Citation Nr: 1328444 Decision Date: 09/05/13 Archive Date: 09/16/13 DOCKET NO. 10-39 802 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Providence, Rhode Island THE ISSUES 1. Entitlement to a disability rating in excess of 20 percent for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity prior to October 26, 2012. 2. Entitlement to a disability rating in excess of 10 percent for sciatica of the right lower extremity prior to October 26, 2012. REPRESENTATION Appellant represented by: Massachusetts Department of Veterans Services WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD T. Azizi-Barcelo, Counsel INTRODUCTION The Veteran served on active duty from October 1961 to August 1962. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which continued a disability rating of 20 percent for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity and 10 percent for sciatica of the right lower extremity. A videoconference hearing was held in August 2012 before the undersigned Veterans Law Judge. A transcript of the testimony is in the claims file. In September 2012, the Board remanded the claims for additional development. During the pendency of this appeal, by a rating decision in February 2013, the Appeals Management Center (AMC) increased the Veteran's rating for degenerative disc disease/intervertebral disc syndrome of the lumbar spine to 60 percent, effective October 26, 2012, and awarded a 100 percent disability rating for loss of use of both lower extremities, also effective October 26, 2012, with appropriate special monthly compensation awarded as well. In July 2013, the Board denied the Veteran's claims for higher disability ratings for disc disease/intervertebral disc syndrome of the lumbar spine and loss of use of both lower extremities, from October 26, 2012. The Board remanded the claim for an increased rating for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity prior to October 26, 2012, as well as the claim for an increased rating for sciatica of the right lower extremity prior to October 26, 2012, for additional development. Accordingly, the issues have been framed as listed on the title page. The Board notes that, in addition to the paper claims file, there is a paperless, electronic claims file associated with the appellant's claims. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. It now returns for further appellate review. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The evidence of record is at least in equipoise as to whether, during the period of the claim prior to October 26, 2012, the Veteran's degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity was manifested by symptoms consistent with flexion limited to 30 degrees. 2. Prior to October 26, 2012, sciatica of the right lower extremity was manifested by no more than mild incomplete paralysis. CONCLUSION OF LAW 1. Prior to October 26, 2012, the criteria for entitlement to an evaluation of 40 percent, but no higher, for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity, were met. 38 U.S.C.A §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5243 (2012). 2. Prior to October 26, 2012, criteria for a rating higher than 10 percent for sciatica of the right lower extremity have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.124, Diagnostic Code 8520 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist VA has a duty to provide the Veteran notification of the information and evidence necessary to substantiate the claims submitted, the division of responsibilities in obtaining evidence, and assistance in developing evidence, pursuant to the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The notice requirements were accomplished in a letters sent in January 2010. Mayfield v. Nicholson, 444 F.3d 1328, 1333 (Fed. Cir. 2006). The letter also provided notice of the type of evidence necessary to establish a disability rating or effective date for the claimed disability under consideration, pursuant to the recent holding in Dingess v. Nicholson, 19 Vet App 473 (2006). The claims were readjudicated in the July 2013 supplemental statement of the case. The Board also finds that all relevant facts have been properly developed, and that all evidence necessary for equitable resolution of the issues has been obtained. The Veteran's service treatment records, and pursuant to the September 2012 and July 2013 Board remands, private and VA treatment records have been obtained. In addition, he has been provided with appropriate VA examinations in connection with the claims. He has not indicated there are any additional records that VA should seek to obtain on his behalf. Therefore, the Board concludes that all reasonable efforts were made by VA to obtain evidence necessary to substantiate the Veteran's claim, and the RO/AMC has substantially complied with the previous remand directives such that no further action is necessary in this regard. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). The Veteran has been afforded a hearing before a Veterans Law Judge (VLJ) in which he presented oral argument in support of his increased rating claim. 