Citation Nr: 21063386 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-28 795 DATE: October 14, 2021 ORDER Entitlement to a rating in excess of 20 percent for sensory-motor neuropathy, left lower extremity (LLE) is denied. Entitlement to a 30 percent rating sensory-motor neuropathy, right lower extremity (RLE) prior to November 4, 2020, and a 40 percent rating thereafter is granted. FINDINGS OF FACT 1. The Veteran's sensory-motor neuropathy LLE was manifested as moderate incomplete paralysis of the common peroneal nerve, musculocutaneous nerve, anterior tibial nerve, tibial nerve, posterior tibial nerve, but did not more nearly approximate severe incomplete paralysis. 2. Resolving reasonable doubt in his favor, prior to November 4, 2020, the Veteran's sensory-motor neuropathy of the RLE was manifested by symptoms commensurate of complete paralysis of the anterior tibial (deep peroneal) nerve. 3. Resolving reasonable doubt in his favor, since November 4, 2020, the Veteran's sensory-motor neuropathy of the RLE, with right foot drop, has been manifested by symptoms commensurate of complete paralysis of the external popliteal nerve. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent, but no higher, for LLE sensory-motor neuropathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8521 (2020). 2. Resolving reasonable doubt in his favor, prior to February 13, 2020, the criteria for an increased 30 percent rating for sensory-motor neuropathy of the RLE, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Codes 8523 and 8524 (2020). 3. Resolving reasonable doubt in his favor, since February 13, 2020, the criteria for an increased 40 percent rating for sensory-motor neuropathy of the RLE, with right foot drop, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Codes 8521, 8522, and 8523 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1977 to July 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of a regional office (RO) of the Department of Veterans Affairs. This matter was previously remanded by the Board of Veterans Appeals (Board) in August 2020 for additional development. It now returns for further appellate review. During the remand, the RO granted a 20 percent rating for the Veteran's left lower extremity sensory-motor neuropathy disability effective October 6, 2015. See July 2021 Rating Decision. The grant does not constitute the highest rating available. As such, this claim is still considered to be on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (The Veteran is presumed to seek the maximum available benefit for a disability.) Increased Rating The Veteran seeks a higher rating for his service-connected bilateral (LLE and RLE) sensory-motor neuropathy disabilities. See March 2017 Notice of Disagreement (NOD). Legal Criteria The Veteran's bilateral (LLE and RLE) sensory-motor neuropathy disabilities have been rated under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8523 and DC 8521. Under DC 8523, a noncompensable rating is assigned for mild incomplete paralysis of the anterior tibial nerve; a 10 percent rating is assigned for moderate incomplete paralysis of the anterior tibial nerve; a 20 percent rating is assigned for severe incomplete paralysis of the anterior tibial nerve; and a 30 percent rating is assigned for complete paralysis of the anterior tibial nerve with dorsal flexion of the foot lost. 38 C.F.R. § 4.124a, DC 8523. DC 8521 provides the rating criteria for paralysis of the external popliteal nerve (common peroneal) where incomplete paralysis when mild is 10 percent, 20 percent when moderate, and 30 percent when severe. A 40 percent rating is warranted for complete paralysis. Other applicable DCs include DC 8522, DC 8524, and DC 8525. DC 8522 provides the rating criteria for paralysis of the musculocutaneous nerve (superficial peroneal) where incomplete paralysis when mild is noncompensable, moderate is 10 percent, and severe is 20 percent. A 30 percent rating is warranted for complete paralysis. DC 8524 provides the rating criteria for paralysis of the interior popliteal nerve (tibial) where incomplete paralysis when mild is 10 percent, moderate is 20 percent and severe is 30 percent. A 40 percent rating is warranted for complete paralysis. DC 8525 provides the rating criteria for paralysis of the posterior tibial nerve where incomplete paralysis when mild is 10 percent, moderate is 10 percent and severe is 20 percent. A 30 percent rating is warranted for complete paralysis. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. VA's Adjudication Procedures Manual (Manual), though not binding on the Board, also provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerves conditions as held by the Court in Chavis v. McDonough. See 2021 U.S. App. Vet. Claims LEXIS 660, 2021 WL 1432578, at *13 (U.S. Vet. App. Apr. 16, 2021). Given such, mild incomplete paralysis is described as the disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. Additionally, a very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis. Moderate incomplete paralysis is described as the maximum evaluation reserved for the most significant cases of sensory-only impairment. Symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished hyperactive reflexes (with or without sensory impairment) graded as medically moderate. 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 a varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. In this case, the Board considers "mild" to correspond to slight symptoms sufficient to support the diagnosis, generally characterized by less persistent sensory deficits, or those affecting a small area, and or very minimal reflex or motor abnormalities. The Board considers "moderate" to correspond to the maximum evaluation available for sensory-only impairment, characterized by symptoms described by the Veteran and considered significantly disabling medically, and/or involving a larger area in nerve distribution. Additionally, moderate can correspond to combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes with or without sensory impairment, graded as medically moderate. Finally, "severe" is characterized by motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes may be seen in severe longstanding neuropathy cases. Although severe incomplete paralysis cases should show findings substantially less than those for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contains signs or symptoms that resemble some of those expected in cases of complete paralysis of the nerve. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve. The Board observes that the Veteran's bilateral lower extremity sensory-motor neuropathy demonstrates impairment of only one nerve branch. The external popliteal nerve (common peroneal), musculocutaneous nerve (superficial peroneal), anterior tibial nerve (deep peroneal), internal popliteal nerve (tibial) and posterior tibial nerve are all part of the sciatic branch and affect the same functions. Thus, a rating is assigned for the predominant nerve branch impairment among this group. Assigning separate evaluations for the Veteran's symptoms from the external popliteal nerve (common peroneal), musculocutaneous nerve (superficial peroneal), posterior tibial nerve, and anterior tibial nerve (deep peroneal) are not warranted as these nerves are part of the same sciatic branch, and therefore the functions associated with these nerves are not separate and distinct, and separate ratings for these symptoms would constitute pyramiding. Factual Background By way of history, the Veteran has been service-connected for RLE sensory-motor neuropathy rated 20 percent disabling, and for LLE sensory-motor neuropathy rated as 10 percent disabling since November 1998. See August 1999 Rating Decision. The Veteran filed the instant claim for increase in October 2015. See October 2015 VA Form 21-526EZ. As such, the appeal period began on October 6, 2015. In December 2015, the Veteran was provided a VA examination. See December 2015 VA Compensation and Pension (C&P) Examination for Peripheral Nerves. The examiner confirmed the Veteran's diagnosis of bilateral lower extremity sensory-motor neuropathy. Id. The Veteran reported his legs had gotten worse. He noted that he wore boots to avoid tripping. The Veteran endorsed peripheral nerve symptoms including moderate LLE intermittent pain, moderate LLE paresthesias and/or dysesthesias, severe numbness in RLE, and moderate numbness in LLE. Id. He denied any constant pain in his lower extremities. The muscle strength testing revealed that the Veteran displayed normal strength (5/5) in bilateral knee extension, and active movement against some resistance (4/5) in bilateral ankle plantar flexion and ankle dorsiflexion. See December 2015 VA C&P Examination for Peripheral Nerves. The Veteran did not have muscle atrophy. The Veteran's reflex examination revealed his deep tendon reflexes (DTRs) were normal (2+) for the brachioradiales and knees bilaterally. The DTRs for his bilateral ankles were 1+, which considered diminished or hypoactive reflexes. On sensory examination, the Veteran had normal sensation in his upper thigh and thigh/knee bilaterally, and decreased sensation in lower leg/ankle and foot/toes bilaterally. See December 2015 VA C&P Examination for Peripheral Nerves. There were no trophic changes noted. The Veteran had normal gait. The examiner found that the Veteran's bilateral sensory motor neuropathy did not involve the sciatic nerve, common peroneal nerve, tibial nerve, femoral nerve, internal saphenous nerve, obturator nerve, external cutaneous nerve of the thigh, and the ilio-inguinal nerve. Id. The Veteran displayed mild incomplete paralysis of the musculocutaneus nerve, anterior tibial nerve, and posterior tibial nerve bilaterally. The Veteran did not use any assistive devices. The electromyography (EMG) indicated advanced bilateral lower extremity peripheral neuropathy, and noted that the right tibial nerve was not obtainable. Id. The examiner opined that the "Veteran's peripheral neuropathy in his lower legs, has a mild to moderate impact on his ability to sustain ambulatory employment...." Id. The March 2016 rating decision continued the assigned disability ratings for the Veteran's disabilities to include a 20 percent rating for RLE sensory-motor neuropathy and 10 percent for LLE sensor-motor neuropathy. The Veteran submitted a private opinion from Ms. G.G.U., ARNP regarding his peripheral neuropathy disabilities dated March 2017. See March 2017 Private Rating Evaluation. Ms. G.G.U. opined that the Veteran' peripheral neuropathy affected his sciatic nerve. She also noted that the Veteran "suffers from severe paresthesias and/or dysesthesias, severe numbness, impaired knee extension..., absent ankle plantar flexion, impaired ankle dorsiflexion...., atrophy of gastroc and flexors ... with a 4cm loss of muscle bulk on the right compared to left." She also noted that the Veteran had absent reflexes in the knee and ankle, and diminished sensation in the distal leg below the knee." Id. She also opined that the Veteran's peripheral neuropathy resulted in complete paralysis of the internal popliteal and musculocutaneus nerves, moderate incomplete paralysis of the posterior tibial nerve and anterior crural nerves. She also stated that "these are multiple branches of the Sciatic Nerve." Id. She concluded her report by stating that the Veteran was eligible for an 80 percent rating for his RLE sensory motor neuropathy. The Veteran also submitted a private peripheral nerves examination and conducted by Mr. B.L.S., PA., in March 2017. See March 2017 Private Peripheral Nerves Disability Benefits Questionnaire (DBQ). Mr. B.L.S. noted that that the Veteran had severe lower extremity weakness and sensory-motor neuropathy. The Veteran endorsed mild intermittent pain in his RLE, and severe paresthesias and/or dysesthesias and numbness in his bilateral lower extremities. He denied any constant pain. The Veteran's muscle strength testing was mostly normal except he had active movement against some resistance (4/5) in his right knee extension, and left ankle plantar flexion, and no movement on his right ankle plantar flexion. Mr. B.L.S. found that the Veteran had muscle atrophy located at gastroc and flexors bilaterally. On reflex examination, the Veteran's DTS reflected absent reflexes (zero) in his bilateral knees and ankles. The Veteran's gait was abnormal and described as distinct neuropathic gait. Mr. B.L.S. found that the Veteran's bilateral lower extremity sensory-motor neuropathy did not involve the sciatic nerve, internal saphenous nerve, and obturator nerves in his bilateral lower extremities. Id. The Veteran had moderate incomplete paralysis of the common peroneal nerve, deep peroneal nerve of his RLE. He had complete paralysis of the musculocutaneous nerve, tibial nerve, and posterior tibial nerve of his RLE. He had moderate incomplete paralysis anterior tibial nerve and mild incomplete paralysis of the femoral nerve of his LLE. The Veteran uses hiking poles as assistive devices. Id. Mr. B.L.S. noted an EMG was taken in December 2016 which reflected abnormal bilateral lower extremities. Specifically, he noted there was evidence of bilateral mixed axonal demyelinating neuropathy. Id. In its August 2020 remand, the Board found that the March 2017 private DBQ was inadequate for rating purposes because it contained conflicting evidence, and did note which nerves were affected in the Veteran's LLE. Consequently, the Board remanded the claim to obtain another VA examination. Pursuant to the August 2020 Board remand, VA obtained two VA examinations and two medical opinions. In November 2020, the Veteran underwent a VA examination. See November 2020 VA Central Nervous System and Neuromuscular Diseases DBQ. The examiner noted the Veteran's diagnosis were bilateral lower extremity neuropathy, idiopathic progressive neuropathy, advanced bilateral lower extremity paralysis right tibial and paralysis of fibular nerves. Id. The Veteran's current symptoms included absence of plantar flexion in right foot and lack of propulsion, heightened step due to foot drop. The examiner also noted that the Veteran had marked muscle atrophy of right calf muscle. On muscle strength testing, the Veteran right lower extremity including his knee extension, ankle plantar flexion, and ankle dorsiflexion was (1/5) which reflects visible muscle movement but no joint movement. The Veteran's left lower extremity testing including his knee extension, ankle plantar flexion, and ankle dorsiflexion was (3/5), which reflects no movement against resistance. The Veteran's DTRs were 1+ in his bilateral lower extremities, indicative of decreased reflexes. The November 2020 VA medical opinion also noted that the Veteran had absent plantar flexion in his right foot, lack of propulsion, and heightened step due to foot drop. See November 2020 VA Medical Opinion DBQ. The examiner also noted that the Veteran had no active movement of muscles below the left knee. Id. In February 2021, the Veteran underwent a peripheral nerves VA examination. See February 2021 VA Peripheral Nerves Conditions DBQ. The Veteran endorsed mild LLE intermittent pain, and severe bilateral lower extremities numbness and paresthesias and/or dysesthesias. Id. He denied constant pain in his lower extremities. Muscle strength testing revealed (1/5) in right knee extension, ankle plantar flexion, and ankle dorsiflexion. The Veteran's left knee extension, ankle plantar flexion, and ankle dorsiflexion were (3/5). The examiner noted that the Veteran had right calf muscle atrophy. The Veteran's DTRs were 1+ in his bilateral knees and ankles. The Veteran had decreased sensation to light touch in his bilateral lower leg/ankle and foot/toes. See February 2021 VA Peripheral Nerves Conditions DBQ. The examiner noted trophic changes in the form of bilateral lower extremity loss of hair. The Veteran's gait was distinct neuropathic and resulted in intermittent loss of balance. The examiner found that the Veteran had normal sciatic nerve, internal saphenous nerve, obturator nerve, external cutaneus nerve of thigh, and ilio-inguinal nerve of his bilateral lower extremities. The Veteran also had normal LLE femoral nerve, musculocutaneous nerve, anterior tibial nerve, tibial nerve, and posterior tibial nerve. Id. The Veteran had moderate incomplete paralysis of his LLE in the common peroneal nerve, musculocutaneous nerve, anterior tibial nerve, tibial nerve, posterior tibial nerve, and femoral nerve of the RLE. The examiner indicated that the Veteran did not use any assistive devices. In a July 2021 rating decision, the RO increased the Veteran's disability rating for his LLE sensory-motor peripheral neuropathy effective October 5, 2016 from 10 percent to 20 percent based on moderate incomplete paralysis of the common peroneal nerve (DC 8521). Analysis 1. LLE Sensory-motor neuropathy The Board notes that the Veteran has been assigned a 20 percent rating for his service-connected LLE sensory-motor neuropathy since the beginning of the period on appeal (October 6, 2015). See July 2021 Rating Decision. Notably, the Veteran was assigned this rating for moderate incomplete paralysis of the common peroneal nerve (DC 8521). Thus, in order for a disability rating in excess of 20 percent to be warranted under 38 C.F.R. § 4.124a, DC 8521, the evidence must show severe incomplete paralysis. Based on the evidence of record as noted above, a rating in excess of 20 percent is not warranted for the Veteran's service-connected LLE sensory-motor neuropathy as the preponderance of the evidence is against a finding that the Veteran has complete paralysis or severe incomplete paralysis of any affected nerve(s). Specifically, the December 2015 VA examination report reflects that the Veteran endorsed peripheral nerve symptoms including moderate LLE intermittent pain, moderate LLE paresthesias and/or dysesthesias. See December 2015 VA C&P Examination for Peripheral Nerves. The examination report also showed that his neurological involvement of the LLE did not cause trophic changes or an abnormal gait and that he had normal reflexes. The Veteran had full muscle strength (5/5) in bilateral knee extension, and active movement against some resistance (4/5) in bilateral ankle plantar flexion and ankle dorsiflexion, and normal reflexes. Notably, the examiner found that the Veteran's LLE sensory-motor neuropathy was manifested by mild incomplete paralysis of the musculocutaneus nerve, anterior tibial nerve, and posterior tibial nerve. While the November 2020 VA examination report demonstrates muscle strength testing of the Veteran's left knee extension, ankle plantar flexion, and ankle dorsiflexion were (3/5), which indicates no movement against resistance, the evidence did not show he had muscle atrophy. See November 2020 VA Central Nervous System and Neuromuscular Diseases DBQ. The Board finds that the November 2020 VA examiner's finding of and 3/5 strength suggests moderate, not severe muscle weakness or muscle atrophy. The February 2021 VA examiner noted trophic changes in the form of bilateral lower extremity loss of hair. See February 2021 VA Peripheral Nerves Conditions DBQ. However, the examiner found that the Veteran had moderate incomplete paralysis of his LLE in the common peroneal nerve, musculocutaneous nerve, anterior tibial nerve, tibial nerve, posterior tibial nerve. Id. Additionally, the muscle strength testing of Veteran's left knee extension, ankle plantar flexion, and ankle dorsiflexion were (3/5). As such, these findings do not reflect severe disability. There was also no LLE muscle atrophy. While trophic changes such as loss of hair may be seen in severe long-standing neuropathy, the Veteran does not demonstrate any other symptom of severe peripheral nerve disability. The Board finds that the findings of the December 2015 VA examination report does not warrant a finding of complete paralysis of the nerve, as the record does not reflect that dorsal flexion of the foot has been lost. Nor does the February 2021 VA peripheral nerves conditions examination report, or any other medical evidence of record, support finding that the Veteran has the had complete paralysis of the LLE. Therefore, entitlement to an even higher rating based on complete paralysis of the external popliteal nerve (common peroneal) or anterior tibial nerve is not warranted. The Board notes that the Veteran's LLE sensory-motor neuropathy involved different nerves including common peroneal nerve, musculocutaneous nerve, anterior tibial nerve, tibial nerve, posterior tibial nerve. However, as noted above separate evaluations for the Veteran's symptoms from the external popliteal nerve (common peroneal), musculocutaneous nerve (superficial peroneal), posterior tibial nerve, and anterior tibial nerve (deep peroneal) are not warranted as these nerves are part of the same sciatic branch. Notably, the Veteran is not entitled to a higher rating under DC 8520, as sciatic nerve involvement is not demonstrated. However, in this case, a rating under DC 8521 is more beneficial to the Veteran as it provides the highest rating available for moderate incomplete paralysis. Regardless of whether the Veteran's LLE disability is rated under DC 8521 or one of the other related DCs like DC 8522, DC 8523, or DC 8524, the evidence, as noted above, reflects that the Veteran's LLE sensory-motor neuropathy does not rise to the level of severity of moderately severe incomplete paralysis of any other related nerve or nerve branch). Nor does the evidence support a finding of complete paralysis of any nerve, or severe incomplete paralysis of the common peroneal, tibial, or femoral nerves. The Board considered the Veteran's lay statements regarding his symptoms of pain, tingling, numbness associated with his LLE sensory-motor neuropathy. His statements are credible and competent. To the extent that the Veteran believes he is entitled to a higher disability rating than presently assigned, the Board notes that it has considered his assertions regarding the severity of the symptoms he has experienced in determining the appropriate disability evaluation. However, the Board finds that the clinical evidence of record is of the greatest probative value as to the level of impairment. Based on the foregoing, the Board finds that a rating in excess of 20 percent is not warranted for his LLE sensory motor neuropathy. Accordingly, the claim for a rating in excess of 20 percent for LLE sensory motor neuropathy is denied. 2. RLE Sensory-motor neuropathy After review of the evidence of record, and resolving reasonable doubt in the Veteran's favor, the Board finds that for the period prior to November 4, 2020, the lay and medical evidence demonstrates that an increased rating of 30 percent is warranted for his RLE sensory-motor neuropathy In this regard, the December 2015 VA examination report shows that the Veteran wore boots to avoid tripping due to problems with his RLE sensory-motor neuropathy, indicating there was a problem with his ability to ambulate. See December 2015 VA C&P Examination for Peripheral Nerves. Notably, the EMG taken in connection with the examination indicates that the Veteran had advanced bilateral lower extremity peripheral neuropathy, and notes that the right tibial nerve was not obtainable. Id. In a private peripheral neuropathy evaluation in March 2017 conducted by Ms. G.G.U., she notes that the Veteran "suffers from severe paresthesias and/or dysesthesias, severe numbness, impaired knee extension..., absent ankle plantar flexion, impaired ankle dorsiflexion...., atrophy of gastroc and flexors ... with a 4cm loss of muscle bulk on the right compared to left." She also notes that the Veteran had absent reflexes in the knee and ankle, and diminished sensation in the distal leg below the knee." See March 2017 Private Rating Evaluation. Similarly, a second private peripheral nerves examination conducted by Mr. B.L.S., PA in March 2017 found that the Veteran has muscle atrophy located at gastroc and flexors bilaterally. See March 2017 Private Peripheral Nerves Disability Benefits Questionnaire (DBQ). On reflex examination, the Veteran's DTRs reflects absent reflexes (zero) in his right knees and ankles. Id. The Veteran's gait was abnormal and described as distinct neuropathic gait. Mr. B.L.S. found that the Veteran had complete paralysis of the musculocutaneous nerve, tibial nerve, and posterior tibial nerve of his RLE. Id. These findings support a 30 percent rating for severe incomplete paralysis of the musculocutaneous nerve, tibial nerve, and posterior tibial. Although, Mr. B.L.S. opines that the Veteran had complete paralysis of the tibial nerve, the evidence does not demonstrate that the Veteran had foot drop, or is unable to dorsiflex the foot or separate his toes, or symptoms associated with complete paralysis of these nerves. See March 2017 Private Peripheral Nerves. However, the November 2020 VA examination report confirmed that the Veteran had advanced bilateral lower extremity paralysis right tibial and paralysis of fibular nerves. See November 2020 VA Central Nervous System and Neuromuscular Diseases DBQ. The Veteran's current symptoms include absence of plantar flexion in right foot and lack of propulsion, heightened step due to foot drop. The examiner also noted that the Veteran had muscle atrophy of right calf muscle. On muscle strength testing, the Veteran RLE including his knee extension, ankle plantar flexion, and ankle dorsiflexion was (1/5) which reflects visible muscle movement but no joint movement. The November 2020 VA medical opinion also notes that the Veteran had absent plantar flexion in his right foot, lack of propulsion, and heightened step due to foot drop. See November 2020 VA Medical Opinion DBQ. The examiner also notes that the Veteran had no active movement of muscles below the left knee. Id. Thus, prior to November 4, 2020, the evidence reflects paralysis of the tibial posterior tibial nerves, sensory impairment, hypoactive reflexes, motor impairment, pain in his right foot, numbness, tingling, loss of sensation, abnormal gait, intermittent pain, tingling, and an inability to walk without falling due to the RLE sensory-motor neuropathy. Significantly, the Veteran exhibits absent reflexes (zero) in his bilateral knees and ankles and had abnormal gait which is described as distinct neuropathic gait. See March 2017 Private Rating Evaluation. When considering the relative impairment in motor function, reflexes, and sensory disturbance (38 C.F.R. § 4.120), the Board finds that the criteria for a higher 30 percent rating under DC 8523 for complete paralysis of the anterior tibial (deep peroneal) nerve is warranted. 38 C.F.R. § 4.124a. The severity of motor disturbance caused by the RLE sensory-motor neuropathy is analogous to loss of dorsal flexion of the foot which is commensurate of complete paralysis of the anterior tibial nerve, warranting a 30 percent rating. As discussed above, a separate rating for the posterior tibial nerve is not warranted and the rating under DC 8525 would not be more advantageous to the Veteran. Therefore, since November 4, 2020, the evidence reflects paralysis of the right external popliteal, musculocutaneous, and anterior tibial nerves, as well as sensory impairment, marked right calf muscle atrophy, absent and hypoactive reflexes, motor impairment, and trophic changes. When considering the relative impairment in motor function, trophic changes, and sensory disturbance (38 C.F.R. § 4.120), as well as the EMG findings, the Board finds that the criteria for a rating of 40 percent under DC 8521 for complete paralysis of the external popliteal (common peroneal) nerve is warranted. 38 C.F.R. § 4.124a. In this regard, the Veteran suffers from right foot drop with weakened adduction, absent reflexes, and numbness/anesthesia covering the entire dorsum of the right foot commensurate with the rating criteria for complete paralysis of the external popliteal nerve, and thus warranting the increased 40 percent rating. As discussed above, separate ratings for the musculocutaneous (superficial peroneal) nerve and anterior tibial nerve (deep peroneal) are not warranted and the rating under DC 8521 would be more advantageous to the Veteran than ratings under these DCs. In granting the claim, the Board considered the Veteran's competent and credible lay statements regarding his RLE sensory-motor neuropathy. His statements are consistent with the medical evidence of record which indicates his disability resulted in complete paralysis of the external popliteal nerve and resulted in foot drop, no active movement of muscles below the knee, and marked atrophy of right calf. Other diagnostic codes were considered in this case and are not for application. Specifically, DC 8520 governs impairment of the sciatic nerve and allows for a maximum schedular rating above 80 percent. However, as the VA examination reports indicate that there is no other nerve involvement, DC 8520 is not for application. In sum, the Board finds that the Veteran is entitled to a disability rating of 30 percent, but no higher, prior to November 4, 2020, and a disability rating of 40 percent, but no higher, thereafter for his RLE sensory-motor neuropathy with right foot drop. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Lilly, 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.