Citation Nr: 0004856 Decision Date: 02/24/00 Archive Date: 02/28/00 DOCKET NO. 97-30 902 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an evaluation in excess of 10 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, prior to October 10, 1997. 2. Entitlement to an evaluation in excess of 40 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, for the period of time from October 10, 1997 to June 9, 1998. 3. Entitlement to an evaluation in excess of 60 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, subsequent to October 1, 1998. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD E. Pomeranz, Associate Counsel INTRODUCTION The appellant served on active duty from May 1970 to May 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 1997 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) located in Jackson, Mississippi. The Board notes that in the appellant's substantive appeal, dated on October 15, 1997, the appellant requested a hearing at a local VA office before a member of the Board. However, in a statement from the appellant to the RO, dated on October 29, 1997, the appellant withdrew his request for a Travel Board hearing and requested that his appeal be forwarded to the Board. FINDINGS OF FACT 1. Prior to October 10, 1997, the appellant's back disability was manifested by tenderness and limitation of motion. 2. From October 10, 1997 to June 9, 1998, the evidence of record did not show more than severe limitation of lumbar motion, more than severe lumbosacral strain, or more than severe intervertebral disc syndrome. 3. From June 9, 1998 to October 1, 1998, the appellant received temporary total disability compensation for a period of surgery and convalescence following L5-S1 laminectomy, microdiscectomy, and posterior lumbar interbody fusion in June 1998. 4. From October 1, 1998, the appellant's service-connected back disability has been manifested by chronic low back pain, left L5-S1 radiculopathy, and left ankle dorsiflexion weakness. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the appellant, the criteria for the assignment of a 40 percent evaluation for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, have been met for the period prior to October 10, 1997. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5292, 5293, 5295 (1999). 2. For the period of time prior to June 9, 1998, the schedular criteria for an evaluation in excess of 40 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5292, 5293, 5295 (1999). 3. The criteria for an evaluation in excess of 60 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, subsequent to October 1, 1998, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5293 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The appellant was originally granted service connection for a lumbosacral strain in a September 1978 rating action. At that time, the RO primarily based its decision on the appellant's service medical records and an August 1978 VA examination. The RO stated that according to the appellant's service medical records, in February 1975, the appellant complained of a lumbosacral strain and was given a profile which excused him from crawling, stooping, jumping, and running. In addition, the appellant's August 1978 VA examination showed that there was a full range of motion and no paravertebral muscle spasm. The examiner noted that there was some mild deep tenderness on pressure in the lumbosacral joint region in the midline. The diagnosis was of recurrent lumbosacral strain by history, with no abnormalities found on examination. Thus, in light of the appellant's in-service profile and his current lumbosacral strain and tenderness, the RO granted the appellant's claim for service connection for a lumbosacral strain and assigned a zero percent disabling rating under Diagnostic Code 5295. Entitlement to a compensable rating was denied by Board decisions in August 1979 and August 1982. In a November 1986 rating action, the RO increased the appellant's rating from zero percent to 10 percent disabling under Diagnostic Codes 5292-5295. At that time, the RO primarily based its decision on outpatient treatment records from the VA Medical Center (VAMC) in Baton Rouge, Louisiana, from February to July 1986, and the appellant's October 1986 VA examination. The RO stated that the outpatient treatment records showed complaints of pain to the lower back, with no definite findings. The RO further noted that in the appellant's October 1986 VA examination, the appellant complained of intermittent low back pain which was aggravated by prolonged sitting, standing, and stooping. In regards to range of motion of the lumbar spine, forward flexion was to 90 degrees, extension was to 30 degrees, lateral flexion was to 40 degrees, and rotation was to 30 degrees. X-rays showed no significant hypertrophic or degenerative changes. In light of the above, the RO increased the appellant's disabling rating from zero percent to 10 percent disabling. In a July 1987 rating action, the RO reduced the appellant's disabling rating for