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) requires that the VLJ who chairs a hearing explain the issues and suggest the submission of evidence that may have been overlooked. Here, during the hearing, the VLJ identified the issues and asked specific questions directed at identifying whether the Veteran had symptoms meeting the criteria for a higher rating. Moreover, the Veteran volunteered his treatment and symptom history. In addition, the VLJ asked clarifying questions regarding where and by whom treatment was provided in order to identify any pertinent evidence not currently associated with the claims folder that might have been overlooked or was outstanding that might substantiate the claim. On remand the VLJ provided the Veteran an opportunity to provide the names of his treatment providers so that those records might be obtained. Additionally, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2) or identified any prejudice in the conduct of the Board hearing. The hearing focused on the elements necessary to substantiate the claims. As such, the Board finds that there is no prejudice to the Veteran in deciding this case and that no further action pursuant to Byrant is necessary. As discussed above, the Veteran was notified and aware of the evidence needed to substantiate his claims, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The Veteran was provided with a meaningful opportunity to participate in the claims process and has done so by providing evidence and argument. Any error in the sequence of events or content of the notices is not shown to have any effect on the case or to cause injury to the Veteran. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40 (2011); see also 38 C.F.R. §§ 4.45, 4.59 (2012). Recently, 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). Disabilities of the lumbar spine (other than intervertebral disc syndrome when evaluated on the basis of incapacitating episodes) are to be rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243 (2012). These criteria are to be applied irrespective of whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area of the spine, and they "are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine." 68 Fed. Reg. at 51,455 (Supplementary Information). For the period of the claim prior to October 26, 2012, the Veteran's degenerative disc disease of the lumbar spine was rated as 20 percent disabling under Diagnostic Code 5237. The Veteran filed the instant claim for increase on January 13, 2010. Under Diagnostic Codes 5235-5242, the criteria for the next higher rating, 40 percent rating, are forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation will be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation will be assigned for unfavorable ankylosis of the entire spine. Any associated objective neurological abnormalities including, but not limited to, bowel or bladder impairment, are to be rated separately from orthopedic manifestations under an appropriate diagnostic code. 38 C.F.R. § 4.71a (2012), Note (1). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a (2012), Note (5). Under the criteria governing disabilities of the lumbar spine, intervertebral disc syndrome is to 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. This formula provides a 40 percent evaluation for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a (2012). An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. See 38 C.F.R. § 4.71a, Note (1) (2012). The rating schedule also provides guidance for separately rating neurologic impairment. See Note (1) of the General Rating Formula of Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. Here, the Board notes that other than the neurological impairment of the service-connected right lower extremity addressed below, at no time during the period on appeal has the Veteran reported bowel or bladder or other impairment associated with his service-connected degenerative disc disease. Ratings for paralysis of the sciatic nerve are set forth at 38 C.F.R. § 4.124A, Diagnostic Code 8520. A 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is assigned for moderately severe incomplete paralysis. A 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy. An 80 percent rating is assigned for complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Code 8620 refers to neuritis of the sciatic nerve, and Diagnostic Code 8720 refers to neuralgia of the sciatic nerve. The term "incomplete paralysis," with this and other peripheral nerve injuries, 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. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board has reviewed all the evidence in the 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 the appellant 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 claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). By way of background, service connection for a lower back disability has been in effect since August 1962 due to injuries the Veteran sustained in a bus accident during service in 1961. An April 2006 rating decision recharacterized the disability as degenerative disc disease of the lumbar spine with painful and limited motion and assigned a separate rating for sciatica of the right lower extremity. The Veteran filed the instant claim for increased ratings in January 2010. As noted in the Introduction of this decision, in July 2013 the Board denied the Veteran's claims for higher disability ratings for disc disease/intervertebral disc syndrome of the lumbar and loss of use of both lower extremities, from October 26, 2012. Thus, currently before the Board are claims for entitlement to higher ratings for a lumbar spine disability and sciatica of the right lower extremity prior to October 26, 2012. VA and private treatment records prior to October 26, 2012 recorded complaints of pain and numbness in the lower back and lower extremities. In a statement in October 2009, the Veteran's VA treating physician indicated that the Veteran's sciatic nerve paralysis and lumbosacral and cervical strain, had worsened due to aging. The clinician reported that the Veteran required a walker for ambulation and was not capable of walking more than 20 to 30 feet without stopping, due to severe low back pain from his sciatica, lumbar osteoarthritis, and difficulty walking. A June 2010 neurological treatment note contained findings of neurological symptoms affecting the lower extremities that were attributed to neuropathy, likely related to ETOH abuse. An assessment of nonorganic gait impairment