Citation Nr: 19128583 Decision Date: 04/12/19 Archive Date: 04/12/19 DOCKET NO. 18-37 621 DATE: April 12, 2019 ORDER Service connection for right foot drop, to include as secondary to degenerative disc disease (DDD) of the lumbar spine is denied. Service connection for left lower extremity radiculopathy, to include as secondary to DDD of the lumbar spine, is denied. Service connection for bilateral upper extremity radiculopathy, to include as secondary to DDD of the cervical spine, is denied. Prior to December 20, 2017, a rating in excess of 10 percent for residuals of a left knee arthroscopy is denied. From February 1, 2018 to December 20, 2018, a 100 percent rating for residuals of a partial left knee replacement is granted, subject to the laws and regulations governing the payment of monetary benefits. Since December 20, 2018, a rating in excess of 40 percent for ankylosis of the left knee is denied. A rating in excess of 10 percent for right knee instability is denied. A rating in excess of 10 percent for residuals of a right knee arthroscopy is denied. A rating of 30 percent, but no higher, for migraine headaches is granted, subject to the laws and regulations governing the payment of monetary benefits. A rating in excess of 10 percent for right lower extremity radiculitis is denied. From February 1, 2018 to December 20, 2018, special monthly compensation (SMC) at the housebound rate is granted, subject to the laws and regulations governing the payment of monetary benefits. REMANDED Service connection for erectile dysfunction, to include as secondary to DDD of the lumbar spine is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to December 20, 2017 is remanded. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis, or any functional impairment related to, right foot drop. 2. The Veteran does not have a current diagnosis, or any functional impairment related to, left lower extremity radiculopathy. 3. The Veteran experiences some upper extremity radicular symptoms, but those symptoms are not attributable to a separate and distinct disability. 4. Prior to his partial left knee replacement on December 20, 2017, the Veteran’s left knee disability was manifested by painful motion. 5. The Veteran underwent a partial left knee replacement on December 20, 2017. 6. After the Veteran’s partial knee replacement, he experienced intermediate degrees of residual weakness, pain, or limitation of motion as well as ankylosis in flexion between 10 degrees and 20 degrees. 7. Since February 14, 2018, the Veteran experienced mild lateral instability in his right knee. 8. For the entire appeals period, the Veteran experienced painful motion in the right knee. 9. With regard to the Veteran’s migraines headaches, the Veteran has 1-2 prostrating attacks per month that are not productive of severe economic inadaptability. 10. The Veteran’s right lower extremity radiculitis is manifested by mild incomplete paralysis of the sciatic nerve. 11. From February 1, 2018 to December 20, 2018, the Veteran’s left knee, post-partial left knee replacement, was rated 100 percent disabling, and the Veteran had separate service-connected disabilities rated at least 60 percent disabling. CONCLUSIONS OF LAW 1. The criteria for service connection for right foot drop have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for bilateral upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. Prior to December 20, 2017, the criteria for a rating in excess of 10 percent for residuals of a left knee arthroscopy were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5261. 5. From February 1, 2018 to December 20, 2018, the criteria for a 100 percent rating for residuals of a partial left knee replacement were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055. 6. Since December 20, 2018, the criteria for a rating in excess of 40 percent for ankylosis of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055, 5256, 5257, 5260, 5261. 7. The criteria for a rating in excess of 10 percent for right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5257. 8. The criteria for a rating in excess of 10 percent for residuals of a right knee arthroscopy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5261. 9. The criteria for a 30 percent rating, but no higher, for migraine headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.124a, DC 8100. 10. The criteria for a rating in excess of 10 percent for right lower extremity radiculitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.124a, DC 8520. 11. From February 1, 2018 to December 20, 2018, the criteria for SMC at the housebound rate were met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1983 to June 1986 and from July 1987 to April 2005. The case is on appeal from an October 2017 rating decision. In a March 2018 rating decision, the RO granted the Veteran a temporary total rating for his left knee from December 20, 2017 to February 1, 2018. As the Veteran was in receipt of a total rating for his left knee, this period is excluded from his claim for an increased rating for his left knee disability. In the March 2018 rating decision, the Veteran was also granted SMC at the housebound rate from December 20, 2017 to February 1, 2018. After February 1, 2018, the end of the convalescence period, a 40 percent rating was assigned for the left knee. In an April 2018 rating decision, a separate 10 percent rating was assigned for right knee instability, which the Board will adjudicate as part and parcel of the right knee increased rating claim on appeal. The Veteran has noted that his knee disabilities prevent him from fully performing his job duties. He has also noted needing to work in the dark, or at times stop working, because of his migraine headaches. Therefore, the Board finds that the issue of entitlement to TDIU has been raised as part and parcel of the increased rating claims on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran is in receipt of a 100 percent rating from June 5, 2018. As he has claimed that more than one disability (i.e., his knee and migraine headaches disabilities) render him unemployable, the issue of TDIU based solely on these disabilities after June 5, 2018 is moot. See Buie v. Shinseki, 24 Vet. App. 242 (2011); 38 C.F.R. § 4.16(a) (noting, in part, that a single disability includes a disability affecting one or both lower extremities, disabilities of a common etiology, and a disability affecting a single body system). As a result of this decision, the Veteran’s left knee replacement disability will be rated at 100 percent and he will be in receipt of SMC at the housebound rate from February 1, 2018 to December 20, 2018. Because the Veteran was already in receipt SMC at the housebound rate and no single disability is said to cause unemployability, the issue of TDIU is moot from December 20, 2017 onward and only the issue of TDIU from the beginning of the claims period to December 20, 2017 remains on appeal. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) 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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). 1. Service connection for right foot drop, to include as secondary to DDD of the lumbar spine The Veteran claims that he experiences right foot drop and that the disorder is related to service. The Veteran’s post-service treatment records do not reveal any diagnosis of right foot drop. The Veteran did, however, note occasional foot drop in a November 2017 statement. The Veteran is service connected for right lower extremity radiculopathy. At a July 2017 VA peripheral nerves examination, the Veteran reported intermittent radiation in the right lower extremity, and his spouse reported dragging of his right lower extremity which sometimes affects his gait. Right lower extremity mild constant and moderate intermittent pain, as well as mild paresthesias and numbness was reported in the right lower extremity. There was no reduction in right lower extremity strength or deep tendon reflexes. However, testing for light touch showed decreased sensation in the right upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. The examiner opined, based on the symptoms reported and observed, that the Veteran experienced mild incomplete paralysis of the right sciatic nerve. Foot dangle and drop, no active movement of muscles below the knee, flexion of knee weakened or lost would have constituted complete paralysis of sciatic nerve, but such symptoms were not present. See 38 C.F.R. § 4.124a, DC 8520. Therefore, the Board finds that there is no current diagnosis for right foot drop. While the Veteran and his spouse have reported occasional right foot dragging that can affect his gait, the Veteran has never sought treatment for his right foot drop or reported similar symptoms in a clinical context. While the Veteran is competent to report his symptoms, Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the most probative evidence of record is the July 2017 VA examination report and medical treatment records which do not indicate impairment from a right foot drop. Therefore, the Board finds that there is no current diagnosis. Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also Saunders, supra; Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007). 2. Service connection for left lower extremity radiculopathy, to include as secondary to DDD of the lumbar spine The Veteran claims that he experiences left lower extremity radiculopathy related to his service-connected DDD of the lumbar spine. The Veteran’s treatment records to not reveal a diagnosis of left lower extremity radiculopathy or functional effects from left lower extremity radicular symptoms. During a July 2017 VA peripheral nerves examination, the Veteran did not report any left lower extremity radicular symptoms. Further, testing did not show any sensory deficiencies in the left lower extremity. Therefore, the Board finds that the Veteran does not have a current diagnosis during the claims period for left lower extremity radiculopathy, or functional effects from left lower extremity radicular symptoms. As a result, service connection for left lower extremity radiculopathy is denied. Brammer, supra; see also Saunders, supra; Romanowsky, supra; McClain, supra. 3. Service connection for bilateral upper extremity radiculopathy, to include as secondary to DDD of the cervical spine The Veteran claims that he has bilateral upper extremity radiculopathy that is related to his service-connected DDD of the cervical spine. The Veteran’s treatment records are silent as to a diagnosis of bilateral upper extremity radiculopathy or similar disorder. The Veteran did undergo surgery in 2008 for carpal tunnel syndrome. In a November 2017 statement, the Veteran noted past surgeries in his elbows and right shoulder. Service connection is in effect for residuals for a right shoulder disability, left wrist disability, and right and left elbow epicondylitis residuals. There is no indication that any reported radiculopathy or pain in the upper extremities is separate and distinct from these service-connected disabilities. At the July 2017 VA peripheral nerves examination, the Veteran reported constant mild pain, mild paresthesias, and numbness in each upper extremity. However, muscle strength, deep tendon reflexes, and testing for light touch sensation were normal. The examiner added that the minor abnormalities reported during the examination did not warrant a diagnosis. Because the Veteran’s bilateral upper extremity radicular symptoms do not cause functional impairment, there is no separate and distinct diagnosis of radiculopathy of the upper extremities, and there is no diagnosis associated with these reported symptoms, service connection is denied. Brammer, supra; see also Saunders, supra; Romanowsky, supra; McClain, supra. Increased Rating Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. For musculoskeletal disabilities, such as those of the knees, there are additional criteria. 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 United States Court of Appeals for Veterans Claims (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. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. Furthermore, the intent of the rating schedule is to recognize painful motion with joint or particular pathology as productive of disability. Thus, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis context, the Board should address its applicability. 4. Entitlement to a rating in excess of 10 percent for a left knee disability prior to December 20, 2017 and in excess of 40 percent since February 1, 2018 5. Entitlement to a rating in excess of 10 percent for residuals of a right knee arthroscopy The Veteran claims that his current ratings for his knee disabilties do not reflect the severity of his symptoms. At the time the Veteran filed his increased rating claim in April 2017, he was in receipt of 10 percent ratings for each knee. On December 20, 2017, the Veteran underwent a partial left knee replacement, and he was then awarded a temporary total rating under 38 C.F.R. § 4.30 until February 1, 2018. Since February 1, 2018, he has been in receipt of a 40 percent rating for ankylosis of the left knee. A rating of 10 percent for right knee instability has also been assigned, effective February 14, 2018. Relevant Rating Criteria Applicable to the Veteran’s left knee prior to December 20, 2017 and to his right knee, are 38 C.F.R. § 4.71a, DCs 5055, 5256, 5257, 5260, and 5261. Ratings for limitation of flexion of the knee are found under 38 C.F.R. § 4.71a DC 5260 and provide for a 30 percent rating for flexion limited to 15 degrees, a 20 percent rating for limitation of flexion limited to 30 degrees, a 10 percent rating for limitation of flexion limited to 45 degrees; and a noncompensable rating for limitation of flexion limited to 60 degrees. Ratings for limitation of extension of the knee are found under 38 C.F.R. § 4.71a DC 5261 and provide for a 50 percent rating for extension limited to 45 degrees, a 40 percent rating for extension limited to 30 degrees, a 30 percent rating for extension limited to 20 degrees, a 20 percent rating for limitation of extension limited to 15 degrees, a 10 percent rating for limitation of extension limited to 10 degrees; and a noncompensable rating for limitation of extension limited to 5 degrees. Ratings for recurrent subluxation or lateral instability of the knee are found under DC 5257. A 10 percent rating is warranted for slight impairment, a 20 percent rating is warranted for moderate impairment; and a 30 percent rating is warranted for severe impairment. Since February 1, 2018, the Veteran’s left knee has been rated under 38 C.F.R. § 4.71a, DC 5256. Per DC 5256, a 60 percent rating is assigned for extremely unfavorable ankylosis of the knee in flexion at an angle of 45 degrees or more; a 50 percent rating is assigned for ankylosis flexion between 20 degrees and 45 degrees; a 40 percent rating is assigned for ankylosis in flexion between 10 degrees and 20 degrees; and a 30 percent rating is assigned for ankylosis in flexion between 0 degrees and 10 degrees. Because the Veteran had undergone a recent knee replacement, the Board must also consider a rating for the left knee under 38 C.F.R. § DC 5055. Hudgens v. McDonald, 823 F.3d 630 (Fed. Cir. 2016). DC 5055 provides for a total rating for the first year following implantation of a prosthesis; a 60 percent rating for chronic residuals consistent of severe painful motion or weakness in the affected extremity; and a minimum rating of 30 percent for intermediate degrees of residual weakness, pain or limitation under the appropriate diagnostic code for less severe residuals. Analysis The Veteran was afforded a VA examination of his knees in July 2017. He reported chronic daily pain that increases with activity. Flare-ups of sharp knee pain were reported in both knees, though frequency and duration of flare-ups were reported as daily and constant, which indicates that the Veteran was describing his typical symptoms rather than a flare-up. No ankylosis was reported in either knee. Bilateral knee flexion and extension was from 0 degrees to 140 degrees with pain on extension. There was no decrease in range of motion on repetition. Pain on palpation was observed