Citation Nr: 21004157 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-37 044 DATE: January 26, 2021 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for obstructive sleep apnea is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include anxiety disorder and depressive disorder, is denied. Entitlement to service connection for right shoulder adhesive capsulitis with bursitis and tendonitis, claimed as joint pain, is granted. Entitlement to service connection for left shoulder adhesive capsulitis with bursitis and tendonitis, claimed as joint pain, is granted. Entitlement to an initial disability rating higher than 20 percent for lumbar spine degenerative spondylosis is denied. Entitlement to an initial disability rating higher than 10 percent for left lower extremity radiculopathy is denied. FINDINGS OF FACT 1. The Veteran has hypertension that was incurred during service. 2. The Veteran has sleep apnea that was neither incurred during service nor caused by or resulted from an in-service injury, illness, or event. 3. The Veteran does not have PTSD. 4. The Veteran has anxiety disorder and depressive disorder that was neither incurred during service nor caused by or resulted from an in-service injury, illness, or event. 5. The Veteran has right shoulder adhesive capsulitis with bursitis, tendonitis, and impingement syndrome that was caused by the Veteran’s active duty service. 6. The Veteran has left shoulder adhesive capsulitis with bursitis, tendonitis, and impingement syndrome that was caused by the Veteran’s active duty service. 7. The Veteran’s lumbar spine degenerative spondylosis has been manifested primarily by chronic low back pain and decreased thoracolumbar spine motion that has included painless flexion to no less than 50 degrees. 8. The Veteran’s left lower extremity radiculopathy was diagnosed during an August 2019 spine examination and has resulted in mild incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for service connection for obstructive sleep apnea are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2020). 3. The criteria for service connection for PTSD are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2020). 4. The criteria for service connection for an acquired psychiatric disorder other than PTSD, to include anxiety disorder and depressive disorder, are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2020). 5. The criteria for service connection for right shoulder adhesive capsulitis with bursitis and tendonitis, claimed as joint pain, are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 6. The criteria for service connection for left shoulder adhesive capsulitis with bursitis and tendonitis claimed as joint pain, are met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 7. The criteria for an initial disability rating higher than 20 percent for lumbar spine degenerative spondylosis are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5242 (2020). 8. The criteria for an initial disability rating higher than 10 percent for left lower extremity radiculopathy are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from February through May of 1975 and from December 1990 through September 1991, to include service in the Southwest Asia Theater of Operations from February through August of 1991. The issues on appeal were remanded previously by the Board in September 2018. The ordered development has been completed by the agency of original jurisdiction (AOJ). The matter now returns to the Board for review. Service Connection Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). As noted, the Veteran had documented service in the Southwest Asia Theater of Operations. Service connection also may be warranted for a Persian Gulf War veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than not later than December 31, 2021. 38 C.F.R. § 3.317(a). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness (MUCMI); and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1)(ii). Signs or symptoms that may be a manifestation of an undiagnosed illness include cardiovascular signs or symptoms. 38 C.F.R. § 3.317(b). Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. 38 C.F.R. § 3.317(a)(4). A MUCMI is defined by a cluster of signs or symptoms and can include such diseases as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders. 38 C.F.R. § 3.317(a)(2)(i) and (ii). In addition to those specified disorders, it refers to a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. MUCMIs of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Signs or symptoms that may be a manifestation of an undiagnosed illness or a MUCMI may include: fatigue; signs or symptoms involving skin; headaches; muscle pain; joint pain; neurological signs or symptoms; neuropsychological signs or symptoms; signs or symptoms involving the upper or lower respiratory system; sleep disturbances; gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and, menstrual disorders. 38 C.F.R. § 3.317(b). 1. Entitlement to service connection for hypertension. The Veteran contends that he is entitled to service connection for hypertension. He theorizes in his September 2014 substantive appeal that his hypertension may be a symptom associated with an undiagnosed illness associated with his service in the Southwest Asia Theater of Operations. Notwithstanding the Veteran’s specific theory, the Board concludes that the evidence shows that the Veteran’s hypertension was likely incurred during service. Accordingly, the Veteran is entitled to service connection on a direct basis pursuant to 38 C.F.R. § 3.303(d). The evidence shows that blood pressure readings taken of the Veteran during an April 1995 examination showed three separate elevated readings that are consistent with hypertension: 140/100 mmHg, 142/98 mmHg, and 140/98 mmHg. See, 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, note (1). Records for subsequent VA and private treatment received by the Veteran show that the Veteran has remained under monitoring and medication for ongoing hypertension. During an August 2019 hypertension examination, the examiner noted the foregoing history and opined that it is likely that the Veteran’s hypertension was incurred or caused by the Veteran’s active duty service. The examiner’s opinion is plausible, supported by the facts in the record, and is not rebutted by any contrary opinion. For these reasons, the Board is persuaded by the examiner’s opinion. The Veteran is entitled to service connection for hypertension. To that extent, this appeal is granted. 2. Entitlement to service connection for obstructive sleep apnea. The Veteran claims entitlement to service connection for sleep apnea. He does not raise any specific allegations or theories to support his claim, although a March 1998 statement received from one of the Veteran’s fellow servicemembers attests that he observed the Veteran experiencing sleeplessness and fatigue during their tour in the Persian Gulf. Although the evidence shows that the Veteran was diagnosed for sleep apnea following an August 2010 sleep study, the preponderance of the evidence shows that the Veteran’s sleep apnea was not incurred during service and did not result from an in-service, injury, illness, or event. Likewise, the evidence shows that the Veteran’s sleep apnea is not a qualifying chronic disability for purposes of 38 C.F.R. § 3.317. The service treatment records reflect no sleep-related complaints by the Veteran and no objective findings suggestive of the onset of sleep apnea during service. Indeed, the Veteran expressly denied having any history of fatigue or sleep-related difficulties during repeated medical examinations conducted throughout the course of his active duty. Notwithstanding the assertions raised in the serviceman’s March 1998 statement, any suggestion that the Veteran experienced the in-service onset of sleep apnea is rebutted and outweighed by the contrary information contained in the service treatment records. As mentioned, the Veteran’ sleep apnea was first diagnosed after sleep studies conducted in August 2010. Records for subsequent private treatment received by the Veteran from Dr. N.J.F. and at Medicina Pulmonar Sureste show that the Veteran has been followed for continuing sleep apnea. Those records, however, reflect no opinion concerning the etiology or origin of the Veteran’s sleep apnea. A March 2012 sleep apnea examination confirmed the August 2010 sleep apnea diagnosis and noted that sleep apnea is a disease with a clear and specific etiology. To that end, the examiner remarked that sleep apnea is defined as a condition caused by an obstruction related to occlusion of the upper airway, usually at the level of the oropharynx, leading to the collapse of the upper airway. Hence, the examiner concluded, the Veteran’s sleep apnea was not related to a specific exposure event during the Veteran’s service in the Southwest Asia Theater of Operations. The Veteran’s sleep apnea diagnosis was again confirmed during an August 2019 examination. The examiner opined, however, that it is less likely than not that the Veteran’s sleep apnea was incurred during service or is caused by an in-service injury, illness, or event. As rationale, she noted that the service treatment records reflect no evidence of recurrent signs, symptoms, diagnoses, treatment, or a chronic disability pattern that supports a diagnosis for obstructive sleep apnea during active duty or within a year from separation from service. Rather, she states, the Veteran’s sleep apnea was neither suspected nor diagnosed until more than 10 years after he was separated from service. Based on the foregoing history, the examiner concluded that the evidence does not support the finding of an etiological nexus between the Veteran’s sleep apnea and his active duty service. The examiner added that it is also less likely than not that the Veteran’s sleep apnea was caused or aggravated by his service-connected back disability. She explained that the medical literature does not support the existence of such a relationship. The negative etiology opinions given during the March 2012 and August 2019 examinations are supported by the facts in the record, are not rebutted by contrary opinions in the record, and appear to be consistent with the current medical literature. For these reasons, those opinions are persuasive. The Veteran is not entitled to service connection for sleep apnea. To that extent, this appeal is denied. 3. Entitlement to service connection for PTSD. The Veteran contends that he is entitled to service connection for PTSD that he believes resulted from various service-related stressors. He reported experiencing combat-related stressors during a March 2013 examination. During a March 2012 examination, he related an incident during his Persian Gulf service in which his unit became lost and encountered forces that were initially believed to be the enemy. During an August 2019 examination, he elaborated that he spent 22 days in the desert and that he performed duties that included delivering ammunition to combat areas. Although the stressors reported by the Veteran are consistent with the nature of his active duty service and are related to fear of enemy activity, the preponderance of the evidence shows that the Veteran does not have PTSD. For that reason, service connection for PTSD cannot be granted to the Veteran. The Veteran reports in his claims submissions that he has experienced various mental health symptoms that include anxiety, depression, stress, memory loss, and sleep disturbances including nightmares. Statements received from his spouse and friend in August 1996 attest that they have observed those symptoms. A March 1997 statement received from the Veteran’s co-worker asserts that the Veteran appeared to have difficulty remembering instructions at work and that the Veteran’s behavior and mental capacity appeared to be changed after he returned from his service in the Southwest Asia Theater of Operations. Indeed, post-service records show that the Veteran has received private and VA mental health treatment for his reported symptoms since approximately 1994. The records for such treatment reflect varying mental diagnoses that include PTSD (diagnosed by Dr. R.L.R.P. in March 2007 and during treatment at the Vet Center in April 2012), anxiety disorder (diagnosed during April 1995 and March 2012 mental health examinations), and major depressive disorder (diagnosed during VA treatment received by the Veteran from 1994 through the present, during treatment with Dr. A.H.R. from 2007 through 2009, and during an August 2019 mental health examination). The Board notes also that a March 2013 mental health examination revealed no mental health diagnosis. The March 2013 examiner opined that, although the Veteran’s stressors met the diagnostic criteria for PTSD, the symptoms reported and shown by the Veteran did not meet those criteria. In that regard, the examiner observed that the Veteran’s symptoms were not marked by persistent re-experiencing of the Veteran’s traumatic events; avoidance of stimuli associated with his reported trauma or numbing of general responsiveness; and/or persistent symptoms of increased arousal. Applying the diagnostic criteria under the DSM-5, the August 2019 examiner concurred. In contrast, the PTSD diagnosis rendered by Dr. R.L.R.P. is not supported by any explanation as to how the Veteran’s presentation meets the diagnostic criteria for PTSD. Likewise, April 2012 records from the Vet Center note that the Veteran was under treatment for PTSD; however, provide no explanation or discussion as to how the Veteran’s symptoms meet the criteria for a PTSD diagnosis. In the absence of such discussion, the Board assigns the PTSD diagnoses given by Dr. R.L.R.P. and during treatment at the Vet Center little probative weight. Rather, the Board is persuaded by the anxiety disorder and depressive disorder diagnoses rendered in the March 2013 and August 2019 mental health examinations. To the extent that the Veteran has asserted that he has PTSD, the Board is similarly unable to assign significant weight to that assertion. The question as to the Veteran’s precise mental health diagnosis is a complex medical question that is answered through application of learned mental health principles to the Veteran’s history and mental health presentation. The Veteran is not qualified to offer a probative opinion as to his precise diagnosis, and for that reason, the Board does not assign any weight to the Veteran’s assertion. The preponderance of the evidence shows that the Veteran does not have PTSD. As such, the Veteran is not entitled to service connection for PTSD. To that extent, this appeal is denied. 4. Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include anxiety disorder and depressive disorder. As discussed in the previous section, it is undisputed that the Veteran has received diagnoses for anxiety disorder and depressive disorder. Nonetheless, the preponderance of the evidence shows that neither disorder was incurred during service or was caused by or resulted from an in-service injury, illness, or event. As mentioned, various lay statements attest to observed mental health symptoms in the Veteran. In an August 1996 statement, the Veteran’s friend related that the Veteran demonstrated memory loss and difficulty retaining simple information. She related anecdotes in which the Veteran had forgotten where he parked his car and that the Veteran’s spouse had told her that the Veteran was having difficulty sleeping. In a March 1997 statement, the Veteran’s co-worker stated that the Veteran’s behavior and mental capacity appeared to be changed after he returned from service in the Persian Gulf. A March 1998 statement from a fellow service member states that the Veteran demonstrated such symptoms as sleeplessness, fatigue, memory loss, and emotional problems during service. Despite the foregoing, the evidence does not support the finding that the Veteran’s anxiety disorder and/or depressive disorder began during service. The service department records are entirely silent for any in-service subjective complaints by the Veteran of any mental health symptoms. Likewise, there is no indication in the service department records of any objectively observed mental health abnormalities, treatment, or mental health diagnoses. Reports from repeated medical examinations conducted throughout the course of the Veteran’s service show that the Veteran consistently denied having any history of mental health problems. Repeated mental health examinations conducted as part of the Veteran’s periodic in-service medical examinations were normal. The post-service records show that the Veteran began seeking VA treatment in October 1997 for reported memory problems, depression, and poor concentration. The Veteran was diagnosed with depressive disorder at that time. Records for subsequent VA and private treatment document ongoing symptoms of anxiety, depression, irritability, sleep disturbances including nightmares, and impaired memory and concentration. Records for VA treatment received by the Veteran through the present show that he has remained under ongoing mental health treatment for major depressive disorder. Nonetheless, the records provide no opinion relating the Veteran’s anxiety disorder and/or depressive disorder to his active duty service. During an August 2019 examination, the examiner opined that it is less likely than not that the Veteran’s disorder was incurred during service or caused by an in-service injury, illness, or event. As rationale, the examiner explained that there is no evidence in the service treatment records of any in-service mental health complaints, objective findings, or treatment, nor is there evidence of such complaints or findings within the one year period after the Veteran’s separation from service. The examiner opined also that it is less likely than not that the Veteran’s disorder resulted from or was aggravated by the Veteran’s lumbar spine disability. The examiner observed that treatment for the Veteran’s anxiety began long after the Veteran’s separation from service and the initial diagnosis for degenerative spondylosis. Rather, the examiner opined, the Veteran’s anxiety seemed to be related to social and family-related stressors. The August 2019 negative etiology opinion is persuasive. In that regard, the opinion is supported by the facts in the record, are not rebutted by contrary opinions in the record, and appears to be consistent with the Veteran’s mental health history and presentation. For these reasons, the Board assigns the August 2019 examiner’s opinion the most probative weight. The Veteran is not entitled to service connection for an acquired psychiatric disorder other than PTSD, to include anxiety disorder and major depressive disorder. To that extent, this appeal is denied. 5. Entitlement to service connection for right and left shoulder adhesive capsulitis with bursitis and tendonitis, claimed as joint pain. The Veteran also claims entitlement to service connection for a disorder in his shoulders that is marked by joint pain. The evidence shows that the Veteran has degeneration and impingement syndrome in both shoulders that likely resulted from his active duty service. The record documents complaints by the Veteran of pain and numbness in his shoulders, beginning during an April 1995 general medical examination. An examination of the Veteran’ shoulders at that time revealed crepitus, tenderness to palpation over both shoulder joints, and decreased bilateral shoulder motion. The examiner diagnosed bilateral shoulder arthralgias and adhesive capsulitis with bursitis and tendonitis. An August 2019 shoulder examination revealed similar objective and radiological findings. The examiner opined that it is likely than that the disorders in the Veteran’s shoulders likely resulted from activities including heavy lifting during service. As mentioned above, the Veteran served in the Southwest Asia Theater of Operations and performed duties that included delivering weapons and ammunition to combat areas. Certainly, the nature of the Veteran’s service is consistent with the examiner’s given rationale. Moreover, the August 2019 examiner’s opinion is not rebutted by any other opinions in the record. For these reasons, the August 2019 examiner’s opinion is entitled significant probative weight. The Veteran is entitled to service connection for right and left shoulder adhesive capsulitis with bursitis and tendonitis. To that extent, this appeal is granted. 6. Entitlement to an initial disability rating higher than 20 percent for lumbar spine degenerative spondylosis. Service connection for lumbar spine degenerative spondylosis was granted to the Veteran in a February 2013 rating decision, effective April 14, 2011. A 20 percent initial disability rating was assigned pursuant to the criteria under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5242 and the General Rating Formula for Diseases and Injuries of the Spine (Spine Formula). The Veteran claims on appeal that he is entitled to a higher initial disability rating. The criteria for rating most spine disabilities are listed under DCs 5235 through 5242. Regardless of which of those criteria that VA selects, disabilities characterized under those DCs are rated pursuant to the Spine Formula. Under the Spine Formula, a 20 percent disability rating is assigned where the evidence demonstrates forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a 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 disability rating is appropriate where there is evidence of forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is warranted where the disability has resulted in unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating contemplates unfavorable ankylosis of the entire spine. For VA compensation purposes, the "combined range of motion" refers to the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. 38 C.F.R. § 4.71a (Plate V) indicates that normal range of motion of the thoracolumbar spine consists of flexion to 90 degrees and extension, bilateral lateral flexion, and bilateral rotation to 30 degrees. As a point of reference, the normal combined range of motion of the thoracolumbar spine is 240 degrees. Ankylosis has been defined as, "immobility and consolidation of a joint due to disease, injury, or surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992). The records for treatment and examinations received by the Veteran for his back over the appeal period document ongoing complaints of chronic low back pain. A July 2012 MRI showed diffuse lumbar disc desiccation and disc bulges at T11-12, L3-4, and L4-5 and mild degenerative facet joint disease at L5-S1. A repeat study conducted in November 2017 was notable for mild discogenic disease at L3-4 with mild right lateral recess stenosis and neural foraminal narrowing with encroachment of the L3 nerve root. Records for private treatment received by the Veteran from 2012 through 2015 with Dr. E.P. document some degree of lost thoracolumbar spine motion; however, specific range of motion findings are not reported in the records. A March 2012 spine examination revealed complaints by the Veteran of chronic low back pain. He described having flare-ups of pain that lasted for periods of up to two weeks but did not report any specific loss of function or loss of motion in association with those flare-ups. The spine examination revealed that the Veteran had retained thoracolumbar spine motion that included forward flexion to 50 degrees, extension to 25 degrees, right lateral flexion to 25 degrees, left latera flexion to 15 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 20 degrees. Pain was reported at the endpoints of all motion. Repetitive motion was not productive of any further loss of motion or other loss of function. The Veteran did not report any tenderness during palpation over the spine and there was no evidence of any spasms or guarding. A neurological examination was normal and revealed no evidence of any radiculopathies or intervertebral disc syndrome (IVDS). In terms of function, the examiner opined that the Veteran's spine disability did not impair the Veteran's ability to feed, toilet, or groom independently; mildly impaired his ability to go shopping, participate in recreational activities, bathe himself, and dress himself; moderately impaired his ability to perform chores, exercise, or travel; and severely impaired in his ability to play sports. The Veteran’s spine was re-examined during an August 2019 spine examination. At that time, the Veteran continued to report chronic back pain and intermittent radiation of pain into his left buttock and thigh with numbness and tingling. He stated that he experienced flare-ups with worsened pain symptoms after prolonged lying, sitting, standing, and walking. He stated that he sometimes needed the assistance of his spouse to help him with his balance. The examination revealed tenderness during palpation over the Veteran’s spine and reported pain during weight-bearing. Guarding behavior was observed, but the examiner noted that it did not result in an abnormal gait or spine contour. The Veteran demonstrated thoracolumbar spine motion that included flexion to 60 degrees; extension and bilateral lateral flexion to 20 degrees; and, bilateral lateral rotation to 30 degrees. The examiner noted that the extent of diminished spine motion would prevent the Veteran from being able to bend down fully to lift objects from the ground. Pain was present in all directions of motion. Three repetitions of motion were not productive of additional loss of motion or other function. The examiner noted that no flare-ups were observed and that the examination was not being conducted after repeated use over time; nonetheless, he noted that the Veteran reported pain, fatigue, weakness, lack of endurance, and incoordination but expressly denied experiencing any further loss of motion during flare-ups and after repetitive use over time. Previous radiological studies from July 2012 and November 2017 were reviewed and noted for showing arthritis. A neurological examination revealed various positive neurological findings that are discussed more fully in the section below. In terms of function, the examiner opined that the Veteran’s lumbar spine disability and associated left lower extremity radiculopathy limited the Veteran’s ability to bend, lift, carry, maintain the same positioning for prolonged periods, and walk. Overall, the evidence shows that the Veteran’s low back disability has been manifested primarily by chronic pain and decreased thoracolumbar spine motion that has included painless forward flexion to no less than 50 degrees, including during flare-ups and after repetitive use over time. In conjunction with the same, there is no evidence in the record that the Veteran has had any ankylosis in his spine; indeed, the degree of motion shown by the Veteran is entirely inconsistent with ankylosis. Based on the foregoing, the criteria for a disability rating higher than 20 percent under the Spine Formula are not met. The Veteran is not entitled to an initial disability rating higher than 20 percent for lumbar spine degenerative spondylosis. To that extent, this appeal is denied. 7. Entitlement to an initial disability rating higher than 10 percent for left lower extremity radiculopathy. As mentioned above, the Veteran reported for the first time during the August 2019 spine examination that he was experiencing radicular symptoms into his left lower extremity which included intermittent radiating pain, numbness, and tingling. A June 2020 rating decision granted to the Veteran a separate 10 percent disability rating for left lower radiculopathy, effective August 27, 2019, the date of the spine examination. Note (1) of the Spine Formula instructs that VA must evaluate any associated objective neurologic abnormalities separately under an appropriate diagnostic code. Based on the same, the Board is compelled to evaluate the Veteran’s left lower extremity radiculopathy and any other demonstrated neurological manifestations associated with the Veteran’s low back disability as part of this appeal. A neurological examination conducted as part of the August 2019 spine examination showed 1+ hypoactive reflexes in the Veteran’s left ankle. Straight leg raise tests were positive in the Veteran’s left lower extremity. The examiner determined that the neurological findings were consistent with a mild left lower extremity radiculopathy involving the sciatic nerve. The examiner also diagnosed IVDS but noted that the Veteran did not have any incapacitating episodes marked by prescribed bed rest over the past 12 months. The Veteran did not report any bowel or bladder dysfunction. Disabilities due to neuritis of the sciatic nerve group are rated in accordance with the criteria under 38 C.F.R. § 4.124a, DC 8520. Under those criteria, a 10 percent disability rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent disability rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent disability rating requires moderately severe incomplete paralysis of the sciatic nerve. A 60 percent disability rating contemplates severe incomplete paralysis with marked muscular atrophy. A maximum schedular 80 percent disability rating is warranted for complete paralysis, i.e., the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, DC 8520. Here, the degree of neurological impairment shown by the Veteran during the August 2019 spine examination is consistent with mild incomplete paralysis of the sciatic nerve and a 10 percent disability rating under DC 8520. The criteria for a disability rating higher than 10 percent are not met. Similarly, the evidence does not support any conclusion that the Veteran’s spine disability was causing any neurological impairment in the Veteran’s left lower extremity prior to the August 2019 examination. To that end, the Veteran reported no radicular symptoms prior to the examination and no objectively observed neurological findings were noted in the records. For this reason, the Veteran is not entitled to a separate disability rating for left lower extremity radiculopathy any earlier than August 27, 2019. There is also no basis in the record to award separate disability ratings for any other radiculopathies or for any other neurological dysfunction at this time. The Veteran is not entitled to an initial disability rating higher than 10 percent for left lower extremity radiculopathy. To that extent, this appeal is denied. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.S. Lee 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.