Citation Nr: 21064281 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-20 173 DATE: October 19, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for right ankle strain is denied. Entitlement to an initial rating in excess of 10 percent for left knee strain is denied. Entitlement to an initial rating in excess of 30 percent for flat feet is denied. Entitlement to an initial rating in excess of 10 percent for thoracolumbar strain (back condition) prior to December 31, 2019, and in excess of 40 percent since, is denied. Entitlement to an initial rating in excess of 10 percent for sciatic radiculopathy of the right lower extremity is denied. REMANDED In addition, entitlement to a separate compensable rating for plantar fasciitis since February 7, 2021 is remanded to the agency of original jurisdiction (AOJ) for additional development. FINDINGS OF FACT 1. The probative evidence of record does not establish that the Veteran's right ankle manifests in marked range of motion or ankylosis. 2. The probative evidence of record establishes that the Veteran's left knee manifests in painful flexion and extension, but is not limited to 30 degrees flexion or 15 degrees extension. 3. The probative evidence of record does not establish that the Veteran's flat feet were not improved by orthopedic shoes or appliances. 4. Prior to December 31, 2019, the probative evidence of record does not establish that the Veteran's back condition, while painful, manifested in limited range of motion. 5. Since December 31, 2019, the probative evidence of record does not establish that the Veteran's back condition manifested in unfavorable ankylosis of the lumbar spine or its functional equivalent. 6. Since December 31, 2019, the probative evidence of record establishes that the Veteran has radiculopathy of the right lower extremity that manifests in no more than mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating in excess of 10 percent for a right ankle condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 2. The criteria for an initial rating in excess of 10 percent for a left knee condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5260. 3. The criteria for an initial rating in excess of 30 percent for bilateral flat feet have not been met 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.71a, Diagnostic Code 5276. 4. The criteria for an initial rating in excess of 10 percent for a back condition; and in excess of 40 percent since December 31, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237, 5243. 5. The criteria for an initial rating in excess of 10 percent for radiculopathy of the right lower extremity as of December 31, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from April 2005 to February 2015. The Veteran's claims were most recently before the Board of Veterans Appeals (Board) in September 2019 wherein they were remanded for additional development. This development was completed, and the claims have returned to the Board. Increased Rating The Veteran contends that increased ratings are warranted for her right ankle, left knee, flat foot, and back disabilities. The Board has considered the entire medical history in deciding the Veteran's claims but will concentrate its analysis on the evidence that would entitle the Veteran to a higher rating. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Staged ratings must be considered, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). See also Fenderson v. West, 12 Vet. App. 119, 126 (1999) (applying this concept to initial ratings). The Board has considered the record and has found that staged ratings are not warranted (except as previously granted) because the degree of disability has remained approximately the same during the period on appeal given the probative evidence of record. Diagnostic Code 5003 provides that degenerative arthritis that is established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. When evaluating musculoskeletal disabilities based on limitation of motion such as the Veteran's left ankle and back, when assessing the severity of musculoskeletal disabilities that are at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when her symptoms are most prevalent ("flare-ups") due to the extent of her pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Further, the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to an initial rating in excess of 10 percent for right ankle strain The Veteran contends that her ankle warrants an increased rating. The Veteran's right ankle disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271. Ratings under this code are available at 10 percent for moderate limited motion and 20 percent for marked limited motion. The terms "moderate" and "marked" are not defined under VA regulations as in effect at the time of this claim. Those terms also do not appear to have a generally accepted medical definition. 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. It should also be noted that use of terminology such as "moderate" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. During the pendency of this appeal, however, VA amended the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020), effective from February 7, 2021. Diagnostic Code 5271 was affected by this change and the terms marked and moderate were given range of motion limitations. "Marked" means less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. "Moderate" means less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion. Alternative and additional Diagnostic Codes for the ankle are available under 38 C.F.R. § 4.71a, as follows: Under Diagnostic Code 5270, ankylosis of the ankle in plantar flexion less than 30 degrees is rated at 20 percent; ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between 0 and 10 degrees is rated at 30 percent; and ankylosis in plantar flexion at more than 40 degrees, in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion, or eversion deformity is rated at 40 percent. Under Diagnostic Code 5272, ankylosis of the subastragalar or tarsal joint is rated at 10 percent for ankylosis in good weight-bearing position and at 20 percent for ankylosis in poor weight-bearing position. Under Diagnostic Code 5273, malunion of the os calcis or astragalus is rated at 10 percent for moderate deformity and 20 percent for marked deformity. Under Diagnostic Code 5274, astragalectomy is rated at 20 percent. The Board finds the most probative evidence of record to be the VA examinations of record. The examiners have the medical expertise to assess objective limitations from the Veteran's service-connected disability. Further, the Board finds that the concurrent medical records to not contain any range of motion measurements or reports of flare-ups or functional loss, but pain is reported. Thus, the Board gives the VA examinations great probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran's lay statements are consistent with the findings of the VA examinations. The Veteran has been afforded two VA examinations in connection with her claim. Her symptomology has been consistent at both examinations, with complaints of pain, weakness, and difficulty walking. However, at most, the range of motion of her right ankle was limited to 35 degrees of plantar flexion (dorsiflexion was within normal limits) at the December 2019 examination. This measurement was taken in consideration of her limitations during flare-ups. The Board finds that the Veteran's right ankle disability, which has been manifested by painful motion, does not more nearly approximate the rating criteria for the maximum limitation of motion rating of 20 percent, corresponding to marked limitation of motion under Diagnostic Code 5271. The Board notes that normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Further, the regulatory changes provide measurements for the required range of motion lost for a marked limitation of motion: less than 5 degrees dorsiflexion and less than 10 degrees plantar flexion. At most, the range of motion of the Veteran's right ankle has manifested in plantar flexion at 35 degrees, with pain during both motions, and pain on weight bearing and non-weight bearing, and considering repeated use and during flare-ups. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The December 2019 examiner, who examined the Veteran when her right ankle had worsened the most, considered additional range of motion lost during flare-ups. Thus, the evidence does not show that even during flare-ups, the Veteran's range of motion or symptomology would approximate a greater degree of range of motion lost. Notwithstanding the above, the Board has also considered other potentially applicable Diagnostic Codes that may provide a basis for higher evaluations for the right ankle. The range of motion findings exhibited by the Veteran are inconsistent with a finding of ankylosis, or "immobility and consolidation." Accordingly, the Board finds that the provisions of Diagnostic Code 5270 pertaining to ankylosis are not for application. Since ankylosis has not been shown, the provisions of Diagnostic 5272, which govern ankylosis of the subastragalar or tarsal joint, are likewise not applicable to the current claim. Additionally, with regard to Diagnostic Code 5273, malunion of the os calcis or astragalus has not been demonstrated. Regarding Diagnostic Code 5274, the medical evidence is without complaints of or treatment for an astragalectomy of the ankle, which involves removal of the ankle bone. As such, a rating under this provision is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5274. Furthermore, there is no evidence of record indicating that the Veteran has neurological manifestations related to her right ankle disability (as opposed to her left ankle for which she is service-connected for neuropathy). While the Veteran reported pain and some functional loss, flareups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flareups must be of such length as to establish that the overall impairment is more severe than currently evaluated. In this instance, the Veteran's statements made in this case do not show that any flareups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted. The specific clinical measures of ranges of motion, including examiners' findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran's report of pain and limitation of function. Despite the Veteran's contention of a greater degree of limitation on her right ankle condition, the disability rating assigned herein indicates a significant impact on her functional ability. Such disability evaluations assigned by VA recognizes her painful motion. The critical question in this case, however, is whether the problems she has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for her right ankle condition. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to an initial rating in excess of 10 percent for left knee strain The Veteran contends her left knee warrants an increased rating. Knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint. While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant Diagnostic Codes for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration. Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, lateral instability and recurrent subluxation of the knee, and meniscal disabilities. The Board will explore all possibilities in this case. Standard range of knee motion is from zero degrees (on extension) to 140 degrees (on flexion). See 38 C.F.R. § 4.71, Plate II. When the limitation of motion is non-compensable under the appropriate diagnostic codes, a rating of 10 percent may be applied to each such major joint (such as the knee) or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under Diagnostic Code 5260, a 0 percent (noncompensable) disability rating is assigned for flexion limited to 60 degrees, a 10 percent disability rating is assigned for flexion limited to 45 degrees, a 20 percent disability rating is assigned for flexion limited to 30 degrees, and a 30 percent disability rating is assigned for flexion limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a 0 percent (noncompensable) disability rating is assigned for extension limited to 5 degrees, a 10 percent disability rating is assigned for extension limited to 10 degrees, a 20 percent disability rating is assigned for extension limited to 15 degrees, a 30 percent disability rating is assigned for extension limited to 20 degrees; a 40 percent disability rating is assigned for extension limited to 30 degrees; a 50 percent disability rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a. During the pendency of this appeal, VA amended the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5257, 5262), effective from February 7, 2021. However, no amendments are implicated in the Veteran's knee ratings. Evidence The Board finds the VA examinations to be the most probative evidence of record related to the Veteran's knees. While there are treatment records noting knee pain, her range of motion is noted as full or within normal limits. The Veteran has been afforded two VA examinations in connection with her claim. Her symptomology has been consistent at both examinations, with complaints of pain, weakness, and difficulty walking. However, at most, the range of motion of her left knee was limited to 0-50 degrees of flexion and extension at the December 2019 examination. This measurement was taken in consideration of her limitations during flare-ups. The Veteran also reported symptoms of catching and giving-way which appeared to be consistent with a meniscus problem, however an addendum opinion clarified that the symptoms can occur without a damaged meniscus. Notably, no instability was found, nor has instability been contended. Analysis In order to warrant a higher initial rating, the Veteran's left knee conditions would need to manifest in symptomology approximating a limitation of 30 degrees flexion or 15 degrees extension. Here, the Board finds that the evidence does not support this finding, even considering pain during both motions, and pain on weight bearing, and considering repeated use and during flare-ups. At most her flexion was limited to 50 degrees. Her extension remains normal. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The December 2019 examiner, who examined the Veteran when her left knee had worsened the most, considered additional range of motion lost during flare-ups. Thus, the evidence does not show that even during flare-ups, the Veteran's range of motion or symptomology would approximate a greater degree of range of motion lost. While the Veteran reported pain and some functional loss, flareups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flareups must be of such length as to establish that the overall impairment is more severe than currently evaluated. In this instance, the Veteran's statements made in this case do not show that any flareups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted. The specific clinical measures of ranges of motion, including examiners' findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran's report of pain and limitation of function. Despite the Veteran's contention of a greater degree of limitation on her left knee condition, the disability rating assigned herein indicates a significant impact on her functional ability. Such disability evaluations assigned by VA recognizes her painful motion. The critical question in this case, however, is whether the problems she has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for her left knee condition. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an initial rating in excess of 30 percent for flat feet is denied The Veteran contends that her bilateral flat feet warrant a higher initial rating of 50 percent. Per her representative's correspondence dated August 2020, she contends that under regulations 38 C.F.R. §§ 4.7 and 4.71a, the criteria for a 50 percent rating have been met. Notably, service connection is in effect for flat feet and bilateral plantar fasciitis. Prior to regulatory amendments implemented in February 2021, plantar fasciitis did not have a separate diagnostic code, and instead, was rated analogously to flat feet. Where the Veteran has both disabilities, they were rated as one under the code for flat feet. The regulatory amendments added a separate diagnostic code for plantar fasciitis. This will be discussed more fully in the Remand portion below. The Veteran's bilateral flat feet disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276 (flatfoot, acquired). Under Diagnostic Code 5276, a 30 percent evaluation requires severe disability with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities, if it is bilateral. A 50 percent evaluation requires pronounced disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo-Achilles on manipulation, that is not improved by orthopedic shoes or appliances, if it is bilateral. Id, (emphasis added). The Board notes that the rating schedule also provides ratings under 38 C.F.R. § 4.71a, Diagnostic Code 5284, for "foot injuries, other." However, the Court of Appeals for Veterans Claims has held that, as a matter of law, Diagnostic Code 5284 does not apply to the eight conditions of the foot specifically listed in § 4.71a. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). As service connection is in effect for pes planus, and that foot disability is one of the eight specifically listed in the schedule, Diagnostic Code 5284 is not applicable. Evidence and Analysis The Board reiterates that in order to receive a higher 50 percent rating under Diagnostic Code 5276, the Veteran's severe symptomology must not be improved by orthopedic shoes or appliances, if it is bilateral. The Board has searched the medical record. At no point do the Veteran's treatment records or the VA examinations reference any orthopedic shoes or appliances. At most, the Board found references to a left ankle brace. Given that the Veteran has not tried orthopedic shoes or appliances, a determination of whether her symptomology has improved cannot be shown. The Veteran's claim for a separate evaluation for plantar fasciitis after February 7, 2021 is remanded below. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for an initial rating in excess of 30 percent for bilateral flat feet. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to an initial rating in excess of 10 percent for thoracolumbar strain (back condition); and in excess of 40 percent since December 31, 2019 5. Entitlement to an initial rating of 10 percent for sciatic radiculopathy of the right lower extremity The Veteran's back condition is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion 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 rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. Ankylosis can also mean the "functional equivalent" of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). In addition to the back rating, the schedule directs that any associated objective neurological abnormalities, such as radiculopathy, are to be evaluated separately under an appropriate diagnostic code. See "General Rating for Diseases and Injuries of the Spine, at Note 1. Disability ratings with respect to neurological conditions ordinarily are assigned in proportion to the impairment of motor, sensory, or mental function. 38 C.F.R. § 4.124a. The Veteran's sciatic radiculopathy of the right lower extremity is rated under Diagnostic Code 8520 for paralysis of the sciatic nerve. Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis. A 20 percent rating is warranted where there is moderate incomplete paralysis. 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. An 80 percent rating is for application where there is complete paralysis of the sciatic nerve (i.e., the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost). 38 C.F.R. § 4.124a. The words mild, moderate, and severe as used in the various Diagnostic Codes are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture 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 is for the mild, or at most, the moderate degree. Evidence The Board finds the most probative evidence of record to be the VA examinations of record. The examiners have the medical expertise to assess objective limitations from the Veteran's service-connected disability. Thus, the Board gives the VA examinations great probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran's lay statements are mostly consistent with the findings of the VA examinations. Further, while there are treatment records noting back pain, her range of motion is noted as full or within normal limits. The Veteran's first VA examination was in December 2015. She reported pain in her back and had spasms in her "upper back" which was later clarified as her thoracic spine, which is evaluated along with the lumbar spine under Diagnostic Code 5237. She reported flare-ups to include not being able to sit in a normal chair and she couldn't walk or stand for long periods of time. Her initial range of motion was full, but painful, but the pain did not cause functional loss. After repeated use and with flares, the clinician found that her back was limited by pain, but could not estimate range of motion lost. The Veteran did not have guarding or muscle spasms that resulted in an abnormal gait or spinal contour. The Veteran had some decreased sensation in her left lower extremity, this was related to her ankle condition. A neurological impairment related to her spine was not indicated. The Veteran's second VA examination was December 31, 2019. She reported an increase in symptomology such that the pain made it difficult to move and had problems sleeping comfortably. She reported severe flare-ups, that last 2-3 days. The flare-ups were precipitated by sitting, standing, or walking too long and she must constantly change position. She reported that she could not relax without having pain. She reported difficulty exercising and had gained weight. Somedays the pain was so bad that she stayed at home, in bed due to pain. Upon initial range of motion, her lumbar flexion was limited to 60 degrees. She reported that she could not pick up items from the floor, it was hard to put on her shoes, she had pain in each range of motion, and pain with weightbearing. After repeated use, the lumbar flexion reduced to 30 degrees. During flare-ups, her range of motion was limited to 5 degrees in each position due to pain. Upon neurological testing, her strength and reflexes were within normal limits, but she had some decreased sensory findings bilaterally. Her straight leg raise testing was negative. She reported bilateral intermittent pain that was moderate and bilateral numbness that was mild. Given these findings, the clinician found bilateral sciatic radiculopathy that was mild in severity. No ankylosis was indicated. Analysis Given the above, the record does not substantiate that ratings in excess of those currently assigned are warranted. In order to warrant a higher initial rating prior to December 31, 2019, (in excess of 10 percent), the Veteran's back would need to manifest in one of the following: (1) forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; (2) or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, (3) muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Here, the Board does not so find. At most, prior to December 31, 2019, the Veteran had painful range of motion, but not limited as required above. The severe limitations found at the December 31, 2019 examination are simply not shown. After December 31, 2019, in order to warrant a rating in excess of 40 percent, the Veteran's back would need to manifest in unfavorable ankylosis or its functional equivalent. While the Veteran's range of motion was severely limited, there was no ankylosis and the Veteran has not contended that her spine is fixed in a position. The Veteran reported flare-ups during the period at issue, and the December 31, 2019 examiner took those limitations under consideration. Prior to December 31, 2019, the clinician did not give an estimated range of motion lost during flare-ups or with repeated use. Even so, the Board does not find that the Veteran's range of motion would be additionally limited, even considering the Veteran's pain on weightbearing and non-weightbearing, during passive range of motion, or considering functional loss. To approximate an initial 20 percent rating, the Veteran's range of motion would need to substantially more limited (as it was noted to be full at the first examination) or her gait or spinal contour would need to be abnormal. The Board does not find these limitations to be approximated. While the Veteran reported pain, flareups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flareups must be of such length as to establish that the overall impairment is more severe than currently evaluated. In this instance, the Veteran's statements made in this case do not show that any flareups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted. While it may seem incongruous that the Veteran's back "suddenly" worsened such that a 40 percent rating is warranted, the Board gives more weight to the contemporaneous medical record because, had the Veteran's back flared to such a severe level, the Board would expect to see more objective range of motion measurements or medical visits due to pain. The specific clinical measures of ranges of motion, including examiners' findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran's report of pain and limitation of function. As for the Veteran's radiculopathy, the Veteran was previously service-connected for radiculopathy of the left lower extremity related to her left ankle. As for her right lower extremity, there is no report of radiculopathy symptomology prior to December 31, 2019. At the VA examination, the objective limitations (decreased sensory findings, numbness) were mild in severity, with intermittent pain noted to be moderate. Thus, the Board finds no greater than mild radiculopathy of the right lower extremity was present, but no earlier than December 31, 2019. Despite the Veteran's contention of a greater degree of limitation on her back condition, the disability ratings assigned herein indicate a significant impact on her functional ability. Such disability evaluations assigned by VA recognize her painful motion. The critical question in this case, however, is whether the problems she has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for increased ratings for her back disability. Further, an increased rating for radiculopathy of the right lower extremity is not warranted. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 6. Entitlement to a separate compensable rating for plantar fasciitis since February 7, 2021 is remanded. The Veteran is currently service-connected for flat feet with plantar fasciitis. Prior to February 7, 2021, there was no Diagnostic Code for plantar fasciitis: it was rated by analogy to other Diagnostic Codes. During the pendency of this appeal, VA amended the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5269), effective from February 7, 2021. Thus, effective February 7, 2021, plantar fasciitis received separate rating criteria listed under Diagnostic Code 5269. The Board has considered the various examinations of record. At the Veteran's foot examinations, plantar fasciitis is a listed diagnosis, but no symptomology is described for the condition. Further, the Veteran's treatment records do not contain any treatment or diagnosis for plantar fasciitis. As the Veteran may be entitled to a 10 percent rating for symptomatic plantar fasciitis, whether unilateral or bilateral, a remand is warranted to determine if the Veteran has a current diagnosis of plantar fasciitis and its current symptomology. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from December 2019 to the Present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected plantar fasciitis disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. Further, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. M. Hitchcock 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.