BVA9501523 DOCKET NO. 90-47 655 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for peripheral vascular disease of the lower extremities secondary to postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis. 2. Entitlement to an increased (extraschedular) rating for postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis, currently assigned a 60 percent evaluation. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD R. P. Harris, Counsel INTRODUCTION The appellant had active service from January 1955 to June 1957. This matter came before the Board of Veterans' Appeals (Board) on appeal from an April 1990 rating decision of the Nashville, Tennessee, Regional Office (RO), which denied an evaluation in excess of 40 percent for postoperative intervertebral disc syndrome of the lumbar spine and a total rating based upon individual unemployability. By rating decision the following month, service connection was granted for spinal stenosis secondary to postoperative intervertebral disc syndrome, which was rated as part of the service-connected postoperative intervertebral disc syndrome of the lumbar spine. In January 1991, the Board remanded the case for evidentiary development. By a rating decision in June 1991, service connection was denied for peripheral vascular disease, and that issue was appealed. In July 1992, the Board again remanded the case to the RO for evidentiary development. By a rating decision in March 1993, the RO increased the evaluation for postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis from 40 percent to 60 percent, effective February 22, 1990. In October 1993, the Board remanded the case to the RO for evidentiary and procedural development. Thereafter, a February 1994 rating decision granted a total rating based upon individual unemployability, effective February 22, 1990; and, therefore, that issue is moot. (The veteran's only other service connected disorder is postoperative left inguinal herniorrhaphy, rated noncompensably disabling.) By a May 1994 rating decision, the RO denied an extraschedular evaluation for the service-connected back disability. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that his peripheral vascular disease is secondary to the service-connected postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis. It is contended that his discogenic back disability is manifested by severe limitation of motion, low back pain radiating down the lower extremities, and neurologic deficits of the lower extremities, including right foot drop. He argues that he cannot sit, stand, or ambulate for any length of time due to the back disability. It is requested that consideration be provided to the regulatory provisions pertaining to the higher of two evaluations and an extraschedular evaluation. Additionally, it is requested that the benefit of the doubt doctrine be applied. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the appellant's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the appellant has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim for service connection for peripheral vascular disease is well grounded. The preponderance of the evidence is against allowance of an increased (extraschedular) evaluation in excess of 60 percent for postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis. FINDINGS OF FACT 1. All available, relevant evidence necessary for disposition of the appeal has been obtained by the RO. 2. The appellant's peripheral vascular disease, initially manifested decades post service, is not shown by competent, credible evidence to have been causally or etiologically related to the postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis. 3. The appellant's service-connected back disability is manifested primarily by complaints of low back pain with radiating pain down the lower extremities, severe limitation of motion of the back, some diminished sensation of the lower extremities, and radiographic findings of degenerative disc disease of the low back, status post lumbar laminectomy. 4. There is no recent clinical evidence of muscle spasm, atrophy, foot drop, or absent deep tendon reflexes except for the right ankle reflex. He ambulates with a nearly normal gait. He is limited in his ability to sit, stand, or ambulate for lengthy periods of time, in part due to the back disability. 5. The back disability does not represent an exceptional or unusual disability picture as to render the regular schedular standards inadequate. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well-grounded claim for entitlement to service connection for peripheral vascular disease. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.310(a) (1993). 2. The criteria for an increased (extraschedular) evaluation in excess of 60 percent for postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.14, 4.40, 4.71a, Codes 5292, 5293, 5295 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Peripheral Vascular Disease The threshold question to be answered at the beginning of the analysis is whether the appellant has presented evidence of a well-grounded claim with respect to the issue of service connection for peripheral vascular disease. Under the provisions of 38 U.S.C.A. § 5107(a), a veteran has the "burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." A well-grounded claim is one which is plausible, meritorious on its own, or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). In Tirpak v. Derwinski, 2 Vet.App. 609 (1992), the United States Court of Veterans Appeals (Court) held that the appellant in that case had not presented a well-grounded claim as a matter of law. The Court pointed out that "unlike civil actions, the Department of Veterans Affairs (previously the Veterans Administration) (VA) benefits system requires more than an allegation; the claimant must submit supporting evidence." If a well-grounded claim has not been presented, the appeal must fail. Id. Service connection may be granted for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Peripheral vascular disease was not shown in service or proximate thereto, and it is not otherwise contended. The appellant alleges, in essence, that his peripheral vascular disease is related to his service-connected back disability. However, he has submitted no competent, credible evidence to support this mere allegation. The appellant is not qualified to offer medical opinion or diagnosis. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The evidentiary record reflects that the earliest clinical evidence even suggestive of peripheral vascular disease was not until the mid- 1980's, when diminished pulsations in the lower extremities were noted. See December 1986 private medical statement. Significantly, hypertension and a long-standing history of cigarette smoking had been reported in a February 1985 Department of Veterans Affairs (VA) outpatient report. In September 1992, a private arterial Doppler study of the lower extremities reported partial stenosis of arteries secondary to atherosclerotic vascular disease (emphasis added). Moreover, on a VA vascular examination in January 1993, the appellant's peripheral vascular disease was diagnosed as most likely related to his history of smoking, and "is also certainly not related to his lumbar spine condition." Since there is no competent or credible evidence to show that the appellant's peripheral vascular disease is causally or etiologically related to the postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis, the claim is not well grounded. Grottveit v. Brown, 5 Vet.App. 91 (1993); Grivois v. Brown, 6 Vet.App. 136 (1994). Accordingly, the appeal as to this issue is dismissed. II. Entitlement to an Increased (Extraschedular) Rating for Postoperative Intervertebral Disc Syndrome of the Lumbar Spine with Spinal Stenosis Initially, the Board finds that the appellant's claim for an increased (extraschedular) rating for the service-connected back disability is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), in that he has presented a claim which is plausible. This being so, the Board must examine the record and determine whether the VA has any further obligation to assist in the development of his claim. 38 U.S.C.A. § 5107(a). After reviewing the record, the Board is satisfied that all relevant facts have been properly developed and that no useful purpose would be served by again remanding the case with directions to provide further assistance to the appellant. A comprehensive medical history and detailed clinical findings regarding his low back disability over the years are documented in the medical evidence. Pursuant to remands, VA orthopaedic and neurologic examinations were conducted in 1991, 1992, and 1993. The reports of orthopaedic examinations in November 1992 and December 1993 included back range of motion studies. Additionally, the reports of neurologic examinations in March 1991, November 1992, and November 1993 included detailed findings particularly with respect to whether paravertebral muscle spasms or neurologic deficits of the lower extremities were manifested, and, if so, the nature, extent, and degree thereof. Furthermore, pursuant to the Board's July 1992 remand, the RO sought recent, relevant private treatment records, and such records that were available were associated with the claims folder. Thus, the Board concludes that the evidence is sufficient for purposes of reaching a fair and well-reasoned decision of the increased rating issue on appeal, and that the duty to assist the appellant as contemplated by 38 U.S.C.A. § 5107(a) has been satisfied. Disability evaluations are determined by application of a schedule of ratings which is based on average impairment of earning capacity under the VA's Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The Board will consider the appellant's service-connected back disability in the context of the total history of that disability, particularly as it affects the ordinary conditions of daily life, including employment, as required by the provisions of 38 C.F.R. §§ 4.1, 4.2, 4.10 and other applicable provisions. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). However, as the Court stated in Francisco v. Brown, 7 Vet.App. 55 (1994), "Where...an increase in the disability rating is at issue, the present level of disability is of primary concern." Francisco at 58. The appellant's service medical records reveal that in 1956, he complained of low back pain radiating down the lower extremities, following an automobile accident. After a myelogram was performed, he underwent a laminectomy for excision of an L4-L5 extruded disc. Later during service, he continued to have complaints of low back pain radiating down the lower extremity, and right sciatic nerve neuralgia was diagnosed in December 1956. A military Physical Evaluation Board in May 1957 found him unfit for duty on account of his back. Reports of VA orthopaedic and neurologic examinations in January 1959 revealed that he had been employed as a spot welder. While he had back pain complaints, there were essentially no restricted spinal motions or neurologic deficits except for a question of somewhat hypoactive reflexes of the lower extremities; and his gait was unimpaired. A noncompensable rating was assigned by rating decision of February 1959. Reports of VA orthopaedic and neurologic examinations in March 1974 revealed that he could bend forward and touch his fingertips to within 16 inches of the floor; and the examiner noted that the majority of restricted back motion appeared voluntary in nature. Neurologic findings reflected absent ankle reflexes and diminished knee reflexes. However, these findings appeared sensory in nature, since his gait was described as normal and no foot drop or motor impairment of the lower extremities were found. Similar findings and complaints were reported on VA examinations during the later 1970's and early 1980's. Interestingly, on a January 1979 examination, he was reported to be obese, weighing 219 pounds at a height of 5 feet 10 inches, and an increase in his lumbar lordotic curve was attributed to his protuberant abdomen. The examiner stated that the appellant made a poor effort to bend forward, touching his fingertips to within 22 inches from the floor; and the approximately 75 percent restriction of back motions were described as voluntary. Moreover, he was able to climb on and off the examining table without difficulty, and hyperextend the spine about normally. There was slight atrophy of the left lower extremity, and absent reflexes. A 20 percent disability rating was assigned by rating decision of April 1974. A 40 percent rating was assigned by rating decision of May 1976. Private radiographic evidence dated in November 1989 reflected degenerative changes of the lumbar spine, including possible calcified disc fragments; however, no nerve root impingement was noted. In a statement dated in December 1989, Daniel H. Donovan, M.D., Ph.D., reported that the appellant complained of low back pain, and that at times, such as walking three blocks, the back and lower extremity pain would become unbearable to the extent he must stop. Clinically, there were diminished strength and sensation with absent reflexes in the lower extremities. However, the physician concluded that although sensory diminishment with absent reflexes indicated peripheral neuropathy, there was no atrophy to suggest muscle wasting as a cause of the weakness; and that his exertional pain was not likely due to neuropathy. In a January 1990 statement, Dr. Donovan reviewed electromyographic and nerve conduction test results, and opined that these showed fasciculations in the lower extremities as a sign of increased muscle irritability possibly from old lumbar injury or peripheral neuropathy; but that there was no evidence of active denervation or muscle atrophy. He further opined that the appellant's primary problem remained his obesity. In another statement dated in January 1990, Dr. Donovan reported that radiographic evidence had suggested diffuse spinal stenosis of a degenerative type. He opined that although the majority of the appellant's complaints of progressive leg pain were due to degenerative lumbar disease, he derived some secondary gain from his disability. A VA examination report in March 1990 revealed that the appellant weighed 245 pounds and moved very slowly. The examiner stated that it was very difficult to get the veteran to bend in any direction, as he was apparently stiff; and moderate muscle spasm was noted. No reflexes were elicited, but there was no atrophy apparent. Clinical records from Michael T. Cox, M.D., reflect that in May 1990, the appellant complained of back and right leg pain, and that the right foot dragged. A right foot brace was prescribed. In an August 1990 statement, Dr. Cox opined that the appellant's lumbar degenerative disc disease with spinal stenosis syndrome and calcified disc fragments resulted in occasional irritation of a right nerve root, which was aggravated by his obesity. In a December 1990 statement, Dr. Cox reported that the appellant was being fitted with a right knee brace, after previously wearing a right ankle brace to aid in ambulation. He opined that the appellant was unable to work due to an inability to stand, sit, lift, or carry objects. It is reiterated that a total rating based upon individual unemployability is in effect, effective February 22, 1990. A VA neurologic examination report in March 1991 reflects that the appellant was able to forward flex to 30 degrees. There were no paraspinal muscle spasms. Deep tendon reflexes were unremarkable except for absent reflexes at the ankles. However, there was only mild decrease of right foot dorsiflexion strength; there was no sensory impairment except for some decrease on the lateral aspect of that foot; and his gait was described as slow but normal. The impression was chronic back pain with mild right L5 radiculopathy. A VA orthopaedic examination report in November 1992 revealed that he complained of low back pain radiating down the lower extremities with numbness. He was described as overweight with a protuberant abdomen, and all low back motions were described as painful and restricted. The back had forward flexion to 20 degrees, 0 degrees backward extension, lateroflexion to 10 degrees, bilaterally, and rotation to 20 degrees, bilaterally. Reflexes were active and equal at the knees, but absent at the ankles. However, there was no demonstrable muscle atrophy or weakness of the lower extremities. A VA neurologic examination conducted in November 1992 revealed that the appellant had similar complaints of low back pain radiating down the lower extremities with numbness. He stated that early in the morning, he would experience no abnormalities, but later would have numbness and weakness. He stated that his feet became numb after more than 15 minutes driving. Clinically, there was decreased sensation in the legs, and deep tendon reflexes were absent in the lower extremities. However, the ankles had normal strength. A straight leg raising test produced [back] pain above 30 degrees. No paraspinal muscle spasm was noted. The examiner concluded that the appellant had low back pain associated with lumbar osteoarthritis. He opined that the appellant may have right L5 distribution radiculopathy and possibly additional radiculopathies, given the generalized absence of reflexes; or may have spinal stenosis. He felt the appellant may have vascular claudication as shown by his pain while walking. See also January 1993 VA vascular examination report, attributing lower extremity exertional pain, at least in part, to vascular claudication. In this regard, it should be pointed out that since service connection is not in effect for peripheral vascular disease of the lower extremities, the leg pain due to vascular causes may not be considered in evaluation of this claim, to the extent this symptom can be reasonably dissociated from the service-connected low back disability. A VA neurologic examination report dated in November 1993 reflects that the appellant complained of low back pain radiating primarily down the right lower extremity. He stated that he could walk about 5 minutes, and then needed to rest due to leg weakness and right leg cramps. He again referred to numbness in his feet upon extended periods of driving, relieved by changing positions. He stated that he was able to conduct minor errands despite his condition, dress himself, and perform other activities of daily living. Clinically, he ambulated with a slight stoop. His gait was described as tentative, but fairly normal. The examiner considered the back disability as extremely limiting, rendering the appellant unemployable. A VA orthopaedic examination in December 1993 reflects similar complaints and findings. The back had forward flexion to 20 degrees, 0 degrees backward extension, lateroflexion to 10 degrees, bilaterally, and rotation to 30 degrees, bilaterally. It is common knowledge that most individuals without back pathology or disability have the ability to bend forward (forward flexion) to at least approximately a right-angle position (90 degrees). It is also common knowledge that backward movement of the upper body (backward extension), and side-to-side movement of the upper body (lateroflexion) are possible to a significantly lesser extent (approximately one-third of forward flexion). From an industrial standpoint, the most important motion of the back is forward flexion, since it is utilized for bending, lifting and pushing. These ranges of motion reported on the November 1992 and December 1993 orthopaedic examinations may be reasonably characterized as severe. A 40 percent evaluation is the maximum evaluation assignable under Diagnostic Code 5292 for severe limitation of motion of the lumbar segment of the spine, in the absence of ankylosis. 38 C.F.R. Part 4, Code 5292. A 40 percent evaluation is the maximum evaluation assignable under Diagnostic Code 5295 for severe lumbosacral strain. 38 C.F.R. Part 4, Code 5295. Consequently, since ankylosis of the lumbar spine was not shown, the RO rated the back disability under Diagnostic Code 5293 for pronounced intervertebral disc syndrome, and granted a 60 percent evaluation, the maximum evaluation assignable under that code. Since the appellant is currently receiving the maximum evaluation for the low back disability assignable under applicable schedular diagnostic codes, the issue for resolution is whether an extraschedular evaluation for the service-connected back disability is warranted. The recent clinical evidence reflects severe limitation of motion of the lumbosacral spine, but nevertheless he retains considerable ranges of motion. His low back disability does not preclude ambulation, driving, dressing, or performance of other daily activities and functions, albeit these activities are limited by his back pain and radiculopathy as contemplated by the 60 percent rating assigned. Furthermore, his back pain has not been described as constant or excruciating in severity, and his lumbar radiculopathy has been clinically shown to result in primarily sensory, not motor, impairment in the lower extremities. Most significantly, the recent clinical evidence does not persuasively show that his lumbar radiculopathy produces foot drop, which could indicate complete or severe incomplete paralysis of the sciatic nerve. Under 38 C.F.R. § 4.124a, Diagnostic Code 8520 (1993), a 60 percent evaluation may be assigned for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. An 80 percent evaluation requires complete paralysis. When there is complete paralysis, the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. For informational purposes, without reliance thereon for deciding this case, the common peroneal and tibial nerves are distal branches of the sciatic nerve, and sensory and/or motor involvement may arise. "The resulting clinical deficit depends on whether the whole nerve has been affected or only certain fibers. In general, the peroneal fibers of the sciatic nerve are more susceptible to damage than those destined for the tibial nerve.... The tibial nerve, the other branch of the sciatic,.... ...reflex changes may accompany involvement of motor or sensory fibers. See Michael J. Aminoff, M.D., Nervous System in Current Medical Diagnosis and Treatment, 845, 846 (Lawrence M. Tierney, Jr., M.D., et al. eds., 33rd ed. 1994). In Bierman v. Brown, 6 Vet.App. 125 (1994), the Court, quoting from a medical manual, stated that: ...the etiology of IDS [intervertebral disc syndrome] may be described as follows:...When the herniated nucleus compresses or irritates the nerve root, sciatica results....In the lumbar area, [more than] 80% of disk ruptures affect L5- S-1 nerve roots. Severe L-5 radiculopathies cause foot drop with weakness of the anterior tibial, posterior tibial, and peroneal muscles and sensory loss over the shin and dorsal foot.... Bierman at 126. In Bierman, the Court referred to a medical dictionary definition of foot drop as "a condition in which the foot hangs in a plantar-flexed position, due to lesion of the peroneal nerve." Id., at 126. However, Bierman can be distinguished from the instant case. In Bierman, the Court cited to VA examination findings as showing "there was a partial foot drop on the right; that there seemed to be some weakness of the peroneal muscles, causing the foot to have the tendency to invert...", and "The examiner noted that in order to walk, appellant had to lift his right foot up to prevent dragging of his toes." However, in the instant case, there is no recent clinical evidence of foot drop or complete or severe, incomplete paralysis of the sciatic nerve. Parenthetically, if foot drop was shown, then a 40 percent evaluation for the orthopaedic aspects of lumbar discogenic disease under Codes 5292 or 5295 could be combined with a 60 percent or 80 percent evaluation assignable under Code 8520 for the respective severe, incomplete or complete paralysis of the sciatic nerve representing the neurologic aspects of lumbar discogenic disease with foot drop; and the combined rating would result in a rating higher than the currently assigned 60 percent. Arguably, if foot drop was shown, the 60 percent rating for the orthopaedic and neurologic aspects of the lumbar discogenic disease under Code 5293 could be combined with the ratings assignable under Codes 8520-8530, since these latter codes include foot drop, whereas Code 5293 does not; and, since different neurologic functions are involved, and are not necessarily duplicative of or overlapping with each other, this would not constitute pyramiding. It is reiterated, however, that although the appellant has some sensory diminishment in the lower extremities with an absent right ankle reflex, nevertheless this is primarily sensory, not motor neurologic impairment, particularly since it does not result in foot drop, and does not significantly impair gait. Therefore, since the discogenic lumbar disease is not manifested by severe incomplete or complete sciatic nerve paralysis, an increased or extraschedular evaluation for peripheral neuropathy under Diagnostic Codes 8520-8530 of the rating schedule is not appropriate, and would violate the proscription against pyramiding of ratings set forth in 38 C.F.R. § 4.14 (1993). In pertinent part, 38 C.F.R. § 4.14 states: "Evaluation of the same manifestation under different diagnoses are to be avoided." In Esteban v. Brown, 6 Vet.App. 259, 262 (1994), the Court stated, "The critical element is that none of the symptomatology for any one of these three conditions is duplicative of or overlapping with the symptomatology of the other two conditions." Again, the appellant's back disability is rated 60 percent, the maximum evaluation assignable under Diagnostic Code 5293. A 60 percent evaluation requires pronounced intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy (i.e., with characteristic pain and demonstrable muscle spasm and an absent ankle jerk or other neurological findings appropriate to the site of the diseased disc) and little intermittent relief. 38 C.F.R. Part 4, Code 5293. Clearly, Diagnostic Code 5293 contemplates sciatic neuropathy affecting the lower extremities, such as absent ankle jerks, involving primarily sensory neurologic impairment of the lower extremities. However, foot drop which involves primarily motor peripheral neurologic dysfunction is rated under Diagnostic Codes 8520-8530. Therefore, in the absence of foot drop, to grant an increased or extraschedular evaluation utilizing Diagnostic Codes 8520-8530 would be inappropriate. Additionally, assigning separate ratings for the orthopaedic aspects of the lumbar discogenic disease under Diagnostic Codes 5292 or 5295 and the neurologic aspects of the lumbar discogenic disease under Diagnostic Code 5293, where a 60 percent rating has been assigned under Code 5293, would constitute pyramiding, since the 60 percent rating assigned under Diagnostic Code 5293 contemplates orthopaedic as well as neurologic aspects of said disability. In particular, the 60 percent criteria in Diagnostic Code 5293 include muscle spasms, as does Diagnostic Code 5295. Moreover, muscle spasms have a distinctly orthopaedic aspect, as indicated by the references thereto in other regulatory provisions, including 38 C.F.R. § 4.59, pertaining to painful motion from arthritis, and 38 C.F.R. § 4. 71a, Code 5003, pertaining to rating criteria for arthritis. For example, Diagnostic Code 5003 provides: "Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion." In short, a 60 percent rating assigned under Diagnostic Code 5293 contemplates orthopaedic aspects of the lumbar discogenic disease, specifically the effect neurologically caused pain and muscle spasms have upon movement of the spine, as well as the neurologic aspects of lumbar discogenic disease, specifically the effect of sciatic neuropathy affecting the lower extremities; and these are duplicative of or overlap with each other such that to assign separate ratings under Codes 5292/5295 and 5293 would be pyramiding. Additionally, an extraschedular evaluation is not warranted, since the evidence does not show that the service-connected back disability presents such an unusual or exceptional disability picture as to render the regular schedular standards impractical. 38 C.F.R. § 3.321(b)(1). We have considered the provisions of 38 C.F.R. § 4.40, which relate to functional loss due to pain, weakness or other musculoskeletal pathology. However, the appellant's lumbar disc disease, manifested by severe limitation of motion and intervertebral disc syndrome, is adequately compensated for by the 60 percent evaluation for the degree of functional loss resulting therefrom. Complaints of back pain, limitation of motion, and sciatic neuropathy are contemplated in the rating that is assigned Accordingly, the Board finds that the appellant's currently assigned 60 percent schedular evaluation assigned under Code 5293 adequately compensates him for the commensurate degree of orthopaedic and neurologic impairment from lumbar discogenic disease without foot drop evident; and an extraschedular evaluation is not warranted, for the foregoing reasons. The fact that a total rating based upon individual unemployability, primarily on account of the service-connected back disability, was awarded by the RO does not mean that an increased rating or extraschedular evaluation for the back disability logically follows, since a total rating based on individual unemployability is determined under different laws and regulations than an increased rating, and may be granted even when the service-connected disability is rated less than total, or 60 percent as the case here. See 38 C.F.R. §§ 3.340, 3.341, 4.16 (1993). Therefore, since the preponderance of the evidence is against allowance of this issue on appeal, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b) (West 1991). ORDER The appellant's claim of entitlement to service connection for peripheral vascular disease is not well grounded, and is the appeal as to that issue is dismissed. An increased (extraschedular) evaluation in excess of 60 percent for postoperative intervertebral disc syndrome of the lumbar spine with spinal stenosis is denied. MICHAEL D. LYON Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.