his service-connected lumbosacral strain from 10 percent to zero percent disabling under Diagnostic Codes 5292 to 5295. However, in a June 1988 decision, the Board restored the 10 percent disabling rating for his low back disability, finding that the appellant's lumbosacral strain was productive of low back pain which was aggravated by bending and bowel movements. The appellant subsequently reopened his claim, and by decision in March 1991, the Board denied a rating in excess of 10 percent, finding that the appellant's lumbosacral strain was productive of characteristic pain on motion without muscle spasm, loss of lateral motion, listing of the spine, or abnormality of gait. In August 1993, the appellant underwent a VA examination. At that time, he gave a history of his lumbosacral strain. The appellant stated that at present, he drove a school bus and that his back would tighten up while driving. According to the appellant, a bowel movement would make his back "stir up" and cause the muscles on the back of his left thigh to jump. After physical examination, the impression was of a history of trauma, and findings and history compatible with degenerative disk disease, mild, left lower root irritation at unidentified level. An x-ray of the appellant's lumbosacral spine showed mild narrowing involving the L5-S1 interspace. In January 1997, the appellant had a Magnetic Resonance Imaging (MRI) taken of his lumbar spine. The MRI was interpreted as showing minimal posterior bulging of the discs at L4-L5 and L5-S1 levels, posterior degenerative spur formation at the lower part of the L5 vertebral body, and minimal degenerative arthritic changes at the L4-L5 and L5-S1 facet joints, bilaterally. In correspondence received on August 6, 1997, the appellant requested that his service-connected lumbar disability be re- evaluated for a higher rating. In September 1997, the appellant underwent a VA examination. At that time, he gave a history of his lumbosacral strain. The appellant stated that at present, he had chronic low back pain which varied in severity. He noted that activities such as bending, lifting, and prolonged periods of weight bearing exacerbated his condition. The appellant further revealed that prolonged sitting, driving, or riding in a car for long periods of time also caused increased pain. According to the appellant, occasionally, the pain radiated from his back into his left leg, down to about the level of the knee. He reported that he was currently unemployed and that he had last worked in June 1997 as a security guard, but that his physician told him to stop working because of high glucose levels. The physical examination showed that the appellant moved about the room somewhat slowly and stiffly. He had no more than a trace limp, and he was able to stand erect with no spasm noted. The appellant had minimal tenderness to palpation over the left lower lumbar region. On range of motion testing, flexion was to 65 degrees and extension was to 25 degrees, with pain on extremes of motion. On supine straight leg raising examination, the appellant had complaints of back pain with raising of either leg. The appellant was able to heel-and-toe walk, and he was able to squat and arise again. Reflexes were intact in the lower extremities, and sensation appeared to be decreased to pinprick over the distal aspect of both feet in a nondermatomal fashion. The diagnosis was of chronic lumbar strain, with degenerative changes. In July 1999, the RO received outpatient and inpatient treatment records from the Jackson VAMC, from January 1997 to June 1999. The records show intermittent treatment for the appellant's low back problems, including herniated nucleus pulposus. The records reflect that in June 1997 the appellant was seen for back and side pain but no objective abnormalities were reported. In August 1997, he was treated after complaining that his chronic back problems were getting worse. At that time, the physical examination showed that the appellant was tender to palpation over his lower lumbar paraspinal muscle. The appellant was able to heel/toe walk, and he had "range of motion secondary to pain." The diagnosis was of degenerative joint disease of the lumbar spine. In September 1997 he reported that his back pain radiated to his side and that medication did not provide relief. The Jackson VAMC outpatient records from January to April 1998 show some limitation of range of back motion, decreased sensation to pinprick noted to be "stocking glove," tenderness and back spasm. In January 1998 deep tendon reflexes were present and equal. In June 1998, the appellant was hospitalized and underwent an L5-S1 laminectomy, microdiscectomy, and posterior lumbar interbody fusion with Pier mesh and bone graft. The post-operative diagnosis was of L5-S1 disc herniation and instability. The records also include a Discharge Summary which shows that the appellant was hospitalized from August 11, 1998 to August 14, 1998. On admission, the appellant complained of lumbar radiculopathy. He was two months status