Citation Nr: 1328538 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 06-03 827A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased rating for herniated nucleus pulposus, lumbar spine, currently evaluated as 40 percent disabling. 2. Entitlement to an increased initial evaluation for service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, currently evaluated as 20 percent disabling prior to December 27, 2012, and as 40 percent disabling thereafter. 3. Entitlement to an increased initial evaluation in excess of 30 percent for service-connected right peroneal nerve palsy. 4. Entitlement to an increased initial evaluation for service-connected left lower extremity radiculopathy, currently evaluated as 10 percent disabling prior to December 23, 2010, and as 20 percent disabling thereafter. 5. Entitlement to an effective date prior to December 27, 2012, for special monthly compensation for loss of use of the right foot. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. WITNESSES AT HEARING ON APPEAL Appellant, appellant's spouse ATTORNEY FOR THE BOARD T. Stephen Eckerman, Counsel INTRODUCTION The Veteran served on active duty for training (ACDUTRA) from August 1969 to December 1969, and again in the New York National Guard from March 24, 1970 to March 30, 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2004 rating decision of the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO) that continued the assignment of a 40 percent rating for a herniated nucleus pulposus of the lumbar spine. By a rating action dated in March 2013, the AMC separate, compensable ratings for "right lower extremity radiculopathy, sciatic, neuropathy with foot drop, external popliteal nerve," "peroneal nerve palsy, right," and left lower extremity radiculopathy. In October 2010, and December 2012, the Board remanded the claim for additional development. The Veteran testified at a Travel Board hearing before the Undersigned in July 2008. A transcript of that hearing is of record and associated with the claims folder. The claim of entitlement to an effective date prior to December 27, 2012, for special monthly compensation for loss of use of the right foot is addressed in the REMAND portion of the decision below, and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. Despite his complaints of pain, pain on motion, and functional loss, the Veteran's herniated nucleus pulposus, lumbar spine, is not shown to result in unfavorable ankylosis of the entire thoracolumbar spine or intervertebral disc syndrome with incapacitating episodes of intervertebral disc syndrome having a total duration of at least 6 weeks during the a 12 month period. 2. Prior to December 27, 2012, the Veteran's service- connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, did not result in moderately severe incomplete paralysis, neuritis, or neuralgia of the sciatic nerve. 3. As of December 27, 2012, the Veteran's service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, did not result in severe incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve. 4. Prior to December 27, 2012, the Veteran's service- connected right peroneal nerve palsy did not result in complete paralysis, neuritis, or neuralgia, of the external popliteal nerve. 5. As of December 27, 2012, the Veteran's service-connected right peroneal nerve palsy, is shown to have been productive of complete paralysis of the external popliteal nerve. 6. Prior to December 23, 2010, the Veteran's service- connected left lower extremity radiculopathy did not result in moderate paralysis, neuritis, or neuralgia, of the sciatic nerve. 7. As of December 23, 2010, the Veteran's service-connected left lower extremity radiculopathy did not result in moderately severe paralysis, neuritis, or neuralgia, of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for service-connected herniated nucleus pulposus, lumbar spine, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b)(1), 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242, 5243 (2012). 2. Prior to December 27, 2012, the criteria for an initial evaluation in excess of 20 percent for service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8520, 8620, 8720 (2012). 3. As of December 27, 2012, the criteria for an evaluation in excess of 40 percent for the Veteran's service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8520, 8620, 8720 (2012). 4. Prior to December 27, 2012, the criteria for an evaluation in excess of 30 percent for the Veteran's service-connected right peroneal nerve palsy have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8521, 8621, 8721 (2012). 5. As of December 27, 2012, the criteria for an evaluation of 40 percent, and no more, for the Veteran's service- connected right peroneal nerve palsy have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8521, 8621, 8721 (2012). 6. Prior to December 23, 2010, the criteria for an initial evaluation in excess of 10 percent for the Veteran's service-connected left lower extremity radiculopathy have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8520, 8620, 8720 (2012). 7. As of December 23, 2010, the criteria for an evaluation in excess of 20 percent for the Veteran's service-connected left lower extremity radiculopathy have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.124a, Diagnostic Codes 8520, 8620, 8720 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased Ratings/Initial Evaluations A. Lumbar Spine The Veteran asserts that he is entitled to a rating in excess of 40 percent for his service-connected herniated nucleus pulposus, lumbar spine. During his hearing, held in July 2008, he testified that although he did not always consult his doctor, he had incapacitating episodes requiring bed rest that warranted an increased rating. He stated that he had symptoms that included pain, spasms, and tics. With regard to the history of the disability in issue, the Veteran's service treatment reports show that in September 1972, he was treated for a back injury after he dismounted from a truck. A May 1973 VA examination report notes a laminectomy at L5 with lateral and posterior spinal fusion and residual narrowing of the L5-S1 disc space. The diagnoses noted residual of herniated nucleus pulposus (HNP) at L5-S1, left with absent ankle jerk. See 38 C.F.R. § 4.1 (2012). In June 1973, the RO granted service connection for herniated nucleus pulposus, lumbar spine. In July 1979, the RO evaluated this disability as 40 percent disabling. In March 2004, the Veteran filed a claim for an increased rating. In May 2004, the RO denied the claim. The Veteran has appealed. The Board notes that in September 2007, the RO granted a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), with an effective date of August 29, 2006. The Veteran did not appeal the determination of the effective date. Disability evaluations are determined by comparing the veteran's present symptomatology with the criteria set forth in the VA's Schedule for Ratings Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's low back disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5243. Under 38 C.F.R. § 4.71a, DC 5243 (intervertebral disc syndrome) and DC 5242 (degenerative arthritis of the spine) (see also DC 5003) are both rated under the "General Rating Formula for Diseases and Injuries of the Spine." The General Rating Formula provides that a 40 percent rating requires forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. Id. A 60 percent rating requires unfavorable ankylosis of the entire thoracolumbar spine. Id. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. In addition, the regulation provides that intervertebral disc syndrome may be rated under either the General Rating Formula or the "Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes", whichever results in a higher rating. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes states that a 40 percent rating is warranted for IDS: With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Id. A 60 percent rating is warranted for IDS: With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Id. For purposes of evaluations under Diagnostic Code 5243, an incapacitating episode is 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. [Note 1]. If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurologic manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. [Note 2]. Ankylosis is the immobility and consolidation of a joint. Lewis v. Derwinski, 3 Vet. App. 259 (1992). The medical evidence is summarized as follows: A March 2004 VA MRI (magnetic resonance imaging) report notes postoperative changes L4 through S1 with an appearance of solid bony fusion bilaterally at L5-S1, disc herniation at L4-L5 with accompanying moderate central canal stenosis, and degenerative changes at L3-L4 with central and bilateral foraminal stenosis. A VA examination report, dated in May 2004, shows that the Veteran had forward flexion to 75 degrees. The report states that there were no incapacitating episodes. The diagnoses noted post-operative laminectomy herniated disc with fusion with radiologic evidence of degenerative disc disease, central canal stenosis and foraminal stenosis, and non-specific lumbar fasciculations associated with the lumbar spine degenerative disc disease. An examination report performed in association with a claim for Social Security Administration (SSA) benefits, dated in June 2004, states that the Veteran's lumbar spine had a full range of motion, and that no gross motor or sensory deficits were noted. An associated report states that lumbar spine flexion, extension, and lateral flexion were WNL (within normal limits), and indicates that there was no ankylosis. Another examination report, dated in December 2004, states that the Veteran's lumbar spine had flexion to 70 degrees, and indicates that there was no ankylosis. A VA examination report, dated in August 2005, shows that the Veteran had forward flexion to 80 degrees. The report states that the Veteran denied having any flare-ups in the past 12 months requiring medical attention. The diagnosis was chronic low back pain with traumatic and degenerative arthritis, spinal stenosis, and decreased range of motion. A decision of the SSA, dated in February 2006, shows that the SSA determined that the Veteran was disabled as of January 2003, with a primary diagnosis of diabetes mellitus, and a secondary diagnosis of depression. He was also noted to have severe disorders that included a lumbar spine disorder. A VA MRI report for the lumbar spine, dated in February 2008, contains an impression noting multilevel degenerative disc disease with facet osteoarthropathy and hypertrophy of ligamentum flavum, severe central and foraminal canal stenosis at L3-L4 with suspected nerve root impingement, moderate to severe central stenosis and a disc extrusion at L4-L5 with suspected nerve impingement, and a right-sided osteophyte encroaching upon the central canal and displacing the right traversing L3 nerve root at the L2-L3 level. A private operative report, dated in May 2008, shows that the Veteran underwent an exploratory lumbar laminectomy L3- 4, 5 bilaterally with lysis of adhesions L4-5 nerve roots, and right-sided microdiscectomy. The post-operative diagnosis was lumbar spinal stenosis with a herniated disc L4-5, L3-4. A report from a private physical therapist, dated in June 2008, states that the Veteran had diagnoses for his cervical and lumbar spines that included "ankylosing of joint," ankylosing spondylitis, and segmental dysfunction of the lumbar and thoracic regions. Lumbar spine range of motion was decreased, "with the patient's percentage of population norms being between 40-48%." A private MRI for the lumbar spine, dated in December 2010, contains an impression noting severe stenosis at L3-L4 with bilateral neuroforaminal and lateral recess stenosis, post- surgical changes at L4-L5 with mild right-sided neuroforaminal narrowing, right-sided lateral recess stenosis at L5-S1 from a small facet cyst, and mild spinal stenosis at L2-L3 with bilateral lateral recess stenosis. A VA examination report, dated in December 2010, shows that the examiner indicated that the Veteran's claims file had been reviewed. The report shows that the Veteran had forward flexion to 15 degrees, extension to 0 degrees, lateral flexion to 10 degrees, bilaterally, left lateral rotation to 15 degrees, and right lateral rotation to 10 degrees. The report states that the Veteran reported having severe flare-ups at least once a month, lasting one to two weeks, during which he was pretty much lying in bed and couldn't do anything. The examiner stated that there were no instances in which a physician ordered bedrest other than at the time of his initial injury, however, the Veteran insisted that he has been incapacitated. The Veteran was noted to have thoracolumbar spine ankylosis in neutral position. The relevant diagnosis was DJD (degenerative joint disease) lumbosacral spine with severe stenosis at L3- L4, L5-S1 and mild stenosis at L2-L3. A private operative report, dated in February 2011, shows that the Veteran underwent a decompressive lumbar laminectomy L2, L3, L4, L5, bilateral lysis of adhesions L2- L3, L3-L4, L4-L5, using microscopic dissection, microdiscectomy right side of L3-L4, posterolateral fusion, structural allograft, and demineralized bone matrix L2-L3, L3-L4, and L4-L5. The postoperative diagnosis was failed back surgery syndrome, severe spinal stenosis L3-L4, moderate L2-L3 and L4-L5, herniated disc, right side of L3- L4. Reports from G.G., M.D., dated between 2008 and 2011, show that the Veteran received a number of treatments for back symptoms. An October 2008 report notes that he was playing golf and that he was "feeling pretty good overall." Overall, VA progress notes show ongoing complaints of low back pain, with use of a cane, and medications to control pain. Reports, dated between 2009 and 2012, show that in December 2009, the Veteran reported that he had been playing golf, and that, "He vents by killing weeds." In October 2011, an MRI was noted to show mild to moderate NF (neuroforminal) stenosis, post-surgical changes at L4-5 with right NF impingement, and mild to moderate bilateral NF stenosis L4-5, and L5-S1. A November 2011 report shows that the Veteran reported that he walked in the woods, and had recently made a nursery. A January 2012 report notes that he stated that he played golf three times a week, did yard work, and planned to join a gym. An April 2012 report shows that the Veteran complained of a recent "incapacitating episode." Several reports note that he was encouraged to exercise. See e.g., reports, dated in July 2011, January and April of 2012. A VA spine Disability Benefits Questionnaire (DBQ), dated in December 2012, indicates that the Veteran's claims file had been reviewed. The Veteran reported that he had been "placed on bed rest" within the past 12 months due to his back symptoms, and that he had an incapacitating episode lasting about 6 weeks, between February and March of 2012, during which he was at "more or less continuous bed rest." The Veteran stated that he was familiar with his own symptoms, and that he saw no reason to call a doctor and ask