Citation Nr: 18140768 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 14-08 819 DATE: ORDER An initial rating in excess of 10 percent for lumbar spondylosis is denied. An initial rating of 10 percent for left lower extremity sciatic nerve paresthesia, as secondary to the service-connected lumbar spondylosis disability, is granted. FINDINGS OF FACT 1. For the entire initial rating period on appeal, the Veteran’s service-connected lumbar spondylosis is primarily productive of lumbar spine degenerative disc disease, thoracolumbar spondylosis with painful motion, forward flexion at worst to 80 degrees, a combined range of motion of the lumbar spine at worst of 230 degrees, without muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or incapacitating episodes of intervertebral disc syndrome (IVDS). 2. For the entire initial rating period on appeal, the Veteran’s lumbar spondylosis has been productive of neurologic deficits of the left lower extremity that results in a disability analogous to mild incomplete paralysis of the sciatic nerve. 3. Service connection is already in effect for radiculopathy of the right lower extremity, as secondary to service connected lumbar spondylosis. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for lumbar spondylosis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5237 (2017). 2. The criteria for a separate initial rating of 10 percent, but no higher, for radiculopathy of the left lower extremity have been met. 38 U.S.C. §§ 1155, 5107 (2002); 38 C.F.R. §§ 4.1, 4.2, 4.124, 4.124a, DC 8520 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served in the Army National Guard, with active duty from August to December 2006 and October 2007 to January 2009, and periods of inactive duty for training (INACDUTRA), including from October to November 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated August 2011 of the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. The Board has recharacterized the issue on appeal to distinguish the Veteran’s lumbar spondylosis disability from left lower extremity radiculopathy, which, as discussed below, is assigned a separate 10 percent initial disability rating. Preliminary Matter The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Ratings Applicable Laws and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the low rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes (DC or DCs), is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several DC; however, the critical element in doing so is that none of the symptomatology is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. The assignment of a particular DC is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One DC may be more appropriate than another based on such factors as an individual’s relevant medical history, the DC, and the demonstrated symptomatology. Any change in a DC by VA must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. See Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, however, the evidence does not establish that staged ratings are warranted. Painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). Schedular ratings for disabilities of the spine are provided by application of the General Rating Formula for Diseases or Injuries of the Spine (General Rating Formula) or by application of the Formula for Rating IVDS (IVDS Formula) Based on Incapacitating Episodes. 38 C.F.R. § 4.71a. The General Rating Formula specifies that the criteria and ratings apply with or without symptoms such as pain, whether or not it radiates, stiffness, or aching in the area affected by residuals of injury or disease. Id. Under the General Rating Formula, the DC criteria pertinent to lumbar spine disabilities provides that a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, a combined range of motion (ROM) of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a combined ROM 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 is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating may be assigned due to unfavorable ankylosis of the entire spine. See 38 C.F.R. § 4.71a. 8 C.F.R. § 4.71a, General Rating Formula. Alternatively, under the IVDS Formula, incapacitating episodes having a total duration of at least six weeks during the past 12 months warrants a 60 percent rating. For incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted. With incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent rating is warranted. With incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months, a 10 percent rating is warranted. 38 C.F.R. § 4.71a, DC 5243. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome which requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, DC 5243 (2017). Ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. 38 C.F.R. § 4.71a, General Rating Formula, Note (5). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate DC. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). 