post lumbosacral discectomy, with bone cage fusion. According to the appellant, since the pre- operative period, he had had left lower extremity radiculopathy, most pronounced in the L5 distribution. The examining physician noted that follow-up x-rays of the lumbar spine revealed a fracture and migration of the left sided bone cage into the region of the left L5-S1 foramen. The Summary shows that during the appellant's hospitalization, he underwent a lumbar exploration where one of his bone cages was found to be tethering the axilla of the left L5 nerve root. The bone cage was removed and the new cage was applied. According to the Summary, post-operatively, the appellant recovered well. Upon his discharge, he was diagnosed with the following: (1) status post removal of bone cage and posterior lumbar fusion instrumentation, and (2) lumbar radiculopathy. The appellant was advised to perform light activity and to avoid driving, lifting, or straining. He was fitted for a brace to wear when out of bed. The Jackson VAMC records reflect that in January 1999, the appellant was treated after complaining of left foot numbness and motor deficits. Following the physical examination, he was diagnosed with left lumbosacral radiculopathy, secondary to L5-S1 cage extrusion. The records further show that in June 1999, the appellant was treated after complaining of low back pain. At that time, the physical examination of the appellant's back showed that he had a decreased range of motion. The impression was of chronic back pain. In July 1999, the appellant underwent a VA examination. At that time, he gave a history of his lumbosacral strain and recent surgeries. The appellant stated that after his last surgery, he started wearing a plastic corset. He noted that with his left lower extremity symptomatology and weakness of his left foot, he was also given a left foot ankle fixation orthotic (AFO), with ankle joint, to wear in his left shoe in order to prevent dragging of the foot or stubbing of the toe. According to the appellant, he received regular treatment at the neurosurgery clinic and the comprehensive pain management clinic. He stated that at present, he had chronic low back pain, and that the pain radiated down to the left lower extremity. The appellant indicated that he had difficulty sitting, standing, walking, and performing any particular activity for any length of time. According to the appellant, he also used a transcutaneous electrical nerve stimulation (TENS) unit, and he took nonsteroidal anti-inflammatory medication. He noted that he had previously worked as a security guard and a driver for rental car services. The appellant revealed that he had also worked for Federal Express, but that he had not worked since May 1997. The physical examination showed that the appellant did not appear to be in any acute distress. The appellant was wearing a plastic body jacket and a left AFO, with ankle joint. He was very obese, and he was able to put on and off his shoes and socks without much difficulty. The appellant was able to remove the braces, but he was not able to walk on his heels or toes. He was also unable to maintain balance on one lower extremity. The appellant could not squat, and he was not able to stand on his left lower extremity. Examination of his lumbosacral spine showed that there was mild paraspinal tenderness on the left side in the lumbosacral area. In regards to range of motion of the lumbosacral spine, flexion was to 50 degrees, with marked pain, extension was to zero degrees, lateral flexion to the left was to five degrees, and lateral flexion to the right was to 10 degrees. Rotation to the right was to 25 degrees and rotation to the left was to 20 degrees. While walking into the clinic, the appellant walked with a stooped posture and wobbling gait. There appeared to be wasting of the left lower extremity muscles, but measurements did not reveal any discrepancy of the right and left lower extremities at the thigh and calf levels. There was obvious weakness of left ankle dorsiflexion as he was able to dorsiflex only to neutral position. Plantar flexion strength was poor. In the right lower extremity, manual muscle strength was normal. Straight leg raising test was with increased back pain, bilaterally, at 80 degrees of straight leg raising. However, the appellant could not perform straight leg raising actively. Sensory function examination was symmetrical in both upper extremities and both lower extremities. Following the physical examination, the examiner stated that functionally, the appellant was independent in activities of daily living (ADL), and he ambulated without the assistance of any straight cane or quad cane. However, the examiner noted that the appellant wore a left AFO, with ankle joint, on the left lower extremity to prevent toe stubbing or dragging of the left foot due to weakness. The diagnoses included the following: (1) status post lumbosacral spine fusion, (2) chronic low back pain, (3) left L5-S1 radiculopathy, (4) left ankle dorsiflexion weakness, and (5) insulin dependent diabetes mellitus. The examiner stated that it was obvious that the appellant had left lower extremity weakness which was directly related to his lumbosacral spine surgery. According to the examiner, the appellant was not able to walk without any assistance devices like the braces. Endurance was not evaluated because the examination was for a limited period of time and the appellant appeared to have tolerated the examination very well. There was no fatigue, but there was obvious weakness of the left lower extremity. The examiner further indicated that there were marked limitations of range of motion which were either due to the surgery, obesity, and/or chronic low back pain. In an August 1999 rating action, the RO increased the rating for the appellant's service-connected low back disability, characterized as status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, from 10 percent to 40 percent under Diagnostic Code 5293, effective October 10, 1997, assigned a temporary total (100 percent) rating pursuant to 38 C.F.R. § 4.30, effective June 9, 1998, and assigned a 60 percent rating under Diagnostic Code 5293, effective October 1, 1998. The RO also granted the appellant's claim for entitlement to special monthly compensation based on loss of the use of the left foot. II. Analysis Initially, the Board finds that the appellant's claims for increased ratings are well grounded pursuant to 38 U.S.C.A. § 5107 (West 1991 & Supp. 1999). This finding is based in part on his assertion that his service-connected back disability has worsened. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). When the appellant submits a well-grounded claim, VA must assist him in developing facts pertinent to that claim. 38 U.S.C.A. § 5107(a). In this regard, records of VA outpatient and inpatient treatment from January 1997 to June 1999 have been obtained, and, in addition, in July 1999, the appellant underwent a VA examination. In light of the above, the Board is satisfied that all relevant evidence is of record and the statutory duty to assist the appellant in the development of evidence pertinent to his claim has been met. Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (1999). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (1999). Where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). When a reasonable doubt arises regarding the degree of disability or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102 (1999). Where an increase in a service-connected disability is at issue, the present level of disability is of primary concern. Although review of the recorded history of a service- connected disability is important in making a more accurate evaluation (see 38 C.F.R. § 4.2), the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The United States Court of Appeals for Veterans Claims (Court) (formerly the United States Court of Veterans Appeals) recently considered the question of functional loss as it relates to the adequacy of assigned disability ratings. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In DeLuca, the Court held that it is not enough for an examiner to state a range of motion. Rather, 38 C.F.R. § 4.40 requires consideration of factors such as lack of normal endurance, functional loss due to pain, and pain on use; specifically limitation of motion due to pain on use including during flare-ups. The Court also held that 38 C.F.R. § 4.45 required consideration of weakened movement, excess fatigability, and incoordination. Moreover, the Court stated that there must be a full description of the effects of the disability on the veteran's ordinary activity. 38 C.F.R. § 4.10. As previously stated, the appellant's service-connected back disability was originally rated under Diagnostic Codes 5292 and 5295. Under the provisions of Diagnostic Code 5292, slight limitation of motion of the lumbar segment of the spine warrants a 10 percent evaluation. Moderate limitation of motion warrants a 20 percent evaluation. A 40 percent evaluation requires severe limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5292. Diagnostic Code 5295 provides for the evaluation of lumbosacral strain. A 10 percent evaluation requires characteristic pain on motion. A 20 percent evaluation requires muscle spasm on extreme forward bending and unilateral loss of lateral spine motion in a standing position. A 40 percent evaluation requires severe lumbosacral strain manifested by listing of the whole spine to the opposite side, a positive Goldthwait's sign, marked limitation of forward bending in a standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of the joint spaces. A 40 percent rating is also warranted if only some of these manifestations are present with abnormal mobility on forced motion. 38 C.F.R. § 4.71a, Diagnostic Code 5295. The Board further notes that the appellant's service- connected back disability is currently rated as 60 percent disabling under Diagnostic Code 5293. Diagnostic Code 5293 provides for the evaluation of intervertebral disc syndrome. When severe, with recurring attack, with intermittent relief, a rating of 40 percent is provided. When pronounced with persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to the site of the diseased disc, with little intermittent relief, a rating of 60 percent is provided. 38 C.F.R. § 4.71a, Diagnostic Code 5293 (1999). The currently assigned 60 percent evaluation is the maximum evaluation provided under Diagnostic Code 5293. Under 38 C.F.R. § 4.71a, Diagnostic Code 5289, a 50 percent evaluation is the maximum schedular rating assignable for ankylosis of the lumbar spine. However, the evidence does not show ankylosis, which is fibrous or bony union, of the spine, and this code is not for application. To summarize, the appellant maintains that his current rating is not high enough for the amount of disability that his service-connected back disability causes him. He indicates that the has chronic low back pain, and that the pain radiates down his left leg. In this regard, lay statements are considered to be competent evidence when describing symptoms of a disease or disability or an event. However, symptoms must be viewed in conjunction with the objective medical evidence of record. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In regards to the appellant's claims for entitlement to an evaluation in excess of 10 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, prior to October 10, 1997, the Board observes that, according to the Jackson VAMC records, in June 1997 the appellant was seen for complaints of back and side pain but no abnormalities were indicated on the objective findings. However, in August 1997, he was treated after complaining that his chronic back problems were worsening, and 2 days later he filed his claim for an increased rating. At that time, he had tenderness over his paraspinal muscles and apparently some limitation of motion due to pain. The following month he reported that medication did not relieve his pain. He had some limitation of motion and moved slowly and stiffly on examination in September 1997. In the instant case, it is the Board's determination that the evidence of record shows that prior to October 10, 1997, the appellant's symptoms had increased significantly and that the level of disability was commensurate with that shown on the outpatient treatment record of October 1997, the date the RO determined that his disability was 40 percent disabling. When consideration is given to the objective findings, and with consideration of 38 C.F.R. § 4.7, it is the opinion of the Board that a 40 percent rating more adequately approximates the level of impairment attributable to the service-connected back disability, prior to October 10, 1997. At the very least, the evidence for and against an evaluation in excess of 10 percent prior to October 10, 1997, is in equipoise, and as such, all reasonable doubt is resolved in favor of the appellant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In arriving at this decision, the Board has considered the possibility of a still-higher schedular evaluation. However, the preponderance of the evidence is clearly weighted against a higher rating. The Board notes that under Diagnostic Code 5292, a 40 percent evaluation is the maximum schedular rating assignable based on limitation of motion of the lumbar segment of the spine and is the maximum schedular rating assignable for a lumbosacral strain under Diagnostic Code 5295. See 38 C.F.R. §§ 4.71a, Diagnostic Code 5292, 5295 (1999). Therefore, the next higher rating is under Diagnostic Code 5293. However, since the symptomatology associated with the appellant's service-connected back disability, prior to October 10, 1997, is not shown by the evidence of record to be consistent with a finding of pronounced neurological impairment of the lumbar spine to warrant a 60 percent rating under Diagnostic Code 5293, the Board finds that the appellant is more appropriately evaluated at the 40 percent rating under Diagnostic Code 5295, prior to October 10, 1997. Additionally, the Board notes that an evaluation in excess of 40 percent for the appellant's back disability, for the period of time from October 10, 1997 to June 9, 1998, is also not warranted. The Board observes that, as stated above, a 40 percent evaluation is the maximum evaluation provided under Diagnostic Codes 5292 and 5295. Thus, the next higher rating for consideration is under Diagnostic Code 5293. Outpatient treatment records in early 1998 showed some decreased sensation to pinprick but this was also attributed in part to diabetes mellitus; there was also muscle spasm and some decreased range of motion. However, motor strength was either normal or only slightly decreased, and ankle jerks were present. The Board finds that the symptomatology associated with the appellant's service-connected back disability, for the period of time from October 10, 1997 to June 9, 1998, is not shown by the evidence of record to be consistent with a finding of pronounced neurological impairment of the lumbar spine to warrant a 60 percent