for prescribed bed rest. The examiner stated the following: this bed rest was apparently self-prescribed by the Veteran. It was not specifically prescribed or ordered by a physician. However, while the Veteran's explanation seemed reasonable and plausible, the examiner noted that he was unable to locate any documentation in the claims file that a physician specifically ordered or prescribed this period of bed rest. Such caused the examiner to mark "no" in the space for "incapacitation" by VBA (Veterans Benefits Administration). The Veteran denied any incapacitating episodes of at least 6 weeks duration in the last 6 months. On examination, the Veteran refused to perform any range of motion tests, claiming he was concerned about pain, possible self-injury, and/or violating the instructions of his treating physicians. The report indicates that the Veteran has IVDS (intervertebral disc syndrome), but that it had not resulted in any incapacitating episodes over the past 12 months. The diagnoses were degenerative disc disease, and status post multiple lumbar spinal surgeries. The Board finds that the claim must be denied. In December 2010, the Veteran was noted to have thoracolumbar spine ankylosis in neutral position. However, the criteria for a 60 percent rating under the General Rating Formula are clear and specific, and there is no evidence to show that the Veteran has ankylosis of the thoracolumbar spine in an unfavorable position. In addition, there is no evidence to show that unfavorable ankylosis has resulted in the required symptoms. See General Rating Formula, Note 5. With regard to "incapacitating episodes," the evidence is insufficient to show that the Veteran's symptoms have been productive of incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. In this regard, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes defines an incapacitating episode 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 Diagnostic Code 5243 [Note 1] (emphasis added). Here, the May 2004 VA examination report states that there were no incapacitating episodes. The August 2005 VA examination report shows that the Veteran denied having any flare-ups in the past 12 months requiring medical attention. The December 2010 VA examination report shows that the examiner stated that there were no instances in which a physician ordered bedrest other than at the time of his initial injury. That examiner also noted that it was reasonable and plausible that the Veteran had self- prescribed bed rest. However, the examiner further stated that when available records were reviewed, he was unable to locate any documentation that a physician specifically ordered or prescribed this period of bed rest, and he indicated that "incapacitation," as defined by governing law, is not shown. Indeed, as there is no documented of the Veteran being prescribed bed rest, there would be little basis for him knowing that the proper treatment for a particular flare-up, if such occurred, necessitated bed rest. There is nothing in the record to show that the Veteran, who has reported that he is a retired financial planner, has ever received any special training or acquired any medical expertise in evaluating or treating lumbar/thoracic spine conditions. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, his lay evidence of "self-prescribed" bed rest/incapacitating episodes does not constitute competent medical evidence and lacks probative value. Id.; see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In summary, the Veteran is not shown to have had incapacitating episodes having a total duration of at least 6 weeks during the past 12 months, as defined under DC 5243, and the claim must be denied. The Board has also considered two VA progress notes which the Veteran has repeatedly submitted in support of his claim: a VA progress report, dated in December 2005, shows that the examiner stated that the Veteran has incapacitating episodes lasting at least six to eight weeks at a time, totaling five to six months of the year. A VA progress report, dated in January 2006, shows that the examiner stated that the Veteran's back had been fused, and that this created a strain on the ends of his vertebrae, and that the only motion the fusion permitted were at the joints adjacent to the fused vertebrae. The examiner stated that the Veteran's pain has lasted for more than 8 weeks at a time, totaling more than 5-6 months per year for the last four years, and that he currently has weakness, fasciculations, and pain due to compression of the L4 (nerve) root on the right. The January 2006 report does not specifically state that the Veteran has incapacitating episodes to the required degree. Furthermore, neither one of these reports are shown to have been based on a review of the Veteran's claims file, or any other detailed and reliable medical history, and they appear to be "by history" only. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion). In addition, these notations are unaccompanied by citation to the alleged instances of incapacitation, they are not supported by the medical evidence of record, and they are otherwise unexplained. Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this regard, the VA examination reports do not support these notations, and the two most recent VA examination reports are shown to have been based on a review of the claims file. This evidence is therefore insufficiently probative to warrant a grant of the claim. Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). With respect to possibility of entitlement to an increased evaluation under 38 C.F.R. §§ 4.40 and 4.45, the Board notes that the functional factors specified in DeLuca v. Brown, 8 Vet. App. 202, 204-206 (1995) are not applicable where the highest rating has been granted for limitation of motion and a higher rating requires ankylosis. Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997). The Board has considered the Veteran's statements that he should be entitled to a higher disability rating for his low back as a result of decreased function due to such symptoms as pain. The Board is required to assess the credibility and probative weight of all relevant evidence. McClain v. Nicholson, 21 Vet. App. 319, 325 (2007). In doing so, the Board may consider factors such as facial plausibility, bias, self interest, and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. at 511; see also Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007); cf. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board may consider the absence of contemporaneous medical evidence when determining the credibility of lay statements, but may not determine that lay evidence lacks credibility solely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Veteran is competent to report his current spine symptoms as these observations come to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also acknowledges the Veteran's belief that his symptoms are of such severity as to warrant a higher rating. However, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. In this regard, in addition to the previously discussed evidence as to his recreational activities, a review of VA progress notes shows that the Veteran has repeatedly expressed a desire for increased compensation to his health care providers. See e.g., VA progress notes, dated in November 2006, June, August and October of 2009, May and November of 2011; Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (personal interest may affect the credibility of the evidence, but the Board may not disregard testimony simply because a claimant stands to gain monetary benefits). The Board therefore finds that the evidence is insufficient to show that the Veteran had a worsening of the disability on appeal such that an increased rating is warranted. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability is evaluated, are more probative than the Veteran's assessment of the severity of his disability. The VA examinations also took into account the Veteran's subjective statements with regard to the severity of his spine disability. Consideration has been given to whether the Veteran experiences any neurological deficits stemming from his low back disability. However, other than the radiculopathies, neuropathies, and palsy affecting his lower extremities, which are already separately rated, no other neurological disorder has been identified. He has not been shown to experience bowel or urinary dysfunction as a result of his herniated nucleus pulposus. In deciding the Veteran's increased rating claim, the Board has considered the determination in Hart v. Mansfield, 21 Vet. App. 505 (2007), and whether the Veteran is entitled to an increased evaluation for separate periods based on the facts found during the appeal period. As noted above, the Board does not find evidence that the Veteran's rating should be increased for any other separate period based on the facts found during the whole appeal period. The evidence of record supports the conclusion that the Veteran is not entitled to increased compensation during any time within the appeal period. (CONTINUED NEXT PAGE) B. Initial Evaluations - Nerves The Veteran asserts that he is entitled to an increased initial evaluation for his separately rated right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, evaluated as 20 percent disabling prior to December 27, 2012, and as 40 percent disabling thereafter; an increased initial evaluation in excess of 30 percent for service-connected right peroneal nerve palsy; and, an increased initial evaluation for service-connected left lower extremity radiculopathy, evaluated as 10 percent disabling prior to December 23, 2010, and as 20 percent disabling thereafter. In March 2004, the Veteran filed a claim for an increased rating for his service-connected low back disability. In May 2004, the RO denied the claim. The Veteran appealed, and in March 2013, the AMC granted service connection for "right lower extremity radiculopathy, sciatic, neuropathy with foot drop, external popliteal nerve," "peroneal nerve palsy, right," and left lower extremity radiculopathy. See General Rating Formula, Note 1 (providing for service connection for associated neurological abnormalities). The Veteran is appealing the original assignments of disability evaluations following awards of service connection. In such a case it is not the present level of disability which is of primary importance, but rather the entire period is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). A note in the Rating Schedule pertaining to "Diseases of the Peripheral Nerves" provides that the term "incomplete paralysis" indicates a degree of lost or impaired function which is substantially less than that which results from complete paralysis of these nerve groups, whether the loss is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, DC's 8510 through 8540 (2012). Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia of a peripheral nerve characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. The term incomplete paralysis, with 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. § 4.124. The words "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6 (2012). It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6 (2012). As an initial matter, the Veteran's representative has asserted that separate ratings are also warranted for a right anterior tibial nerve disability, a right internal popliteal nerve disability, and a right posterior nerve disability. See Veteran's representative's statement, dated in May 2013. Impairment of these nerves is first shown in a December 2012 VA DBQ. Neurological disorders are ordinarily to be rated in proportion to the impairment of motor, sensory, or mental function. In rating peripheral nerve injuries and their residuals, attention is given to the site and character of the injury, and the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120 (2012). The assignment of a particular Diagnostic Code is "completely dependent on the facts of a particular case." 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. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Court has held that a claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993). With regard to the nerves, the Veteran is currently in receipt of separate ratings for "right lower extremity radiculopathy, sciatic, and neuropathy with foot drop, external popliteal nerve," "peroneal nerve palsy, right," and left lower extremity radiculopathy. The Veteran is also receiving special monthly compensation for loss of use of the right foot. A separate rating is not warranted for the a right anterior tibial nerve disability, a right internal popliteal nerve disability, or a right posterior nerve disability. The Board first notes that the AMC's basis for assigning two separate ratings for the right lower extremity nerves is unclear, as it assigned separate ratings under DCs "8520- 8521" (right sciatic lower extremity radiculopathy with foot drop, external popliteal nerve), and under DC 8521 (peroneal nerve palsy, right). While the Board will not disturb the AMC's decision at this time, it is less than clear if the AMC's assignment of two separate ratings for the right lower extremity nerves under the same diagnostic code violates the prohibitions against pyramiding. See 38 C.F.R. § 4.14. Similarly, the Board notes that the diagnostic codes for the anterior tibial nerve (DCs 8523, 8623, and 8723), the internal popliteal nerve (DCs 8524, 8624, and 8724), and the posterior nerve (DCs 8525, 8625, and 8725), all compensate for impairment of the foot and toes. The presently assigned rating under DC 8521 is in fact an equal or greater rating than the maximum ratings under those codes. Put another, it is in the Veteran's best interest to evaluate the neurological dysfunction of his lower extremities under DC 8521 as opposed to DCs 8523, 8623, 8723, 8524, 8624, 8724, 8525, 8625, and 8725. It is equally important to emphasize that the Veteran is already being compensated for all of his right lower extremity impairment, and that no right lower extremity symptoms have been dissociated from his service-connected ratings. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The January 2013 VA examiner made no attempt to differentiate these nerves in terms of function or impairment, and the Board is precluded from drawing such an independent medical conclusion. See Colvin v. Derwinski, 1 Vet. App. 171, 172 (1991). Consequently, the Board finds that awards of separate ratings for these functionally indistinguishable nerves would violate VA's rule against pyramiding. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1994). 1. Right Sciatic Neuropathy, with Foot Drop, External Popliteal Nerve The Veteran's service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, has been evaluated as 20 percent disabling prior to December 27, 2012, and as 40 percent disabling thereafter. The criteria for evaluating the severity or impairment of the sciatic nerve is set forth under Diagnostic Codes 8520, 8620, and 8720. Under DC 8520, a 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating requires severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. Diagnostic Codes 8620 and 8720 address the criteria for evaluating neuritis and neuralgia of the sciatic nerve, respectively. The criteria are consistent with the criteria for evaluating degrees of paralysis as set forth above. 