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 extension are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined ROM refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined ROM for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, General Rating Formula, Note (2). Each ROM measurement is to be rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula, Note (4). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through their senses. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Analysis The Veteran’s lumbar spondylosis is currently rated as 10 percent disabling under the General Rating Formula. See Rating Decision August 30, 2011. In February 2012 the Veteran submitted a Notice of Disagreement, indicating that his symptoms warrant a higher rating. Turning to the evidence, the Veteran’s service treatment records (STRs) reflect that he suffered a low back injury while loading weapons onto a truck in October 2009 during INACDUTRA, and was thereafter placed on physical profiles imposing functional limitations on his service duties. See Statement of Medical Examination and Duty Status (DD Form 2173) dated February 2, 2010; see e.g. Physical Profile dated June 21, 2010. A November 2009 treatment record from a private hospital emergency room shows that the Veteran complained of low back pain from an injury during drill training. The diagnosis was musculoskeletal pain, and the Veteran was given medication for pain stiffness caused by muscle spasms. A January 2010 VA treatment record reflects that the Veteran reported the sudden on-set of back pain while stepping up onto a truck, which he described as being similar to pain he had two months earlier. On examination, the muscles over the lumbar spine and the paraspinous muscles left of the lumbar spine were tender with spasm. The impression was back pain most likely from muscle strain. A February 2010 VA treatment record noted that the Veteran had slight muscle spasm of the left mid paralumbar muscles. It was noted that the Veteran had full ROM of the extremities. X-rays of the lumbar spine revealed no acute process. Also in February 2010, the Veteran reported during a VA outpatient visit that he experienced dull pain in his lower left side that did not radiate into his leg, aggravated by prolonged sitting, but that it was not aggravated by standing or walking. The Veteran reported that the medication he was taking was not mitigating pain. The Veteran was tender in the lumbar spine area, with greater tenderness on the left side. The examiner noted a hard area on the back, left side in the area of the T-10 vertebra. There was no loss of function, no weakness, no numbness, paralysis or seizures. Reflexes and neurologic functioning were normal An MRI dated in March 2010 revealed multilevel lumbar spondylotic changes. During a March 2010 VA outpatient visit, the Veteran reported numbness in his left lower extremity. The examiner attributed the numbness to compression of a nerve at the S-1 vertebra. In May 2010, during a VA neurosurgery consultation, the Veteran reported low back pain that radiated into his left buttock. The Veteran said it was more painful at night. The Veteran had decreased ROM in flexion and extension of the lumbar spine, although ROM measurements were not noted. The Veteran’s gait and straight leg raising test were both normal. The examiner was unable to illicit nerve pain. The assessment was degenerative disc disease. It was noted that no neurosurgical intervention was needed at that time. The Veteran was advised not to do any heavy lifting on a regular basis in the work setting. The Veteran was given a VA spine examination in August 2010. He appeared for the examination using no ambulation aids. The Veteran reported constant low back pain ranging in severity, with radiation to the left buttock two to three days a week. The diagnosis was lumbar spondylosis with lumbar radiculopathy. On examination, ROM testing of the lumbar spine revealed flexion to 80 degrees; extension to 30 degrees; lateral flexion to 30 degrees, bilaterally; and lateral rotation to 30 degrees, bilaterally. Combined ROM was 230 degrees. Pain was not noted on ROM exercises. The Veteran was able to perform repetitive-use testing with three repetitions, with no loss of ROM after three repetitions. The examiner noted that the Veteran was not additionally limited by pain, weakness, fatigability, lack of endurance or incoordination after repetitive use testing. The Veteran was positive for levoscoliosis; negative for ankylosis of the thoracolumbar spine. There was no guarding, spasm, or antalgia indicated. The Veteran’s gait was normal. There was no muscle atrophy. Motor strength was normal bilaterally in the upper and lower extremities. Fine touch sensory and vibration testing were normal bilaterally in the upper and lower extremities. Straight-leg tests were normal, bilaterally. The Veteran was able to toe-and-heel, tandem-walk, and squat without objective evidence of pain or discomfort. The Veteran was negative for IVDS, cyanosis, clubbing, and edema of the bilateral upper and lower extremities. The examiner noted that x-ray studies of the thoracic and lumbar spines taken in February 2010 were normal. The Veteran complained of stiffness of the lumbar spine as well as fatigue. However, he denied numbness, paresthesia, foot weakness, bladder or bowel complaints, and erectile dysfunction. He denied being unsteady, but added that he had a history of falls. He stated that his low back disability did not limit how far he could walk. The examiner recorded conflicting observations regarding palpation of the thoracolumbar spine, noting tenderness with palpation of the thoracolumbar spine indicated by the Veteran’s facial grimacing and movement, and also noting that there was no objective evidence of pain with palpation of the thoracolumbar spine. He stated that flare-ups impacted his job as a corrections officer, and that he had difficulty wearing a bulletproof vest, which caused increased severity of pain to his low back. The Veteran noted that his lumbar spine disability did not affect his activities of daily living such as eating, grooming, toileting, bathing and dressing. During an August 2010 VA outpatient visit, the Veteran reported dull low back pain radiating into the left hip and buttock area as well as tingling. The assessment was low back pain and degenerative disc disease. In October 2010, the Veteran reported chronic low back pain and numbness in the left lower extremity, which the VA clinician attributed to compression of a nerve at the S1 vertebra. The assessment was chronic low back pain and degenerative disc disease. A February 2011 VA outpatient records reflects that the Veteran’s degenerative changes of the lower spine were best treated through physical rehabilitation, non-opiod medications for short term management of exacerbations, use of nonsteroidal anti-inflammatory medications, non-opioid analgesics, and weight control. The Veteran’s VA treatment include a March 2011 notation that he contacted Shreveport VAMC to report that his back pain was getting worse, it was interfering with his job at a tire retailer, and that even though he rolled tires instead of picking them up, he still had back pain that radiated into his leg. A May 2011 VA outpatient record shows that the Veteran complained of low back pain. Neurologic symptoms were noted to be grossly physiologic. VA outpatient notes dated June 2011 reflect that the Veteran had full ROM in his extremities. He was noted to be positive for grimace; negative for groan, guarding, overreaction, inconsistencies, or give way. An assessment of his gait indicated that he had good balance, base of support, shoulder rotation, no circumduction or antalgic pain, and he was able to tandem-walk, toe-raise, and heel-raise. Core stabilization testing showed that he was able to stand on one leg and do a single leg squat. There was no muscle imbalance, atrophy, no scoliosis, kyphosis, or excessive lordosis. There were no surgical scars. The Veteran was tender to palpation over the posterior superior iliac spine and lumbar paraspinal muscles. The clinician noted that the Veteran had full ROM in flexion, extension, lateral flexion and lateral rotation, and full hip ROM without pain. He had negative facet loading response. Cold sensation, vibratory, proprioception, negative allodynia or hyperpathia of the lower extremities were intact. The assessment was lumbar radicular pain. During an October 2011 VA outpatient visit, the Veteran reported dull pain in low back, radiating into left buttock and hip area with tingling. The Veteran reported during a May 2012 telephone call to VA that he had constant lower back pain with “lightning” radiating into his hips, bilaterally, and to his right lower extremity, with pain worsened with prolonged standing and activity, numbness in his right buttock, and weakness in both feet. Straight leg raise test was positive at 45 degrees, bilaterally. A FABER examination was negative bilaterally. Facet loading was positive in the lumbar region, bilaterally. The Veteran was tender to palpation of the paraspinous muscles. Muscle strength testing was 5/5, or normal, for the right lower extremity and 4-4+/5 for the left lower extremity. Neurologic functioning was grossly intact. The assessment was degenerative disc disease, radiculopathy of the right L5 vertebra, myofascial pain of the paraspinous muscle, and chronic pain. From May to July 2012, the Veteran was given epidural steroid injections (ESI) to the right L5-S1 vertebrae. An MRI dated in October 2012 revealed multilevel lumbar spondylotic changes and interval progression at the L5-S1 vertebrae. The report notes that nerve conduction studies were normal. It was also noted that the Veteran had tried ESI injections in July 2012 and reported no relief and that his pain was worse after the third injection. In October 2012, during a VA physical rehabilitation consultation, the Veteran complained of left side paraspinal pain radiated into left hip, buttock and knee. His gait was slightly antalgic but within normal limits. He was treated with transcutaneous electrical nerve stimulation (TENS) for 60 minutes. Also in October 2012, the Veteran’s wife contacted the Shreveport VAMC, reporting that the Veteran had not gotten out of bed for four days because he was in so much pain, but that he had been able to get up to soak in a hot tub or take a shower. She reported that even using the TENS unit and taking prescribed medication, the Veteran’s pain was not tolerable. A January 2013 VA outpatient neurosurgery consultation note reflects that the Veteran reported low back pain radiating into his left hip, and that the pain was worse with prolonged standing, but that he obtained some relief when lying on his side. It was noted that the Veteran had not tried physical therapy. The Veteran denied numbness and tingling in his legs, radiculopathy, and bowel and bladder symptoms. On examination, pain was limited to the Veteran’s back without any evidence of spondylolisthesis. The impression was mild degenerative changes. In his March 2014 substantive appeal, the Veteran claimed that the disability rating assigned by VA did not take into consideration medical findings reflected in a 2012 MRI or spinal injections he received from May to July 2012 when his pain grew worse. The Veteran also asserted that pain that initially radiated into his left buttock had spread to his left leg, resulting in greater limitations in mobility than reflected in the RO’s decisional documents. See Appeal to Board of Veterans’ Appeals (VA Form 9) dated March 3, 2014. VA primary care note dated November 2015 reflects that the Veteran reported ongoing back pain and neuropathy, which increased with movement, standing and/or walking. The Veteran was taking the medication Gabapentin for neuropathy. The Veteran was given a VA spine examination in June 2017. He appeared for the examination using no ambulation aids. The diagnosis was lumbar spondylosis with intermittent, mild right lower extremity radiculopathy. On examination, ROM testing of the lumbar spine revealed flexion to 90 degrees; extension to 25 degrees; lateral flexion to 30 degrees, bilaterally; and lateral rotation to 30 degrees, bilaterally. Combined ROM was 235 degrees. Pain was objectively indicated during extension, but the examiner noted that did not result in functional loss. The Veteran was able to perform repetitive-use testing with three repetitions, with no loss of ROM after three repetitions. The examiner noted that the Veteran was not additionally limited by pain, weakness, fatigability, lack of endurance or incoordination after repetitive use testing. The Veteran reported functional loss or functional impairment of the thoracolumbar spine, regardless of repetitive use, that he described as having good movement but his back aches. The examiner noted that determining whether there was pain with passive ROM could not be performed or was not medically appropriate. There was no evidence of pain with weight bearing or non-weight bearing. The examiner reported that he was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time, because the Veteran was not examined after repeated use. The Veteran denied flare-ups, saying that he just had daily symptoms of back pain, which he described as sharp, dull intermittent pain across his lower, middle center back, rated during the examination as five on a scale of 10, with intermittent numbness in the right lower extremity. He endorsed occasional muscle spasm. He also endorsed radicular symptoms of intermittent pain into the right lower extremity as far as the knee. He denied loss of bowel or bladder control. There was no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine. The Veteran’s gait was normal, and Romberg, toe-and-heel walk, and sitting straight-leg raising tests were all normal. The Veteran was negative for guarding and muscle spasm. Muscle strength testing was normal, bilaterally. There was no muscle atrophy. Reflexes, neuromotor, and neurosensory testing were normal, bilaterally. Sensation to light touch was normal. Straight leg raising test was negative. The Veteran was positive for mild radiculopathy of the right lower extremity, specifically numbness and mild intermittent pain involving the right nerve-roots L4/L5/S1/S2/S3 (sciatic nerve). The examiner noted the severity of radiculopathy as mild. The Veteran was negative for ankylosis of the spine, IVDS, and scoliosis. The examiner concluded that the Veteran’s thoracolumbar spine disability impacted his ability to work to the extent that he should avoid prolonged standing or sitting, lifting, carrying, bending, and twisting during episodes of pain. The examiner cautioned that occupational safety issues need to be considered since the Veteran’s use of pain medication and muscle