Citation Nr: 1323796 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 09-12 869 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to an initial disability rating in excess of 20 percent for a low back disability prior to December 18, 2011. 2. Entitlement to an initial disability rating in excess of 40 percent for a low back disability from December 18, 2011. 3. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the right lower extremity prior to December 18, 2011. 4. Entitlement to an initial disability rating in excess of 20 percent for radiculopathy of the right lower extremity from December 18, 2011. 5. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the left lower extremity prior to December 18, 2011. 6. Entitlement to an initial disability rating in excess of 20 percent for radiculopathy of the left lower extremity from December 18, 2011. REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD Patricia Veresink, Associate Counsel INTRODUCTION The Veteran had active service from September 1967 to February 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board remanded the case for further development in November 2012 to obtain a VA examination and medical assessment. The examination was provided in April 2013. Therefore, a review of the record indicates that the Board's directives were substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). FINDINGS OF FACT 1. Prior to December 18, 2011, even considering the Veteran's pain and corresponding functional impairment, his low back disability manifested with forward flexion of the thoracolumbar spine greater than 30 degrees, no ankylosis, and no incapacitating episodes. 2. From December 18, 2011, the Veteran's low back disability manifested without unfavorable ankylosis of the entire thoracolumbar spine and with incapacitating episodes lasting less than 4 weeks. 3. Throughout the appeal, the preponderance of the evidence shows that the Veteran's low back disability is not productive of bowel or bladder impairment. 4. Prior to December 18, 2011, the Veteran's right lower extremity radiculopathy manifested by no more than mild symptoms to include numbness, pain, and diminished reflexes. 5. From December 18, 2011, the Veteran's right lower extremity radiculopathy manifested by no more than moderate symptoms to include numbness, pain, sensory deficits, and diminished reflexes. 6. Prior to December 18, 2011, the Veteran's left lower extremity radiculopathy manifested by no more than mild symptoms to include numbness, pain, and diminished reflexes. 7. From December 18, 2011, the Veteran's left lower extremity radiculopathy manifested by no more than moderate symptoms to include numbness, pain, sensory deficits, and diminished reflexes. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 20 percent for a low back disability prior to December 18, 2011, have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.71a, Diagnostic Codes 5010, 5235-5243 (2012). 2. The criteria for an initial disability rating in excess of 40 percent for a low back disability from December 18, 2011 have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.71a, Diagnostic Codes 5010, 5235-5243 (2012). 3. The criteria for an initial disability rating in excess of 10 percent for a right lower extremity radiculopathy prior to December 18, 2011, have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520 (2012). 4. The criteria for an initial disability rating in excess of 20 percent for a right lower extremity radiculopathy from December 18, 2011, have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520 (2012). 5. The criteria for an initial disability rating in excess of 10 percent for a left lower extremity radiculopathy prior to December 18, 2011, have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520 (2012). 6. The criteria for an initial disability rating in excess of 20 percent for a right lower extremity radiculopathy from December 18, 2011, have not been met. 38 U.S.C.A. §§ 1154(a), 1155, 5107(b) (West 2002); 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Under the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107 and 5126 (West 2002) and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2010), VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). The appeals for higher initial ratings arise from a disagreement with the initial evaluations following the grants of service connection. Courts have held that once service connection is granted the claim is substantiated, additional notice is not required, and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Therefore, no further notice is needed under VCAA regarding those issues. The Board also finds that there has been compliance with the VCAA assistance provisions. The record in this case includes service treatment records, VA treatment records, private treatment records, VA examination reports, and lay evidence. The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide the case, and no further action is necessary. See generally 38 C.F.R. § 3.159(c). No additional pertinent evidence has been identified by the Veteran. The Veteran was afforded VA examinations in November 2007, June 2008, December 2011, February 2012, January 2013, and April 2013. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Board notes that the examiners were provided with an accurate history, the Veteran's history and complaints were recorded, the examination reports set forth detailed examination findings in a manner that allows for informed appellate review under applicable VA laws and regulations, and the examiners offered the necessary findings. Therefore, the Board finds the examinations to be sufficient and adequate for rating purposes. Higher Initial Rating - Laws and Regulations Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In any increased rating claim, different ratings can be assigned for different periods of time in a practice known as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Higher Initial Rating - Low Back The Veteran's multilevel degenerative disc disease and facet joint disease of the lumbar spine is rated under Diagnostic Code 5010 for traumatic arthritis. Under that regulation, traumatic arthritis is rated under the General Rating Formula for Diseases and Injuries of the Spine. Under the general rating formula, a 20 percent evaluation is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating requires that the condition be manifested by forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating requires unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating requires unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. For VA compensation purposes, 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. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. §§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Intervertebral Disc Syndrome is rated under Diagnostic Code 5243, based upon the frequency of incapacitating episodes. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Intervertebral disc syndrome is evaluated either on the total duration of incapacitating episodes over the past twelve months, or by combining under 38 C.F.R. § 4.25 separate ratings of its chronic orthopedic and neurologic manifestations along with rating of all other disabilities, whichever method results in the higher rating. Incapacitating episodes having a total duration of 6 weeks in the past 12 months warrants a 60 percent rating and 4 to 6 weeks warrants a 40 percent rating. 38 C.F.R. § 4.71a. The Veteran was afforded a VA examination in November 2007. The Veteran reported stiffness with bending and weakness with lifting and walking. He also reported constant pain. The examiner noted no ankylosis or muscle spasm. He found tenderness with palpation over the thoracic and lumbar spinous processes. The Veteran's range of motion was noted as flexion to 60 degrees, extension to 10 degrees, bilateral lateral flexion to 10 degrees and bilateral rotation to 20 degrees. The Veteran experienced pain only upon reaching the limits of his motion. The examiner noted pain, lack of endurance, fatigue, weakness, and incoordination, but found that it did not add any additional limitation of motion. The Veteran did have intervertebral disc disease, but no incapacitating episodes were noted. From March 2006 through April 2006 and July 2007 through January 2008, the Veteran received epidural blocks to alleviate severe radiating pain. The Veteran received a VA examination in June 2008. The Veteran reported stiffness, weakness, dizziness, numbness, bladder frequency, and painful bowel movements. The examiner noted muscle spasms and tenderness along the spine. He noted no ankylosis. Range of motion was flexion to 90 degrees, non-painful extension to 20 degrees, painful right lateral flexion to 15 degrees, painful left lateral flexion to 20 degrees, and painful bilateral lateral rotation to 20 degrees. Repetitive motion produces pain, but no weakness, fatigue, or lack of endurance. During a December 2011 VA examination, the Veteran reported stiffness, spasms, decreased motion, paresthesia, and numbness. He also reported pain. The Veteran noted no incapacitation in the prior 12 months. The Veteran's range of motion was flexion to 20 degrees, extension to 5 degrees, bilateral lateral flexion to 10 degrees, and bilateral lateral rotation to 10 degrees. These findings were not affected by pain or repetitive motion testing. The examiner noted weakened and painful movement, but no guarding or muscle spasm. Although the Veteran claimed bowel and bladder dysfunction related to his low back disability, the examiner found no neurologic abnormality or findings related the back condition other than the Veteran's already service-connected radiculopathy. The Veteran was afforded another VA examination in February 2012. The examiner diagnosed intervertebral disc syndrome and degenerative joint disease. The Veteran's range of motion was forward flexion to 20 degrees, extension to 5 degrees, bilateral lateral flexion to 10 degrees, and bilateral lateral rotation to 10 degrees. The findings were not altered with pain or repetitive use testing. The Veteran had localized tenderness or pain to palpation for joints and soft tissue of the spine. The examiner found no neurologic abnormalities other than the radiculopathy. A VA examiner in January 2013 reviewed the Veteran's record and found that his current bladder involvement may be completely unrelated to his lumbar spine, as he has comorbid diabetes mellitus, hypertension, and coronary artery disease, which may all be the etiology or contributory. He also reported a level of impotence. The 2009 MRI showed very little pathology present that would explain his lack of motion and bladder involvement. Upon the suggestion of the January 2013 reviewer, the Veteran was again provided a VA examination in April 2013. The examiner diagnosed lumbar spondylosis. The Veteran reported low back pain that has been worsening. The examiner reported range of motion of flexion to 65 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees with no additional limitation due to pain or repetitive testing. The examination revealed normal muscle strength and reflex examinations. The examiner noted no other neurologic abnormalities, such as bowel or bladder problems, due to his low back. He did note incapacitating episodes of at least 2 weeks, but less than 4 weeks. The examiner opined that the Veteran's bowel and bladder impairments are not likely due to his spinal pathology. He noted multiple comorbid problems, most notably severe coronary artery disease, peripheral vascular disease, and vasculopathy that contribute significantly to his lower extremity symptoms as well as erectile dysfunction. Prior to December 18, 2011, to receive a higher rating the evidence must show forward flexion of the thoracolumbar spine of 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes of at least 2 weeks. The evidence shows flexion to a minimum of 60 degrees, no ankylosis, and no incapacitating episodes. Therefore, the Board finds that a preponderance of the evidence is against the claim prior to December 18, 2011. From December 18, 2011, to receive a higher rating, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine or incapacitating episodes of at least 4 weeks. The evidence does not show any evidence of ankylosis. The VA examiners specifically note no ankylosis upon examination. Additionally, although one VA examiner noted incapacitating episodes, he noted the total time as less than 4 weeks. Therefore, the Board finds that a preponderance of the evidence is against the claim. The Board notes that the criteria set forth in DeLuca have been addressed. Although the Veteran experiences pain with motion, this pain has not caused the required limitation of motion, ankylosis, or incapacitating episodes to meet the criteria for a higher disability rating. 38 C.F.R. § 4.71a. The VA examiners addressed the criteria set forth in DeLuca v. Brown, 8 Vet. App. 202 (1995), and specifically noted no change in range of motion findings due to pain or repetition. The Veteran did report pain; however, the Board finds that the Veteran's complaints of pain do not impair the Veteran's functioning to the degree required to more closely approximate a higher rating for the low back. Mitchell v. Shinseki, 25 Vet.App. 32 (2011). The Board further finds that additional compensation for bowel or bladder impairment or erectile dysfunction is not warranted, based on the January 2013 VA examiner's determination that the Veteran had no other neurologic abnormalities, including, specifically, bowel or bladder problems, that are related to his lumbar spine condition. Although the Veteran is competent to report those symptoms, the Board finds that his opinions regarding their causes are entitled to no probative weight because those issues are complex. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). In this case, because the impact of the Veteran's disability on his neurologic abnormalities is not subject to lay observation and requires complex medical testing, the Board finds that the Veteran's opinions as to the causes thereof are not competent for VA purposes. By contrast, the VA examiner's opinion is competent because he is qualified through education, training, or experience to offer medical diagnoses, statements, and opinions. 38 C.F.R. § 3.159(a)(1). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002). Higher Initial Rating - Radiculopathy The Board will address the right and left lower extremity radiculopathy together as they stem from the same factual basis and are controlled by the same legal criteria. Sciatic nerve disabilities are rated at 80 percent where there is complete paralysis; the foot dangles and drops, there is no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. A 60 percent rating applies where there is severe incomplete paralysis with marked muscular atrophy. A 40 percent rating applies where there is moderately severe incomplete paralysis. Moderate incomplete paralysis is rated at 20 percent. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Neuritis of the sciatic nerve, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes will be that for moderately severe, incomplete paralysis where there is sciatic nerve involvement. 38 C.F.R. §§ 4.123, 4.124a, DC 8620. Neuralgia of the sciatic nerve, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. §§ 4.124, 4.124a, DC 8720. The Veteran was afforded a VA examination in November 2007. At that time, the examiner noted sensory deficit of bilateral anterior lower thighs, bilateral lateral thighs, bilateral medial legs, bilateral lateral legs, and bilateral dorsal feet. He also found motor weakness of bilateral hip flexion of 4/5, bilateral feet extension of 4/5, bilateral knee flexion of 4/5, and bilateral plantar flexion of 4/5. Examination revealed knee jerk and ankle jerk 1+. He noted that the peripheral nerve affected was the sciatic nerve. From March 2006 through April 2006 and July 2007 through January 2008, the Veteran received epidural blocks to alleviate severe radiating pain. In a February 2008 VA treatment record, the Veteran reported cold sensations in his legs at night. In April 2008, he reported pain down both legs. A January 2008 neurologic examination showed decreased sensation over his left lateral calf. He also has decreased sensation of the bilateral feet below the ankles to light touch and pinprick. The Veteran's reflexes were 1+ at the bilateral knees. The Veteran's Achilles reflexes were difficult to elicit. The examiner noted function and symmetric strength with no evidence of atrophy. During the June 2008 VA examination, the Veteran reported radiation down to the soles of his feet. He has aching, burning, and coldness in the feet. Neurological examination showed decreased strength in his bilateral lower extremities and reflexes of 1+ at the knees and ankles bilaterally. During a December 2011 VA examination, the examiner noted normal motor function and sensory examination to light touch. The Veteran's lower extremity reflexes revealed knee jerk and ankle jerk of 2+ bilaterally. The Veteran presented with bilateral radicular pain and numbness that is moderate in nature. The radiculopathy involves the sciatic nerve and is moderate in nature. The Veteran was afforded another VA examination in February 2012. The Veteran's his deep tendon reflexes were normal at the knee and ankle. The Veteran's sensory examination was also normal. The Veteran's radiculopathy manifested with moderate pain and numbness in the lower extremities. The Veteran was again provided a VA examination in April 2013. The examiner diagnosed lumbar spondylosis. The Veteran reported shooting pains associated with numbness and tingling. The examination revealed normal reflexes of the knees and ankles. The sensory examination showed decreased sensation to light touch in the left lower leg, ankle, and feet. The examiner diagnosed mild intermittent pain, paresthesias, and numbness. He noted involvement of the sciatic nerve. To receive a higher disability rating prior to December 18, 2011, the evidence must show moderate incomplete paralysis of the sciatic nerve. The evidence shows pain and cold sensation of the lower extremities with some sensory deficit. The Veteran's reflexes were hypoactive. The examiners noted no strength problems or atrophy and no loss of movement. The Board finds that the Veteran's symptoms manifest to a moderate level and the preponderance of the evidence is against the claim. To receive a higher disability rating from December 18, 2011, the evidence must show moderately severe incomplete paralysis of the sciatic nerve. The December 2011 examiner described the radiculopathy as moderate. The Veteran's reflexes were normal. The Veteran's radiculopathy manifested with moderate pain and numbness in the lower extremities. In April 2013, the VA examiner described the Veteran's symptoms as mild. Due to the lack of moderately severe symptoms, the Board finds that the preponderance of the evidence is against the claim. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002). Extraschedular Consideration The RO must refer a claim to the Chief Benefits Director or the Director, Compensation and Pension Service, for consideration of an extraschedular rating where a service-connected disability presents an exceptional or unusual disability picture with marked interference with employment or frequent periods of hospitalization that render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b) (1) (2012). An exceptional or unusual disability picture occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a veteran's service-connected disability. Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, then the Board must consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Id. at 115-116. When those two elements are met, the appeal must be referred for consideration of the assignment of an extraschedular rating, otherwise, the schedular evaluation is adequate, and referral is not required. Id. at 116. The Board finds that the rating criteria contemplate the Veteran's disabilities. The Veteran's low back disability is manifested by pain and limitation of motion, while his radiculopathy is manifested by numbness, cold sensation, and pain. These manifestations are contemplated in the applicable rating criteria. The Board does not find that the Veteran has described other functional effects that are "exceptional" or not otherwise contemplated by the assigned evaluation. Rather, his description of low back and radiculopathy symptomatology is consistent with the degree of disability addressed by such evaluations. Therefore, the rating criteria are adequate to evaluate the Veteran's disability and referral for consideration of an extraschedular rating is not warranted. Finally, the Court has held that entitlement to total disability based on individual unemployability (TDIU) is an element of all appeals for a higher rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran's entitlement to TDIU was separately adjudicated. See Locklear v. Shinseki, 24 Vet. App. 311, 315 (2011) (distinguishing Rice). In addition, in granting entitlement to a TDIU in a March 2012 rating decision the RO considered the aggregate impact of the Veteran's service-connected disabilities, i.e., it included more than his low back disability and its manifestations. Indeed, in doing so, the RO acted consistent with the Veteran's contention, which was that it was the combined impact of his service-connected disability that rendered him unable to secure or follow a substantially gainful occupation. See Veteran's April 2009 Substantive Appeal. As such, the Veteran's entitlement to a TDIU need not be addressed further by the Board in this decision. ORDER Entitlement to an initial disability rating in excess of 20 percent for a low back disability prior to December 18, 2011 is denied. Entitlement to an initial disability rating in excess of 40 percent for a low back disability from December 18, 2011 is denied. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the right lower extremity prior to December 18, 2011 is denied. Entitlement to an initial disability rating in excess of 20 percent for radiculopathy of the right lower extremity from December 18, 2011 is denied. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the left lower extremity prior to December 18, 2011 is denied. Entitlement to an initial disability rating in excess of 20 percent for radiculopathy of the left lower extremity from December 18, 2011 is denied. ____________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs