Citation Nr: 18141517 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 11-15 345 DATE: October 10, 2018 ORDER Entitlement to service connection for hepatitis is denied. Entitlement to an increased disability rating of 40 percent, but no higher, is granted for service-connected lumbar spine intervertebral disc syndrome for the entirety of the appeal period (exclusive of the temporary total rating for this disability noted below). Entitlement to a disability rating in excess of 40 percent for service-connected right lower extremity radiculopathy is denied. Entitlement to a disability rating in excess of 20 percent for service-connected left lower extremity radiculopathy is denied. Entitlement to an increased disability rating for service-connected cervical spine intervertebral disc syndrome, rated as 10 percent disabling prior to January 8, 2018 and as 30 percent disabling thereafter (exclusive of the temporary total rating for this disability noted below) is denied. Entitlement to an increased disability rating of 20 percent, but no higher, is granted for service-connected radiculopathy of the right upper extremity beginning September 18, 2009. Entitlement to an increased disability rating of 20 percent, but no higher, is granted for service-connected radiculopathy of the left upper extremity beginning September 18, 2009. Entitlement to a special monthly compensation based on housebound status beyond December 31, 2009 is denied. Entitlement to a temporary rating for convalescence for intervertebral disc syndrome of the cervical spine beyond December 31, 2009 is denied. FINDINGS OF FACT 1. The probative, competent evidence is against a finding that the Veteran presently has hepatitis that is related to active duty service. 2. The Veteran’s service-connected lumbar intervertebral disc syndrome is manifested by limitation of forward flexion less than 30 degrees but not unfavorable ankylosis of the entire thoracolumbar spine. 3. Prior to October 30, 2013, the Veteran did not have severe paralysis of the external cutaneous nerve or demonstrated impairment of the sciatic nerve in either lower extremity. 4. Since October 30, 2013, the Veteran’s lower extremity radiculopathy is indicative of no more than moderately severe incomplete paralysis of the sciatic nerve on the right and moderate incomplete paralysis of the sciatic nerve on the left. 5. Prior to November 15, 2009, and from January 1, 2010, to January 7, 2018, the Veteran’s service-connected cervical intervertebral disc syndrome manifested with a combined range of motion to 215 degrees with forward flexion of the cervical spine greater than 30 degrees; there was no ankylosis, muscle spasm, or guarding. 6. Beginning January 8, 2018, the Veteran’s service-connected cervical intervertebral disc syndrome manifested with favorable ankylosis of the cervical spine. 7. Throughout the period on appeal, the Veteran’s service-connected radiculopathy of the left and right upper extremities manifested with mild incomplete paralysis. 8. For the period beyond January 1, 2010, the Veteran has not had a service-connected disability rated as 100 percent disabling and was not substantially confined to his dwelling or other area as a result of his service-connected disabilities. 9. The Veteran’s November 16, 2009, cervical spine surgery did not necessitate convalescence beyond December 31, 2009. CONCLUSIONS OF LAW 1. The criteria for service connection for hepatitis have not been satisfied. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307. 2. Throughout the appeal, the criteria for a 40 percent but no higher rating for service-connected lumbar intervertebral disc syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a; Diagnostic Codes 5235 to 5243. 3. The criteria for a rating in excess of 40 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 4. The criteria for a rating in excess of 20 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 5. Prior to November 15, 2009, and from January 1, 2010, to January 7, 2018, the criteria for a disability rating in excess of 10 percent for service-connected cervical intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a; Diagnostic Codes 5235 to 5243. 6. Beginning January 8, 2018, the criteria for a disability rating in excess of 30 percent for service-connected cervical intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a; Diagnostic Codes 5235 to 5243. 7. Beginning September 18, 2009, the criteria for an increased disability rating of 20 percent, but no higher, for service-connected radiculopathy of the right upper extremity have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a; Diagnostic Code 8511 to 8513. 8. Beginning September 18, 2009, the criteria for an increased disability rating of 20 percent, but no higher, for service-connected radiculopathy of the left upper extremity have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a; Diagnostic Codes 8511 to 8513. 9. The criteria for entitlement to special monthly compensation based on housebound status have not been met beyond December 31, 2009. 38 U.S.C. 1114(s); 38 C.F.R. 3.350(i). 10. The criteria for entitlement to a temporary total rating for convalescence for intervertebral disc syndrome of the cervical spine beyond December 31, 2009 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1979 to June 1988. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office. The Board previously remanded these issues in October 2014 and November 2017. The Board notes that the Veteran was granted a temporary 100 percent disability rating for his service-connected lumbar spine intervertebral disc syndrome from June 15, 2016, to December 31, 2016, and was granted a temporary 100 percent disability rating for his service-connected cervical spine intervertebral disc syndrome from November 16, 2009, to December 31, 2009. As these are the highest disability ratings available these periods are no longer on appeal and are unaffected by this decision. AB v. Brown, 6 Vet. App. 35, 38 (1993). Additionally, the Board notes that the Veteran had prior claims of entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to September 18, 2009, on an extraschedular basis, and entitlement to Dependents Educational Assistance (DEA) prior to September 18, 2009, both of which were granted for the period of the claim by a November 2017 Board decision. As noted by the Veteran, it appears the Regional Office has not adjudicated these issues as directed. Therefore, these matters are referred to the Agency of Original Jurisdiction for further action. 38 C.F.R. 19.9(b). The Veteran’s prior attorney made several general contentions that the VA examinations were inadequate but there were no specific contentions that related to a particular VA examination. Therefore, these contentions were considered but cannot be specifically addressed. Neither the Veteran nor his representatives has raised any other issues with the duty to notify or duty to assist. 