rating under Diagnostic Code 5293. The Board also concludes that the preponderance of the evidence is against an evaluation in excess of 40 percent under Diagnostic Code 5293, for the period of time from October 10, 1997 to June 9, 1998. In regards to the appellant's claim of entitlement to an evaluation in excess of 60 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, subsequent to October 1, 1998, it is the Board's determination that an increased schedular evaluation under Diagnostic Code 5293 is not possible because a 60 percent evaluation is already assigned to the appellant's service-connected back disability, which is the maximum evaluation under Diagnostic Code 5293. In addition, the next higher rating under 38 C.F.R. § 4.71a, Diagnostic Code 5286, shows that a 100 percent rating is assignable when there is complete bony fixation (ankylosis) of the spine at an unfavorable angle with marked deformity and involvement of major joints (Marie-Strumpell type) or without other joint involvement (Bechterew type). The Board observes that the evidence of record is negative for any complaints or findings of ankylosis of the lumbar spine. Therefore, in light of the above, an evaluation in excess of 60 percent, under Diagnostic Code 5286, is not warranted. Finally, pursuant to 38 C.F.R. § 3.321(b)(1), an extraschedular rating is in order when there exists such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. Clearly, due to the nature and severity of the appellant's service-connected back disability, interference with the appellant's employment is foreseeable. However, the record does not reflect frequent periods of hospitalization because of the service-connected disability in question, nor interference with employment to a degree greater than that contemplated by the regular schedular standards. The Board recognizes that in the appellant's most recent VA examination, in July 1999, the appellant stated that although he had worked as a security guard, a driver for rental car services, and for Federal Express, he had not worked since May 1997. The Board further recognizes that in the appellant's July 1999 VA examination, the examiner stated that it was obvious that the appellant had left lower extremity weakness which was directly related to his lumbosacral spine surgery, and that he was not able to walk without any assistance devices like the braces. However, the Board notes that the examiner also indicated that functionally, the appellant was independent in activities of daily living (ADL). Moreover, the Board further observes that although the appellant in his September 1997 VA examination stated that he had last worked in June 1997, he also indicated that his physician had told him to stop working because of high glucose levels, a nonservice- connected disability, and the record shows some neuropathy is due to diabetes mellitus. Thus, in light of the above, it is the Board's determination that the evidence of record does not reflect factors which take the appellant outside of the norm, or which present an exceptional case where his currently assigned 60 percent rating is found to be inadequate. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). Accordingly, the Board determines that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not meet. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Floyd v. Brown, 9 Vet. App. 88, 94-95 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In any event, the VA has an obligation under 38 U.S.C.A. § 5103(a) (West 1991) to advise an appellant of the evidence necessary to complete his or her application for VA benefits. In this case, the appellant is hereby notified that preliminary review indicates that the evidence necessary for consideration of his claim on an extra-schedular rating under 38 C.F.R. § 3.321(b)(1), is documentary and/ or lay evidence which relates to such factors as interference with his employment status (i.e., employment, personnel, and medical data, etc.), as well as competent medical evidence of frequent periods of inpatient care, due solely to the service-connected disability at issue. See Spurgeon v. Brown, 10 Vet. App. 194, 197-98 (1997). Accordingly, the Board views its discussion as sufficient to inform the veteran of the elements necessary to complete his application for a claim for increased VA benefits on an extraschedular basis. See Robinette v. Brown, 8 Vet. App. 69, 80 (1995). ORDER Subject to the provisions governing the award of monetary benefits, a 40 percent evaluation for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, for the period prior to October 10, 1997, is granted. Entitlement to an evaluation in excess of 40 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, for the period of time prior to June 9, 1998, is denied. Entitlement to an evaluation in excess of 60 percent for status post lumbosacral fusion, chronic low back pain, with left L5-S1 radiculopathy, history of lumbosacral strain, subsequent to October 1, 1998, is denied. HOLLY E. MOEHLMANN Member, Board of Veterans' Appeals