Citation Nr: 21062921 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 18-24 326 DATE: October 12, 2021 ORDER The issue of an initial rating higher than 40 percent for a traumatic brain injury (TBI) is dismissed. The issue of an initial rating higher than 20 percent for right shoulder labral tear (right shoulder disability) is dismissed. The issue of an initial rating higher than 10 percent for right wrist tendonitis (right wrist disability) is dismissed. The issue of service connection for a lung disability is dismissed. An initial 70 percent rating, but no higher, for posttraumatic stress disorder (PTSD) is granted. An initial 40 percent rating, but no higher, for spondylosis of the lumbosacral spine with lumbar spinal stenosis (low back disability), prior to April 21, 2018, is granted. A rating higher than 40 percent for a low back disability, since April 21, 2018, is denied. An initial 30 percent rating, but no higher, for degenerative arthritis of the cervical spine (cervical spine disability) prior to April 21, 2018, is granted. A rating higher than 30 percent for a cervical spine disability, since April 21, 2018, is denied. An initial 40 percent rating, but no higher, for right lower extremity radiculopathy, involving the sciatic nerve, prior to April 21, 2018, and since August 16, 2021, is granted. A rating higher than 40 percent for right lower extremity radiculopathy, involving the sciatic nerve, from April 21, 2018, to August 16, 2021, is denied. An initial 30 percent rating, but no higher, for right lower extremity radiculopathy, involving the femoral nerve is granted. An initial 20 percent rating, but no higher, for left lower extremity radiculopathy, involving the sciatic nerve, is granted. An initial 20 percent rating, but no higher, for left lower extremity radiculopathy, involving the femoral nerve, is granted. REMANDED The issue of service connection for bilateral hearing loss is remanded. The issue of an initial rating higher than 20 percent left upper extremity radiculopathy is remanded. The issue of an initial rating higher than 20 percent for right upper extremity radiculopathy, prior to April 21, 2018, is remanded. The issue of a rating higher than 40 percent for right upper extremity radiculopathy, from April 21, 2018, to August 15, 2021, is remanded. The issue of a rating higher than 30 percent for right upper extremity radiculopathy, since August 16, 2021, is remanded. The issue of a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. During the March 2021 Board hearing, prior to the promulgation of a decision in the appeal, the Veteran withdrew the issues of higher ratings for TBI, right shoulder disability, right wrist disability, and service connection for a lung disability. 2. The Veteran's PTSD symptoms and overall impairment manifested by no more than occupational and social impairment with deficiencies in most areas. 3. Throughout the appeal period, the Veteran's low back disability more nearly approximates forward flexion to 30 degrees or less when considering pain, functional loss and impairment, and the degree of additional limitation during flare ups; his low back disability did not result in spinal ankylosis or the functional equivalent of spinal ankylosis, and he did not experience incapacitating episodes due to intervertebral disc syndrome (IVDS) having a total duration of at least 6 weeks during the past 12 months. 4. Throughout the appeal period, the Veteran's cervical spine disability more nearly approximates forward flexion to 15 degrees or less when considering pain, functional loss and impairment and the degree of additional limitation during flare ups; his cervical spine disability did not result in spinal ankylosis or the functional equivalent of spinal ankylosis, and he did not experience incapacitating episodes due to IVDS having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 5. Throughout the appeal period, the Veteran's right lower extremity radiculopathy, involving the sciatic nerve, more nearly approximates moderately severe incomplete paralysis of the sciatic nerve; his symptoms did not more nearly approximate severe incomplete paralysis, with marked muscular atrophy, as there was no muscular atrophy, extremely intense right lower extremity radiculopathy symptoms, or complete paralysis. 6. Throughout the appeal period, the Veteran's right lower extremity radiculopathy, involving the femoral nerve, more nearly approximates severe incomplete paralysis of the femoral nerve; his symptoms did not more nearly approximate complete paralysis of quadriceps extensor muscles. 7. Throughout the appeal period, the Veteran's left lower extremity radiculopathy, involving the sciatic nerve, more nearly approximates moderate incomplete paralysis of the sciatic nerve; his symptoms did not more nearly approximate moderately severe incomplete paralysis. 8. Throughout the appeal period, the Veteran's left lower extremity radiculopathy, involving the femoral nerve, more nearly approximates moderate incomplete paralysis of the femoral nerve; his symptoms did not more nearly approximate severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a withdrawal of an appeal of the issue of an initial rating higher than 40 percent for a TBI have been met. 38 C.F.R. § 19.55. 2. The criteria for a withdrawal of an appeal of the issue of an initial rating higher than 20 percent for a right shoulder disability have been met. 38 C.F.R. § 19.55. 3. The criteria for a withdrawal of an appeal of the issue of an initial rating higher than 10 percent for a right wrist disability have been met. 38 C.F.R. § 19.55. 4. The criteria for a withdrawal of an appeal of the issue of service connection for a lung disability have been met. 38 C.F.R. § 19.55. 5. The criteria for an initial rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411. 6. The criteria for an initial 40 percent disability rating, but no higher, prior to April 21, 2018, for the low back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242. 7. The criteria for a rating higher than 40 percent since April 21, 2018, for the low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242. 8. The criteria for an initial 30 percent disability rating, but no higher, prior to April 21, 2018, for the cervical spine disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242. 9. The criteria for a rating higher than 30 percent since April 21, 2018, for the cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242. 10. The criteria for an initial 40 percent rating, but no higher, for right lower extremity radiculopathy, involving the sciatic nerve, prior to April 21, 2018, and since August 16, 2021, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 8520. 11. The criteria a rating higher than 40 percent rating for right lower extremity radiculopathy, involving the sciatic nerve, from April 21, 2018, to August 16, 2021, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 8520. 12. The criteria for an initial 30 percent rating, but no higher, for right lower extremity radiculopathy, involving the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 8526. 13. The criteria for an initial 20 percent rating, but no higher, for left lower extremity radiculopathy, involving the sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 8520. 14. The criteria for an initial 20 percent rating, but no higher, for left lower extremity radiculopathy, involving the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2006 to October 2007 and January 2011 to April 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2017, February 2018, and April 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran presented testimony before the undersigned Veterans Law Judge. With respect to the issue of an initial higher rating for PTSD, during the March 2021 Board hearing, the Veteran testified that a 70 percent rating for PTSD would satisfy his increased rating claim for PTSD in full. The issue of a TDIU has been raised as part and parcel of the increased rating claims on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Withdrawal The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. During the March 2021 Board hearing, prior to the promulgation of a decision in the appeal, the Veteran withdrew the issues of higher ratings for TBI, right shoulder disability, right wrist disability, and service connection for a lung disability. "[W]ithdrawal of a claim is only effective where the withdrawal is explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the claimant." Delisio v. Shinseki, 25 Vet. App. 45, 57 (2011). A Board determination that a claimant validly withdrew his appeal orally must include a finding regarding whether [the appellant] understood the consequences of withdrawing his claims." Acree v. O'Rourke, 891 F.3d 1009, 1015 (Fed. Cir. 2018). During the March 2021 Board hearing, the Veterans Law Judge explained the consequences of withdrawing the issues of higher ratings for TBI, right shoulder disability, right wrist disability, and service connection for a lung disability. The Veteran confirmed that he wished to withdraw his appeal as to the issues of higher ratings for TBI, right shoulder disability, right wrist disability, and service connection for a lung disability. Additionally, given the discussion during the Board hearing regarding the other claims on appeal, the Board finds that the Veteran understood the consequences of withdrawing the appeal as to the issues of higher ratings for TBI, right shoulder disability, right wrist disability, and service connection for a lung disability. The Board finds that the Veteran's oral statement expressing his intent to withdraw his appeal regarding the issues of higher ratings for TBI, right shoulder disability, and right wrist disability, and service connection for a lung disability was explicit, unambiguous, and undertaken with a full understanding of the consequences of such action, and constitutes as valid withdrawal of those issues. See id; Tomlin v. Brown, 5 Vet. App. 355, 357-58 (finding an oral statement of a representative to be a writing because it was transcribed). In light of the above, there remains no allegations of errors of fact or law for appellate consideration as to these issues. Accordingly, the Board does not have jurisdiction to review the appeal of the issues, and they are dismissed. Higher Initial Ratings Disability evaluations are determined by evaluating 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, including employment, by comparing his or her symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. An initial rating higher than 30 percent for PTSD. The Veteran's PTSD is rated as 30 percent disabling pursuant to 38 C.F.R. § 4.130, DC 9411. All acquired psychiatric disorders, with the exception of eating disorders, are evaluated under the General Rating Formula for Mental Disorders. Under this criteria, a 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § § 4.130, DC 9411. A 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty establishing effective work and social relationships. Id. A 70 percent rating is assigned when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned when there is evidence of total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; memory loss for names of close relatives, own occupation or name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). Under the General Rating Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). For the following reasons, an initial rating of 70 percent, but no higher, for PTSD is warranted. The evidence shows that the Veteran's PTSD symptoms and overall impairment more nearly approximates occupational and social impairment with deficiencies in most areas. For instance, during the July 2017 VA examination, a June 2018 psychosocial assessment, a private July 2018 disability benefits questionnaire (DBQ), the March 2021 Board hearing, the Veteran reported anxiety, social isolation, family problems, difficulty getting along with others in the workplace, irritability, outburst of anger, impaired concertation, memory impairment (such as forgetting names, directions, or recent events), bouts of severe depression, difficulty establishing friendships, difficulty adapting to stressful circumstances, difficulty in establishing and maintaining effective work and social relationships, chronic sleep impairment with nightmares, and difficulty trusting others due to his PTSD. With respect to social impairment, although the Veteran reported he was married and had two children, the evidence reveals that the Veteran's PTSD resulted in significant social impairment, as he had strained relationships, had difficulty getting along with others, socially isolated himself from others, and had few friends. See, e.g., Board hearing transcript (March 2021). Specifically, the Veteran stated that he had marriage and family issues and that his relationship with his wife was strained. See Board hearing transcript (March 2021). He explained that on bad days, he would get in his vehicle and isolate himself. Id. As to other family relationships, earlier in the appeal period, the Veteran described his relationship with his mother as "really good" but also indicated that he was distant with his mother, as he wanted to be "left alone." See VA examination report (July 2017). Later in the appeal period, the Veteran indicated that he lost contact with his parents and that he did not have a relationship with his parents. See Board hearing transcript (March 2021). He reported that he did not have a good relationship with his sisters and half-sisters. See VA examination report (July 2017). He reported that he enjoyed spending time with his in-laws. Id. With respect to relationships other than his family, during a June 2018 psychosocial assessment, the Veteran stated he had a hard time forming emotional relationships with others and that he isolated himself. He reported that he had very few close friends and at the March 2021 Board hearing, he testified that he had "maybe two friends". Additionally, he reported that he had difficulty getting along with others in the workplace. Id. Moreover, during the appeal period, the Veteran indicated that he preferred social isolation and that he avoided crowds. See Board hearing transcript (March 2021). He stated that he lost interest in attending sporting events and concerts, due to his PTSD symptoms. See psychosocial assessment (June 2018). He reported that he attempted to attend a bible study group; however, he felt "on edge", because he was in a group setting. See VA examination report (July 2017). As to occupational impairment, the Veteran has been employed throughout the appeal period; however, the evidence demonstrates that the Veteran's PTSD caused some occupational impairment. See, e.g., psychosocial assessment (June 2018). In particular, the evidence shows that the Veteran had difficulty getting along with others in the workplace, he was frustrated in the workplace, and that he had to take days off work due to his PTSD symptoms, namely, due to his frustration, anger, anxiety, and depression. See psychosocial assessment (June 2018); Board hearing transcript (March 2021). He stated that he had difficulty "staying focused on the job", had lack of motivation, intermittent problems with his ability to focus, and short-term memory loss, due to his PTSD symptoms. See VA examination report (July 2017); psychosocial assessment (June 2018). Furthermore, the evidence shows that in an April 2018 letter, Dr. R. Townsend, D.O., indicated that the Veteran had gross impairment in thought process and communication. In the June 2018 psychosocial assessment, E.M. Trippi, Ph.D., CRC (private psychologist) and in an April 2018 letter, Dr. R. Townsend, D.O., found that the Veteran's PTSD symptoms caused occupational and social impairment with deficiencies in most areas and characterized the Veteran's symptoms as either severe or serious. The June 2018 private psychologist indicated that she reviewed the claims file, interviewed him, and found that the severity of the Veteran's PTSD symptoms had remained the same throughout the appeal period. The Board notes that in a June 2021 VA examination, concerning the Veteran's increased rating claims for his radiculopathy, the VA examiner wrote that the Veteran was "not physically able to do his job." As such, the evidence since June 2021 is unclear whether the Veteran is employed. Regardless, the evidence suggests that if the Veteran is currently unemployed it is associated with his physical limitations. In sum, the evidence shows that the severity, frequency, duration, and impairment of the Veteran's PTSD resulted in social and occupational impairment with deficiencies in most areas, as he had strained relationships, few friends, difficulty maintaining effective relationships, had irritability, impaired concentration, and difficulties in his workplace. Thus, resolving all reasonable doubt in the Veteran's favor, an initial 70 percent rating for PTSD is granted. As noted above, this represents a full grant of the benefits sought, as the Veteran testified at the March 2021 Board hearing, that a grant of a 70 percent disability rating would satisfy his appeal concerning the issue of a higher rating for PTSD in full. See AB v. Brown, 6 Vet. App. 35. The Rating Criteria and Applicable Law for Higher Ratings for Low Back and Cervical Spine Disabilities The Veteran's low back disability is currently rated as 20 percent disabling prior to April 21, 2018, and 40 percent disabling thereafter under 38 C.F.R. § 4.71a, DC 5242. His cervical spine disability is currently rated as 10 percent disabling prior to April 21, 2018, and 30 percent disabling thereafter under 38 C.F.R. § 4.71a, DC 5242. The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). DC 5242 rating criteria was not amended, other than revising the title to "degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome". 38 C.F.R. § 4.71A, DC 5242. Under the applicable criteria, disabilities rated under DCs 5235 to 5243, unless 5243 is evaluated for Formula for Rating IVDS Based on Incapacitating Episodes, are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (General Rating Formula). 38 C.F.R. § 4.71a, DCs 5235, 5237. Under the General Rating Formula, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings apply: A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. Id. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is warranted for ankylosis of the entire spine. Id. Note (2) provides that normal forward flexion, extension, and left and right lateral flexion of the cervical spine are all zero to 45 degrees and left and right lateral rotation of the cervical spine are both zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is to zero to 90 degrees and extension and left and right lateral flexion and rotation of the thoracolumbar spine are all zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and the normal combine range of motion of the thoracolumbar spine is 240 degrees. Each range of motion measurement is to be rounded to the nearest five degrees. The rating criteria provide that 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. 38 C.F.R. § 4.71A, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The Court has held that a veteran may be entitled to a rating higher than 40 percent under the General Rating Formula if he experiences the functional equivalent of ankylosis when considering the provisions of 38 C.F.R. §§ 4.40 and 4.45. Chavis v. McDonough, No. 18-2928, 2021 U.S. App. Vet. Claims LEXIS 660 (Vet. App. Apr. 16, 2021). Under DC 5243 both prior to and since the regulatory change, IVDS (preoperatively or postoperatively) is rated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71A , DC 5243. Under the criteria for rating IVDS, the following ratings apply: a 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months; and a 60 percent rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Id. For purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, DC 5243, Note (1). Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The United States Court of Appeals for Veterans Claims (Court) has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations, if feasible, are to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point at which such factors cause functional impairment. Moreover, 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. Correia v. McDonald, 28 Vet. App. 158 (2016); DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.59. Further, in claims for higher ratings for musculoskeletal disabilities, where a veteran has a noncompensable rating and complaints of pain on motion, the veteran may be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the Court held that under 38 C.F.R. § 4.59, "the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint," and it explained that 38 C.F.R. § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that 38 C.F.R. § 4.59 does not require "objective" evidence but can be satisfied with lay and other nonmedical evidence. Id. at 429. The provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Id. Moreover, the plain language of § 4.59 indicates that it is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable, or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is being evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). 2. An initial rating higher than 20 percent for the low back disability prior to April 21, 2018. 3. An initial rating higher than 10 percent for the cervical spine disability prior to April 21, 2018. For the reasons stated below, a 40 percent rating for the low back disability and a 30 percent rating for the cervical spine disability under the General Rating Formula for Diseases and Injuries of the Spine prior to April 21, 2018, is warranted. The Veteran's low back disability more nearly approximated forward flexion to 30 degrees or less and his cervical spine disability more nearly approximated forward flexion to 15 degrees or less when considering pain, functional loss and impairment, and the degree of additional limitation during flare ups. For example, during March 2018 and June 2021 VA examinations, and private April 2018 DBQs, the Veteran reported low back and cervical spine pain, flare ups, low back pain with dull throbbing pain, difficulty moving his head due to neck pain, limited endurance upon activity, and limited range of motion of the low back and cervical spine. Specifically, with respect to low back flare-ups, the Veteran reported that he had frequent low back flare-ups that occurred once a week when twisting, bending, lifting objects, and sitting for more than 20 minutes. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). As to his cervical spine flare-ups, he stated that flare ups occurred a couple times a week and when lifting objects heavier than 15 to 20 pounds. Id. He also indicated that he had increased neck pain during flare ups. See VA examination report (June 2021). Upon physical examination of the Veteran's low back, range of motion measurements (including upon repetitive use-testing and passive range of motion testing) were recorded, at best, for forward flexion to 35 degrees, with pain, and at worst, to 30 degrees. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). The April 2018 and June 2021 examiners provided estimated low back range of motion measurements during periods of pain, weakness, fatigability, flare ups, and other symptoms. Specifically, the April 2018 VA examiner estimated that the Veteran's thoracolumbar spine forward flexion would be limited to 30 degrees and the June 2021 VA examiner estimated that the Veteran's thoracolumbar spine forward flexion would be limited to 10 degrees during periods of pain, weakness, fatigability, flare ups, and other symptoms. Upon physical examination of the Veteran's cervical spine, range of motion measurements (including upon repetitive use-testing and passive range of motion testing) were recorded at best, for forward flexion to 45 degrees, with pain, and at worst, to 15 degrees. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). The April 2018 and June 2021 examiners provided estimated cervical spine range of motion measurements during periods of pain, weakness, fatigability, flare ups, and other symptoms. Specifically, the April 2018 VA examiner estimated that the Veteran's cervical spine forward flexion would be limited to 15 degrees and the June 2021 VA examiner estimated that the Veteran's cervical spine forward flexion would be limited to 10 degrees during periods of pain, weakness, fatigability, flare ups, and other symptoms. The Board finds that the April 2018 and June 2021 thoracolumbar and cervical spine range of motion findings are the most probative evidence as to the Veteran's limitation of motion of the spine, because the April 2018 and June 2021 examiners considered the Veteran's statements of pain, flare ups, other symptoms, and the impact that such symptoms would have on the Veteran's range of motion of the spine. As the March 2018 VA examiner did not provide estimated range of motion measurements of the Veteran's spine during periods of pain and flare ups and there is no evidence that the Veteran's condition improved during the period on appeal, the April 2018 and June 2021 thoracolumbar and cervical spine range of motion measurements will be applied throughout the appeal period. With respect to the Veteran's low back disability, the April 2018 and June 2021 examiners estimated that the Veteran's limitation of flexion would be limited to 30 degrees or less during periods of pain, flare ups, and other symptoms. Thus, the criteria for a 40 percent rating for the low back disability prior to April 21, 2018, under DC 5242 has been met, as his limitation of flexion of the low back was to 30 degrees or less. As to the cervical spine disability, the April 2018 examiner estimated limitation of motion for forward flexion during periods of pain, weakness, fatigability, flare ups and other symptoms was 15 degrees or less. The June 2021 examiner estimated limitation of motion for forward flexions during flare up to less than 15 degrees. Additionally, the April 2018 examiner estimated that the Veteran's limitation of flexion would be 15 degrees during periods of pain, weakness, fatigability, flare ups, and other symptoms. Resolving any reasonable doubt in the Veteran's favor, the Board finds that prior to April 21, 2018, the Veteran's cervical spine disability more nearly approximated limitation of flexion to 15 degrees or less, considering the type and extent, frequency, and/or severity of his cervical spine disability symptoms. In sum, a 40 percent rating for the low back disability, prior to April 21, 2018, and a 30 percent rating for the cervical spine disability, prior to April 21, 2018, is granted. 4. A rating higher than 40 percent for the low back disability throughout the appeal period. 5. A rating higher than 30 percent for the cervical disability throughout the appeal period. The evidence of record shows that the Veteran did not have spinal ankylosis. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). Neither the VA examination reports, private DBQ, or treatment records indicate that there was unfavorable ankylosis of the entire thoracolumbar spine or the entire spine. Id. Despite the significantly limited ranges of spinal motion, the Board finds that even considering back and cervical pain, flare ups, and other functional factors, the Veteran did not experience actual ankylosis or the functional equivalent of spinal ankylosis (as defined above) throughout the appeal period. In other words, a preponderance of the evidence shows that even considering pain, flare ups, and other functional factors, the Veteran's low back and cervical spine symptoms were not shown to have been so disabling to actually or effectively result in fixation of the entire thoracolumbar and cervical spine in flexion or extension with any of the additional symptoms or limitations listed in Note (5) of the General Rating Formula. Moreover, the evidence shows that the Veteran did not experience incapacitating episodes due to IVDS having a total duration of at least 4 weeks during the past 12 months. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). Notably, although the June 2021 VA examiner indicated that the Veteran had IVDS of the thoracolumbar spine, the examiner indicated that the Veteran did not have episodes that required bed rest prescribed by a physician. Notably, in an August 2021 peripheral neuropathy examination, the examiner wrote that the Veteran was on "bedrest." The Board finds that the August 2021 VA examiner's notation that the Veteran was on "bedrest" is of no probative value in evaluating the Veteran's low back and cervical spine disabilities, as the examiner notation was vague, provided no further details, and did not indicate that the Veteran was on bedrest prescribed by a physician due to his low back and cervical spine disabilities. Therefore, higher ratings are not warranted on the basis of IVDS at any time during the appeal period. The VA and private examiners indicated that the Veteran had radiculopathy in his right and left upper and lower extremities due to his service-connected low back and cervical spine disability. The Veteran has been awarded service connection for radiculopathy in his right and left upper and lower extremities and entitlement to whether the Veteran is entitled to higher ratings for radiculopathy in his right and left upper and lower extremities is addressed below. To the extent, the Veteran contends that his symptoms warrant higher ratings, the Veteran is credible and competent to report subjective symptoms such as pain. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Veteran is not considered competent to assess the relative severity of his low back and cervical spine disabilities, as doing so involves medical testing and medical knowledge the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Consequently, the Board gives more probative weight to the competent medical evidence which includes the VA examinations and private medical evidence that are against the Veteran's claims for a higher rating than to the Veteran's lay statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As such, the criteria a rating higher than 40 percent for the low back disability and a rating higher than 30 percent for the cervical spine disability are not met. The benefit-of-the-doubt doctrine is not for application, and a rating higher than 40 percent for the low back disability and a rating higher than 30 percent for the cervical spine disability is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The Rating Criteria for Radiculopathy The Veteran's radiculopathy in the right and left lower extremities are currently rated under DCs 8526 and 8520. Under DC 8526 for the anterior crural (femoral) nerve, moderate incomplete paralysis warrants 20 percent; and severe incomplete paralysis warrants 30 percent. With complete paralysis of the femoral nerve which warrants a 40 percent rating, there is paralysis of the quadriceps extensor muscles. Under DC 8520, a 10 percent is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis; a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy; and an 80 percent rating is assigned for complete paralysis of the sciatic nerve, where the foot dangles and drops, and there is no active movement possible of muscles below the knee, flexion of knee weakened, or (very rarely), lost. Id. In Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018), the Court noted that "DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms." One possible source for such definitions would be the dictionary. Webster's II New College Dictionary defines "mild" as "not severe." Id. at 694 (1995). A synonym for "mild" is "slight," and definitions for "slight" includes "small in size, degree, or amount." Id. at 1038. The definitions for "moderate" include "of average or medium quantity, quality, or extent." Id. at 704. Finally, definitions for "severe" include "extremely intense." Id. at 1012. "[M]oderately severe" includes impairment that is considered more than "moderate" but not to the extent as to be considered "severe." The rating schedule provides guidance for rating neurological disabilities. With regard to rating neurological disabilities, cranial or 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. 38 C.F.R. § 4.123. The maximum rating that can be assigned for neuritis not characterized by organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Cranial or peripheral neuralgia, usually characterized by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. 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. When the involvement is wholly sensory, the rating should be mild, or at most, the moderate degree. 38 C.F.R. § 4.124A. A. Right lower extremity radiculopathy, involving the sciatic nerve rated under DC 8520 The Veteran's right lower extremity radiculopathy, involving the sciatic nerve, is rated as 10 percent disabling prior to April 21, 2018, 40 percent disabling from April 21, 2018, to August 15, 2021, and 20 percent disabling since August 16, 2021 under DC 8520. 1. Right lower extremity radiculopathy, involving the sciatic nerve prior to April 21, 2018, and since August 16, 2021. For the following reasons, an initial 40 percent rating for right lower extremity radiculopathy, involving the sciatic nerve, prior to April 21, 2018, and since August 16, 2021, is warranted. Prior to April 21, 2018, and since August 16, 2021, the Veteran's right lower extremity radiculopathy, involving the sciatic nerve, more nearly approximates moderately severe incomplete paralysis of the sciatic nerve. For instance, throughout the appeal period, the Veteran reported that he has right lower extremity pain with numbness, paresthesias and/or dysesthesias, numbness, dull pain, and constant pain in the right lower extremity. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). The Veteran and the examiners of record have characterized the severity of the Veteran's right lower extremity radiculopathy symptoms ranging from mild to severe. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). As early in the appeal period as March 2018, the Veteran had some sensory impairment, as sensation to light touch testing was decreased in the right foot and toes during the March 2018 VA examination. The March 2018 examiners indicated that the Veteran's right lower sciatic nerve was affected. The Board finds that moderately severe impairment is characterized by manifestations beyond wholly sensory impairment, such as drop reflex, diminished reflexes, or strength deficits. As stated above, Webster's II New College Dictionary defines "moderately severe" as impairment that is considered more than "moderate" but not to the extent as to be considered "severe." To this extent, the Veteran's right lower extremity radiculopathy, involving the sciatic nerve, manifested by symptoms beyond wholly sensory impairment, as he had decreased sensation in the right foot toes, early in the appeal period. Additionally, the Board finds that the Veteran's right lower extremity radiculopathy is moderately severe as defined by Webster's II New College Dictionary, as during the appeal period, the Veteran and examiners characterized the severity of the Veteran's right lower extremity radiculopathy symptoms ranging from mild to severe. The Board finds that the severity of the Veteran's right lower extremity disability has remained the same throughout the appeal period, as the Veteran has consistently reported similar symptoms throughout the appeal and he had sensory impairment early in the appeal period. Moreover, during the March 2021 Board hearing, the Veteran testified that his right lower extremity radiculopathy symptoms had remained the same throughout the appeal period. Resolving any reasonable doubt in the Veteran's favor, a 40 percent rating prior to April 21, 2018, and since August 16, 2021, for his right lower extremity radiculopathy, involving the sciatic nerve, under DC 8520 is granted. 2. A rating higher than 40 percent for right lower extremity radiculopathy, involving the sciatic nerve throughout the appeal period. For the following reasons, a rating higher than 40 percent for right lower extremity radiculopathy, involving the sciatic nerve, throughout the appeal period is not warranted. The Veteran's right lower extremity radiculopathy, involving the sciatic nerve, does not more nearly approximate severe incomplete paralysis, with marked muscular atrophy, as there was no muscular atrophy, extremely intense right lower extremity radiculopathy symptoms, or complete paralysis. For example, throughout appeal period, the medical evidence shows that the Veteran did not have muscular atrophy. See VA examination reports (March 2018; June 2021); private DBQ (April 2018). Although the Veteran characterized the severity of some of his right lower extremity radiculopathy symptoms as severe, the Veteran did not described his symptoms as extremely intense as defined by Webster's II New College Dictionary. As the preponderance of the evidence is against a higher rating, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. B. Right lower extremity radiculopathy, involving the femoral nerve, under DC 8526 The Veteran's right lower extremity radiculopathy, involving the femoral nerve, is currently rated as 20 percent disabling under DC 8526. For the following reasons, a 30 percent rating, but no higher, for right lower extremity radiculopathy, involving the femoral nerve is warranted. Throughout the appeal period, the Veteran's right lower extremity radiculopathy, involving the femoral nerve, more nearly approximates severe incomplete paralysis of the femoral nerve. For instance, throughout the appeal period, the Veteran reported mild to severe right lower extremity pain with numbness, paresthesias and/or dysesthesias, numbness, dull pain, and constant pain in the right lower extremity. See VA examination report (June 2021); private DBQ (April 2018). The examiners of record have characterized the severity of the Veteran's right lower extremity radiculopathy symptoms ranging from mild to severe. See VA examination report (June 2021); private DBQ (April 2018). During a private April 2018 DBQ, the Veteran underwent sensation to light touch testing that showed decreased sensations in the right lower upper anterior thigh, thigh and knee, and leg and ankle. To this extent, the Veteran's right lower extremity radiculopathy, involving the femoral nerve, manifested by symptoms beyond wholly sensory impairment, as he had decreased sensations in the right lower extremity, early in the appeal period. Resolving any reasonable doubt in the Veteran's favor, an initial 30 percent rating, but no higher, for the right lower extremity radiculopathy, involving the femoral nerve, under DC 8526 is granted. A rating higher than 30 percent for right lower extremity radiculopathy, involving the femoral nerve, under DC 8526, is not warranted, as his symptoms did not more nearly approximate complete paralysis of quadriceps extensor muscles. To this extent, neither the Veteran nor medical professionals during the appeal period indicated that the Veteran had complete paralysis of quadriceps extensor muscles. In fact, during the April 2018 and June 2021 examinations, the Veteran had normal muscle strength (5/5) and normal reflexes (2+) in the right lower extremity. As the preponderance of the evidence is against a higher rating, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. C. Left lower extremity radiculopathy, involving the sciatic nerve, rated under DC 8520. D. Left lower extremity radiculopathy, involving the femoral nerve, rated under DC 8526. The Veteran's left lower extremity radiculopathy, involving the sciatic nerve, and left lower extremity radiculopathy, involving the femoral nerve are currently rated separately as 10 percent disabling under DCs 8520 and 8526, accordingly. For the following reasons, separate 20 percent ratings for the left lower extremity radiculopathy (involving the sciatic and femoral nerves) under DCs 8520 and 8526, accordingly, are warranted. The Veteran's left lower extremity radiculopathy, involving the sciatic nerve, more nearly approximates moderate incomplete paralysis of the sciatic nerve under DC 8520. The Veteran's left lower extremity radiculopathy, involving the femoral nerve, more nearly approximates moderate incomplete paralysis of the femoral nerve under DC 8526. For example, throughout the appeal period, the Veteran reported mild left lower extremity radiculopathy symptoms. See VA examination report (June 2021); private DBQ (April 2018). At the April 2018 VA examination, sensation to light touch testing showed decreased sensations in the left lower upper anterior thigh and thigh and knee. The April 2018 examiner indicated that the Veteran's left lower femoral and sciatic nerves were affected. The Veteran's left lower extremity radiculopathy, involving the sciatic and femoral nerves, manifested by symptoms beyond wholly sensory impairment, as he had decreased sensations in the left lower extremity. Additionally, the Board finds that the Veteran's left lower extremity radiculopathy, involving the sciatic and femoral nerves, symptoms are best characterized as moderate as defined by Webster's II New College Dictionary, as the Veteran described his pain as mild, which closes approximates "average or medium quantity, quality, or extent" defined by the Webster's II New College Dictionary. Resolving any reasonable doubt in the Veteran's favor, separate 20 percent ratings, for the left lower extremity radiculopathy (involving the sciatic and femoral nerves) under DCs 8520 and 8526, accordingly, is granted. For the following reasons, ratings higher than 20 percent for the left lower extremity radiculopathy (involving the sciatic and femoral nerves) under DCs 8520 and 8526, are not warranted. The Veteran's left lower extremity radiculopathy (involving the sciatic nerve) did not more nearly approximate moderately severe incomplete paralysis. The Veteran's left lower extremity radiculopathy (involving the femoral nerve) did not more nearly approximate severe incomplete paralysis. The Veteran's left lower extremity radiculopathy (involving the sciatic and femoral nerves) symptoms are not moderately severe or severe as defined by Webster's II New College Dictionary, as the Veteran and the examiners, throughout the appeal period appeal characterized the Veteran's left lower extremity radiculopathy symptoms at worst, as mild. Thus, the Veteran did not express that his symptoms were average or medium quantity or extremely intense. Additionally, during the April 2018 and June 2021 examinations, the Veteran had normal muscle strength (5/5) and normal reflexes (2+) in the left lower extremity. As the preponderance of the evidence is against a higher rating, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. The issue of service connection for bilateral hearing loss is remanded. The Veteran claims that his bilateral hearing loss is due to his in-service noise exposure. Specifically, the Veteran asserts that he was exposed to loud noise during service, such as motor attacks, explosions, and rifle fire. The Veteran's DD Form 214 shows that his military occupational specialist was military police and that he served in a designated imminent danger zone. The Veteran's in-service noise exposure has been conceded based on the circumstances of his service. In May 2017, the Veteran was afforded a VA hearing loss examination. Although the VA examiner provided a positive nexus opinion between the Veteran's bilateral hearing loss and his in-service noise exposure, the Veteran did have bilateral hearing loss for VA purposes. During the March 2021 Board hearing, the Veteran testified that his hearing loss had worsened since his last VA examination in May 2017. Considering the Veteran's worsening symptoms since the May 2017 examination, a remand is necessary to schedule him for a VA examination to determine whether he has bilateral hearing loss for VA purposes. 2. The issue of an initial rating higher than 20 percent left upper extremity radiculopathy is remanded. 3. The issue of an initial rating higher than 20 percent for right upper extremity radiculopathy, prior to April 21, 2018, is remanded. 4. The issue of a rating higher than 40 percent for right upper extremity radiculopathy, from April 21, 2018, to August 15, 2021, is remanded. 5. The issue of a rating higher than 30 percent for right upper extremity radiculopathy, since August 16, 2021, is remanded. Throughout the appeal period, the Veteran has reported consistent symptoms regarding his right and left upper extremity radiculopathy. To this extent, the examination reports of record provide varying reports as to which upper extremity nerve is involved. For example, a private April 2018 DBQ shows that the examiner found that the Veteran had severe (characterized by the examiner) upper right extremity radiculopathy and mild upper left extremity radiculopathy involving the upper and lower radicular groups. On the other hand, a June 2021 VA examination reports shows that although the Veteran had right and left upper extremity radiculopathy symptoms including other nerves, such symptoms did not involve the upper and lower radicular groups. Notably, no electromyography was performed. The Board finds that in light of the discrepancies between the April 2018 and June 2021 examinations, the Veteran should be afforded a VA examination to assess the severity of his right and left upper extremity radiculopathy and for an examiner to explain, if possible, the discrepancies between the examinations. 6. The issue of a TDIU is remanded. The evidence shows that the Veteran has been employed throughout the appeal period. However, at an August 2021 examination, the VA examiner wrote that the Veteran was "not physically able to do his job," suggesting that the Veteran was unemployed. The Veteran has not submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability and the Agency of Original Jurisdiction (AOJ) has not adjudicated this matter. Therefore, a remand is necessary. Upon remand, after giving the Veteran an opportunity to file a formal claim for a TDIU, the AOJ should address this matter, in the first instance. The matters are REMANDED for the following action: 1. Request that the Veteran complete VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. Afford the Veteran a reasonable opportunity for response. 2. Schedule the Veteran for an audiological examination to determine whether he has bilateral hearing loss for VA purposes. The audiologist must conduct audiometric and speech discrimination (Maryland CNC) testing of the right and left ear. Notably, no opinion regarding the etiology of the Veteran's bilateral hearing loss is necessary, as the evidence of record establishes that the Veteran's bilateral hearing loss is related to his in-service noise exposure. 3. Schedule the Veteran for a VA examination to determine the current severity of his service-connected right and left upper extremity radiculopathy. All necessary tests should be conducted, including an EMG. The claims file must be sent to the examiner for review. The examiner should examine the Veteran and provide findings in accordance with the currently applicable disability benefits questionnaire. Additionally, the examiner if possible, should explain the discrepancies between the April 2018 and June 2021 examinations involving which nerves of the right and left upper extremities are involved, and if the Veteran's symptoms worsened, when this occurred during the period on appeal. All opinions must be supported by a detailed rationale. 4. Adjudicate the issue of entitlement to a TDIU. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Castillo, 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.