was also noted. On neurological evaluation in April 2011, the Veteran reported generalized weakness, sensory loss and numbness in all extremities. Sensory examination was inconsistent with a radiculopathic pattern. Rather, the distal sensory loss was circumferential and suggestive of neuropathy. The Veteran's neuropathy was attributed to alcohol abuse. The Veteran underwent a VA spine examination in February 2010. The examiner noted that the Veteran had considerable difficulty walking and taking off his trousers and shoes. He used a walker for ambulation. His gait was slow. Straight leg raise was to 20 degrees in the right leg, with pain and limited movement. On the left, straight leg raise was to 40 degrees. There was no weakness or lack of endurance. The examiner was unable to test the Veteran's forward flexion due to the Veteran's "almost disastrous loss of balance" and weakness, noting that "any attempt at forward flexion resulted in almost three falls," and that the Veteran's "legs seemed to give out from under him." The examiner diagnosed a past history of osteoarthritis of the spine and neuropathy of the left leg. The Veteran was also given a VA peripheral nerve examination in February 2010. He reported back pain with radiating to his legs, along with numbness in his feet. The Veteran related inability to bend over or do any lifting. A lumbar myelogram was normal. On examination, the right lower extremity was exhibited mild weakness of the distal leg/foot musculature. The distal peripheral nerves in both legs were affected. There was decreased sensory function in the lower extremities bilaterally. Plantar flexion was normal. Knee reflexes were absent. The Veteran's gait was antalgic. X- rays of the lumbar spine revealed degenerative joint disease. The Veteran denied any bowel or bladder impairment. The examiner diagnosed back pain associated with right and left sciatica associated with the service- connected injury. The examiner opined that while the service-connected disability was productive of significant pain, it was unlikely that worsening of the Veteran's neurological symptoms affecting the lower extremities was due to the service connected disability. Instead, the examiner concluded that the Veteran's peripheral neuropathy was more likely than not responsible for the bulk of the Veteran's balance difficulties, weak lower leg and foot musculature, wide based gait, and symmetrically numb feet and lower legs, which was not a service-connected injury. The examiner found that peripheral neuropathy, along with peripheral vascular disease, were more likely than not responsible for the Veteran's lower extremity symptomatology. Initially, the Board notes that prior to October 26, 2012, the evidence of record does not demonstrate that the Veteran was prescribed bed rest by a physician. As such, the Veteran does not satisfy the criteria for an increased rating under Diagnostic Code 5243 for intervertebral disc syndrome because the record does not show documented periods of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician. Accordingly, the Board finds that he is not entitled to higher disability ratings based upon incapacitating episodes at any time prior to October 26, 2012. As the Veteran is not entitled to an increased rating based upon incapacitating episodes, it is necessary to determine whether he is entitled to higher ratings based upon his combined orthopedic and neurological manifestations. Turning first to orthopedic manifestations, VA and private treatment records prior to October 26, 2012 recorded complaints of severe pain and numbness in the lower back. The condition was noted to be worsening with age and contributed to the Veteran's need for assistive devices for ambulation. The Veteran complained of severe back pain. While on VA examination in February 2010 range of motion studies were not possible due to balance problems, straight leg raise was to 20 degrees with pain in the right leg, and to 40 degrees in the left leg. Of note, on VA spine examination two years later, the flexion of the lumbar spine was to 20 degree with pain. Hence, the Board finds that after resolving reasonable doubt in the Veteran's favor, a higher 40 percent rating is warranted for the period of the claim prior to October 26, 2012, as forward flexion of the thoracolumbar spine was likely consistent with limitation to 30 degrees when considering pain and functional loss. See 38 C.F.R. § 4.40; Mitchell, supra. An even higher 50 percent rating is not warranted during this period, as the evidence does not demonstrate unfavorable ankylosis of the entire thoracolumbar spine. Resolving reasonable doubt in his favor, a higher disability rating of 40 percent is warranted for limitation of motion of the lumbar spine for the period of the claim prior to October 26, 2012. To the extent that the Veteran's low back disability has neurological manifestations, the Veteran was assigned a 10 percent disability rating for right-sided radiculopathy under 38 C.F.R. § 4.124a, Diagnostic Code 8520. He has appealed for a higher rating. VA and private treatment records prior to October 26, 2012, recorded complaints of pain and numbness in the lower extremities, along with gait problems, and difficulties with ambulation and balance. However, the clinicians who treated the Veteran attributed his neurologic complaints to the nonservice-connected neuropathy. Specifically, on neurological evaluation in April 2011 sensory examination was inconsistent with a radiculopathic pattern. Rather, the distal sensory loss was circumferential and suggestive of neuropathy. The Veteran's neuropathy was attributed to alcohol abuse and is not service-connected. Consistent with these findings, following an examination of the Veteran in February 2010, the VA examiner, a neurologist, diagnosed back pain associated with right and left sciatica and opined that while the condition was productive of significant pain, the increase in neurologic damage was not likely due to the service-connected disability. Instead, the neurologist found the Veteran's peripheral neuropathy was more likely than not responsible for the bulk of the Veteran's balance difficulties, weak lower leg and foot musculature, wide based gait, and symmetrically numb feet and lower legs, and was not a service-connected injury. It was further noted that the nonservice-connected peripheral neuropathy, along with peripheral vascular disease, were more likely than not responsible for the Veteran's lower extremity symptomatology. As such, despite the Veteran's symptoms, they are the result of nonservice connected conditions that are unrelated to his lumbar spine condition. As the Veteran's neurological complaints affecting the right and left lower extremities were attributed to the nonservice connected neuropathy and peripheral vascular disease, it cannot be considered in evaluating his right lower extremity sciatica. 38 C.F.R. § 4.14 (the use of manifestations not resulting from service connected disability for evaluating a service connected disability is to be avoided). Thus, prior to October 26, 2012, the Veteran's right leg sciatica was characterized by subjective complaints of pain, which equates to involvement that is wholly sensory and mild in severity. In the absence of evidence showing moderate incomplete paralysis of the sciatic nerve due to right leg radiculopathy, the criteria for a rating higher than 10 percent under Diagnostic Code 8520 have not been met. 38 C.F.R. § 4.124a, Diagnostic Code 8520 (2012). The Board further finds that prior to October 26, 2012, the preponderance of the evidence is against a finding of any additional neurological impairment, including but not limited to loss of bowel or bladder control, consistent with a separate and distinct neurological disability associated with the Veteran's lumbar spine disability warranting a separate compensable rating. Additionally, as the left lower extremity neurological complaints were attributed to nonservice-connected conditions, the evidence does not support the assignment of a separate compensable rating for left leg radiculopathy prior to October 26, 2012. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note 1 (2012). In sum, affording the Veteran the benefit of the doubt, the Board finds that the Veteran's degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity supports the criteria for a 40 percent disability rating, and not higher, based on limitation of motion of the lumbar spine prior to October 26, 2012. The Board finds that the preponderance of the evidence is against the assignment of disability rating higher than 10 percent for the service-connected right lower extremity sciatica prior to October 26, 2012. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The Board acknowledges that the February 2013 rating decision concluded that the Veteran's lower extremity neuropathy was as likely as not related to his service- connected low back disability based on the October 26, 2012 VA examination. However, such conclusion was based on a statement by a nurse practitioner that she could not render an opinion. The rating decision did not weigh other contrary evidence of record, to include the negative opinion in 2010 by a neurologist. In addressing the claim for increase for the period prior to October 26, 2012, the Board finds the evidence and opinions rendered during that period to be significantly more probative of the level of service- connected disability during that period. While the Appeals Management Center has chosen to interpret a nonopinion by a nurse practitioner rendered on October 26, 2012 as being a favorable opinion, the Board is not bound by such conclusion for purposes of adjudicating the claim for a higher rating during the period prior to October 26, 2012. McBurney v. Shinseki, 23 Vet. App. 136, 139 (2009) ("[T]he Board, as the final trier of fact, is not constrained by favorable determinations below."). As a final matter, the Board has also considered whether the Veteran's disability presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of extra-schedular ratings is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). 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. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology and provide for additional or more severe symptoms than currently shown by the evidence. The Board has considered the various diagnostic codes for evaluating the lumbar spine, but finds that his symptomatology is adequately addressed by the evaluations assigned. Indeed, the current objective findings support only a 40 percent rating for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity, and a separate rating of 10 percent for right lower extremity sciatica, prior to October 26, 2012. The Veteran's disability ratings contemplate industrial impairment and frequent periods of hospitalization have not been demonstrated during the appeal period. Thus, his disability picture is contemplated by the rating schedule, and the assigned 40 and 10 percent schedular evaluations are, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extraschedular consideration is not warranted. ORDER Subject to the law and regulations governing payment of monetary benefits, a disability rating of 40 percent for degenerative disc disease of the lumbar spine with complaint of sciatic left lower extremity, prior to October 26, 2012, is granted. A disability rating in excess of 10 percent for sciatica of the right lower extremity, prior to October 26, 2012, is denied. ____________________________________________ K. A. BANFIELD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs