Citation Nr: 21069702 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 18-42 724 DATE: November 19, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to an initial compensable rating for left foot hallux valgus is denied. Entitlement to an initial compensable rating for right foot hallux valgus is denied. Entitlement to an initial 20 percent, but no higher, rating for left lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an initial 20 percent, but no higher, rating for right lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. REMANDED Entitlement to an initial rating in excess of 10 percent for left knee degenerative arthritis prior to May 6, 2021 is remanded. Entitlement to an initial rating in excess of 10 percent for right knee degenerative arthritis with scarring prior to May 6, 2021 is remanded. Entitlement to a rating in excess of 30 percent for left knee degenerative arthritis from May 6, 2021 is remanded. Entitlement to a rating in excess of 30 percent for right knee degenerative arthritis with scarring from May 6, 2021 is remanded. Entitlement to an initial rating in excess of 10 percent for degenerative arthritis of the spine prior to August 7, 2017 is remanded. Entitlement to a rating in excess of 20 percent for degenerative arthritis of the spine from August 7, 2017 to May 6, 2021 is remanded. Entitlement to a rating in excess of 40 percent for degenerative arthritis of the spine from May 6, 2021 is remanded. FINDINGS OF FACT 1. The Veteran's personality disorder is considered a congenital or development defect and is not a disease or injury subject to service connection. 2. The Veteran's left foot hallux valgus has not manifested as severe equivalent to amputation of the greater toe or by operation with resection of the metatarsal head. 3. The Veteran's right foot hallux valgus has not manifested as severe equivalent to amputation of the greater toe or by operation with resection of the metatarsal head. 4. The Veteran's left lower extremity radiculopathy has manifested by no more than moderate incomplete paralysis. 5. The Veteran's right lower extremity radiculopathy has manifested by no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder are not met. 38 U.S.C. § §§ 105, 1131, 5107(b); 38 C.F.R. § §§ 3.102, 3.301, 3.303, 3.310. 2. The criteria for an initial compensable evaluation for left foot hallux valgus are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5280. 3. The criteria for an initial compensable evaluation for right foot hallux valgus are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5280. 4. The criteria for an initial rating of 20 percent, but no higher, for radiculopathy of the left lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.120, 4.124a, DC 8520. 5. The criteria for an initial rating of 20 percent, but no higher, for radiculopathy of the right lower extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.120, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1986 to August 1989. This matter is on appeal from a September 2017 decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in March 2019 when the Board denied the matters on appeal and remanded entitlement to service connection for an acquired psychiatric disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In May 2020, the Court issued an Order that vacated the March 2019 Board decision and remanded the matter for readjudication consistent with instructions outlined in a Joint Motion for Partial Remand by the parties. In January 2021, the Board remanded the matter for further development. In an August 2021 correspondence, the Veteran's attorney requested a 90-day period until October 31, 2021, to submit additional evidence. In September 2021, VA received a VA Form 21-4138, Statement in Support of Claim, in which the Veteran provided additional statements in support of his claim. As the Veteran did not request initial review of this evidence by the agency of original jurisdiction (AOJ), the Board will proceed to review this evidence in the first instance. 38 U.S.C. § 7105(e)(1). Service Connection Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131. To establish service connection, the evidence must show: (1) the existence of a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. For example, lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing observable symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Acquired Psychiatric Disorder The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder. Under VA regulations, personality disorders are considered defects, and not "diseases or injuries" within the meaning of applicable legislation for VA disability compensation purposes. Therefore, personality disorders cannot be service connected either directly or on the basis of secondary causation or aggravation. See 38 C.F.R. §§ 3.303(c), 4.9, 4.127. Defects are defined as "structural or inherent abnormalities or conditions which are more or less stationary in nature." VAOPGCPREC 82-90. Congenital or developmental "defects," such as personality disorders, automatically rebut the presumption of soundness and are considered to have pre-existed service. 