Citation Nr: 21004491 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 14-15 871A DATE: January 27, 2021 ORDER A disability rating greater than 20 percent prior to August 21, 2013 for degenerative disc disease (DDD), lumbar spine with L3/L4 and L5/S1 fusion (previously rated as DDD, lumbar spine status post fixation surgery, L5-S1) (hereinafter referred to as the service-connected back disability) is denied. A disability rating of 40 percent, and no greater, beginning August 21, 2013 for service-connected back disability is granted. A compensable disability rating prior to May 1, 2019 and greater than 10 percent thereafter for left wrist, status post tendon repair with scar is denied. A compensable disability rating for scars, status post back surgeries, as secondary to the service-connected back disability, is denied. Beginning October 13, 2020, a separate 30 percent disability rating for “scars, painful” is granted. A compensable disability rating for scar, status post varicocele repair, left scrotum, is denied. An initial disability rating greater than 10 percent prior to July 24, 2017, and greater than 20 percent thereafter, for radiculopathy, left lower extremity (femoral nerve) is denied. An initial disability rating greater than 10 percent prior to July 24, 2017, and greater than 20 percent thereafter, for radiculopathy, left lower extremity (sciatic nerve) is denied. An initial disability rating greater than 10 percent prior to March 16, 2019, and greater than 20 percent thereafter, for radiculopathy, right lower extremity (femoral nerve) is denied. An initial disability rating greater than 10 percent prior to March 16, 2019, and greater than 20 percent thereafter, for radiculopathy, right lower extremity (sciatic nerve) is denied. REMANDED The claim of entitlement to service connection for a right hand disorder, to include as secondary to service-connected back disability, is remanded. The claim of entitlement to service connection for a left hand disorder, to include as secondary to service-connected back disability, is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disability prior to June 25, 2015 is remanded. FINDINGS OF FACT 1. Prior to August 21, 2013, the Veteran’s back disability was manifested by functional impairment consisting of subjective complaints of pain and objective limitation of motion to 50 degrees of flexion. Incapacitating episodes have not been shown, and the evidence has not shown any objective neurologic abnormalities associated with the back disability, apart from the already compensated left lower extremity radiculopathy. 2. Beginning August 21, 2013, the Veteran’s back disability has been manifested by functional impairment consisting of subjective complaints of pain and objective limitation of motion to 20 degrees of flexion, without ankylosis of the thoracolumbar spine. Incapacitating episodes have not been shown. 3. The Veteran is right-hand dominant; therefore, his left wrist is part of his minor upper extremity. 4. Prior to May 1, 2019, the Veteran’s left wrist disability was manifested by full range of motion and no complaints of pain. 5. Beginning May 1, 2019, the Veteran’s left wrist disability has been manifested by full range of motion and complaints of pain. 6. Prior to October 13, 2020, there was no evidence that the Veteran’s surgical scars, status post back surgeries, as secondary to the service-connected back disability, were deep, unstable, painful, lost their covering repeatedly, covered an area of 144 square inches or greater, or that they adversely affected any function. 7. Beginning October 13, 2020, the Veteran has been found to have five painful scars which all appear to be service-connected. 8. Beginning October 13, 2020, the Veteran is separately service-connected for “scars, painful” and has been awarded a 30 percent disability rating for painful scars. There is no evidence that the Veteran’s scars of the back are deep, unstable, lose their covering repeatedly, cover an area of 144 square inches or greater, or that they adversely affect any function. 9. The Veteran’s scar, status post varicocele repair, left scrotum, is no longer visible and is asymptomatic. 10. Prior to July 24, 2017, the Veteran’s radiculopathy, left lower extremity (femoral nerve) was manifested by no more than mild incomplete paralysis of the femoral nerve. 11. Beginning July 24, 2017, the Veteran’s radiculopathy, left lower extremity (femoral nerve) has been manifested by no more than moderate incomplete paralysis of the femoral nerve. 12. Prior to July 24, 2017, the Veteran’s radiculopathy, left lower extremity (sciatic nerve) was manifested by no more than mild incomplete paralysis of the sciatic nerve. 13. Beginning July 24, 2017, the Veteran’s radiculopathy, left lower extremity (sciatic nerve) has been manifested by no more than moderate incomplete paralysis of the sciatic nerve. 14. Prior to March 16, 2019, the Veteran’s radiculopathy, right lower extremity (femoral nerve) was manifested by no more than mild incomplete paralysis of the femoral nerve. 15. Beginning March 16, 2019, the Veteran’s radiculopathy, right lower extremity (femoral nerve) has been manifested by no more than moderate incomplete paralysis of the femoral nerve. 16. Prior to March 16, 2019, the Veteran’s radiculopathy, right lower extremity (sciatic nerve) was manifested by no more than mild incomplete paralysis of the femoral nerve. 17. Beginning March 16, 2019, the Veteran’s radiculopathy, right lower extremity (sciatic nerve) has been manifested by no more than moderate incomplete paralysis of the femoral nerve. CONCLUSIONS OF LAW 1. Prior to August 21, 2013, the criteria for a disability rating greater than 20 percent for the Veteran’s back disability were not met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.69, 4.71a, Diagnostic Code (DC) 5242.  2. Beginning August 21, 2013, the criteria for a disability rating of 40 percent, but no higher, for the Veteran’s back disability have been met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.69, 4.71a, DC 5242. 3. Prior to May 1, 2019, the criteria for a compensable disability rating for the Veteran’s left wrist disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.69, 4.71a, DC 5215. 4. Beginning May 1, 2019, the criteria for a disability rating greater than 10 percent for the Veteran’s left wrist disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.10, 4.40, 4.45, 4.69, 4.71a, DC 5215. 5. The criteria for a compensable disability rating for scars, status post back surgeries, as secondary to the service-connected back disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.118, DC 7805. 6. Beginning October 13, 2020, the criteria for a separate 30 percent disability rating for separately service-connected “scars, painful” have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.118, DC 7804. 7. The criteria for a compensable disability rating for scar, status post varicocele repair, left scrotum, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.118, DC 7805. 8. Prior to July 24, 2017, the criteria for an initial disability rating greater than 10 percent for radiculopathy, left lower extremity (femoral nerve) were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8526. 9. Beginning July 24, 2017, the criteria for a disability rating greater than 20 percent for radiculopathy, left lower extremity (femoral nerve) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8526. 10. Prior to July 24, 2017, the criteria for an initial disability rating greater than 10 percent for radiculopathy, left lower extremity (sciatic nerve) were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8520. 11. Beginning July 24, 2017, the criteria for a disability rating greater than 20 percent for radiculopathy, left lower extremity (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8520. 12. Prior to March 16, 2019, the criteria for an initial disability rating greater than 10 percent for radiculopathy, right lower extremity (femoral nerve) were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8526. 13. Beginning March 16, 2019, the criteria for a disability rating greater than 20 percent for radiculopathy, right lower extremity (femoral nerve) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8526. 14. Prior to March 16, 2019, the criteria for an initial disability rating greater than 10 percent for radiculopathy, right lower extremity (sciatic nerve) were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8520. 15. Beginning March 16, 2019, the criteria for a disability rating greater than 20 percent for radiculopathy, right lower extremity (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Air Force from August 1977 to September 1994. These matters are before the Board of Veterans’ Appeal (Board) on appeal of May 2013 and October 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. Specifically, the May 2013 rating decision, in part, granted service connection for scars, status post back surgeries as secondary to the service-connected back disability, assigning a noncompensable disability rating effective September 20, 1994; continued a 20 percent disability rating for the Veteran’s back disability; continued a noncompensable disability rating for the Veteran’s scar, status post varicocele repair, left scrotum; and denied service connection for bilateral hand disorders. The October 2015 rating decision granted service connection for bilateral lower extremity radiculopathy, assigning separate 10 percent disability ratings for the left femoral and sciatic nerves and a 10 percent disability rating for the right femoral nerve, and increased the Veteran’s disability rating for the back from 20 to 40 percent disabling, each effective June 25, 2015, the date of the most recent VA spine examination report. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in May 2019. A transcript of this proceeding has been associated with the claims file. Significantly, the Veteran’s representative requested a TDIU during the May 2019 Board hearing pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) as part and parcel to his increased rating claims. Subsequently, by rating decision dated in August 2019, the RO granted a TDIU effective June 25, 2015. As the Veteran’s claim for an increased rating has been pending since May 2011, the Board finds that the issue of entitlement to a TDIU prior to June 25, 2015 remains on appeal. In October 2019, the Board granted an earlier effective date for the award of August 21, 2013 for the grant of service connection for radiculopathy of the bilateral lower extremities. The Board remanded the remaining issues on appeal for further development. Thereafter, by rating decision dated in October 2020, the RO increased the Veteran’s disability rating for right lower radiculopathy (femoral nerve) from 10 to 20 percent disabling effective March 16, 2019; granted service connection for right lower radiculopathy (sciatic nerve), assigning a 20 percent disability rating effective March 16, 2019; increased the Veteran’s disability rating for the left wrist from noncompensable to 10 percent disabling effective May 1, 2019; granted service connection for painful scars, assigning a 10 percent disability rating effective October 13, 2020; granted service connection for scars of the anterior trunk post lumbar surgery, assigning a noncompensable disability rating effective March 16, 2019; and granted service connection for a scar of the left wrist, status post tendon repair, assigning a noncompensable disability rating effective October 13, 2020. Also, by rating decision dated in November 2020, the RO assigned a 10 percent disability rating effective July 24, 2017 and continued a 20 percent disability rating effective March 16, 2019 for right lower radiculopathy (sciatic nerve). Notably, while the Veteran has not formally appealed the disability rating assigned for his right lower radiculopathy (sciatic nerve), the Board has taken jurisdiction of this issue as part of his claim for a higher rating for his service-connected back disability. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability.  Separate diagnostic codes identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran.  38 C.F.R. § 4.3.  A Veteran’s entire history is to be considered when assigning disability ratings.  38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).  The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal.  Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria.  See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995).  The Court also has issued the opinion of Correia v. McDonald, 28 Vet. App. 158 (2016), which clarifies additional requirements that VA examiners should address when assessing musculoskeletal disabilities, holding specifically, that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.  In addition, assignment of a disability rating should take into account consideration of limitation of functional ability during flare-ups or when a joint is used repeatedly over a period of time.  See DeLuca, supra. Specifically, in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court stated that flare-ups must be considered in providing an estimate of additional functional loss based on range of motion. Unfortunately, the guidance on how to evaluate flare-ups has not been particularly clear. As a consequence, it is determined that the holding in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), will be expanded and flare-ups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. 1. A disability rating greater than 20 percent prior to August 21, 2013 for back disability is denied; a disability rating of 40 percent, and no greater, beginning August 21, 2013 for back disability is granted. The Veteran seeks a higher disability rating for his service-connected back disability, both prior to and beginning June 25, 2015. By way of history, service treatment records show that the Veteran injured his back while lifting a desk in 1981. An April 1991 magnetic resonance imaging (MRI) scan showed a “ruptured disc, L5-S1 “ and the Veteran underwent a discectomy in July 1991 and an L5-S1 spinal fusion in January 1993. By rating decision dated in March 1995, the RO granted service connection for DDD with spinal fusion, assigning a 20 percent disability rating effective September 20, 1994. This 20 percent disability rating was continued by rating decisions dated in August 1995, July 2004, April 2006, and May 2006 (with a temporary total rating awarded from January 15, 2004 through May 31, 2004). The Veteran filed a claim for an increased rating that was received in May 2011. In the May 2013 rating decision that is the subject of this appeal, the RO continued the 20 percent disability rating for the Veteran’s back disability (with another temporary total rating from November 2012 through May 31, 2013). The Veteran disagreed with this decision and perfected this appeal. Thereafter, by rating decision dated in October 2015, the RO increased the back disability rating from 20 percent to 40 percent disabling effective June 25, 2015, the date of a VA examination showing an increase in severity. Back disabilities may be evaluated under either of two general rating formulas.  One applies to intervertebral disc syndrome (IVDS), and is based upon the duration of incapacitating episodes.  The other general rating formula involves the General Rating Formula for Diseases and Injuries of the Spine.  Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is assigned 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 requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.  A 50 percent rating will be assigned with evidence of unfavorable ankylosis of the entire thoracolumbar spine.  A 100 percent rating requires evidence of unfavorable ankylosis of the entire spine.  Pertinent to this appeal, Note (1) of the rating schedule indicates that the agency is to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Also, from Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.  Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  Alternatively, the Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted when there are incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating is warranted when there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months; and a 40 percent rating is warranted when there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months.  A 60 percent rating is warranted when there are incapacitating episodes having a total duration of at least six weeks during the past 12 months.  An incapacitating episode is defined as 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.  38 C.F.R. § 4.71a, DC 5243, Note (1).  Evidence relevant to the level of severity of the Veteran’s back disability during the pendency of this appeal includes VA examination reports dated in July 2011, June 2015, and March 2019. Also of record are VA and private treatment records dated through October 2020. During the July 2011 VA spine examination, the examiner continued a diagnosis of DDD lumbosacral spine, status post surgery, L5-S1. The Veteran reported a history of several back surgeries, most recently in March 2010 when he underwent dorsal stimulator which had given improvement to his symptoms. It was noted that the Veteran worked as an internet trainer until 2005 when he quit after obtaining Social Security disability benefits. He was able to drive long distances, shop, engage in self-care, and go boating. He denied experiencing flare-ups of the lumbar spine. The Veteran reported that he no longer has any radicular symptoms from his back and was only left with some slight decreased sensation from the MTP joints, distally, in all his toes of both feet. He was told that this was some type of peripheral neuropathy and that no treatment was available. Physical examination of the spine revealed normal posture, normal head position, and symmetry appearance. There were no abnormal spinal curvatures. Significantly, there was no muscle spasm, localized tenderness, or guarding severe enough to be responsible for abnormal gait or abnormal spinal contour. Range of motion testing of the lumbar spine revealed flexion to 50 degrees, extension to 20 degrees, left lateral flexion to 20 degrees, left lateral rotation to 0 degrees, right lateral flexion to 20 degrees, and right lateral rotation to 0 degrees. There was no objective evidence of pain on active range of motion. There was also no objective evidence of pain following repetitive motion and no additional limitations after three repetitions of range of motion. Reflex examination was normal, with the exception of right ankle jerk, which was absent. Sensory examination was normal with the exception of decreased vibration and decreased pain/pinprick of the bilateral peripheral lower big toes. Motor examination was normal, along with muscle tone, and there was no muscle atrophy. Lasegue’s sign was negative and Miner’s test was normal. He had positive Waddell’s test for superficial tenderness, axial loading, and simulated rotation since he rotated from the knees and not the lumbosacral spine, yet still complained of low back pain. There was regional disturbance since his toes sensation did not correlate with a dermatome or a peripheral nerve related to a back condition. The Veteran also had decreased right Achilles reflexes, but did not have a sensory ot motor abnormality to correlate with the suggested right S1 nerve root abnormality. The Veteran could perform a heel walk, toe walk, hop on each foot, squat and raise from a squatted position getting out of a chair, and had a normal brisk gait. He had no difficulty dressing or getting on and off the examination table without assistance. He had no evidence of pain with these maneuvers. This, according to the examiner, suggested a non-organic problem. During the June 2015 VA examination, the examiner continued a diagnosis of DDD with L3/L4 and L5/S1 fusion and also noted a diagnosis of bilateral lower extremity radiculopathy. At that time, the Veteran reported experiencing back pain for 13 years despite the use of pain medication. The pain was such that he could not sit for more than 30 minutes and had trouble sleeping more than 30 minutes. The pain radiated down his legs and was pins/needles on his calves/feet, left worse than right. He continued to report a history of multiple back surgeries, the last surgery occurring in January 2014. The Veteran reported experiencing flare-ups of the lumbar spine. The flare-ups were described as pain, weakness, and stiffness occurring five times per year and lasting anywhere from two weeks to two months. During these flare-ups, the Veteran is completely immobilized. The examiner noted that both pain and fatigability could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. However, the examiner noted that there was no additional loss of motion during a flare-up. The examiner also noted that the Veteran was limited in lifting more than 10 to 15 pounds, walking more than 2 standard blocks at one time, walking more than 2 hours during an 8 hour period (4 times at 30 minutes each), sitting/standing more than 10 minutes at one time without repositioning, and sitting/standing more than 1.5 hours during an 8 hour day. Range of motion testing of the lumbar spine revealed flexion to 30 degrees (with pain beginning at 20 degrees), extension to 15 degrees (with and without pain), right lateral flexion to 20 degrees (with pain beginning at 15 degrees), left lateral flexion to 15 degrees (with pain beginning at 10 degrees), right lateral rotation to 20 degrees (with pain beginning at 15 degrees), and left lateral rotation to 15 degrees (with and without pain). Significantly, the examiner noted that the Veteran’s back was “quite painful” and also noted the presence of four scars on his back. The Veteran was not able to perform repetitive-use testing with three repetitions due to pain on initial range of motion. There was functional loss and/or functional impairment of the back, specifically less movement than normal, weakened movement, and pain on movement. There was localized tenderness or pain to palpation for joints and/or soft tissue of the back, specifically, pain upon palpation was mild at thoracic T11/12 and lumbar L3, 4, and 5. There was no guarding or muscle spasm of the spine. There was no muscle atrophy and reflex examination was normal. Sensory examination was normal with the exception of the bilateral feet/toes. Straight leg raising test was positive. There was radiculopathy resulting in mild constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness. There were no other signs or symptoms of radiculopathy. The radiculopathy involved both the femoral and sciatic nerves and was mild in severity, bilaterally. There were no other neurologic abnormalities and there was no IVDS. The Veteran occasionally used a brace and/or a cane to assist with locomotion. There was no functional impairment of the lumbar spine such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were scars of the back but none of the scars were painful and/or unstable nor did they have a total area greater than 39 square centimeters (one scar at the mid thoracic back measured 7 centimeters and another scar at the lumbar area measured 12 centimeters). There were no other pertinent physical findings. No imaging studies were available. With regard to functional impact, the examiner wrote that the Veteran’s back disability impacted his ability to work. During the March 2019 VA spine examination, the examiner continued diagnoses of DDD with L3/L4 and L5/S1 and bilateral lower extremity radiculopathy. The examiner also noted a diagnosis of failed back syndrome. The Veteran reported that he experienced flare-ups of the thoracolumbar spine, described as movement, activities, prolonged sitting, standing, walking, kneeling, and bending. The Veteran also reported experiencing functional loss/impairment due to his lumbar spine disability, described as an inability to lift items off the floor, engage in sports or other physical activities, stand to cook for more than 15 minutes, and/or get in and out of a boat. Range of motion testing of the lumbar spine revealed flexion to 45 