Citation Nr: 21069800 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 19-18 443 DATE: November 19, 2021 ORDER Entitlement to a rating in excess of 20 percent prior to May 22, 2019 for lumbar spine disorder is denied. From May 15, 2014, entitlement to a rating of 10 percent for right lower extremity radiculopathy is granted. From May 15, 2014, entitlement to a rating of 10 percent for left lower extremity radiculopathy is granted. Entitlement to a rating in excess of 40 percent from May 22, 2019 for lumbar spine disorder is denied. FINDINGS OF FACT 1. Prior to May 22, 2019, lumbar spine disorder did not more approximate forward flexion to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 2. From May 15, 2014, Veteran's right lower extremity radiculopathy manifests as mild incomplete paralysis of the right sciatic nerve. 3. From May 15, 2014, Veteran's left lower extremity radiculopathy manifests as mild incomplete paralysis of the right sciatic nerve. 4. From May 22, 2019, lumbar spine disorder did not more approximate unfavorable ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. Prior to May 22, 2019 the criteria for a rating in excess of 20 percent for lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.59. 4.71a, Diagnostic 5237. 2. From May 15, 2014, the criteria for a disability rating of 10 percent for right lower extremity radiculopathy have been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.59, 4.124a, Diagnostic Code 5237-8620. 3. From May 15, 2014, the criteria for a disability rating of 10 percent for left lower extremity radiculopathy have been met. 38 U.S.C. § § 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.59, 4.124a, Diagnostic Code 5237-8620. 4. From May 22, 2019 the criteria for a rating in excess of 40 percent for lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.59. 4.71a, Diagnostic 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty for training in the United States Army National Guard from December 1996 to October 1997 with additional periods of training through 2017 that included May 31, 2008 to June 14, 2008; July 7, 2013 to July 21, 2013; and from July 5, 2014 to July 19, 2014. In a May 2019 rating decision, the RO increased the rating for the Veteran's lumbar spine disorder. As the increased benefits do not constitute a full grant of the benefits sought, the issues remain in appellate status. See AB v. Brown, 6 Vet. App. 35, 39 (1993). Evidence Standards 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 also include statements conveying sound medical principles found in medical treatises. It also includes 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. 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). Competent lay evidence may also include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Increased Ratings The Veteran asserts that the assigned ratings do not reflect of the severity of his service-connected lumbar spine disorder during the applicable time frames. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various Diagnostic Codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. Deluca v. Brown, 8 Vet. App. 202, 206-8 (1995). Functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The Court has held that VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca, 8 Vet. App. 202. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. However, the evaluation of painful motion as limited motion only applies when the limitation of motion is noncompensable under the applicable Diagnostic Code. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. See Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). Musculoskeletal VA examinations, to be adequate, must address particular issues when are where that are practicable and medically possible to include active and passive motion; weight bearing and non-weight bearing; range of motion of an opposing joint; and findings as to loss of motion during flare-ups. See Correia v. McDonald, 28 Vet. App. (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The RO has rated this disability under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is assigned 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. 38 C.F.R. § 4.71a. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. The U.S. Court of Appeals for Veterans Claims (Court) has defined ankylosis as follows. See, e.g., Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); Chavis v. McDonough, No. 18-2928 (April 16, 2021) ("flare-ups resulting in symptoms more nearly approximating ankylosis can warrant a higher rating under the general rating formula"). An alternative method of evaluating spine disabilities is pursuant to Diagnostic Code 5243, which compensates based on incapacitating episodes due to intervertebral disc syndrome (IVDS). These ratings are not to be combined, and only the rating which results in a higher evaluation is to be granted. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under this Diagnostic Code, incapacitating episodes having a total duration of at least 6 weeks during the past 12 months warrants a 60 percent rating. Incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months warrants a 40 percent rating. And, incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Note (1) following the IVDS section stipulates that an "incapacitating episode" is a period of acute signs and symptoms attributable to IVDS that requires physician-prescribed bed rest and treatment. Id. When considering disability of the musculoskeletal system, arthritis is considered. An evaluation of traumatic arthritis, Diagnostic Code 5010, is rated under the criteria for Diagnostic Code 5003, which in turn evaluates disabilities based on the degree of limitation of motion under the appropriate Diagnostic Codes. 38 C.F.R. § 4.71a. If the disability is noncompensable under the appropriate Diagnostic Code for the joint involved, a 10 percent rating will be for application for such major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a. The rating criteria pertaining to Diagnostic Code 5010 was revised effective February 7, 2021. Posttraumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under an affected joint. If there are two or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Prior to May 22, 2019 Service treatment records show that the Veteran injured his lower back in June 2008 while on active duty for training. In October 2008, the RO granted service connection for lumbar muscle spasms and assigned a 10 percent rating, effective June 21, 2008. The RO received the Veteran's claim for an increased rating in February 2012. After additional development, in August 2012, the RO granted a 20 percent rating, effective February 15, 2012. The RO received the Veteran's current claim for an increased rating in May 2015. In a November 2014 record, a private chiropractor reported that the Veteran complaint of thoracic-lumbar pain. This chiropractor wrote that the were existing x-rays; however, he provided no assessments. The chiropractor indicated that the Veteran would undergo chiropractic manipulation and exercises. Private physical therapy (PT) progress notes (translated) show that the Veteran received on-going PT treatment throughout the period of appeal. Clinicians reported multiple exercise and therapeutic regimens including massage; myofascial release; stretching; William's exercises; back stabilization; pelvic tilt; McKenzie's exercise; and home protocols. These clinicians indicated that the Veteran was taking benzodiazepine muscle relaxers. Associated medical clinicians diagnosed disc disease and low back pain. In July 2014, a VA clinician opined that straightening of lumbar lordosis may be reactive to muscle spasm. Concurrent imaging showed mild L5/S1 degenerative changes that remained unchanged since 2013. Citing a March 2015 private magnetic resonance imaging (MRI) of the lumbsacral spine, a radiologist diagnosed mild lumbar spine degenerative disc disease (DDD) with subtle posterior annular bulges, probable related muscle spasm, and mild thoracic spine. In a July 2015 VA opinion, a clinician noted a review of the Veteran's claims file that the Veteran's separate thoracolumbar spine diagnoses were inseparable. It was infeasible to separate the signs and symptoms of each of the "conditions" because the conditions share almost all of the same symptomatology. In a November 12, 2015 private electrodiagnostic study, a clinician ruled out a history of lumbar radiculopathy; however, the clinician indicated a current abnormal study with "evidence of lumbar radiculopathy S1 and thorax radiculopathy along the lower thorax (sic) spine." In December 2015, a private clinician submitted a report, via VA Form 21-0960M-14. This clinician did not indicate whether she had reviewed the claims file; nevertheless, she diagnosed thoracolumbar sprain, disc hernia, IVDS, and radiculopathy. She indicated that the Veteran endorsed intense pain and spasms all the time. The Veteran had forward flexion to 45 degrees, with pain throughout; extension to 30 degrees; right lateral flexion to 20 degrees; left lateral flexion to 30 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 30 degrees. This clinician provided no findings as to measurement upon repetitive use. There was pain on active range of motion and tenderness at the muscle bands at the thoracic and lumbar paraspinal muscles. The clinician also reported lumbar paraspinal swelling. The clinician indicated functional loss and additional limitation of range of motion, notably less movement than normal; pain on movement; and swelling. The Veteran had full muscle strength and a lack of muscle atrophy. There was no evidence of ankylosis. The clinician reported bilateral