38 C.F.R. § 4.124a, DC's 8520, 8620, 8720 (2012). a) Prior to December 27, 2012 The medical evidence dated during the time period in issue includes reports from G.G., M.D., dated in February, March, and April of 2011, which state that the Veteran was neurologically intact. The claims files include VA examination reports which indicate that the Veteran was examined on December 23, 2010. A peripheral nerves examination report shows that the Veteran complained of symptoms that included right leg tingling and pain from the mid-tibia to the toes. He also complained that his legs "give out" at times. It was noted that he used a cane. On examination, the right knee and ankle had 2+ (normal) reflexes. Right plantar flexion was normal. Vibration, position sense, pain or pinprick, and light touch were normal. There were no dysthesias. Right hip, and knee flexion strength, and right toe extension strength, were 5/5. Ankle dorsiflexion and plantar flexion strength were 1/5. There was decreased muscle tone at the dorsiflexor of the right foot. The right calf was 1.5 cm. less in diameter than the left. The Veteran had an antalgic gait favoring the right side. The report notes that there was no paralysis or neuritis, but that there was neuralgia. The Veteran's symptoms were noted to cause increased absenteeism, with decreased mobility, problems with lifting and carrying, lack of stamina, weakness or fatigue, decreased strength, and pain. Many of these findings are repeated in a VA spine examination report for the same day. The Board finds that, prior to December 27, 2012, the Veteran's condition is not shown to have been manifested by moderately severe incomplete paralysis, such that an initial evaluation in excess of 20 percent for the right lower extremity is warranted under DC 8720. Briefly stated, the December 2010 VA examination report shows that he is shown to have normal reflexes, with full (5/5) strength at the hip and knee, and decreased strength at the ankle (1/5). There is neuralgia. A sensory examination was normal. There were no dysthesias. The right calf was 1.5 cm. less in diameter than the left. Based on the foregoing, the Board finds that the evidence does not show that the Veteran's right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, is manifested by symptomatology that more nearly approximates the criteria for an initial evaluation in excess of 20 percent under DC 8720, and that the preponderance of the evidence is against an increased initial evaluation. The Board also concludes that the evidence does not demonstrate that the Veteran's right lower extremity is shown to have been manifested by moderately severe incomplete paralysis or neuritis, such that an increased initial evaluation is warranted under DC 8620 or DC 8720. Specifically, the December 2010 VA examination report states that there is no paralysis, and no neuritis. Given the aforementioned medical evidence, to include the findings (or lack thereof) as to strength, sensation, reflexes, and limitation of range of motion, the Board finds that it is not shown that the Veteran's service-connected right sciatic neuropathy, and neuropathy with foot drop resulted in moderately severe paralysis or neuritis of the sciatic nerve. An initial evaluation in excess of 20 percent for the right lower extremity is not warranted under DC's 8520, and 8620. b) As of December 27, 2012 The only relevant medical evidence consists of VA spine and peripheral nerve Disability Benefits Questionnaires (DBQs) which indicate that the Veteran was examined on December 27, 2012. The peripheral nerves DBQ contains diagnoses of lumbar radiculopathies, and right peroneal neuropathy with foot drop. The report notes the following: there is no constant pain in the right lower extremity. The right lower extremity had moderate numbness. Strength at the right knee was 5/5, and 1/5 at the right ankle (plantar flexion), and 0/5 (dorsiflexion). There was no muscle atrophy. Reflexes at the right knee and ankle were 0 (absent). There was decreased sensation at the right lower leg, and no sensation at the right foot and toes. Gait was slow, using a cane, due to the Veteran's back condition, and foot drop. The Veteran used a brace and a cane on a regular basis, and a walk-aid (nerve stimulator) on a constant basis. There was no functional impairment of the right extremity such that no effective function remains other than that which would be equally well-served by an amputation with prosthesis. The examiner noted that EMG (electromyography) studies from 2008-09 were abnormal, with bilateral L5-S1 lumbar radiculopathies, and a right peroneal neuropathy. The right sciatic nerve was normal. The right external popliteal nerve had complete paralysis. The right musculocutaneous (superficial peroneal) nerve was normal. The right anterior tibial (deep peroneral) nerve, and the right internal popliteal (tibial) nerve, and the right posterior tibial nerve, all had severe incomplete paralysis. The right anterior crural (femoral) nerve, the right internal saphenous nerve, the right obturator nerve, the right external cutaneous nerve of the thigh, and the right ilio- inguinal nerve, were all normal. The Veteran's peripheral nerve condition impacted the Veteran's ability to work by interfering with normal mobility, limited walking and standing time, and distance, and interference with normal physical activities. As of December 27, 2012, the Board finds that the evidence does not demonstrate that the Veteran's disability is shown to have been manifested by severe incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve, with marked muscle atrophy, such that an evaluation in excess of 40 percent is warranted under DC's 8520, 8620, or 8720. The VA peripheral nerves DBQ states that the right lower extremity had moderate numbness, with 5/5 strength at the right knee, and 1/5 strength at the right ankle (plantar flexion), and 0/5 (dorsiflexion). Reflexes at the right knee and ankle were 0 (absent). There was decreased sensation at the right lower leg, and no sensation at the right foot and toes. However, of particular importance, the report states that there was no muscle atrophy. Given the aforementioned medical evidence, to include the findings as to muscle atrophy, strength, and sensation, the Board finds that the Veteran's neurological complications from his right sciatic nerve injury have not resulted in severe incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve, with marked muscle atrophy, as contemplated by these diagnostic codes. Accordingly, the criteria for an evaluation in excess of 40 percent have not been met under DC's 8520, 8620, or DC 8720. (CONTINUED NEXT PAGE) 2. Peroneal Nerve Palsy The Veteran's service-connected right peroneal nerve palsy has been evaluated as 30 percent disabling under 38 C.F.R. § 4.124a, DC 8521. Under DC 8521 a 30 percent rating is assigned for severe incomplete paralysis. A 40 percent rating is for application where there is severe complete paralysis of the external popliteal nerve manifested by foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes. 38 C.F.R. § 4.121a, DC 8521. Diagnostic Codes 8621 and 8721 address the criteria for evaluating neuritis and neuralgia of the external popliteal nerve, respectively. The criteria are consistent with the criteria for evaluating degrees of paralysis as set forth above. 38 C.F.R. § 4.124a, DC's 8521, 8621, 8721 (2012). a). Prior to December 27, 2012 Reports from G.G., M.D., dated between August 2008 and 2011, note that the Veteran has right foot drop; an August 2008 report notes that his foot drop had "improved considerably." An October 2008 report notes that he was playing golf and that he was "feeling pretty good overall." It was noted that he "still has a little bit of weakness involving the right foot." Reports from Ewing and Thomas, dated in June of 2008, show that the Veteran underwent physical therapy, and note that the Veteran had difficulty with any active dorsiflexion of the ankle. Other reports notes that he was not having any radicular symptoms, and that he had 4/5 strength or greater in the right lower extremity (other than the foot). There was trace amount of contraction to anterior tibialis. He could not move the ankle against gravity or resist manual muscle testing. A VA progress note, dated in August 2008, notes that the Veteran was undergoing physical therapy, and that his right leg had 4+/5 strength at hip, 5/5 strength at the knee, and 1/5 strength at the ankle. The Veteran was noted to be independent in all ADLs (activities of daily living), to have strength within normal limits except for his right lower extremity, and to have intact sensation. He was noted to ambulate with a cane, with right foot drop. VA progress notes show that he underwent additional physical therapy through November 2008. A VA peripheral nerves examination report, dated in October 2009, shows that the Veteran complained of progressively worse foot drop that was now permanent. He also complained of paralysis, weakness, numbness and paresthesias from the mid-tibial area to the distal foot, with numbness and tingling at the lateral-anterior aspect of foot and ankle. The right lower extremity was noted to have 1/5 strength at the foot dorsiflexor, with an affected peroneal nerve. A sensory function examination was normal for the right side. Reflexes at the right knee were 2+, normal at right plantar flexion, and 0 at the right ankle. There was no muscle atrophy. There was decreased muscle tone to the dorsiflexor of the right foot. No joint function was affected by the nerve disorder. Gait was antalgic on the right, and the Veteran used a cane for assistance. An EMG from August 2009 was noted to show evidence of right peroneal neuropathy across the fibular head and concurrent right L5-S1 radiculopathy. There was paralysis, but no neuritis or neuralgia. There were significant effects on the Veteran's occupation, specifically, decreased mobility, problems with lifting and carrying, lack of stamina, and decreased strength in the lower extremity. The effects were characterized as "none" (grooming, toileting, dressing, bathing, and feeding), "moderate" (traveling, recreation, shopping, and chores), and "prevents" (sports and exercise). The diagnoses included peroneal nerve palsy, right, with right foot drop. Reports from G.G., M.D., dated in February, March, and April of 2011, state that the Veteran was neurologically intact. The Board finds that the evidence does not demonstrate that the Veteran's disability is shown to have been manifested by complete paralysis, neuritis, or neuralgia, of the external popliteal nerve, such that an initial evaluation in excess of 30 percent is warranted under DC's 8521, 8621, or 8721. The Veteran is shown to have right foot drop. Further, as of October 2009, he was noted not to have reflexes at the ankle, and to have 1/5 strength at the foot dorsiflexor. However, the totality of the evidence does not support a finding of complete paralysis. Sensory function examination was normal for the right side. Reflexes at the right knee were 2+, and normal at right plantar flexion. There was no muscle atrophy. The examiner stated that no joint function was affected by the nerve disorder. Accordingly, the criteria for an initial evaluation in excess of 30 percent have not been met under DC's 8521, 8621, or DC 8721. b). As of December 27, 2012 As of December 27, 2012, the Board finds that the criteria for a 40 percent rating are shown to have been met. VA spine, and peripheral nerves, Disability Benefits Questionnaires (DBQs) indicate that the Veteran was examined on December 27, 2012. The findings were discussed in Part I.B.1.b. Briefly stated, the December 2012 DBQ shows that strength at the right knee was 5/5, and 1/5 at the right ankle (plantar flexion), and 0/5 (dorsiflexion). Reflexes at the right knee and ankle were 0 (absent). There was decreased sensation at the right lower leg, and no sensation at the right foot and toes. Of particular note, his external popliteal nerve was noted to be productive of complete paralysis. He was shown to have 0/5 strength on dorsiflexion. Therefore, affording the Veteran the benefit of all doubt, the Board finds that the evidence is at least in equipoise, and that the criteria for a 40 percent rating for the Veteran's service-connected right peroneal nerve palsy are shown to have been met as of December 27, 2012. The Board notes that an evaluation in excess of 40 percent is not warranted, as the 40 percent evaluation is the maximum rating provided for under DCs 8521, 8621, and 8721. In addition, as discussed infra, an extraschedular rating is not warranted. See 38 C.F.R. § 3.321(b)(1). 3. Left Lower Extremity Radiculopathy In March 2013, the AMC granted service connection for left lower extremity radiculopathy, evaluated as 10 percent disabling prior to December 23, 2010, and as 20 percent disabling thereafter. The AMC assigned an effective date of July 24, 2008. The criteria for 20 percent and 40 percent ratings under DCs 8520, 8620 and 8720 have previously been discussed. a). Prior to December 23, 2010 A VA examination report, dated in October 2009, shows that the Veteran complained of left lower extremity pain and weakness since 2007. He reported that he had weakness and pain that went from the posterior aspect of the upper thigh to the distal calf. On examination, the left lower extremity had 5/5 strength. A sensory function examination was normal for the left lower extremity. There was no muscle atrophy. Reflexes at the left knee were 2+, and 0 at the left ankle. Left plantar flexion was normal. The relevant diagnosis was left lower extremity radiculopathy. There was chronic leg pain, with neuritis and neuralgia, but not paralysis. There were significant effects upon the Veteran's occupation, characterized as "none" (grooming, toileting, dressing, bathing, and feeding), "moderate" (traveling, recreation, shopping, and chores), and "prevents" (exercise and sports). The impact on occupational activities was decreased mobility, problems with lifting and carrying, lack of stamina, weakness or fatigue, decreased strength, and lower extremity pain. The Board finds that the evidence does not demonstrate that the Veteran's disability is shown to have been manifested by moderate paralysis, neuritis, or neuralgia, of the sciatic nerve, such that an initial evaluation in excess of 10 percent is warranted under DC's 8520, 8620, or 8720. The October 2009 VA examination report shows that the left lower extremity had 5/5 strength. A sensory function examination was normal for the left lower extremity. There was no muscle atrophy. While there were no reflexes in the left ankle, reflexes at the left knee were retained at 2+. Left plantar flexion was also normal. Given the aforementioned medical evidence, the Board finds that the Veteran's service-connected left lower extremity radiculopathy did not result in moderate paralysis, neuritis, or neuralgia, of the sciatic nerve. An initial evaluation in excess of 10 percent under DCs 8520, 8620, or 8720 is not warranted. b). As of December 23, 2010 The Veteran was examined on December 23, 2010. A peripheral nerves examination report shows that the Veteran complained of left leg tingling pain from the superior posterior thigh to the distal calf. He also complained that his legs "give out" at times, and that his left leg bothered him more than the right. On examination the left knee and left ankle had 2+ (normal) reflexes. Plantar flexion was normal. A sensory examination was normal, and there were no dysthesias. Strength was 5/5 at the left hip, knee, ankle, and great toe. The right calf was 1.5 cm. less in diameter than the right. The diagnosis was bilateral lower extremity radiculopathy. There was neuralgia, but no paralysis or neuritis. The Veteran's symptoms were noted to cause increased absenteeism, with decreased mobility, problems with lifting and carrying, lack of stamina, weakness or fatigue, decreased strength, and pain. The Board notes that many of these findings are repeated in a VA spine examination report for the same day. Reports from G.G., M.D., dated as of December 2010 include a January 2011 report which notes atrophy involving the posterior tibialis muscle on the left side, but that there is no evidence of foot drop. Reports, dated in February, March, and April of 2011, state that the Veteran was neurologically intact. VA spine, and peripheral nerves, Disability Benefits Questionnaires (DBQs) indicate that the Veteran was examined on December 27, 2012. The examiner indicated that the Veteran's claims file had been reviewed. The spine examination shows that the Veteran complained of lumbar radiculopathy affecting his left lower extremity. On examination, strength was 5/5 for left ankle plantar flexion, left ankle dorsiflexion, and left great toe extension. There was no muscle atrophy. Reflexes at the left knee and left ankle were 0. A sensory examination was normal for the left thigh and left knee, and decreased at the left lower leg and ankle, and left foot and toes. The left lower extremity did not have constant pain. The peripheral nerves examination report shows that the relevant diagnosis was lumbar radiculopathies, bilateral lower extremities. There was no constant pain in the left lower extremity. Strength of left knee extension, left ankle plantar flexion, and left ankle dorsiflexion was 5/5. There was no muscle atrophy. Reflexes for the left knee and left ankle were 0. Gait was slow, using a cane, due to the Veteran's back disorder and right foot drop. The left sciatic nerve was normal, as was the left external popliteal and left musculocutaneous (superficial peroneal) nerve, the left anterior tibial (deep peroneral) nerve, the left internal popliteal (deep peroneal) nerve, the left internal popliteal (tibial) nerve, the left posterior tibial nerve, the left anterior crural (femoral) nerve, the left internal saphenous nerve, the left obturator nerve, the left external cutaneous nerve of the thigh, and the left ilio-inguinal nerve. The report notes that the Veteran regularly used braces, and a cane, with constant use of a walk-aid (nerve stimulator). The examiner stated that the Veteran's left- sided radiculopathies were considered moderate, based on his history and a physical. An EMG study from 2008-09 was noted to be abnormal for the left lower extremity. The Veteran's peripheral nerve condition impacted the Veteran's ability to work by interfering with normal mobility, limited walking and standing time, and distance, and interference with normal physical activities. The Board finds that, as of December 23, 2010, the Veteran's condition is not shown to have been manifested by moderately severe incomplete paralysis, such that an evaluation in excess of 20 percent for the left lower extremity is warranted. Briefly stated, the December 2010 VA examination report shows that the left knee and left ankle had 2+ (normal) reflexes. Plantar flexion was normal. A sensory examination was normal, and there were no dysthesias. Strength was 5/5 at the left hip, knee, ankle, and great toe. The right calf was 1.5 cm. less in diameter than the left. The diagnosis was bilateral lower extremity radiculopathy. There was neuralgia, but no paralysis or neuritis. The December 2012 VA DBQs show that there was not constant pain in the left lower extremity. Strength of left knee extension, left ankle plantar flexion, and left ankle dorsiflexion was 5/5. There was no muscle atrophy. Reflexes for the left knee and left ankle were 0. Gait was slow, using a cane, due to the Veteran's back disorder and right foot drop. The left sciatic nerve was normal, as were all other nerves in the left lower extremity. The examiner stated that the Veteran's left-sided radiculopathies were considered moderate. Based on the foregoing, the Board finds that the evidence does not show that the Veteran's left lower extremity radiculopathy is manifested by symptomatology that more nearly approximates the criteria for an evaluation in excess of 20 percent under DCs 8520, 8620, or 8720, and that the preponderance of the evidence is against an increased initial evaluation. 4. Conclusion The Board acknowledges that the Veteran is competent to report symptoms of his lumbar spine and lower extremities. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). Additionally, he is credible in his reports of symptoms and their effect on his activities. He is not however competent to identify a specific level of disability of his disability according to the appropriate diagnostic code. Such competent evidence concerning the nature and extent of the Veteran's service- connected lumbar spine disability has been provided by VA medical professionals who have examined him. The medical findings directly address the criteria under which this disability is evaluated. The Board finds these records to be the only competent and probative evidence of record, and therefore is accorded greater weight than the Veteran's subjective complaints of increased symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Consideration has also been given to whether the schedular evaluations are inadequate, thus requiring that the RO refer a claim to the Under Secretary for Benefits or the Director, Compensation and Pension Service, for consideration of "an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service- connected disability or disabilities." 38 C.F.R. § 3.321(b)(1) (2012); Barringer v. Peake, 22 Vet. App. 242, 243-44 (2008) (noting that the issue of an extraschedular rating is a component of a claim for an increased rating and referral for consideration must be addressed either when raised by the veteran or reasonably raised by the record). In determining whether an extra-schedular evaluation is for consideration, the Board must first consider whether there is an exceptional or unusual disability picture, which occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a Veteran's service-connected disability. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, the Board must next consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 115-16. When those two elements are met, the appeal must be referred for consideration of the assignment of an extra-schedular rating. Otherwise, the schedular evaluation is adequate, and referral is not required. 38 C.F.R. § 3.321(b)(1) (2012); Thun, 22 Vet. App. at 116. The schedular evaluations in this case are not inadequate. With the exception of the right external popliteal nerve evaluation, higher evaluations are provided for certain manifestations of all of the service-connected disabilities in issue, but the evidence reflects that those manifestations are not present in this case. Additionally, the diagnostic criteria adequately describe the severity and symptomatology of the Veteran's disabilities, as the criteria assess the level of occupational and social impairment attributable to the Veteran's symptoms. As the Board finds that the Veteran's disability picture is contemplated by the rating schedule, the inquiry ends and the Board need not consider whether the disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Referral for consideration of an extra-schedular rating is not warranted. In reaching these decisions, to the extent that the claims have been denied, the Board considered the benefit-of-the- doubt rule; however, as the preponderance of the evidence is against the appellant's claims, such rule is not for application. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). II. The Veterans Claims Assistance Act of 2000 The Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012). The notification obligations in this case were accomplished by way of letters from the RO to the Veteran dated in April 2004, and February 2008. Quartuccio v. Principi, 16 Vet. App. 183 (2002); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F. 3d 1328 (Fed. Cir. 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). With regard to the claims for increased initial evaluations, where, as here, 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 was intended to serve has been fulfilled; no additional § 5103(a) notice is required. Dingess, 19 Vet. App. at 491. The RO has provided assistance to the appellant as required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c), as indicated under the facts and circumstances in this case. It appears that all known and available service treatment reports, and post-service records relevant to the issues on appeal have been obtained and are associated with the Veteran's claims file. The RO has obtained the Veteran's VA and non-VA medical records, and SSA records. The Veteran has been afforded several examinations. In December 2012, the Board remanded this claim. The Board directed that the RO/Appeals Management Center (AMC) obtain and associate with the claims file any new medical evidence, from VA or otherwise, that may have come into existence since the time the claims file was last updated by the RO/AMC, specifically since the Veteran's February 2011 private decompressive lumbar laminectomy. That same month, the Veteran was sent a duty-to-assist letter in compliance with the Board's remand. VA progress notes, dated through December 2012, were subsequently associated with the claims file. The Board further directed that the Veteran undergo an appropriate VA neurologic examination to determine the current severity of his herniated lumbar pulposus, lumbar spine. In December 2012, this was done. Concerning this examination, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the December 2012 VA DBQs show that the examiner reviewed the Veteran's medical history, recorded his current complaints, conducted an appropriate examination, provided the appropriate findings, and rendered diagnoses that are consistent with the remainder of the evidence of record. Under the circumstances, the Board finds that there has been substantial compliance with its remand. See Dyment v. West, 13 Vet. App. 141, 146-147 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where Board's remand instructions were substantially complied with); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). In July 2008, the Veteran was provided an opportunity to set forth his contentions during a hearing before the undersigned. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the U.S. Court of Appeals for Veterans Claims recently held that 38 C.F.R. § 3.103(c)(2) requires that the RO Decision Review Officer who chairs a hearing to fulfill two duties: (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010). Here, during the July 2008 hearing, the undersigned identified the issue on appeal. Also, information was solicited regarding the severity of his disability. The testimony did not reflect that there were any outstanding medical records available that would support his claim. Therefore, not only was the issue "explained . . . in terms of the scope of the claim for benefits," but "the outstanding issues material to substantiating the claim" were also fully explained. See Bryant, 23 Vet. App. at 497. Moreover, the hearing discussion did not reveal any evidence that might be available that had not been submitted. As such, the Board finds that, consistent with Bryant, the undersigned complied with the duties set forth in 38 C.F.R. 3.103(c)(2) and that the Board may proceed to adjudicate the claim based on the current record. The Board concludes, therefore, that decisions on the merits at this time do not violate the VCAA, nor prejudice the appellant under Bernard v. Brown, 4 Vet. App. 384 (1993). Based on the foregoing, the Board finds that the Veteran has not been prejudiced by a failure of VA in its duty to assist, and that any violation of the duty to assist could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). ORDER A rating in excess of 40 percent for service-connected herniated nucleus pulposus, lumbar spine, is denied. Prior to December 27, 2012, a rating in excess of 20 percent for service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, is denied. As of December 27, 2012, a rating in excess of 40 percent for the Veteran's service-connected right sciatic neuropathy, and neuropathy with foot drop, external popliteal nerve, is denied. Prior to December 27, 2012, a rating in excess of 30 percent for the Veteran's service-connected right peroneal nerve palsy is denied. As of December 27, 2012, a rating of 40 percent, and no more, for the Veteran's service-connected right peroneal nerve palsy is granted, subject to the laws and regulations governing the award of monetary benefits. Prior to December 23, 2010, a rating in excess of 10 percent for the Veteran's service-connected left lower extremity radiculopathy is denied. As of December 23, 2010, a rating in excess of 20 percent for the Veteran's service-connected left lower extremity radiculopathy is denied. REMAND In May 2013, the RO granted special monthly compensation based on loss of use of the right foot. In May 2013, the Veteran's representative filed a timely notice of disagreement (NOD) as to the issue of entitlement to an earlier effective date. A statement of the case has not yet been issued as to this claim. Because a timely NOD was filed to the May 2013 rating decision, the RO must now provide the Veteran with a statement of the case on the issue of entitlement to an effective date prior to December 27, 2012, for special monthly compensation for loss of use of the right foot. See Manlincon v. West, 12 Vet. App. 238 (1999). Accordingly, the case is REMANDED for the following action: Issue a statement of the case with respect to the issue of entitlement to an effective date prior to December 27, 2012, for special monthly compensation for loss of use of the right foot. The Veteran should be advised that he may perfect his appeal of this issue by filing a Substantive Appeal within 60 days of the issuance of the Statement of the Case. See 38 C.F.R. § 20.302(b). The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008). ____________________________________________ MICHAEL A. HERMAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs