Citation Nr: 21062471 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 14-31 929 DATE: October 7, 2021 ORDER Entitlement to service connection for right foot plantar fasciitis is granted. Entitlement to an initial disability rating in excess of 10 percent for low back strain is denied. Entitlement to an initial disability rating in excess of 10 percent for left leg neuropathy prior to July 27, 2015; and in excess of 20 percent disabling thereafter is denied. FINDINGS OF FACT 1. The probative evidence of record is at least in relative equipoise that the Veteran's right foot plantar fasciitis is related to active military service. 2. The evidence of record demonstrates the Veteran's disability of the lumbar spine manifested as pain on movement, with forward flexion greater than 60 degrees and a combined range of motion (ROM) greater than 120 degrees; without ankylosis, muscle spasm, or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or incapacitating episodes of intervertebral disc syndrome (IVDS). 3. Prior to July 27, 2015, the evidence of record shows the Veteran's left leg neuropathy manifested as no more than mild incomplete paralysis. 4. Since July 27, 2015, the evidence of record shows the Veteran's left leg neuropathy manifested as no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for right foot plantar fasciitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to an initial disability rating in excess of 10 percent for low back strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5237, DC 5243 (2021). 3. The criteria for entitlement to an initial disability rating in excess of 10 percent for left leg neuropathy prior to July 27, 2015; and in excess of 20 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.124a, DC 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Marine Corps on active duty from April 2008 to April 2012. The issues come before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Board denied the Veteran's claims of entitlement to service connection for right foot plantar fasciitis and an increased initial rating for left leg meralgia paresthetic. Additionally, the Board remanded the Veteran's claim for an increased initial rating for low back disability. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In August 2020, the Court granted a Joint Motion for Partial Remand (JMPR). The Court found that VA failed to fulfill its duty to assist to obtain VA treatment records. Pursuant to the JMPR, the Court vacated and remanded the matter to the Board. In February 2021, the Board remanded to obtain outstanding VA medical records and provide new VA examinations. During the pendency of the Veteran's appeal, in a May 2020 rating decision, the RO granted an increased initial rating for the Veteran's left leg neuropathy, to 20 percent disabling, effective July 27, 2015. As the full benefit was not granted, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be warranted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 1. Entitlement to service connection for right foot plantar fasciitis The Veteran contends that his right foot plantar fasciitis is related to his active-duty service. Notably the Veteran states that he has suffered foot pain, diagnosed as plantar fasciitis, since bootcamp. A review of the Veteran's medical records shows the Veteran received treatment for foot pain in service. The Veteran's March 2008 enlistment physical examination reported the Veteran had mild asymptomatic pes planus but did not have a history of foot pain. The Veteran's May 2009 service treatment record provided the Veteran a diagnosis of plantar fasciitis of the right foot. Further, the Veteran's December 2012 separation examination reported the Veteran's history of foot pain in service and noted the Veteran's right heel pain onset in bootcamp. The Veteran's July 2021 VA podiatry record notes the Veteran's diagnosis of chronic plantar fasciitis of the right foot. Moreover, the Veteran's treating VA podiatrist provided the medical opinion that it was more likely than not that the Veteran's plantar fasciitis was caused by his military service. The VA podiatrist stated that the cause of the Veteran's plantar fasciitis was likely the carrying of a heavy rucksack on long marches in service. The Board finds the July 2021 VA podiatrist's medical opinion to be probative evidence that the Veteran's right foot plantar fasciitis had its onset in and is otherwise related to active duty. The Board assigns probative weight to the treating VA podiatrist's medical opinion as the opinion was supported by a fully articulated rationale with consideration of the Veteran's medical history and a thorough physical examination of the Veteran. See Prejean v. West, 13 Vet. App. 444 (2000); see also Guerrieri v. Brown, 4 Vet. App. 467 (1993). Additionally, the Veteran, as a lay person is competent to provide opinions on observable symptomatology, to include pain; and the Veteran's statements regarding the onset of his right foot condition are consistent with the Veteran's service treatment records. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Accordingly, the lay and medical evidence of record has established the Veteran's right foot plantar fasciitis is related to the Veteran's active-duty service. The Board recognizes the negative nexus opinion regarding the Veteran's right foot plantar fasciitis provided by the April 2021 examination. However, the Board finds that, given the Veteran's competent lay statements and the July 2021 VA addendum medical opinion establishing the connection of the Veteran's plantar fasciitis and his in-service injury, the evidence is at least in relative equipoise on this matter. The Board must consider all the evidence of record and make appropriate competence, credibility, and weight determinations. See Washington v. Nicholson, 19 Vet. App. 362, 367-68 (2005). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Thus, the benefit of the doubt must be resolved in favor of the Veteran and entitlement to service connection for the Veteran's right foot plantar fasciitis is granted. Increased Rating VA has adopted the Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally 38 C.F.R. Part IV. The Board determines the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 C.F.R. § 4.10. The degrees of disabilities are based on the average impairment of earning capacity and individual disabilities are assigned diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various percentage ratings for each disability and the criteria for specific ratings. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Where there is a question of which of two ratings should be applied, the higher rating will be assigned if the disability assessment more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Additionally, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In a claim for a greater original rating after an initial award of service connection, all evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999); 38 C.F.R. § 4.2. However, consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119 (1999); see also 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 (2019); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. 38 C.F.R. § 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. 2. Entitlement to an initial disability rating in excess of 10 percent for low back strain The Veteran contends that he suffers from symptoms of a low back strain warranting an initial disability rating in excess of 10 percent. As a preliminary matter, the regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria from that date. VA will apply the rating criteria that is more favorable to the Veteran from the effective date of the change. Here, the Veteran's lumbar spine condition is rated under 38 C.F.R. § 4.71a, DC 5237, for lumbosacral strain. Disabilities of the spine are rated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). While the diagnostic criteria dealing with degenerative arthritis of the spine and IVDS were updated with the new regulations, the rating criteria of the General Formula and IVDS Formula did not change under the new regulations. See 38 C.F.R. § 4.71a, DC 5235-43 (2021). As such, the rating criteria for the Veteran's lumbar spine condition is unchanged and the Board will proceed with adjudication. Under the General Formula, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; the combined ROM 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 assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, DC 5237. Additionally, under the IVDS Formula, a 10 percent rating is awarded for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. 38 C.F.R. § 4.71a. A 20 percent rating is awarded for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. Id. A 40 percent rating is awarded for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Id. A 60 percent rating is assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. Id. Note (1): For purposes of evaluations under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. The VA provided the Veteran with a thoracolumbar examination in October 2012. The Veteran complained that his back hurt almost daily. The Veteran noted his low back pain was worse in the cold and with overuse, including bending and lifting. He noted his pain at best was two out of ten. The VA examination noted the Veteran had a history of flare-ups. The Veteran noted an increased level of pain when lifting his son or other heavy objects. He noted his pain level to be eight out of ten during flare-ups. The Veteran's initial ROM was noted with forward flexion to 80 degrees with pain noted at 70 degrees; extension to 25 degrees with pain; right lateral flexion to 25 degrees with pain; left lateral flexion to 25 degrees with pain; right lateral rotation to 30 degrees or greater with no objective evidence of painful motion; and left lateral rotation to 30 degrees or greater with no objective evidence of painful motion. The VA examination measured the Veteran's ROM after repetitive use testing as forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion to 30 degrees or greater, and left and right lateral rotation to 30 degrees or greater. The examiner noted the Veteran did not have additional limitation of ROM after repetitive-use testing. The examiner noted the Veteran exhibited functional loss of the thoracolumbar spine, listing contributing factors as less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and/or weight bearing. The VA examination noted that the Veteran had localized tenderness upon palpation of the joints and soft tissue of the thoracolumbar spine. The examiner noted the Veteran did not have guarding or muscle spasms of the thoracolumbar spine. The examination noted normal findings on the reflex and sensory examinations of the lower extremities. The Veteran exhibited normal flexion and extension of the lower extremities, with full muscle strength. The VA examination reported negative results for the Veteran's bilateral straight leg test. The VA examiner did not find a diagnosis of IVDS. The examination did not report findings of muscle atrophy or ankylosis of the spine. The Veteran was noted to occasionally use an elastic back splint when doing heavy work. The VA examiner noted that the Veteran's lower back pain limited the Veteran's ability to perform work involving heavy lifting and bending. The VA examination noted the Veteran exhibited signs and symptoms due to radiculopathy. The VA examiner noted the Veteran's radicular symptoms as mild numbness, paresthesias and/or dysesthesias of the left leg. The VA examiner reported the Veteran's radiculopathy as mild involvement of the left femoral nerve roots. In July 2015, the Veteran received a VA examination. The examiner reviewed the Veteran's medical history and noted a diagnosis of lumbosacral strain. The Veteran complained, since his last VA examination, that he experienced more stiffness in his lower back with more pain to his right. The Veteran reported that his back continued to hurt almost daily. The examination noted the Veteran reported flare-ups as stiffness in the morning. The Veteran reported increased pain in cold weather and with overuse. Initial ROM testing found forward flexion to 90 degrees, extension to 30 degrees, left and right lateral flexion to 30 degrees, and left and right lateral rotation to 30 degrees. The Veteran's ROM itself did not contribute to functional loss. The Veteran exhibited pain during the examination, but the pain noted did not result in functional loss. The VA examination recorded there was no evidence of pain with weight bearing, but there was evidence of localized tenderness or pain on palpation of the joints. The Veteran was able to perform repetitive use testing, and there was no additional loss of function or ROM. The VA examination found that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time or during flare-ups. As the Veteran did not report a history of flare-ups, the VA examiner did not provide assessments of ROM during flare-ups. The VA examiner noted the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The Veteran had normal bilateral hip flexion, bilateral hip extension, bilateral knee extension, bilateral ankle dorsiflexion, bilateral ankle plantar flexion, and bilateral great toe extension. The Veteran's upper and lower extremities were normal with full muscle strength. Deep tendon reflexes were normal. The VA examination reported negative results for the Veteran's bilateral straight leg raise test. The VA sensory examination showed decreased sensation to touch for the Veteran's left upper anterior thigh. All other sensory findings of the lower extremities were normal. The examination noted the Veteran did not have guarding or muscle spasms of the thoracolumbar spine. The VA examiner did not find a diagnosis of IVDS. Further, the examination did not report findings of muscle atrophy or ankylosis of the spine. The VA examiner noted no signs of radicular pain or symptoms due to radiculopathy. The VA examiner remarked that the Veteran had numbness and tingling of the left anterior thigh. However, the examiner attributed these symptoms to compression of the femoral nerve as it passed under the inguinal ligament, not due to radiculopathy. Finally, the VA examination reported the Veteran's low back disability did not impact the Veteran's ability to work. The RO provided the Veteran a low back VA examination in October 2020. The examiner reviewed the Veteran's medical history and noted a diagnosis of lumbosacral strain. The VA examination noted the Veteran's stiffness and pain worsened over time. The Veteran reported daily low back pain. The examination noted the Veteran reported flare-ups which occurred four to five times a week. The examination reported the flare-ups as moderate to severe, which are precipitated by activity. The Veteran noted flare-ups last hours and are alleviated by pain medication, ice heat, massage, and rest. The Veteran reported ath during flare-ups, his low back strain interferes with bending, twisting, and lifting objects over 20 pounds. Initial ROM testing found forward flexion to 80 degrees, extension to 20 degrees, left and right lateral flexion to 30 degrees, and left and right lateral rotation to 30 degrees. The Veteran's ROM itself contributed to functional loss. The examiner noted that with flares, the Veteran's functional loss includes interference with lifting over 20 pounds and problems with bending and twisting. The Veteran exhibited pain during the examination in all measured areas of flexion and rotation that caused functional loss. The VA examination recorded there was no evidence of pain with weight bearing. There was evidence of localized tenderness or pain on palpation of the joints. The Veteran was able to perform repetitive use testing, and there was no additional loss of function or ROM. The Veteran was examined immediately after repetitive use over time. The VA examination found that pain significantly limited the Veteran's functional ability with repeated use over time. The VA examination reported the Veteran's ROM with repetitive use over time as forward flexion to 70 degrees, extension to 20 degrees, left and right lateral flexion to 20 degrees, and left and right lateral rotation to 20 degrees. The examination did not occur during a flare-up of the Veteran's low back symptoms. The VA examiner noted the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The VA examination found that pain significantly limited the Veteran's functional ability during flare-ups. The VA examination described the Veteran's ROM during flare-ups as forward flexion to 70 degrees, extension to 20 degrees, left and right lateral flexion to 20 degrees, and left and right lateral rotation to 20 degrees. The Veteran had normal bilateral hip flexion, bilateral hip extension, bilateral knee extension, bilateral ankle dorsiflexion, bilateral ankle plantar flexion, and bilateral great toe extension. The Veteran's lower extremities were normal with full muscle strength. Deep tendon reflexes sensory examination showed normal findings. The VA examination reported negative results for the Veteran's bilateral straight leg raise test. The VA examiner noted no signs or symptoms of radiculopathy or any other neurological abnormality related to the Veteran's low back condition. The examination noted the Veteran did not have guarding or muscle spasms of the thoracolumbar spine. The VA examiner did not find a diagnosis of IVDS. Further, the examination did not report findings of muscle atrophy or ankylosis of the spine. The VA examiner noted the Veteran used a back brace a couple times a week. Finally, the VA examination reported the Veteran's low back disability impacted the Veteran's ability to perform work involving bending, twisting, and lifting objects weighing over 20 pounds. Pursuant the Board remand, the Veteran underwent a VA lumbar back examination in August 2021. The examiner reviewed the Veteran's medical history and confirmed a diagnosis of lumbosacral strain. The VA examination noted the Veteran's low back pain progressed since onset. The Veteran reported current symptoms of low back pain. The examination noted the Veteran reported monthly flare-ups of increased low back pain lasting one to two days. The examination reported the flare-ups were precipitated by bending forward at the waist and side bending. The Veteran noted The Veteran reported functional impairment during flare-ups, as the inability to bend forward or to the sides at the waist. The VA examination reported normal initial ROM for the Veteran. Testing found forward flexion to 90 degrees, extension to 30 degrees, left and right lateral flexion to 30 degrees, and left and right lateral rotation to 30 degrees. The Veteran exhibited pain during the examination. The VA examination found that pain, weakness, fatigability or incoordination did not attribute to any limitation of motion. The VA examination recorded evidence of pain with weight bearing and active motion, but the pain did not result in or cause functional loss. There was no evidence of localized tenderness or pain on palpation of the joints or evidence of crepitus. The Veteran was able to perform repetitive use testing, and there was no additional loss of function or ROM after three repetitions. The Veteran was not examined immediately after repetitive use over time. The VA examination found that pain significantly limited the Veteran's functional ability with repeated use over time. The VA examination reported evidence did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. The examination did not occur during a flare-up of the Veteran's low back symptoms. The VA examination found that pain significantly limited the Veteran's functional ability during flare-ups. The VA examination described the Veteran's ROM during flare-ups as forward flexion to 80 degrees, extension to 25 degrees, left and right lateral flexion to 25 degrees, and left and right lateral rotation to 25 degrees. The Veteran had normal bilateral hip flexion, bilateral hip extension, bilateral knee extension, bilateral ankle dorsiflexion, bilateral ankle plantar flexion, and bilateral great toe extension. The Veteran's lower extremities were normal with full muscle strength. Deep tendon reflexes sensory examination showed normal findings. The VA examination reported negative results for the Veteran's bilateral straight leg raise test. The VA examiner noted no signs or symptoms of radiculopathy or any other neurological abnormality related to the Veteran's low back condition. The examination noted the Veteran did not have guarding or muscle spasms of the thoracolumbar spine. The VA examiner did not find a diagnosis of IVDS. Further, the examination did not report findings of muscle atrophy or ankylosis of the spine. The VA examiner noted the Veteran used an abdominal binder for back support. Finally, the VA examination reported the Veteran's low back disability impacted the Veteran's ability to perform work in an active occupation requiring prolonged walking and standing. While the record contains evidence noting the Veteran's low back condition, no other records during the period on appeal address the Veteran's measured limitation of his lumbar spine. After review of the evidence of record, the Board finds that the symptoms of the Veteran's low back disability most closely approximated a 10 percent lumbar spine disability under 38 C.F.R. § 4.71a, DC 5237. The ROM testing evidence of record shows the Veteran's lumbar disability has been primarily manifested by limitation of forward flexion greater than 60 degrees but not greater than 85 degrees; and, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, with functional loss due to pain and stiffness on movement. See 38 C.F.R. § 4.71a, DC 5237. Additionally, there is no evidence of record that shows the Veteran experienced ankylosis of the spine, muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. The Board acknowledges that the Veteran identified increased pain and stiffness during flare-ups. The Veteran's reports of flare ups have been consistent throughout the period on appeal. The Board assigns probative weight to the October 2020 VA examination, which described the Veteran's functional impairment as decreased ROM during flare-ups and repetitive use over time. However, the October 2020 examiner determined the Veteran's reported pain and limitation of movement during flare-ups did not significantly limit functional impairment to the degree warranting an initial rating greater than 10 percent disabling. As such, the Board finds that an initial rating of 10 percent disabling under DC 5237 accurately reflects the Veteran's low back disability throughout the pendency of the appeal. The Board 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 criteria when evaluating limitation of motion for joint disabilities. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The October 2012 VA examination noted less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and/or weight bearing were contributing factors to the Veteran's functional loss. Here, the VA examination noted the Veteran's measured decrease in ROM where painful motion begins. The Board acknowledges the Veteran's pain and loss of movement; however, the Veteran's medical records do not show functional impairment due to the Veteran's lumbar spine disability to the level consistent of a limitation in combined ROM less than 120 degrees or forward flexion less than 60 degrees. Thus, consideration under DeLuca has been provided and additional consideration for a rating in excess of 10 percent is not warranted. The Board acknowledges the Veteran's reported history of increased symptoms of his lumbar spine disability during flare-ups. Specifically, the Veteran has reported during his VA examinations that flare-ups are very painful and interfere with bending twisting and lifting heavy objects. The Board also recognizes the Veteran's assertions that the severity of his symptoms warrants an increased rating. As a lay person the Veteran is competent to provide opinions on certain subjective medical issues and of observable symptomatology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Although the Veteran is competent to report his symptoms, any opinion regarding whether the Veteran's symptoms have worsened to a certain severity or level of functional impairment requires medical expertise that the Veteran has not demonstrated. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). The Board has considered whether higher ratings may be available under the Formula for Rating IVDS Based on Incapacitating Episodes. However, the evidence of record shows the Veteran has not been diagnosed with IVDS, and the Veteran did not require bed rest prescribed by a physician at any time during the appeal period for his lumbar spine symptoms. The Board has also considered whether separate ratings are warranted for the neurological manifestations of the Veteran's lumbar spine disability. The Board acknowledges the Veteran's medical and lay evidence of record show complaints of numbness and tingling in the lower back with pain radiating in the left leg. The Board notes that the Veteran is already in receipt of a separate noncompensable ratings for left lower extremity radiculopathy associated with his lumbosacral strain under DC 8523 and DC 8529, and no additional rating is warranted to compensate for the Veteran's left lower extremity neurological impairment. In sum, the evidence of record is against an initial rating in excess of 10 percent for the Veteran's service-connected thoracolumbar spine disability, and the claim is denied. In reaching this conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against a rating in excess of that currently assigned, the doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 3. Entitlement to an increased initial disability rating for left leg neuropathy The Veteran contends that his service-connected left leg neuropathy condition has manifest as symptoms warranting an increased initial disability rating. The Veteran's left leg disability is evaluated under 38 C.F.R. § 4.124a, DC 8526. Diagnostic Code 8526 evaluates femoral nerve impairments based on level of paralysis. See 38 C.F.R. § 4.124a, DC 8526. A 10 percent rating is warranted for mild, incomplete paralysis. Id. A 20 percent rating is warranted for moderate, incomplete paralysis. Id. A 30 percent rating is warranted for severe, incomplete paralysis. Id. A 40 percent rating (maximum schedular) is warranted for complete paralysis (of the quadriceps extensor muscles). Id. The words "mild," "moderate," and "severe" are not defined in the VA Schedule for Rating Disabilities. 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. In applying the schedular criteria for rating peripheral nerve disabilities, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Entitlement to an increased initial disability rating prior to July 27, 2015 After review of the evidence of record, the Board finds an initial rating in excess of 10 percent is not warranted prior to July 27, 2015. The Board finds that the Veteran's neuropathy of the left leg is appropriately represented as "mild" under DC 8526. The Veteran underwent a VA peripheral nerve condition examination in October 2012. The Veteran reported complete numbness on the anterior surface of his left thigh. The Veteran did not report pain. The VA examiner remarked that Veteran's neurological and physical examinations were negative, however, the VA examination recorded the Veteran's reported left leg neurologic symptoms as moderate paresthesias and/or dysesthesias and numbness. The VA examiner noted the Veteran showed decrease sensation to touch on his left thigh. The Veteran demonstrated normal muscle strength and reflexes. The Veteran exhibited a normal gait. The examiner noted the Veteran occasionally used a brace as an assistive device, but did not specify the device used or conditions for use. The VA examiner noted mild incomplete paralysis of the left leg affected by musculocutaneous (superficial peroneal), posterior tibial, and anterior crural (femoral) nerves. The VA examiner noted the Veteran's left leg nerve condition did not impact his ability to work. The record contains the Veteran's July 2012 VA orthopedic surgery consultation note, which reported the Veteran complained of pain behind his knee and in his left posterior thigh. The Veteran stated he did not experience symptoms when walking, but if he ran, he experienced a feeling behind his knee and in his posterior thigh and occasionally he got numbness that radiated into his upper thigh and down toward his calf. On examination, the treating VA orthopedist noted decreased sensation to light touch along the lateral and medial thigh. The treating VA physician reported the Veteran walked without an antalgic gait. The record contains the Veteran's November 2012 VA Nerve Conduction and Electromyography (EMG) report. The Veteran reported constant left thigh numbness. The Veteran also complained of back left knee pain that caused numbness in the lateral leg and spread to his big toe. The Veteran noted he thought he experienced foot drop sometimes but reported no falls. The examination noted normal muscle strength and reflexes of the left leg and foot. The VA physician noted the Veteran had decreased sensation in his left anterior thigh. The VA electrodiagnostic study showed no evidence or peroneal nerve entrapment across the fibula head, femoral neuropathy, or radiculopathy. The Veteran submitted lay statements regarding his left leg disability in his April 2013 Notice of Disagreement. The Veteran stated that while walking he experienced severe radiating pain shooting down from his hip to his toes. The Board also acknowledges the Veteran's lay statements that he experienced constant left thigh numbness. Additionally, the Board notes the Veteran's reports of severe radiating pain and foot drop. The Board acknowledges that as a lay person the Veteran is competent to provide opinions on certain subjective medical issues and of observable symptomatology, such as pain, sensory deficits, and foot drop. See generally Kahana, 24 Vet. App. at 435. However, objective clinical findings after examinations of the Veteran do not reflect complete paralysis of the left leg, and the evidence of record has not shown the Veteran's neuropathy symptoms rose to the level of moderate or severe incomplete paralysis. See 38 C.F.R. § 4.124a, DC 8526. Specifically, the Veteran's November 2012 nerve conduction and EMG report found no evidence of femoral neuropathy, and the Veteran's October 2012 VA examination was negative for evidence of physical or other neurologic abnormalities. The Board recognizes the Veteran's assessment of the severity of the symptoms; however, the Board assigns greater probative value to the October 2012 VA examination report and the November 2012 VA medical treatment record as to whether the Veteran has complete paralysis or moderate and severe incomplete paralysis. Further, the Board notes the VA treatment record and examination adequately recorded the Veteran's reported symptoms of his left leg neuropathy. Thus, prior to July 27, 2015, the probative evidence of record does not indicate the Veteran's left leg nerve condition manifested as moderate or severe incomplete paralysis, or symptoms equivalent to complete paralysis of quadriceps extensor muscles. 38 C.F.R. § 4.124a, DC 8526. Accordingly, a rating in excess of 10 percent for the Veteran's left leg neuropathy is not warranted, and the benefit of the doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Entitlement to an increased initial disability since July 27, 2015 In July 2015, the Veteran underwent a VA peripheral nerve condition examination. The VA examiner confirmed the Veteran's diagnosis of meralgia paresthetica of the left side femoral nerve branch. The examination reported the Veteran's history of numbness along the left anterior thigh from groin to knee. The VA examination recorded the Veteran's reported left leg neurologic symptoms as moderate paresthesias and/or dysesthesias and numbness. The VA examiner noted the Veteran showed decrease sensation to touch on his left thigh. The Veteran demonstrated normal muscle strength and reflexes. The Veteran did not exhibit trophic changes attributable to peripheral neuropathy or muscle atrophy. The Veteran exhibited a normal gait and did not report the use of assistive devices. The VA examiner noted moderate incomplete paralysis of the left leg affected by the anterior crural (femoral) nerves. The VA examiner noted the Veteran's left leg nerve condition did not impact his ability to work. Pursuant to the Board remand, the RO provided the Veteran with a peripheral nerve examination in April 2021. The VA examiner changed the Veteran's previous diagnosis of meralgia paresthetica left side femoral nerve branch to radiculopathy of the lumbar region. The examiner noted the Veteran reported numbness that started at the left hip and radiated down the left lateral aspect of his thigh to his knee crossing over to his medial side of his calf stopping at his ankle. The examiner noted this symptomatology was more consistent with radiculopathy of the lumbar spine. The Veteran reported tightness and stiffness in the lateral and posterior aspects of his left calf. The Veteran exhibited a full ROM in the left ankle and foot, with no weakness noted on examination. The VA examination recorded the Veteran's reported left leg neurologic symptoms as moderate constant pain, paresthesias and/or dysesthesias, and numbness. The VA examiner noted the Veteran showed decrease sensation to touch on his left thigh/knee and lower leg/ankle. The Veteran demonstrated normal muscle strength and reflexes. The Veteran did not exhibit trophic changes attributable to peripheral neuropathy or muscle atrophy. The Veteran exhibited a normal gait and did not report the use of assistive devices. The VA examiner noted mild incomplete paralysis of the left leg affected by the posterior tibial nerve, internal saphenous nerve, external cutaneous nerve of the thigh, and anterior crural (femoral) nerve. The VA examiner noted the Veteran's left leg condition impacted his ability to perform tasks involving prolonged standing. The Veteran's VA medical treatment records note the Veteran complained of sensory deficits and radiating pain in the left leg. The Veteran's December 2018 VA primary care note stated the Veteran complained of swelling and pain behind his knee. He noted pain which shot down his knee from time to time to his foot. The Veteran denied falls but stated his left leg felt weak. Based on the evidence of record as a whole, the Board finds an initial disability rating in excess of 20 percent is not warranted. See 38 C.F.R. § 4.124a, DC 8526. As noted above, for a wholly sensory impairment, a rating commensurate with mild incomplete paralysis is reasonably assigned when symptoms are recurrent but not continuous and are not noted, when occurring, to be more than moderate. 38 C.F.R. § 4.124a. The evidence of record since July 27, 2015 suggests the Veteran's symptoms are wholly sensory. The Board acknowledges the Veteran's reported symptoms of severe radiating pain and numbness down his left leg. However, the Veteran's left neuropathy at no time during the period on appeal has the Veteran's clinical evidence identified the Veteran's symptoms as severe or categorized the Veteran's condition as severe incomplete paralysis. Additionally, the lay and medical evidence of record does not suggest the Veteran suffered complete paralysis of the left quadriceps extensor muscles. Again, the Board assigns probative value to the medical treatment records and VA examination reports demonstrating that the Veteran's left leg disability has not manifested as severe incomplete paralysis or complete paralysis of the left leg. Continued on Next Page Thus, since July 27, 2015, the probative evidence of record demonstrates the Veteran's left leg disability more closely approximated the criteria for a 20 percent initial rating under 38 C.F.R. § 4.124a, DC 8526, and the claim for an increased initial rating is denied. In reaching this conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against a rating in excess of that assigned since July 27, 2015, the doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.