relaxants can affect dexterity and alertness. The examiner noted that the Veteran’s low back disability had no impact on performance of activities of daily living. The examiner reported that imaging studies indicate arthritis, but are negative for thoracic vertebral fracture with loss of 50 percent of height. After a review of the evidence of record, the Board finds that a rating higher than 10 percent is not warranted because the Veteran’s disability has not been shown to be manifested by forward flexion of the thoracolumbar spine less than 60 degrees; a 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, which is required by the 20 percent rating criteria. See 38 C.F.R. § 4.71a. Forward flexion of the lumbar spine has been no worse than 80 degrees during the appeal period. The Board has considered whether a higher disability rating for the Veteran’s low back disability is warranted on the basis of functional loss due to pain, weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See also DeLuca. However, the rating criteria are intended to take into account functional limitations due to painful motion which is already contemplated by the currently assigned 10 percent disability ratings. Notably, 80 to 90 degrees flexion of the Veteran’s thoracolumbar spine during the period on appeal approximates normal flexion for VA compensation purposes. 38 C.F.R. § 4.71a, General Rating Formula, Note (2). As discussed above, the June 2017 VA examination specifically determined that pain during ROM testing did not result in functional loss. Thus, even considering pain on flexion, the examiner’s objective findings reflect that the Veteran’s range of motion do not approximate the criteria for a 20 percent disability rating. Therefore, the provisions of 38 C.F.R. §§ 4.40, 4.45, do not provide a basis for a higher evaluation. The Board also considered the Veteran’s report of functional loss after repeated use, e.g. “Movement is there and good, but my back aches.” See VA examination report dated June 27, 2017 at pg. 4; see also VA examination report dated August 20, 2010 at pg. 3 (no loss of ROM after three repetitions). However, taking this into consideration, it does not more nearly approximate the criteria for a 20 percent rating. As discussed above, competent medical evidence of record demonstrates that, at the worst, the Veteran’s flexion is 80 degrees, and combined ROMs of the thoracolumbar spine is 230 degrees. Guarding and/or muscle spasms is not shown. Likewise, a rating higher than 10 percent is not warranted under the IVDS Formula. There is evidence of disc disease, however the Veteran has not been diagnosed with IVDS. The Veteran’s medical records for the period on appeal are negative for IVDS, and the Veteran was specifically found not to have IVDS in the August 2010 and June 2017 VA examinations. Moreover, there is no evidence of incapacitating episodes of the Veteran’s back disability. Accordingly, a rating higher than 10 percent for the low back disability is not warranted under DC 5243 based on the IVDS Formula. In addition to consideration of the orthopedic manifestations of the low back disability, VA regulations require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. DC 8520 provides ratings for incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124, DC 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. The Board finds that, based on the lay and medical evidence, the Veteran has had neurologic symptoms in his left lower extremity secondary to his lumbar spine disability during the entire period on appeal. His leg symptoms are analogous to no more than mild impairment. As such, the Board concludes that the evidence supports his entitlement to a separate 10 percent rating under DC 8520 for radiculopathy of the left lower extremity. However, an even higher rating of 20 percent is not warranted, as the Veteran’s neurologic symptoms appear to be wholly sensory and there is clearly no evidence of radicular impairment to a moderate degree. See 38 C.F.R. § 4.124a. Indeed, the testing of the Veteran’s left lower extremity revealed normal reflexes, sensation and motor aspects. Lastly, the RO recently awarded a 10 percent rating under DC 8599-8522 for the Veteran’s radiculopathy of the right lower extremity based on mild incomplete paralysis. See Rating Decision dated September 21, 2017. To date, there is no indication that the Veteran has disagreed with the rating assigned. Moreover, there is no evidence supporting the award of a higher rating as the radiculopathy of the right lower extremity is shown to be wholly sensory and there is no evidence of radicular impairment to a moderate degree. See 38 C.F.R. § 4.124a. The competent evidence does not reflect any other objective neurologic abnormalities associated with the Veteran’s lumbar spine disability so as to warrant any additional separate ratings. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brad Farrell, Associate Counsel