Citation Nr: 1323597 Decision Date: 07/24/13 Archive Date: 08/01/13 DOCKET NO. 09-14 331 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to a rating in excess of 10 percent for osteoarthritis and degenerative disc disease of the lumbar spine with a history of low back strain, prior to January 6, 2009 and beyond 20 percent thereafter. 2. Entitlement to a rating in excess of 20 percent for osteoarthritis and degenerative disc disease of the lumbar spine with a history of low back strain, beginning January 6, 2009. REPRESENTATION Veteran represented by: Virginia Department of Veterans Services WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Nadine W. Benjamin, Counsel INTRODUCTION The Veteran served on active duty from July 1978 to February 1979. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. FINDINGS OF FACT 1. Prior to January 6, 2009, the Veteran's lumbosacral spine disability has been manifested by forward flexion to no less than 90 degrees; no muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour; and no incapacitating episodes. 2. From January 6 2009, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. 3. Sciatica and mild radiculopathy of the right lower extremity is associated with the Veteran's service-connected lumbar spine disorder, beginning on June 9, 2008. CONCLUSIONS OF LAW 1. Prior to January 6, 2009, the criteria for an evaluation in excess of 10 percent for osteoarthritis and degenerative disc disease of the lumbar spine, with a history of low back strain, are not met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, 5235-5243 (2009). 2. From January 6, 2009, the criteria for an evaluation in excess of 20 percent for osteoarthritis and degenerative disc disease of the lumbar spine, with a history of low back strain, are not met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, 5235-5243 (2012). 3. The criteria for a separate evaluation for right lower extremity radiculopathy have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243, Note (1) (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS With respect to the Veteran's claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2012). Proper notice from VA must inform the Veteran of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the Veteran is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The RO's November 2007 and August 2008 letters to the Veteran satisfied the duty to notify provisions relating to the Veteran's claim at issue herein. 38 U.S.C.A. § 5103 (a); 38 C.F.R. § 3.159 (b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The purpose behind the notice requirement has been satisfied because the Veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claim, including the opportunity to present pertinent evidence. Additionally, an August 2008 letter to the Veteran notified him that he must submit, or request that VA obtain, evidence of the worsening of his disabilities and the different types of evidence available to substantiate his claim for a higher rating. Moreover, this letter informed him of the requirements to obtain higher ratings and notified him of the need to submit evidence of how such worsening effected his employment. For these reasons, the Board finds that the content requirements of the notice VA is to provide have been met and no further development is required regarding the duty to notify. See Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). The duty to assist the Veteran has been satisfied in this case. The RO has obtained the Veteran's service treatment records and his identified VA and private treatment records. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Moreover, the Veteran has been afforded VA examinations that are adequate for rating purposes. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Specifically, the November 2007, January 2011 and May 2012 VA examiners took into account the Veteran's statements and treatment records, which allowed for a fully-informed evaluation of the claimed disability. Id. The Veteran himself has not submitted any statement that his disability has worsened or provided evidence of a material change in his condition since he was last examined. As such, there is no indication in the record that additional evidence relevant to the issues being decided herein is available and not part of the record. See Pelegrini, 18 Vet. App. at 120. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); see also Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination); Fenstermacher v. Phila. Nat'l Bank, 493 F.2d 333, 337 (3d Cir. 1974) ("[N]o error can be predicated on insufficiency of notice since its purpose had been served."). In July 2011, and again in April 2012, the Board remanded this claim for additional development. At that time the issues were whether new and material evidence had been submitted to reopen the claim of entitlement to service connection for a left knee strain and entitlement to an increased rating for osteoarthritis and degenerative disc disease of the lumbar spine with a history of low back strain, currently evaluated as 10 percent disabling. The Board reopened the claim for service connection for a left knee strain and remanded the issue for development. While the case was in remand status, the RO granted service connection for a left knee disability. The RO also granted a 20 percent evaluation for the Veteran's low back disorder effective from January 6, 2009. Because the increase in the evaluation of the Veteran's back disorder does not represent the highest possible evaluation available for the condition, the claim remains in appellate status. AB v. Brown, 6 Vet. App. 35 (1993) (finding that where a claimant has filed a notice of disagreement as to an RO decision assigning a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule). 38 C.F.R. Part 4 (2012). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2012). In resolving this factual issue, the Board may only consider the specific factors as are enumerated in the applicable rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2012). Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). This involves a factual determination of the current severity of the disability. Id. at 58. Staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). In determining the applicable disability rating, pertinent regulations do not require that all cases show all findings specified by the Schedule; rather, it is expected in all cases that the findings be sufficiently characteristic as to identify the disease and the resulting disability, and above all, to coordinate the impairment of function with the rating. 38 C.F.R. § 4.21 (2012). Therefore, with respect to each of the claims herein, the Board will consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Service connection for low back strain was granted by an April 1979 rating decision, and a 20 percent evaluation was assigned. See 38 C.F.R. § 4.71a, Diagnostic Code 5293 (1979). In April 1981 the RO assigned a 10 percent evaluation for the disorder, effective from July 1, 1981. In August 2007, the Veteran submitted a claim for an increased evaluation for his low back strain. The Veteran's claim was denied in the April 2008 rating decision, and the Veteran perfected the current appeal. Subsequently, in a January 2013 rating decision, the RO partially granted the Veteran's claim for an increased evaluation. A 20 percent evaluation was assigned under 38 C.F.R. § 4.71a, Diagnostic Code 5237, effective January 6, 2009. Consequently, staged ratings have been created. Hart, 21 Vet. App. at 509. Under 38 C.F.R. § 4.71a, Diagnostic Code 5237, lumbosacral strains are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. The General Rating Formula states that a 10 percent disability rating is warranted 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 disability rating is warranted 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 disability rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. See 38 C.F.R. § 4.71a, General Rating Formula. Ankylosis is "immobility and consolidation of a joint due to a disease, injury, surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th Ed. 1987)). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are rated separately under an appropriate diagnostic code. Id. at Note (1). The Board has reviewed all the evidence of record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Prior to January 6, 2009 Private medical records received in November 2008 show that in July 2007, the Veteran was seen after he reported that one day prior, he was trying to prevent a ladder from falling and suddenly developed pain in his back on the left side. He reported having chronic back problems but that this sudden movement of trying to hold the ladder put him in more pain. He denied any bowel or bladder dysfunction. Examination showed tenderness on the left lower side of the back. Movement around the spine and reflexes were within normal limits. The Veteran underwent a QTC examination in November 2007. He complained of stiffness, with no weakness, but with pain, which traveled to the leg. He stated that pain could be elicited by physical activity and was relieved by medication. The Veteran reported having incapacitating episodes as often as two times per year which lasted for three to four days. He stated that over the past year he had two to three incidents of incapacitation for a total of seven days. The examiner stated that the Veteran's gait and posture were within normal limits and that he required no assistive device for ambulation. Examination revealed no evidence of radiating pain on movement. Muscle spasm was absent. There was tenderness and straight leg raising was negative on the right and left. There was no ankylosis. Flexion was to 90 degrees and extension was to 30 degrees. Right and left lateral flexion were to 30 degrees and right and left rotation were to 30 degrees. The examiner stated that there were no signs of intervertebral disc syndrome, without chronic and permanent nerve root involvement. Motor function and sensory function were within normal limits. Right and left knee and ankle jerks were 2+. X-rays showed minimal arthritic changes at L5-S1. The examiner stated that the established diagnosis of low back strain had progressed to osteoarthritis, lumbar spine. VA outpatient treatment records show treatment for complaints of back pain from his neck to his legs beginning in 2008 and private treatment records show continuing treatment for low back complaints. As to the VA treatment, in June 2008, the Veteran complained of sciatica down both legs, with the right being worse than the left. Radiculopathy to the right buttock, down the right posterior thigh to the knee region, had been constant over the past six months. It was noted the Veteran had been treated with medication and had gone through physical therapy. Later that same month, an magnetic resonance imaging scan (MRI) showed degenerative changes at the L5-S1 level, with mild bulging of the disc. In July 2008, the Veteran complained of back pain from his neck to his legs since he had awakened that morning. He indicated that he had stepped from a curb higher than he had anticipated the day before and felt a pinch in his back. He complained of tingling in his back and legs. Again in July 2008, he complained of low back pain, with associated radiculopathy involving the right posterior leg. He reported having misstepped from a curb a few days prior. Examination showed pain with change of position and a positive straight leg raising on the right. Later in July 2008, on a pain consultation, the Veteran reported having sharp cutting pain with burning and pins and needles. On sensory examination, light touch was decreased o the right, S1. The preliminary diagnosis was, right S1 arthropathy, right S1 radiculopathy, and right lower lumbar facet mediated pain. The examiner noted uncertainty as to if the right thigh pain is radiation from S1 joint or if it is true S1 radiculopathy. In August 2008, he complained of back pain and requested medication. The pain was noted too be in the lower back radiating down the right leg. In September 2008, the Veteran underwent a right sacroiliac steroid injection. The diagnosis was sacroilitis. After a review of all the evidence, lay and medical, in this Veteran's case, the Board finds that a preponderance of the evidence is against the claim for an increased evaluation in excess of 10 percent for service-connected chronic low back disorder prior to January 6, 2009. For this rating period, even with consideration of additional limitations and function due to pain and other limiting factors, the Veteran's service-connected lumbosacral spine disability did not manifest forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, 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, as required for an evaluation in excess of 10 percent under the General Rating Formula, or incapacitating episodes of intervertebral disc syndrome of at least two weeks in duration, for an evaluation in excess of 10 percent under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. 38 C.F.R. § 4.71a. In this regard flexion was to 90 degrees, and the combined range of motion was 140 degrees. The examiner noted no muscle spasm or guarding present that produced an abnormal gait or abnormal spinal contour. His posture was normal. The Veteran stated that he had incapacitating episodes. However, there is no evidence in the evidence of record showing that bedrest was prescribed by a physician. Therefore, the criteria for a rating in excess of 10 percent is not warranted under Diagnostic Code 5243. Here, the QTC examiner noted in November 2007 that the function of the spine was limited after repetitive use due to pain, fatigue, lack of endurance, and incoordination, but not weakness. However, the examiner found no additional limitations of motion after repetition. Thus, even if pain, fatigue, lack of endurance, and incoordination, is taken into consideration, the range of motion measurements do not meet the criteria for a higher rating. The Veteran contends that his service-connected disability is more disabling than reflected in the current rating percentages assigned. In this regard, lay statements are considered competent evidence when describing symptoms or an event. However, symptoms must be viewed in conjunction with the examination of clinical data gathered by competent medical professionals. See Massey, 7 Vet. App. at 208. The Board finds the specific clinical measures of ranges of motion are of more probative value than the general descriptions of symptoms of pain or limitations provided by the Veteran. Thus, the more probative evidence does not show that pain or other factors have resulted in additional functional limitation or limitation of motion to enable an increased evaluation under the General Rating Formula. The Board has also considered whether any separate evaluations are applicable for additional disability or neurological disorders associated with the service-connected back disability. As noted above, VA outpatient treatment records dated beginning on June 9, 2008 show findings of sciatica associated with the Veteran's service-connected low back disorder. The Board finds that a separate evaluation for radiculopathy is warranted as an associated neurologic manifestation of the service-connected lumbar spine disability. 38 C.F.R. § 4.71a, General Rating Formula at Note (1). The Board finds that the weight of the evidence is against a finding of an evaluation in excess of 10 percent for the Veteran's service-connected low back disorder at any time prior to January 6, 2009, but that a separate rating for right lower extremity radiculopathy is warranted. From January 6, 2009 Private records show treatment and physical therapy in 2009. In January 2009, range of motion of the lumbar spine was recorded as flexion to 50 degrees, extension to 60 degrees and rotation to 62 degrees on the right and to 55 degrees on the left. In February 2009, flexion was to 50 degrees, extension was to 50 degrees, rotation on the right was to 55 degrees, and rotation to the left was to 60 degrees. In April 2009, flexion was to 50 degrees, extension was to 140 degrees, rotation on the right was to 55 degrees, and rotation to the left was to 60 degrees. The Veteran underwent a VA QTC examination in January 2011. The Veteran's history was noted. He reported limitation in walking due to his spine and spasms in his back and legs, and that on average he could walk 30 feet. He complained of spasms, decreased motion, pain, and paresthesias. He reported weakness, but no bowel problems, bladder problems, or erectile dysfunction. He stated that he had a tingling sensation on the right side. Examination showed a 1.3 centimeter (cm.) by 0.5 cm. scar on the posterior side of the trunk which was described as superficial, with no underlying tissue damage, inflammation, edema, or keloid. The scar was not disfiguring, and did not limit motion or function of the spine. The Veteran stated the scar was caused by epidural surgery of the back in 2007. He stated that the scar was not painful. The Veteran's posture was normal and his gait was within normal limits. His walking was steady and he used no assistive device for ambulation. There was no evidence of radiating pain on movement and muscle spasm was absent. There was no guarding or weakness, and muscle tone was normal. Flexion was to 90 degrees and with repetition it was 90 degrees. Extension, right and left lateral flexion, and right and left rotation were to 30 degrees. With repetition there was no additional degree of limitation. Accordingly, the examiner found that the function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. X-rays showed moderate spondylosis at L5-S1. The examiner stated that there were no sensory deficits from L1-L5 or the S1 as tested on pinprick. Reflexes in the lower extremities were normal. The examiner diagnosed status post epidural steroid injection lumbar spine, with normal healed surgical scar, and osteoarthritis of the lumbar spine, with degenerative disc disease. In March 2011, private records show that the Veteran injured his back while lifting at work. He reported having pain that radiated down his right leg, accompanied by numbness down to his right thigh. There was no bowel or bladder dysfunction. The examiner stated that flexion was limited due to pain, but that lateral bending and extension were full. The back was tender to palpation along the low lumbar area. Straight leg raising was negative, bilaterally, and the Veteran's gait was normal. Deep tendon reflexes were 2+ and equal, bilaterally. In May 2011, flexion was to 60 degrees, and extension was to 20 degrees. Right and left lateral flexion were to 20 degrees and right rotation was to 30 degrees. Left rotation was to 25 degrees. Deep tendon reflexes were 2+. The Veteran was examined by VA in May 2012. The examiner noted that lumbar degenerative disc disease and degenerative joint disease had been diagnosed. The Veteran reported having flare-ups weekly of moderate sharp pain, which lasted approximately eight to 12 hours. Flexion was to 40 degrees, with painful motion at 40 degrees. Extension was to 20 degrees, with painful motion at 20 degrees. Right and left lateral flexion were to 20 degrees, with painful motion at 20 degrees. Right and left lateral rotation were to 20 degrees, with painful motion at 20 degrees. The Veteran was able to perform repetitive use tests, with three repetitions. Flexion ended at 40 degrees, extension ended at 20 degrees, right and left lateral flexion ended at 20 degrees, and right and left lateral rotation ended at 20 degrees. The examiner noted there was no additional limitation of motion following repetitive testing. There was no tenderness, guarding, or muscle spasm. Muscle atrophy was not shown. Deep tendon reflexes were 2+, bilaterally, in the knees and ankles. There was decreased sensation in the right lower leg, and straight leg testing was positive on the right and negative on the left. Symptoms of radiculopathy were noted. There was moderate intermittent pain and moderate paresthesia in the right lower extremity. The examiner noted involvement of the nerve roots at the L4/L5/S1/S2/S3 levels on the right. The radiculopathy on the right was noted as mild. The examiner found intervertebral disc syndrome (IVDS), without incapacitating episodes over the past 12 months. It was noted that the Veteran used no assistive devices. X-rays documented arthritis, and an MRI showed degenerative changes, with no evidence of root impingement. An EMG was normal, with no evidence of radiculopathy. The examiner indicated that the disorder impacted on the Veteran's ability to work since he needed help to lift things. Based upon these findings and the lay evidence of record, the Board finds the assignment of an increased rating in excess of 20 percent for a lumbosacral spine disability is not warranted for this time period, as the requirements of forward flexion of the thoracolumbar spine 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes of intervertebral disc syndrome of at least four weeks in duration, were not met at any time during this period on appeal. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Private records show flexion was to 50 degrees, and extension was to 50 degrees on one occasion and to 60 degrees on another. These findings do not show that flexion is 30 degrees or less or that there is ankylosis, and therefore do not meet the criteria for a rating in excess of what is currently assigned. The May 2012 VA examiner noted objective evidence of pain on active range of motion testing and following repetitive motion. However, no additional limitation following repetition was found. Thus, even if the pain is taken into consideration, the range of motion measurements still do not meet the criteria for an increased rating. The specific clinical measures of ranges of motion, including examiner's findings and opinions regarding additional limitation of motion due to pain, weakness, fatigue, and incoordination, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general descriptions of symptoms of pain or limitations. The overall evidence does not show that pain or other factors have resulted in additional functional limitation or limitation of motion to enable a finding that the disability picture more nearly approximates a 40 percent evaluation under the General Rating Formula. The Board has considered whether a rating in excess of 20 percent is warranted under Diagnostic Code 5243 based on incapacitating episodes. However, in order to meet the criteria for a compensable rating under this diagnostic code, the evidence must show that a physician ordered bed rest to treat the disorder. In this case, the Veteran denied incapacitating episodes at the May 2012 VA examination, and there are no physician's orders or other evidence that the Veteran's doctors prescribed bed rest; therefore, the criteria for a higher rating under Diagnostic Code 5243 have not been met. The Board has considered whether a separate evaluation is applicable during this period for neurological disorders associated with the service-connected back disability. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). EMG testing in 2012 was normal; however, the examiner reported decreased sensation in the right lower leg, and straight leg testing was positive on the right. Moderate intermittent pain and moderate paresthesia in the right lower extremity has been reported. The examiner noted involvement of the nerve roots at the L4/L5/S1/S2/S3 levels on the right. Accordingly, the Board finds that a separate rating for right lower extremity radiculopathy as associated with the Veteran's service-connected back disorder is warranted. The Board has also considered whether a separate evaluation is warranted for the Veteran's lumbar spine surgical scar. See Esteban v. Brown, 6 Vet. App. 259 (1994) (finding that when a Veteran has separate and distinct manifestations from the same injury he should be compensated under different diagnostic codes). During the pendency of this appeal, VA revised the criteria for diagnosing and evaluating the skin, effective October 23, 2008. See 73 Fed. Reg. 54708-12 (Sept. 23, 2008). As the Veteran's claim was received prior to October 23, 2008, the revised criteria are not for application in his case. A request a review of a scar disability under the revised criteria irrespective of whether the Veteran's disability has increased since the last review was not made. Id. A separate rating for the Veteran's lumbar spine surgical scar is not warranted , as there is no evidence that the Veteran's scar was deep, caused limited motion, exceeded 144 square inches (929 square cm.), was unstable, was painful on examination, or caused limitation of function of the spine. 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802, 7803, 7804, 7805 (2008). Accordingly, a separate evaluation for a lumbar spine surgical scar is not warranted. For all the foregoing reasons, the Board finds that a 20 percent rating is warranted for the thoracolumbar spine disability during this period, as well as a separate rating for radiculopathy of the right lower extremity. Other Considerations Generally, evaluating a disability using either the corresponding or analogous diagnostic codes contained in the Schedule is sufficient. See 38 C.F.R. §§ 4.20, 4.27 (2012). However, because the ratings are averages, it follows that an assigned rating may not completely account for each individual Veteran's circumstance, but nevertheless would still be adequate to address the average impairment in earning capacity caused by disability. However, in exceptional cases where the rating is inadequate, it may be appropriate to assign an extraschedular rating. 38 C.F.R. § 3.321(b) (2012). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate, a task performed either by the RO or the Board. Id.; see Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd, 572 F.3d 1366 (2009); see also Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[S]chedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Therefore, initially, there must be a comparison between the level of severity and symptomatology of the Veteran's service-connected disability with the established criteria found in the Schedule for that disability. Thun, 22 Vet. App. at 115. If the criteria reasonably describe the Veteran's disability level and symptomatology, then the Veteran's disability picture is contemplated by the Schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. The Board finds that the Veteran's disability picture is not so unusual or exceptional in nature as to render the already assigned rating inadequate. The Veteran's service-connected back disorder was evaluated as a disease or injury of the spine, the criteria of which is found by the Board to specifically contemplate the level of occupational and social impairment caused by this disability. 38 C.F.R. § 4.71a, Diagnostic Code 5237. Prior to January 1, 2009, the Veteran's lumbosacral spine disability was manifested by forward flexion no less than 90 degrees; no muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour; and no incapacitating episodes. From January 1, 2009, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. When comparing this disability picture with the symptoms contemplated by the Schedule, the Board finds that the Veteran's experiences are congruent with the disability picture represented by the ratings currently assigned. Evaluations in excess of those assigned are provided for certain manifestations of the disorder, but the evidence demonstrates that those manifestations are not present in this case. The criteria for a 10 percent and for a 20 percent rating reasonably describe the Veteran's disability level and symptomatology during the time frames noted. Consequently, the Board concludes that a schedular evaluation is adequate and that referral of the Veteran's case for extraschedular consideration is not required. See 38 C.F.R. § 4.71a, Diagnostic Code 5237; see also VAOGCPREC 6-96; 61 Fed. Reg. 66749 (1996). The Veteran has not specifically indicated, and the record does not reflect, that his service-connected disability prevents him from obtaining and/or maintaining employment. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). In reaching these decisions, the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the Veteran's claim of entitlement to ratings in excess of those currently assigned for his service-connected low back disorder, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER A rating in excess of 10 percent for osteoarthritis and degenerative disc disease of the lumbar spine, with a history of low back strain, prior to January 6, 2009, is denied. A rating in excess of 20 percent for osteoarthritis and degenerative disc disease of the lumbar spine, with a history of low back strain, beginning on January 6, 2009, is denied. A separate evaluation for radiculopathy of the lower right extremity is granted, subject to the applicable regulations concerning the payment of monetary benefits. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs