Citation Nr: 20007571 Decision Date: 01/30/20 Archive Date: 01/29/20 DOCKET NO. 16-11 343 DATE: January 30, 2020 ORDER Entitlement to a rating in excess of 10 percent prior to March 18, 2019, for limitation of left knee flexion is denied. Entitlement to a separate rating of 10 percent, but no higher, from March 18, 2019, for limitation of left knee flexion is granted. Entitlement to a separate 20 percent rating is warranted from August 19, 2014, to March 17, 2019, for left knee meniscal surgery residuals. Entitlement to a rating in excess of 20 percent for left knee meniscal surgery residuals from March 18, 2019, is denied. Entitlement to a rating in excess of 10 percent prior to March 18, 2019, and in excess of 20 percent thereafter for service-connected low back strain is denied. Entitlement to a rating in excess of 20 percent from March 18, 2019 for service-connected radiculopathy, right lower extremity, is denied. Entitlement to a rating in excess of 20 percent from March 18, 2019 for service-connected radiculopathy, left lower extremity, is denied. Entitlement to a rating in excess of 30 percent prior to March 18, 2019, and in excess of 50 percent thereafter for service-connected migraine headaches is denied. FINDINGS OF FACT 1. Throughout the appeal the Veteran’s left knee disability was manifested by limitation of motion due to degenerative joint disease; it did not manifest in flexion limited to 30 degrees or less or extension limited to 10 degrees or instability or lateral subluxation or ankylosis. 2. Throughout the appeal, the Veteran’s left knee residuals of meniscal surgery has been manifested by X-ray evidence of meniscal surgery with locking and frequent episodes of pain and effusion into the joint. 3. Prior to March 18, 2019, the Veteran’s low back disability has not been shown to be manifested by forward flexion functionally limited to 60 degrees or less, combined range of motion functionally limited to 120 degrees or less, or with muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour or separately compensable neurological abnormality. 4. From March 18, 2019, the Veteran’s low back disability has not been shown to be functionally limited to 30 degrees or less, and favorable ankylosis of the entire thoracolumbar spine has not been diagnosed. 5. From March 18, 2019, the Veteran’s radiculopathy of the lower extremities has not been manifested by moderately severe incomplete paralysis of the left sciatic nerve or severe incomplete paralysis of the right femoral nerve. 6. Prior to March 18, 2019, the Veteran’s service-connected migraine headaches were not manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 7. From March 18, 2019, the Veteran’s service-connected migraine headaches have been assigned a 50 percent disability rating, which is the maximum schedular rating authorized under the applicable criteria. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to March 18, 2019, for left knee limitation of flexion is denied. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260. 2. The criteria for a separate rating of 10 percent, but no higher, for left knee limitation of flexion from March 18, 2019, is granted. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260. 3. The criteria for a separate rating of 20 percent, the maximum schedular rating, for left knee residuals of meniscal surgery prior to March 18, 2019 is granted. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5258. 4. Twenty percent is the maximum schedular rating for left knee residuals of meniscal surgery. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5258. 5. The criteria for a rating in excess of 10 percent prior to March 18, 2019, and in excess of 20 percent thereafter for service-connected low back strain have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 6. The criteria for a rating in excess of 20 percent for each lower extremity for radiculopathy related to service-connected low back disability from March 18, 2019, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.124a, Diagnostic Code 8520, 8526. 7. The criteria for a rating in excess of 30 percent prior to March 18, 2019, and in excess of 50 percent from that date, for service-connected migraine headaches have not been met. 38 U.S.C. §§ 1154(a), 5107; 38 C.F.R. §§ 3.321(b), 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2001 to May 2002 and October 2002 to August 2008, to include multiple tours in Iraq. The Board thanks the Veteran for his honorable service to our country. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In the October 2014 rating decision, the RO continued the Veteran’s 10 percent rating for his low back strain, 10 percent rating for his left knee degenerative joint disease, and his noncompensable rating for his migraine headaches. In a July 2016 rating decision, the RO assigned a 30 percent rating for his service-connected migraine headaches, effective August 19, 2014, the date of claim. In a September 2019 rating decision, the RO assigned a 50 percent rating for his service-connected migraine headaches, a 20 percent rating for his left knee degenerative joint disease with surgery, and a 20 percent rating for his low back strain, all effective March 18, 2019. In addition, separate 20 percent ratings were granted for radiculopathy of each lower extremity related to the service-connected back disability. As neurological symptomatology is a part of evaluation of back disability, the Board will include these ratings in its consideration of the appeal for higher ratings for the back disability. As higher ratings remain available for his disabilities, the claim remains on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). This matter was previously before the Board in September 2018, at which time it was remanded for additional development for outstanding treatment records and new VA examinations. The appeal has now been returned to the Board for further appellate action. As updated treatment records have been associated with the virtual file and the requested examinations were performed, the Board finds that there has been substantial compliance with the Board’s remand. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings 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. However, the criteria for rating migraines are successive. Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018). Successive criteria exist where the evaluation for each higher disability rating includes the criteria of each lower disability rating, such that if a component is not met at any one level, the Veteran can only be rated at the level that does not require the missing component. Tatum v. Shinseki, 23 Vet. App. 152, 156 (2008). Although 38 C.F.R. §§ 4.7 and 4.21 generally provide that symptoms need only more nearly approximate the criteria for a higher rating in order to warrant such a rating, those regulations do not apply where the rating schedule establishes successive criteria. While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different findings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 10 percent prior to March 18, 2019, and in excess of 20 percent thereafter for service-connected left knee degenerative joint disease with surgery Historically, the Veteran injured his knee in service in 2004 and underwent surgery in 2005 after MRI of the left knee revealed tears of the medial and lateral menisci and the ACL with joint effusion. Prior to March 18, 2019, the Veteran’s left knee disability was rated under Diagnostic Code 5003-5260, for degenerative arthritis rated as limitation of flexion and assigned a 10 percent rating. The September 2019 rating decision recharacterized his left knee disability rating to 5003-5258, rating it under the criteria for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion in the joint. That rating decision replaced the 10 percent rating under 5003-5260 with a 20 percent rating under 5003-5258 starting on March 18, 2019, the date of a VA examination. The appropriate diagnostic codes for rating limitation of motion of the knee are Diagnostic Codes 5260 and 5261. 38 C.F.R. § 4.71a. Normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. In VAOPGCPREC 9-2004, the VA General Counsel interpreted that, when considering Diagnostic Codes 5260 and 5261 together with 38 C.F.R. § 4.71, a Veteran may receive a rating for limitation in flexion only, limitation of extension only, or, if the 10 percent criteria are met for both limitations of flexion and extension, separate ratings for limitations in both flexion and extension under Diagnostic 5260 (leg, limitation of flexion) and Diagnostic Code 5261 (leg, limitation of extension). The diagnostic criteria applicable to semilunar cartilage are found at 38 C.F.R. § 4.71a, Diagnostic Code 5258 and 5259. Under 5258, a maximum 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. Under 5259, a maximum 10 percent rating is warranted for symptomatic removal of semilunar cartilage. Under Diagnostic Code 5260, limitation of knee flexion is rated noncompensable where flexion is limited to 60 degrees; 10 percent disabling where flexion is limited to 45 degrees; 20 percent disabling where flexion is limited to 30 degrees; and 30 percent disabling where flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, limitation of knee extension is rated noncompensable where extension is limited to 5 degrees; 10 percent disabling where extension is limited to 10 degrees; 20 percent disabling where extension is limited to 15 degrees; 30 percent disabling where extension is limited to 20 degrees; 40 percent disabling where extension is limited to 30 degrees; and 50 percent disabling where extension is limited to 45 degrees. Evaluation of a knee disability for limitation of motion under 38 C.F.R. § 4.71a, Diagnostic Codes 5260 or 5261 does not preclude, as a matter of law, separate evaluation of a meniscal disability of the same knee under 38 C.F.R. § 4.71a, Diagnostic Code 5258. Nor does evaluation of a meniscal disability under Diagnostic Code 5258 preclude, as a matter of law, separate evaluation of a different disability of the same knee under Diagnostic Code 5260 or 5261. See Lyles v. Shulkin, 29 Vet. App. 107 (2017). When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability and incoordination. An adequate orthopedic examination should record the range of motion for pain on active motion and passive motion, in weight bearing and non-weight bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). An examination does not need to be conducted during an actual flare-up to account for additional functional impairment, but examiners are asked to estimate the functional impairment experienced during a flare-up, considering all competent evidence of functional loss that is available in the record. Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017). The Veteran was accorded a VA examination in October 2014. The Veteran reported constant knee pain. On examination, he demonstrated flexion to 140 degrees and full range of extension, with objective evidence of painful motion at 95 degrees flexion. The Veteran was able to perform repetitive use testing with no additional functional loss. Functional loss and impairment were noted as incoordination, impaired ability to execute skilled movements smoothly, pain on movement, and swelling. The Veteran reported flare-ups resulting in increased pain. The Veteran had normal muscle strength without atrophy. The examiner noted no recurrent subluxation or lateral instability, or any tibial or fibular impairment. The examiner noted effusion and tenderness or pain to palpation. The examiner also noted that the Veteran had arthroscopic surgery for an ACL repair on his left knee in 2005 with residual pain. The examiner indicated that the Veteran’s diagnosis had changed to left knee degenerative joint disease. The Veteran was examined again in December 2015. The Veteran reported he cannot run or climb stairs, and the examiner noted that he had altered weight-bearing status and an antalgic gait. On examination, he demonstrated flexion to 90 degrees and extension to 90 degrees, and range of motion itself contributes to functional loss because he cannot squat. The Veteran was able to perform repetitive use testing with no additional functional loss. The Veteran did not report flare-ups. Additional disability factors of disturbance of locomotion and interference with standing were noted. The Veteran reported functional loss and impairment with repeated use over time, as he has to limit prolonged walking and standing. The Veteran had normal muscle strength without atrophy. The examiner noted no recurrent subluxation or lateral instability, or any tibial or fibular impairment. The examiner noted there was no history of recurrent effusion and the Veteran did not have a semilunar cartilage condition. The examiner also noted the Veteran’s 2005 ACL repair surgery with residual pain and limited motion and that he uses a cane regularly. The Veteran was accorded another examination in April 2016. The Veteran reported that his knee pain had worsened and that he had chronic pain rated an 8 out of 10. On examination, he demonstrated flexion to 80 degrees and extension to 80 degrees, with pain noted and that caused functional loss. The examiner noted difficulty with bending and pain with weight-bearing. The Veteran was able to perform repetitive use testing with no additional functional loss. The Veteran did not report flare-ups. There was objective evidence of localized tenderness or pain on palpation with mild pain under the patella and medial knee. Swelling was indicated as an additional factor contributing to disability. The Veteran had reduced muscle strength without atrophy and without ankylosis. The examiner noted no recurrent subluxation or lateral instability, or any tibial or fibular impairment. The examiner noted mild chronic effusion and that the Veteran did not have a semilunar cartilage condition. The examiner indicated that the Veteran’s condition would impact his ability to perform any type of occupational task due to difficulty with bending, prolonged standing, and climbing stairs. On the March 2019 examination, the Veteran reported aching, throbbing, and sharp constant pain in his left knee. He further reported edema in his left knee with ambulation, sitting, and standing. On examination, he demonstrated flexion to 110 degrees and extension to 110 degrees, with pain noted on the examination and caused functional loss. The Veteran was able to perform repetitive use testing with no additional functional loss. The Veteran reported flare-ups with increased pain and edema with physical activity. The examiner was unable to describe the Veteran’s limited functional ability with flare-ups in terms of range of motion, as the Veteran reported that it would depend on how strenuously he used his knee. The Veteran had reduced muscle strength without atrophy or ankylosis. The examiner noted no recurrent subluxation or lateral instability, or any tibial or fibular impairment. The examiner noted the Veteran had a history of recurrent effusion, with edema in his left knee with ambulation, sitting, and standing. The examiner noted that the Veteran has a semilunar cartilage condition of a meniscal tear, with frequent episodes of joint pain and joint effusion. Regarding the Correia criteria, the examiner indicated that there was objective evidence of pain with non-weightbearing and that the Veteran’s passive range of motion testing was the same as his active range of motion. The Board notes that the 2014 VA knee examination noted June 2013 X-ray showed effusion of the left knee with evidence of prior ACL repair. During that examination, the Veteran reported constant left knee pain and physical examination noted lateral, medial and anterior joint line pain. A 2015 VA left knee examination report also noted joint line pain. Slightly prior to the one-year period prior to the claim for increase, in March 2013, a VA treatment record noted effusion in the