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. This loss of motion contributed to a functional loss, described as an inability to bend, lift, push, or pull. There was objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the spine, described as severe. There was no evidence of pain with weight bearing. The Veteran was not able to perform repetitive-use testing with three repetitions due to pain. The Veteran was not examined immediately after repetitive use over time and the examination was not medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Both pain and weakness significantly limited functional ability with repeated use over a period of time. The examiner estimated this additional loss of motion as follows: forward flexion to 20 degrees, extension to 0 degrees, right lateral flexion to 5 degrees, left lateral flexion to 5 degrees, right lateral rotation to 5 degrees, and left lateral rotation to 5 degrees. The Veteran was not examined during a flare-up and the examination was not medically consistent with the Veteran’s statements describing functional loss during flare-up. Both pain and weakness significantly limited functional ability with flare-ups. The examiner estimated this additional loss of motion as follows: forward flexion to 20 degrees, extension to 0 degrees, right lateral flexion to 5 degrees, left lateral flexion to 5 degrees, right lateral rotation to 5 degrees, and left lateral rotation to 5 degrees. While there was guarding, this did not result in abnormal gait or abnormal spinal contour. There were no additional factors contributing to disability. Muscle strength testing was normal for the hips but slightly abnormal (active movement against some resistance) for the knees, ankles, and great toes, bilaterally. There was no muscle atrophy. Reflex examination was normal. Sensory examination was normal for the bilateral upper anterior thighs but decreased for the thigh/knee, lower leg/ankle, foot/toes, bilaterally. Straight leg raising testing was positive bilaterally. There was radiculopathy of both lower extremities, described as constant pain, paresthesias and/or dysesthesias, and numbness (moderate on the right and severe on the left) involving both the femoral and sciatic nerves. Overall, the examiner found that the Veteran experienced moderate radiculopathy of the right lower extremity and severe radiculopathy of the left lower extremity. There was no ankylosis, other neurologic abnormalities, or IVDS. The Veteran occasionally used a cane to assist with locomotion. There was no functional impairment of the lumbar spine such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were several scars but none of these scars were painful, unstable, or greater than 39 square centimeters in size. Imaging studies were not available. With regard to functional impact, the examiner wrote that the Veteran’s lumbar spine disability impacted his ability to work, specifically the Veteran was unable to engage in work which required lifting, pushing, pulling, prolonged walking, or standing. With regard to Correia, the examiner wrote that there was objective evidence of pain when the back is used in non-weight bearing. Passive range of motion testing could not be performed or was not medically appropriate. VA and private treatment records dated through October 2020 show findings similar to those noted above but are negative for specific range of motion testing. However, an August 21, 2013 private treatment record shows that the Veteran first experienced pain when testing forward flexion of the lumbar spine at 30 degrees or less. This private treatment record also shows six weeks or more of incapacitating episodes of the lumbar spine. Upon review of the record, the Board finds that the criteria for a 40 percent disability rating are met beginning August 21, 2013 when the Veteran was found to experience pain when testing forward flexion of the lumbar spine at 30 degrees or less. As above, a 40 percent disability rating is warranted with evidence of forward flexion of the thoracolumbar spine to 30 degrees or less. As for the period of time prior to August 21, 2013, the Board finds that a disability rating greater than 20 percent is not warranted for the Veteran’s back disability because there is no medical evidence of limitation of forward flexion to 30 degrees or less, or evidence of favorable ankylosis of the entire thoracolumbar spine.  As above, the July 2011 VA examination report shows lumbar flexion to 50 degrees.  With regard to the possibility that the Veteran exhibited additional loss of motion of the lumbar spine prior to June 25, 2015 due to flare-ups of the back pursuant to Sharp, the Board notes that, prior to June 25, 2015, there is no indication of flare-ups. Significantly, while the Veteran reported experiencing flare-ups during the June 2015 VA examination, he specifically denied experiencing flare-ups during the July 2011 VA examination. Furthermore, even if the Veteran did experience flare-ups prior to June 25, 2015, the guidance on how to evaluate flare-ups has not been particularly clear and, pursuant to Mitchell, flare-ups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flare-ups must be of such length as to establish that the overall impairment is more severe than currently evaluated. The statements made in this case do not show that any flare-ups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher or staged rating would not violate the rule regarding stabilization of ratings. In particular, the VA examiners attempted to elicit information from the Veteran in this regard, and he stated only that he has pain in the lumbar spine and avoids certain activities. As for the period of time beginning August 21, 2013, the Board concludes that a disability rating greater than 40 percent for the Veteran’s back disability is not warranted. As above, a rating higher than 40 percent based on orthopedic impairment requires a finding of ankylosis. Ankylosis is defined in general as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Colayong v. West, 12 Vet. App. 524 (1999) (citing Dorland’s Illustrated Medical Dictionary (28th ed. 1994) at 86). For VA compensation purposes, unfavorable ankylosis is a condition in which the thoracolumbar spine, or the entire spine, is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). There is no evidence that the Veteran’s spine is fixed in position, or ankylosed. Significantly, the Veteran had flexion to 30 degrees (20 degrees with pain and during flare-ups) during the June 2015 VA examination and had flexion to 45 degrees (20 degrees with pain and during flare-ups) during the March 2019 VA examination. With regard to the entire appellate period beginning May 2011, the Board has also considered whether any other diagnostic codes might serve as a basis for an increased rating.  In this regard, DC 5003 addresses degenerative arthritis.  However, in this case, the maximum evaluation possible under DC 5003 is 10 percent, as only one major joint or group of minor joints is involved in this claim.  Therefore, it does not allow for a higher evaluation.  Also, even though the August 21, 2013 private treatment record shows six weeks or more of incapacitating episodes of the lumbar spine, the Veteran has not been diagnosed with IVDS at any time during the entire appeal period.  There are no other applicable codes available for consideration.  In denying higher disability ratings for the Veteran’s back disability, the Board has considered the Veteran’s statements that his back disability is worse, as well as his report of pain.  While he is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions regarding whether his symptoms meet the next higher rating criteria under VA regulations.  Such competent evidence concerning the nature and extent of the Veteran’s back disability has been provided by the medical personnel who have examined him during the current appeal.  The medical findings (as provided in the examination reports and clinical records) directly address the criteria under which this disability is evaluated.  The specific clinical measures of ranges of motion, including examiners’ findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board.  Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran’s report of pain and limitation of function.  Thus, the overall evidence does not show that pain or other factors have resulted in additional functional limitation or limitation of motion such as to enable a finding that the disability picture more nearly approximates the next-higher disability ratings either prior to or beginning August 21, 2013. Despite the Veteran’s contention of a debilitating back disability, the disability ratings assigned herein indicate a significant impact on his functional ability.  Such disability evaluations assigned by VA recognize his painful motion.  The critical question in this case, however, is whether the problems he has cited meet an even higher level under the rating criteria.  For reasons cited above, the Board finds they do not.  2. A compensable disability rating prior to May 1, 2019 and greater than 10 percent thereafter for left wrist, status post tendon repair with scar is denied. The Veteran seeks a higher (compensable) disability rating for his service-connected left wrist disability prior to May 1, 2019 and a disability rating greater than 10 percent thereafter. By way of history, service treatment records show that the Veteran underwent surgery on his left wrist in June 1981, specifically transplantation of the palmaris muscle tendon into the dorsum of the left wrist to hold the other tendon in place. By rating decision dated in March 1995, the RO granted service connection for left wrist status post tendon repair with scar, assigning a noncompensable disability rating effective September 20, 1994. The Veteran filed a claim for an increased rating that was received in May 2011. In the May 2013 rating decision that is the subject of this appeal, the RO continued the noncompensable disability rating for the Veteran’s left wrist disability. The Veteran disagreed with this decision and perfected this appeal. As above, by rating decision dated in October 2020, the RO increased the Veteran’s disability rating for the left wrist from noncompensable to 10 percent disabling effective May 1, 2019, the date of the Board hearing testimony wherein the Veteran provided testimony concerning subjective evidence of left wrist pain. The Veteran’s left wrist disability is currently rated under DC 5215. Pursuant to DC 5215, a 10 percent rating is warranted when palmar flexion is limited to a position in line with the forearm, or when dorsiflexion is less than 15 degrees. This 10 percent rating is applicable for either the major or minor limb. A 10 percent rating is the only, and therefore the maximum, rating available under this code. Also pertinent to this claim is DC 5214, which provides for higher evaluations for ankylosis of the wrist. Under this code, a 40 percent rating is warranted when there is unfavorable ankylosis, in any degree of palmar flexion, or with ulnar or radial deviation of the minor wrist. A 30 percent rating is warranted when there is ankylosis of the minor wrist in any other position, except favorable. Finally, a 20 percent rating is warranted when there is favorable ankylosis in 20 degrees to 30 degrees dorsiflexion in the minor wrist. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury or surgical procedure.” See Colayong v. West, 12 Vet. App. 524, 528 (1999); Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Normal range of motion is: dorsiflexion (extension) to 70 degrees, palmar flexion to 80 degrees, ulnar deviation to 45 degrees, and radial deviation to 20 degrees. 38 C.F.R. § 4.71, Plate I. For rating purposes, a distinction is made between major (dominant) and minor musculoskeletal groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. 38 C.F.R. § 4.69. Here, as the medical evidence shows that the Veteran is right-hand dominant, for rating purposes, his left wrist is part of his mior upper extremity. Evidence relevant to the level of severity of the Veteran’s left wrist disability, includes VA examination reports dated in July 2011 and October 2020. Also of record are VA and private treatment records dated through October 2020. During the July 2011 VA joints examination, the examiner noted a diagnosis of postoperative tendon repair, left wrist. At that time, the Veteran reported that he was right-hand dominant. There was no deformity, giving way, instability, pain, stiffness, weakness, incoordination, decreased speed of joint motion, episodes of dislocation or subluxation, locking episodes, effusions, symptoms of inflammation, or flare-ups. There were also no constitutional symptoms/incapacitating episodes of arthritis, standing limitations, functional limitations on walking, or assistive devices. On physical examination there was no abnormal weight bearing, loss of bone or part of bone, recurrent dislocations, or inflammatory arthritis. The Veteran had no heat, swelling, or deformity and had full range of motion in all directions. The only residual was a scar at the distal ulna area of the lateral left wrist. On range of motion testing, there was no objective evidence of pain with active motion on the left side. Significantly, the Veteran had active dorsiflexion to 70 degrees, palmar flexion to 80 degrees, radial deviation to 20 degrees, and ulnar deviation to 45 degrees. There was no objective evidence of pain following repetitive motion and no additional limitations after three repetitions of range of motion. There was also no joint ankylosis. Significantly, while it was noted that the Veteran previously worked in computer programming but had not worked in the past six years due to disability, the examiner noted that the Veteran’s left wrist disability resulted in no significant effects on either his usual occupation or daily activities and did not limit his ability to seek and maintain gainful employment nor limit his physical activity. During the October 2020 VA wrist examination, the examiner continued a diagnosis of left wrist status post tendon repair with scar. At the time of the examination, the Veteran reported experiencing intermittent pain with lifting and grasping. He also experienced popping in his wrist “all the time” with aches during the cold weather. The Veteran reiterated that he was right-hand dominant. Significantly, the Veteran reported that he experienced flare-ups of the left wrist, reportedly once or twice per week. According to the Veteran, these flare-ups resulted in a pain level of 6/10, were precipitated by lifting, grasping, and driving, and were alleviated by pain medication and rest. The Veteran also reported that he experienced functional loss/impairment due to his left wrist disability, specifically difficulty cooking, lifting/carrying more than 10 to 15 pounds, using the computer or driving for more than an hour, rotating his wrist, and playing sports. On range of motion testing, the Veteran had normal motion of the left wrist. Specifically, the Veteran had palmar flexion to 80 degrees, dorsiflexion to 70 degrees, ulnar deviation to 45 degrees, and radial deviation to 20 degrees. There was pain which caused functional loss on all movements as well las evidence of pain with weight bearing. There was also objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, specifically the left lateral wrist showed moderate impairment. However, there was no evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. The Veteran’s left wrist was not examined immediately after repetitive use over time, but the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain and fatigue significantly limited the Veteran’s functional ability with repeated use over a period of time, however, there was no additional loss of motion. The Veteran’s left wrist was also not examined during a flare-up but the examination was medically consistent with the Veteran’s statements describing functional loss during flare-up. Also, pain significantly limited the Veteran’s functional ability with flare-ups but, again, there was no additional loss of motion. There were no additional contributing factors to the Veteran’s left wrist disability. Muscle strength testing was normal and there was no reduction in muscle strength nor muscle atrophy. There was also no ankylosis. There were no other pertinent physical findings other than a scar which was neither painful nor unstable and was less than 39 square centimeters. The Veteran did not use any assistive devices and there was no functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. Imaging studies were not available and there were no other significant diagnostic testing results. The examiner found that the Veteran’s left wrist disability did not impact his ability to perform any type of occupational task. VA and private treatment records dated through October 2020 show findings similar to those noted above but are negative for range of motion testing. As for the period of time prior to May 1, 2019, the Board finds that a compensable disability rating is not warranted for the Veteran’s left wrist disability. As above, a 10 percent rating under DC 5215 requires evidence of dorsiflexion less than 15 degrees or palmar flexion limited in line with the forearm. However, the Veteran had dorsiflexion to 70 degrees and palmar flexion to 80 degrees during the July 2011 VA examination. Furthermore, the Veteran denied experiencing flare-ups during the July 2011 VA examination. In fact, he denied experiencing any pain of the left wrist at all during the July 2011 VA examination. Thus, a higher (compensable) rating is not warranted prior to May 1, 2019 under DC 5215. As for the period of time beginning May 1, 2019, the Board finds that a disability rating greater than 10 percent is not warranted for the Veteran’s left wrist disability. As above, a 10 percent rating is the highest rating possible under DC 5215. However, under DC 5214, a 20 percent rating is warranted when there is favorable ankylosis in 20 degrees to 30 degrees dorsiflexion in the minor wrist. Here, the Veteran had dorsiflexion to 70 degrees and palmar flexion to 80 degrees during the October 2020 VA examination so there is no indication of ankylosis. While the Veteran has complained of pain in his left wrist, such complaints are contemplated by his 10 percent disability rating beginning May 1, 2019. Thus, a higher disability rating of 20 percent for ankylosis of the wrist is not warranted under DC 5214. 3. A compensable disability rating for scars, status post back surgeries, as secondary to the service-connected back disability, is denied; a compensable disability rating for scar, status post varicocele repair, left scrotum, is denied. The Veteran seeks higher (compensable) disability ratings for his service-connected scars of the back and left scrotum. By way of history, service treatment records show that the Veteran underwent spinal surgeries in July 1991 and in March 1995 and varicocele repair of the left scrotum in 1993. By rating decision dated in March 1995, the RO granted service connection for scar, status post varicocele repair, left scrotum, assigning a noncompensable disability rating effective September 20, 1994. The Veteran filed a claim for an increased rating for his back disability and scar of the left scrotum that was received in May 2011. In the May 2013 rating decision that is the subject of this appeal, the RO continued the noncompensable disability rating for the Veteran’s left scrotum scar and granted service connection for scars, status post back surgeries, as secondary to the service-connected back disability, assigning a noncompensable disability rating effective September 20, 1994. The Veteran disagreed with this decision and perfected this appeal. The Veteran’s back and left scrotum scars are current rated under 38 C.F.R. § 4.118, DC 7805. The diagnostic criteria for disorders of the skin are found at 38 C.F.R. § 4.118, DC’s 7801-7805. Under DC 7801, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) warrant a 10 percent rating. Under DC 7802, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater warrant a 10 percent evaluation. Note (2) under that code provides that if multiple qualifying scars are present, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity. Under DC 7804, one or two scars that are unstable or painful warrant a 10 percent evaluation, three or four scars that are unstable or painful warrant a 20 percent evaluation, five or more scars that are unstable or painful warrant a 30 percent evaluation. Note (2) for that code provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) under that provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7803, when applicable. DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. §§ 4.118, DCs 7801-7805. Evidence relevant to the current level of severity of the Veteran’s scars of the back and left scrotum includes July 2011 VA spine and scar examinations, June 2015 and March 2019 VA spine examinations, and October 2020 VA male reproductive and scar examinations. Also of record are VA and private treatment records dated through October 2020. During the July 2011 VA spine examination, it was noted that there were scars of the back but none of the scars were painful and/or unstable nor did they have a total area greater than 39 square centimeters (one scar at the mid thoracic back measured 7 centimeters and another scar at the lumbar area measured 12 centimeters). During the July 2011 VA scar examination, it was noted that the Veteran’s scar of the scrotum could not be found. Physical examination was negative for pain, skin breakdown, inflammation, edema, and/or keloid formation and the impression was “alleged scrotal scar no longer present.” During the June 2015 VA spine examination, it was noted that there were scars of the back but none of the scars were painful and/or unstable nor did they have a total area greater than 39 square centimeters (one scar at the mid thoracic back measured 7 centimeters and another scar at the lumbar area measured 12 centimeters). During the March 2019 VA spine examination, it was noted that there were several scars but none of these scars were painful, unstable, or greater than 39 square centimeters in size. During the October 2020 VA scar examination, the examiner noted 15 different scars of the neck, back, abdomen, wrists, and elbows. Notably, at least 8 of these 15 scars appear to be associated with the Veteran’s service-connected back surgeries and the examiner did not note a scar of the scrotum. The examiner noted that five or more of these scars are painful, specifically scars of the posterior neck, lumbar spine, left lateral low back, left side, and left wrist. However, none of these scars were found to be unstable, with frequent loss of covering. The scars of the anterior trunk had a total area of 8.7 centimeters and the scars of the posterior trunk had a total area of 27 centimeters. None of the Veteran’s scars resulted in limitation of function and there were no other pertinent physical findings. The examiner found that the Veteran’s scars did not impact his ability to work. With regard to the Veteran’s scar of the scrotum, the Veteran reported that this scar is no longer visible, was not painful, and was “not an issue.” VA and private treatment records dated through October 2020 show findings similar to those noted above. Notably, during the course of this appeal, by rating decision dated in October 2020, the RO granted service connection for “scars, painful,” assigning a 10 percent disability rating effective October 13, 2020 based on the findings of painful scars during the October 13, 2020 VA scar examination. This award contemplates the pain noted in the Veteran’s back scars and assigning a separate compensable disability rating for each scar found to be painful would result in unlawful pyramiding. However, it appears that the combined 10 percent disability rating assigned for “scars, painful,” fails to consider the number of service-connected painful scars the Veteran experiences. As above, pursuant DC 7804, unstable or painful scars are rated together and, if a veteran has five or more scars that are painful or unstable, the veteran is entitled to the maximum 30 percent schedular rating. In this case, the Veteran appears to have five service-connected scars which are painful (scars of the posterior neck, lumbar spine, left lateral low back, left side, and left wrist), which qualifies for the maximum schedular rating of 30 percent under DC 7804. As such, a 30 percent disability rating for “scars, painful” is warranted beginning October 13, 2020. As for the potential for an even higher disability rating beginning October 13, 2020, there is no evidence that either the back or left scrotum scars are deep, unstable, lose their covering repeatedly, cover an area of 144 square inches or greater, or that they adversely affect any function. As such, a higher disability rating is not warranted for these disabilities under any other diagnostic code regarding the skin. As for the period of time prior to October 13, 2020, there is a complete absence of any competent or objective medical evidence on file which shows that the Veteran suffered from any residuals of the service-connected back and left scrotum scars. There was no evidence that the scars were deep, unstable, painful, lost their covering repeatedly, covered an area of 144 square inches or greater, or that they adversely affected any function. As above, the July 2011, June 2015, and March 2019 VA spine examinations also indicate that the Veteran’s back scars were not painful. As such, they were appropriately rated as noncompensable. 4. An initial disability rating greater than 10 percent prior to July 24, 2017, and greater than 20 percent thereafter, for radiculopathy, left lower extremity (femoral nerve) is denied; an initial disability rating greater than 10 percent prior to July 24, 2017, and greater than 20 percent thereafter, for radiculopathy, left lower extremity (sciatic nerve) is denied; an initial disability rating greater than 10 percent prior to March 16, 2019, and greater than 20 percent thereafter, for radiculopathy, right lower extremity (femoral nerve) is denied; and an initial disability rating greater than 10 percent prior to March 16, 2019, and greater than 20 percent thereafter, for radiculopathy, right lower extremity (sciatic nerve) is denied. As above, by rating decision dated in March 1995, the RO granted service connection for DDD with spinal fusion, assigning a 20 percent disability rating effective September 20, 1994. The Veteran filed a claim for an increased rating for his back disability that was received in May 2011 and, by rating decision dated in October 2015, the RO granted service connection for radiculopathy of the bilateral lower extremities, assigning separate 10 percent disability ratings for the left lower femoral nerve, right lower femoral nerve, and left lower sciatic nerve, each effective June 25, 2015, the date of a VA spine examination showing radiculopathy. The Veteran disagreed with this decision and perfected this appeal. Thereafter, by rating decision dated in December 2017, the RO increased the disability rating for radiculopathy of the left lower femoral and sciatic nerves from 10 to 20 percent disabling, each effective July 24, 2017, the date of a VA examination showing an increase in severity. Even more recently, by rating decision dated in October 2020, the RO granted service connection for right lower radiculopathy (sciatic nerve), assigning a 20 percent disability rating effective March 16, 2019, and increased the disability rating for radiculopathy of the right lower femoral nerve from 10 to 20 percent disabling effective March 16, 2019, the date of a VA examination showing an increase in severity. Subsequently, by rating decision dated in November 2020, the RO assigned a 10 percent disability rating effective July 24, 2017 and continued a 20 percent disability rating effective March 16, 2019 for right lower radiculopathy (sciatic nerve). The Veteran’s service-connected radiculopathy of the lower extremities is rated under the provisions of 38 C.F.R. § 4.124a, DCs 8526 and 8520. DC 8526 assigns 10, 20, 30, and 40 percent ratings for incomplete paralysis of the femoral nerve that is mild, moderate, moderately severe, and severe with marked muscular atrophy, respectively. 38 C.F.R. § 4.124a, DC 8726. DC 8520 assigns 10, 20, 40, and 60 percent ratings for incomplete paralysis of the sciatic nerve that is mild, moderate, moderately severe, and severe with marked muscular atrophy, respectively. 38 C.F.R. § 4.124a, DC 8520. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis for a particular nerve, whether due to varied level of the nerve lesion or to partial regeneration. The terms “mild,” “moderate,” “moderately severe,” and “severe” are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. However, 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. Peripheral neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Evidence relevant to the severity of the Veteran’s radiculopathy of the lower extremities includes June 2015, July 2017, and March 2019 VA examination reports. Also of record are VA and private treatment records dated through October 2020. During the June 2015 VA spine examination, there was radiculopathy resulting in mild constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness. There were no other signs or symptoms of radiculopathy. The radiculopathy involved both the femoral and sciatic nerves and was mild in severity, bilaterally. During the July 2017 VA peripheral nerves examination, the examiner noted diagnoses of bilateral lower extremity radiculopathy. The Veteran reported that, despite 14 surgeries on his back as well as pain medication, he continued to experience bilateral lower extremity pain which limited his activities. Specifically, he was unable to stand longer than 10 minutes, walk more than 100 yards, sit more than 30 minutes, walk up one flight of stairs, and/or get more than 2 hours of straight sleep (pain wakes him up). He also had multiple falls due to problems with balance and discomfort with intercourse. He had not worked since the age of 43 due to his back. The examiner noted mild constant pain, moderate intermittent pain, severe paresthesias and/or dysesthesias, and moderate numbness of the right lower extremity. There was moderate constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and moderate numbness of the left lower extremity. Muscle strength testing was normal and there was no muscle atrophy. Reflex examination was also normal. Sensory examination was normal on the right and decreased on the left. There were no trophic changes and the Veteran’s gait was normal. The examiner found that there was incomplete paralysis of the right sciatic nerve of a mild severity and incomplete paralysis of the left sciatic nerve of a moderate severity. There was also incomplete paralysis of the left femoral nerve of a moderate severity. The Veteran regularly used a cane to assist with locomotion. There was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent findings and electromyography (EMG) testing was not done. The examiner found that the Veteran’s radiculopathy impacted his ability to work as he cannot walk long distances, cannot sit for a prolonged period of time, and cannot climb stairs/ladders. During the March 2019 VA spine examination, there was radiculopathy of both lower extremities, described as constant pain, paresthesias and/or dysesthesias, and numbness (moderate on the right and severe on the left) involving both the femoral and sciatic nerves. Overall, the examiner found that the Veteran experienced moderate radiculopathy of the right lower extremity and severe radiculopathy of the left lower extremity. VA and private treatment records dated through October 2020 show findings similar to those noted above. With regard to the left lower extremity, the Board finds that disability ratings greater than 10 percent for radiculopathy of the left lower femoral and sciatic nerves are not warranted prior to July 24, 2017. The medical evidence of record reflects that the Veteran’s left lower radiculopathy was comparable to no more than mild incomplete paralysis of the femoral/sciatic nerves prior to July 24, 2017. As above, the June 2015 VA spine examiner found that the Veteran’s radiculopathy was mild in severity, bilaterally. The earliest evidence of moderate incomplete paralysis of the femoral/sciatic nerves is the July 2017 VA peripheral nerves examination. The Board also finds that disability ratings greater than 20 percent for radiculopathy of the left lower femoral and sciatic nerves are not warranted beginning July 24, 2017. While the March 2019 VA spine examiner characterized the Veteran’s radiculopathy of the left lower extremity to be of severe severity, this assessment considers both the femoral and sciatic nerves as opposed to just one nerve. Given the disparity between the March 2019 VA spine examination report (finding severe radiculopathy of both the sciatic and femoral nerves, in combination) in comparison to the July 2017 peripheral nerves examination report (finding only moderate radiculopathy of each the femoral and sciatic nerves, individually) the Board finds that the more generalized description of the Veteran’s radiculopathy in the March 2019 VA spine examination report, as opposed to the more specific description of the Veteran’s radiculopathy in the July 2017 peripheral nerves examination report, is entitled to less weight. Furthermore, as above, use of terminology such as “moderate” and “severe” by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. With regard to the right lower extremity, the Board finds that disability ratings greater than 10 percent for radiculopathy of the femoral and sciatic nerves are not warranted prior to March 16, 2019. The medical evidence of record reflects that the Veteran’s right lower radiculopathy was comparable to no more than mild incomplete paralysis of the femoral/sciatic nerve prior to March 16, 2019. As above, the June 2015 VA spine and July 2017 peripheral nerve examiners found that the Veteran’s right lower radiculopathy was mild in severity. The earliest evidence of moderate incomplete paralysis of the right lower femoral/sciatic nerves is the March 2019 VA spine examination. The Board also finds that disability ratings greater than 20 percent for radiculopathy of the right lower femoral and sciatic nerves are not warranted beginning March 16, 2019. Notably, the March 2019 VA examiner found that the Veteran experienced moderate radiculopathy of the right lower extremity. A higher rating under DCs 8526/8520 requires evidence of severe radiculopathy. Furthermore, the Board notes the disparity between the March 2019 VA spine examination report (finding moderate radiculopathy of both the sciatic and femoral nerves) in comparison to the July 2017 peripheral nerves examination report (finding only mild radiculopathy of the femoral nerve) and, as above, questions the accuracy the more generalized description of the Veteran’s radiculopathy in the March 2019 VA spine examination report with the more specific description of the Veteran’s radiculopathy in the July 2017 peripheral nerves examination report but will not disturb the findings of the Veteran’s current awards. In sum, the Board concludes that the Veteran’s radiculopathy of the lower extremities is not manifested by symptomatology that nearly approximates the criteria for the next higher ratings under DCs 8526 and/or 8520 under the time periods on appeal. REASONS FOR REMAND 1. The claims of entitlement to service connection for bilateral hand disorders, to include as secondary to service-connected back disability, are remanded. The Veteran contends that he experiences a bilateral hand disorder secondary to his service-connected lumbar spine disability. Post-service private treatment records show treatment for right cubital syndrome as early as September 2006 and left cubital syndrome as early as January 2007. These treatment records suggest that the Veteran’s cubital syndrome may be related to the Veteran’s service-connected lumbar spine disability. See VBMS, document labeled Private Treatment Records Furnished by SSA, receipt date 3/21/2013, page 19. Pursuant to the October 2019 Board remand, the Veteran was afforded a VA hand examination in October 2020. Significantly, this examiner diagnosed bilateral status post cubital tunnel release (2012) and provided a negative nexus opinion on a direct basis but also appears to provide a negative nexus opinion regarding whether the Veteran’s bilateral status post cubital tunnel release is secondary to his service-connected left wrist disability. Unfortunately, the Board finds that the October 2020 VA opinion is inadequate.  Initially, while the October 2020 medical opinion discusses the possible connection between the Veteran’s bilateral status post cubital tunnel release and his service-connected left wrist disability, the opinion does not discuss the suggestion that the Veteran’s cubital syndrome may be related to the Veteran’s service-connected lumbar spine disability, to include whether a right hand disability is aggravated by the Veteran’s service-connected back disability. Furthermore, the October 2020 VA opinion appears to be based on factual inaccuracy as the examiner noted an onset of 2012 for the Veteran’s cubital syndrome instead of 2006/2007, as shown by a review of the claims file. As such, VA must obtain an addendum medical opinion that provides an adequate discussion as to whether the Veteran’s claimed hand disorders can be related to his military service on either a direct, secondary, or aggravation basis.  2. The claim of entitlement to a TDIU due to service-connected disability prior to June 25, 2015 is remanded. A review of the record shows that the Veteran was awarded Social Security disability benefits effective October 7, 2003 due, at least in part, to his lumbar spine disability. Also, during the May 2019 Board hearing, the Veteran reported that he has not worked full-time during the appeal period beginning May 2011 due to his service-connected disabilities. Currently, the Veteran does not meet the schedular criteria for a TDIU until June 25, 2015. However, as above, the Board is remanding service connection claims for additional development. As these determinations may affect whether the Veteran meets the schedular criteria for a TDIU prior to June 25, 2015, the Board finds that these issues are inextricably intertwined with the remanded service connection issues. Harris v. Derwinski, 1 Vet. App. 180 (1991). Finally, with regard to all of the remanded issues, the Board notes that there are likely outstanding VA treatment records as the most recent VA medical records in the claims file are dated in October 2020. Therefore, all outstanding VA treatment records should be obtained on remand. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records dated since October 2020. 2. Request an addendum from the October 2020 VA examiner regarding the Veteran’s bilateral status post cubital tunnel release.  Access to the electronic claims file should be made available to the examiner.  If the October 2020 VA examiner is not available, the claims file should be provided to an appropriate examiner to render the requested opinions.  The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion.  The examiner is asked to provide an opinion as to whether it is at least as likely as not that the Veteran’s bilateral status post cubital tunnel release is (i) caused, or (ii) aggravated by his service-connected disabilities (particularly his service-connected back).  Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The opinion should address the post-service private treatment records showing cubital tunnel syndrome as early as September 2006 as well as the suggestion that the Veteran’s cubital syndrome may be related to the Veteran’s service-connected lumbar spine disability. See VBMS, document labeled Private Treatment Records Furnished by SSA, receipt date 3/21/2013, page 19. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board April Maddox, 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.