Citation Nr: 20007264 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 15-42 722 DATE: January 28, 2020 ORDER Service connection for major depressive disorder (MDD), as secondary to a service-connected disability is granted. An increased rating in excess of 10 percent for cervical spine strain prior to February 26, 2019, is denied. A rating of 20 percent for cervical spine disability as of February 26, 2019, is granted. A rating of 40 percent for radiculopathy of the right upper extremity, the lower radicular group from February 26, 2019, is granted. An increased rating in excess of 10 percent for degenerative disc disease of the lumbar spine prior to February 26, 2019, is denied. A rating of 20 percent for degenerative disc disease of the lumbar spine as of February 26, 2019, is granted. A rating of 10 percent for radiculopathy of the left lower extremity from February 26, 2019, is granted. REMANDED Entitlement to service connection for a dental disability for compensation purposes is remanded. FINDINGS OF FACT 1. The Veteran’s MDD is proximately due to his service-connected cervical and lumbar spine disabilities. 2. Prior to February 26, 2019, the Veteran’s cervical spine strain was primarily manifested by decreased range of motion that did contribute to a functional loss, without muscle spasm or guarding, pain on examination or with weight bearing, or incapacitating episodes of IVDS. 3. On February 26, 2019, the Veteran’s cervical spine strain was shown to be manifested by decreased range of motion, pain on weight bearing and with non-weight bearing and muscle spasm and guarding. 4. On February 26, 2019, the Veteran manifested moderate incomplete paralysis of the lower radicular group of the right upper extremity. 5. Prior to February 26, 2019, the Veteran’s degenerative disc disease of the lumbar spine was primarily manifested by range of motion of forward flexion to 75 degrees, extension to 25 degrees, lateral flexion to 30 degrees bilaterally and rotation to 30 degrees bilaterally, without muscle spasm or guarding, pain on examination or with weight bearing, or incapacitating episodes of IVDS; no more than moderate incomplete paralysis of the right sciatic nerve is demonstrated. 6. On February 26, 2019, the Veteran’s degenerative disc disease of the lumbar spine was manifested by total limitation of motion of the spine of 123 degrees and evidence of guarding that affected gait. 7. On February 26, 2019, the Veteran manifested mild incomplete paralysis of the left sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for service connection for MDD as secondary to a service-connected disease or injury are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for an increased rating in excess of 10 percent for cervical spine strain prior to February 26, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 3. The criteria for a rating of 20 percent for cervical spine strain as of February 26, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 4. The criteria for a separate rating of 40 percent for radiculopathy of the right upper extremity related to cervical spine strain have been met as of February 26, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 8512. 5. The criteria for an increased rating in excess of 10 percent for degenerative disc disease of the lumbar spine prior to February 26, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5239. 6. The criteria for a rating of 20 percent for degenerative disc disease of the lumbar spine as of February 26, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5239. 7. The criteria for a separate rating of 10 percent for radiculopathy of the left lower extremity related to degenerative disease of the lumbar spine have been met as of February 26, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2000 to December 2003. The Veteran initially requested to testify at a formal hearing before the Board. In December 2019 correspondence, the hearing request was formally withdrawn. Service Connection MDD as secondary to a service-connected disability The Veteran contends that service connection should be established for MDD as secondary to his service-connected disabilities. On VA examination in August 2015 the VA examiner was asked to render an opinion regarding whether the Veteran has an acquired psychiatric disorder, including MDD, that is related to a service-connected disability. The examiner opined that the Veteran’s symptoms were not consistent with a known psychiatric disorder other than cannibis use disorder. As the Veteran was not diagnosed with depression, no relationship with a service-connected disability was found. A VA outpatient treatment noted dated in September 2015 includes a diagnosis of MDD secondary to another medical condition. On VA examination in February 2019, the diagnosis was MDD, recurrent, moderate. At that time, the examiner opined that it is at least as likely as not related to the service-connected conditions of cervical spine strain, degenerative disc disease, and radiculopathy. The rationale included that pain and depression were closely related and that depression is one of the most common mental health problems facing people with chronic pain. The examiner went on to state that, at times, depression and pain caused a “vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.” Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current MDD is proximately due to his service-connected cervical and lumbar spine disabilities. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for MDD is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.” Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The United States Court of Appeals for Veterans Claims (Court) has held that “staged” ratings are appropriate for an increased rating claim where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that it has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. An increased rating for cervical spine strain Service connection for cervical spine strain was granted by the RO in a January 2004 rating decision. A 10 percent rating was awarded at that time under Diagnostic Code 5237. The Veteran requested an increased rating for the cervical spine strain in May 2015. An examination was conducted by VA in August 2015. At that time, the diagnosis was cervical strain. The Veteran stated that he had recurring neck pain if he looked down for prolonged periods of time. This was described as a localized burning sensation, which he stated constituted flare-ups of his disorder. He had not sought treatment for his neck symptoms. He reported having no functional loss or functional impairment of the cervical spine. Range of motion was forward flexion to 40 degrees, extension to 40 degrees, right and left lateral flexion to 30 degrees and right and left lateral rotation to 40 degrees. The examiner stated that the Veteran demonstrated poor effort on range of motion testing. The examiner found that decreased range of motion did not itself contribute to a functional loss. No pain was noted on examination and there was no pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the cervical spine. The Veteran was able to perform repetitive use testing without further loss of function or range of motion. The Veteran was not examined after repeated use over time and the examiner would not speculate regarding any additional functional loss. The examination was not conducted during a flare-up. There was no evidence of localized tenderness, guarding or muscle spasm of the cervical spine. Strength testing of the upper extremities was 5/5. There was no evidence of muscle atrophy. Reflexes of the upper extremities was 2+ throughout. Sensory examination was normal. There was no radiculopathy, no ankylosis, and no intervertebral disc syndrome (IVDS). The examiner stated that the Veteran’s cervical spine disorder did not impact his ability to work. An examination was conducted by VA on February 26. 2019. At that time, it was noted that the Veteran was right handed. The Veteran described his current symptoms as pain, clicking, and stiffness of the neck. The pain traveled down the neck and he had decreased range of motion. The Veteran reported having flare-ups that were often triggered by work due to occupational activities. He would get increased pain and required frequent breaks at work. Functional loss was described as limited movement, fatigue and pain. Range of motion was forward flexion to 31 degrees with pain at 21 degrees; extension was to 40 degrees, with pain at 40 degrees; right lateral flexion to 20 degrees with pain at 20 degrees; left lateral flexion to 12 degrees, with pain at 12 degrees; right rotation to 55 degrees with pain at 44 degrees, and left rotation to 76 degrees with pain at 72 degrees. The Veteran was able to perform repetitive use testing with post testing range of motion being forward flexion to 20 degrees, extension to 40 degrees, left lateral flexion to 14 degrees, right lateral flexion to 16 degrees, eft rotation to 64 degrees and right rotation to 53 degrees. After testing, fatigue caused an increase in pain. As noted, pain was found on all range of motion testing and also on weight bearing or with non-weight bearing. The Veteran had localized tenderness or pain on palpation. Right paraspinal muscle and trapezius muscle spasm was noted as was guarding. Gait and spinal contour were normal. Factors contributing to functional loss included less movement than normal, incoordination, pain on movement, and interference with function of the right upper extremity due to radiculopathy. During flare-ups or when the joint was used repeatedly, the Veteran ceased activity in all planes of motion. He stated that he stopped activity to assist with discomfort. This resulted in frequent breaks to alleviate discomfort. Muscle strength testing was normal except in the right wrist, for which the Veteran is separately service connected with a separate rating and for the left wrist, which the examiner noted may be related to the Veteran’s service-connected left shoulder disorder. There was no muscle atrophy or ankylosis. Reflexes were normal at the biceps, absent at the triceps, and hyperactive without clonus at the brachioradials. Sensory examination on the right was normal in the shoulder area nad inner and outer forearm, but decreased in the hands and fingers. Sensory examination on the left was decreased in the left shoulder area, inner and outer forearm, and in the hands and fingers. The paresthesia of the left arm was associated with the Veteran’s left shoulder disorder and not with his neck condition. There was no excruciating or intermittent pain, but mild, dull pain was present in the right upper extremity. There was also mild paresthesia and moderate numbness in the right upper extremity. There was moderate radiculopathy of the right upper extremity with involvement of the C8/T1 nerve roots (the lower radicular group.) There was no evidence of IVDS. X-ray studies of the cervical spine documented arthritis. Employment status was impacted by limited repetitive movements that triggered a flare-up. He had weakness in the right that was related to radiculopathy of the cervical spine and the Veteran was limited in the amount of weight that the Veteran could carry. The Veteran’s cervical spine disorder is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for cervical spine strain prior to February 26, 2019. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain in the neck, stating that his condition had worsened to the point where he frequently had to take breaks while working to apply heated patches to his neck. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by these statements do not demonstrate that he has limitation of motion more nearly approximating forward flexion of 15 degrees but not greater than 30 degrees or the combined range of motion of the cervical spine not greater than 170 degrees. Additionally, the Veteran did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis prior to February 26, 2019. In this regard, it is noted that examiner in August 2015 found that any decreased range of motion did not itself contribute to a functional loss, there was no pain was noted on examination and no pain with weight bearing, no objective evidence of localized tenderness or pain on palpation of the cervical spine and the and the Veteran was able to perform repetitive use testing without further loss of function or range of motion. As such, a rating in excess of 10 percent is not shown to be warranted prior to February 26, 2019. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. However, the Veteran does not have incapacitating episodes of IVDS, and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The August 2015 examination report showed no IVDS. Regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability prior to February 26, 2019. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for cervical spine strain prior to February 26, 2019. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. On examination on February 26, 2019, the Veteran was noted to have additional limitation in the ranges of motion with pain on all planes of motion as well as on weight bearing and non-weight bearing. Significantly, muscle spasm with guarding was noted on examination. With the resolution of reasonable doubt, the Board finds that a 20 percent rating is appropriate for the Veteran’s cervical spine strain as of February 26, 2019. The Board further notes that there is no basis for a rating in excess of 20 percent, as the record does not show forward flexion of the cervical spine to 15 degrees or less or favorable ankylosis of the cervical spine. The Board notes that on examination on February 26, 2019, the Veteran was noted to have mild, dull pain, mild paresthesia, and moderate numbness of the right upper extremity. The examiner quantified the Veteran’s right upper extremity as being moderate radiculopathy with involvement of the C8/T1 nerve roots, which is the lower radicular group. The record shows that the Veteran’s right hand is his major extremity. Diagnostic Code 8512 provides ratings for paralysis of the lower radicular group of nerves. Diagnostic Code 8512 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the lower radicular group, with all intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand), is rated 70 percent disabling on the major side and 60 percent on the minor side. The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to 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. 38 C.F.R. § 4.124a. The moderate impairment of the Veteran’s right upper extremity, his major extremity, warrants a 40 percent rating on the basis of incomplete paralysis of the lower radicular group. While the record also shows neurologic impairment of the left upper extremity, the examiner found that this was associated with the Veteran’s left shoulder disorder and, as such, is not currently part of the appeal before the Board. An increased rating for degenerative disc disease of the lumbar spine Service connection for degenerative disc disease of the lumbar spine was granted by the RO in a January 2004 rating decision. A 10 percent rating was awarded at that time under Diagnostic Codes 5243 and 5239. The Veteran requested an increased rating for the lumbosacral spine disorder in May 2015. An examination was conducted by VA in August 2015. At that time, the diagnoses were degenerative arthritis of the spine, IVDS, and spinal stenosis. In addition, the Veteran was noted to have radiculopathy of the right lower extremity, for which service connection was granted in October 2014 with an award of a 20 percent rating. On examination, the Veteran reported that his low back disorder had persisted and worsened over the past year. He had had a course of physical therapy with no significant improvement. He stated that he had difficulty bending, lifting, prolonged sitting, and walking. These he described as flare-ups. He had sharp pain shooting down the right leg to the foot with numbness, tingling, and burning. A back brace and TENS unit provided no relief. He had difficulty tolerating medications that had been prescribed. He had just started using the medication Duloxetine, but it was too soon to assess the effects. He did not report having any functional loss due to impairment of the thoracolumbar spine. Range of motion was reported to be forward flexion to 75 degrees, extension to 25 degrees, lateral flexion to 30 degrees bilaterally and rotation to 30 degrees bilaterally. The decrease in range of motion did not contribute to a functional loss. Pain was noted on forward flexion and extension. There was no evidence of pain with weight bearing. There was tenderness to palpation with no palpable abnormalities. The Veteran was able to perform repetitive use testing without additional loss of function or range of motion. The Veteran was not examined immediately after repetitive use over time or during a flare-up. The Veteran did not have guarding or muscle spasm, but did have localized tenderness that did not result in abnormal gait or spinal contour. Muscle strength testing was normal throughout, without evidence of muscle atrophy. Reflexes were 2+ and equal, which is normal. Sensory examination was normal throughout. Straight leg raising was positive on the right and negative on the left. Radiculopathy was not demonstrated in the left lower extremity, but was shown in the right lower extremity. This was manifested by sever intermittent pain, severe paresthesias, and severe numbness. There were no other signs or symptoms of radiculopathy. Involvement of the nerve routs of the sciatic nerve was noted on the right. This was described as being productive of mild impairment. There was no ankylosis. There were no other neurologic abnormalities, but there was evidence of IVDS. He had not had episodes of IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not use any assistive devices. Arthritis was documented. The examiner did not find that the Veteran’s thoracolumbar spine disability impacted his ability to work. An examination was conducted by VA on February 26, 2019. At that time, the diagnoses were degenerative disc disease and radiculopathy. The examination report noted flare-ups that impacted the function of the thoracolumbar spine that caused decreased in mobility and an increase in lower extremity symptoms. This was often triggered by occupational activities, most notably forward flexion and bending. Functional loss was described as decreased mobility and increased pain. Forward flexion was to 40 degrees, with pain at 30 degrees. Extension was to 10 degrees, with pain at 9 degrees. Right lateral flexion was to 17 degrees, with pain at 19 degrees. Left lateral flexion was to 20 degrees, with pain at 19 degrees. Right rotation was to 21 degrees, with pain at 18 degrees. Left rotation was to 25 degrees with pain at 20 degrees. The abnormal ranges of motion contributed to functional loss. The Veteran was able to perform repetitive use testing with forward flexion further limited to 33 degrees, extension to 0 degrees, left lateral flexion to 15 degrees, right lateral flexion to 20 degrees, left lateral rotation to 30 degrees and right lateral flexion to 25 degrees. Post-test limitations contributing to functional loss caused an increase in pain causing fatigue. Ranges of motion were painful on active and passive testing. There was pain on weight-bearing or in non-weight-bearing. There was localized tenderness of the central lumbar spine. There was an abnormal gait due to guarding of the spine. Spinal contour was normal. Functional loss was caused by excess fatigability, incoordination, pain on movement, disturbances of locomotion, interference with sitting, and interference with standing. Flare-ups and repetitive used caused increased pain, decreased range of motion, fatigue and weakness. Muscle strength testing was noted in both lower extremities, but this was found to be due to the Veteran’s service-connected right knee and left foot disorders. There was no muscle atrophy or ankylosis. Reflexes were 0 at each knee and 2+ at each ankle. Sensory examination was decreased in both lower legs, ankles, and the feet and toes. Straight leg raising was normal. Radiculopathy was noted on both lower extremities, with moderate intermittent pain, paresthesias, and numbness on the right and mild intermittent pain, paresthesias, and numbness on the left. Radiculopathy was noted to be moderate in the right lower extremity and mild in the left lower extremity. Involvement of both femoral and both sciatic nerves was demonstrated. There were no incapacitating episodes of IVDS. Imaging studies demonstrated arthritis. The Veteran’s lumbar spine disorder is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5239 and 5243. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for lumbar spine disability prior to February 26, 2019. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to difficulty bending, lifting, prolonged sitting, and walking. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements are not shown to result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the thoracolumbar spine not greater than 120 degrees. Additionally, the Veteran did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. As noted, examination showed only tenderness that did not result in abnormal gait or spinal contour. Moreover, there was no evidence that the Veteran had incapacitating episodes of IVDS. As such there is no basis for a rating in excess of 10 percent under the criteria for evaluation of IVDS. See Diagnostic Code 5243. Regarding neurological impairment, as noted, the Veteran has been service-connected for right lower extremity neuropathy, rated 20 percent under Diagnostic Code 8520. Diagnostic Code 8520 provides ratings for paralysis of the sciatic nerve. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; moderately severe incomplete paralysis is rated 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. The 2015 VA examination demonstrated that the Veteran had severe intermittent pain, paresthesias and numbness, but the examiner characterized the disability as mild. As such, the neurologic impairment of the right lower extremity is found to be productive of moderate, not severe incomplete paralysis and a rating in excess of 20 percent is not shown to be warranted. On examination on February 26, 2019, the Veteran’s lumbosacral spine is shown to manifest forward flexion limited to 40 degrees, with total limitation in all planes of 123 degrees of limitation. This approaches the criteria for a rating of 20 percent. Moreover, guarding that interfered with the Veteran’s gait was demonstrated. As such, a rating of 20 percent is shown to be warranted as of the date of the examination. Regarding neurologic impairment, the examination now demonstrated radiculopathy in both lower extremities. Moderate intermittent pain, paresthesias, and numbness was shown on the right and mild intermittent pain, paresthesias, and numbness was shown on the left. Thus, the nerve impairment of the lower extremities is shown to be productive of moderate impairment in the right lower extremity and mild in the left lower extremity. Under the criteria outlined for impairment of the sciatic nerve, the 20 percent rating continues to be warranted in the right lower extremity, with a separate 10 percent rating now demonstrated in the left lower extremity. In summation, the Board finds that, prior to February 26, 2019, the Veteran’s thoracolumbar spine disability is shown to warrant no more than a 10 percent rating for limitation of motion of the lumbar spine and a 20 percent rating for sciatic nerve involvement of the right lower extremity. As of February 26, 2019, a 20 percent rating is warranted for the Veteran’s degenerative disease of the lumbar spine. In addition, while the rating for the neuropathy of the Veteran’s right lower extremity should be maintained at 20 percent, an additional 10 percent rating is shown to be warranted for neurologic impairment of the Veteran’s left lower extremity. To these extents, the appeal is allowed. REASONS FOR REMAND Entitlement to service connection for a dental disability for compensation purposes is remanded. The Veteran has claimed service connection for a dental disability. Pertinent regulations applicable to such claims reflect the respective responsibilities of the Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) in determinations concerning such claims. 38 C.F.R. § 3.381(a). The regulation states that VBA will adjudicate a claim for service connection of a dental condition after VHA determines that a veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests that VBA make a determination on relevant questions. 38 C.F.R. § 3.381(a). In this case, the RO explicitly adjudicated, and denied, the claim for entitlement to service connection for a dental disability for purposes of compensation and referred the claim of dental treatment to VHA. The regulation states, however, that one of the determinations to be made by VHA is whether the Veteran has a compensable dental disability. Id. Review of the Veteran’s service treatment records (STRs) show that on examination at entry into service the Veteran’s dental health was acceptable. STRs show that on dental examination in August 2000 the Veteran was noted to have a root tip of tooth numbered 31 and a supernumerary tooth at tooth numbered 16. A November 2000 screening examination did not indicate any needed treatment, but a March 2001 evaluation showed that the Veteran was in need of a prosthetic appointment as soon as possible. This is over 180 days from entry into service. Examination showed numerous missing upper and lower teeth. While service connection may not be established for compensation purposes based on noncompensable dental disability. A compensable rating for missing teeth may be awarded if the missing teeth are not replaceable by suitable prosthesis. 38 C.F.R. § 4.150, Diagnostic Code 9913. The Veteran has not been afforded a VA dental examination to ascertain whether the Veteran may wear prosthesis. As such, an examination must be conducted, and the Veteran’s claim must be first adjudicated by VHA. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any dental disorder. The examiner must evaluate the extent of the Veteran’s tooth loss and opine whether it is at least as likely as not replaceable by suitable prosthesis. 2. Refer the claim for dental treatment to the appropriate VA Medical Center (VAMC) to determine if the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161. If the VAMC determines that the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests VBA make any determination, adjudicate the claim. Rachel Erdheim Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.