 26, 2013. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DC 5237 (2012). 2. The criteria for a 10 percent rating, but no higher, for radiculopathy of the right lower extremity, secondary to the service-connected lumbar spine disability have been met, effective prior to April 26, 2013. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.124a, DC 8520 (2012). 3. The criteria for a rating higher than 20 percent for service-connected lumbar spine disability have not been met, effective April 26, 2013. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DC 5237 (2012). 4. The criteria for a rating higher than 40 percent for radiculopathy of the right lower extremity, secondary to the service-connected lumbar spine disability have not been met, effective April 26, 2013. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.124a, DC 8520 (2012). 5. The criteria for a rating higher than 10 percent, effective prior to April 26, 2013, or 20 percent, effective April 26, 2013, for the service-connected right ankle disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DC 5271 (2012). 6. The criteria for a rating higher than 10 percent, effective prior to April 26, 2013, or 50 percent, effective April 26, 2013, for the service-connected sinusitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DCs 6513, 6510 (2012). 7. The criteria for a compensable rating for the service-connected rhinitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.71a, DC 6522 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claim, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). An RO letter dated in April 2008 informed the Veteran of all of the elements required by 38 C.F.R. § 3.159(b), as stated above. The Veteran was also notified that he should submit evidence demonstrating the effect that worsening of his right ankle, sinusitis, and allergic rhinitis disabilities had on employment, in that he was told that he could submit statements from employers as to job performance, lost time, or other information regarding how his conditions affect his ability to work. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94 (2010). The April 2008 letter also provided the Veteran with information on how VA determines and assigns effective dates. As such, April 2008 letter satisfied VA's duty to notify. Regarding the lumbar spine disability, in this case, the Veteran is challenging the initial evaluation for his lumbar spine disability assigned following the grant of service connection. In Dingess, the Court held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, because legally sufficient notice was provided in April 2008, and before the claim was readjudicated in the August 2008 rating decision, VA's duty to notify in this case has been satisfied. Regarding the duty to assist, the RO has obtained the Veteran's service records and VA treatment records. The RO also has provided him with VA examinations in April 2008, September 2009, December 2011, and April 2013. The examination reports adequately address all the necessary criteria for rating the claims. The Veteran was afforded a hearing before a Veterans Law Judge (VLJ) in November 2012, in which he presented oral argument. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) (2010) requires that the VLJ/DRO who chairs a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, the Veteran, who was represented by a Veterans Service Organization, acknowledged that the increased rating claims were on appeal and provided testimony regarding the present severity of his disabilities. The VLJ did not specifically note the bases of the prior determinations or the elements that were lacking to substantiate the claims. The VLJ asked specific questions, however, directed at identifying the criteria for an increased rating. The VLJ did not specifically seek to identify any pertinent evidence not currently associated with the claims. This was not necessary, however, because the Veteran volunteered his treatment history and present symptoms. Accordingly, the Veteran is not shown to be prejudiced on this basis. Also, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2), nor has he identified any prejudice in the conduct of the Board hearing. Accordingly, the duty to assist has been satisfied and there is no reasonable possibility that any further assistance to the Veteran by VA would be capable of substantiating his claim. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Because VA's duties to notify and assist have been met, there is no prejudice to the Veteran in adjudicating this appeal. II. Increased Rating The Veteran seeks higher ratings for his service-connected lumbar spine disability, sinusitis, allergic rhinitis, and right ankle disabilities. Disability ratings are based on the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. In a claim for a greater original rating after an initial award of service connection, such as the initial rating claim for the back disability, all of the evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). Although the Veteran's entire history is reviewed when assigning a disability evaluation, 38 C.F.R. § 4.1, where service connection has already been established and an increase in the disability rating is at issue, such as for the increased rating claims for sinusitis, right ankle disability, and allergic rhinitis, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The Court has held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where 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 Veteran bears the burden of presenting and supporting his claim for benefits. 38 U.S.C.A. § 5107(a). In its evaluation, the Board considers all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id. Under the anti-pyramiding provision of 38 C.F.R. § 4.14 , the evaluation of the "same disability" or the "same manifestation" under various diagnoses is to be avoided. The Court held, in Esteban v. Brown, 6 Vet. App. 259 (1994), that for purposes of determining whether the appellant is entitled to separate ratings for different problems or residuals of an injury, such that separate evaluations do not violate the prohibition against pyramiding, the critical element is that none of the symptomatology for any one of the conditions is duplicative of, or overlapping with, the symptomatology of the other conditions. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). A. Lumbar Spine Disability The RO granted service connection for lumbar strain in an August 2008 rating decision, assigning a 0 percent rating, effective February 8, 2008. The Veteran appealed this rating assigned. He is currently assigned a 0 percent rating for his lumbar spine disability (characterized as lumbar strain), effective February 8, 2008, and a 20 percent rating for his lumbar spine disability (characterized as intervertebral disc syndrome), effective April 26, 2013. Effective February 8, 2008 to April 26, 2013, the Veteran's lumbar spine was rated under 38 C.F.R. § 4.71a, DC 5237 for lumbosacral strain. Diagnostic Codes 5235 to 5243 are evaluated under the General Rating Formula for Diseases and Injuries of the Spine (unless DC 5243 is rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes). Under the General Rating Formula for Diseases and Injuries of the Spine, 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, 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 warrants a 10 percent disability rating. 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 warrants a 20 percent disability rating. Forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine warrants a 40 percent disability rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent disability rating. Unfavorable ankylosis of the entire spine warrants a 100 percent disability rating. 38 C.F.R. § 4.71a, DC 5237 (2012). Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal flexion of the thoracolumbar is zero to 90 degrees, extension is 0 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. Effective April 26, 2013, the Veteran's lumbar spine disability is evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5243 for intervertebral disc syndrome. Intervertebral disc syndrome should be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months; a 40 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months; and a 60 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2012). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. A February 2008 VA x-ray examination report shows minimal narrowing at L4-5 and L5-S1. A May 2008 QTC examination report shows the Veteran reported being diagnosed with lumbar disc disease and that the condition had existed since 1996. He reported stiffness, numbness, difficulty twisting, weakness, difficulty lifting heavy objects, and numbness in his entire right leg. The pain in his back was constant and travelled to the legs. Over the past 12 months he described two incapacitating episodes (one in February 2008 for 14 days, and one in April 2008 for 14 days). On objective evaluation, forward flexion of the thoracolumbar spine was to 90 degrees, which is the degree at which pain occurred, extension was to 30 degrees, which is the degree at which pain occurred, and right and left lateral flexion and rotation were each to 30 degrees. Pain occurred at 30 degrees of right rotation. Pain was the major functional impact. There was no additional limitation following repetitive use due to fatigue, weakness, lack of endurance, and incoordination. The inspection of the spine revealed normal head position with symmetry in appearance. There also was symmetry of spinal motion with normal curvatures of the spine. There were no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement. Neurological examination of the lower extremities was within normal limits including motor and sensory function. Reflexes revealed 2+ knee and ankle jerks bilaterally. X-rays of the lumbar spine also were within normal limits. The thoracic spine x-ray showed minimal left curvature of the spine. The diagnosis was lumbar strain; the subjective factors were complaints of low back pain. The objective factors were tenderness on palpation of the lumbar paraspinous. A later May 2008 VA treatment record notes that the Veteran had requested a statement to support his claim for VA benefits. He reported that he started having back problems when he developed a limp and tilt in his back in order to relieve pain and take weight off his right knee and ankle. His back problem had progressively worsened. The physician determined that it was possible the Veteran's back pain could have been caused by the problems in his right knee and ankle. In June 2008, a VA MRI report shows no abnormalities at the T12-L1 level through L3-4 level. At the L4-5 level there was loss of T2 signal of the disc compatible with desiccation. There was a central/ right paracentral focal disc protrusion measuring approximately 3.5 mm AP x 9mm transverse. There was posterior displacement of the thecal sac and impingement of the right descending L5 nerve root and likely the right S1 nerve root. There was no abnormality at L5-S1. A June 2009 VA chiropractor note shows the Veteran's chief complaint was pain radiating down the right leg. He had difficulty walking, which was worse in the morning and when he stood for long periods of time. Low back pain was described at a level of 7 out of 10, constant, chronic, and sharp, that radiated to the right leg with numbness. X-rays of the lumbosacral spine were normal. The assessment was probable lumbar degenerative disc disease/ degenerative joint disease, and probable lumbar herniation. The Veteran was provided with another VA examination in September 2009. At that time the examiner took issue with whether the Veteran's lumbar strain should have been granted service connection in the first place, even though the examiner's primary task was to assess the level of present severity of the lumbar spine disability. The examiner found that the Veteran's current herniated nucleus pulposus at L4-5 with radiculopathy on the right started in January 2004 after he lifted a heavy jug of water, which was after his military service, and that there was no indication that his service-connected ankle, knee, or any other service-connected disability contributed to his back disability. The examiner also determined that the diagnosis of lumbar strain was totally inaccurate and that the Veteran never had lumbar strain. The examiner found that the Veteran's only back disability was herniation of the nucleus pulposus L4-5 that was from a lifting injury in January 2004 that was not caused by or a result of his lower extremity service-connected disabilities. The examiner also physically examined the Veteran and found him to have extreme limitation of motion in the lumbar spine but indicated that this was the result of Waddell's signs (i.e., malingering or over-exaggeration), considering that he did not have any limitation of motion of the spine on the previous examination in 2008. A May 2010 VA treatment record shows an assessment of low back pain with radiculopathy and right knee pain. A November 2010 VA x-ray examination report of the lumbosacral spine shows an impression of minimal degenerative change demonstrated at the facet joints at the lower part of the lumbar spine (L4-5 and L5-S1 levels). On a July 2012 MRI report, it is noted that there was no significant change since the June 2008 MRI report. In January 2013, the Board found that in addressing the issue of the present severity of the Veteran's lumbar spine disability, it was not clear if any of the present impairment in his lumbar spine was a result of his service-connected disabilities and/or his military service. Even though the issue before the Board is not service connection, the original reason why service connection was assigned is significant in this case, as the Veteran is only entitled to compensation for impairment that has been service connected. The Board is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence which does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996). However, the examiner in September 2009 was clear in the assessment that the Veteran's only disability in the lumbar spine was the herniated nucleus pulposus that was not related to his service-connected impairment. The Board indicated in January 2013 that what was left to assess was whether there is any impairment in the spine that is associated with his service-connected right ankle or knee disability, specifically the impairment caused by his favoring his right side and tilting his spine; or his military service. This was not clear from the examinations that were provided in 2008 or 2009. The Veteran testified at the November 2012 Board hearing that he continued to have numbness down his right lower extremity and that he could not stand or sit for prolonged periods of time due to his back pain. Thus, the Board found that another examination was warranted to specifically address the impairment in his lumbar spine that has been attributed to his service-connected right ankle and/or knee disability, if possible, as differentiated from his nonservice-connected impairment due to injury in 2004. An April 26, 2013 VA examination report shows the Veteran reported that his right ankle disability had affected his knee and back. He said that his back hurt during military service but he was never fully evaluated. MRI examination revealed disk protrusion and an annular tear at L4-5 plus severe canal stenosis. Surgery was recommended, but he was only taking pain medication until he had to have surgery. The pain was daily with radiation down the right leg. The Veteran reported flare-ups and difficulty walking with flare-ups. On range of motion testing forward flexion was to 45 degrees with pain beginning at this point; extension was to 10 degrees with pain beginning at that point. Right and left lateral flexion and rotation each were to 30 degrees with no objective evidence of painful motion. After repetitive movement, the ranges of motion in the spine were unchanged. Functional impairment of the spine after repetitive use included less movement than normal, weakened movement, incoordination (impaired ability to execute skilled movements smoothly), pain on movement, disturbance of locomotion, and interference with sitting, standing, and/or weight-bearing. The Veteran had localized tenderness or pain to palpation of the joints and/or soft tissue of the thoracolumbar spine. There was no guarding or muscle spasm. Muscle strength testing was 5 out of 5 in the lower extremities with no muscle atrophy. Reflex examination was 2+ in the knees and ankles; and the sensory examination in the lower extremities was normal. Straight-leg testing was positive on the right side but negative on the left. The Veteran was found to have severe intermittent pain, paresthesias and/or dysesthesias, and numbness in the right lower extremity. Nerve roots involved were the L4-5, S1, S2, and S3 nerve roots (sciatic nerve) on the right. The left side was not affected by radiculopathy. There were no other neurological abnormalities or findings related to the thoracolumbar spine (such as bowel or bladder problems/ pathologic reflexes). The Veteran was found to have intervertebral disc syndrome with incapacitating episodes within the last 12 months for at least two weeks but less than four weeks. There were no assistive devices used, including brace, crutches, or cane. There was no functional impairment of an extremity due to the thoracolumbar spine such that no effective function remained other than that which would be equally-well served by an amputation with prosthesis. There also were no scars or any other pertinent physical findings, complications, conditions, or signs or symptoms. The examiner commented that arthritis was not documented on imaging studies and that there was no vertebral fracture. However, an August 2011 MRI study of the lumbar spine noted posterior disk protrusion with annular tear at L4-5 level with severe spinal canal stenosis. There also was congenital narrowing of the spinal canal from L3 to S1 level due to short pedicles. Finally, it was noted that the Veteran's thoracolumbar spine condition did not affect his ability to work. Finally, the April 2013 VA examiner found that the Veteran's lumbar degenerative disc disease was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran had back pain while in service and there was no other apparent cause of his degenerative disc disease. The examiner further found that it was less likely that the Veteran's back was hurting due to the ankle condition. Thereafter, the RO granted a 20 percent rating for intervertebral disc syndrome, effective the date of the examination, April 26, 2013. Prior to April 26, 2013, the 0 percent rating for the lumbar spine disability remained unchanged. As noted above, the Board is precluded from differentiating between impairment attributed to a service-connected disability and a non-service connected disability in the absence of medical evidence that does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996). Although the September 2009 VA examiner determined that the Veteran did not have lumbar strain and that his herniation of the nucleus pulposus L4-5 was from a post-service injury and was not related to military service or his right ankle disability, the April 2013 VA examiner found that the Veteran's degenerative disc disease was, in fact, due to military service. The rest of the medical evidence does not clearly differentiate between the impairment attributed to the Veteran's service-connected lumbar spine disability and any impairment attributed to his post-service injury in 2004. Therefore, the Board will resolve all doubt in the Veteran's favor and attribute all of the impairment in the Veteran's lumbar spine to his service-connected disability. Prior to April 26, 2013, the Veteran's lumbar spine disability is manifested by complaints of low back pain, with tenderness on palpation of the lumbar paraspinous region. Range of motion, as reported in May 2008, was full with no additional limitations after repetitive motion. Although the forward flexion of the lumbar spine was only to 10 degrees on VA examination in September 2009, the examiner determined that this was a result of the Veteran's lack of effort, or malingering, as this finding was inconsistent with previous findings of record. While range of motion of the lumbar spine was full, the May 2008 report noted localized tenderness in the lumbar spine; specifically there was tenderness on palpation of the lumbar paraspinous region, on objective evaluation. This finding warrants a 10 percent rating under the General Rating Formula for Diseases and Injuries of the Spine, as there is localized tenderness not resulting in abnormal gait or abnormal spinal contour. A rating higher than this is not warranted as there is no limitation of motion, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. In considering a rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, the medical evidence shows that the Veteran does not actually have objectively documented intervertebral disc syndrome prior to April 26, 2013. While the Veteran reported during the May 2008 VA examination that he had two incapacitating episodes lasting for two weeks in 2008, which would normally warrant a 20 percent rating under the rating criteria for incapacitating episodes, the May 2008 VA examination report specifically noted that there was no evidence of intervertebral disc syndrome. Therefore, a rating under the diagnostic criteria for intervertebral disc syndrome is not warranted prior to April 26, 2013. As previously noted, under the General Rating Formula for Diseases and Injuries of the Spine, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code. 68 Fed. Reg. 51,456 (2003) (now codified at 38 C.F.R. § 4.71a, DC 5243 (2012)(Note (1)). The Veteran's radiculopathy of the right lower extremity is presently rated as 40 percent disabling from April 26, 2013 under 38 C.F.R. § 4.124a, Diagnostic Code 8620 for neuritis of the sciatic nerve. Another applicable diagnostic code is Diagnostic Code 8520, which provides the rating criteria for paralysis of the sciatic nerve, and therefore, neuritis and neuralgia of that nerve. 38 U.S.C.A. § 4.124a, Diagnostic Code 8520. 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. Id. Disability ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis which is mild, moderate or moderately severe in degree, respectively. Id. A 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy. Id. 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. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. The Veteran has consistent complaints of pain and numbness radiating primarily to the right lower extremity, as reported on a QTC examination in May 2008, a June 2009 VA chiropractic record, September 2009 VA examination report, and May 2010 VA treatment record. Neurological evaluation of the lower extremities has been normal. However, a June 2008 VA MRI report shows posterior displacement of the thecal sac and impingement of the right descending L5 nerve root and likely the right S1 nerve root. Based on these findings the Board finds that a 10 percent rating is warranted for radiculopathy of the right lower extremity prior to April 26, 2013, for mild incomplete paralysis of the right lower extremity. A rating higher than 10 percent is not warranted, as neurological, sensory, and muscle testing was normal in the right lower extremity. Further a separate rating for radiculopathy of the left lower extremity is not warranted, as the evidence does not show any impairment in the left lower extremity. With respect to a higher rating for the lumbar spine, effective April 26, 2013, as noted, in a May 2013 rating decision, the RO recharacterized the Veteran's lumbar spine disability, as intervertebral disc syndrome, and rated the Veteran's lumbar spine disability as 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5243 for intervertebral disc syndrome, effective April 26, 2013. Intervertebral disc syndrome should be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. In May 2013, the RO also granted a 40 percent rating for radiculopathy of the right lower extremity, effective April 26, 2013, for impairment associated with the Veteran's intervertebral disc syndrome under 38 C.F.R. § 4.124a, Diagnostic Code 8620 for neuritis of the sciatic nerve. The Veteran should either receive a rating under the General Rating Formula for Diseases and Injuries of the Spine with a separate rating for neurological impairment in the right lower extremity; or he can receive one rating under the diagnostic criteria for intervertebral disc syndrome, which would also incorporate any neurological impairment of the right lower extremity. The April 2013 VA examination report shows that a rating higher than 20 percent is not warranted under the General Rating Formula for Diseases and Injuries of the Spine, as forward flexion was to 45 degrees. After repetitive movement, the ranges of motion in the spine were unchanged. These findings do not warrant the next higher 40 percent rating under the General Rating Formula for Diseases and Injuries of the Spine. The April 2013 report further showed that the Veteran was found to have severe intermittent pain, paresthesias and/or dysesthesias, and numbness in the right lower extremity. Nerve roots involved were the L4-5, S1, S2, and S3 nerve roots (sciatic nerve) on the right. Straight-leg testing was positive on the right side but negative on the left. For this reason, the Veteran's radiculopathy of the right lower extremity is presently rated as 40 percent disabling from April 26, 2013 under 38 C.F.R. § 4.124a, Diagnostic Code 8620 for neuritis of the sciatic nerve. A rating higher than 40 percent is not warranted for right lower extremity radiculopathy, as the medical evidence does not demonstrate severe paralysis of the sciatic nerve with marked muscular atrophy. On examination in April 2013, muscle strength testing was 5 out of 5 in the lower extremities with no muscle atrophy. Reflex examination also was 2+ in the knees and ankles; and the sensory examination in the lower extremities was normal. There also were no other neurological abnormalities or findings related to the thoracolumbar spine (such as bowel or bladder problems/ pathologic reflexes). Also, as the left side was not affected by radiculopathy, a separate rating for left side lower extremity radiculopathy is not warranted. Effective April 26, 2013, the Veteran also cannot receive a rating higher than 20 percent under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, as the examination report notes that the Veteran was found to have intervertebral disc syndrome with incapacitating episodes within the last 12 months for at least two weeks but less than four weeks. This meets the criteria for a 20 percent rating, but no higher. In reviewing the medical evidence, it is more favorable to the Veteran to be rated under the General Rating Formula for Diseases and Injuries of the Spine, because under this rating criteria he can receive a 20 percent rating based on limitation of motion, and a separate 40 percent rating for right lower extremity radiculopathy, effective April 26, 2013. While under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, he would only receive a 20 percent rating. For all the foregoing reasons, the Board finds that a 10 percent rating, but no higher, is warranted for the Veteran's lumbar spine disability prior to April 26, 2013, and a separate 10 percent rating, but no higher, for radiculopathy of the right lower extremity is warranted prior to April 26, 2013. Effective April 26, 2013, a rating higher than 20 percent under the General Rating Formula for Diseases and Injuries of the Spine is not warranted; and a separate rating higher than 40 percent for right lower extremity radiculopathy also is not warranted. The Board finds that there are no objective medical findings that would support the assignment of ratings in excess of the 10 and 20 percent ratings assigned for the lumbar spine disability; or ratings in excess of the 10 and 40 percent ratings assigned for radiculopathy of the right lower extremity. B. Right Ankle Disability The RO granted service connection for a right ankle disability in August 2003, assigning a 10 percent disability rating. In February 2008, the Veteran filed an increased rating claim for his right ankle disability. The Veteran testified at the November 2012 Board hearing that he had weakness and instability in the right ankle and that he wore a brace (although it was not clear if this was for his knee or ankle disability). In May 2013, the RO granted an increased rating of 20 percent for the right ankle disability, effective April 26, 2013. The Veteran has not indicated that he is satisfied with this rating. A May 2008 QTC examination report shows complaints of weakness, lack of endurance, and dislocation. He had localized pain characterized as aching and sharp, elicited by prolonged standing or walking. On physical evaluation the right ankle had tenderness. There were no signs of edema, effusion, weakness, redness, heat, or guarding of movement. Range of motion was normal. Pain had the major functional impact, but there was no loss of motion due to pain after repetitive use. Joint function also was not additionally limited after repetitive use by fatigue, weakness, lack of endurance, or incoordination. There was no indication of a malunion to the os calcis or astralgus on the right. X-ray findings of the right ankle were within normal limits. The diagnosis was right ankle tendonitis. The subjective factors were right ankle pain; the objective factors were tenderness on palpation and movement. A December 2011 VA examination report shows the Veteran's continued complaints of weakness and lack of endurance. He indicated that he had to walk more slowly and that the ankle would easily twist. On physical examination of the feet did not reveal any signs of abnormal weight-bearing or breakdown, callosities, or any unusual shoe wear pattern. The Veteran also did not use any sort of assistive device as a normal mode of locomotion, including use of a brace. Muscle strength testing was 5 out of 5 for right ankle plantar flexion and dorsiflexion. There was no ankylosis of the ankle. The right ankle plantar flexion was to 45 degrees or greater with no evidence of painful motion. Right ankle dorsiflexion was to 20 degrees or greater and painful motion began at 15 degrees. The Veteran was able to perform use testing with three repetitions on the right; and after repetitive use his right ankle plantar flexion was to 45 degrees or greater, and dorsiflexion was to 20 degrees or greater. There was no additional limitation in range of motion of the ankle following repetitive use, nor did he have any functional loss and/ or impairment of the right ankle. He had localized tenderness and pain on palpation of the soft tissue joints of the right ankle. The anterior drawer and talar tilt tests did not show laxity of either ankle in comparison. The lower extremities did not have diminished function. X-rays were within normal limits; there was no indication of a malunion or os calcis or astragalus on the right. The diagnosis was unchanged of right ankle sprain. Subjective factors were pain, weakness, and lack of endurance. Objective factors were full range of motion with pain in plantar flexion. The impact of the ankle condition on the Veteran's ability to work was pain, difficulty standing and walking for extended periods of time, and difficulty climbing and descending stairs. The Veteran underwent another VA examination in April 2013. On objective evaluation right ankle plantar flexion was to 20 degrees (with normal endpoint being at 45 degrees); there was no objective evidence of painful motion. Right ankle dorsiflexion was to 10 degrees (with normal endpoint being to 20 degrees); there was no objective evidence of painful motion. After repetitive use testing the range of motion remained the same. Functional impairment in the right ankle included less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, disturbance of locomotion, and interference with sitting, standing, and weight-bearing. The Veteran also had localized tenderness or pain on palpation of the joints/ soft tissue on the right ankle. Muscle strength testing was 4 out of 5 on right ankle plantar flexion and dorsiflexion. There was no laxity or ankylosis. It was noted that the Veteran used a brace regularly. The right ankle disability was not found to impact the Veteran's ability to work. There also was not functional impairment of an extremity such that no effective function remained other than that which would be equally served by an amputation with prosthesis. The Veteran's right ankle disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271 for limitation of motion. Moderate limitation of motion warrants a 10 percent rating. Marked limitation of motion warrants a 20 percent rating. Normal range of motion is from 0 to 20 degrees of ankle dorsiflexion and 0 to 45 degrees of ankle plantar flexion. 38 C.F.R. § 4.71a, Plate II. As noted above, the Veteran's right ankle disability is rated as 10 percent disabling prior to April 26, 2013, and 20 percent disabling, effective April 26, 2013. QTC examination in May 2008 shows that the Veteran had no limitation of motion in the right ankle. While he was noted as having painful motion, there was no limitation of motion shown as a result of the pain. He complained of weakness and lack of endurance in the right ankle, and dislocation. He also had tenderness on palpation. The December 2011 VA examination report notes full dorsiflexion and plantar flexion but notes that painful motion started at 15 degrees of dorsiflexion (which is 5 degrees less than normal). These findings do not demonstrate more than moderate limitation of motion of the right ankle. The evidence does show that the Veteran experiences painful motion of the right ankle; however, it does not result in a separate and/or higher rating unless it actually results in additional functional loss. See Mitchell, 25 Vet. App. at 38-43; DeLuca, 8 Vet. App. at 204-7. Here, recent examination showed no additional loss of motion after repetition; most of the evidence of record shows full range of motion with some painful motion that limited dorsiflexion to 15 degrees. Therefore, a rating higher than 10 percent is not warranted under Diagnostic Code 5271 prior to April 26, 2013. A rating higher than 10 percent also is not warranted under any of the other diagnostic codes pertaining to the right ankle, as the medical evidence shows no ankylosis of the right ankle, or ankylosis of the subastragalar or tarsal joint, malunion of the os calci or astragalus, or astragalectomy. See Diagnostic Codes 5270, 5272, 5273, and 5274. The April 2013 VA examination report shows an increase in limitation of motion of the right ankle in that plantar flexion was only to 20 degrees (rather than the normal 45 degrees, as previously shown), and dorsiflexion was to 10 degrees (rather than the normal 20 degrees). The Veteran also was shown as using a brace for the right ankle. For this reason, the Veteran was assigned an increased rating of 20 percent under Diagnostic Code 5271 for marked limitation of motion. The Board finds that a higher rating is not warranted for the right ankle disability. Twenty percent is the highest schedular rating available under Diagnostic Code 5271. None of the other diagnostic codes pertaining to the ankle apply, as noted above, as the medical evidence after April 26, 2013 continues to show that there was no ankylosis of the ankle, subastragalar, or tarsal joint, malunion of the os calci or astragalus, or astragalectomy. See Diagnostic Codes 5270, 5272, 5273, and 5274. The Veteran is competent to report symptoms associated with his right ankle disability, and there is no reason shown to doubt his credibility in this regard. However, as a layperson, lacking in medical training and expertise, he cannot provide a competent opinion on a matter as complex as the severity of the clinical manifestations of his right ankle disability and his views are of little probative value. And, even if his opinion were entitled to be accorded greater probative value, it is far outweighed by the medical evidence of record demonstrating clinical analysis of the right ankle. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In view of the foregoing, the preponderance of the evidence is against the claim for ratings higher than 10 percent prior to April 26, 2013, and 20 percent, effective April 26, 2013 for the Veteran's right ankle disability; there is no reasonable doubt to be resolved; and an increased rating is not warranted. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 57-58. C. Sinusitis/ Allergic Rhinitis The RO granted service connection for allergic rhinitis in January 1999 assigning a 0 percent rating. In January 2005, the RO granted service connection for sinusitis, secondary to allergic rhinitis, assigning a 10 percent rating. An increased rating for sinusitis and allergic rhinitis was denied in March 2006. The Veteran filed his present claim in February 2008. In May 2013, the RO granted an increased rating of 50 percent for sinusitis (recharacterizing the disability as chronic pansinusitis), effective April 26, 2013. The Veteran is assigned a 10 percent rating for sinusitis under the General Rating Formula for Sinusitis (DCs 6510 through 6514), effective prior to April 26, 2013, and 50 percent, effective April 26, 2013. 38 C.F.R. § 4.97 (2012). A 10 percent rating is assigned for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is assigned for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is assigned following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. A Note to the General Rating Formula for Sinusitis provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97. The Veteran is rated as 0 percent disabled for allergic rhinitis. Under 38 C.F.R. § 4.97, DC 6522 (2012), allergic rhinitis without polyps, but with greater than 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side warrants a 10 percent rating. Allergic rhinitis with polyps warrants a 30 percent rating. Where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (2012). Examination provided in April 2008 shows the Veteran reported being diagnosed with sinusitis and allergic rhinitis since 1994. He described sinus problems as being constant and noted that he was incapacitated as often as three times per week, with each incident lasting for two days. He experienced headaches with his sinus episodes and antibiotic treatment lasting four to six weeks was needed for his sinus problems. He reported purulent discharge from the nose, hoarseness of the voice, and running nose. He had no interference with breathing through the nose, pain, and crusting. Nose bleeding occurred in the morning and it was hard to swallow. Physical examination showed no sinusitis was detected. Examination of the nose revealed nasal obstruction in the right nostril of 40 percent and the left 40 percent. There were no nasal polyps. Rhinitis present was believed to be allergic in origin because of the sneezing and itchy nose. It was noted in the diagnosis section that the VA established diagnoses of sinusitis and allergic rhinitis were unchanged. There were subjective complaints of sinusitis and sneezing, itchy nose, but no objective findings of sinusitis on examination, which meant the sinusitis was likely in remission. There was swelling and redness of the nasal mucosa on examination with no bacterial rhinitis. Examination provided in September 2009 shows that x-rays showed no radiographic evidence of sinusitis or signs of sinusitis. However, the Veteran reported nasal congestion and bleeding from the nose every morning. His symptoms were worse during in the cold and during pollen season. He stated that he used nasal drops, albuterol inhaler, and loratadine, although these prescriptions were shown as expired in the medical records. He also was prescribed pseudoephedrine in November 2008 for chronic rhinitis. Computed tomography examination in November 2010 continued to show no evidence of sinusitis. The Veteran testified at the November 2012 Board hearing that he had nasal discharge involving blood and mucus primarily in the morning but that some of his symptoms persisted all day long including itchiness, post-nasal drip, and coughing. He also indicated that he had a couple of sinus infections in the last year and that he went to the doctor for these infections and was prescribed antibiotics. He further stated that his doctor told him about a year ago that he might need nasal surgery because there was some sort of obstruction. The Board determined in January 2013, that although the medical evidence of record prior to the Board hearing did not indicate impairment that would likely warrant higher ratings, the Veteran's testimony suggested that his service-connected sinusitis and allergic rhinitis might have increased in severity since that time, as he stated that he had sinus infections requiring antibiotics and was told he had some sort of nasal obstruction for which he might need surgery. For this reason, it was determined that additional examinations were warranted to assess the present severity of his service-connected sinusitis and allergic rhinitis. In April 2013, a VA examination shows the Veteran had near constant sinusitis with pain and tenderness of the affected sinus. He also had seven or more non-incapacitating episodes of sinusitis over the past 12 months. He had not had any incapacitating episodes. He also had had no sinus surgery. Regarding his rhinitis, he did not have greater than 50 percent obstruction on both sides or complete obstruction on one side due to rhinitis. There was not permanent hypertrophy of the nasal turbinates or nasal polyps. He also did not have any granulomatous conditions. X-rays of the paranasal sinuses were pneumatized; there was no mucosal thickening or fluid level. The nasal septum was midline and bony walls were intact. The examiner determined that the Veteran's sinus and nose condition did not affect his ability to work. The RO assigned a 50 percent rating for the Veteran's sinusitis on the basis of the April 2013 VA examination report. The medical evidence shows that prior to April 26, 2013, the Veteran is not entitled to a rating higher than 10 percent for his sinusitis. In April 2008 the Veteran described being incapacitated from sinus problems as often as three times per week. However, the rating criteria for sinusitis specifically note that incapacitating episodes means that bed rest and treatment is required by a physician. The Veteran did not indicate that a physician had required him to have bed rest and be treated during these episodes. Therefore, the incidents described by the Veteran do not constitute incapacitating episodes as contemplated by the rating criteria for sinusitis. The Veteran noted that his symptoms were constant and had complaints of sinusitis and sneezing, itchy nose, purulent discharge, bloody nose, and headaches with non-incapacitating episodes and antibiotic treatment lasting four to six weeks. He testified at the November 2012 Board hearing that he had nasal discharge involving blood and mucus primarily in the morning but that some of his symptoms persisted all day long including itchiness, post-nasal drip, and coughing. He also indicated that he had a couple of sinus infections in the last year and that he went to the doctor for these infections and was prescribed antibiotics. These findings are more consistent with the rating criteria for a 10 percent rating for sinusitis under General Rating Formula for Sinusitis. While the Veteran has described near constant symptoms of sinusitis, there is no evidence of surgery or repeated surgeries because of his sinusitis. So the rating criteria for a 50 percent rating would not apply based on these complaints. It is also significant that there are no objective findings of sinusitis on x-ray or CT examination; and it was medically determined that the Veteran's sinusitis was in remission. Effective April 26, 2013, the Veteran also is not entitled to a rating higher than 50 percent for sinusitis. Specifically 50 percent is the highest schedular rating available; and none of the other diagnostic codes under 38 C.F.R. § 4.97 address sinusitis impairment. Regarding allergic rhinitis, the Veteran is not entitled to a compensable rating, as the medical evidence does not show any polyps, or greater than 50 percent nasal obstruction on both sides, or complete nasal obstruction on one side. The April 2008 VA examination report shows that there were no polyps and only 40 percent nasal obstruction on both sides. Rhinitis present was believed to be allergic in origin because of the sneezing and itchy nose. Although the Veteran testified at the November 2012 that his doctor told him about a year ago that he might need nasal surgery because there was some sort of obstruction, examination in April 2013 showed that he did not have greater than 50 percent obstruction on both sides or complete obstruction on one side due to rhinitis. There also was not permanent hypertrophy of the nasal turbinates or nasal polyps. The Veteran is competent to report symptoms associated with his sinusitis and allergic rhinitis disorders, and there is no reason shown to doubt his credibility in this regard. However, as a layperson, lacking in medical training and expertise, he cannot provide a competent opinion on a matter as complex as the severity of the clinical manifestations of his sinusitis and allergic rhinitis and his views are of little probative value. And, even if his opinion were entitled to be accorded greater probative value, it is far outweighed by the medical evidence of record demonstrating clinical analysis of the sinuses and nose. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In view of the foregoing, the preponderance of the evidence is against the claim for a rating higher than 10 percent for sinusitis prior to April 26, 2013, and 50 percent, effective April 26, 2013 for the service-connected sinusitis; or a compensable evaluation for the service-connected allergic rhinitis; there is no reasonable doubt to be resolved; and an increased rating is not warranted. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 57-58. III. Total Disability Rating Based on Individual Unemployability (TDIU) An inferred claim for a TDIU under Rice v. Shinseki, 22 Vet. App. 447 (2009) also has been considered. It is noted that the Veteran's back disability somewhat affects his work in that he has pain with prolonged sitting and standing. However, the record does not show the Veteran has been rendered unemployable as a result of his back disability, right ankle disability, sinusitis, and/or allergic rhinitis. He testified at the Board hearing that he was employed as a computer programmer. Therefore, any inferred TDIU claim is inapplicable in this case. IV. Extraschedular Rating The rating schedule represents as far as is practicable, the average impairment of earning capacity. Ratings will generally be based on average impairment. See 38 C.F.R. § 3.321(a), (b) (2012). To afford justice in exceptional situations, an extraschedular rating can be provided. See 38 C.F.R. § 3.321(b). The Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted in Thun v. Peake, 22 Vet. App. 111 (2008). First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the C&P Service to determine whether, to accord justice, the veteran's disability picture requires the assignment of an extraschedular rating. The symptoms associated with the Veteran's the lumbar spine disability with radiculopathy (i.e., painful motion, and radiating pain and decreased sensation into the right lower extremity, as well as severe intermittent pain, paresthesias and/or dysesthesias, and numbness in the right lower extremity involving the sciatic nerve) are not shown to cause any impairment that is not already contemplated by the rating criteria. The 10 and 20 percent ratings assigned under DC 5237 contemplate symptoms such as localized pain and limitation of motion in the spine due to pain; and the separate 10 and 40 percent ratings under DC 8520 contemplate mild to moderately severe neurological impairment from the sciatic nerve. The symptoms associated with the right ankle disability (i.e., limitation of motion) are contemplated by the 10 and 20 percent ratings assigned under DC 5271. The Veteran also had complaints of weakness, instability, and was prescribed a right ankle brace; but his muscle strength testing in the ankle was 5 out of 5, and 4 out of 5, with no laxity shown. The symptoms associated with the Veteran's sinusitis (i.e., constant purulent discharge, bloody nose, sneezing, itchy nose, and headaches with non-incapacitating episodes and antibiotic treatment lasting four to six weeks ) and rhinitis are not shown to cause any impairment that is not already contemplated by the rating criteria. The 10 percent rating assigned under DC 6513 contemplates symptoms such as three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting; the 50 percent rating under DC 6510 contemplates near constant sinusitis characterized by headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries; and the 0 percent rating under DC 6522 is appropriate for the allergic rhinitis as the evidence does not show any polyps or sufficient nasal obstruction to warrant a compensable rating. Thus, the Board finds that these rating criteria reasonably describe the Veteran's disabilities. For these reasons, referral for consideration of an extraschedular rating is not warranted for this claim. ORDER Entitlement to an initial evaluation of 10 percent, but no higher, for a lumbar spine disability, effective from February 8, 2008 to April 26, 2013 (characterized as residuals of lumbar strain), is granted, subject to the rules governing payment of monetary benefits. Entitlement to a separate 10 percent rating, but no higher, for radiculopathy of the right lower extremity is granted, effective prior to April 26, 2013, subject to the rules governing payment of monetary benefits. Entitlement to an initial evaluation higher than 20 percent for a lumbar spine disability (characterized as intervertebral disc syndrome, previously rated as lumbar strain), effective April 26, 2013, is denied. Entitlement to a separate rating higher than 40 percent for radiculopathy of the right lower extremity, effective April 26, 2013, is denied. Entitlement to an evaluation higher than 10 percent for sinusitis, effective prior to April 26, 2013, and 50 percent, effective April 26, 2013, is denied. Entitlement to an evaluation higher than 10 percent for residuals of a right ankle injury, effective prior to April 26, 2013, and 20 percent, effective April 26, 2013, is denied. Entitlement to a compensable evaluation for allergic rhinitis is denied. ____________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs