Citation Nr: 21026847 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 01-01 607 DATE: May 4, 2021 ORDER Entitlement to a rating in excess of 40 percent prior to June 9, 2008 for lumbar spine degenerative disc disease, arthritis, and retrolisthesis on an extraschedular basis is denied. FINDING OF FACT Prior to June 9, 2008, the Veteran's service-connected lumbar spine degenerative disc disease, arthritis, and retrolisthesis has not been shown to be so exception or unusual, with such related factors as marked interference with employment or repeated hospitalization, to warrant the assignment of a higher rating on an extraschedular basis. CONCLUSION OF LAW The criteria for higher disability rating for the Veteran's lumbar spine degenerative disc disease, arthritis, and retrolisthesis prior to June 9, 2008 on an extraschedular basis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from July 1975 to July 1984. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2000 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. Jurisdiction of this appeal is currently with the RO in St. Petersburg, Florida. By way of history, in August 2001, the Veteran was afforded a hearing before a Veterans Law Judge sitting at the Montgomery, Alabama, Regional Office. The hearing transcript is of record. In September 2003, the Board of Veterans' Appeals (Board) denied a rating in excess of 20 percent for lumbosacral strain with mechanical low back pain and a total rating for compensation purposes based on individual unemployability due to service connected disabilities (TDIU). The Veteran subsequently appealed to the United States Court of Appeals for Veterans Claims (Court). In March 2006, the Court vacated that portion of the September 2003 Board decision which denied a rating in excess of 20 percent for the service connected lumbosacral spine disability and remanded the issue to the Board for additional action. In June 2006, the Veteran was informed in writing that the Veterans Law Judge who conducted the August 2001 hearing was no longer employed by the Board and his right to have an additional hearing before another Veterans Law Judge. In June 2006, the Veteran stated that he did not wanted an additional hearing. In January 2009, the Board granted separate 10 percent ratings for right lower extremity radiculopathy and left lower extremity radiculopathy; effectuated those awards as of September 23, 2002; and denied a rating in excess of 20 percent for the lumbosacral spine disability. The Veteran subsequently again appealed to the Court. In September 2009, the Court granted the Parties' Joint Motion for Remand; vacated that portion of the January 2009 Board decision which denied a rating in excess of 20 percent for the service connected lumbosacral spine disability; and remanded that issue to the Board for additional action. In September 2011, the Agency of Original Jurisdiction (AOJ) recharacterized the service connected lumbosacral spine disability as lumbar spine degenerative disc disease, arthritis, and retrolisthesis rated as 40 percent disabling; increased the ratings for the right lower extremity radiculopathy and left lower extremity radiculopathy from 10 to 20 percent effective as of May 13, 2011; and granted a TDIU effective as of June 9, 2008. In July 2015, the Board denied a rating in excess of 40 percent for lumbar spine degenerative disc disease, arthritis, and retrolisthesis on both a schedular and extraschedular basis. The Veteran subsequently again appealed to the Court. In December 2016, the Court affirmed that portion of the July 2015 Board decision which denied a schedular rating in excess of 40 percent of the lumbar spine disability; vacated that portion the Board decision which denied an extraschedular rating for the lumbar spine disability; and remanded the issue of entitlement to an extraschedular rating for the period prior to June 9, 2008, for the lumbar spine disability to the Board for additional action. In August 2017, the Board remanded the issue of entitlement to a rating in excess of 40 percent prior to June 9, 2008, for lumbar spine degenerative disc disease, arthritis, and retrolisthesis on an extraschedular basis for additional action including referral to the Department of Veterans Affairs (VA) Under Secretary for Benefits or Director of Compensation and Pension Service. In March 2020, the Board issued a decision denying entitlement to a rating in excess of 40 percent prior to June 9, 2008 for a lumbar spine disorder on an extraschedular basis. The Veteran appealed that decision to the Court. In a November 2020 Order, the Court granted a Joint Motion for Partial Remand of the parties and remanded the case to the Board for action consistent with the Joint Motion. Increased Rating for a Lumbar Spine Degenerative Disc Disease on an Extraschedular Basis The Veteran contends that he is entitled to an extraschedular rating for his service-connected lumbar spine degenerative disc disease prior to June 9, 2008. Specifically, the Veteran's attorney asserts that the disability has increased in severity to the point that he was unemployable prior to June 9, 2008, that he was totally disabled due to a combination of his back pain and fibromyalgia, that he had significant interference with daily activities, to include tying his shoes and toileting and was essentially housebound due to his back symptoms. See Appellate Brief, March 2, 2021. Additionally, his attorney asserts that the Veteran's lumbar spine disorder has worsened in severity since his military service, and that his symptomatology is exceptional due to symptoms of inability to walk or drive distances, relying on heavy pain medication that "knock him out," and that he spent most of his time in a bed or recliner due to back pain. Id. His attorney also argues that the Veteran used multiple assistive devices, and that the schedular criteria do not indicate that difficulty walking, including the use of multiple assistive devices, is contemplated by the currently assigned rating. Id. Furthermore, his attorney asserts that the evidence shows marked interference with employment because he is totally disabled from employment due to his back and fibromyalgia. Id. I. Legal Criteria The question of an extraschedular rating is a component of a claim for an increased rating. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). Pursuant to § 3.321b)(1), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case "presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards." 38 C.F.R. § 3.321 (b)(1) (2016). 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 disability with the established criteria found in the rating schedule for that disability. Thun v. Peake, 22 Vet. App. 111 (2008). The determination of whether a Veteran is entitled to an extraschedular rating is a three-step inquiry. Thun v. Peake, 22 Vet. App. 111, 115-16 (2008); see also 38 C.F.R. § 3.321 (b) (1). First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Board must compare the level of severity and symptomatology of a veteran's service-connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the veteran's disability level and symptomatology, then the veteran's disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. In such cases, no referral is required. Second, if the schedular evaluation does not contemplate the veteran's level of disability and symptomatology and is, therefore, inadequate, the RO or Board must determine whether the veteran's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." If the first two questions are answered in the affirmative, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran's disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. 115 -16. As noted above, the procedural history of this matter is extensive, and has been before the Board and the Court several times over the past two decades. Most recently, the Board referred the claim to the Director of Compensation Service to in August 2017. The Director of Compensation Service issued a memorandum opinion in November 2019. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event. It may find that the preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. The Veteran's service-connected lumbar spine disability is currently rated as 40 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5237-5242, from February 11, 2000. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic code indicates that the Veteran's lumbar spine disorder is rated, by analogy, under the criteria of the General Rating Formula (Diagnostic Code 5237) and (Diagnostic Code 5242). The General Formula for rating a disability of the spine provides in pertinent part: a 40 percent rating for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. The Veteran does not have a diagnosis of intervertebral disc syndrome (IVDS), and therefore, he is not eligible to have his disability rated under the IVDS formula. See VA examination report, July 17, 2012. Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. 38 C.F.R. § 4.71a, Note 2; see also 38 C.F.R. § 4.71, Plate V. II. Pertinent Evidence Turning to the evidence, in a private opinion submitted by Dr. D.M., Dr. D.M. opined that the Veteran was "totally disabled" due to his fibromyalgia and mechanical back pain. See VA Form 21-4138 Statement in Support of Claim, August 25, 1999, also dated February 2, 2000. Specifically, Dr. D.M. noted the Veteran was totally disabled from any employment due to the combined effects of his GERD, herpes zoster, fibromyalgia, and lumbar spine. Id. At a March 2000 VA examination, the Veteran reported his lumbar spine disorder manifested in symptoms including pain, weakness, stiffness, fatigability and lack of endurance. The examiner noted the Veteran's motion stopped when pain began, that he got in and out of his chair very cautiously, walked well with a cane, wore a back and neck brace, had normal posture, and muscle atrophy. The examiner noted that obesity was a big factor in the Veteran's disability. An April 2000 private treatment record indicates that the Veteran may have had a "slight bulge" at the L5-S1, and that there was no significant abnormality. See Private treatment record, April 4, 2000. February 2001 private treatment records indicate the Veteran reported severe chronic back pain, and that his pain was so severe he considered suicide. See Private treatment records, February 23-24, 2001. At a December 2001 VA examination, the Veteran reported that his lumbar spine disorder manifested in symptoms including pain, normal reflexes and a small disc protrusion in the cervical spine, without any significant abnormalities of the thoracic or cervical spine. The examiner also included handwritten annotations stating that the Veteran's low back pain caused no significant weakness, incoordination, pain on movement, swelling, deformity, or atrophy; and that the examiner could not evaluate fatigability. The examiner opined that the Veteran's low back pain "should have no effect on employability since there is no evidence of any significant lumbosacral spine problem." A December 2001 statement was submitted by the Veteran's wife. At this time, she stated that the Veteran's health had deteriorated grates, that he spent most of his time in bed and that she believed the Veteran's disability warranted a higher rating. See VA Form 21-4138 Statement in Support of Claim, December 13, 2001. A March 2002 VA treatment record by Dr. H. indicated there were no low back problems, no limitations, and no functional limitations of the Veteran's low back, that the Veteran had normal range of motion without pain and that there was no structural abnormality. At a January 2003 VA examination, the Veteran reported that his lumbar spine disorder manifested in symptoms including painful motion. The examiner noted that he presented with a back brace, spasm, weakness, tenderness, postural abnormality and fixed deformity. A February 2003 statement was submitted by the Veteran. At that time, he stated that he spent most of his life in pain and spent a lot of time "knocked out" from pain medications. See VA Form 21-4138 Statement in Support of Claim, February 11, 2003. Social Security Administration (SSA) records have been obtained. Notably, a February 2008 SSA record indicates the Veteran had no lumbar spine pathology found; a March 2008 SSA record indicates the Veteran was independent with all activities of daily living and had a normal gait and an April 2008 SSA record indicates the Veteran had no medically determinable impairment. An April 2008 SSA determination indicated that the Veteran's condition was not severe enough to keep him from work and that the evidence showed his musculoskeletal problems and fibromyalgia allowed him to carry out most activities. At an April 2008 VA examination, the Veteran reported lumbar spine symptoms that included mechanical low back pain, myalgia, daily back pain, that he was housebound and spent most of his time in a recliner. The Veteran reported he used two canes to walk, and was unable to walk more than a few yards. The examiner noted that the Veteran was unemployed, and had at worst, moderate effects on his daily activities such as chores and exercise, due to his lumbar spine disability. A May 2008 statement was submitted by the Veteran's brother, J.B. At that time, J.B. stated the Veteran was "mostly housebound," that he no longer drove, that he needed transportation to medical appointments, that he had fairly limited mobility, that he was dangerously overweight and had balance problems, that he walked in an unsteady manor with the aid of two canes, that he needed assistance getting in and out of a car, and that he had personality changes. J.B. stated that he could not imagine the Veteran would be able to work due to his issues with mobility, balance, personality, pain, and communication issues. A May 2008 statement was submitted by Dr. R.M., in his capacity as brother-in-law of the Veteran and a doctor. Dr. R.M. noted he first met the Veteran when his sister began dating the Veteran and were later married. Dr. R.M. stated that over the years, and subsequent to his back injury, the Veteran became less active, that he required increasing amounts of pain medications, that he no longer able to participate in activities he once enjoyed, that his driving was limited to thirty minutes without any freeway driving; rarely driving, that he seldom left the house and that in general his back problems have made him an "invalid." A May 2008 statement was submitted by the Veteran's friend, K.N. At that time, K.N. stated the Veteran was unable to work due to his pain, and that his quality of life had greatly diminished over the years. A May 2008 statement was submitted by the Veteran. At that time, he reported that he was "pretty much housebound," had a lot of pain and pain medication, and could not participate in sexual activity due to back pain. Of record is an undated statement submitted by the Veteran's brother, L.B. At that time, L.B. stated that the Veteran had trouble walking, that he used a cane to maintain balance; took a lot of pain medications and had a debilitating effect of pain medications. L.B. stated that the Veteran's pain and back had progressively worsened over the years, and made the Veteran a "virtual shut-in." A June 2008 statement submitted by the Veteran's friend D.E. At that time, D.E. stated the Veteran's life had deteriorated, and that he did not live a "normal life" and that the Veteran was listed as a "shut-in." Of record is an undated statement submitted by the Veteran's wife. At that time, she reported that the Veteran's ability to cope with everyday life skills continue to decline; was unable to drive for more than thirty minutes, that he was no longer active and that had become a homebound person. She reported the Veteran was unable to walk any distance without difficult, and relies on a great amount of pain medication. In addition to the evidence above, the Veteran's claims file was twice referred to the Director of Compensation Service for consideration of an extraschedular rating for the Veteran's service-connected lumbar spine degenerative disc disease. The first advisory opinion was issued in October 2012 and the Director of Compensation Service denied the claim. This opinion noted that the Veteran had a history of treatment records and SSA records, that his SSA records showed the primary disability was obesity, with a secondary disability of fibromyalgia and that his disability was not severe enough to keep him from working. The opinion noted that the physical residual functional capacity assessment noted that the Veteran also had degenerative disc disease of the lumbar and cervical spines and that the Veteran was able to occasionally lift 20 pounds, frequently lift 10 pounds, able to stand and/or walk for about six hours in an eight hour work day, able to sit for about six hours in an eight hour work day, and had an unlimited capacity to push and pull. The opinion also noted the Veteran was able to climb a ramp or stairs occasionally; a ladder, rope, or scaffold never; balancing occasionally; stooping occasionally; kneeling occasionally; crouching occasionally; crawling occasionally; there were no manipulative limitations; no visual limitations; no communicative limitations; avoidance of exposure to extreme cold and heat was recommended; there was no limitations as to wetness, humidity, noise, vibration, fumes; and the Veteran was to avoid all exposure as to hazards of machinery and heights. The October 2012 advisory opinion further noted the Veteran's private and VA treatment records. After a review of the evidence, the October 2012 advisory opinion found that the evidence did not establish that the Veteran's lumbar spine degenerative disc disease, arthritis or retrolisthesis (formerly rated as lumbosacral strain with mechanical back pain and limitation of motion) presented such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards; and entitlement to an extraschedular rating in excess of 40 percent prior to June 9, 2008 was not established. Then, pursuant to a July 2015 Court Order, the claim was again referred to the Director of Compensation Service in August 2017. In November 2019, the Director of Compensation Service issued its second advisory opinion and denied the claim. This opinion noted the statements submitted, the Board hearing transcript, a February 2000 written statement provided by Dr. D.M. and various statements submitted from 2001 to 2008. The advisory opinion found that the statements submitted gave an overarching views of the Veteran's health deterioration and the fact that the Veteran was mostly housebound and now used a cane to walk. The advisory opinion noted the February 2000 private opinion that the Veteran was totally disabled due to his fibromyalgia (which is not service-connected), mechanical back pain, and neck pain (which was also not service-connected). In addition, the advisory opinion noted that the February 2000 private opinion did not provide any information that would render the current lumbar spine evaluation inadequate. After a review of the evidence, the advisory opinion noted that the Veteran, his family members, his acquaintances, and the noted clinicians were competent to attest to his disability and problematic effects of that disability. However, the advisory opinion found that the medical and lay evidence of record did not demonstrate that the lumbar spine disorder produced marked interference with the Veteran's employment, or caused frequent periods of hospitalization. Therefore, the advisory opinion found that the record failed to show that his lumbar spine disorder presented such an exceptional picture as to prove the current evaluation assigned was not adequately addressed under the current rating schedular criteria, and entitlement to a higher level of compensation, on an extraschedular basis was denied. III. Analysis With respect to the first prong in Thun, the evidence in this case does not show such an exceptional or unusual disability picture that the available schedular rating for service-connected lumbar spine degenerative disc disease, prior to June 9, 2008, is inadequate. The Veteran himself did not claim that his service-connected lumbar spine degenerative disc disease symptoms were exceptional or unusual; he simply requested higher ratings, to include unemployability (TDIU). See e.g. VA Form 9, January 26, 2001; see VA Form 21-4138 Statement in Support of Claim, December 29, 2000; see also Board hearing testimony, August 14, 2001; see also VA Form 9, May 29, 2002. In this regard, the Veteran asserted that his lumbar spine disorder symptoms resulted in pain, difficulty with ambulation, difficulty with driving, and the use of pain medication. Moreover, the Veteran's attorney argues that the Veteran used multiple assistive devices, and that the schedular criteria do not indicate that difficulty walking, including the use of multiple assistive devices, is contemplated by the currently assigned rating. See Appellate Brief, March 2, 2021. Furthermore, his attorney asserts that the evidence shows marked interference with employment because he is totally disabled from employment due to his back and fibromyalgia. Id. The Board also notes that the November 2020 JMR found that the Board previously erred in not addressing or discussing evidence from a March 2000 VA spine examination, an undated statement submitted by the Veteran's wife, reports of daily back pain and being housebound at an April 2008 VA examination, with pain that was constant, moderate to severe, and radiating to both legs and a May 2008 statement submitted by the Veteran. The JMR further noted that the Board erred in not discussing a May 2008 statement submitted by Dr. M. and a statement submitted by the Veteran's brother, indicating that the Veteran had difficulty walking, walked in an unsteady manner, and took a lot of pain medication. Based on the foregoing, to include the lay and medical evidence of record, the Board finds that the symptoms related to the Veteran's service-connected lumbar spine degenerative disc disease manifested in limited range of motion, pain, being housebound, radiating pain into his legs, difficulty walking, walking in an unsteady manner, interference with activities of daily activities, interference with bending, and pain medication for management of symptoms. A review of all of the schedular diagnostic code ratings currently assigned to the lumbar spine disorder indicate that these symptoms are adequately addressed by the schedular rating criteria. Diagnostic Code 5237 does not specifically list all the Veteran's symptoms. However, the Veteran's reported symptoms are reasonably similar to pain, stiffness, limitation of motion, aching, and guarding, which are listed under Diagnostic Code 5237. Additionally, for all musculoskeletal disabilities, the Rating Schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance that affects stability, standing and weight-bearing. 38 C.F.R. §§ 4.40, 4.45; Mitchell, 25 Vet. App. 32, 37 (2011). For disabilities of the joints in particular, the Rating Schedule specifically contemplates factors such as weakened movement, excess fatigability, pain on movement, disturbance of locomotion and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. The Board finds that the rating criteria and the provisions of 38 C.F.R. § 4.40, 4.45, and 4.59 reasonably describe the Veteran's disability level and symptomatology, the disability picture is contemplated by the rating schedule, and the assigned schedular rating is adequate. Because the Rating Schedule was purposely designed to compensate for such functional effects of the Veteran's disabilities in all spheres of his daily life, including at work and at home, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran's disability picture. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. Therefore, the arguments of the Veteran's attorney, even in contemplation of the Veteran's assertions and the statements of record, are without merit. The fact that a particular symptom or manifestation may not be mentioned in the rating criteria does not in itself show an exceptional or unusual disability picture. In this regard, all schedular criteria are meant to consider the average impairment in earning capacity resulting from service-connected disabilities. See 38 C.F.R. § 4.1. The basis of the schedular criteria is one's ability to function under the ordinary conditions of daily life, including employment. See 38 C.F.R. § 4.10. Viewed in this light, although a particular diagnostic code may provide for evaluations of a disability in terms of objective clinical data rather than in terms of symptoms, as is the case with musculoskeletal disorders, the purpose of the schedular ratings is to provide compensation for the symptoms and functional impairment caused by the disability in question, particularly with regard to how they affect earning capacity. See 38 C.F.R. §§ 4.1, 4.10, 4.21. Moreover, the Veteran's service connected lumbar spine degenerative disc disease was found to be manifested by limitation of motion due to pain and no ankylosis. The record reflects that the Veteran used a cane to assist him with ambulation. Additionally, the statements submitted by the Veteran's wife, brother-in-law, and Veteran indicate he spent most of his time in a recliner or in bed, and was essentially housebound or a "shut-in." However, the use of these assistive devices alone or spending time in a recliner or bed does not render the service-connected disability unique or unusual or the schedular criteria inadequate. Although the Veteran's attorney argues that the Veteran's lumbar spine degenerative disc disease has worsened since service, the attorney did not explain how the Veteran's schedular rating did not adequately compensate for this worsening. The use of an assistive device is not unexpected when a person experiences significant spinal pain. While acknowledging the Veteran's reports of symptoms including functional loss due to back pain, the use of assistive devices for ambulation, pain during flare ups, reliance on medication, the inability to drive, the February 2000 statement from D.M. M.D. conveying that the Veteran was totally disabled from any employment due to his conditions and that the service connected lumbar spine degenerative disc disease was productive of significant occupational impairment as is reflected by the currently assigned schedular rating. With regards to the Veteran's argument that he relied on pain medicine to control his lumbar spine pain and that he suffered side effects of that medication, the Board notes that the record reflects that he did take pain medicine during this time. The Veteran wrote in a February 2003 statement that spent much of his life in pain and that he felt "knocked out" by the pain medication, presumably meaning that he felt fatigue or drowsiness as a result of such medication. However, neither the Veteran nor his attorney have explained how the Veteran's use of pain medication to treat his lumbar spine degenerative disc disease would cause an exceptional or unusual disability picture that would render the available schedular rating inadequate nor do they argue that the Veteran would suffer further impairment to range of motion but for the use of pain medication. Pain is specifically contemplated under the schedular criteria, as discussed above. Moreover, it is not clear whether the pain medicine referenced by the Veteran was used to treat pain related to his service connected lumbar spine degenerative disc disease. The Board notes that the Veteran was also treated for nonservice-connected fibromyalgia and cervical spine osteoarthritis during the appeal period and that private treatment notes dated from January 2003 through December 2007 indicate that he had been prescribed pain medication while being treated for a variety of nonservice-connected disabilities as well as lumbar spine osteoarthritis. This argument is therefore without merit. The Board notes that the record establishes that the Veteran had difficulty with ambulation and that he used multiple assistive devices, to include two canes. While the use of an assistive device, such as a wheelchair or a cane, is not specifically listed in the rating criteria for evaluating the Veteran's lumbar degenerative disc disease, assistive devices are provided to alleviate the presence of symptoms and/or functional limitations caused by an individual's disability. For instance, a cane is provided to normalize an abnormal gait that may be limited by instability in the joint, pain, weakness, or decreased endurance. Furthermore, the use of an assistive device is not a symptom of the Veteran's lumbar spine degenerative disc disease; rather, it is utilized as a result of such symptoms. In this regard, the Veteran uses an assistive device due to pain, weakness, and instability in his lumbar spine, but such are symptoms that are specifically contemplated by the schedular rating criteria. Specifically, as previously discussed, pain and weakness are contemplated as they cause functional loss, to include limitation of motion as contemplated by Diagnostic Code 5237. The same is true with limitations as to walking, climbing, or standing. The Veteran has difficulty standing and walking because of an increase in pain. As such, even though the Veteran does use assistive devices, and has trouble with walking and standing, the schedular rating criteria reasonably describe his symptomatology. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see e.g. Spellers v. Wilkie, 30 Vet. App. 211 (2018). The Veteran has also described additional symptoms, such as difficulty tying his shoes, difficulty driving and an inability to perform household chores. However, the Board notes that the type of movement required to dress oneself or drive (i.e., the ability to bend or twist the back to put on socks or pants) is largely determined by the lumbar spine's ability to flex and rotate, which is exactly what is measured under the schedular rating. See General Rating Formula for Disease and Injuries of the Spine, 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Likewise, to the extent that household chores and exercise involve any type of lumbar spine motion such functional impairment is contemplated under the schedular rating. Id. Activities that involve prolonged standing, sitting, walking, or bending, or functional impairment manifested by symptoms such as weakness, fatigability, and incoordination are also contemplated under the regulations. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). In addition, the pain elicited by such movements is contemplated in the schedular rating. See 38 C.F.R. § 4.59. As the Veteran's symptomology is contemplated by the schedular criteria, extraschedular consideration is not warranted. The Board acknowledges that there is some evidence of interference with the Veteran's employment, to include contentions that the side effects from his pain medications render him unemployable. However, the SSA records, as well as treatment records show that the Veteran's lumbar spine degenerative disc disease did not render him unemployable. Rather, SSA records and VA examination reports indicate the combination of service-connected and nonservice-connected disabilities interfered with his ability to work and generally showed that his lumbar spine degenerative disc disease alone would not render him unemployable. In contrast, many of his treatment records show the Veteran either had no significant abnormality, or mild effects of his lumbar spine degenerative disc disease, even in consideration of his reported significant pain. There is also no indication of demotion or special accommodation having to be made to compensate for his lumbar spine disorder. There is simply no probative evidence of "marked" interference of the sort contemplated under 38 C.F.R. § 3.321(b), nor indeed is there evidence of other factors such as frequent periods of hospitalization or other compelling factors which brings this case within the realm of exceptional disability due to Veteran's lumbar spine symptomatology. This argument is therefore without merit. In sum, the evidence of record does not establish that the Veteran's lumbar spine degenerative disc disease has produced symptoms not contemplated by the rating criteria, as applied to his schedular ratings under Diagnostic Code 5237. The Board therefore finds that this is not an exceptional case where the criteria in VA's Rating Schedule are inadequate. 38 C.F.R. § 3.321(b)(1). Accordingly, the available schedular evaluations are adequate to rate this disability. In the absence of this threshold finding, the Board need not conduct the second step of the inquiry, namely whether there are "related factors" such as marked interference with employment or frequent periods of hospitalization. See Thun, 22 Vet. App. at 118-19. In conclusion, the Board finds that the schedular criteria are adequate to rate the Veteran's lumbar spine degenerative disc disease. The preponderance of the evidence is against assigning a higher rating on an extraschedular basis. There is no reasonable doubt to be resolved as to this issue. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.