Citation Nr: 20021064 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 15-06 068 DATE: March 24, 2020 ORDER Entitlement to service connection for left upper extremity radiculopathy secondary to service-connected cervical spine disorder is granted. Entitlement to a disability evaluation in excess of 20 percent for post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) prior to October 28, 2014, is denied. Entitlement to a disability evaluation in excess of 40 percent for post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) from October 28, 2014, is denied. A 60 percent disability evaluation for right lower extremity radiculopathy from November 15, 2010, to October 28, 2014 is granted. An evaluation in excess of 40 percent for right lower extremity radiculopathy from October 28, 2014, is denied. A 10 percent disability, and no more, for left lower extremity radiculopathy from November 15, 2010, is granted. REMANDED Entitlement to service connection for an acquired psychiatric condition is remanded. FINDINGS OF FACT 1. The Veteran's left upper extremity radiculopathy has been shown to be etiologically related to his now service-connected cervical spine disorder. 2. For the time period prior to October 28, 2014, post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) was not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine; there were also no incapacitating episodes of intervertebral disc disease demonstrated during this time period. 3. For the time period from October 28, 2014, post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) was not manifested by unfavorable ankylosis of the entire thoracolumbar spine or incapacitating episodes requiring prescribed bed rest during any 12 month time period. 4. Radiculopathy of the right lower extremity caused severe impairment from October 15, 2010, to October 28, 2014. 5. Radiculopathy of the right lower extremity has caused no more than moderate impairment since October 28, 2014. 6. Radiculopathy of the left lower extremity has caused no more than mild impairment from October 5, 2010, the date of the Veteran’s request for service connection. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in favor of the Veteran, left upper extremity radiculopathy is caused by the service-connected cervical spine disorder. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 2. The criteria for an evaluation in excess of 20 percent for post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) based upon limitation of motion and/or incapacitating episodes, prior to October 28, 2014 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45. 4.71a, Diagnostic Codes Diagnostic Codes 5003, 5242, 5235-5243 (2019). 3. The criteria for an evaluation in excess of 40 percent for post laminectomy syndrome (previously rated as post laminectomy L4-5, L5-S1with chronic lower back pain) based upon limitation of motion and/or incapacitating episodes, from October 28, 2014 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45. 4.71a, Diagnostic Codes Diagnostic Codes 5003, 5242, 5235-5243 (2019). 4. The criteria for a 60 percent disability evaluation, and no more, for right lower extremity radiculopathy from October 15, 2010 to October 28, 2014, were met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code 8520 (2019). 5. The criteria for an evaluation in excess of 40 percent for right lower extremity radiculopathy from October 28, 2014, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code 8520 (2019). 6. Resolving reasonable doubt in favor of the Veteran, the criteria for a 10 percent disability evaluation, and no more, for left lower extremity radiculopathy have been met from October 15, 2010. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, Diagnostic Code 8520 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from June 2005 to November 2005 and from June 2006 to December 2006. Left Upper Extremity Radiculopathy Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). To establish secondary service connection, the law states that there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between a service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998), 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. In evaluating the evidence in any given appeal, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). The Veteran maintains that he currently has left upper extremity radiculopathy as secondary to his now service-connected cervical spine disorder. In conjunction with his claim, the Veteran was afforded a VA examination in October 2019. At that time, the Veteran was found to have no symptoms related to his left arm with regard to radiculopathy. In response to the question of whether the Veteran’s bilateral upper extremity radiculopathy was caused by or related to his military service or was secondary to his service-connected cervical spine disorder, the examiner stated that it was at least as likely as not that the Veteran’s claimed condition was due to or the result of his service-connected condition. The examiner indicated that the Veteran has had symptoms of bilateral upper extremity radiculopathy but presently had no current symptoms in his left arm. Although the Board notes that the examiner has indicated that the Veteran currently has no symptomatology related to his left arm radiculopathy, he has indicated that it is at least as likely as not that the left arm radiculopathy is related to his service-connected cervical spine disorder. The Board notes that service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). Thus, resolving reasonable doubt in favor of the Veteran, the Board will find that the Veteran has left arm radiculopathy due to or the result of his service-connected cervical spine disorder, which has been found to be currently asymptomatic. Evaluations Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 3 8 U.S.C. § 1155; 38 C.F.R. Part 4. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). 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. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Diagnostic Code 5003 provides that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is assigned where x-ray evidence shows involvement of two or more major joints or 2 or more minor joint groups. Where there is x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, a 20 percent evaluation is assigned. Note (1) to Diagnostic Code 5003 states that the 20 and 10 percent ratings based on x-ray findings, above, will not be combined with ratings based on limitation of motion. Id. Diseases and injuries to the spine are to be evaluated under diagnostic codes 5235 to 5243 as follows: With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine: 100 percent Unfavorable ankylosis of the entire thoracolumbar spine: 50 percent Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine: 40 percent Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 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: 20 percent Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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: 10 percent The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is as follows: With incapacitating episodes having a total duration of at least six weeks during the past 12 months 60 percent With incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months 40 percent With incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months 20 percent With incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months 10 percent Note (1): For purposes of evaluations under 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating for Formula and Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, Diagnostic Code 5235-5243. Disability of the musculoskeletal system is the inability to perform normal working movement with normal excursion, strength, speed, coordination, and endurance. Weakness is as important as limitation of motion, and a part which becomes disabled on use must be regarded as seriously disabled. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is to be considered in evaluating the degree of disability, but a little-used part of the musculoskeletal system may be expected to show evidence of disuse, through atrophy, the condition of the skin, absence of normal callosity, or the like. 38 C.F.R. § 4.40. The provisions of 38 C.F.R. § 4.45 contemplate inquiry into whether there is crepitation, limitation of motion, weakness, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, pain on movement, swelling, deformity, or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing are also related considerations. It is the intention of the rating schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as at least minimally compensable. See also DeLuca v. Brown, 8 Vet. App. 202 (1995) (indicates that pursuant to 38 C.F.R. §§ 4.40 and 4.45, pain may be the basis for a rating for a disability rated based on limitation of motion, regardless of whether the limitation of motion specified in the Diagnostic Code criteria is shown). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. The evidence of record, to include VA examinations, are sufficient for rating purposes. Neuritis, cranial or peripheral, 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 which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral the rating should include the application of the bilateral factor. 38 C.F.R. § 4.124a. Under 38 C.F.R. § 4.124a, Diagnostic Code 8520, which provides criteria for rating impairment of the sciatic nerve, a 10 percent evaluation is warranted for mild incomplete paralysis. A 20 percent rating requires moderate incomplete paralysis, and a 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. The next higher evaluation of 60 percent requires severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. An 80 percent evaluation requires complete paralysis of the sciatic nerve, in which the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. The Veteran maintains that the symptomatology associated with his lumbar spine disorder and resulting radiculopathy is worse than the disability evaluations which have been currently assigned. Treatment records reveal that at the time of a February 2011 VA outpatient visit, the Veteran reported having chronic low back pain. There was pain in the right side of the lower back which went posterolaterally to the right hip and down the right leg to the knee level. The worst pain was in the right hip and back of the knee. Neurological impairment in the lateral aspect of the right leg was noted. Range of motion revealed flexion to 60 degrees with pain, extension to 20 degrees with pain, lateral bending left and right to 30 degrees with pain, and rotation to the left of 35 degrees with pain and to 35 degrees on the right with no pain. In conjunction with his claim, the Veteran was afforded a VA examination in November 2011. At the time of the examination, the Veteran reported that his back pain had been getting worse and had been radiating down the right leg lateral thigh to the mid-calf since the inservice accident. The Veteran did not report having any flare-ups. Range of motion testing revealed flexion from 0 to 55 degrees, with pain beginning at 50 degrees. Extension was from 0 to 25 degrees, with pain beginning at 25 degrees. Right and left lateral flexion was from 0 to 30 degrees or greater, with no pain. Right and left lateral rotation was from 0 to 30 degrees or greater, with pain beginning at 30 degrees or greater. There was no additional loss of motion after repetitive use for any range of motion. The Veteran was noted to have less movement than normal and pain on movement. There was no localized