in the right medial knee. There was no evidence of pain on weight-bearing or crepitus bilaterally. No instability was noted on testing. The Veteran experienced frequent episodes of joint pain bilaterally. The examiner noted scars from knee surgery, though the Veteran is separately rated for these scars. To ambulate, he occasionally used a walking stick while walking his dogs. Functional impacts included knee pain with stairs, and when walking, standing, or sitting for long periods of time. In December 2017, the Veteran underwent a partial left knee replacement, and another VA examination was conducted in February 2018. Knee pain with stairs and pain to touch of left knee was noted. He also reported increasing pain with ambulation, prolonged sitting and standing, and as the day progresses. Daily flare-ups of severe pain were noted. Right knee flexion and extension was from 0 degrees to 95 degrees. Pain was reported in flexion, on weight-bearing, and on nonweight-bearing. Left knee extension and flexion were from 5 degrees to 65 degrees. Pain was noted on palpation to the knee cap, in flexion and extension, on weight-bearing, and on nonweight-bearing. There was also evidence of crepitus and pain on passive range of motion testing bilaterally. There was no evidence of reduce range of motion in the right knee on repetition. Repetitive motion testing was not conducted in the left knee because of the recent knee replacement and increasing pain. The Veteran experienced interference with sitting and standing in each knee as well as swelling and less movement than normal in the left knee. Muscle strength was 3/5 in the left knee on flexion and extension. Favorable ankylosis in full extension or in slight flexion was noted in the left knee at 10 degrees. There was a history of slight lateral instability bilaterally, but no instability shown on testing. Frequent episodes of joint effusion were noted in the left knee. The Veteran used a cane to ambulate due to his recent surgery. He also occasionally used a brace as well. The Veteran had lost 2-4 weeks of work in the prior year and was working in an administrative position due to recent knee surgery. He reported being unable to do his job fully because of his bilateral knee pain and recent increasing left knee pain. Prior to December 20, 2017, a rating in excess of 10 percent for left knee limitation in flexion is not warranted. Prior to his surgery, the Veteran noted pain on flexion movement of his left knee. There was no evidence of ankylosis, instability, or other symptomatology during this period. Further, the Veteran’s flare-ups were described as occurring daily and resulting in constant pain. Though the examiner stated that the examination was not conducted during a flare-up, the Veteran’s lay reported repetitive motion testing would have shown the functional effects of a flare. Nonetheless, this did not result in further decreases in range of motion. Therefore, even when considering reported increased pain with activity, a rating in excess of 10 percent for painful motion of the left knee prior to December 20, 2017 is not warranted. See Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). Further a separate rating for pain on extension and pain on flexion is not warranted. 38 C.F.R. § 4.14. A total rating for the Veteran’s left knee is granted from February 1, 2018 to December 20, 2018. Under DC 5055, a 100 percent rating is warranted for the first year after a knee replacement. See also Hudgens, supra. Since December 20, 2018, a rating in excess of 40 percent for left knee ankylosis is not warranted. The Veteran has ankylosis of the left knee as he cannot move past 10 degrees. The 40 percent rating under DC 5256 ankylosis contemplates in flexion between 20 degrees and 40 degrees and any limitations in flexion and extension as well as possible functional effects from reported instability. Further, a higher rating of 60 percent under DC 5055 is not warranted. The Veteran does experience swelling and painful motion on repetition in the left knee. However, these symptoms do not represent severe painful motion or weakness. Rather, the minimum rating for intermediate degrees of weakness, pain, and limitation would have been assigned in the absence of a 40 percent rating under DC 5256. The Veteran did report a general history of left knee instability, but none was shown on examination. The Board finds that the VA examination reports showing no left knee instability on testing are more probative. See English v. Wilkie, 30 Vet. App. 347 (2018). Thus, a separate rating for left knee instability is not warranted. Finally, an effective date prior to December 20, 2018 for the 40 percent rating is not warranted. The Veteran’s increased symptoms stem from his December 20, 2017 partial left knee replacement. Until December 20, 2018, he has been assigned a total rating under DC 5055. Therefore, December 20, 2018 is the earliest effective date available for the 40 percent rating. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015). With regard to the right knee, a rating in excess of 10 percent for instability under DC 5257 is not warranted. On examination, the Veteran reported a history of instability, and 0-5 millimeters of lateral instability was found on objective testing. The Veteran’s treatment records do not further demonstrate symptoms or reports of right knee instability or subluxation, and the February 2018 examination report is the best indication of the degree of instability the Veteran experiences. Therefore, any instability present is mild, and a rating in excess of 10 percent is not warranted. A separate rating in excess of 10 percent for painful motion of the right knee is not warranted. See Southall-Norman, supra. At both the July 2017 and February 2018 VA examinations, painful motion was noted on extension. At the February 2018 VA examination, painful motion was also noted on flexion, but a separate minimum compensable rating for painful motion alone is not warranted. 38 C.F.R. §§ 4.14, 4.71a, DCs 5260, 5261. With regard to the effective date, the Veteran’s right knee instability was first reported at the February VA examination which was conducted on February 14, 2018. There is no earlier ascertainable date on which right knee instability began in the medical or lay evidence of record. Therefore, under Swain, an earlier effective date for the 10 percent rating is not warranted. In summary, the Board is granting a total rating for the Veteran’s left knee for the first year post partial knee replacement (until December 20, 2018) under 38 C.F.R. § 4.71a, DC 5055. The Veteran’s claim for higher ratings for his left and right knee disabilities are otherwise denied. 6. Entitlement to a rating in excess of 10 percent for migraine headaches The Veteran claims that his 10 percent rating for migraine headaches does not reflect the current severity of his symptoms. In support, the Veteran has submitted a “Headache Log” detailing the frequency, treatment, and suspected triggers of his headaches. The Veteran’s service-connected headaches are rated as 10 percent disabling pursuant to 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, a 50 percent rating requires that the disability be manifested by very frequent and prostrating and prolonged attacks that are productive of severe economic inadaptability. A 30 percent rating requires headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A 10 percent rating requires headaches with characteristic prostrating attacks occurring on an average of once in 2 months over last several months. A noncompensable rating is available for headaches manifested by less frequent attacks. See also Johnson v. Wilkie, 30 Vet. App. 245 (2018) (noting that DC 8100 contains “successive rating criteria,” every one of which must be met to be entitled to the rating). The term “productive of economic inadaptability” means “producing” or “capable of producing” severe economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). In July 2017, the Veteran was afforded an examination. Constant head pain was noted. The Veteran reported having 2-3 headaches per month lasting 2-72 hours, typically with pain behind his eyes. The headaches were said not to be characteristic prostrating attacks and not to cause severe economic inadaptability. The Veteran reported losing 1-2 weeks of work in 12 months because he needed to be in a quiet environment to relieve pain. Topamax has improved symptoms, but he still gets headaches. Additionally, the Veteran’s headache log is acknowledged. The Board notes that the Veteran averaged about three headaches per month of varying severity and duration in 2017. About half of the headaches required the Veteran to stay in bed, or, if able to work, do so with little light and contact with others. The Board finds that a 30 percent rating, but no higher, is warranted. The Board finds that the Veteran gets 1-2 prostrating attacks per month, characterized by having to sleep, remain in the dark, and/or miss time from work. The Veteran at the examination reported 1-2 weeks of missed work due to his headaches, but the duration is unspecified. Further, in his headache log for 2017, the Veteran reported being able to work in the dark during an attack. This shows that the Veteran, despite the prostrating attacks, has been able to adapt at work most of the time. There are no reports that work during these periods suffered in quality or that the Veteran was unable to be productive. Therefore, the Board finds that the Veteran’s headaches are not productive of severe economic inadaptability. See Pierce, supra. Further, the Veteran’s 1-2 prostrating attacks per month more closely approximate the 30 percent criteria of one prostrating attack per month. As a result, the Board does not find that the Veteran has very frequent prostrating attacks, as stated in the 50 percent criteria. Based on the frequency and severity of the Veteran’s migraine headaches, the Board finds that a 30 percent rating, but no higher is warranted. See Johnson, supra. 