Citation Nr: 20031132 Decision Date: 05/04/20 Archive Date: 05/04/20 DOCKET NO. 19-31 574 DATE: May 4, 2020 ORDER Entitlement to service connection for headaches is denied. Entitlement to service connection for insomnia is denied. Entitlement to service connection for sleep apnea is denied. Entitlement to a disability rating in excess of 10 percent for tinnitus is denied. Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) prior to April 6, 2017 is denied. Entitlement to a disability rating in excess of 10 percent for radiculopathy of the upper right long thoracic nerve is denied. Entitlement to a disability rating in excess of 10 percent prior to April 14, 2017 and in excess of 30 percent thereafter for radiculopathy of the upper left middle radicular group is denied. Entitlement to a disability rating in excess of 10 percent for radiculopathy of the lower right extremity sciatic nerve is denied. Entitlement to a disability rating in excess of 10 percent for radiculopathy of the lower left extremity sciatic nerve prior to April 14, 2017, and in excess of 20 percent, thereafter, is denied. REMANDED Entitlement to a disability rating in excess of 10 for intervertebral disc syndrome with degenerative arthritis of the cervical and thoracic spine is remanded. Entitlement to a disability rating in excess of 20 percent for intervertebral disc syndrome with degenerative arthritis of the lumbar spine is remanded. Entitlement to a disability rating in excess of 20 percent for hypertension is remanded. Entitlement to a compensable disability rating for hearing loss is remanded. FINDINGS OF FACT 1. The Veteran does not have a headache disability which is related to service. 2. The Veteran does not have an insomnia disability which is related to service. 3. The Veteran does not have a sleep apnea disability which is related to service. 4. The Veteran's tinnitus causes no worse than recurrent ringing in both ears. 5. The severity, frequency, and duration of the Veteran’s PTSD symptoms did not more closely approximate total occupational and social for the period on appeal. 6. The Veteran’s radiculopathy of the upper right extremity, long thoracic nerve, is manifested by no more than mild incomplete paralysis of the major extremity. 7. Prior to April 14, 2017 the Veteran’s radiculopathy of the upper left middle radicular group is manifest by no more than mild incomplete paralysis of the minor extremity. From April 14, 2017, the Veteran’s radiculopathy of the upper left middle radicular group is manifested by no more than moderate incomplete paralysis of the minor extremity. 8. The Veteran’s radiculopathy of the lower right extremity, sciatic nerve is manifested by no more than mild incomplete paralysis. 9. Prior to April 14, 2017, the Veteran’s radiculopathy of the lower left extremity, sciatic nerve is manifested by no more than mild incomplete paralysis. From April 14, 2017, the Veteran’s radiculopathy of the lower left extremity, sciatic nerve is manifested by no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for insomnia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to an initial disability rating greater than 10 percent for tinnitus have not been met. 38 C.F.R. § 4.87, Diagnostic Code 6260. 5. The criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 6. The criteria for a disability rating in excess of 10 percent for radiculopathy of the right upper extremity long thoracic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8519. 7. The criteria for a disability rating in excess of 10 percent for radiculopathy upper left middle radicular group prior to April 14, 2017 and in excess of 30 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Codes 8519, 8511. 8. The criteria for a disability rating in excess of 10 percent for radiculopathy of the right lower extremity, sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 9. The criteria for a disability rating in excess of 10 percent for radiculopathy of the left lower extremity, sciatic nerve, prior to April 14, 2017, and in excess of 20 percent, thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1973 to November 1993. These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision by the RO. The Board notes that, in his notice of disagreement, as pertaining to the increased rating claims, the Veteran stated that he objected to the effective dates of the award. However, because he is not requesting an earlier effective date for the initial grant of service connection, his request for earlier effectives date is correctly described as a claim for a staged increased rating (meaning the Veteran is requesting that the increased rating be effective earlier during the appeal period). Accordingly, the Board has addressed the request for an "earlier effective date" in the analysis of the dates relevant to the current increased ratings. This analysis will encompass all effective date concerns and maximize the benefits awarded to the Veteran. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Entitlement to Service Connection for Headaches The Veteran asserts that he has a headache disability which is related to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service treatment records include a January 1981 treatment note in which the Veteran reported a nervous feeling in his stomach, headache, vomiting and loose stools, an assessment of gastritis was assigned. A June 1987 treatment note reported hypertension, there was significant emotional anxiety with headache. In an October 1993 service treatment note, the Veteran denied headache. The Veteran’s October 1993 report of medical examination for separation was silent as to any diagnosis for or symptoms of headaches. The Veteran reported that he did not have a history of, nor did he have frequent or severe headaches in his October 1993 report of medical history. Post-service treatment notes include a September 2010 VA medical center note in which the Veteran denied headache. The Veteran denied migraine headaches in a November 2010 treatment note. In December 2010, the Veteran reported neck pain which sometimes fluctuated to an eight or nine out of ten on the pain scale with severe headaches. The Veteran again denied headaches during October 2011 during treatment for viral gastroenteritis. August 2013, October 2014 and December 2016 treatment notes report that the Veteran denied chronic or recent unusual headaches. At an April 2017 VA examination for peripheral neuropathy, the Veteran reported that he had headaches in the left forehead intermittently. While headaches are shown sporadically within the record over a span of many years, the Board concludes that the Veteran does not have a disability manifested by headaches and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In fact, the record is largely silent as to headache symptoms at all, to include pain due to headaches, with some exception described in the Veteran’s explaining that his neck pain sometimes caused severe headache. However, the record does not demonstrate that such caused functional impairment of earning capacity, as, again symptoms are largely absent entirely from the record. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). As the overwhelming evidence of record fails to show a disability manifested by headaches, service connection must be denied. Entitlement to Service Connection for Insomnia The Veteran contends that he has insomnia which is due to his active duty service. Service treatment records include the Veteran’s October 1993 report of medical examination for separation which does not note a sleep disorder. An October 1993 treatment record associated with inpatient treatment for alcohol abuse includes a note that the Veteran was given Ativan as needed for insomnia. The Veteran’s October 1993 report of medical history for separation in which the Veteran reported that he did not experience frequent trouble sleeping. The Veteran’s post-service treatment records include an April 2010 treatment note, in which the Veteran described difficulty sleeping due to pain and nightmares. Treatment notes also include depression screens in which the Veteran reported trouble staying asleep or sleeping too much in June 2010, September 2010, December 2012, June 2012, January 2013. The Veteran reported sleep disturbance symptoms and distressing dreams during his April 2011 VA PTSD examination and reported trouble sleeping for thirteen years. The Veteran reported distressing dreams. The VA examiner described the Veteran’s difficulty falling or staying asleep in the criteria of the Veteran’s PTSD symptoms. In a July 2015 VA examination for PTSD, the Veteran reported that he slept well for years when he worked full time and started to decompensate after the death of his wife in 2011. The Veteran’s April 2017 VA examiner described sleep disturbance as one of the Veteran’s PTSD symptoms. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of insomnia and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While the Veteran is shown to report trouble sleeping, this symptom has been associated with psychiatric symptoms, is a symptom of PTSD, and the Veteran is in receipt of service connection for PTSD. Thus, while the record demonstrates that the Veteran experiences trouble with sleep, a separate sleep disorder is not shown by the evidence of record. While the Veteran believes he has a current diagnosis of insomnia, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical knowledge to determine the causes of the Veteran’s troubled sleep. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence and service connection for insomnia is denied. Entitlement to Service Connection for Sleep Apnea The Veteran asserts that he has sleep apnea due to service. Service treatment records include the Veteran’s October 1993 report of medical examination for separation which does not note a sleep disorder and his October 1993 report of medical history for separation in which the Veteran reported that he did not experience frequent trouble sleeping. Post-service treatment records include a November 2010 treatment note in which the Veteran denied snoring or obstructive sleep apnea. As described in the analysis above, the Veteran does report trouble sleeping, however this has been associated with his service-connected PTSD and the evidence does not demonstrate that the Veteran has had sleep apnea during any period on appeal. As the evidence fails to demonstrate a current disability, service connection must be denied. Increased Ratings Generally Disability ratings are determined by comparing a Veteran's present symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where an increase in the disability rating is at issue, the present level of the Veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). It is also noted that staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119 (1999), Hart v. Mansfield, 21 Vet. App. 505 (2007). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Entitlement to a Disability Rating in Excess of 10 Percent for Tinnitus In an April 2011 rating decision, the RO granted service connection for tinnitus and assigned an initial 10 percent disability rating pursuant to 38 C.F.R. § 4.87, Diagnostic Code 6260, effective January 18, 2010. The 10 percent rating was continued in the appealed August 2015 rating decision. The regulations pertaining to the evaluation of diseases and injuries of the ears were revised effective June 10, 1999. See 64 Fed. Reg. 25, 202 (1999) (codified at 38 C.F.R. § 4.85 - 4.87 (2002)). The regulation was again revised in May 2003, effective June 13, 2003. See 68 Fed. Reg. 25,822 (2003). The June 13, 2003 revision was undertaken, in part, to clarify existing VA practice that only a single 10 percent evaluation is assigned for recurrent tinnitus pursuant to Diagnostic Code 6260, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note 2. In this case, the Veteran's claim for service connection for tinnitus was received after the June 2003 change. Therefore, no more than a single 10 percent rating is permissible for the Veteran's tinnitus. See also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006) (affirming the VA's long-standing interpretation of pre-June 13, 2003 Diagnostic Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral). In light of the foregoing, the Board concludes that Diagnostic Code 6260 precludes the assignment of an initial rating in excess of 10 percent for the Veteran's service-connected tinnitus. As such, the Veteran's claim for an initial rating in excess of 10 percent for his service-connected tinnitus must be denied. Entitlement to a Disability Rating in Excess of 70 Percent for PTSD prior to April 6, 2017 The Veteran contends that his PTSD symptoms warrant a disability rating in excess of 70 percent prior to April 6, 2017. In May 2015, the Veteran submitted a claim for an increased rating for PTSD and, in the appealed August 2015 rating decision, the RO continued the 70 percent disability rating. Following an April 6, 2017 VA examination which demonstrated increased symptoms, in an October 2019 rating decision, the Veteran’s rating was increased to 100 percent, the highest available rating, effective the date of that examination. As the Veteran’s appeal was granted in full from April 6, 2017 onward, the Board will examine the Veteran’s symptoms from May 5, 2014, considering a "one-year lookback" starting a year before the claim for an increased rating was submitted, to April 5, 2017, the last day of the Veteran’s 70 percent disability rating. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran’s symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that more closely approximated the level of impairment associated with a 70 percent rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. At his July 2015 VA examination, the Veteran reported that he was last suicidal in 2010. When asked about his PTSD symptoms he reported that he is always up and is “protecting,” he reported that he slept well for years when working full time. It was noted that the symptom that applied to the Veteran’s diagnosis was suspiciousness. The examiner Veteran concluded that the Veteran’s had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication, the rating criteria for a 10 percent disability rating. The examiner stated that at the time of examination, the Veteran’s condition was quiescent. VA medical center treatment notes include a November 2015 treatment note that included a positive PTSD screen, the Veteran reported nightmares about stressors, avoidance, being on guard, that he was watchful or easily startled and that he felt numb or detached from others, activities, or his surroundings. In October 2014 and November 2015, suicidal and homicidal ideation were denied. In December 2016, the Veteran denied homicidal ideation. The Board finds the severity, frequency, and duration of the Veteran’s symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. In fact, as demonstrated by the Veteran’s July 2015 VA examination, the Veteran’s symptoms appear to have been less severe than the symptoms described in the 70 percent rating for the period on appeal. Notably, the Veteran’s VA examiner described symptoms as “quiescent” i.e. dormant, and the Veteran’s treatment notes demonstrate startle symptoms, nightmares and avoidance but symptoms described in the 100 percent rating such as being a danger to himself or others and impairment in thought processes, communication and delusions or hallucinations or symptoms approximating such are not demonstrated. The Veteran is not shown to be disoriented or to have memory loss to the severity described by the 100 percent rating. As the severity of the Veteran’s PTSD is shown to best meet the criteria for a 70 percent rating, or lower, for the period on appeal, the 70 percent disability rating will not be interrupted, but a higher, 100 percent disability rating is not warranted. Entitlement to Increased Ratings for Upper Right and Upper Left Extremity Radiculopathy As much of the fact pattern and rating criteria for the Veteran’s right and left upper extremity radiculopathy are similar, the issues are considered together, below. The Veteran contends that he is entitled to higher ratings for his right and left arm radiculopathy. The August 2015 rating decision on appeal continued the Veteran’s 10 percent disability ratings for radiculopathy of both upper extremities under diagnostic code 8519. In an October 2019 rating decision, the RO increased the Veteran’s evaluation for left upper extremity radiculopathy to 30 percent under diagnostic code 8511, to afford the Veteran a higher rating under that diagnostic code than available under 8519, effective April 14, 2017. Under the criteria for paralysis of the long thoracic nerve, mild incomplete paralysis is rated as noncompensable for both the major and minor extremity. Moderate incomplete paralysis is rated as 10 percent for each extremity. Severe incomplete paralysis is rated as 20 percent for each extremity. Complete paralysis of the long thoracic nerve with the inability to raise the arm above shoulder level, winged scapula deformity is rated as 20 percent disabling for the minor extremity and 30 percent disabling for the major extremity. Paralysis of the middle radicular group is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8511. Under these criteria, mild incomplete paralysis is rated as 20 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent disabling for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis where adduction, abduction and rotation of the arm, flexion of elbow and extension of wrists are lost or severely affected is rated at 70 percent for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 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 is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions In a July 2015 VA examination of the cervical spine, the Veteran was not found to have radicular pain or signs and symptoms due to radiculopathy associated with the left upper extremity. No neurological symptoms were found. The Veteran’s 10 percent disability ratings for both extremities were continued in the appealed March 2015 rating decision. The Veteran’s April 2017 VA examination of the peripheral nerves noted the Veteran’s report of worsening pins and needles and numbness which was constant in the left arm and intermittent in the right. The Veteran reported constant pain which was mild in the right upper extremity and moderate in the left, intermittent pain was described as moderate in the right upper extremity and severe in the left, paresthesias and/or dysesthesias was mild on the right and moderate on the left and numbness was reported as mild in the right upper extremity and moderate in the left. It was noted that the Veteran’s dominant hand was the right hand. There were no trophic changes. Tinel’s sign was negative bilaterally. Reflexes were hypoactive in the left triceps but were otherwise normal in the upper extremities. Regarding sensory disturbance, sensory examination was normal on the right side, sensory examination was decreased in the inner/outer forearm and the hand and fingers on the left side. Muscle strength was normal but for decreased strength during left wrist flexion and extension. The Veteran was found to have moderate incomplete paralysis of the left median ulnar and circumflex nerves. All nerve groups on the right side were found to be normal, incomplete paralysis was not shown. The examiner concluded that the severity of any upper extremity peripheral neuropathy found was moderate. The examiner was asked whether there were any other pertinent physical findings, complications, conditions, signs or symptoms, he responded that the Veteran made a poor effort on the examination and there was no physiological reason for such significant symptoms. Based on the above, the Board finds that mild incomplete paralysis is found, at worst, throughout the appeal period for the right upper extremity. Further, prior to the April 14, 2017 examination, the Veteran’s left right upper extremity disability is best described in resulting in mild incomplete paralysis. From the date of the examination, however, the Veteran’s symptoms are better described as moderate as reflected in the findings of the VA examiner, and a 30 percent disability rating, but no higher as moderately severe or severe symptoms are not shown, is warranted. The Board acknowledges the Veteran’s assertions that higher ratings are warranted However, the Board finds the medical of evidence of record to be more probative because those findings are based upon expert medical testing and, significantly, the evidence suggests that the Veteran may have exaggerated his symptoms at his April 2017 VA examination, rendering him less credible in his assertions in support of his claim. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence which would allow for a higher disability rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for radiculopathy of the right upper extremity throughout the period on appeal and that a disability rating in excess of 10 percent for left upper extremity radiculopathy is not warranted prior to April 14, 2017, and a rating in excess of 30 percent is not warranted thereafter. In denying higher ratings, 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. Entitlement to a Disability Rating in Excess of 10 Percent for the Radiculopathy of the Sciatic Nerve of the Right Lower Extremity and in Excess of 10 Percent from May 5, 2014 to April 13, 2017, and in Excess of 20 Percent thereafter for Radiculopathy of the Sciatic Nerve the Left Lower Extremity As much of the fact pattern and rating criteria for the Veteran’s right and left lower extremity radiculopathy are similar, the issues are considered together, below. The Veteran contends that the severity of his right and left lower extremity radiculopathy warrant ratings higher than those presently assigned. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 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 is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. The evidence of record for the period on appeal includes a July 2015 VA examination. At that examination no atrophy was found on examination. Reflexes were normal. Sensory examination was normal and straight leg raising tests were negative. The examiner found that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. A December 2016 VA medical center treatment note reported that the Veteran’s lumbar spine radiculopathy was stable with a back brace, acetaminophen and exercise. At the Veteran’s April 2017 VA examination of the peripheral nerves, the Veteran described pins and needles in all extremities, which was constant in the left leg and intermittent in the right. Regarding pain, the Veteran described mild constant pain in the right lower extremity and moderate constant pain in the left. He described moderate intermittent pain in the right lower extremity and severe intermittent pain in the left. The Veteran reported mild paresthesias and/or dysesthesias in the right lower extremity and moderate in the left and mild numbness in the right lower extremity and moderate numbness in the left. Muscle strength testing was normal but for decreased strength in the right ankle dorsiflexion which was a 4/5. Muscle atrophy was not found. Reflex testing was normal and sensory examination was normal except for decreased sensation in the left lower leg and ankle and left foot and toes. It was noted that radiculopathy caused the Veteran to have an antalgic gait, and that the Veteran did not flex the left knee completely. The examiner found that the severity of the lower extremity nerves was best described as normal in the right leg and that moderate incomplete paralysis of the left leg was demonstrated. The examiner noted that the right leg sciatic nerve was normal, and the left demonstrate incomplete paralysis which was moderate. All other nerves affecting the lower extremities were found to be normal. When asked if there were other pertinent physical findings, the examiner stated that the Veteran made a poor effort on examination and that there was no physiologic reason for such significant symptoms. Based on the above, the Board finds that the disability is primarily manifest by incomplete paralysis which is mild at worst in the right leg and moderate at worst in the left leg beginning on April 14, 2017. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis in the right leg as few symptoms of incomplete paralysis are demonstrate, and in the left leg prior to a demonstration of more severe symptoms during the April 2017 VA examination where the Veteran’s symptoms most closely approximate moderate incomplete paralysis. While the Board is cognizant of the finding that the Veteran’s left leg radiculopathy caused an antalgic gait, the Board finds that a finding of moderate incomplete paralysis is still most appropriate where the severity of the Veteran’s neuropathy as a whole is described by the examiner as moderate. This is especially true under conditions where the examiner indicates that the examination may reflect exaggerated symptoms, thus that the Veteran’s condition is actually less severe than the moderate characterization indicates. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a compensable rating/rating in excess of 10 percent for the right lower extremity during the period on appeal, in excess of 10 percent for the left lower extremity prior to April 14, 2017, and in excess of 30 percent thereafter. 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. REASONS FOR REMAND As pertaining to the Veteran’s lumbar and cervical spine disorder, hypertension and bilateral hearing loss claims, examinations were last conducted in order to determine the severity of the conditions in June and July of 2015. As these examinations are nearly five years old, the Veteran should be scheduled for new examinations in order to determine the current severity of those conditions. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected cervical spine and lumbar spine intervertebral disc syndrome. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Further, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. (Continued on the next page)   3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 4. Then readjudicate the claims remaining on appeal. If any of the benefits sought are not granted in full, furnish the Veteran and his representative with a supplemental statement of the case and an opportunity to respond, and return the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Slovick, 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.