tenderness or pain to palpation for joints and or soft tissue of the thoracolumbar spine. The Veteran did not have guarding or muscle spasm. Muscle strength was 5/5 for the lower extremities. Reflex examination for the knee and ankle was normal. Sensory examination was normal throughout. Straight leg raising was positive. Radiculopathy was noted. The Veteran was found to have severe constant pain on the right lower extremity and no constant pain in the left extremity. There was no intermittent pain, paresthesia/dysesthesia, or numbness in either the right or the left lower extremity. The Veteran was noted to have sciatic nerve involvement, on the right, which was described as severe, and no nerve involvement on the left. There was no intervertebral syndrome and the Veteran did not use any assistive devices. The examiner specifically indicated that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran was afforded an additional VA examination in October 2014. At the time of the examination, the Veteran reported having daily constant pain, stiffness, weakness, and poor mobility. Range of motion testing revealed flexion from 0 to 40 degrees, with pain beginning at 20 degrees. Extension was from 0 to 15 degrees, with pain beginning at 15 degrees. Right and left lateral flexion was from 0 to 20 degrees, with pain at 15 degrees on the right and 10 degrees on the left. Right and left lateral rotation was from 0 to 15 degrees with pain beginning at 15 degrees. With repetitive motion, flexion was limited to 30 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left rotation to 15 degrees. The Veteran was noted to have less movement than normal and to have interference with sitting, standing, or weight-bearing. There was pain but no weakness, fatigability, or incoordination. Tenderness was noted on the right sacroiliac region. Muscle strength was 4/5 on the right extremity throughout, and 5/5 on the left with hip flexion and knee extension and 4/5 for ankle plantar flexion, ankle dorsiflexion, and great toe extension. There was no muscle atrophy. Reflex examination was normal on the right and left, with the exception of 1+/2 on the right for the knee. Sensory examination was normal for both lower extremities. Straight leg raising was positive on the right and negative on the left. As to radiculopathy, the Veteran was noted to have moderate constant pain in the right lower extremity and mild paresthesia/dysesthesia. There was no intermittent pain or numbness for either extremity and no constant pain or paresthesias/dysesthesia on the left. The Veteran was found to have sciatic nerve involvement, with it being described as moderate on the right and none on the left. The Veteran did have intervertebral disc syndrome, but it had not resulted in any incapacitating episodes in the past 12 months. The Veteran reported occasionally using a brace. The examiner specifically indicated that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. At the time of his April 2018 hearing, the Veteran reported a worsening of his left leg radiculopathy and his overall low back disorder. Following the hearing, the Veteran was afforded an additional VA examination in October 2019. At that time, the Veteran reported that he had low grade pain in his lower back all the time. He had a continual numbness and tingling in the right leg situated on the back of his right thigh, lateral calf, and toes. He had pain in the right buttock but not down the right leg. The buttock pain lasted 5-30 minutes and could occur intermittently several times a day. The Veteran’s left leg had a slight tingling in his toes that was constant, but he had no numbness. There was no pain in the left leg or buttock after his third low back surgery in 2016. He took ibuprofen 800 mg twice a day for his pain. The Veteran did not have flare-ups. Range of motion testing revealed forward flexion to 65 degrees, extension to 25 degrees, right lateral flexion to 30 degrees, left lateral flexion to 20 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 30 degrees. There was pain with weightbearing. There was no additional functional loss with repetitive motion. There was no guarding or muscle spasm of the lumbar spine. Muscle strength was 5/5 for the left and right lower extremity. There was no muscle atrophy. Reflex examination was normal for the knee on the left and right and for the ankle on the left. It was absent in the ankle on the right. Sensory examination was normal for both extremities. Straight leg raising was negative. Radiculopathy was noted to be present. The Veteran was reported to have no constant pain in ether extremity. There was mild intermittent pain in the right lower extremity and none on the left. Mild paresthesias and/or dysesthesia was present in both lower extremities. Mild numbness was noted on the right but not the left. The examiner indicated that there was sciatic nerve involvement which was moderate on the right and mild on the left. There was no ankylosis. The examiner specifically reported that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. A VA nerve examination found that the Veteran had radicular neuropathy of both lower extremities. The Veteran was noted to have no constant pain in ether extremity. There was mild intermittent pain in the right lower extremity and none on the left. Mild paresthesias and/or dysesthesia was present in both lower extremities. Mild numbness was noted on the right but not the left. Muscle strength was 5/5. Reflex examination was normal for the knee on the left and right and for the ankle on the left. It was absent in the ankle on the right. The examiner indicated that the Veteran had mild incomplete paralysis on the left and right for the sciatic nerve and mild incomplete paralysis of the external popliteal nerve on the right but not the left. Evaluation for Post Laminectomy Syndrome (Previously Rated as Post Laminectomy L4-5, L5-S1 with Chronic Lower Back Pain) Based Upon Limitation of Motion/Incapacitating Episodes Prior to October 28, 2014 The Board finds that during this time the weight of the lay and medical evidence demonstrates that an evaluation in excess of 20 percent was not warranted on the basis of limitation of motion or incapacitating episodes. Forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine was not demonstrated during this time period. Moreover, as noted above, the Veteran was found to have forward flexion to no less than 50 degrees with no ankylosis being reported during this time frame. There were also no reports or findings of incapacitating episodes/physician prescribed bed rest, as defined in the regulation, totaling 4 weeks over any 12 month period during this time period. The competent evidence reflects consideration of the Veteran's complaints of pain, weakness, and fatigability by medical professionals. The VA examiner found no additional limitation of motion after repetition. Even when considering any additional limitation of motion caused by pain, fatigue, weakness and flare-ups, neither the actual range of motion nor the functional limitation warrants an evaluation in excess of 20 percent for limitation of motion based upon the appropriate codes governing limitation of motion for this time period. In sum, the weight of the lay and medical evidence demonstrates that an evaluation in excess of 20 percent is not warranted for at any time based upon range of motion or incapacitating episodes during this time period. 38 C.F.R. § 4.71a.   Evaluation for Post Laminectomy Syndrome (Previously Rated as Post Laminectomy L4-5, L5-S1 with Chronic Lower Back Pain) Based Upon Limitation of Motion/Incapacitating Episodes From October 28, 2014 The Board finds that the weight of the evidence demonstrates that a 40 percent rating, and no more, is warranted from October 28, 2014. At the time of the October 28, 2014 VA examination, the Veteran was found to have forward flexion to 20 degrees. At the time of the October 2019 examination, the Veteran was found to have flexion to 65 degrees. An evaluation in excess of 40 percent is not warranted as the Veteran has not been shown to have unfavorable ankylosis of the entire thoracolumbar spine. There has been no demonstration of unfavorable ankylosis at the time of any VA examination or in any VA treatment records. For example, at the time of his most recent VA examination, the Veteran was specifically found to not have ankylosis. As such, no more than a 40 percent disability evaluation based upon limitation of motion would be warranted. The evidence reflects consideration of the Veteran's complaints of pain, weakness, and fatigability by medical professionals. Even when considering any pain, fatigue, weakness and flare-ups, neither the actual range of motion nor the functional limitation warrants an evaluation in excess of 40 percent for limitation of motion based upon the governing limitation of motion. As to incapacitating episodes, as noted above, an incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician. The Veteran does not meet the criteria, as defined by regulation, that would allow for a 60 percent disability evaluation, the next higher evaluation, based upon incapacitating episodes, as there has been no demonstration of prescribed bedrest. Moreover, no VA examiner has indicated that the Veteran has IVDS which resulted in any physician prescribed bed rest or incapacitating episodes having a total duration of at least six weeks during the past 12 months. As such, a 60 percent evaluation, based upon incapacitating episodes, is not warranted at any time. Radiculopathy for the Right Lower Extremity Prior to October 28, 2014 As noted above, at the time of the Veteran's November 2011 VA examination, he was noted to have severe constant pain of the right lower extremity. The examiner found the Veteran to have sciatic nerve involvement, which was described as severe. As such, the Veteran has met the criteria for a 60 percent evaluation for right lower extremity radiculopathy until the time of the October 28, 2014 VA examination, when moderate impairment was demonstrated. An evaluation in excess of 60 percent was not warranted for this time period as the Veteran was not shown to have complete paralysis of the sciatic nerve, in which the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. The findings made prior to October 28, 2014 VA examination would not support an 80 percent disability evaluation. For these reasons, the Board finds that the preponderance of the evidence is against a rating in excess of 60 percent for right lower extremity radiculopathy for the time period prior to October 28, 2014. As the preponderance of the evidence is against an evaluation in excess of 60 percent for this period, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Radiculopathy for the Right Lower Extremity From October 28, 2014 As noted above, the RO assigned a 40 percent disability evaluation for right lower extremity radiculopathy from October 28, 2014. An evaluation in excess of 40 percent is not warranted as the Veteran was not shown to have severe radiculopathy during this time frame. For example, at the time of the October 2014 VA examination, muscle strength was no less than 4/5 with no muscle atrophy. Reflex examination was normal on the right, with the exception of 1+/2 on the right for the knee, and sensory examination was normal. As to radiculopathy, the Veteran was noted to have moderate constant pain on the right lower extremity and mild paresthesia/dysesthesia. The examiner described the Veteran’s sciatic nerve involvement as moderate. At the October 2019 VA examination, the Veteran was found to have mild intermittent pain and mild paresthesias and/or dysesthesia, and mild numbness. Muscle strength was 5/5 and reflex examination was normal for the knee and absent in the ankle on the right. The examiner indicated that the Veteran had mild incomplete paralysis for the sciatic nerve and mild incomplete paralysis of the external popliteal nerve. For these reasons, the Board finds that the preponderance of the evidence is against an evaluation in excess of 40 percent for right lower extremity radiculopathy for the time period from October 28, 2014. As the preponderance of the evidence is against an evaluation in excess of 40 percent for this period, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Left Lower Extremity Radiculopathy As to the left lower extremity, the Board notes that the Veteran has reported having tingling and numbness in his left lower extremity throughout the appeal period, including in VA treatment records and at the time of VA examinations. Moreover, the Veteran was found to have a positive straight leg raise test, which is indicative of radiculopathy. Resolving reasonable doubt in favor of the Veteran, the Board will find that his left lower extremity has resulted in mild impairment throughout the course of the appeal, warranting a 10 percent evaluation. An evaluation in excess of 10 percent is not warranted at any time. At the time of VA examinations, the Veteran has been found to have no more than mild neurological impairment of the left lower extremity, to include findings of no neurological impairment at the time of the 2011 and 2014 VA examinations, and no more than mild neurological impairment being found at the time of the 2019 VA examination. There have been no findings of moderate left lower extremity neurological impairment at any time. For these reasons, the Board finds that the preponderance of the evidence is against an evaluation in excess of 10 percent for left lower extremity throughout the appeal period. As the preponderance of the evidence is against an evaluation in excess of 10 percent, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND As it relates to the claim of service connection for a psychiatric disorder, to include PTSD, also claimed as secondary to service-connected disabilities, the Board notes that this matter was previously remanded in November 2018 for an examination. The examiner was requested to offer the following opinions: Was it as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, was etiologically related to the Veteran's periods of active service? If not, was it as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, was caused by any service-connected disorder? If not, was it at least as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, was aggravated by current service-connected disorder? The Veteran was afforded the requested examination in October 2019. Following examination, the examiner rendered a diagnosis of moderate cannibis use disorder. The examiner then stated that as the Veteran reported daily cannibis use, which he has done for several years, DSM-V criteria precluded making other mental health related diagnosis. This was because chronic cannibis use was known to cause and/or aggravate symptoms related to mood (depression, anxiety, dysphoria, irritability, etc., and is often associated with reduced concentration, memory and poor motivation and anhedonia). Therefore, the evaluating psychologist was unable to accurately assess for functional impairments and left section 3a. of the DBQ blank. He noted that the Veteran should obtain no less than 6 months abstinence prior to re-attempting psychological evaluation for disability purposes. As such, no medical opinion was posited. Unfortunately, the examiner did not provide the requested opinions. Therefore, additional development is warranted. Where the Board makes a decision based on an examination report that does not contain sufficient detail, remand is required "for compliance with the duty to assist by conducting a thorough and contemporaneous medical examination." Goss v. Brown, 9 Vet. App. 109, 114 (1996); Stanton v. Brown, 5 Vet. App. 563, 569 (1993). Moreover, the treatment records available indicate that the Veteran has been variously diagnosed as having a mood disorder, anxiety, depression as secondary to a general medical condition, along with being diagnosed as having PTSD and recurrent major depression, during the course of the appeal. Given the above, the Veteran should be afforded an additional VA examination to determine the etiology of any psychiatric disorder diagnosed during the course of the appeal and its relationship, if any, to his period of service or service-connected disabilities. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any current psychiatric disorder, to include PTSD. All indicated tests and studies should be performed and all findings should be reported in detail. The entire record should be made available to the examiner. The examiner is requested to offer the following opinions: Is it as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, is etiologically related to the Veteran's periods of active service? If not, is it as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, is caused by any service-connected disorder? If not, is it at least as likely as not (50 percent probability or greater) that any current psychiatric disorder, to include PTSD, is aggravated by current service-connected disorder? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. The examiner must also address the psychiatric disorders diagnosed during the course of the appeal, to include PTSD and major depression, when rendering the above opinions. Complete detailed rationale is requested for each opinion that is rendered. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. S. Kelly, Counsel 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.