left knee with mild warmth. In addition, the 2016 VA examination report noted mild chronic effusion. Given the consistent findings of limitation of left knee flexion in the 2014 and 2016 VA left knee examinations in addition to the notations on both examinations of effusion and joint pain, the Board finds that the evidence is at least in equipoise with respect to affording separate evaluations for meniscal disability under DC 5258 in addition to limitation of flexion under DC 5260 throughout the appeal. Considering the evidence of record, the Board finds that a rating in excess of 10 percent under DC 5260 or a separate rating under 5261 is not warranted at any time during the period on appeal. At no point has the Veteran’s left knee been shown to suffer any limitation of motion contemplated by the next highest rating criteria. At worst, the Veteran’s flexion has been limited to 80 degrees and his extension limited to 80 degrees. A higher rating of 20 percent requires flexion limited to 30 degrees; a separate rating under DC 5261 requires extension limited to 10 degrees. As the Veteran does not have the limitation of motion required for the next highest rating for flexion or for a compensable rating for extension, a rating in excess of 10 percent based on limitation of motion is denied. The provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 have been considered and applied. Pain itself does not constitute functional loss, and painful motion does not constitute limited motion for the purposes of rating under Diagnostic Codes pertaining to limitation of motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Pain must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss. Id. The Veteran’s complaints of painful motion and weakness with repeated use over time and with flare-ups were specifically accounted for in the VA examinations, with the most detailed information provided in the 2019 examination. The Veteran denied flare-ups in the 2016 VA examination. The Board acknowledges the competent and credible lay reports of pain, but such evidence does not establish entitlement to a higher rating based on limitation of motion. The 2016 and 2019 examiners found no additional loss of function or range of motion after 3 repetitions. In 2019, and the Veteran reported his loss of range of motion was variable depending on how strenuously the joint was used, from inability to flex to minimal loss of range of motion. The examiner stated range of motion testing was the same with active and passive motion and with objective evidence of pain. The Board has also considered whether a higher disability rating or separate disability is warranted under other diagnostic codes. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5262, and 5263. However, throughout the appeal, the medical evidence of record concluded that the Veteran does not demonstrate malunion of the tibia and fibula with moderate knee or ankle disability, genu recurvatum, ankylosis, or recurrent subluxation or lateral instability. As such, no higher or separate disability ratings are warranted under Diagnostic Codes 5256, 5257, 5262, 5263, or any others. 2. Entitlement to a rating in excess of 10 percent prior to March 18, 2019, and in excess of 20 percent thereafter for service-connected low back strain Disabilities of the spine, including those rated under Diagnostic Code 5237, are rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. The General Rating Formula for rating Diseases and Injuries of the Spine provides for a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or the 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; 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 with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar 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. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. Normal combined range of motion of the thoracolumbar spine is 240 degrees. Normal ranges of motion for each component of spinal motion provided are the maximum usable for calculating the combined range of motion. 38 C.F.R. § 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note 2. In October 2014, the Veteran was provided a VA thoracolumbar spine examination. He reported constant low back pain that is worse in the morning, with bending, lifting, and running. He reported flare ups with pain ranging from a 5 out of 10 to a 9 out of 10. Forward flexion was recorded at 70 degrees and pain was noted with all range of motion. The Veteran’s total range of motion was 175 degrees. The examiner noted that the Veteran had functional loss and impairment with less movement than normal, pain on movement, and interference with sitting, standing and weight-bearing. The examiner noted that the Veteran would have additional limits on his functional ability during flare-ups or when the joint is used repeatedly over time, but the Veteran was unable to estimate this additional limitation in terms of range of motion because it would vary due to severity of pain, weakness, fatigability, and overuse. The Veteran had tenderness to palpation along the lumbar paraspinal muscles. There was no evidence of muscle spasm or guarding. No ankylosis was indicated during the examination. The Veteran was accorded another VA examination in April 2016. The Veteran reported that he has constant, chronic pain that he described as an 8 out of 10. He reported flare-ups with shooting pain and functional loss and impairment requiring him to use a cane. Forward flexion was recorded at 90 degrees, and pain did not contribute to functional loss. His total range of motion was 170 degrees. There was no evidence of pain with weight bearing. There was localized tenderness in the lower lumbar paraspinal muscle bilaterally and no guarding and no muscle spasm were noted during the examination. The examiner was unable to say whether pain, weakness, fatigability, or incoordination would significant limit functional ability with repeated use over time or with flare-ups. No ankylosis was noted. At the March 2019 VA examination, the Veteran reported that he had aching, throbbing, and sharp constant pain in his lower back. He reported flare-ups with increased dull pain and numbness in his lower back and bilateral lower extremities. The Veteran reported functional loss or impairment due to difficulty with bending, standing, and lifting heavy objects. Forward flexion was recorded at 50 degrees. The examiner indicated that with repeated use over time and during flare-ups, the Veteran’s range of motion would be decreased due to pain, weakness, fatigability, or incoordination, but that the examiner could not describe this in terms of range of motion because the Veteran stated the loss of range of motion depends on how strenuously the joint was used. The examiner indicated that additional factors contributing to disability were interference with sitting and standing and that pain increases in the lower back with prolonged sitting and standing. No ankylosis of the thoracolumbar spine was indicated on the examination report. Regarding the Correia criteria, the examiner indicated objective evidence of pain when the back is used in non-weightbearing, and passive range of motion could not be performed or was not medically appropriate. The examiner opined that the Veteran’s condition impacts his ability to work because his back pain causes limitations with prolonged standing, sitting, and lifting heavy objects. For the appeal period prior to March 18, 2019, the evidence of record does not indicate a rating higher than 10 percent is warranted for his lower back strain. There is no evidence that the Veteran’s low back disability was limited to forward flexion 60 degrees or less, combined range of motion limited to 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. For this period, the Veteran’s service-connected lower back strain was manifested by painful flexion that, at its most severe, was limited to 70 degrees, the total range of motion was limited at worse to 170 degrees, and no muscle spasm or guarding was shown. Accordingly, a rating in excess of 10 percent for this period is not warranted. From March 18, 2019, the Board finds that the criteria for a rating in excess of 20 percent are not met. There is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less. For this portion of the appeal period, the Veteran’s service-connected lumbar spine strain was manifested by painful flexion that, at its most severe, was limited to 50 degrees. Furthermore, there is no evidence of favorable ankylosis of the entire thoracolumbar spine at any point during the appeal period. The Board has considered whether a higher rating is appropriate under 38 C.F.R. §§ 4.40, 4.45, and 4.59, and concluded that such is not warranted for any period on appeal. Pain itself does not constitute functional loss, and painful motion does not constitute limited motion for the purposes of rating under Diagnostic Codes pertaining to limitation of motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Pain must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss. Id. The Veteran’s complaints of painful motion, fatigue, and weakness with repeated use over time and with flare-ups were specifically accounted for in the VA examinations. The Board acknowledges the competent and credible lay reports of pain, but such evidence does not establish entitlement to a higher rating. In light of the probative evidence of record, the record does not support the claim for a rating in excess of 10 percent prior to March 18, 2019, or in excess of 20 percent thereafter for the Veteran’s service-connected low back strain. With respect to the Veteran’s separate ratings for radiculopathy of the lower extremities, rated 20 percent each from March 18, 2019, the Board finds that a higher rating is not warranted for that period. The left leg is rated under DC 8520 which requires moderately severe incomplete paralysis of the sciatic nerve for the next higher, 40 percent rating, and more severe symptoms for even higher ratings under that DC. The right leg is rated under DC 8526 which requires severe incomplete paralysis of the femoral nerve for a higher rating and complete paralysis of the related muscles for an even higher rating. The preponderance of the evidence is against a finding of moderately severe incomplete paralysis of the sciatic nerve on the left of severe incomplete paralysis of the femoral nerve on the right. The 2019 VA examination report showed the Veteran complained of purely sensory symptoms, including numbness and tingling in the lower extremities. While the examiner assessed the Veteran’s numbness and paresthesias and/or dysesthesias as severe, and severe constant pain in the left lower extremity with moderate constant pain on the right, the examiner assessed the degree of impairment as moderate for both extremities. There was no muscle atrophy, reflexes were normal, and light touch was at most decreased, not absent. Accordingly, the preponderance of the evidence is against a finding that the criteria for higher radiculopathy ratings are warranted for either lower extremity. With respect to the period prior to March 18, 2019, while a March 2014 VA treatment record noted numbness and tingling in the left lower extremity and a May 2015 VA treatment record noted numbness, a VA treatment record in April 2014 denied numbness, tingling or weakness in the lower extremities and the 2014 and 2016 VA examinations found no neurological abnormalities or findings related to the back disability. The Veteran specifically denied radiculopathy during the 2014 VA examination. Accordingly, the preponderance of the evidence is against a finding that a separate rating for any neurological symptoms prior to March 18, 2019 is warranted. In reaching this determination, the Board is mindful that all reasonable doubt is to be resolved in the Veteran’s favor. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). However, because the preponderance of the evidence is against the claim, the claim must be denied. 3. Entitlement to a rating in excess of excess of 30 percent prior to March 17, 2019, and in excess of 50 percent from that date for service-connected migraine headaches The Veteran seeks a rating in excess of 30 percent prior to March 18, 2019, and in excess of 50 percent from that date. The Veteran’s service-connected headaches are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under Diagnostic Code 8100, a noncompensable rating is assigned for headaches with characteristic prostrating attacks averaging less than one in two months over the last several months. A 10 percent rating is assigned for headaches with characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is assigned for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A maximum schedular 50 percent rating is assigned for headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Although the rating criteria do not define “prostrating,” according to Dorland’s Illustrated Medical Dictionary 1531 (32nd Ed. 2012), “prostration” is defined as “extreme exhaustion or powerlessness.” The term “productive of severe economic inadaptability” is not defined by VA regulations. The Court, however, has stated that this term is not synonymous with being completely unable to work and that the phrase “productive of” could be read to mean either “producing” or “capable of producing” economic inadaptability. Pierce v. Principi, 18 Vet. App. 440, 446-47 (2004). For the period prior to March 17, 2019, the preponderance of the evidence of record is against a finding that the Veteran’s service-connected headaches met the criteria for a 50 percent rating. The Veteran reported persistent headaches with blurred vision and sensitivity to light and sound during his April 2016 VA examination. The Veteran reported daily headaches that can last for an hour at a time and he indicated he experiences characteristic prostrating attacks once every month. The examiner indicated that the Veteran’s migraine headaches were not productive of severe economic inadaptability and the Veteran did not report that they resulted in extreme exhaustion or powerlessness. Based on a review of the evidence of record, the Board finds that a rating in excess of 30 percent is not warranted for the period prior to March 17, 2019. The evidence does not show that his headaches were productive of very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability or that they resulted in extreme exhaustion or powerlessness. As such, the criteria corresponding to a higher rating of 50 percent were not met, and the Veteran’s 30 percent rating for this period is better reflective of his level of disability. Accordingly, entitlement to a rating in excess of 30 percent for service-connected headaches prior to March 17, 2019 is denied. On the March 2019 examination, it was noted that the Veteran experienced prostrating attacks of migraine headache pain more frequently than once per month that were productive of severe economic inadaptability. The examiner indicated that his migraine headaches impact his ability to work as they affect the Veteran’s concentration. Based on this examination, the Veteran was assigned a 50 percent rating for his service-connected headaches, effective March 18, 2019. As noted above, the 50 percent rating is the maximum schedular evaluation allowed under Diagnostic Code 8100. 38 C.F.R. § 4.124a. As the Veteran is now in receipt of the maximum schedular rating for his migraine headaches under Diagnostic Code 8100, the preponderance of the evidence is against a higher schedular rating and the benefit of the doubt rule is not for application. Accordingly, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent prior to March 17, 2019, and in excess of 50 percent from that date for his service-connected migraine headaches. As the preponderance of the evidence is against the claim, the claim is denied. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Goreham 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.