38 C.F.R. § 3.303(c); Winn v. Brown, 8 Vet. App. 510, 516 (1996) (holding that a personality disorder is not the type of disease or injury related defect to which the presumption of soundness can apply); see also Quirin v. Shinseki, 22 Vet. App. 390, 397 (2009) (holding that the presumption of soundness does not apply to congenital defects). However, 38 C.F.R. § 4.127 provides that disability resulting from a mental disorder that is superimposed upon a personality disorder may be service connected. See VAOPGCPREC 82-90 (noting that congenital and developmental defects can be subject to superimposed disease or injury such that service connection may be granted where the superimposed disease or injury occurs during service). Therefore, although 38 C.F.R. §§ 3.303(c), 4.9, and 4.127 prohibit any grant of service connection for a personality disorder, even if aggravated in service, a diagnosed psychiatric disorder may provide a basis for service connection if the evidence demonstrates the psychiatric disorder was superimposed upon a veteran's diagnosed personality disorder during service. In this case, a July 2017 statement from Dr. P.Y. notes a provisional diagnosis of posttraumatic stress disorder (PTSD) which is as likely as not caused by service. However, the clinician did not provide a rationale for this conclusion, and the opinion was rendered by an orthopedic clinician. Dr. P.Y. also noted that the Veteran was undergoing evaluation by an "appropriately credentialed and licensed mental health professional." As Dr. P.Y. provided no rationale for the opinion and did not discuss the diagnostic requirements under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the Board assigns no probative value to these findings. 38 C.F.R. § 4.125(a). In August 2017, VA received a disability benefits questionnaire (DBQ) completed by Dr. W.A., who noted no diagnosis of PTSD but noted subclinical symptomatology of PTSD and adjustment disorder with mixed anxiety and depressed mood. Dr. W.A. noted sentinel events including stressors incurred after service in the Veteran's work as a corrections officer. Dr. W.A. discussed the Veteran's relevant history but did not opine on the likelihood of the Veteran's condition being incurred in or caused by an in-service event, injury, or disease. Thus, the Board assigns minimal probative value to this opinion for the purpose of establishing service connection. The Veteran was provided with a VA examination in December 2019 in which the examiner diagnosed the Veteran's condition as adjustment disorder, unspecified, and stated that the diagnosis meets DSM criteria. 38 C.F.R. § 4.125(a). The clinician noted that there is no report of mental health issues during the Veteran's service time and no consistent report of ongoing mental health problems since military service. In a separate examination report, the examiner discussed the Veteran's relevant history and symptoms. However, as discussed in the prior remand, the examiner did not discuss the provisional diagnosis noted by Dr. P.Y. Thus, the Board assigns minimal probative value to this opinion. In May 2021, VA obtained an additional medical opinion in which the clinician noted that the Veteran has a diagnosis of unspecified personality disorder. The clinician noted that the Veteran has a long pattern of behavior marked by ineffectual responses to external stimuli of an emotional, social, and intellectual nature. The clinician explained that the personality disorder was developed before he joined the service but to what degree is unknown. She noted that the Veteran's personality disorder was likely to worsen as its natural progression until middle age and is unlikely that his time in service aggravated beyond its natural progression. She noted that the Veteran has a personality disorder and no other diagnosis. She explained that the PTSD and "other specified trauma and stressor-related disorder" are closely related diagnoses. She explained that the Veteran does not meet the criteria for PTSD or its closely related diagnosis of other specified trauma and stressor-related disorder. She noted that the Veteran "was confused regarding what PTSD was" because he believed "that he has PTSD because he never felt accepted in life." The examiner noted that the Veteran did not bring up a story about shrapnel and a tent catching on fire until the end of the session and "then only after he asked if he had PTSD and I explained that he did not meet the criteria for PTSD." She noted that the Veteran "displayed little distress when describing this, especially as compared to his stories of not feeling accepted during his lifetime." The clinician opined that the Veteran's condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She explained that the Veteran's current diagnosis meets DSM criteria but that there is no evidence that it is related to the Veteran's military service. She explained that most personality disorders develop progressively in adolescence and are not acquired due to circumstances in adulthood. This examination report reflects thorough consideration of the Veteran's medical history and provides a well-supported rationale. Thus, the Board assigns a high degree of probative value to this opinion. In September 2021, the Veteran submitted a VA Form 21-4138, Statement in Support of Claim, in which he stated that the May 2021 examiner "only asked me about PTSD which was confusing because I didn't think that was what I was supposed to be there for." He stated that he thought he was there "to talk about my anxiety and depression that has also been diagnosed as adjustment disorder" and that he believes it is "largely attributable to chronic pain from my service-connected conditions." The Veteran stated that the examination was inadequate, and he was not provided with an opportunity to discuss how his chronic pain impacts his mental health. The Board acknowledges the Veteran's contentions but notes that the May 2021 examination report reflects extensive consideration of the Veteran's medical history and symptoms, for the reasons explained above. Further, the Board acknowledges the Veteran's contention regarding worsening of his psychiatric symptoms due to pain from his service-connected disabilities. However, as explained above, personality disorders cannot be service connected either directly or on the basis of secondary causation or aggravation. See 38 C.F.R. §§ 3.303(c), 4.9, 4.127. Thus, the Board assigns minimal to no probative value to these lay statements. Accordingly, the Board finds that the Veteran's personality disorder is considered a congenital or development defect and is not a disease or injury subject to service connection. The Board has considered the benefit-of-the-doubt rule; however, since a preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107(b). As such, service connection cannot be awarded by law and regulation, as personality disorders are not a disease or injury subject to service connection, and the claim is denied. 38 U.S.C. §§ 105, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.301, 3.303, 3.310. Increased Rating In general, disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity caused by a given disability, and separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. During the pendency of the appeal, the rating criteria for evaluating musculo-skeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). Additionally, VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38U.S.C. §5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F.3d 1327. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In both initial and increased rating claims, the Board must consider staged ratings for the entire period on appeal. A staged rating is appropriate when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings under the applicable diagnostic code. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). The potential for staged ratings accounts for the possible dynamic nature of a disability while the claim works its way through the adjudication process. Id. The Board has therefore considered the claim on appeal with the potential for a staged rating in mind. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 1. Left and Right Foot Hallux Valgus The Veteran contends that he is entitled to an initial compensable evaluation for his service-connected right and left foot hallux valgus. DC 5280 provides for a 10 percent rating for unilateral hallux valgus operated with resection of the metatarsal head or severe hallux valgus, if equivalent to amputation of the great toe. The amendments to the musculoskeletal criteria did not change the criteria under DC 5280. In this case, the Veteran was provided with a VA examination in May 2016 in which the examiner noted moderate symptomatic pes planus mainly on the right as well as right foot arthritis which is likely a progression to his in-service foot condition. The Veteran reported pain as moderate on the right foot. He reported intermittent pain when walking. The examiner noted pain on use of both feet accentuated on use. There was no pain on manipulation of the feet. There was no indication of swelling on use or characteristic calluses. There was no extreme tenderness on the plantar surfaces of the feet. There was decreased longitudinal arch height on both feet. There was no marked deformity or pronation. The examiner noted mild or moderate symptoms of hallux valgus in both feet. The examiner noted that the Veteran had no surgery for hallux valgus. There was no pain upon examination. The examiner noted pain on weight bearing and during flare-ups, resulting in impairment in standing, walking, running, and driving for a long period of time. The examiner no use of an assistive device. A July 2017 letter from Dr. P.Y. notes bilateral bunion pain with marked extension. He noted increased pain which is constant in varying degrees that intensifies with all weight bearing activities including ambulation, and stairs are problematic and dangerous. Digital examination of the area was positive and poorly tolerated due to pain. He noted that the constant pain inhibits weight bearing and walking. In September 2017, the Veteran was provided with an additional VA examination in which the examiner noted no pain or flare-ups. The Veteran had no pain on use or manipulation of the feet. There was no indication of swelling on use. There was no extreme tenderness of plantar surfaces, no decreased longitudinal arch height, no objective evidence of marked deformity, and no marked pronation. There was no inward bowing or marked inward displacement with severe spasms. The examiner noted mild or moderate symptoms of hallux valgus. There was no pain upon examination. The examiner no additional functional loss from pain, weakness, fatigability, or incoordination on during flare-ups. April 2020 VA treatment records note reports of a possible ingrown toenail. In a July 2020 VA Form 21-4138, Statement in Support of Claim, the Veteran reported bunions in both big toes that cause pain daily that is consistent when he walks or moves. He reported chronic ingrown toenails from the bunions that cause pain when putting on shoes or walking. He stated that his doctor told him that he might need surgery to have the big toenails removed. The Board's January 2021 remand acknowledged the Veteran's attempt to raise the issue of service connection for ingrown toenails as secondary to service-connected hallux valgus. The Board advised the Veteran to file a formal claim for benefits if he wished to apply for secondary service connection. The record does not reflect that the Veteran filed a formal claim for ingrown toenails, thus the Board will not address entitlement to benefits for that condition at this time. Upon review of the record, the Board finds that the Veteran's bilateral hallux valgus has not manifested as severe equivalent to amputation of the greater toe or by operation with resection of the metatarsal head. The Veteran is currently service connected for bilateral pes planus and assigned a ten percent evaluation under DC 5276 for each foot. See June 2021 Rating Codesheet. Thus, the Veteran is in receipt of a minimum compensable evaluation for the bilateral foot pain. See Southall-Norman v. McDonald, 28 Vet. App. 346 (2016); 38 C.F.R. § 4.59. To assign another compensable rating for pain would be pyramiding, which is not allowable. 38 C.F.R. § 4.14. The Board has considered the application of other diagnostic codes by analogy; however, as hallux valgus is specifically contemplated in DC 5280, no other schedular criteria are applicable. As such, the Board finds that the preponderance of the evidence is against the Veteran's claim. The Board has considered the benefit-of-the-doubt rule; however, since a preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Left and Right Lower Extremity Radiculopathy The Veteran contends that he is entitled to an increased rating for his service-connected left and right lower extremity radiculopathy, which is currently assigned an initial 10 percent evaluation under DC 8520. Under DC 8520, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis; a 40 percent rating is assigned for moderately severe incomplete paralysis; and a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy. 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. 38 C.F.R. § 4.124A, DC 8520. Under DC 8521, a 10 percent rating is assigned for mild incomplete paralysis of the common peroneal nerve; a 20 percent rating is assigned for moderate incomplete paralysis; a 30 percent rating is assigned for severe incomplete paralysis; and, a 40 percent rating is assigned for complete paralysis with foot dangles and drops, no active, movement possible of muscles below the knee, or flexion of the knee weakened or lost. Under DC 8522, a 10 percent rating is assigned for mild incomplete paralysis of the superficial peroneal nerve; a 10 percent rating is assigned for moderate paralysis; a 20 percent rating is assigned for severe paralysis; and, a 30 percent rating is assigned for complete paralysis with eversion of the foot weakened. Under DC 8523, a 0 percent rating is assigned for mild incomplete paralysis of the deep peroneal nerve; a 10 percent rating is assigned for mild paralysis; a 20 percent rating is assigned for severe paralysis; and, a 30 percent rating is assigned for complete paralysis with dorsal flexion of the foot lost. Under 9524, a 10 percent rating is assigned for mild incomplete paralysis of the internal popliteal nerve; a 20 percent rating is assigned for moderate paralysis; a 30 percent rating is assigned for severe paralysis; and, a 40 percent rating is assigned for complete paralysis with plantar flexion lost, frank adduction of the foot impossible, flexion and separation of toes abolished, no muscle in the sole can move, or in lesions of the nerve high in popliteal fossa, plantar flexion of the foot is lost. Under DC 8525, a 10 percent rating is assigned for mild or moderate incomplete paralysis of the posterior tibial nerve; a 20 percent rating is assigned for severe incompletely paralysis; and, a 30 percent rating is assigned for complete paralysis with paralysis of all muscles of the sole of the foot, frequently with painful paralysis of a causalgic nature, toes cannot be flex, adduction is weakened, or plantar flexion is impaired. Words such as "severe," "moderate," and "mild" 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, such use is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. In rating diseases of the peripheral nerves, 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 should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. In this case, the Veteran was provided with a VA examination in May 2016 in which the Veteran had a positive straight leg raising test for the right lower extremity and a negative test for the left lower extremity. The examiner noted no constant pain in either lower extremity. The examiner noted moderate intermittent pain in the right lower extremity and mild intermittent pain in the left lower extremity. The examiner noted moderate paresthesias and/or dysesthesias in the right lower extremity and mild in the left lower extremity. The examiner noted moderate numbness in the right lower extremity and mild in the left lower extremity. The examiner noted no other signs or symptoms of radiculopathy. In September 2017, the Veteran was provided with a VA examination in which the examiner noted mild bilateral lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. Muscle strength testing was normal. The examiner noted no muscle atrophy. Reflex testing was normal. The examiner noted decreased bilateral sensation testing for light touch in the lower leg and ankle and foot and toes. The examiner noted mild incomplete paralysis bilaterally. The examiner noted the other nerves as normal. The examiner noted that the Veteran does not use an assistive device for locomotion. In May 2021, the Veteran was provided with an additional VA examination in which the examiner noted no constant pain and bilateral mild intermittent pain, paresthesias and/or dysesthesias, and numbness. The examiner noted muscle weakness and abnormal knee and ankle reflexes in the lower extremities. The examiner noted constant cane use for his bilateral knee degenerative arthritis and bilateral radiculopathy. In September 2021, VA received a VA Form 21-4138, Statement in Support of Claim, in which the Veteran stated that he disagreed with the May 2021 examiner that his radiculopathy is "mild" because "the shooting pain, numbness, and tingling is really bad and something that I have had to deal with daily" since before he filed a claim. He stated that his doctor agreed that the condition is severe. The Board notes that the Veteran's description of the severity of his condition is credible, and he is competent to report readily observable symptoms such as pain, numbness, and tingling. See, e.g., Washington v. Nicholson, 21 Vet. App. 191, 195 (2007). The Board also notes that the Veteran's lay statement is supported by medical evidence from prior to the period on appeal, as a January 2013 notation from Dr. C.G. notes radiculopathy pain. Thus, the Board assigns a high degree of probative value to the Veteran's credible and competent reports. Upon review of the record, the Board finds that the preponderance of the evidence more nearly approximates moderate incomplete paralysis of the sciatic nerve throughout the appeal period. The May 2016 VA examiner found moderate symptomatology in the right lower extremity and mild symptomatology in the left lower extremity, while the other examiners have noted only mild symptomatology bilaterally. However, as explained above, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of descriptive terminology such as "mild" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. In this regard, the Board finds the September 2021 statement from the Veteran to be highly probative, as his description of the symptomatology reflects greater than mild impairment. The Board has considered the Veteran's contention that his symptomatology is severe but finds that the Veteran's condition manifests as no more than moderate. The Board acknowledges the Veteran's recent use of a cane for ambulation. However, the evidence does not reflect severe impairment during muscle or reflex testing upon examination or upon light touch testing. Accordingly, the Board finds that a rating of 20 percent, but no higher, is warranted for the Veteran's left and right lower extremity radiculopathy. REASONS FOR REMAND 1. Entitlement to initial ratings in excess of 10 percent for left and right knee degenerative arthritis prior to May 6, 2021 is remanded. 2. Entitlement to ratings in excess of 30 percent for left and right knee degenerative arthritis with scarring from May 6, 2021 is remanded. The Veteran contends that he is entitled to an increased rating for his service-connected left and right knee degenerative arthritis with scarring. However, upon review of the record, the Board finds that an addendum opinion must be obtained to address the extent to which flare-ups result in additional functional limitation. In this case, the Veteran was provided with a VA examination in June 2016 in which the Veteran reported flare-ups of the knees involving pain and swelling that result in additional limitation of motion. The examiner noted that the examination was not being conducted during a flare-up and that the degree of additional limitation in range of motion during a flare-up could not be estimated as it would require mere speculation. However, observation of functional impairment during a flare-up is not a prerequisite to offering an opinion that estimates the degree of additional limitation of motion. When estimating the additional functional limitation during a flareup, an examiner must obtain adequate information (i.e., frequency, duration, characteristics, severity, or functional loss) to estimate functional loss during these flare-ups. See Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017). The Veteran has been provided with additional VA examinations, to include in May 2021, but these examiners have not provided an estimate of the additional limitation in motion during flare-ups or have noted "no" when asked whether the Veteran experiences flare-ups, despite the prior reports of flare-ups. The May 2021 VA examiner explained that the Veteran has experienced consistent 100 degree and 0 degree range of motion (i.e., no flare-ups). However, the record does not make clear whether the additional limitation of motion during flare-ups noted during the June 2016 examination was incorrect or whether the Veteran's flare-ups have resolved. Thus, an addendum opinion is necessary to clarify whether the Veteran experiences (or experienced) flare-ups which result in additional limitation in range of motion. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. 3. Entitlement to an initial rating in excess of 10 percent for degenerative arthritis of the spine prior to August 7, 2017 is remanded. 4. Entitlement to a rating in excess of 20 percent for degenerative arthritis of the spine from August 7, 2017 to May 6, 2021 is remanded. 5. Entitlement to a rating in excess of 40 percent for degenerative arthritis of the spine from May 6, 2021 is remanded. The Veteran contends that he is entitled to an increased rating for his service-connected degenerative arthritis of the spine. However, upon review of the record, the Board finds that an addendum opinion must be obtained to address the extent to which flare-ups result in additional functional limitation. In this case, the Veteran was provided with a VA examination in May 2016 in which the examiner noted flare-ups which result in additional functional limitation. However, the examiner noted that an estimate of the additional limitation in motion could not be estimated as it would require mere speculation. As explained above, when estimating the additional functional limitation during a flareup, an examiner must obtain adequate information (i.e., frequency, duration, characteristics, severity, or functional loss) to estimate functional loss during these flare-ups. See Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017). The Veteran was most recently provided with a VA examination in May 2021, but the examiner noted no reports of flare-ups and did not address the extent to which flare-ups resulted in additional limitation of motion. Thus, an addendum opinion is necessary to clarify whether the Veteran experiences (or experienced) flare-ups which result in additional limitation in range of motion. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from March 2021 to the present. 2. After completing the development requested in item 1, return the claims file to the May 2021 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion. The reviewing clinician is asked to clarify whether the Veteran experiences (or experienced) flare-ups from pain and swelling in the knees and spine that results (or resulted) in additional limitation in range of motion. If the examiner notes that the Veteran does or did experience flare-ups resulting in additional limitation of motion of the knees or spine, the examiner must provide an estimate of the additional limitation in range of motion. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.