Citation Nr: 21000168 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-45 984 DATE: January 4, 2021 ORDER Entitlement to an increased rating of 10 percent as of May 8, 2015, for right lower extremity meralgia paresthetica is granted. Entitlement to an increased rating of 10 percent as of May 8, 2015, for left lower extremity meralgia paresthetica is granted. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran’s right lower extremity meralgia paresthetica manifested as severe, incomplete paralysis as of May 8, 2015. 2. The evidence is in equipoise as to whether the Veteran’s left lower extremity meralgia paresthetica manifested as severe, incomplete paralysis as of May 8, 2015. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating of 10 percent as of May 8, 2015, for right lower extremity meralgia paresthetica have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.124a, Diagnostic Code 8529. 2. The criteria for entitlement to an increased rating of 10 percent as of May 8, 2015, for left lower extremity meralgia paresthetica have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.124a, Diagnostic Code 8529. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1968 until his honorable retirement in December 1988. In May 2011, the Denver, Colorado, Regional Office (RO) of the United States Department of Veterans Affairs (VA) granted the Veteran service connection for left lower extremity meralgia paresthetica and right lower extremity meralgia paresthetica, each with an initial noncompensable disability rating effective January 6, 2011. These matters come before the Board of Veterans’ Appeals (Board) on appeal from July 2015 rating decision by the Denver, Colorado, Regional Office (RO) of the United States Department of Veterans Affairs (VA), which denied the Veteran’s claim for an increased rating as to both his left and right extremity meralgia paresthetica. In June 2017, the Veteran and his spouse testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the record on appeal. In February 2019, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to obtain the Veteran’s outstanding private medical records and to obtain a VA examination as to the Veteran’s disabilities. On review of the record, the Board finds that there has been substantial compliance with the Board’s previous remand directives regarding the issues on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). Evidentiary Standards In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a). VA is required to give due consideration to all pertinent medical and lay evidence when rating disabilities. Golden v Shulkin, 29 Vet. App. 221, 224 (2017) (citation omitted); see 38 C.F.R. §§ 4.1, 4.6. The Board, as factfinder, is responsible for assessing the credibility and weight to be given to evidence. Id. at 1337. When assessing the credibility of lay documentary evidence, the Board may consider factors such as facial plausibility, bias, self-interest, internal consistency, and consistency with other evidence of record. Caluza v Brown, 7 Vet. App. 498, 511 (1995); Southall-Norman v. McDonald, 28 Vet. App. 346, 355 (2016). When assessing oral testimony before the Board, the Board may consider the demeanor of the witness(es), the facial plausibility of the testimony, and the consistency of the testimony with other testimony and affidavits submitted on behalf of the veteran. Caluza, 7 Vet. App. at 511. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 C.F.R. § 4.3. To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128‒29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis that follows focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Diagnostic Codes (DCs) are assigned to individual disabilities. Diagnostic Codes provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Id. An increased rating is generally assigned based on a showing that a service-connected disability has worsened. The general rule under 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400 is that the effective date of an increase in a veteran’s disability compensation shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(b)(2) provides an exception to this general rule: “The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date.” See also 38 C.F.R. § 3.400(o)(2). Thus, “the plain language of [section] 5110(b)(2) . . . only permits an earlier effective date for increased disability compensation if that disability increased during the one-year period before the filing of the claim.” Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010). Thus, three possible dates may be assigned depending on the facts: (1) If an increase in disability occurs after the claim is filed, then the date that the increase is shown to have occurred, whichever is later (date entitlement arose) (38 C.F.R. § 3.400(o)(1)); (2) If an increase in disability precedes the claim by a year or less, then the date that the increase is factually shown to have occurred (factually ascertainable) (38 C.F.R. § 3.400(o)(2)); or (3) If an increase in disability precedes the claim by more than a year, and it is not factually ascertainable that the disability increased within the year prior to the filing of the claim, then the date that the claim is received (date of claim) (38 C.F.R. § 3.400(o)(2)). Disability Rating Schedule – External Cutaneous Nerve of Thigh The Veteran’s left and right lower extremity meralgia paresthetica disabilities (collectively referred to as “meralgia” hereinafter) is rated under Diagnostic Code 8529 and is found under the heading “Diseases of the Peripheral Nerves.” Diagnostic Code 8529 provides: Rating (%) Paralysis of: Severe to Complete 10 Mild or Moderate 0 38 C.F.R. § 4.124a defines the phrase “incomplete paralysis,” with respect to peripheral nerves, as indicating “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.” Furthermore, section 4.124a states that “when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.” Diagnostic Code 8529 does not define the terms “mild,” “moderate,” or “severe,” nor does the DC associate them with specific symptoms. This lack of objective criteria for differentiating between the specified severity levels means the Board must analyze the criteria in the context of all available, relevant evidence. See 38 C.F.R. § 4.6. Nonetheless, VA has provided procedural and analytical guidance to regional offices when assessing levels of (incomplete) paralysis under these criteria, which the Board finds persuasive and applicable to this case. See Gray v. Sec’y of Veterans Affairs, 875 F.3d 1102, 1108 (Fed. Cir. 2017); Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). 1. Entitlement to an increased rating of 10 percent as of May 8, 2015, for right lower extremity meralgia paresthetica 2. Entitlement to an increased rating of 10 percent as of May 8, 2015, for left lower extremity meralgia paresthetica As the analysis and disposition for each of these issues is the same, the Board will address them together. Appeal Period: May 8, 2014 to May 8, 2015 First, the Board analyzes the evidence associated with the one-year timeframe preceding the filing of the Veterans May 8, 2015 claim to determine whether it is factually ascertainable that an increased disability rating is warranted. See 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). The Veteran presented for a VA examination in April 2014. Although this examination falls outside of the one-year timeframe, the Board finds the examination is relevant to the Veteran’s entire disability picture. In particular, the Board finds this examination is an appropriate way to establish a general baseline for the Board’s later analysis of the Veteran’s disability. The April 2014 VA examiner reviewed the Veteran’s VA claims file, computerized medical records, including prior VA examinations, and conducted an in-person examination of the Veteran. The examiner recorded that the Veteran reported discomfort in his thighs, which interfered with prolonged sitting or activities. The examiner found that the Veteran had “moderate” intermittent pain (usually dull), “moderate” paresthesias and/or dysesthesias, and “moderate” numbness in both is right and left lower extremity. The Veteran had “decreased” sensation for light touch in the upper thigh (L2) and thigh/knee (L3/4). The Veteran had trophic changes, to include loss of hair on each thigh, anterior and lateral. The Veteran did not have muscle atrophy. The Veteran had normal gait. The examiner found that the Veteran had “moderate, incomplete paralysis” of the external cutaneous nerve of the left and right thigh. For purposes of this analysis, the Board finds the April 2014 VA examiner was competent. Cox v. Nicholson, 20 Vet. App. 563, 569 (2007) (the competence of VA examiners is presumed absent evidence to the contrary). The Board also finds the examiner was credible. Buchanan, 451 F.3d at 1337. The Board finds the examination has significant probative value as it pertains to the Veteran’s disability in and around April 2014. The Board finds the Veteran’s disability picture as found on the April 2014 VA examination was most consistent with moderate, incomplete paralysis in and around 2014. A June 2014 VA physical medicine rehab outpatient note recorded that the Veteran was not on medications for his meralgia, and the Veteran “had not noticed a change in his symptoms other than more numbness in a more proximal distribution.” The Veteran reported his pain was “5-6/10 sharp pain on average but is tolerable.” Besides this VA medical note, the Board is unable to locate any other VA or non-VA medical documents between May 8, 2014, and May 8, 2015. The Board finds the Veteran was competent to report his physical symptoms, sensations, and experiences in June 2014. The Board also finds the Veteran’s statements credible and probative. The Board notes the Veteran submitted a “peripheral nerves condition” disability benefits questionnaire (DBQ) dated May 7, 2015, signed by a treating physician. This DBQ, however, was received by VA on May 8, 2015, with the Veteran’s claim for an increased rating. The Board finds it is more appropriate to treat this DBQ as evidence associated with the Veteran’s May 8, 2015 claim rather than treating it as evidence falling within the one-year preceding his claim. Utilizing the Veteran’s April 2014 VA examination, which is the most recent medical examination prior to the Veteran’s May 2015 claim, as a baseline to measure the Veteran’s disability, the Board finds the evidence weighs against finding that an increased rating is warranted between May 8, 2014 and May 8, 2015. The June 2014 VA medical note indicates the Veteran’s symptoms had not worsened, except with respect numbness. Nonetheless, the Veteran reported average, manageable pain. The Board finds this evidence indicates the Veteran did not experience a worsening of his meralgia consistent with either severe, incomplete paralysis or complete paralysis. During this appeal period, the Veteran’s total disability picture remained consistent with his April 2014 VA examination, which most nearly approximated moderate, incomplete paralysis. Appeal Period: May 8, 2015 through the present Next the Board analyzes whether the Veteran’s meralgia warrants an increased rating as of May 8, 2015, and the Board determines that it does because the evidence is in equipoise. The Veteran provided a May 7, 2015 peripheral nerves conditions DBQ that was completed by his treating physician. His physician found that the Veteran had “moderate” constant pain (may be excruciating at times), “moderate” paresthesias and/or dysesthesias, and “moderate” numbness in both is right and left lower extremity. The physician found a decreased sensation for light touch in the Veteran’s thigh/knee (L3/4). The physician did not find trophic changes. The physician recorded that the Veteran’s pain management of his lateral thigh neuropathy impacted functioning at times, including walking and sleeping. The Board finds the physician competent and credible and finds the Veteran competent to report his physical sensations, symptoms, and experiences to the physician. Although the physician did not make a finding as to the Veteran’s severity of paralysis within the DBQ, the Board still finds the DBQ probative on the aspects of the Veteran’s symptoms associated with his meralgia at that time. The Veteran appeared for a July 2015 VA-contracted examination. The examiner completed a peripheral nerve conditions DBQ. The examiner reviewed the Veteran’s medical records, VA claims file, and accurately recorded his medical history and lay statements as to his meralgia. The examiner found the Veteran had “moderate” constant pain (may be excruciating at times), “severe” intermittent pain (usually dull), “moderate” paresthesias and/or dysesthesias, and “severe” numbness in both is right and left lower extremity. The physician found decreased sensation for light touch in the upper anterior thigh (L2). The Veteran did not have muscle atrophy or trophic changes. The physician found the Veteran had mild, incomplete paralysis of the external cutaneous nerve of the left and right thigh and found the Veteran had moderate peripheral neuropathy. As of July 2015, the Veteran was not using medications for neuropathic pain. Absent evidence to the contrary, the Board finds the July 2015 VA-contracted examiner is competent. The Board also finds the examiner is credible. The Board also determines that the examination and findings have significant probative value because the examination and findings were clear, thorough, and relied on adequate facts, including the Veteran’s medical history and lay statements. In a May 2016 VA physical medicine rehab outpatient note, the Veteran’s treating VA physician recorded that the Veteran experienced “numbness” and an “electrical feeling in the bilateral anterior thighs.” The Veteran described the sensation as “like a cattle prod.” The physician recorded that the “sharp, electrical feeling seem[ed] to be going further down the left leg to below the knee, near the fibular head.” In addition, the pain “seem[ed] to be extending up the lateral hip/buttock region, to nearly the waist.” The Veteran reported these sensations occurred over the preceding six months. He also stated that, at its worst, the electrical feeling of pain was a 9 or 10 on a 10-point scale. The Veteran also reported a “burning, very sensitive pain” in his bilateral hips, up to the waist, which was, at its worst, a 7or 8 on a 10-point scale, and it was especially prominent at night. The Veteran was taking Flexeril to assist his sleeping. The Veteran did not report weakness in his legs. The Board finds the physician competent and credible and finds the Veteran competent to report his physical sensations, symptoms, and experiences, and finds his statements credible. The Board finds the physician’s examination and the Veteran’s statements highly probative of his meralgia. The Veteran was specific about his pain sensations, including severity and frequency. In July 2016, the Veteran reported to VA that he was being treated by a VA physician for his meralgia. He reported that his “pain and numbness” had progressed to below his thigh area. July 2016 Form VA 27-0820 Report of General Information. A July 2016 VA addendum note recorded that the Veteran experienced “intermittent shooting pains below the knee, lateral lower leg on the left and right sides.” The Veteran’s treating physician scheduled the Veteran for an MRI, which revealed narrowing of the L5-S1 vertebrate. The physician thought this could be causing the Veteran’s increased pain. The Board finds the Veteran competent to report his physical sensations, symptoms, and experiences to the physician, and finds his statements credible and probative. The Veteran then appeared for a VA examination in July 2016. The examiner reviewed the Veteran’s VA electronic folder, computerized medical records, and conducted an in-person examination. The examiner noted the Veteran was scheduled for lower back steroid injections as a result of his MRI findings. The Veteran described his thigh sensations at that time as “a sense of being electrocuted,” making the muscles jump, sometimes like “a cat is digging in their claws” that may sometimes “bring tears to his eyes.” His thigh muscles “get so tight that it is hard to drive.” He has a dull, burning pain, which is constant in the proximal anterolateral thighs. He generally experienced all of the pain is in the lower two-thirds of the left and right anterolateral thigh regions. He described his pain as “a steady 7/10” on a 10-point scale. He occasionally experienced pain as “10/10” lasting for one to two minutes. As to functional impact of his thigh pain, he stated he avoided “almost everything except sitting” and this has been the case for “the last couple of years.” The examiner documented that the Veteran had “moderate” constant pain (may be excruciating at times), “severe” intermittent pain (usually dull), “moderate” paresthesias and/or dysesthesias, and “moderate” numbness in both is right and left lower extremity. The examiner found decreased sensation for light touch in the upper anterior thigh (L2). The Veteran did not have muscle atrophy or trophic changes. The examiner found the Veteran had moderate, incomplete paralysis of the external cutaneous nerve of the left and right thigh and found the Veteran had moderate peripheral neuropathy. The examiner provided an addendum addressing the whether it was possible to separate the Veteran’s symptoms as belonging to his lumbar spine condition or his meralgia. The examiner explained that there was no evidence of left or right lumbosacral radiculopathy at the time of the examination. Thus, the examiner could not provide such an opinion. Absent evidence to the contrary, the Board finds the July 2016 VA-contracted examiner is competent. The Board also finds the examiner is credible. The Board also finds the examination and findings to have significant probative value because the examination and findings were clear, thorough, and relied on adequate facts, including the Veteran’s medical history and lay statements. Although the examiner was unable to separate the Veteran’s symptoms as due to his thigh versus back pain, the Board does not find that such an inability detracts from the probative value of the examination, findings, or opinion. Following the July 2016 VA examination, the Veteran underwent lower back injections of Dexamethasone and Lidocaine into each hip. July 2016 VA Procedure Consult Report. The Veteran appeared for a follow-up with his treating VA physician in September 2016. The physician recorded that the injections helped for about two weeks, but then the Veteran’s shooting pains below his knees returned. The Veteran reported the pain was, at worst, 8 out 10 on a 10-point scale. The Veteran also reported that his thigh pain was now “severe all of the time,” an 8 to 10 on a 10-point scale. He was still taking Flexeril at night to sleep. The Board finds the physician competent and credible and finds the Veteran competent to report his physical sensations, symptoms, and experiences. The Board finds the physician’s examination and the Veteran’s statements highly probative of his meralgia. The Veteran was specific about his pain sensations, including severity and frequency. At his June 2017 Board hearing, the Veteran testified he had “constant pain in both hip areas.” He described the pain as an “electric shock.” He testified the pain comes periodically, “sometimes every five minutes, sometimes every 20 minutes.” He described the pain as “disabling.” The Veteran testified about the treatments he experienced to relieve his pain, including the future placement of a neurostimulator in his body. He testified as to how his ability to function has been impeded. The Veteran’s wife testified that during the night, she hears and observes the Veteran wake up “screaming and banging on his legs because the pain is so severe.” She testified that she does the primary share of household responsibilities, to include driving and cleaning, because the Veteran’s pain is too severe. The Board finds the Veteran competent to report his physical sensations, symptoms, and experiences. The Board finds the Veteran’s wife competent to report her observations of what occurs with the Veteran’s symptoms and what she does for the household as a result of the Veteran’s meralgia. The Board finds the Veteran and his wife credible and finds their respective testimony to have significant probative value as to the severity, frequency, and duration of the Veteran’s meralgia. Following the Board hearing, the Veteran had a dorsal root ganglion (DRG) neurostimulator implanted in his lumbar spine by VA in June 2017. See June 2017 VA Operative Report. At that time, his pain was “constant.” He described his pain as “aching, burning, shooting, stabbing, squeezing, and sharp.” His pain now radiated down to his ankles. He described the severity as 7 to 9 out 10 on a 10-point scale over the course of the preceding two weeks. See June 2017 VA H & P Note. After receiving the neurostimulator, in a June 2017 post-surgery follow-up, the Veteran reported “greater than 80% relief of his pain.” June 2017 Pain Outpatient Note. He described increased functionality and quality of life. He still experienced occasional burning pain in his thighs. In June 2019, a private physician examined the Veteran. He continued to report intermittent, sharp, shocking, and burning pain in his thighs. He denied that the pain radiated beyond on his thighs. See June 2019 Apria Health Care Note. Over the preceding two weeks prior to his examination, the Veteran reported the worst experienced pain was a 9 and the least experienced pain was a 0 on a 10-point scale. In November 2019, he reported the same symptoms and experiences to the same physician at follow-up examination. See November 2019 Apria Health Care Note. The Board finds the Veteran competent to report his physical sensations, symptoms, and experiences in June 2017, June 2019, and November 2019. The Board finds the Veteran credible and finds his statements to his medical professionals to have significant probative value as to the severity, frequency, and duration of the Veteran’s meralgia. Finally, the Veteran presented for a January 2020 VA-contracted examination. The examiner reviewed the Veteran’s VA electronic folder and conducted an in-person examination. The examiner recorded the course of the Veteran’s meralgia since its onset. The examiner noted that the Veteran is not currently on medications, and he has been off medications since 2013 because the Veteran found them unhelpful. Since 2017, the Veteran has had a DRG neurostimulator, which has helped the Veteran significantly. The Veteran stated that prior to the stimulator, his pain was 9 out of 10 and now his pain is about 5 out of 10 on a 10-point scale. He stated that he did experience “zaps of pain” that felt “like burning and electric shock” and muscle spasms. He continued to have numbness in the anterior of his thighs. The physician found the Veteran had no constant pain, “mild” intermittent pain (usually dull), “mild” paresthesias and/or dysesthesias, and “mild” numbness in both is right and left lower extremity. The examiner found decreased sensation for light touch in the upper anterior thigh (L2). The Veteran did not have muscle atrophy or trophic changes. The examiner found the Veteran had mild, incomplete paralysis of the external cutaneous nerve of the left and right thighs. The examiner opined that “[b]ased on the test results and his physical examination, there is no indication that his thigh pain, numbness, and muscle cramping are stemming from his lumbar spine. . . . These symptoms are a result of meralgia paresthetica.” January 2020 VA-Contracted Medical Opinion. Absent evidence to the contrary, the Board finds the January 2020 examiner is competent. The Board also finds the examiner is credible. this unique situation, the Board affords significant weight to the examiner’s opinion regarding as to which disability his symptoms are attributable, but must afford the examination’s findings no probative value because the examination did not discount the ameliorative effects of the Veteran’s DRG neurostimulator. See Jones v. Shinseki, 26 Vet. App. 56, 61‒63 (2012). The Board finds the January 2020 VA-contracted examination does not accurately depict the Veteran’s disability picture for purposes of rating the Veteran’s meralgia. The examiner was tasked with evaluating the Veteran as he was at the time of the examination, which she appropriately accomplished. The Board, on the other hand, is required to consider the ameliorative effects of medications in this case when rating the Veteran’s meralgia, whereas the examiner was not required to undertake this task during the examination. See id. In Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), the court held that, when assigning a disability rating, the Board may not consider the ameliorative effects of medication where those effects are not explicitly contemplated by the rating criteria. “Thus, if [the applicable diagnostic code (DC)] does not specifically contemplate the effects of medication, the Board is required pursuant to Jones to discount the ameliorative effects of medication when evaluating [the disability]. Conversely, if [the applicable DC] does specifically contemplate the effects of medication, then Jones is inapplicable.” McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (en banc). Here, the criteria for rating the Veteran’s meralgia under DC 8529 do not mention or reasonably suggest the ameliorative effects of medications are incorporated within the criteria. Thus, the ameliorative effects of medication may not be considered in an analysis for a higher disability evaluation. The Veteran is not on “medication” per se. He does, however, have a DRG neurostimulator implanted in his spine, the purpose of which is to alleviate the pain associated with his service-connected meralgia. For all intents and purposes, his DRG neurostimulator operates in the same manner as medication. Therefore, the Board finds that equity and justice require the Board to review the Veteran’s symptomatology associated with his meralgia since June 2017 by asking, “What would the Veteran’s disability picture look like if he did not have the DRG neurostimulator?” From May 2015 to June 2017, the time at which he received the DRG neurostimulator, the Veteran’s disability picture reasonably indicated a worsening of symptoms associated with his meralgia. In May 2015, he had “moderate” constant pain, “moderate” paresthesias and/or dysesthesias, and “moderate” numbness. In July 2015, he continued to have “moderate” constant pain “moderate” paresthesias and/or dysesthesias, but his numbness became “severe.” In May 2016, the Veteran credibly reported experiencing radiating “numbness” and an “electrical feeling in the bilateral anterior thighs,” which he described reaching a 9 or 10 on a 10-point scale at times. The Veteran reported radiating “burning” and “very sensitive pain,” which was, at its worst, a 7 or 8 on a 10-point scale. In July 2016, he now experienced pain in the lower two-thirds of the anterolateral thigh regions. He described his pain as “a steady 7/10” on a 10-point scale. He occasionally experienced pain as “10/10,” lasting for one to two minutes. The July 2016 VA examiner document the Veteran had “moderate” constant pain, “moderate” paresthesias and/or dysesthesias, and “moderate” numbness, but had “severe” intermittent pain. The Veteran’s pain was so discomforting that in July 2016 he underwent a series of steroid injections in his lower back to alleviate the pain, which was unsuccessful in the long term. In September 2016, the Veteran reported the pain was, at worst, 8 out 10 on a 10-point scale and was now “severe all of the time.” His June 2017 Board hearing testimony is consistent with the foregoing evidence. Even at the time of his surgery in June 2017, he reported his pain was “constant” and now radiated even further, to his ankles. Following his surgery, the Veteran’s symptomatology greatly decreased, to include severity, frequency, and duration of his pain. He gained more functionality and his quality of life increased. Notably, the January 2020 examiner found his symptoms were “mild” as opposed to his previous documentation of “moderate” and “severe.” The examiner also found the Veteran had no constant pain, which is a marked difference from his prior examination which noted “moderate” constant pain. The Board reasonably attributes the Veteran’s marked decrease in symptomatology of his meralgia as due to his DRG neurostimulator. Accordingly, the Board finds it is not appropriate to rely on the January 2020 VA examination in this instance because the examination and findings as to symptomatology are reasonably due to the Veteran’s DRG neurostimulator, which provided ameliorative effects not contemplated by DC 8529. Jones, 26 Vet. App. at 61‒63. Significantly, he still experienced mild symptoms with the neurostimulator. Based on the progression of the Veteran’s symptomology, it is highly likely and reasonable to conclude that if the Veteran did not have the implantation of his DRG neurostimulator, his symptomatology would have become even worse based on the well-documented progressive worsening his symptoms. The Board recognizes the July 2015 VA examiner found the Veteran had mild, incomplete paralysis of the external cutaneous nerve of each thigh, and that the July 2016 VA examiner found the Veteran had moderate, incomplete paralysis of the external cutaneous nerve of each thigh. While probative, the Board finds these opinions are not entirely consistent with the Veteran’s overall disability picture during the appeal period. See 38 C.F.R. §§ 4.1, 4.6. Considering not only all of the medical professionals’ findings but also the Veteran and his wife’s respective credible and probative statements and testimony, the Board finds the evidence is in equipoise as to whether the Veteran’s meralgia symptoms most closely approximate a rating of “moderate” or “severe” as of May 8, 2015. See 38 C.F.R. § 4.120 (“attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances”). The Veteran did not only experience sensory symptoms, such as numbness and pain, but experienced an inability to function appropriately, to include sleeping, walking, driving, and other daily activities. In addition, his pain became progressively constant in severity, frequency, and duration, and progressively increased in radius, all the way to his ankles prior to his DRG neurostimulator. Notably, the January 2020 examiner attributed the Veteran’s symptoms to his meralgia, rather than his lumbar back disability. Moreover, without the DRG neurostimulator, it is reasonable to conclude the Veteran’s symptoms would have worsened based on his historical symptomatology. This evidence suggests that a “moderate” rating is not necessarily appropriate. Yet, the Veteran did not experience muscle atrophy or weakness, gait disturbance, or diminished reflexes, which suggests that a “severe” rating is not necessarily appropriate. Nor do the Veteran’s symptoms closely approximate complete paralysis, suggesting that a “severe” disability may not be warranted. Accordingly, as the relevant evidence of record demonstrates that either a “moderate” rating or “severe” rating may be appropriate for this Veteran’s meralgia as of May 8, 2015, the Board affords the Veteran the benefit of the doubt and finds his meralgia more nearly approximates the “severe” rating under DC 8529 and assigns him a 10-percent disability rating for the period on appeal. See 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7. As 10-percent is the highest disability rating under 38 C.F.R. § 4.124a, DC 8529, there are no other rating criteria to consider under this DC. The Board has carefully considered the Veteran’s symptoms and finds that each is adequately and appropriately captured under DC 8529, and there is no other appropriate DC under which to rate the Veteran’s disability. In sum, the Veteran is not entitled to an increased disability rating prior to May 8, 2015, under 38 C.F.R. § 4.124a, DC 8529, but he is entitled to an increased disability rating of 10-percent under 38 C.F.R. § 4.124a, DC 8529 as of May 8, 2015. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. F. Sawka, Associate 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.