1. Hepatitis C Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Entitlement to service connection requires a current disability. In the absence of competent evidence showing a current disability, service connection cannot be established. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Preliminarily, the Board notes that the Veteran’s treatment records throughout the period on appeal reflect no present definitive diagnosis of hepatitis. The Veteran has had consistent treatment through VA but there has not been a present diagnosis of hepatitis, at least during the period on appeal. There is no other evidence that has been submitted which documents a present hepatitis disability. In this case there is evidence that the Veteran contracted hepatitis during active duty service. The Veteran asserted that he was told that he likely contracted hepatitis through food poisoning during service. Alternatively, the Veteran has asserted that he had direct percutaneous blood exposure during service. The Veteran was diagnosed with hepatitis in October 1984. Private treatment notes from the Veteran indicate that he has a history of hepatitis. The Veteran underwent VA examination in connection with his claim in January 2018. At the time, the VA examiner observed that while the Veteran had been diagnosed with hepatitis in service it appeared as though that condition had resolved. The VA examiner observed that the Veteran did not require continuous medication for the condition and that there were no signs or symptoms of a chronic or infectious liver disease. The VA examiner noted that the Veteran had not been diagnosed with hepatitis C and that there had been no incapacitating episodes. The laboratory results yielded nonreactive hepatitis A lgM, hepatitis B surface antigen, and a hepatitis B core antibody. The VA examiner concluded that the Veteran had no diagnosis because there was no pathology to render a diagnosis. The Veteran has not pointed to any evidence of a present hepatitis diagnosis. Moreover, there is nothing in the treatment records presently that shows symptoms of a current hepatitis disability. The Board concedes that the Veteran was diagnosed with hepatitis during service, but there is nothing to suggest that he still has that disability. As the VA examiner concluded, the hepatitis may have resolved since separation from service based on the lack of a present diagnosis. Simply stated, the Veteran does not currently have hepatitis. To the extent that the Veteran has contended that he has a present hepatitis disability, he has not shown that he has specialized training sufficient to diagnose this disability or determine its etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this regard, while the Veteran is competent to report observable symptomatology, the diagnosis of a present hepatitis disability is not capable of lay observation, and requires medical expertise to determine. Accordingly, his opinion as to whether a disability exists and the etiology of such is not competent evidence. While the Veteran reports being diagnosed with hepatitis, such a diagnosis is not shown in the medical records and is counter to the probative findings of the VA examiner. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1131. In the absence of proof of present disability there can be no valid claim. Brammer, 3 Vet. App. at 225. Thus, in the absence of competent evidence showing a current diagnosis of a hepatitis disability, it is unnecessary to address the remaining elements of the claim for direct service connection. See Brammer, 3 Vet. App. at 225. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and entitlement to service connection for a hepatitis disability is denied. In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 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 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 which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Regulations specify that disabilities of the spine should be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (Spinal Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When intervertebral disc syndrome (IVDS) is present, it is to be evaluated under the Spinal Formula unless it is more favorable to rate under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Ratings under the Spinal Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. As relevant to the thoracolumbar spine, the Spinal Formula provides for a 20 percent disability rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Spinal Formula. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is to 90 degrees and the normal combined range of motion is 240 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). As relevant to the cervical spine, the Spinal Formula provides for a 20 percent disability rating when forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees, when the combined range of motion of the cervical spine is not greater than 170 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent disability rating is assigned for forward flexion of the cervical spine to 15 degrees or less, or favorable ankylosis of the entire cervical spine. A 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Spinal Formula. For VA compensation purposes, normal forward flexion of the cervical spine is to 45 degrees and the normal combined range of motion is 340 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). A 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks. Higher ratings are available with incapacitating episodes of greater duration during a 12 month period. In this instance, the Board finds that the Veteran’s neck and spinal difficulties are intertwined with his radiculopathy symptoms, and that all of these disabilities are interrelated and on appeal. As a result, the Board will dispense with a recitation of the facts and then do individual analyses of each disability. The Veteran has a history of ongoing spinal disabilities, and in October 2009 he had a MRI of the lumbar spine that showed multiple disc bulges and narrowing of the spinal column. In November 2009 he had an anterior cervical diskectomy and fusion. Although at this time he began the recovery process, a treatment provider indicated that the Veteran’s left shoulder pain was a manifestation of the cervical radiculopathy. In March 2010 the Veteran underwent VA examination in connection with his claim, and at the time the Veteran reported that he was able to walk without limitation and that he did not have any falling, but that he had stiffness, fatigue, spasms, a decreased range of motion in the spine, paresthesias, numbness, and weakness in the spine and leg. The Veteran denied having any bowel or bladder problems but indicated that he had pain in the lower spine, neck, and shoulder, and that he felt stiffness when moving. He asserted that he could walk 100 feet in 30 minutes. The Veteran reported incapacitation after surgery (as opposed to bed rest because of episodes of IVDS). He also reported 7 days of incapacitation in March 2010 due to his neck and shoulder and 7 days of bed rest in March 2010 for his back and legs. During the physical examination testing the Veteran had a normal posture and gait, and his cervical spine showed no evidence of radiating pain on movement, and there was no evidence of muscle spasm, tenderness, guarding, weakness, loss of tone, atrophy of limbs, or ankylosis. During the range of motion testing the Veteran had a full extension and rotation of the cervical spine to 45 degrees, and his bilateral flexion was normal to 45 degrees, although his bilateral rotation was limited to 40 degrees out of 80 degrees. Upon examination of the thoracolumbar spine the Veteran had no radiating pain on movement, and there was no evidence of muscle spasm, tenderness, guarding, or weakness. His muscle tone was normal, he had a negative straight leg raise bilaterally, and there was no evidence of atrophy or ankylosis. The Veteran’s forward flexion was from zero to 45 degrees out of 90 and his extension was from zero to 20 degrees out of 30. His bilateral flexion and rotation was from zero to 20 degrees out of 30. The Veteran had impaired sensory function in the cervical spine as evidenced by sensory deficits of the hands, fingers, and forearms at C6-C8, with signs of cervical intervertebral disc syndrome. The lumbar spine had impaired sensory function as well, with impaired sensation at L2-L3 and signs of lumbar intervertebral disc syndrome. Upper extremity reflexes were normal, as were lower extremity reflexes on the right. On the left, knee and ankle reflexes were 1+ (hypoactive). There was no sign of weakness in the extremities. The VA examiner noted that the Veteran’s neurological deficits did not cause bowel or bladder problems or erectile dysfunction. Regarding the neck disability the examiner concluded the diagnosis was IVDS, which most likely involved the median and ulnar nerves bilaterally, with reduced range of motion as well as decreased sensation in the hands. Regarding the back disability the examiner concluded the diagnosis was IVDS, which most likely involved the external cutaneous nerve bilaterally, with reduced range of motion as well as decreased sensation in the anterior thighs. In March 2010 the Veteran reported having coldness and sharp pains in the legs with numbness, but his physical examination revealed normal muscle tone, strength, and bulk. His reflexes were 3s (hyperactive without clonus) with plantar flexor responses. His pinprick sensation, vibratory sensation, and proprioception were normal, and his EMG nerve conduction study showed only evidence of chronic right L4 radiculopathy with no evidence of ongoing denervation. Less than one year later the Veteran reported that he had recuperated from his neck surgery and that he was no longer falling; he indicated that he had a 70 percent improvement in pain and that he was only taking medication every few days when he was active. In October 2013 the Veteran underwent another VA examination in connection with his claim. And at the time he asserted that his pain was so severe that he was rendered immobile, and that he had a severe loss of motion and that he was only able to do a few physical activities for a short period of time. The Veteran’s forward flexion of the thoracolumbar spine was from zero to 80 degrees of 90 with pain beginning at 80 degrees, and his extension was from zero to 20 of 30 degrees with pain beginning at 20 degrees. His bilateral flexion and rotation was from zero to 5 degrees out of 30, except that there was zero degrees of left lateral rotation. The Veteran was unable to do repetition testing due to pain. The VA examiner observed that the Veteran had functional loss of less movement, weakened movement, fatigability, incoordination, pain, instability, and disturbance of locomotion. The Veteran exhibited tenderness in the spine which was described as muscle spasms which caused abnormal gait and abnormal spinal contour. Regarding the lower extremities, the Veteran had normal muscle strength, no atrophy, hyperactive reflexes in the knees, but normal reflexes in the ankles. His sensation was normal and he had a negative straight leg raise. He had severe constant pain in the right lower extremity and severe intermittent pain in the left lower extremity, consistent with radiculopathy. The examiner noted shooting pain in the bilateral lower extremities. The VA examiner noted that the Veteran had severe radiculopathy on the right side and moderate radiculopathy on the left side, both affecting the sciatic nerve. He also had hyperreflexia in the bilateral knees. The Veteran was diagnosed with lumbar spine intervertebral disc syndrome with no incapacitating episodes, and it was noted that the Veteran used an occasional walker but used a cane constantly. The Veteran was noted to have no vertebral fracture but a slow and painful limp while using a cane. The VA examiner concluded that the Veteran had pain in the right lower extremity and back with contributing factors of pain, weakness, fatigability, and incoordination with additional limitation of functional ability in the thoracolumbar spine during flare-ups or repeated use over time. The examiner noted that the additional limitation was that he was unable to move at all or get out of bed (per the Veteran), and that the examiner was unable to provide additional range of motion loss due to the Veteran’s inability to move during severe incapacitation. At the time, the Veteran’s spinal MRI revealed postoperative changes at L4-L5 without residual disc herniation and with an enhancing scar resulting in right lateral recess narrowing and moderate right neuroforaminal narrowing. He had a mild diffuse disc bulge with mild to moderate canal stenosis and moderate bilateral neuroforaminal narrowing and a mild diffuse disc bulge at L2-L3 with mild spinal canal stenosis. An x-ray of the lumbar spine showed mild degenerative disc disease of the lumbar spine. In June 2016 the Veteran underwent a lumbar decompression at L3-L5 and a transforaminal lumbar interbody fusion at L4-L5. The following month he reported for treatment of the back pain and at the time he reported having pain in the axial back down the left leg to the foot without any significant right lower extremity pain. The Veteran reported having some tripping when walking but that he had no loss of bowel or bladder control. Nonetheless his upper extremities were normal and he was observed to be doing well overall and was ready for physical therapy treatment. Two months later the Veteran reported having continued pain with sensitivity to palpitation on examination, and that his numbness had increased in the extremities. In January 2018 the Veteran underwent VA examination in connection with his cervical spine claim. At the time he was diagnosed with cervical intervertebral disc syndrome and a prior spinal fusion. The Veteran asserted at the time that he could hardly turn his head and that he had severe pain in the back and neck, and that he had pain flare-ups daily that were controlled with pain medication, but that when he tried to turn the neck to look around he had pain. During the range of motion testing the Veteran’s cervical spine flexion, extension, lateral flexion and lateral rotation were all from zero to 5 degrees. He had pain noted on the examination that caused functional loss, and he had evidence of pain with weightbearing, as well as mild posterior cervical tenderness caused by the neck condition; there was no change in range of motion on repetition. The VA examiner observed that the Veteran’s pain, weakness, fatigability, and incoordination limited the Veteran’s functional ability, but that this functional loss did not equate to an additional limitation in range of motion per the Veteran, and instead caused an increase in pain. The VA examiner continued that the Veteran’s range of motion was variable depending on the severity of the episode and duration and type activity. The VA examiner noted that the Veteran did not have any guarding or muscle spasm, that he had normal strength in the arms without atrophy, and that his sensation and reflexes in the arms were normal. The Veteran had mild paresthesias in the bilateral lower extremities but no other symptoms of radiculopathy; his radiculopathy in the upper extremities was mild and affected the middle radicular group bilaterally. The VA examiner noted that the Veteran had favorable ankylosis of the entire cervical spine and had intervertebral disc syndrome but no episodes of bed rest. The examiner concluded that there was a progression of the previous diagnosis as the Veteran had required surgery. The Veteran also underwent VA examination in connection with his lumbar spine disability at this time and was diagnosed with intervertebral disc syndrome and spinal fusion. He asserted that he had flare-ups of pain in the lumbar spine when bending, walking, standing, or lifting, and that he had to take pain medication daily. The Veteran contended that he was unable to tie his shoes sometimes. During the physical examination the Veteran had a forward flexion from zero to five degrees out of 90 and no extension. His right lateral flexion was from zero to ten degrees out of 30, his right lateral flexion was from zero to five degrees out of 30, his right lateral rotation was from zero to five degrees out of 30; he had no left lateral rotation. The VA examiner noted that the Veteran’s rotation caused pain and functional loss, and that he had pain with weightbearing. Passive range of motion testing was not performed due to risk of injury. Non-weight bearing testing was not performed as a gravity-free environment was not available. The VA examiner observed that the Veteran had mild lumbar paraspinal muscle tenderness caused by the back condition with no change on repetition, but that the functional loss could only be described in terms of pain per the Veteran, rather than a loss of range of motion. It was noted that the Veteran’s pain, weakness, fatigability, and incoordination significantly limited his functional ability with flare-ups, and that there was no evidence of muscle spasm or guarding. The Veteran had full strength in the lower extremities with no atrophy, and his reflexes in the ankles and knees were normal, with normal sensation. The Veteran had a positive straight leg raise in the left leg and moderate pain in the right lower extremity with mild intermittent pain in the left lower extremity; his bilateral lower extremities showed evidence of mild paresthesias and numbness with involvement of the sciatic nerve roots. The radiculopathy was described as mild incomplete paralysis bilaterally. The VA examiner determined that the Veteran had no ankylosis of the spine and that he had intervertebral disc syndrome with no episodes of bed rest. At the time the Veteran was using a cane constantly. There is limited evidence of treatment or symptom flare-ups after this time. 2. Lumbar intervertebral disc syndrome This issue is on appeal from a claim filed October 7, 2009. By way of history the Veteran was granted entitlement to service connection for a lumbar spine disability in an August 1988 rating decision and was assigned a 10 percent disability rating as the June 14, 1988 application date. On May 21, 1999 that disability rating rose to 20 percent, and on March 7, 2000 that disability rating rose to 40 percent. The Veteran had a period of convalescence with a 100 percent disability rating from September 18, 2002, to November 31, 2002. The Veteran was in receipt of a 40 percent disability rating from December 1, 2002, to October 29, 2013 (which includes the first portion of the appeal). From October 30, 2013, to January 7, 2018, outside of a period of convalescence from June 15, 2016, to December 31, 2016, the Veteran has been in receipt of a 20 percent disability rating. The Veteran has been in receipt of a 40 percent disability rating since January 8, 2018. The Board recognizes the lumbar spine rating was changed from 40 percent to 20 percent, effective October 30, 2013. The 40 percent rating had been assigned by a previous version of the diagnostic code that considered both neurologic and orthopedic manifestations of a spine disability. See 67 Fed. Reg. 54,345 (Aug. 22, 2002); 68 Fed. Reg. 51,454 (Aug. 27, 2003). That version of the diagnostic code cannot be used for evaluation in this case as the claim was filed years after the effective date of the amendment to the corresponding regulation. Id. Effective October 30, 2013, the Veteran was also awarded 20 and 40 percent ratings for neurological manifestations of the lumbar spine disability; specifically, radiculopathy to the left and right lower extremities, respectively. Hence, the disability rating for the lumbar spine disability was not reduced. Instead, the Veteran received separate ratings for the orthopedic and neurologic manifestations of his lumbar spine disability (which were previously combined into a single rating) which combine to an even higher rating than 40 percent. A. Orthopedic manifestations of lumbar spine disability The Board finds that a 40 percent disability rating is appropriate for the entirety of the appeal period for the orthopedic manifestations of the Veteran’s lumbar spine disability. While range of motion findings may not have fallen in the requisite range for such a rating during certain periods, the Veteran has described debilitating flare-ups of this condition. For example, at the October 2013 VA examination the Veteran reported that during flare-ups he was essentially immobile. In essence, the Veteran’s range of motion when considering functional loss and flare-ups is less than 30 degrees throughout the appeal and warrants a 40 percent rating. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. A rating in excess of 40 percent requires unfavorable ankylosis of the entire thoracolumbar spine. Id. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 93 (30th ed. 2003). While spinal fusion may have been performed on sections of the Veteran’s thoracolumbar spine, ankylosis of the entire thoracolumbar spine is not alleged or demonstrated by the evidence of record. While the Veteran has had limited motion of the thoracolumbar spine, he has had some motion and examiners have specifically found he does not have ankylosis of the entire thoracolumbar spine. None of the medical evidence suggests ankylosis of the entire thoracolumbar spine. To the extent the Veteran asserts during flare-ups he is essentially immobile, the Board finds this is not the equivalent of unfavorable ankylosis of the entire thoracolumbar spine. First, being immobile from pain is not the same as alleging that the entire thoracolumbar spine is fixed in one position. Second, even if the allegation was that the entire thoracolumbar spine was fixed in one position, the lay and medical evidence does not suggest fixation in an unfavorable position, which is defined by regulation as resulting in one or more of the following: difficulty walking because of a limited line of vision, restricted opening of the mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, Spinal Formula. The Veteran has never alleged that he suffers from any of the above. Third, if the Veteran was debilitated to the degree required for a rating based on the functional equivalent of ankylosis of the entire thoracolumbar spine, the Board would expect the Veteran to report this to clinicians during his medical treatment given the severity of the disability and its impact on everyday life. This is not reflected in the medical records. Given the above, the Board finds that the functional equivalent of unfavorable ankylosis of the entire thoracolumbar spine is not shown at any point during this appeal. B. Neurologic manifestations of lumbar spine disability While the Board acknowledges that the Veteran has carried the disability of lumbar intervertebral disc syndrome, the Veteran has not reported more than 7 days of incapacitating episodes outside of his period of convalescence, and incapacitating episodes are a defining trait of this rating criteria. See 38 C.F.R. § 4.71a, IVDS Formula. Thus, a higher rating of 60 percent (the maximum available for IVDS) is not warranted as 6 weeks of incapacitating episodes are not shown during a 12 month period. Notably, the IVDS Formula contemplates both orthopedic manifestations and neurologic manifestations such that other ratings could not be assigned for the back if it was rated under the IVDS Formula. See id.; see also 38 C.F.R. § 4.14. In this case the Veteran is currently rated at 40 percent for the orthopedic manifestations of his thoracolumbar spine as well as 40 percent for right lower extremity radiculopathy and 20 percent for left lower extremity radiculopathy. The currently assigned individual ratings combine to a rating pf 70 percent since October 30, 2013, which is more beneficial than the highest rating available under the IVDS Formula. 38 C.F.R. §§ 4.25, 4.71a, IVDS Formula. Neurological manifestations of the lumbar spine disability other than radiculopathy are not shown by the medical evidence or alleged by the Veteran. Thus, separate ratings other than the currently assigned ratings for radiculopathy are not warranted. The Veteran has been assigned 40 and 20 percent disability ratings for right and left lower extremity radiculopathy, respectively, since October 30, 2013, the date of VA examination first diagnosing sciatic radiculopathy. These ratings are assigned under Diagnostic Code 8520. 38 C.F.R. § 4.124a. Diagnostic Code 8520 assigns ratings based on complete and incomplete paralysis of the sciatic nerve. Ratings of 10, 20, 40, and 60 percent are warranted for incomplete paralysis that is mild, moderate, moderately severe, or severe with marked muscular atrophy, respectively. Complete paralysis warrants an 80 percent rating and is characterized as: the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Id. Compensable ratings for left and right lower extremity radiculopathy are not warranted prior to October 30, 2013. During examination in March 2010 the examiner noted that the external cutaneous nerve was most likely affected bilaterally and manifested with decreased sensation in the anterior thighs. For a compensable rating for impairment of the external cutaneous nerve there must be severe to complete paralysis of the nerve, which is not demonstrated in this case. See 38 C.F.R. § 4.124a, Diagnostic Code 8529. In addition to decreased sensation in the anterior thigh, during examination in March 2010 it was noted that left knee and ankle reflexes were hypoactive and there was no sign of weakness in the extremities. Separately in March 2010 the Veteran reported having coldness and sharp pains in the legs with numbness; his physical examination revealed normal muscle tone, strength, and bulk with hyperactive reflexes without clonus. The Board considers the symptomatology present prior to October 30, 2013 to be of a lesser degree than severe paralysis as it consists of diminished sensation and slightly altered reflexes. Sciatic radiculopathy is not demonstrated until October 30, 2013. Since, October 30, 2013, the evidence reflects that the right lower extremity is no worse than moderately severe incomplete paralysis of the sciatic nerve and the left lower extremity is no worse than moderate incomplete paralysis of the sciatic nerve. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. While the October 2013 examiner described the right side radiculopathy as severe, marked muscular atrophy, which is noted in the criteria for a higher rating, was not present. The Board recognizes that if the condition more nearly approximates the higher rating, such should be assigned. 38 C.F.R. § 4.7. That is not the case here. At the October 2013 examination, the lower extremities exhibited normal muscle strength, no atrophy, hyperactive reflexes in the knees, and normal reflexes in the ankles. Sensation testing was normal. The Veteran reported severe constant pain in the right lower extremity and severe intermittent pain in the left lower extremity. Notably, the examiner described the left side radiculopathy as moderate. Severe, constant pain and hyperactive reflexes with no muscle weakness or diminished sensation is at most equivalent to moderately severe incomplete paralysis. Severe, intermittent pain and hyperactive reflexes with no muscle weakness or diminished sensation is at most equivalent to moderate incomplete paralysis. In addition, the examiner in January 2018 described the radiculopathy as mild incomplete paralysis of the sciatic nerve, bilaterally. The Veteran had full strength in the lower extremities with no atrophy, and his reflexes in the ankles and knees were normal, with normal sensation. The Veteran reported moderate pain in the right lower extremity with mild intermittent pain in the left lower extremity; his bilateral lower extremities showed evidence of mild paresthesias and numbness. Such symptomatology is not indicative of any more than moderate incomplete paralysis of the sciatic nerve on either side. It is noted that the Veteran’s description of his symptoms and their severity was considered by the examiners in their determinations as to the level of disability. Given such consideration and that the findings were reported after examination and testing by medical professionals, the Board finds the examination findings to be the most probative evidence as to the level of disability as a result of the radiculopathy. Given the above, the Board finds that higher ratings for radiculopathy are not warranted at any point as the preponderance of the evidence reflects severity no more severe than that contemplated by the currently assigned ratings. 3. Cervical intervertebral disc syndrome By way of history, the Veteran was granted entitlement to service connection for a cervical spine disability in a December 2012 rating decision, and he was assigned a 10 percent disability rating as of September 18, 2009. In November 2009 the Veteran underwent a cervical discectomy, and he was awarded a period of convalescence from November 16, 2009, to December 31, 2009. Beginning January 1, 2010, the Veteran was in receipt of a 10 percent disability rating until January 8, 2018, wherein his disability rating rose to 30 percent. Each period will be discussed separately. A. Prior to November 15, 2009, and from January 1, 2010 to January 7, 2018 During these periods the Veteran has been in receipt of a 10 percent disability rating. Therefore, to warrant a higher disability rating the evidence must show forward flexion of the cervical spine to 30 degrees or less, a combined range of motion to 170 degrees or less, muscle spasm or guarding severe enough to result in abnormal gait or guarding, or favorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a, Spinal Formula. During these periods the Veteran underwent VA examination of the cervical spine once in March 2010. Range of motion testing was performed and showed full forward flexion to 45 degrees and a combined range of motion no less than 215 degrees, which is consistent with a 10 percent disability rating. During examination the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. No report suggests that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. While the Veteran has essentially stated that he has reduced motion in his spine, he has not described a range of motion which would warrant a higher rating. In this regard, during the March 2010 VA examination he did report flare-ups but described the flare-ups as consisting of increased pain, stiffness in the joints, and weakness in the spine and leg. The Veteran’s statements do not suggest the requisite limitation of motion necessary for a higher rating. Treatment records do not show greater limitation of motion than the examination findings. Absent indication by the Veteran or other evidence suggesting additional limitation of motion during flare-up or after repetitive use over time there is no reason to suspect range of motion is limited any more than reflected during examination and additional inquiry in this regard is unnecessary. It is noteworthy that in January 2011 the Veteran reported that he was recuperating from neck pain and that he had a 70 percent improvement in pain symptoms which caused him to take less pain medication. Given the above, a higher rating is not warranted based on limitation of motion. Ankylosis of the spine is not shown by the medical evidence or alleged by the Veteran. The March 2010 VA examination specifically denied any evidence of ankylosis. The examiner also noted that there was no evidence of muscle spasm or guarding, which is strong evidence against a finding of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Regarding relevant neurological findings, the examiner noted that the Veteran had evidence of bilateral upper extremity radiculopathy during the March 2010 VA examination, and as a result the Veteran was granted entitlement to service connection for bilateral upper extremity radiculopathy as of September 18, 2009, which is discussed in greater detail in the following sections. There is no other evidence in significant conflict with these findings. Therefore, the Board finds there are no other symptoms which should be addressed by a separately assigned disability rating. The Board is aware that the Veteran carries the diagnosis of cervical intervertebral disc syndrome, but outside of his period of convalescence, there is no evidence of prescribed bed rest greater than 7 days in a 12 month period. As a result, rating the Veteran under the diagnostic code for intervertebral disc syndrome would hinder him as it would equate to a noncompensable disability rating. 38 C.F.R. § 4.71a, IVDS Formula. In viewing the totality of the evidence during these periods, the Board finds that it is consistent with a 10 percent disability rating based on painful motion. However, given that the range of motion loss is still within the range for a 10 percent disability rating and because there is no evidence of ankylosis or muscle spasm or guarding, a disability rating in excess of 10 percent is not warranted. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against assignment of a higher disability rating, that doctrine is not applicable in this instance. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. B. From January 8, 2018 During this period the Veteran has been in receipt of a 30 percent disability rating. Therefore, to warrant a higher disability rating the evidence must show unfavorable ankylosis of the entire cervical spine. As noted, the Veteran underwent VA examination in connection with his claim in January 2018 and at the time he reported that he could hardly turn his head and that he had severe pain in the back and neck, with daily pain flare-ups. The Veteran’s cervical spine flexion and extension were from zero to 5 degrees, and the VA examiner indicated that the Veteran had favorable ankylosis of the entire cervical spine, which his consistent with a 40 percent disability rating. However, there is no indication in this VA examination report or elsewhere in the medical evidence during this period that the Veteran has had unfavorable ankylosis in the cervical spine or in the entire spine. Indicators of unfavorable ankylosis are noted above, and the Board again finds that the Veteran has also not alleged any of the indicators of unfavorable ankylosis. Given the lack of unfavorable ankylosis, the Board finds that a disability rating in excess of 30 percent is not warranted for this period. 38 C.F.R. § 4.71a, Spinal Formula. As noted, although the Veteran has been diagnosed with cervical intervertebral disc syndrome he has had no more than 7 days of bedrest for this disability outside of his period of convalescence, therefore evaluating him under that disability rating criteria would not be to his benefit as it would result in a lower disability rating. 38 C.F.R. § 4.71a, IVDS Formula. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against assignment of a higher disability rating that doctrine is inapplicable and the increased rating must be denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. 4. Radiculopathy of the right and left upper extremities Prior to December 3, 2014, the Veteran’s right and left upper extremity radiculopathy disabilities were evaluated under Diagnostic Code 8515, which contemplates paralysis of the median nerve. 38 C.F.R. § 4.124a. Under Diagnostic Code 8515, mild incomplete paralysis of the median nerve is rated at 10 percent disabling for both the major and minor side. Moderate incomplete paralysis is rated at 30 percent for the major side and 20 percent for the minor side. Severe incomplete paralysis is rated at 50 percent for the major side and 40 percent for the minor side. Complete paralysis is rated at 70 percent for the major side and 60 percent for the minor side. Complete paralysis of the median nerve is marked by the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the ulnar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbance. Id. From December 3, 2014, the Veteran’s right and left upper extremity radiculopathy disabilities have been evaluated under Diagnostic Code 8511, which contemplates impairment of the middle radicular group. Id. Under Diagnostic Code 8511, mild incomplete paralysis is rated 20 percent disabling on the major and minor side. Moderate incomplete paralysis is rated 30 percent disabling on the minor side and 40 percent disabling on the major side. Severe incomplete paralysis is rated 40 percent disabling on the minor side and 50 percent disabling on the major side. Complete paralysis is rated as 60 percent disabling on the minor side and 70 percent disabling on the major side. 38 C.F.R. § 4.124a. Complete paralysis is described as adduction, abduction and rotation of arm, flexion of elbow, and extension of wrist lost or severely affected. Id. To the extent that Diagnostic Code 8512 (Lower radicular group) or Diagnostic Code 8513 (All radicular groups) could apply in this case, the Board notes that the ratings for mild incomplete paralysis, which the Board is finding as the level of impairment in this case, is rated the same regardless of the radicular group affected. Id. Incomplete paralysis 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 partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. Id. By way of history, the Veteran was granted entitlement to service connection for right and left upper extremity radiculopathy in a December 2012 rating decision, and was assigned a 10 percent disability rating for each upper extremity. Each of those disability ratings was raised to 20 percent beginning January 8, 2018. In March 2010, a VA examiner found that the Veteran’s cervical spine IVDS most likely involved the median and ulnar nerves bilaterally. In January 2018, a VA examiner found that the middle radicular group was affected. As such, it is appropriate to rate this disability under one of the radicular groups. 38 C.F.R. § 4.124a, Diagnostic Codes 8511 to 8513. The minimum rating under these diagnostic codes is 20 percent; thus, a 20 percent rating is appropriate throughout the course of the appeal. A rating in excess of 20 percent is not warranted as the disability does not more nearly approximate moderate incomplete paralysis at any point. Id. In March 2010 the Veteran had a neurological evaluation of the cervical spine that revealed impaired cervical spine sensory function. Although there was no motor weakness there was evidence of sensory deficit at C6-C8, to include deficits of the bilateral thumbs, bilateral index fingers, and bilateral lateral long fingers, bilateral distal forearms, bilateral ulnar side of the ring fingers, and bilateral little fingers. The Veteran had normal reflexes in the biceps and triceps of both arms, with no signs of pathologic reflexes. While the Veteran did not have continuous treatment for these disabilities, it was noted that he had hypoactive reflexes with absent Hoffman’s sign in the upper extremities in April 2016. The January 2018 VA examination revealed normal muscle strength in the upper extremities with normal reflexes bilaterally. The Veteran exhibited mild paresthesias in the bilateral upper extremities with involvement of the C7 nerve root, and the VA examiner deemed that the Veteran had mild radiculopathy of the cervical spine bilaterally. There was no other evidence during this period classifying the Veteran’s radiculopathy symptoms and his statements are not in significant conflict with the findings on examination. The examination findings are found most probative as they were made by a medical professional after examination of the Veteran, review of the relevant history, and with consideration of the Veteran’s reports of symptomatology. In evaluating the evidence, the Board finds that it is consistent with mild incomplete paralysis of each upper extremity, which is consistent with no more than a 20 percent disability rating. 38 C.F.R. § 4.124a. There is no evidence in the VA examinations or elsewhere that suggests that the Veteran has moderate radicular symptoms during this period such that a higher disability rating would be warranted. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against assignment of a higher disability rating, that doctrine is not for application and any increased rating must be denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. Other Considerations 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, 369-370 (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). 5. Entitlement to a special monthly compensation based on housebound status beyond January 1, 2010 Special monthly compensation at the housebound rate is payable when a Veteran has a single service-connected disability rated 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or, (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. 1114(s); 38 C.F.R. 3.350(i)(1). The requirements of 38 U.S.C. 1114(s)(2) are met when a Veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 C.F.R. 3.350(i)(2). Initially, the Board notes the Veteran received a temporary total rating (100 percent) from November 16, 2009 to December 31, 2009, based on his convalescence after his anterior cervical discectomy and fusion. The Veteran was awarded special monthly compensation based on housebound status for the duration of the above-described period of convalescence. The award of the convalescent rating met the requirement for a 100 percent rating, and the Veteran’s remaining service-connected disabilities combined to more than 60 percent. However, with the termination of the convalescent rating as of January 1, 2010, respectively, he no longer met the first prong of entitlement to special monthly compensation at the housebound rate, having a single service-connected disability rated 100 percent. 38 U.S.C. 1114(s); 38 C.F.R. 3.350(i)(1). Further, although the Veteran has asserted that he has been rendered permanently housebound by reason of his service-connected disabilities, the evidence of record does not otherwise support finding that he is permanently housebound, as required by 38 U.S.C. 1114(s)(2) and 38 C.F.R. 3.350(i)(2). The evidence of record demonstrates that he is not restricted such as to be limited to the confines of his home. Rather, the record shows that he can leave his home and function, which is discussed in greater detail in the following section. He had a full range of motion in the cervical spine and could walk without limitation at the March 2010 VA examination; the posture and gait were within normal limits. Indeed, in January 2011 the Veteran reported a 70 percent improvement in pain after surgery, which may suggest an increase in the ability to function. In view of the foregoing, the Board finds that an extension of special monthly compensation based on housebound status beyond January 1, 2010, is not warranted. In reaching its decision, the Board has duly considered the benefit-of-the-doubt doctrine but has found that a preponderance of the evidence weighs against the Veteran’s claim. As such, the doctrine is inapplicable and the claim must be denied. 6. Entitlement to a temporary rating for convalescence for intervertebral disc syndrome of the cervical spine beyond December 31, 2009 The Veteran underwent surgery on his cervical spine on November 16, 2009. Following the surgery, the Regional Office awarded a temporary total rating for postsurgical convalescence under 38 C.F.R. § 4.30, effective from November 16, 2009, to December 31, 2009. The Veteran requested an extension of the temporary total rating assigned for the November 2009 surgery, stating that he was entitled to a longer period for a 100 percent temporary rating. The applicable regulations provide that a total disability rating of 100 percent will be assigned without regard to other provision of the rating schedule when it is established by report at hospital discharge, regular discharge, or release to non-bed care, or outpatient release, that entitlement is warranted. 38 C.F.R. § 4.30. A temporary total rating for convalescence will be assigned from the date of hospital admission and continue for one, two, or three months from the first day of the month following hospital discharge when treatment of a service-connected disability results in (1) surgery necessitating at least one month of convalescence; (2) surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30(a). The total rating will be followed by an open rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physical examination will be scheduled prior to the end of the total rating period. An extension of one, two, or three months beyond the initial three months may be granted and extensions of one or more months up to six months beyond the initial six months period may be made, upon approval of the Veterans Service Center Manager. 38 C.F.R. § 4.30(b). Upon review of all the evidence of record, both lay and medical, the Board finds that the weight of the evidence demonstrates that an additional period of convalescence was not necessary beyond the current January 1, 2010 termination date. The Veteran underwent an anterior cervical discectomy and fusion on November 16, 2009. On January 5, 2010 the Veteran followed up with his treatment provider and at the time he had full motor strength and reflexes in the extremities; the Veteran described some scapula pain which was improving. At the time his x-rays were normal and the Veteran was prescribed a soft collar and was encouraged to use the bone stimulator for pain; the treatment provider indicated that the Veteran was doing extremely well overall and that he did not need to return for another month. The Board notes that the Veteran underwent physical therapy beginning in February 2010, and at the time he reported that he was driving a car but that he had some difficulty turning to look over his shoulder due to neck pain. The following month he reported that he had an increased ability to use his left arm for activities of daily living such as carrying groceries. At that time, he reported that he was pleased with the surgical results but that he had some remaining deficits including his ability to turn his neck while driving, looking up to shave, or looking down to read the paper. When the Veteran underwent VA examination in March 2010, he reported that he could only walk 100 feet and that it would take him 30 minutes to do this; he also asserted that he was incapacitated for six months following his November 2009 surgery. Nonetheless, the Veteran’s cervical spine findings were relatively normal; he had a normal gait and normal range of motion. The Veteran did not describe many of his daily activities at that time, but the Board notes that the objective evidence of his cervical spine deficits does not suggest that he would be rendered immobile or unable to leave the home. Overall, although the Veteran had some functional loss that required rehabilitation after his surgery and had a cervical collar following his surgery, there is nothing to suggest that he was housebound or required a walker or crutches or an immobilizing device after January 1, 2010. While a soft collar was prescribed in January 2010 the record does not indicate that the Veteran’s neck was required to be immobilized. The fact that he was attending physical therapy goes against a finding that immobilization was required. The evidence, particularly the January 5, 2010 report that the Veteran was doing extremely well, is against a finding that convalescence was required after December 31, 2009. The Veteran has not met the criteria set forth above to warrant an additional period of convalescence. The evidence demonstrates that cervical spine surgery performed on November 16, 2009 did not necessitate a period of convalescence beyond December 31, 2009 as there is no indication from private or VA treatment records that the cervical spine disability required bed rest, therapeutic immobilization of the neck, application of a body cast, the necessity for use of a wheelchair or crutches (regular weight-bearing prohibited), or necessitated house confinement after that date. For these reasons, the Board finds that the conditions specified for extension of the temporary total rating beyond December 31, 2009 are not met, and the claim must be denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Brandau, Associate Counsel