Citation Nr: 1329262 Decision Date: 09/12/13 Archive Date: 09/20/13 DOCKET NO. 08-29 738A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an initial evaluation in excess of 10 percent for lumbosacral degenerative disc disease with bilateral lower extremity radiculopathy. 2. Entitlement to an initial compensable evaluation for left (minor) carpal tunnel syndrome. 3. Entitlement to an initial evaluation in excess of 10 percent for right (major) cubital tunnel syndrome. 4. Entitlement to an initial evaluation in excess of 10 percent for right knee patellofemoral syndrome. 5. Entitlement to an initial compensable evaluation for left ankle sprain. 6. Entitlement to an initial compensable evaluation for migraine headaches. 7. Entitlement to an initial compensable evaluation for onychomycosis. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD R. Casadei, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1988 to January 2008. This case comes before the Board of Veterans' Appeals (Board) on appeal of a March 2008 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah, as well as a May 2008 decision by the RO in Waco, Texas. In an August 2008 rating decision, the RO granted a 10 percent evaluation for right knee patellofemoral syndrome, effective February 1, 2008, the date following release from service. Although the RO granted a higher 10 percent disability rating, the claim remains in controversy because the Veteran is not in receipt of the maximum benefit allowable. See A.B. v. Brown, 6 Vet. App. 35 (1993). In his Notice of Disagreement received in April 2008, the Veteran brought to the RO's attention the fact that they had failed to adjudicate the issue of service connection for skin cancer/actinic keratosis. Inasmuch as that issue has not been developed or certified for appellate review, it is not for consideration at this time. It is, however, being referred to the RO for appropriate action. FINDINGS OF FACT 1. The Veteran has not provided good cause for failed to report to the May 2012 VA neurological, dermatological, and spine examinations scheduled in connection with his claims on appeal. 2. For the entire initial rating period on appeal, the Veteran's service-connected lumbosacral degenerative disc disease is characterized by forward flexion of the thoracolumbar spine of 70 degrees, and a combined range of thoracolumbar motion of 220 degrees. The Veteran did not have incapacitating episodes due to degenerative disc disease of the lumbar spine, requiring bed rest prescribed by a physician and treatment by a physician. 3. For the entire initial rating period on appeal, the Veteran has consistently reported numbness and pain in both legs associated with his lumbosacral degenerative disc disease characterized as mild manifestation of bilateral lower extremity radiculopathy. 4. For the entire initial rating period on appeal, symptoms pertaining to the Veteran's left carpal tunnel syndrome do not more nearly approximate mild incomplete paralysis of the median nerve as there is no evidence of neurological or sensory loss. 5. For the entire initial rating period on appeal, the Veteran's right cubital tunnel syndrome do not more nearly approximate mild incomplete paralysis of the median nerve as there is no evidence of neurological or sensory loss. 6. For the entire initial rating period on appeal, the Veteran's right knee disability has been manifested by flexion exceeding 30 degrees and extension to zero degrees with no lateral instability. 7. For the entire initial rating period on appeal, the Veteran's left ankle disability has been manifested by pain with at least 20 degrees dorsiflexion and 45 degrees plantar flexion in the left ankle. 8. For the entire initial rating period on appeal, the Veteran's migraines have not been characterized as "prostrating" and he reported no loss of workdays during the last 12 month period secondary to his migraine condition. 9. For the entire initial rating period on appeal, the Veteran's onychomycosis has represented less than one percent of total body surface and zero percent of exposed body surface and has not required the use of intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for treatment of his disability. CONCLUSIONS OF LAW 1. For the entire initial rating period on appeal, the criteria for an initial evaluation in excess of 10 percent for service-connected lumbosacral degenerative disc disease have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010-5242 (2012). 2. For the entire initial rating period on appeal, the criteria for a separate rating of 10 percent for right lower extremity radiculopathy have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2012). 3. For the entire initial rating period on appeal, the criteria for a separate rating of 10 percent for left lower extremity radiculopathy have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2012). 4. For the entire initial rating period on appeal, the criteria for a compensable rating for carpal tunnel syndrome of the left upper extremity have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Codes 8515, 8599 (2012). 5. For the entire initial rating period on appeal, the criteria for a compensable rating for cubital tunnel syndrome of the right upper extremity have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Codes 8516, 8599 (2012). 6. For the entire initial rating period on appeal, the criteria for a rating in excess of 10 percent, for the Veteran's service-connected patellofemoral syndrome of the right knee, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 4.71a, Diagnostic Codes 5010, 5256, 5258, 5259, 5260, 5261, 5262, 5263 (2012). 7. For the entire initial rating period on appeal, the criteria for an initial compensable evaluation for left ankle sprain, have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.71, Plate II, 4.71a, Diagnostic Code 5271 (2012). 8. For the entire initial rating period on appeal, the criteria for a compensable rating for service-connected migraine headaches have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.10, 4.124a, Diagnostic Code 8100 (2012). 9. For the entire initial rating period on appeal, the criteria for a compensable rating for onychomycosis have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Codes 7806, 7899 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Because the current appeal arises from the Veteran's disagreement with the initial evaluations following the grant of service connection for the claims currently on appeal, no additional notice is required. The United States Court of Appeals for the Federal Circuit (Federal Circuit) and the United States Court of Appeals for Veterans Claims (Court) have held that, once service connection is granted and the claim is substantiated, additional notice is not required, and any defect in notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App.112 (2007); 38 C.F.R. § 3.159(b)(3)(i) (no duty to provide VCAA notice upon receipt of a notice of disagreement); VAOPGCPREC 8-2003 (in which the VA General Counsel interpreted that separate notification is not required for "downstream" issues following a service connection grant, such as initial rating and effective date claims). The Board finds that all necessary development has been accomplished; therefore, appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). VA has made reasonable efforts to assist the Veteran in obtaining evidence necessary to substantiate his claim. 38 U.S.C.A. § 5103A. VA has obtained service records, private treatment records, VA treatment records, and other records identified by the Veteran. Further, the issues on appeal were previously remanded by the Board in September 2010 for further evidentiary development of requesting outstanding post-service VA treatment records and to obtain VA neurological, dermatological, and spine examinations to assist in determining the current nature and severity of the Veteran's disabilities. In this regard, the RO obtained outstanding VA treatment records, associated them with the claims file, and scheduled the Veteran for the abovementioned VA examinations in May 2012. However, the Veteran cancelled the May 2012 VA dermatological examination, failed to report to the May 2012 VA neurological examination, and refused the May 2012 VA spine examination. See June 2012 RO report of contact. Further, the Veteran has not shown good cause for his failure to report to any of these examinations. In a July 2013 informal hearing presentation, the Veteran's representative noted that the Veteran was "unable to attend" the May 2012 VA examinations, but provided no explanation or basis for his failure to report or to reschedule the examinations. The Court has held that "[t]he duty to assist is not always a one-way street." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The failure to report to a scheduled examination, without good cause, may result in a denial of a claim for a higher initial disability rating (an original claim), as the claim will be considered on the basis of evidence of record. See 38 C.F.R. § 3.655 (2012). Therefore, because the Veteran has not shown good cause for his failure to report for his most recently scheduled VA examinations, the Board will proceed to decide the claims based on the remaining evidence of record. See Wood, 1 Vet. App. at 193; see also Kowalski v. Nicholson, 19 Vet. App. 171, 180 (2005). For these reasons, the Board finds that there was substantial compliance with the September 2010 Board remand directives. Accordingly, no further remand is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). Legal Criteria for Initial Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating 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. § 4.97 (2012). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has been established and a higher initial disability rating is at issue, the level of disability at the time entitlement arose is of primary concern. Consideration must also be given to a longitudinal picture of a Veteran's disability to determine if the assignment of separate ratings for separate periods of time, a practice known as "staged" ratings, is warranted. See Fenderson v. West, 12 Vet. App. 119 (1999). Upon review of the evidence of record, and for the reasons explained in detail below, the Board finds that staged ratings are not applicable in this case. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. 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 it 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 that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The factors involved in evaluating, and rating disabilities of the joints include weakness; fatigability; incoordination; restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. Initial Rating for Lumbar Spine Disability The Veteran claims his lumbar spine disability warrants an initial evaluation in excess of 10 percent. See April 2008 notice of disagreement and July 2013 informal hearing presentation. The RO granted service connection for lumbosacral degenerative disc disease with bilateral lower extremity radiculopathy, with a 10 percent evaluation, in the March 2008 rating decision on appeal. The Board finds that the RO appropriately rated the Veteran's spine disability under Diagnostic Code 5010-5242. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 (2012). Diagnostic Code 5010 contemplates traumatic arthritis and directs that disabilities under this Diagnostic Code be rated as degenerative arthritis under Diagnostic Code 5003. In turn, Diagnostic Code 5003 directs that degenerative arthritis be rated based on limitation of motion of the affected part. Diagnostic Code 5242, which contemplates lumbosacral strain and rates based on limitation of motion of the spine, is subsumed into the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). That notwithstanding, the Board will also will consider all applicable diagnostic codes under 38 C.F.R. § 4.71a. See 38 C.F.R. § 4.27. The General Rating Formula provides that diseases and injuries of the spine should be rated as follows: 5235, vertebral fracture or dislocation; 5236, sacroiliac injury and weakness; 5237, lumbosacral or cervical strain; 5238, spinal stenosis; 5239, spondylolisthesis or segmental instability; 5240, ankylosing spondylitis; 5241, spinal fusion; 5242, degenerative arthritis of the spine (see also Diagnostic Code 5003); and 5243, intervertebral disc syndrome. 38 C.F.R. § 4.71a. Under the general rating formula for diseases and injuries of the spine, ratings are assigned as follows: with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent disability evaluation is assigned when there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a. A 50 percent rating is awarded for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. In the present case, the Veteran is service connected for radiculopathy of the right and left lower extremities. See March 2008 rating decision. Because the Veteran's radiculopathy was found to be noncompensable, the RO did not rate the radiculopathy and lumbar spine disabilities separately, but instead, included radiculopathy in the evaluation of the lumbar disability. Despite the RO's actions, the Board will consider whether separate compensable disability ratings are warranted for the Veteran's service-connected lower bilateral radiculopathy disabilities. 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. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 38 C.F.R. § 4.71a. Intervertebral disc syndrome (preoperatively or postoperatively) may be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (2012) (combined ratings table). The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months warrants a 20 percent evaluation. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. As noted above, the Veteran has not provided good cause for failure to attend the scheduled May 2012 VA spine examination; therefore, the Board will adjudicate the initial rating claim based on the evidence of record. See 38 C.F.R. § 3.655. Initially, it has not been contended or shown at any time during the rating period that the Veteran has residuals of a fracture of the vertebra (Diagnostic Code 5235), sacroiliac injury and weakness (Diagnostic Code 5236), spondylolisthesis or segmental instability (Diagnostic Code 5239), ankylosing spondylitis (Diagnostic Code 5240), or spinal fusion (Diagnostic Code 5241). Accordingly, the diagnostic codes pertaining to those disabilities are not applicable in this case. Next, in order to obtain the next higher 20 percent rating under the general rating formula for diseases and injuries of the spine, the Veteran's spine disability must manifest forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Here, the Veteran's spine disability has not manifested forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees. Specifically, forward flexion of the Veteran's thoracolumbar spine was to 90 degrees in the September 2007 VA examination and to 70 degrees in the October 2010 VA examination. Further, the Veteran's combined range of motion of the thoracolumbar spine was greater than 120 degrees. In the September 2007 VA examination, the combined range of motion of the thoracolumbar spine was 240 degrees. It was 220 degrees in the most recent October 2010 VA examination. Finally, the Veteran has not manifested muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The September 2007 VA examiner noted no muscle atrophy, no abnormality of posture of gait, and no other overt deformities of the spine. The October 2010 VA examiner noted a normal gait and no spinal abnormalities. Objective clinical findings revealed no muscle spasms and no guarding. For these reasons, the Board finds that a higher initial rating in excess of 10 percent for the Veteran's lumbosacral degenerative disc disease is not warranted under the general rating formula for diseases and injuries of the spine. 38 C.F.R. § 4.71a. It is observed that the Veteran was found to have degenerative joint disease in his lumbar spine. See October 2010 VA examination report. Arthritis shown by X-ray studies is rated based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a. The evaluation of arthritis is conducted under Diagnostic Code 5003, which states that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The lumbar vertebrae are considered a group of minor joints that is ratable on parity with a major joint. 38 C.F.R. § 4.45. Diagnostic Code 5003 allows for the assignment of a maximum 20 percent rating only where there is X-ray evidence of arthritis of two or more major joints or two or more minor joint groups. The lumbar spine may only be rated as one major joint. Accordingly, the evidence does not support a rating in excess of 10 percent for the service-connected lumbar spine disability under Diagnostic Codes 5003 and 5010. 38 C.F.R. § 4.71a. The medical evidence of record, including the September 2007 and October 2010 VA examinations, specifically found that the Veteran had degenerative disc disease of the lumbar spine (i.e., intervertebral disc syndrome (IVDS)). To receive a rating in excess of 10 percent based on incapacitating episodes based on the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, the record would need to show evidence of bed rest, prescribed by a physician, having a total duration of at least 2 weeks during the past 12-month time period. Here, the September 2007 VA examiner specifically noted that the Veteran had not been placed on strict bed rest by a physical for incapacitating episodes during the last twelve months. The October 2010 VA examiner noted no incapacitating episodes of spine disease and no limitation to walking. For these reasons, and based on the evidence of record, the Board finds that a higher rating in excess of 10 percent under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is not warranted. The Board acknowledges that the Veteran has chronic low back pain and thus, recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. Nevertheless, higher compensation is not warranted under these provisions because the persuasive and credible evidence of additional functional loss due to pain, weakness, fatigue, or incoordination does not show limited motion or function to such a degree so as to warrant a rating in excess of 10 percent for any period of time. Furthermore, the Board has considered the possibility for staged ratings. Fenderson, supra. However, as the evidence does not show that the criteria for a rating in excess of 10 percent have been met at any time during the initial rating period, the Board concludes that staged ratings are inapplicable. In sum, the weight of the credible and competent evidence shows the orthopedic manifestations of the Veteran's low back disability do not warrant an initial rating in excess of 10 percent for any period of time during the appellate period. 38 U.S.C.A. § 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.3, 4.7. Separate Rating for Neurological Manifestations The Board has also considered whether separate evaluations for neurological disabilities are warranted. As instructed by Note (1) to the General Rating Formula for Disabilities of the Spine, associated objective neurological abnormalities should be rated separately under an appropriate Diagnostic Code. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Following a review of the claims file, the Board finds that separate ratings of 10 percent for radiculopathy of each lower extremity are warranted. The Board finds that the Veteran's radiculopathy disability is most properly rated under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8520 for impairment of the sciatic nerve. See May 2008 rating decision. Further, the RO found that bilateral lower extremity radiculopathy had been chronic since 1999. See March 2008 rating decision; see also September 2007 VA medical examination diagnosing radiculopathy. Under Diagnostic Code 8520, paralysis of the sciatic nerve, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; 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; and 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. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. Words such as "mild," "moderate," "moderately severe" and "severe" 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 "moderate" or "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. The evidence of record demonstrates that the Veteran has credibly and consistently reported numbness and pain in both legs as due to his lumbar spine disability. See July 2007 report of medical assessment, September 2007 VA examination report, and June 2008 lay statement from Veteran's wife. Specifically, the Veteran has reported pain and numbness in the front of his legs which impacts his ability to remain seated or standing for long periods of time. As such, while the most recent October 2010 VA examination report reflected no neurological deficit at that time, the Board finds the record reflects that the Veteran has a current diagnosis of radiculopathy with symptoms manifesting the bilateral lower extremities during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007). For these reasons, the Board further finds that the Veteran's neurological abnormality warrants a 10 percent rating for each lower extremity. The Board finds that neurological findings described above show no more than a "mild" manifestation of radiculopathy. See 38 C.F.R. § 4.6. As such, the Board finds that a separate 10 percent evaluation for mild radiculopathy of each lower extremity is warranted. Rating for Left Carpal Tunnel Syndrome and Right Cubital Tunnel Syndrome In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120 (2012). Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of 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 only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, 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 equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. The RO rated the Veteran's left carpal tunnel syndrome and right cubital tunnel syndrome under Diagnostic Codes 8515 and 8516, respectively, which pertain to paralysis of the median nerve and ulnar nerve, respectively. 38 C.F.R. § 4.124a, Diagnostic Codes 8515, 8516. The evidence in this case indicates that the Veteran is right handed, and therefore, for the right arm, the Board will apply the criteria applicable to the major extremity, and for the left arm, the Board will apply the criteria applicable to the minor extremity. 38 C.F.R. § 4.69 (2012). The criteria for evaluating the severity or impairment of the median nerve is set forth under Diagnostic Codes 8515. Under Diagnostic Code 8515, complete paralysis of the median nerve is where the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition of abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances. This code provides a 10 percent rating for mild incomplete paralysis of the median nerve. A 20 percent rating is warranted for moderate incomplete paralysis of the minor extremity. A 30 percent rating is warranted for moderate incomplete paralysis of the median nerve in the major extremity. A 40 percent rating requires severe incomplete paralysis of the median nerve in the minor extremity, and a 50 percent rating is warranted for severe incomplete paralysis of the median nerve in the major extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8515. Diagnostic Code 8516 provides for the rating for paralysis of the ulnar nerve. Complete paralysis of the ulnar nerve of the major upper extremity, which is rated 60 percent disabling, contemplates a "griffin claw" deformity due to flexor contraction of the right and little fingers, very marked atrophy in the dorsal interspaces and the thenar and hypothenar eminences, loss of extension of the right and little fingers, an inability to spread (or reverse) the fingers, an inability to adduct the thumb, and weakness of the flexion of the wrist. Disability ratings of 10 percent, 30 percent and 40 percent are assignable for incomplete paralysis of the ulnar nerve of the major upper extremity, which is mild, moderate, or severe in degree, respectively. 38 C.F.R. § 4.124a, Diagnostic Code 8516. Service treatment records reflect that when undergoing nerve conduction studies in June 2007, the Veteran was diagnosed with left carpal tunnel syndrome. At the September 2007 VA examination, the left wrist was tender to palpation circumferentially. Further, the Veteran reported limitations, including difficulty performing motions which required torque, such as opening a jar, using mechanical tools, and difficulty conducting physical exercise. Upon examination, the wrist and all fingers on the left hand had normal ranges of motion with no pain on motion. The September 2007 diagnosed left carpal tunnel syndrome, but there was no evidence of a neurological or sensory loss. In the October 2010 VA examination, the Veteran reported no current symptoms, but described the course of his symptoms as intermittent with remissions. Based upon review of all the evidence of record, both lay and medical, the Board finds that symptoms pertaining to the Veteran's left carpal tunnel syndrome do not more nearly approximate mild incomplete paralysis of the median nerve as the evidence of record does not include a finding of neurological or sensory loss. As such, the Board finds that a compensable rating is not warranted for mild left carpal tunnel syndrome. In regard to the Veteran's service-connected right cubital tunnel syndrome, the Board finds that the September 2007 VA examiner diagnosed the Veteran with right cubital tunnel syndrome based on the same examination and subjective symptomatology as reported above under the carpal tunnel section. Accordingly, the Board finds that the Veteran's right cubital tunnel syndrome does not more nearly approximate mild incomplete paralysis of the ulnar nerve as there is no evidence of neurological or sensory loss. As such, the Board finds that a compensable rating is not warranted for mild right cubital tunnel syndrome. Initial Rating for Right Knee Patellofemoral Syndrome In the November 2008 rating decision, the Veteran's patellofemoral syndrome, was assigned a 10 percent rating under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5260. In this regard, although the record does not demonstrate a diagnosis of arthritis of the right knee, there is evidence of limited motion and painful motion. The provisions of 38 C.F.R. § 4.59 establish that the Veteran is entitled to a minimum compensable (10 percent) evaluation for painful motion. See also Burton v. Shinseki, 25 Vet. App. 1 (2011). However, evaluations in excess of the minimum compensable rating (10 percent) must be based on demonstrated functional impairment. Under Diagnostic Code 5260, limitation of knee flexion is rated 30 percent where flexion is limited to 15 degrees; 20 percent where flexion is limited to 30 degrees; and 10 percent where flexion is limited to 45 degrees. 38 C.F.R. § 4.71a. The Board may also assign a separate rating for limitation of extension under Diagnostic Code 5261. Limitation of knee extension is rated 50 percent where extension is limited to 45 degrees; 40 percent where extension is limited to 30 degrees; 30 percent where extension is limited to 20 degrees; 20 percent where extension is limited to 15 degrees; 10 percent where extension is limited to 10 degrees; and 0 percent where extension is limited to 5 degrees. 38 C.F.R. § 4.71a. In the present case, in the September 2007 VA examination, flexion of the Veteran's right knee was noted to 130 degrees with no pain on motion. The Board notes that extension of the right knee was not recorded in the September 2007 VA examination. At the October 2010 VA examination, flexion was to 140 degrees and extension was normal with no pain on motion and no pain after repetitive use. Based on the above evidence regarding ranges of motion of the right knee, the Board finds that the criteria for a rating in excess of 10 percent are not met for any period. That is, even with the consideration that painful motion limits motion at the point where the pain begins, the evidence has always demonstrated flexion of the right knee that exceeds 30 degrees, so the disability does not more nearly approximate the criteria for a 20 percent disability rating under Diagnostic Code 5260, and demonstrates extension of the right knee that is possible to zero degrees, so does not more nearly approximate the criteria for a separate 10 percent rating for extension under Diagnostic Code 5261. 38 C.F.R. § 4.71a. Although pain may cause a functional loss, pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. In any view of the matter, the results here exclude the possibility that the range of motion was ever limited-either by functional loss due to pain or structural limitationto 30 degrees, as required for a higher disability rating of 20 percent under Diagnostic Code 5260. The Board acknowledges that the Veteran has right knee pain and thus, recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. That notwithstanding, a higher compensation is not warranted under these provisions because the persuasive and credible evidence of additional functional loss due to pain, weakness, fatigue, or incoordination does not show limited motion or function to such a degree so as to warrant a rating in excess of 10 percent for any period of time. The Board has also considered entitlement to a higher rating or a separate rating on the basis of lateral instability or recurrent subluxation. Under Diagnostic Code 5257, a 30 percent rating is available where such impairment is severe; a 20 percent rating is available where such impairment is moderate; and a 10 percent rating is available where such impairment is slight. Here, in the October 2010 VA examination, the examiner noted no instability after conducting a physical examination of the Veteran's right knee. In the September 2007 VA examination, the examiner noted no swelling, no effusion, and no ligamentous instability. For these reasons, the Board finds that a higher or separate rating under Diagnostic Code 5257 is not warranted. Although the record does not contain any evidence of right knee arthritis, the maximum disability rating for the right knee, a major joint, for painful arthritis productive of noncompensable limitation of motion of the knee, under Diagnostic Code 5003, is 10 percent. The provisions of Diagnostic Code 5003 specifically provide that higher ratings are to be based on limitation of motion caused by arthritis (including separate compensable ratings for both limitation of flexion and limitation of extension), to be rated under the specific Diagnostic Codes for limitation of motion of the knee. 38 C.F.R. § 4.71a. As the Veteran is already in receipt of a 10 percent rating, a higher or separate rating under Diagnostic Code 5003 is not possible. The Board has also considered whether any other diagnostic code would be appropriate. Upon review of the evidence of record, including the September 2007 and October 2010 VA examination, the Board finds that there is no evidence of ankylosis and a rating under Diagnostic Code 5256 is therefore not appropriate. As there is no history of cartilage injury, dislocation, or removal, a rating under Diagnostic Codes 5258 and 5259 is also not warranted. Further, there is no evidence of nonunion or malunion of the tibia and fibula; as such, a rating under Diagnostic Code 5262 is not warranted. The record also does not demonstrate evidence or diagnosis of genu recurvatum; therefore, a rating under Diagnostic Code 5263 is not warranted. For these reasons, the Board finds that the weight of the evidence is against a finding of an initial rating in excess of 10 percent for patellofemoral syndrome of the right knee for any period on appeal. To the extent any higher level of compensation is sought, the preponderance of the evidence is against this claim, and the benefit-of-the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Initial Rating for Left Ankle Sprain After a review of all the evidence, lay and medical, the Board finds that, for the entire rating period, a compensable rating is not warranted for a left ankle disability under Diagnostic Code 5271. The Veteran's left ankle disability has been manifested by pain with at least 20 degrees dorsiflexion and 45 degrees plantar flexion in the left ankle. The Board notes that normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the ankle is evaluated under Diagnostic Code 5271. 38 C.F.R. § 4.71a. Under this diagnostic code moderate limitation of motion of the ankle is rated as 10 percent disabling; and marked limitation of motion of the ankle is rated as 20 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5271. Additionally, ankylosis of the ankle is evaluated under Diagnostic Code 5270. 38 C.F.R. § 4.71a. A 20 percent evaluation is warranted for ankylosis of the ankle in planter flexion less than 30 degrees. A 30 percent evaluation is warranted for ankylosis of the ankle in planter flexion between 30 degrees and 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees. A 40 percent evaluation is warranted for ankylosis of the ankle in planter flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion, or eversion deformity. 38 C.F.R. § 4.71a, Diagnostic Code 5270. The evidence of record does not show limitation of motion or ankylosis of the right ankle. In both the September 2007 and October 2010 VA examination, the Veteran's range of motion (dorsiflexion and plantar flexion) were normal. Specifically, both VA examiners found dorsiflexion to 20 degrees and plantar flexion to 45 degrees. There was no evidence of ankylosis in either VA examination. There was no evidence of ankle instability, tendon abnormality or angulation. Indeed, the Veteran presented solely with complaints of tenderness on palpation at the September 2007 VA examination and some difficulty running long distances, navigating stairs, and standing for long periods of time. In the October 2010 VA examination, the examiner noted mostly mild effects on daily activities. Based on the above, the Veteran's left ankle disability most nearly approximates the criteria for the current noncompensable (0 percent) disability evaluation and no more. A compensable rating for limitation of motion of the ankle pursuant to Diagnostic Code 5271 requires limitation of motion that is at least moderate in degree. See 38 C.F.R. § 4.71a. In this case, while the Veteran sprained his right ankle in service, there is no residual loss of range of motion and no painful motion upon examination. His symptoms are essentially limited to his subjective complaints of some difficulty performing some daily tasks, including exercising, sports, recreation, traveling, and chores. See October 2010 VA examination report. These complaints alone are insufficient to yield a compensable rating. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Board has also considered additional limitation of function per 38 C.F.R. §§ 4.40 and 4.45 and DeLuca. In this regard, the Board acknowledges the Veteran's complaints of pain. However, despite his subjective complaints of pain, the objective evidence of record does not show any additional functional limitation due to this pain that are tantamount to the moderate degree of limitation required to achieve the higher 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5271. Moreover, as the Veteran is currently in receipt of separate disability ratings for radiculopathy of the bilateral lower extremities (granted herein), additional compensation for the same neurological symptoms is to be avoided as impermissible pyramiding. 38 C.F.R. § 4.14 (2012). As such, a higher or separate evaluation is not warranted. Initial Rating for Migraine Headaches The March 2008 rating decision, in pertinent part, granted service connection for migraine headaches, and assigned a noncompensable rating, effective February 1, 2008. The Veteran's headaches are rated under Diagnostic Code 8100, which contemplates migraine headaches. That diagnostic code provides for a 10 percent rating for characteristic prostrating attacks occurring an average of once every two months over the several months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average of once a month over the last several months. A maximum 50 percent rating is warranted for very frequent completely prostrating attacks productive of severe economic inadaptability. For rating codes, such as Diagnostic Code 8100, which do not provide for a 0 percent rating, a 0 percent rating will nevertheless be assigned when the symptomatology required for the minimum compensable rating is not shown. 38 C.F.R. § 4.31 (2011). As noted above, the Veteran has not provided good cause for failure attend the scheduled neurological VA examination in May 2012 in order to assist in determining the severity of currently diagnosed migraine disability. Upon review of the available evidence of record, the Board finds that evidence does not support the assignment of a compensable rating for service-connected migraine headaches. During the September 2007 VA examination, the Veteran reported the onset of migraines in the early 1990s. When present, the Veteran stated that the migraines affect the frontal skull and consist of a throbbing sensation. Occurrences were noted to be two to three times a month with 24 hour duration when present. Accompanying symptoms were described as emesis, nausea, distraction, fatigue, weakness, and photophobia. The Veteran denied blurred vision or scotomas and reported that he used Tylenol medication with no relief. The Veteran further reported no loss of workdays during the last 12 month period secondary to his migraine condition. Initially, the Board finds that neither the Veteran nor the September 2007 VA examiner characterizes the migraines as "prostrating." Though the Diagnostic Code does not provide a definition for "prostrating," by way of reference, the Board notes that according to WEBSTER'S NEW COLLEGE DICTIONARY 909 (3d Ed. 2008), "prostrate" is defined as "physically or emotionally exhausted." "Incapacitated" is listed as a synonym. A very similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st Ed. 2007), in which "prostration" is defined as "extreme exhaustion or powerlessness." Further, although the Veteran reported symptoms of emesis, nausea, distraction, fatigue, weakness, and photophobia, he denied missing work in the last 12 months. This suggests to the Board that the Veteran's migraine episodes were not incapacitating or prostrating. Moreover, the Board finds that the medical evidence of record does not demonstrate on- going treatment for the Veteran's migraines. It is reasonable to assume that if the Veteran were suffering from prostrating migraines, causing "extreme exhaustion or powerlessness," he would have informed his medical providers and/or sought treatment for such incapacitating symptoms. For these reasons, the Board finds that the weight of the evidence of record demonstrates that the Veteran's migraine headaches are not characteristic of prostrating attacks occurring an average of once every two months over the last several months. As such, an initial compensable rating for migraine headaches is not warranted. Initial Rating for Onychomycosis The Veteran's onychomycosis is currently rated by analogy under 38 C.F.R. § 4.118, Diagnostic Codes 7899-7806, applicable to dermatophytosis and dermatitis, respectively. 38 C.F.R. § 4.20. As the Veteran's skin disability relates to his toes, and not the head, face, or scarring, it is rated by analogy as dermatitis under Diagnostic Code 7806. Under Diagnostic Code 7806, a noncompensable rating is warranted if less than five percent of the entire body or less than five percent of exposed areas are affected, and; no more than topical therapy was required during the past twelve-month period. A 10 percent rating is warranted if at least five percent, but less than 20 percent, of the entire body, or at least five percent, but less than 20 percent, of exposed areas are affected, or; if intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past twelve-month period. A 30 percent rating is warranted if 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; if systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of six weeks or more, but not constantly, during the past twelve-month period. A 60 percent rating is warranted if more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or; if constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs were required during the past twelve-month period. As discussed above, the Veteran did not report to the scheduled May 2012 VA dermatological examination which was requested by the Board in order to assess the current severity of his onychomycosis. The only evidence of record pertaining to the Veteran's onychomycosis is the September 2007 VA examination report where the examiner found that the Veteran's little toes of both feet were brittle, discolored, and thickened. The examiner noted that it represented less than one percent of total body surface and zero percent of exposed body surface. During the September 2007 VA examination, the Veteran also denied the use of intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for treatment of his onychomycosis disability. The Board further finds that the remaining evidence of record is silent as to the severity of the Veteran's onychomycosis. As such, the Board finds that the preponderance of the evidence reflects that the Veteran's symptoms have not more nearly approximated the criteria for a compensable rating at any time during the appeal period. Extraschedular Consideration The Board has considered whether referral for an extraschedular evaluation is warranted for the Veteran's disabilities. In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321 (2012). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disabilities with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. In the second step of the inquiry, however, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). When the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for completion of the third step-a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. Id. Turning to the first step of the extraschedular analysis, the Board finds that the symptomatology and impairments caused by the Veteran's disabilities are specifically contemplated by the schedular rating criteria and no referral for extraschedular consideration is required. The schedular rating criteria for each of the Veteran's disabilities specifically provides for disability ratings based on a combination of history, symptoms, and clinical findings. The schedular rating criteria for the Veteran's lumbar spine, right knee, and left ankle disabilities specifically provide for ratings based on limitation of motion, including due to pain and other orthopedic factors. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca. In this case, considering the lay and medical evidence, the Veteran's service-connected lumbosacral degenerative disc disease is characterized by forward flexion of the thoracolumbar spine of 70 degrees, and a combined range of thoracolumbar motion of 220 degrees. The Veteran did not have incapacitating episodes due to degenerative disc disease of the lumbar spine, requiring bed rest prescribed by a physician and treatment by a physician. The Veteran's right knee disability has been manifested by flexion exceeding 30 degrees and extension to zero degrees with no lateral instability. The service-connected left ankle disability has been manifested by pain with at least 20 degrees dorsiflexion and 45 degrees plantar flexion in the left ankle. The schedular rating criteria specifically allows for different ratings based on the severity of the limitations of motion of the spine, knee and ankle. Further, the Veteran's reported numbness and pain in both legs associated with his lumbosacral degenerative disc disease characterized as mild manifestation of bilateral lower extremity radiculopathy are contemplated in the 10 percent rating under Diagnostic Code 8520. As for the Veteran's service-connected left carpal tunnel syndrome and right cubital tunnel syndrome (noncompensable) disabilities, Diagnostic Codes 8515 and 8516 specifically addresses incomplete paralysis of the median and ulnar nerves. Similarly, symptoms relating to the Veteran's migraines and onychomycosis are adequately contemplated in Diagnostic Codes 8100 and 7806, respectively. A comparison between the level of severity and symptomatology of the Veteran's disabilities as discussed above, with the established criteria found in the rating schedule shows that the rating criteria reasonably describe the Veteran's disability level and symptomatology. Additionally, none of the Veteran's disabilities have shown to result in any functional or occupational impairment at the time of the most recent October 2010 VA examination. The schedule is intended to compensate for average impairments in earning capacity resulting from service- connected disability in civil occupations. 38 U.S.C.A. § 1155. "Generally, the degrees of disability specified [in the rating schedule] are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability." 38 C.F.R. § 4.1. In this case, the problems reported by the Veteran are specifically contemplated by the criteria discussed above, including the effect on his daily life. In the absence of exceptional factors associated with the Veteran's disabilities, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER For the entire initial rating period, an evaluation in excess of 10 percent for lumbosacral degenerative disc disease is denied. For the entire initial rating period, a separate 10 percent disability rating for left lower extremity radiculopathy is granted. For the entire initial rating period, a separate 10 percent disability rating for right lower extremity radiculopathy is granted. For the entire initial rating period, a compensable rating for left (minor) carpal tunnel syndrome is denied. For the entire initial rating period, a compensable rating for right (major) cubital tunnel syndrome is denied. For the entire initial rating period, a rating in excess of 10 percent for right knee patellofemoral syndrome is denied. For the entire initial rating period, a compensable rating for left ankle sprain is denied. For the entire initial rating period, a compensable rating for migraine headaches is denied. For the entire initial rating period, a compensable evaluation for onychomycosis is denied. ____________________________________________ M. TENNER Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs