Citation Nr: 20049931 Decision Date: 07/27/20 Archive Date: 07/27/20 DOCKET NO. 12-27 223A DATE: July 27, 2020 ORDER Entitlement to a 10 percent rating prior to April 26, 2011 for left knee traumatic arthritis disability is denied. Entitlement to a rating in excess of 10 percent prior to April 26, 2011 for left knee traumatic arthritis, based on limitation of flexion, disability is denied. Entitlement to a rating in excess of 30 percent from June 1, 2012 for residuals, post total left knee replacement disability is denied. Entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease disability is denied. Entitlement to a separate 10 percent rating for associated radiculopathy of the right lower extremity disability prior to March 21, 2019 is granted. Entitlement to a separate 10 percent rating for associated radiculopathy of the right lower extremity disability prior to March 21, 2019 is granted. Entitlement to a rating in excess of 10 percent since March 21, 2019 for associated radiculopathy of the right lower extremity is denied. Entitlement to a rating in excess of 10 percent since March 21, 2019 for associated radiculopathy of the left lower extremity is denied. REMANDED Entitlement to a total disability rating due to individual unemployability prior to April 26, 2011 is remanded. FINDINGS OF FACT 1. Prior to April 26, 2011, the Veteran’s left knee traumatic arthritis has been manifested by no more than painful limitation of motion without compensable limitation of flexion or extension, and has not been manifested by objective evidence ankylosis, instability, or impairment of tibia and fibula and genu recurvatum. 2. Prior to April 26, 2011, the Veteran’s left knee traumatic arthritis has a history meniscectomy with symptomatic residuals of frequent swelling, but not frequent episodes of locking. 3. Since June 1, 2012, the Veteran’s left knee replacement has been manifested by no more than residual weakness, pain or limitation of motion without any intermediate or higher degree of symptomatology. 4. Throughout the pendency of the appeal, the Veteran’s lumbar degenerative disc disease has been manifested by no more than limitation of flexion to 50 degrees, ranges of motion accompanied by pain and functional loss, and without evidence of incapacitating episodes. 5. Throughout the pendency of the appeal, mild neurological impairment in the right lower extremity has been associated with lumbar degenerative disc disease. 6. Throughout the pendency of the appeal, mild neurological impairment in the left lower extremity has been associated with lumbar degenerative disc disease. 7. At no point during the pendency of the appeal has the associated radiculopathy in the right lower extremity been manifested by no more than mild sensory disturbances of right lower extremity. 8. At no point during the pendency of the appeal has the associated radiculopathy in the right lower extremity been manifested by no more than mild sensory disturbances of left lower extremity. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to April 26, 2011 for left knee traumatic arthritis, limitation of flexion disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for entitlement to a rating in excess of 10 percent prior to April 26, 2011 for left knee traumatic arthritis, residuals of meniscectomy disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5259. 3. The criteria for entitlement to a rating in excess of 30 percent from June 1, 2012 for residuals, post total left knee replacement disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5055. 4. The criteria for entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 5. The criteria for a separate 10 percent rating, but no higher, prior to March 21, 2019 for associated radiculopathy of the right lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for a separate 10 percent rating, but no higher, prior to March 21, 2019 for associated radiculopathy of the left lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8520. 7. The criteria for a 10 percent rating since March 21, 2019 for associated radiculopathy of the right lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8520. 8. The criteria for a 10 percent rating since March 21, 2019 for associated radiculopathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from April 1968 to April 1972. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, and 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. If feasible, these determinations are to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. Moreover, joint testing is to be conducted on both active 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, 170 (2016). 1. Entitlement to a rating in excess of 10 percent prior to April 26, 2011 for left knee traumatic arthritis, limitation of flexion, disability 2. Entitlement to a rating in excess of 10 percent prior to April 26, 2011 for left knee traumatic arthritis, limitation of extension disability The Veteran seeks higher rating for his left knee disabilities. Prior to April 26, 2011, the Veteran is in receipt of two 10 percent ratings for limitation of flexion and limitation of extension for his left knee disability under Diagnostic Codes 5260 and 5261, respectively. On April 26, 2011, the Veteran underwent a left total knee replacement (TKR). An October 2012 rating decision changed the Diagnostic Code for the Veteran’s left knee disability to 5055 for prosthetic replacement of knee joint and assigned a 30 percent evaluation has been assigned since June 1, 2012. A temporary total rating has been assigned for the Veteran’s left knee for the period from April 26, 2011 to May 31, 2012 for the year following the implantation of the prothesis (left TKR). During that period, the Veteran received the maximum benefits allowed; therefore, it will not be discussed. Disabilities of the knees are evaluated pursuant to the criteria within 38 C.F.R. § 4.71a , including Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). Diagnostic Code 5256, which evaluates ankylosis of the knee, provides for a 30 percent rating for favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating is assigned when there is ankylosis of the knee in flexion between 10 and 20 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5257 evaluates recurrent subluxation or lateral instability of a knee and provides for a 10 percent disabling for a slight impairment; a 20 percent disabling for a moderate impairment; and a 30 percent disabling for a severe impairment. 38 C.F.R. § 4.71a. When semilunar cartilage is dislocated with frequent episodes of locking, pain, and effusion into the joint, a 20 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5258. When semilunar cartilage has been removed, but remains symptomatic, a 10 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Separate ratings under Diagnostic Code 5260 and Diagnostic Code 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, VAOPGCPREC 23-97 held that a claimant who has both arthritis and instability of the knee may receive two separate disability ratings under Diagnostic Codes 5003-5010 and Diagnostic Code 5257 without violating the prohibition of pyramiding of ratings. It was specified that, for a knee disorder already rated under Diagnostic Code 5257, a claimant would have additional disability justifying a separate rating if there is limitation of motion under Diagnostic Code 5260 or Diagnostic Code 5261. Diagnostic Codes 5262 and 5263 provide ratings for impairment of tibia and fibula and genu recurvatum, respectively. Initially, prior to April 26, 2011, the Board notes that the Veteran’s left knee disabilities is currently rated with two separate ratings under Diagnostic Codes that are applicable to limitation of motion on extension and on flexion However, after review of the evidence, both lay and medical, the Board finds that the Veteran’s service connected left knee is more appropriately rated under Diagnostic Code 5259, for residuals of semilunar cartilage removal, and under Diagnostic Code 5260, for limitation of flexion. The assignment of a particular Diagnostic Code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, diagnosis, and demonstrated symptomatology. Any change in Diagnostic Code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Specifically, in this case, the Veteran is currently diagnosed with traumatic arthritis of the left knee, but he has a medical history of medial and lateral meniscectomy during his period of service and post-service as well as a post-serve arthroscopy with resection of ganglion cyst. VA medical records dated prior to April 2011 show the Veteran complained of pain and frequent episodes of swelling. See April 2010 and July 2010 VA treatment records, and August 2010 VA examination report. In addition, the Veteran has reported functional limitation with lifting and carrying heavy items, repetitively bending, squatting, kneeling, and climbing stairs. Such symptomatology supports the assignment of a 10 percent rating under Diagnostic Code 5259 for residuals of meniscectomy (semilunar cartilage removal) for the period prior to April 26, 2011. See 38 C.F.R. § 4.71a, Diagnostic Code 5259. The Board has considered whether the record supports the assignment of a 20 rating under Diagnostic Code 5258 which provides for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the knee joint. Although the record reflects that the Veteran has complained of pain and frequent episodes of swelling, VA medical records do not reflect findings of current meniscus (semilunar cartilage) abnormality in the left knee. Further, at no time during the appeal period has the Veteran complained of his knees locking or an inability to bend or straighten either knee. Hence, a separate rating under Diagnostic Code 5258 is not warranted. See 38 C.F.R. § 4.71a. In addition, for the period prior to April 26, 2011, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left knee traumatic arthritis based on limitation of flexion under Diagnostic Code 5260. See 38 C.F.R. § 4.71a. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to decreased range of motion, weakness, and chronic pain which limits him from prolonged walking or standing and he is unable to squat, pivot, or kneel. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, his symptomatology would not result in limitation of motion more nearly approximating flexion limited to 30 degrees. In this regard, VA treatment records do show the Veteran complained of chronic left knee pain with episodes of stiffness and swelling, and he had difficulty with prolonged walking and standing. A July 2010 VA treatment record noted that on clinical evaluation, the Veteran had an antalgic gait on left and he had left knee range of motion from 5 to 122 degrees. The August 2010 VA examination report shows that on clinical evaluation, the Veteran had range of motion in his left knee zero to 120 degrees. There was objective evidence of painful motion and pain after repetitive use but no additional loss of motion. Findings from clinical evaluation do not show his range of motion was limited to the extent necessary to warrant a higher rating under Diagnostic Code 5260. Specifically, the competent medical evidence demonstrates the Veteran’s left knee flexion was limited to, at worst, 120 degrees prior to April 26, 2011, but such does not result in additional functional loss more nearly approximating limitation of flexion to 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, of incoordination, or as a result of repetitive motion and/or flare-ups, which is required for a higher rating under Diagnostic Code 5260. Thus, a rating in excess of 10 percent for the Veteran’s left knee disability under Diagnostic 5260 is not warranted. A separate compensable rating is not warranted pursuant to Diagnostic Code 5261 for limitation of extension as the Veteran’s left knee extension has not been shown to be limited to 10 degrees, the threshold for a compensable percent rating, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. See 38 C.F.R. § 4.71a, Diagnostic Code 5261. Further, the Veteran is in receipt of the highest rating for pain under 38 C.F.R. § 4.59 base on limitation of flexion under Diagnostic Code 5260. Thus, a separate compensable rating for the Veteran’s left knee disability under Diagnostic 5261 is not warranted. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The Board has considered the application of a separate rating under Diagnostic Code 5257 given the Veteran’s complaints that his left knee gives away and has resulted in falls in the past. However, the August 2010 VA examination report did not reveal evidence of instability on clinical evaluation. VA treatment records also show no evidence of instability in the left knee, despite the Veteran’s complaints of giving away. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257. Therefore, objective medical evidence cannot be categorically found more probative than lay evidence with respect to this DC. English v. Wilkie, 30 Vet. App. 347, 349 (2018). However, the Board finds that actual lateral knee instability is not an observable symptomatology as it requires special testing of the ligaments to determine. See Id. As such, absent any clinical evidence correlating with an underlying pathology to account for the complaints of instability, the complaints of instability can be considered no more than minimal. Hence, this evidence of instability does not arise to the “slight” level needed to assign a separate 10 percent disability rating under Diagnostic Code 5257 at any point prior to April 26, 2011. At no time during the appeal period has there been ankylosis of knee or impairment of the tibia and fibula warranting a higher rating under Diagnostic Codes 5256 or 5262. In making these determinations, the Board has carefully considered the Veteran’s own statements regarding his symptomatology. It is generally within the competence of a lay person to identify and observe the effect of a disability under the ordinary conditions of daily life. Moreover, the Veteran’s left knee disability manifests with some symptoms readily observable by a lay person, such as pain and functional limitations. Accordingly, the lay evidence is competent evidence to this extent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Petitti v. McDonald, 27 Vet. App. 415, 427-28 (2015); Fountain, 27 Vet. App. at 274-75. However, the rating schedule for evaluating the knee requires precise medical findings, including findings as to range of motion, stability, and semilunar cartilage impairment. It does not appear that the Veteran has a background in medicine, or a related field, such that he can be recognized as having the medical expertise needed to make such medical findings. Accordingly, his testimony is useful in understanding those symptoms he is competent to identify and the effect of the disability on his daily life but does not provide a basis for assigning a higher rating. See Petitti, 27 Vet. App. at 427-28. Thus, the preponderance of the evidence is against higher ratings for the service-connected left knee disabilities prior to April 26, 2011, and the appeal is denied. 3. Entitlement to a rating in excess of 30 percent from June 1, 2012 for residuals, post total left knee replacement disability The Veteran underwent a left total knee replacement in April 2011. Under Diagnostic Code 5055, prosthetic replacement of knee joint, provides that for 1 year following implantation of prosthesis a 100 percent rating will be assigned. Thereafter, a 30 percent rating is the minimum rating assigned. A 60 percent rating is warranted for chronic residuals consisting of severe painful motion or weakness in the affected extremity. With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262. 38 C.F.R. § 4.71a. This “intermediate” level of disability is consistent with a 40 or 50 percent rating. Tedesco v. Wilkie, 31 Vet. App. 360, 364 (2019). Under Diagnostic Code 5055, severe painful motion and limitation of motion are distinct concepts. It is severe painful motion, not limitation of motion, that is required. Id. at 365. Limitation of motion is but one factor when assessing the disability commensurate with “severe painful motion.” Range of motion test results, and the corresponding evaluation under the pertinent limitation-of-motion Diagnostic Code, cannot be the only evidence cited. Id. at 366. As discussed, the Veteran was assigned a total (100 percent) rating under Diagnostic Code 5055 after the left total knee replacement, from April 2011 through May 2012. A 30 percent rating has been assigned from June 1, 2012. Following his April 2011 surgery, the Veteran’s VA treatment records reveal he reported improvement in his left knee symptomatology following the total knee replacement, although he continued to experience chronic left knee pain. The Board finds the Veteran’s left knee disability does not warrant a rating in excess of 30 percent as of June 1, 2012. In this regard, since June 1, 2012, the Veteran’s left total knee replacement involved symptoms of residual weakness, pain or limitation of motion. The rating criteria provides that intermediate degrees of residual weakness, pain or limitation of motions are to be rated by analogy to Diagnostic Codes 5256, 5261, or 5262. The March 2019 VA examination report shows that on clinical evaluation, the Veteran had limitation of flexion to 113 degrees during his VA examination, which equates at most to a 10 percent rating under Diagnostic Code 5260. He had full extension of the left knee to 0 degrees, which equates with a noncompensable rating under Diagnostic Code 5261. See 38 C.F.R. § 4.71a. Even when considering any additional functional loss after repetitive use, the findings from clinical evaluation do not support the assignment of a higher intermediate rating of 40 or 50 percent based on limitation of motion in the left knee. There was evidence of mild discomfort lateral and medial knee areas on palpation. In this regard, the examiner found the Veteran’s left knee disability caused him additional functional impairment with repeated use over a period of time; however, the VA examiner was unable to describe in range of motion because the Veteran only reported subjective evidence of decreased range of motion after repetitive activities lasting longer than 5 minutes. The Veteran had specifically denied experiencing flare-ups in the left knee. Further, there was no left knee ankylosis or impairment of the tibia or fibula recorded in the March 2019 VA examination. Thus, Diagnostic Codes 5256 or DC 5262 are not available. 38 C.F.R. § 4.71a. The March 2019 VA examiner also found no symptoms other than pain and limitation of motion related to the past history of meniscectomy and arthroscopy. The March 2019 VA examiner medically graded the Veteran as having intermediate degrees of residual weakness, pain or limitation of motion. Nonetheless, it is the responsibility of VA adjudicators, not medical examiners, to make the findings of fact and law necessary to decide a claimant’s entitlement to disability benefits. Hence, the Board errs when it relies on a medical examiner’s opinion on a purely adjudicative matter. See Delrio v. Wilkie, 32 Vet. App. 232 (2019). To this end, the VA examiner’s findings do not correspond with any higher disability levels when rated by analogy to diagnostic codes 5256, 5261, or 5262. Hence, the VA examiner’s classification alone is not sufficient to warrant an intermediate disability rating between 30 and 60 degrees. The Board has considered that an April 2019 VA treatment records show he reported injuries from a fall when he “felt left knee go”; however, on clinical evaluation two days later, there was no evidence of laxity and the Veteran had range of motion from zero to 135 degrees. The Veteran also reported that his left knee pain was improving. An April 2019 VA x-ray of the left knee revealed post-op changes total knee replacement, without evidence of loosening or infection. Subsequent VA treatment records show that the Veteran reported improvement of knee pain. Here, the Board finds that remand is not needed for a new VA examination, as the VA treatment records do not indicate a material worsening of the left knee disability. Rather, the subsequent VA treatment records demonstrate that the Veteran suffered from temporary increase of symptoms which had already begun resolve two days after the injury. See, e.g., 38 C.F.R. §§ 3.326, 3.327 (2015); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). Thus, overall, for the period from June 1, 2012, a rating in excess of 30 percent for the Veteran’s left total knee replacement is not warranted. 4. Entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease disability 5. Entitlement to a separate 10 percent rating for right lower extremity radiculitis associated with lumbar spine disability prior to March 21, 2019 6. Entitlement to a separate 10 percent rating for left lower extremity radiculitis associated with lumbar spine disability prior to March 21, 2019 7. Entitlement to rating in excess of 10 percent for right lower extremity radiculitis associated with lumbar spine disability since March 21, 2019 8. Entitlement to rating in excess of 10 percent for left lower extremity radiculitis associated with lumbar spine disability since March 21, 2019 The Veteran contends that he is entitled to a higher rating for his lumbar spine disability because it causes him functional impairment that impedes his ability to perform activities of daily living. The Veteran’s lumbar spine degenerative arthritis with radiculitis disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, for intervertebral disc syndrome (IVDS). Diagnostic Code 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 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. Id. at Note 1. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for lumbar spine degenerative disc disease with radiculitis based on incapacitating episodes. Although both the August 2010 and March 2019 VA examiners found that the Veteran has IVDS, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. In this regard, VA medical records do not show, and the Veteran does not assert, that he has been prescribed bed rest of any duration during the pendency of the appeal. While the Veteran has reported that during severe flare-ups of low back pain, he needs to cease all activities and lie down to rest until symptoms resolve, there is no indication that he has suffered incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months to support the assignment of a higher rating under Diagnostic Code 5243. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. The preponderance of the evidence is also against a rating in excess of 20 percent for lumbar spine degenerative disc disease under the General Rating Criteria. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to chronic pain, weakened movement, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. In this regard, both the August 2010 and March 2019 VA examination reports show the Veteran has range of motion in his lumbar spine well-beyond 30 degrees, despite his complaints of decreased range of motion after periods of repetitive use. Moreover, the March 2019 VA examiner specifically did not find that the Veteran suffered from additional loss of motion or functional impairment after repetitive use. Although the March 2019 VA examiner noted that the Veteran does have additional functional loss during flare-ups of low back pain and weakness, it did not result in additional loss of motion. The Veteran’s reported symptoms have been considered, and they support the currently assigned 20 percent rating under the General Rating Formula. See 38 C.F.R. § 4.71a. The evidence does not show that the criteria for a disability rating greater than 20 percent were approximated at any time. Thus, the weight of the evidence is against the grant of a disability rating greater than 20 percent for the Veteran’s lumbar spine degenerative disc disease, based on orthopedic findings throughout the rating period. In addition, throughout the pendency of appeal, the Veteran he has described some sensory deficits in both of his legs. The Board finds the Veteran’s statements to be credible. Moreover, both the August 2010 and March 2019 VA examiners found that the Veteran had diagnosis of radiculitis associated with his lumbar spine degenerative disc disease. The Veteran has already been assigned separate 10 percent ratings for radiculopathy in each lower extremity, effective from March 21, 2019, the date of the VA examination. However, the Board finds that separate 10 percent rating for each lower extremity is warranted throughout the pendency of the appeal. Mild incomplete paralysis of the sciatic nerve of the lower extremity warrants a 10 percent rating. A 20 percent evaluation may be assigned for moderate incomplete paralysis of the sciatic nerve of the lower extremity. A 40 percent evaluation may be assigned for moderately severe incomplete paralysis of the sciatic nerve of the lower extremity. A 60 percent evaluation may be assigned for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy of the lower extremity. An 80 percent evaluation may be assigned for complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis of this nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Complete paralysis of the sciatic nerve is indicated when the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Throughout the rating period, neurological deficits have been associated with lumbar degenerative disc disease in the both lower extremities. The August 2010 VA examination report shows that the Veteran complained of radiating pain down his left lower extremity, despite a normal neurologic evaluation. An August 2010 VA neurology clinic note shows that the Veteran complained of numbness in his toes and there were decreased sensory findings on clinical evaluation. Accordingly, the evidence favors the assignment of a 10 percent rating, but no higher, for each leg based on mild sensory impairment in lower extremity throughout the pendency of the appeal. The preponderance of the competent evidence does not support the assignment of a rating in excess of 10 percent in either leg at any point during the pendency of the appeal. In this regard, the preponderance of the evidence is against a finding of moderate neurologic impairment in either leg. The Board has considered that the March 2019 VA examiner found that the Veteran had sciatic nerve involvement, bilaterally, moderate in severity based on the Veteran’s complaints of pain in his legs and positive straight leg raise test. However, neurologic evaluation showed normal muscle strength, reflexes, and sensation in both lower extremities. Given the Veteran’s radiculopathy in his lower extremities is primarily manifested by sensory complaints, without evidence of decreased muscle strength or reflexes, or muscle atrophy, a finding of more than mild neurologic impairment in either leg has not been demonstrated. A rating in excess of 10 percent for radiculopathy in either leg is not warranted at any point during the pendency of the appeal. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. No other neurological impairment associated with the lumbar spine degenerative disc disease disability been demonstrated. REASONS FOR REMAND 1. Entitlement to a total disability rating due to individual unemployability prior to April 26, 2011 is remanded. A claim for TDIU was incorporated into the appeal by the January 2019 Board remand. See Rice v. Shinseki, 22 Vet. App. 447, 454-55 (2009). Notably, the Veteran was awarded service connection for PTSD disability and assigned a 100 percent rating, effective from April 15, 2010, and based on the award above for separate 10 percent ratings for radiculopathy of right and left lower extremities effective from March 31, 2010, he had is in receipt of additional disabilities independently ratable at 60 percent or more, effective from June 1, 2010. As such, from June 1, 2012, the Veteran’s service-connected disabilities support assignment of special monthly compensation (SMC) under statutory housebound rate and he is in receipt of the maximum benefit allowable. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). The Veteran has already been awarded SMC statutory housebound rate from April 26, 2011 to June 1, 2012, when he was in receipt of a 100 percent rating for left knee total knee replacement under Diagnostic Code 5055. Prior to April 26, 2011, the Veteran does not meet the SMC criteria, as the disability ratings aside from the Veteran’s 100 schedular rating for service-connected PTSD disability do not combine to a total of 60 percent under 38 C.F.R. § 4.25. An award of a TDIU based on disability other than PTSD would result in a statutory housebound rate prior to April 26, 2011. See 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i); Buie v. Shinseki, 24 Vet. App. 242, 251 (2011); Bradley v. Peake, 22 Vet. App. 280, 293 (2008). The Board must consider whether an award of TDIU, aside from PTSD, for the period prior to April 26, 2011. It is unclear from the evidence of record whether the Veteran participated in more than marginal employment for the period prior to April 26, 2011. During the applicable period, the Veteran has consistently reported that he has been self-employed working in boat maintenance and construction, but he has reported long periods of unemployment due to back and knee pain. The record reflects unsuccessful attempts have been made to have the Veteran submit a completed VA Form 21-8940, Application for Increased Compensation Based on Unemployability due to undeliverable mail. See December 24, 2019 notification letter returned February 18, 2020, and March 5, 2020 notification letter returned March 24, 2020. The Board finds that in order to fulfill the duty to assist VA should make one more attempt to confirm the Veteran’s current address of record and re-send the notice for development of TDIU claim. See 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Contact the Veteran to confirm his current mailing address. (Continued on the next page)   2. Request that the Veteran submit an Application for Increased Compensation Based on Unemployability (TDIU) (VA Form 21-8940) that contains updated information concerning his employment prior to April 2011, to specifically note any periods of unemployment. 3. After directive one, complete and undertake any additional development deemed necessary to adjudicate the Veteran’s TDIU. If any benefits sought on appeal remain denied, the Veteran should be issued a supplemental statement of the case and allowed an appropriate period to respond before the case is returned to the Board, if in order. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Murray, 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.