Citation Nr: 18142335 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 14-09 202 DATE: October 15, 2018 ORDER 1. Entitlement to a disability rating in excess of 20 percent for status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome prior to July 1, 2014, and in excess of 10 percent thereafter, is denied. 2. An increased 10 percent disability rating for sciatica of the right lower extremity is granted effective July 1, 2014, subject to the laws and regulations governing the award of monetary benefits 3. Entitlement to an initial disability rating in excess of 10 percent throughout the appeal period for sciatica of the right lower extremity is denied. 4. An increased 10 percent disability rating for sciatica of the left lower extremity is granted effective July 1, 2014, subject to the laws and regulations governing the award of monetary benefits. 5. Entitlement to an initial disability rating in excess of 10 percent throughout the appeal period for sciatica of the left lower extremity is denied. FINDINGS OF FACT 1. Prior to July 1, 2014, status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome, was not manifested by forward flexion of the thoracolumbar spine limited to 30 degrees or less, or favorable or unfavorable ankylosis of the entire thoracolumbar spine and the Veteran’s intervertebral disc syndrome (IVDS) did not result in incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during a 12-month period at any point during the appeal period. 2. Since July 1, 2014, status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome, has not exhibited forward flexion of the thoracolumbar spine limited to 60 degrees or less, combined range of motion of the thoracolumbar spine less than 120 degrees; and the preponderance of the evidence is against findings of muscle spasm of guarding severe enough to result in an abnormal gait or spinal contour; or favorable or unfavorable ankylosis of the entire thoracolumbar spine and the Veteran’s intervertebral disc syndrome (IVDS) did not result in incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during a 12-month period. 3. Affording the Veteran the benefit of the doubt, prior to July 1, 2014, sciatica of the right lower extremity was manifested by mild impairment of the sciatic nerve group. 4. Sciatica of the right lower extremity has not been manifested by moderate incomplete paralysis of the sciatic nerve at any point during the appeal period. 5. Affording the Veteran the benefit of the doubt, prior to July 1, 2014, sciatica of the left lower extremity was manifested by mild impairment of the sciatic nerve group. 6. Sciatica of the left lower extremity has not been manifested by moderate incomplete paralysis of the sciatic nerve at any point during the appeal period. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome, prior to July 1, 2014, and in excess of 10 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5243 (2017). 2. As of July 1, 2014, the criteria for a rating of 10 percent for sciatica of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, DC 8620 (2017). 3. The criteria for an initial rating in excess of 10 percent for sciatica of the right lower extremity throughout the appeal period have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, DC 8620 (2017). 4. As of July 1, 2014, the criteria for an initial rating in excess of 10 percent for sciatica of the left lower extremity have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, DC 8620 (2017). 5. The criteria for an initial rating in excess of 10 percent for sciatica of the left lower extremity throughout the appeal period have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, DC 8620 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1982 to April 2006. In an April 2014 rating decision, the Regional Office (RO) decreased the Veteran’s disability rating for his status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome to 10 percent, effective from July 1, 2014. The RO also decreased the Veteran’s disability ratings for his sciatica of the right and left lower extremities, each to a noncompensable or 0 percent disability rating, effective from July 1, 2014. In April 2018, the RO granted an increased 10 percent disability rating for the Veteran’s sciatica of the right and left lower extremities, effective from August 17, 2015. As this was not a full grant of the benefits sought on appeal, and the Veteran did not indicate that he agreed with the ratings, his claims have remained on appeal. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). In September 2017, the Veteran provided testimony in a video conference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. In February 2018, the Board remanded the Veteran’s claims for additional development. There was substantial compliance with the Board’s remand directives to decide the claims on appeal. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. See 38 C.F.R. § 4.7 (2017). When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. See id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a) (2012). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). 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 Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. See 38 C.F.R. § 4.40. 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. Under 38 C.F.R. § 4.45, functional loss due to weakened movement, excess fatigability, and incoordination must also be considered. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id. Pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). All spinal disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Degenerative disc disease of the lumbar spine is to be evaluated either under the General Rating Formula or under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (38 C.F.R. § 4.71a, DC 5243 (2017)), whichever method results in the higher rating. Under the General Rating Formula, a 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is 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 when the forward flexion of the thoracolumbar spine is 30 degrees or less; or, favorable ankyloses of the entire thoracolumbar spin. A 50 percent rating is assigned for unfavorable ankylosis of entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a, DC 5243. The General Rating Formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate DC. Id. at Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note (2). Under DC 8520, which provides the rating criteria for paralysis of the sciatic nerve a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve group, a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve group, a 40 percent rating is assigned for moderately severe incomplete paralysis of the sciatic nerve group, a 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve group, with marked muscular atrophy, and an 80 percent rating is assigned for complete paralysis of the sciatic nerve group (the foot dangles and drops, no active movement possible of the muscles below the knee, flexion of the knee weakened or (very rarely) lost). Neuritis of the sciatic nerve is rated under DC 8620. Neuritis is characterized by loss of reflexes, muscle atrophy, sensory disturbances and constant pain and is rated on the scale assigned for injury of the nerve involved. The maximum rating available for neuritis of the sciatic nerve not characterized by organic changes is moderately severe incomplete paralysis, or 40 percent. 38 C.F.R. § 4.123. Neuralgia of the sciatic nerve is rated under DC 8720. Neuralgia is characterized by dull and intermittent pain and is to be rated on a scale for the affected nerve, with a maximum equal to moderate incomplete paralysis, or 20 percent. 38 C.F.R. § 4.124. 1. Entitlement to a disability rating in excess of 20 percent for status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome prior to July 1, 2014, and in excess of 10 percent thereafter. The Veteran contends that his lumbar spine disability should be rated higher than the assigned disability ratings of 20 percent prior to July 1, 2014 and 10 percent thereafter, under 38 C.F.R. § 4.71a, DC 5243. During the September 2017 Board video conference hearing, the Veteran testified that his back had not gotten any better in terms of pain or range of motion. He explained that he had pressure points in his back that caused pain and discomfort following surgery in the summer of 2008 and that as the bone started to grow around the screws, range of motion decreased. the Veteran testified that he experienced difficulty with his back with getting dressed and undressed, sitting in his vehicle and desk, putting on and taking off his shoes, and simple daily activities around the home, including lifting groceries and taking out the trash due to pain and limitation of motion. He testified that he had daily pain with some days where limitation of motion was worse. He asserted that he overextended himself during the VA examinations and it did not represent the actual picture. In the March 2011 examination report, the Veteran reported constant severe to moderate lower back pain, which could be aggravated by physical activity and relieved by rest, except for lying down, which made it worse. He also complained of stiffness, decreased motion, and weakness in his lower back but was able to function generally without medications. He indicated that he was able to walk a couple of miles even though he was in pain and had trouble with bending over. The Veteran stated that he had problems with falls and averaged two falls a year. The Veteran denied bowel or bladder problems and erectile dysfunction. The Veteran had no recommendation for incapacitation. The examiner indicated that muscle tone was normal and straight leg raise tests were negative. A physical examination revealed normal posture and gait and a steady walk without any ambulation devices. There was no evidence of tenderness, guarding, muscle spasm, radiation of pain on movement, weakness, atrophy, nor ankylosis. The Veteran’s lumbar spine range of motion showed forward flexion to 45 degrees with pain, extension to 30 degrees with pain, left lateral flexion to 30 degrees with pain, right lateral flexion to 30 degrees with pain, left lateral rotation to 30 degrees with pain, and right lateral rotation to 30 degrees with pain. The combined range of motion was 195 degrees. The Veteran was able to perform repetitive motion testing with three repetitions with no additional loss of range of motion. However, repetitive use caused lower back pain, fatigue, weakness, and lack of endurance, but not incoordination. The examiner indicated that an inspection of the spine revealed normal head position with symmetry in appearance and symmetry of spinal motion with normal curves of the spine. The Veteran was examined again in October 2011. The Veteran reported that he could walk without limitation but had experienced falls due to his spine disability. He indicated that he had symptoms associated with the spinal disability including stiffness, decreased motion, and numbness. He stated that he did not experience fatigue, spasms, and paresthesia. The Veteran experienced moderate pain constantly, which traveled to his hips and buttocks, which is exacerbated by physical activity and relieved by rest. He could function without medication and at the time of pain he experienced limitation of motion of the joint, which was described as walking, bending over, and difficulty getting dressed and undressed. The Veteran denied bowel or bladder problems and erectile dysfunction and any incapacitation in the preceding 12-months. Upon physical examination, the Veteran’s lumbar spine range of motion showed forward flexion to 45 degrees with pain, extension to 15 degrees with pain, left lateral flexion to 25 degrees with pain, right lateral flexion to 25 degrees with pain, left lateral rotation to 25 degrees with pain, and right lateral rotation to 25 degrees with pain. The combined range of motion was 160 degrees. The Veteran was able to perform repetitive motion testing with three repetitions with no additional loss of range of motion and joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The Veteran had normal posture and gait and a steady walk without any ambulation devices. There was no evidence of guarding of movement, muscle spasm, or radiation of pain on movement. There was tenderness to parathoracolumbar, however, the spinal contour was preserved. Examination did not reveal any weakness, atrophy, nor ankylosis. Straight leg raising was positive bilaterally and Lasegue’s sign was also positive. The examiner indicated that an inspection of the spine revealed normal head position with symmetry in appearance and symmetry of spinal motion with normal curves of the spine. During the December 2013 VA examination, the Veteran reported constant pain but did not report flare-ups of the back. X-ray imaging performed of the lumbar spine indicated posterior internal fixation of L5-S1 with an artificial disc spacer in between, no hardware complication, and were otherwise negative. The Veteran’s lumbar spine range of motion showed forward flexion to 75 degrees (with pain at 15 degrees), extension to 10 degrees with pain, left lateral flexion to 30 degrees (with pain at 15 degrees), right lateral flexion to 30 degrees (with pain at 15 degrees), left lateral rotation to 15 degrees with pain, and right lateral rotation to 15 degrees with pain. The combined range of motion was 175 degrees. The Veteran was able to perform repetitive-use testing with three repetitions with no additional loss of range of motion or functional loss. The Veteran did not exhibit tenderness or pain to palpation, muscle atrophy or ankylosis and there was no guarding of movement or muscle spasm of the back. The examiner indicated that the Veteran did not have IVDS of the thoracolumbar spine. In an April 2018 VA examination report, the Veteran reported flare-ups of the back as increased pain with activity and pain that radiated into both thighs. The Veteran’s lumbar spine range of motion showed forward flexion to 70 degrees, extension to 20 degrees, left lateral flexion to 30 degrees, right lateral flexion to 30 degrees, left lateral rotation to 30 degrees and right lateral rotation to 30 degrees with pain on all ranges of motion. The combined range of motion was 210 degrees. Although pain on range of motion testing was expressed at all ranges tested, range of motion itself did not contribute to a functional loss but pain noted on examination did not result or cause functional loss. Repetitive use over time caused increased pain but did not decrease range of motion. The Veteran was able to perform repetitive-use testing with three repetitions with no additional loss of function or range of motion. Pain was also noted to increase with flare-ups limiting tolerance for activity without change in range of motion. The examiner indicated that there is no evidence of pain on passive range of motion testing of the back or pain on non-weight bearing testing of the back. There was no objective evidence of localized tenderness or pain on palpation and the Veteran did not have guarding or muscle spasm of the back. Furthermore, the examiner indicated that the Veteran did not have muscle atrophy or ankylosis of the spine. The Veteran had IVDS of the thoracolumbar spine but did not have any incapacitating episodes, which required bed rest in the 12 months preceding the April 2018 VA examination While the Board has considered the lay evidence of record, to include September 2017 testimony at the Board video conference hearing, the Board finds the contemporaneous medical records to be the most probative evidence. The evidence indicates that during the appeal period prior to July 1, 2014, the Veteran’s lumbar spine disability manifested with pain and limitation of motion, however, forward flexion of the thoracolumbar spine was not limited to 30 degrees or less; and favorable or unfavorable ankylosis of the entire thoracolumbar spine has not been shown. At worst, forward flexion of the thoracolumbar spine was 45 degrees during the March 2011 and October 2011 VA examinations. Furthermore, the Veteran has not shown ankylosis during the any of the VA examinations. The March 2011 and October 2011 VA examiners made specific findings that there was no ankylosis of the spine. The Veteran did not have IVDS of the thoracolumbar spine, as noted in December 2013 VA examination report. Accordingly, a disability rating in excess of 20 percent for a lumbar spine disability prior to July 1, 2014, is not warranted. The evidence also indicates that during the appeal period since to July 1, 2014, the Veteran’s lumbar spine disability manifested with pain and limitation of motion, however, forward flexion of the thoracolumbar spine was not limited to 60 degrees or less, combined range of motion of the thoracolumbar spine was not less than 120 degrees; muscle spasm of guarding severe enough to result in an abnormal gait or spinal contour was not shown; and favorable or unfavorable ankylosis of the entire thoracolumbar spine has also not been shown. At worst, forward flexion of the thoracolumbar spine was 70 degrees during the April 2018 VA examination with a combined range of motion of 210 degrees. The Veteran exhibited, at worst, combined range of motion of 175 degrees during the December 2013 VA examination. The Veteran has also not experienced incapacitating episodes due to IVDS. Accordingly, a disability rating in excess of 10 percent for a lumbar spine disability since July 1, 2014, is not warranted. The Board has considered whether a higher rating should be assigned pursuant to 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria, but a higher rating is not warranted for the Veteran’s disability picture. The range of motion testing conducted during the medical evaluations considered the thresholds at which pain limited motion. The Veteran reported functional impairment of limited capacity to bend and lift and limited tolerance for standing, walking and running, and increased pain during flare-ups. However, March 2011, October 2011, December 2013, and April 2018 examination reports indicate that the Veteran was able to perform repetitive motion testing with three repetitions with no additional loss of range of motion even with pain following repetitive motion. To the extent that the Veteran has asserted that he had limited capacity to bend and lift and limited tolerance for standing, walking, and running because of the pain that he experienced, the Board finds that the VA examiners have fully considered these factors as discussed above, and the respective evaluations contemplate pain and how it affects a person, such as difficulty walking and standing because of pain, difficulty running because of pain, difficulty lifting weight because of pain, and difficulty bending because of pain. Although the Board is required to consider the effect of pain when making a rating determination, it is important to emphasize that the rating schedule does not provide a separate rating for pain. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). After considering the effects of pain and functional loss, forward flexion is not limited to 30 degrees or less and favorable ankylosis of the entire thoracolumbar spine is not shown to warrant an increased 40 percent rating prior to July 1, 2014. Further, forward flexion is not limited to 60 degrees or less for the thoracolumbar spine; combined range of motion of the thoracolumbar spine was not less than 120 degrees; and favorable or unfavorable ankylosis of the entire thoracolumbar spine was not shown since July 1, 2014, to warrant an increased 20 percent rating. Thus, a higher rating under 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria is not approximated in the Veteran’s disability picture for the entire appellate period. Separate ratings for neurological abnormalities, other than radiculopathy, associated with the Veteran’s thoracolumbar spine disability were also considered but are not warranted. The Veteran denied bowel or bladder problems and erectile dysfunction during the March 2011 and October 2011 examinations. The April 2018 VA examiner indicated that the Veteran did not have these neurological abnormalities related to the thoracolumbar spine disability; to include bowel or bladder problems. The December 2013 VA examiner noted that the Veteran suffered from bilateral pyriformis syndrome under the section of the examination report for other neurologic abnormalities, which the Board will discuss in its analysis of the Veteran’s increased rating claims for left and right lower extremity sciatica. Accordingly, a separate rating for neurological symptoms is not applicable. Further, the Board has considered the Veteran’s testimony from the September 2017 Board video conference hearing. The Veteran testified has constant back pain and sciatica of the bilateral legs, which caused difficulty with daily activities. The Veteran also reported similar symptoms during the VA examinations provided. The Board finds that the VA examiners have fully addressed these symptoms as reported by the Veteran and the Board has fully considered them in evaluating the Veteran’s disability rating. The Veteran also contended that private medical records would show treatment of injections and physical therapy and would reflect increased intensity of pain and limited range of motion. However, after a review of the Veteran’s private treatment records, the Board finds no records, which show forward flexion limited to 30 degrees or less prior to July 1, 2014, or forward flexion limited to 60 degrees and combined range of motion less than 120 degrees since July 1, 2014. While the private records reflect treatment as testified by the Veteran, ankylosis and incapacitating episodes due to IVDS at any point during the appellate period have not been shown. In sum, the preponderance of the evidence is against a finding that a disability rating in excess of 20 percent for status post L5-S1 discectomy, status post fusion L5-S1 with instrumentation, and intervertebral disc syndrome prior to July 1, 2014, and in excess of 10 percent thereafter, is warranted. As the preponderance of the evidence is against the claim for higher ratings, to this extent, the benefit of the doubt doctrine is not for application, and the Veteran’s claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. & 3. Entitlement to an initial disability rating in excess of 10 percent for sciatica of the right lower extremity prior to July 1, 2014, a compensable evaluation from July 1, 2014 to August 16, 2015, and in excess of 10 percent thereafter. The Veteran contends that his sciatica of the right lower extremity should be rated higher than the initially-assigned disability rating of 10 percent, noncompensable rating from July 1, 2014 to August 16, 2015, and the currently-assigned disability rating of 10 percent, under 38 C.F.R. § 4.71a, DC 8620. During the September 2017 Board video conference hearing, the Veteran testified that he experienced pain that radiated down both legs to the outside of his thighs, inner thighs, and went down to about mid-thigh, down the lower back. He explained it as a constant debilitating pressure on the nerves, which he had to shift from one side or the other to attempt to alleviate the pain. He indicated that he experienced a shooting pain, which was throbbing. The Veteran’s representative asserted that the evaluation for the sciatica should not have been decreased and should remain at 10 percent. The March 2011 examiner noted that there was no radiation of pain on movement nor weakness and straight leg raising test was negative. Further, the examiner indicated that there was no history of radiculopathy of the Veteran’s lumbar spine. The October 2011 examination report reflects that the Veteran experienced falls and weakness of the spine and leg. The Veteran experienced pain that traveled to his hip and buttocks. Straight leg raising test and Lasegue’s sign test were positive. There was L4, L5, S1 sensory deficit of the bilateral lateral thighs, legs, and back of thighs, respectfully. The examiner indicated a diagnosis of intervertebral disc syndrome with the most likely involved peripheral nerve of the sciatic nerve. During the December 2013 VA examination, a neurological examination of the right lower extremity revealed motor function within normal limits, sensory examination was normal, and deep tendon reflexes were rated “2+” or normal. Straight leg raising test was negative, and the examiner indicated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. The examiner noted that the Veteran had other neurologic abnormalities and explained that the Veteran suffered periodically from bilateral pyriformis syndrome and was tender in the area of the pyriformis when palpated on examination. The Veteran also reported pain localizing to the area of the pyriformis muscle when a pyriformis stretch was done. The examiner changed the diagnosis of sciatica of the right lower extremity to pyriformis syndrome. In an August 2016 private medical record, the Veteran complained of low back pain and the medical professional noted that the Veteran had “no frank radiculopathy its more actually along the lateral aspects of the hips and he has been sleeping on that side.” In April 2018, the VA examiner found that the Veteran had mild right lower extremity radiculopathy with moderate intermittent pain and involvement of the L4, L5, S1, S2, and S3 nerve roots or the sciatic nerve. The examiner noted that there was no constant pain, paresthesias and/or dysesthesias, or numbness in the right lower extremity. Straight leg raising test was negative, muscle strength testing, and reflex and sensory examinations were normal. After affording the Veteran the benefit of the doubt, since July 1, 2014, the Veteran’s radicular symptoms of the right lower extremity are analogous to mild incomplete paralysis, which warrants a 10 percent rating. While the December 2013 VA examiner indicated that Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy, he changed the diagnosis of sciatica of the right lower extremity to pyriformis syndrome. The examiner also noted that the Veteran was tender in the area of the pyriformis when palpated and experienced localized pain during the examination. The Board also finds that the Veteran’s radicular symptoms of the right lower extremity warrants no higher than a 10 percent rating throughout the appellate period as the preponderance of the evidence is against a finding of moderate incomplete paralysis during this time period. The Veteran did not require the use of an assistive device and the VA examiners have at worst only found mild radiculopathy of the right lower extremity, as noted in the VA examination reports discussed above. While the Veteran reported pain, he had normal reflexes and has not shown muscle atrophy or sensory disturbances. Therefore, the Veteran’s right lower extremity radiculopathy had not been shown to a level of moderate at any point during this part of the appeal period. Therefore, an increased 20 percent rating is not applicable. 38 C.F.R. § 4.71a, DC 8620. Furthermore, during the September 2017 Board hearing, the Veterans representative explained that the Veteran believed that a 10 percent for each leg for radiculopathy is the more accurate rating, should have never been decreased, and have remained at the 10 percent. A grant of an increased rating of 10 percent for right lower extremity radiculopathy since July 1, 2014, would therefore be a full grant of the benefit sought. As the Veteran was represented by an attorney at the hearing, the Board finds that the Veteran made this statement with a full understanding of what that meant, which was that he did not believe he was entitled to an evaluation in excess of 10 percent for his sciatica of the right lower extremity. In sum, affording the Veteran the benefit of the doubt, since July 1, 2014, the Veteran’s radicular symptoms of the right lower extremity are analogous to mild incomplete paralysis, which warrants a 10 percent disability rating. However, the preponderance of the evidence is against a finding that a disability rating in excess of 10 percent thereafter for sciatica of the right lower extremity is warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 4. & 5. Entitlement to an initial disability rating in excess of 10 percent for sciatica of the left lower extremity prior to July 1, 2014, a compensable evaluation from July 1, 2014 to August 16, 2015, and in excess of 10 percent thereafter. The Veteran contends that his sciatica of the left lower extremity should be rated higher than the initially-assigned disability rating of 10 percent, noncompensable rating from July 1, 2014 to August 16, 2015, and the currently-assigned disability rating of 10 percent, under 38 C.F.R. § 4.71a, DC 8620. During the September 2017 Board video conference hearing, the Veteran testified that he experienced pain that radiated down both legs to the outside of his thighs, inner thighs, and went down to about mid-thigh, down the lower back. He explained it as a constant debilitating pressure on the nerves, which he had to shift from one side or the other to attempt to alleviate the pain. He indicated that he experienced a shooting pain, which was throbbing. The Veteran’s representative asserted that the evaluation for the sciatica should not have been decreased and should remain at 10 percent. The March 2011 examiner noted that there was no radiation of pain on movement nor weakness and straight leg raising test was negative. Further, the examiner indicated that there was no history of radiculopathy of the Veteran’s lumbar spine. The October 2011 examination report reflects that the Veteran experienced falls and weakness of the spine and leg. The Veteran experienced pain that traveled to his hip and buttocks. Straight leg raising test and Lasegue’s sign test were positive. There was L4, L5, S1 sensory deficit of the bilateral lateral thighs, legs, and back of thighs, respectfully. The examiner indicated a diagnosis of intervertebral disc syndrome with the most likely involved peripheral nerve of the sciatic nerve. During the December 2013 VA examination, a neurological examination of the right lower extremity revealed motor function within normal limits, sensory examination was normal, and deep tendon reflexes were rated “2+” or normal. Straight leg raising test was negative and the examiner indicated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. The examiner noted that the Veteran had other neurologic abnormalities and explained that the Veteran suffered periodically from bilateral pyriformis syndrome and was tender in the area of the pyriformis when palpated on examination. The Veteran also reported pain localizing to the area of the pyriformis muscle when a pyriformis stretch was done. The examiner changed the diagnosis of sciatica of the left lower extremity to pyriformis syndrome. In an August 2016 private medical record, the Veteran complained of low back pain and the medical professional noted that the Veteran had “no frank radiculopathy its more actually along the lateral aspects of the hips and he has been sleeping on that side.” In April 2018, the VA examiner found that the Veteran had mild left lower extremity radiculopathy with moderate intermittent pain and involvement of the L4, L5, S1, S2, and S3 nerve roots or the sciatic nerve. The examiner noted that there was no constant pain, paresthesias and/or dysesthesias, or numbness in the right lower extremity. Straight leg raising test was negative, muscle strength testing, and reflex and sensory examinations were normal. After affording the Veteran the benefit of the doubt, since July 1, 2014, the Veteran’s radicular symptoms of the left lower extremity are analogous to mild incomplete paralysis, which warrants a 10 percent rating. While the December 2013 VA examiner indicated that Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy, he changed the diagnosis of sciatica of the left lower extremity to pyriformis syndrome. The examiner also noted that the Veteran was tender in the area of the pyriformis when palpated and experienced localized pain during the examination. The Board also finds that the Veteran’s radicular symptoms of the left lower extremity warrants no higher than a 10 percent rating throughout the appellate period as the preponderance of the evidence is against a finding of moderate incomplete paralysis. The Veteran did not require the use of an assistive device and the VA examiners have at worst only found mild radiculopathy of the left lower extremity as noted in the VA examination reports, discussed above. While the Veteran reported pain, he had normal reflexes and has not shown muscle atrophy or sensory disturbances. Therefore, the Veteran’s left lower extremity radiculopathy had not been shown to a level of moderate at any point during the appeal period therefore an increased 20 percent rating is not applicable. 38 C.F.R. § 4.71a, DC 8620. Furthermore, during the September 2017 Board hearing, the Veterans representative explained that the Veteran believed that a 10 percent for each leg for radiculopathy is the more accurate rating, should have never been decreased and have remained at the 10 percent. A grant of an increased rating of 10 percent for left lower extremity radiculopathy since July 1, 2014, would therefore be a full grant of the benefit sought. As the Veteran was represented by an attorney at the hearing, the Board finds that the Veteran made this statement with a full understanding of what that meant, which was that he did not believe he was entitled to an evaluation in excess of 10 percent for his sciatica of the left lower extremity. In sum, affording the Veteran the benefit of the doubt, since July 1, 2014, the Veteran’s radicular symptoms of the left lower extremity are analogous to mild incomplete paralysis, which warrants a 10 percent disability rating. However, the preponderance of the evidence is against a finding that a disability rating in excess of 10 percent thereafter for sciatica of the left lower extremity is warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cheng, Associate Counsel