7. Entitlement to a rating in excess of 10 percent for right lower extremity radiculitis The Veteran claims that his current 10 percent rating for right lower extremity radiculitis does not reflect the severity of his symptoms. The Veteran’s right lower extremity radiculopathy is rated under 38 C.F.R. § 4.124a, DC 8520. DC 8520 provides for a 10 percent rating for mild incomplete paralysis of the sciatic nerve in either lower extremity, a 20 percent rating for moderate incomplete paralysis of the sciatic nerve in either lower extremity, a 40 percent rating for moderately severe incomplete paralysis of the sciatic nerve in either lower extremity, a 60 percent rating for severe incomplete paralysis of the sciatic nerve with marked muscle atrophy in either lower extremity; and 80 percent for complete paralysis of the sciatic nerve described as the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. The Veteran was afforded a VA examination of his right lower extremity radiculitis in July 2017. He reported chronic low back pain with intermittent radiation down his right lower extremity. Further, pain in the lower back sometimes affects his gait when his legs are tired or fatigued. His spouse also reported that the Veteran starts dragging his right lower extremity at times. He reported taking Celebrex for pain. Mild constant pain, moderate intermittent pain, mild paresthesias, and mild numbness were reported in the lower right extremity. Muscle strength was normal. Testing for light touch showed decreased sensation in the upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. The Veteran was reported to have a normal gait. An absence of muscle atrophy was noted. The examiner described the Veteran’s symptoms as mild incomplete paralysis of the sciatic nerve. The Board finds that a rating in excess of 10 percent is not warranted. The Veteran’s symptoms are primarily subjective; however, light touch testing showed decreased sensation throughout the right lower extremity. While the Veteran reported a right foot drop that at times affected his gait, evidence of a right foot drop has not been demonstrated. In any event, any affect on his gait from low back symptoms is contemplated by the Veteran’s 20 percent rating for his DDD of the lumbar spine. 38 C.F.R. § 4.71, General Rating Criteria for Diseases and Injuries of the Lumbar Spine. Though the Veteran and his spouse have reported occasional foot drop, it does not appear that this symptom is typical of the Veteran’s right lower extremity radiculitis. There are no reports of more than mild symptoms of radiculitis in the July 2017 VA examination report or in the Veteran’s treatment records. After weighing the evidence, the Board finds that the Veteran’s right lower extremity radiculitis is manifested by mild incomplete paralysis of the sciatic nerve, and a rating in excess of 10 percent for right lower extremity radiculitis is denied. 8. Entitlement to SMC at the housebound rate The Veteran that he is entitled to SMC at the housebound rate from February 1, 2018 to December 20, 2018. SMC at the housebound rate is available where a Veteran is in receipt of a 100 percent rating (or TDIU) based on a single disability and either (i) has additional disabilities independently rated at 60 percent or greater or (ii) if he is permanently housebound by reason of service-connected disability or disabilities. 38 C.F.R. § 3.350(i)(2). As explained above, the Board has granted the Veteran a total rating for his partial left knee replacement from February 1, 2018 to December 20, 2018. With the grant of this rating, the Veteran from February 1, 2018 to December 20, 2018 was in receipt of a total rating for his left knee as well as combined 60 percent ratings for separately rated disabilities. Therefore, SMC at the housebound rate is granted from February 1, 2018 to December 20, 2018.   REASONS FOR REMAND 1. Service connection for erectile dysfunction, to include as secondary to DDD of the lumbar spine The Veteran is claiming service connection for erectile dysfunction. Private treatment records from 2005 show a diagnosis of erectile dysfunction, though he has not sought more recent treatment from VA. Notably, the symptoms of erectile dysfunction are observable of lay observation. Jandreau, supra. The Veteran has indicated his belief that his erectile dysfunction is related to his service-connected DDD of the lumbar spine. He has not yet been afforded a VA examination of his erectile dysfunction. Therefore, on remand, the Board will order that the Veteran be afforded a VA examination of his erectile dysfunction and that a medical opinion as to the etiology of the Veteran’s erectile dysfunction be obtained. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to TDIU prior to December 20, 2017 As noted above, the issue of entitlement to TDIU has been raised in connection with the Veteran’s claims for increased ratings of his knees and migraine headaches currently on appeal. The RO has not yet had the opportunity to adjudicate this claim or gather information from the Veteran regarding his employment and educational background. The Board also notes that at the time of the February 2018 VA examination, the Veteran reported doing administrative work due to knee surgery. As the Veteran continued to recover from the surgery, he may have been able to resume additional duties. It would be useful to the Board in adjudicating the claim if the Veteran also reported limitations in his current job. Therefore, the Board will remain the claim for TDIU so that this development can be completed. The matters are REMANDED for the following action: 1. Request that the Veteran provide information regarding his education and employment history by completing VA Form 21-8940 and report current limitations on his work at his current job due to his disabilities. 2. Afford the Veteran a VA examination to determine the etiology of his erectile dysfunction. The examiner should opine as to whether: It is at least as likely as not that the Veteran’s erectile dysfunction was caused or aggravated by his service-connected DDD of the lumbar spine. A complete rationale should be provided for any opinion rendered. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. George