Citation Nr: 18153140 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-44 113 DATE: November 27, 2018 ORDER Entitlement to a 40 percent rating, but no higher, for degenerative arthritis, lumbosacral spine is granted from June 18, 2014, subject to controlling regulations governing the payment of monetary awards. Entitlement to a separate 10 percent rating, but no higher, for left lower extremity radiculopathy is granted from November 11, 2016, subject to controlling regulations governing the payment of monetary awards. FINDINGS OF FACT 1. From June 18, 2014, the evidence is at least evenly balanced as to whether the Veteran's lumbar spine disability more nearly approximated flexion to 30 degrees or less with consideration to functional impairment, but it did not more nearly approximate ankylosis or incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 2. From November 11, 2016, the Veteran has had left lower extremity lumbar radiculopathy that more nearly approximated mild incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, from June 18, 2014, the criteria for a 40 percent rating, but no higher, for degenerative arthritis, lumbosacral spine have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.400(o), 4.1-4.10, 4.40, 4.45, 4.59, 4.71(a), Diagnostic Code (DC) 5242. 2. With reasonable doubt resolved in favor of the Veteran, from November 11, 2016, the criteria for a separate rating of 10 percent, but no higher, for left lower extremity lumbar radiculopathy associated with degenerative arthritis, lumbosacral spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.400. 4.1-4.10, 4.71a, DC 5242, Note 1, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2002 to May 2009 with service in Afghanistan. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran appointed the American Red Cross as his representative. The Board recognizes this change in representation. I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159. This appeal originates from a March 2015 VA Form 21-526EZ Fully Developed Claim (FDC). Under the FDC, the requisite notice is included as part of the claim and the claims form satisfies the duty to notify. For the duty to assist, VA obtained identified and available evidence needed to substantiate the claim. The Veteran was most recently afforded VA examinations for his service-connected back disability in January 2017. To the extent any portion of the VA spine examinations are not totally complaint with the most recent holding regarding the adequacy of VA orthopedic examinations, the instant decision results in an award of the maximum schedular rating for lumbar spine motion loss. Thus, for the reasons discussed below, the Veteran is not prejudiced from any VA examination inadequacy in ascertaining functional impairment. Cf. Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017); Correia v. McDonald, 28 Vet. App. 158 (2016); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Therefore, the Board concludes that a remand for additional notice or development would result in additional delay without any benefit flowing to the Veteran. Winters v. West, 12 Vet. App. 203, 208 (1999) (en banc) ("[A] remand is not required in those situations where doing so would result in the imposition of unnecessary burdens on the [Board] without the possibility of any benefits flowing to the appellant"); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (noting that "[a] veteran's interest may be better served by prompt resolution of his claims rather than by further remands to cure procedural errors that, at the end of the day, may be irrelevant to final resolution and may indeed merely delay resolution"). For the above reasons, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of this claim. II. Entitlement to an increased rating for degenerative arthritis, lumbosacral spine Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When the evidence is in relative equipoise, the veteran is accorded the benefit of the doubt. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the rating period on appeal, assignment of staged ratings would be permissible. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s service-connected degenerative arthritis, lumbosacral spine disability is currently rated as 10 percent prior to February 10, 2016; 20 percent prior to November 11, 2016; 40 percent prior to January 27, 2017 and 20 percent thereafter pursuant to Diagnostic Code (DC) 5242. 38 U.S.C. § 4.71a, DC 5242. DC 5242 provides rating under the General Rating Formula for Diseases and Injuries of the Spine. Id. Under the General Rating Formula, a 10 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion 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 evaluation is warranted for forward flexion of the thoracolumbar spine 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 evaluation is warranted where forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. The only higher schedular evaluations under the General Rating Formula are 50 percent for unfavorable ankylosis of the entire thoracolumbar spine and 100 percent for ankylosis of the entire spine. 38 C.F.R. § 4.71a, DC 5242. Alternatively, under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (IVDS Formula), a 20 percent evaluation is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months; and a 60 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a. An "incapacitating episode" for purposes of totaling the cumulative time is defined as "period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician." 38 C.F.R. § 4.71a, DC 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1. Additional considerations pertain to musculoskeletal disabilities. Such disability 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 of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). 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 enervation, 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. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The Court has held that VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). In Mitchell, the 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). Joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; see also Correia, 28 Vet. App. at 169-170. After accounting for functional loss or impairment, a rating is determined, in this case, based on the 38 C.F.R. § 4.71a criteria. Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of 38 C.F.R. § 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.”). Turning to the evidence, on June 18, 2014, the Veteran sought private medical treatment for back pain from Dr. Y. The Veteran complained about daily 3/10 low back pain that increased to 8/10 severity during flare-ups. Clinical evaluation showed the Veteran to have a normal gait and lower extremity muscle strength. He had pain with extension, right lumbar lateral flexion and left lumbar rotation. Sensory evaluation was normal. The clinician assessed lumbago and recommended physical therapy (PT). June 23, 2014 private PT records showed lumbar spine forward flexion range of motion (ROM) to 35 degrees. August 2014 private PT records indicated that the Veteran had lumbar forward flexion to approximately 70 degrees. October 2014 private PT records included a normal lumbar spine ROM. November 2014 private PT records showed that the estimated limitation for lumbar forward flexion ROM was to 55 degrees. Notably, the Veteran reported increased low back pain. January 2015 private PT records stated the Veteran had 75 percent of normal lumbar ROM, which is approximately 65 to 70 degrees. In April 2015, the Veteran underwent a VA spine examination. The examiner assessed the Veteran’s lumbar spine as normal. He cited the X-rays and characterized the Veteran’s complaints as mechanical and functional. He stated that the Veteran had a completely normal ROM in all lumbar spine planes without pain. Neurological findings were listed as normal. The examiner stated that there was no functional impact due to back disability. In February 2016, Dr. Y issued a letter in support of the claim. He had providing the Veteran with conservative care for back pain since 2014. He noted the ROM findings from the April 2015 VA examination. He stated that the Veteran had 61 percent of normal active ROM for the lumbar spine, which is approximately 55 degrees for the forward flexion. His physical examination indicated that the Veteran had lumbar spine forward flexion to 38 degrees with pain. In the April 2016 notice of disagreement (NOD), the Veteran stated that the April 2015 VA examiner did not measure ROM. He cited the findings from Dr. Y in support of his claim. In May 2016, the Veteran was afforded another VA spine examination. The examiner diagnosed degenerative arthritis of spine. He noted that the Veteran reported being diagnosed with degenerative arthritis in 2009. The Veteran said his back disability worsened in 2015. The examiner did not note reports of flare-ups, but listed functional impairment as limited mobility of the spine. Lumbar spine ROM showed forward flexion to 75 degrees. Extension was to 20 degrees. Right and left lateral flexion were to 25 degrees. Right and left lateral rotation were to 30 degrees. Pain was noted for all planes except right and left lateral rotation. Repetitive motion did not cause further motion loss. The examiner reported that pain significantly limited functional ability with repeated use over time. However, he could not describe such functional loss in terms of degrees of motion loss due to an inability to observe the Veteran. The examiner further noted paraspinal spasms, but found that it did not result in an abnormal gait or spinal contour. He listed less movement than normal, interference with sitting and standing as additional factors contributing to disability. Neurological findings were normal. The examiner reported that ankylosis and IVDS were not indicated. He described the functional impact as an ability to perform light duty tasks with proper movements and use of back. There was no specific limitation in total sitting and standing. In September 2016, the Veteran stated that the VA examination reports did not include ROM studies by a physician. He described his back pain as varying. He had significant flare-ups approximately two to three times per year. During flare-ups, he was unable to walk and experienced additional shooting pain down his legs. The flare up episodes lasted about a week. He managed his pain with chiropractic care from Dr. Y. He requested that VA consider his daily pain associated with routine motion and flare-ups. In November 2016, the Veteran reported that Dr. Y’s February 2016 ROM studies represented his general ROM and the accompany Disability Benefits Questionnaire (DBQ) represented his ROM on worse days. Then, he reported having incapacitating episodes occurring two to three times per year that were not accounted for in the November 2016 DBQ. The November 2016 DBQ completed by Dr. Y showed that the Veteran had lumbar pain, thoracic pain and radiculopathy. Dr. Y noted that the Veteran had incapacitating episodes of back pain two to three times per year. He stated that the Veteran had limited activity from being unable to stand for prolonged periods or run and from reduced domestic activities. ROM of the lumbar spine forward flexion was to 25 degrees. Dr. Y noted sharp pain and motion restriction due to pain. He also found localized tenderness and muscle spasm. Abnormal gait and muscle contour was associated with it. He listed less movement than normal, pain on movement, and interference with sitting and standing as contributing factors of disability. Straight leg raise (SLR) was positive bilaterally. For left lower extremity neurological disturbances, Dr. Y assessed moderate constant pain and intermittent pain and mild dull pain, paresthesias and/or dysesthesias and numbness. He assessed moderate left lower extremity radiculopathy. He described occupational impact as an inability for prolonged sitting and business travel. December 2016 private magnetic resonance imaging (MRI) study of the lumbar spine showed abnormal straightening of the normal lumbar curvature with adjusting muscle spasm. L2/L3 had a disc bulge. L4/L5 and L5/S1 had central disc protrusions. In January 2017, the Veteran underwent a VA-contract examination. The examiner diagnosed degenerative arthritis of the lumbar spine. The Veteran reported his back condition had progressed. He had aching low back pain. One to two time per year, he had week long muscle spasms and had to work at home. During flare-ups, he could not straighten up easily. Lumbar spine ROM was forward flexion to 60 degrees. All other planes of lumbar motion were normal. The examiner noted pain with forward flexion, but stated it did not result in functional loss. Palpation of the spine revealed moderately severe muscle spasms. Repetitive motion did not result in additional motion loss. The examiner declined to estimate additional motion loss from repetitive use due his inability to observe the Veteran. He stated that pain would significantly limit functional ability during flares-ups, but not result in additional forward flexion motion loss. He reported that the lumbar muscle spasm resulted in an abnormal gait or spine contour. Muscle strength, reflex, and sensory findings were normal. SLR was normal bilaterally. Radiculopathy was not found. The examiner reported that ankylosis or IVDS were not indicated. In March 2017, the Veteran disputed the staged ratings that were less than 40 percent. He reported that the January 2017 examiner pushed him to gain an additional 15 degrees of lumbar spine forward flexion motion. He asserted Dr. Y’s evaluations supported higher ratings. He described having good days and bad days with varying lumbar spine motion limitation. Additionally, he had severe week-long flare ups two to three times per year that rendered him nearly incapacitated. Turning to review of the record, the Veteran contends a uniform 40 percent rating for lumbar spine disability is warranted. Resolving reasonable doubt in his favor, the Board finds a uniform 40 percent rating from June 18, 2014 for degenerative arthritis, lumbosacral spine is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.400(o), 4.3. The June 18, 2014 effective date is appropriate because it is the initial report of increased back pain occurring within a year of the March 2015 claim for increase. Id. Multiple lumbar spine ROM studies are of record. The only one confirming lumbar spine motion loss meeting the 40 percent rating criteria is the November 2016 DBQ from Dr. Y. 38 C.F.R. § 4.71a, DC 5242. Notably, ROM studies from June 2014 private PT and February 2016 Dr. Y assessment included lumbar spine forward flexion motion loss more closely approximating the 40 percent rating criteria as compared to the 20 percent rating criteria. Id. In assessing the appropriate rating for lumbar spine disability due to motion loss, functional impairment must also be considered. English v. Wilkie, No. 17-2083 (Vet. App. Nov. 1, 2018) (the Board must adequately explain how it considered functional loss due to pain, including during flare-ups); 38 C.F.R. §§ 4.40, 4.45, 4.59. All of the examination reports showed that the examiners declined to estimate motion loss from functional impairment or during flare-up episodes due to their inability to observe the Veteran. Sharp, 29 Vet. App. at 33. Nonetheless, the Veteran is competent to report his symptoms and the Board considers his accounts of functional impairment credible. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n. 4 (Fed. Cir. 2007) (lay evidence competent for readily observable symptoms); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) (VA adjudicators may properly consider internal inconsistency, facial plausibility and consistency with other evidence submitted on behalf of the Veteran in weighing evidence). He has generally described varying symptoms with good days and bad days in addition to severe flare-ups occurring two or three times per year and lasting an entire week. See September 2016 and March 2017 Veteran’s statements. It is reasonable to infer from his reports that during reportedly bad days or flare-up episodes the Veteran’s lumbar spine motion loss is significantly greater than reflected on most ROM studies. Mitchell, 25 Vet. App. at 44; Thompson, 815 F.3d at 785 (“[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.”); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5242. Specifically, the Veteran identified the November 2016 DBQ showing forward flexion to 25 degrees as being representative of a bad day. Again, the Board considers his report to be competent and credible evidence that his lumbar spine motion loss is regularly greater than the motion loss reflected on the VA examination reports. Caluza, 7 Vet. App. at 506. Given the above, the Board resolves reasonable doubt to find that the Veteran’s lumbar spine flexion motion loss more nearly approximate 30 degrees with consideration to functional impairment. English, supra.; Id. The Board has considered whether a rating greater than 40 percent is warranted under the General Rating Formula. 38 C.F.R. § 4.71a, DC 5242. As noted above, a higher 50 percent rating under the General Rating Formula contemplates ankylosis of the lumbar spine disability. There is no evidence suggesting ankylosis of the thoracolumbar spine. Moreover, in Johnston v. Brown, 10 Vet. App. 80, 85 (1997), the Court indicated that where the Veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, the cited regulations are not for application. See id. at 84-85 (although the Secretary suggested remand because of the Board’s failure to consider functional loss due to pain, remand was not appropriate because higher schedular rating required ankylosis). A rating greater than 40 percent under the General Rating Formula is not for further consideration. Id. The Board has also considered whether a rating greater than 40 percent is warranted based upon the IVDS Formula. Id. The Veteran’s reports indicate that he has severe back pain flare-ups approximately three weeks per year and he is nearly incapacitated during these episodes. Even construing his reports in the most favorable manner, the duration of these episodes does not more nearly approximate six weeks to result in a more favorable rating under the IVDS formula. Further consideration of the IVDS formula is not warranted. 38 C.F.R. § 4.71a, DC 5243 IVDS Rating Formula. For the foregoing reasons, a uniform 40 percent rating from June 18, 2014 is granted for degenerative arthritis, lumbosacral spine. The preponderance of the evidence reflects the symptoms of the Veteran's lumbar spine disability do not more nearly approximate the criteria for a rating higher than 40 percent. Thus, the benefit of the doubt doctrine is not for application and a rating greater than 40 percent must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. III. Left lower extremity radiculopathy The Veteran is not separately evaluated for any neurological impairment associated with his lumbar spine disability. However, entitlement to a separate rating for left lower extremity neurological impairment is raised by the record. 38 C.F.R. § 4.71a, DC 5242, Note 1. Specifically, the November 2016 DBQ includes an assessment of left lower extremity sciatic nerve impairment. Diseases affecting the nerves are rated on the basis of degree of paralysis, neuritis, or neuralgia under 38 C.F.R. § 4.124a. Paralysis of the sciatic nerve, such as that caused by sciatica, is rated under DC 8520. Under DC 8520, a maximum schedular rating of 80 percent is awarded for complete paralysis of the sciatic nerve. With 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. When there is incomplete paralysis, a 60 percent rating is in order for severe disability with marked muscular atrophy. Moderately severe incomplete paralysis warrants a 40 percent evaluation, and moderate incomplete paralysis warrants a 20 percent rating. Finally, mild incomplete paralysis warrants a 10 percent rating. See 38 C.F.R. § 4.124a, DC 8520. 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. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. The words "mild," "moderate," and "severe" are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." See 38 C.F.R. § 4.6. The term "incomplete paralysis," with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to the partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. See 38 C.F.R. § 4.124a, DCs 8510-8730. The evidence of neurological impairment is limited. The initial report of neurological disturbances comes from the Veteran’s September 2016 report of shooting type pain in his lower extremity during flare-ups. The November 11, 2016 VA DBQ from Dr. Y included an assessment of moderate left lower extremity radiculopathy. The neurological findings from the January 2017 VA examination report did not show any neurological disturbances of the lower extremities. Resolving reasonable doubt in the Veteran’s favor, the Board finds that a 10 percent rating for mild left lower extremity sciatica from November 11, 2016, is warranted. 38 C.F.R. §§ 3.400, 4.124a, DC 8520. November 11, 2016 is the first date that left lower extremity sciatica is confirmed. Id. The medical and lay reports prior to November 11, 2016 are uncertain as to a lower extremity neurological disorder. The Veteran’s September 2016 report referenced generalized radiating lower extremity pain during flare up episodes. The medical records prior to November 2016 do not otherwise suggest a radiculopathy diagnosis. The Board finds the weight of the evidence prior to Dr. Y’s November 2016 DBQ is too uncertain to confirm this disability and that November 11, 2016 is the appropriate effective date. Caluza, 7 Vet. App. at 506; 38 C.F.R. § 3.400. As to the determination the left lower extremity radiculopathy is mild, the Board has considered Dr. Y’s assessment that the overall left lower extremity radiculopathy is moderate. However, Dr. Y did not conduct muscle strength or reflex testing. The January 2017 left lower extremity muscle strength and reflex studies do not show any impairment and the Veteran has not disputed these findings. The Veteran's reports do not describe neurological impairment beyond sensory disturbances. There is no evidence the left lower extremity sensory disturbance otherwise affects a larger area than the left sciatic nerve distribution or causes unusual neurological impairment. Given this background, the Board finds the evidence does not more nearly approximate moderate partial paralysis of the sciatic nerve. Id.; 38 C.F.R. §§ 4.3, 4.6, 4.7, 4.124a, DC 8520. In sum, a 10 percent rating for left lower extremity radiculopathy is warranted from November 11, 2016. The preponderance of the evidence is against the claim for an initial rating in excess of 10 percent for left lower extremity radiculopathy in all other respects, and the benefit of the doubt doctrine is therefore not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. IV. Additional considerations The Veteran does not report unemployability due to his service-connected lumbar spine disability. Additional development regarding a total disability rating based upon individual unemployability (TDIU) is not warranted. (Continued on the next page)   Neither the Veteran, nor his representative, has raised any other issues, nor have any other issues been reasonably raised by the record for this disability. 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). Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. D. Simpson, Counsel