radiculopathy, manifesting as bilateral mild constant pain; mild bilateral intermittent pain; and mild right lower extremity lower paresthesias and/or dysesthesias. Overall severity of radiculopathy was mild, with involvement of the right sciatic root. This clinician reported that the disabilities were of probable traumatic origin; however, the clinician did not point to either evidence or medical literature to support this conditional finding. In March 2016, the Veteran reported for a VA thoracolumbar spine examination. The VA clinician reviewed the claims file; considered the Veteran's lay account of his medical history; and conducted an appropriate evaluation. The clinician diagnosed of lumbosacral strain and IVDS. The clinician noted that the Veteran did report flare-ups, which occurred with prolonged walking or standing activities. The Veteran had forward flexion to 40 degrees; extension to 20 degrees; right lateral flexion to 20 degrees; left lateral flexion to 20 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. The Veteran reported pain at all ranges of motion. There was no pain with weight bearing. There was mild tenderness to the lumbar paravertebral muscle. The Veteran was capable of repetitive-use testing, without additional loss of motion. There was guarding and muscle spasm which did not result in abnormal gait; abnormal spinal contour. The Veteran commanded full muscle strength and did not suffer from muscle atrophy. Reflexes were normal. The clinician did report the presence of bilateral lower extremity radiculopathy, manifesting as bilateral mild constant pain; left lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. The clinician indicated involvement of the bilateral sciatic nerve roots. Right and left lower extremity radiculopathy were mild. There was no evidence of ankylosis. The Veteran reported that he used a brace on a regular basis. X-ray imaging disclosed arthritis and there was no evidence of a thoracic vertebral fracture of loss of 50 percent of more of height. The Veteran provided the clinician with a copy of November 2015 private electrodiagnostic study, noting "evidence of lumbar radiculopathy S1 and thorax radiculopathy along the lower thorax (sic) spine". As to functional limitations on the Veteran's ability to work, the clinician noted limitation in prolonged standing activities and prolonged ambulation. The Veteran contends that his lumbar spine was more severe than that contemplated by a 20 percent rating prior to May 22. 2019. The Veteran is competent to report discernable symptoms of pain and achiness. The Board has considered the Veteran lay statements. 38 C.F.R. § 3.159(a)(2). The Veteran's reporting of discernable symptoms is competent and assigned some probative weight, particularly those reported during medical examinations; however, upon review of the evidence of record the Veteran does not possess the specialized orthopedic education, training, or experience to offer medical diagnoses, statements, or opinions as to the clinical severity of a lumbar spine disorder. 38 C.F.R. § 3.159(a)(1). Prior to May 22, 2019, the RO assigned a 20 percent rating under Diagnostic Code 5237. This 20 percent rating contemplated forward flexion of the thoracolumbar spine greater that 30 degrees but not greater than 120 degrees. For an increased rating prior to May 22. 2019, there would have had to be a showing of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. As noted above, both private and VA clinicians indicated that the Veteran has IVDS. However, no clinician indicated that IVDS resulted in incapacitating episodes over the previous 12 months. As such, even a compensable rating for IVDS is not warranted under 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Board has discussed the pertinent evidence above. No VA or private clinician found during the time frame under consideration forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45; see also DeLuca 8 Vet. App. 202. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance, and must manifest by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Here, more than the minimal compensable rating for the thoracolumbar spine is already assigned, and analysis must turn to whether functional loss warranting a higher than 20 percent rating is reasonably shown. While VA clinicians noted that the Veteran's lumbar spine disorder functionally impacted the Veteran's ability to work by limiting prolonged standing activities and prolonged ambulation, clinicians did not indicate that flare-ups or losses in ranges of motion upon repetitive use. Consequently, an increased rating based on functional limitations due to these factors is not warranted. In sum, the Board finds that the weight of evidence is against the claim for a rating in excess of 20 percent for the Veteran's lumbar spine disorder prior to May 22, 2018 Right lower extremity radiculopathy Left lower extremity radiculopathy In establishing an effective date for an increased rating for a disability already found to be service-connected, the Board will assess evidence to ascertain an increase in severity up to one year prior to the date of claim for an increase38 C.F.R. § 3.400 (o)(2). The applicable diagnostic code for rating the spine includes consideration of neurological complications. Prior to the date of receipt of the current claim in May 2015, the Veteran underwent a VA lumbar spine examination in August 2012. The examiner noted radiculopathy of the right and left lower extremities with mild pain, paresthesias, and numbness involving the sciatic roots. From November 12, 2015 private electrodiagnostic study, the medical evidence of records has shown that the Veteran's lumbar spine disorder includes right and left lower extremity radiculopathy, which manifests, at worst, as bilateral mild constant pain; left lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. There is evidence of the involvement of the bilateral sciatic nerve root to the extent that bilateral lower extremity radiculopathy presents overall as mild. Here, the Board finds that Diagnostic Code 5237-8520 appropriately contemplates sciatic radiculopathy of the bilateral lower extremities. Diagnostic Codes 8520-8720 address ratings for paralysis of the peripheral nerves affecting the lower extremities, neuritis, and neuralgia. Diagnostic Codes 8520, 8620, and 8720 provide ratings for paralysis, neuritis, and neuralgia of the sciatic nerve. Neuritis and neuralgia are rated as incomplete paralysis. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted for complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. 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. 3 8 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Thus, the Board finds that the most robust analysis of bilateral lower extremity radiculopathy was that of the March 2016 VA clinician, in whose report the Board assigns significant probative weight, found that the severity of the Veteran's right and left lower extremity radiculopathy, associated with her service-connected lumbar spine disorder, presents overall as mild with associated symptoms of bilateral mild constant pain; left lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. Consequently, the Board finds that the mild radiculopathy was present in the record one year prior to the date of claim for an increased rating for the lumbar spine or May 15, 2014. The weight of evidence warrants granting a 10 percent disability rating for right lower extremity radiculopathy and granting a 10 percent disability for left lower extremity radiculopathy. From May 22, 2019 On May 22, 2019, the Veteran reported for a VA thoracolumbar spine examination. The Veteran reported flare-ups, namely severe low back pain. The Veteran reported function loss as "difficulty bending over". The Veteran had forward flexion to 40 degrees; extension to 20 degrees; right lateral flexion to 20 degrees; left lateral flexion to 20 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. Range of motion itself contributed to functional loss, namely "difficulty bending over". There was pain at all ranges of motion, thoracolumbar spasm, and pain with weight bearing. The Veteran was capable of repetitive use (of at least three repetitions) without additional loss in ranges of motion. Nevertheless, the clinician reported that pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time. The clinician translated this into forward flexion to 20 degrees; extension to 10 degrees; right lateral flexion to 10 degrees; left lateral flexion to 10 degrees; right lateral rotation to 10 degrees; and left lateral rotation to 10 degrees. The clinician made the same findings for flare-ups. Muscle spasm did not result in abnormal gait or abnormal spinal contour. The Veteran maintained normal muscle strength and did not have muscle atrophy. Reflexes and sensory vectors were normal. As to bilateral lower extremity radiculopathy, manifestations included bilateral moderate constant pain and bilateral numbness. The clinician indicated the involvement of the bilateral sciatic nerve roots. Considering, the manifestations (and complete absence of intermittent pain and paresthesias and/or dysesthesias, the clinician indicated that the overall severity of radiculopathy was mild. There was no evidence of ankylosis. This clinician indicated that the Veteran did not have IVDS. The Veteran reported that he used a brace on a regular basis. X-ray imaging showed arthritis. As to functional impact, the clinician reported that the Veteran worked as a technician in hemodialysis and had difficulty with prolonged standing and walking. There was pain on passive range of motion and upon non-weight bearing. In May 2021 the Veteran reported for a VA thoracolumbar spine examination. The Veteran did not endorse flare-ups. The Veteran also did not endorse functional impairment. The Veteran commanded forward flexion to 75 degrees; extension to 25 degrees; right lateral flexion to 25 degrees; left lateral flexion to 25 degrees; right lateral rotation to 25 degrees; and left lateral rotation to 25 degrees. There was pain at all ranges of motion. Passive range of motion findings were duplicative of active range of motion findings. There was pain upon weight bearing and active motion; however, this pain was not productive of functional loss. There was no evidence of crepitus or localized tenderness. The Veteran was capable of repetitive use (of at least three repetitions) without additional loss in ranges of motion. There was no evidence that pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time. The clinician made the same observations as to flare-ups. There was no evidence of muscle spasm or guarding. The Veteran maintained normal muscle strength and did not have muscle atrophy. Reflexes and sensory vectors were normal. This clinician reported a total absence of bilateral lower extremity radiculopathy. There was no evidence of ankylosis or IVDS. The Veteran did not use ab assistive of any kind. MRI disclosed the presence of DDD. This clinician opined that lumbar spine disorder did not functionally impact the Veteran's ability to perform any occupational task. The Veteran contends that his lumbar spine was more severe than that contemplated by a 40 percent rating from May 22. 2019. The Veteran is certainly competent to report discernable symptoms of pain and achiness. The Board has considered the Veteran lay statements. 38 C.F.R. § 3.159(a)(2). The Veteran reporting of discernable symptoms is competent and assigned some probative weight, particularly those reported during medical examinations; however, upon review of the evidence of record the Veteran does not possess the specialized orthopedic education, training, or experience to offer medical diagnoses, statements, or opinions as to the clinical severity of a lumbar spine disorder. 38 C.F.R. § 3.159(a)(1). As noted above for an increased rating, there would need to be a showing of unfavorable ankylosis of the entire thoracolumbar spine. Such is not disclosed in the competent medical evidence of record. At worst, the Veteran had forward flexion to 40 degrees and combined range of motion of 140 degrees as of the May 22, 2019 VA examination. Such ranges of motion fall within a 20 percent rating under Diagnostic Code 5257. There was no objective evidence of IVDS, hence a compensable rating for IVDS is not warranted under 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45; see also DeLuca 8 Vet. App. 202. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance, and must manifest by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Here, more than the minimal compensable rating for the thoracolumbar spine is already assigned, and analysis must turn to whether functional loss warranting a higher than 20 percent rating is reasonably shown. Noting that the Veteran was employed as a technician in hemodialysis, the May 22. 2019 VA clinician opined that difficulty with prolonged standing and walking functionally impacted the Veteran's ability to work. Here, this VA clinician indicated that pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time and during flare-ups. The clinician translated each of such into the significant losses in ranges of motion, wherein (upon repetitive use over a period of time and during flare-ups), the Veteran only maintained forward flexion to 20 degrees; extension to 10 degrees; right lateral flexion to 10 degrees; left lateral flexion to 10 degrees; right lateral rotation to 10 degrees; and left lateral rotation to 10 degrees. Pain may cause a functional loss, but of itself does not constitute functional loss. See Saunders, 886 F. 3d 1356. Rather, as is the case here, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," to constitute functional loss warranting an increased rating. Id.; see 38 C.F.R. § 4.40. Consequently, the Board finds that a 40 percent rating most nearly approximates the severity of the Veteran's service-connected lumbar spine disability from May 22, 2019. As there is not a showing of unfavorable ankylosis of the entire thoracolumbar spine (or any ankylosis), the possibility of granting a rating in excess of 40 percent from this date is not possible. Right lower extremity radiculopathy Left lower extremity radiculopathy The pertinent evidence is summarized above. The May 22, 2019 VA clinician indicated that right and left lower extremity radiculopathy manifested as bilateral moderate constant pain and bilateral numbness. The clinician did recognize the involvement of the bilateral sciatic nerve roots. Considering, the manifestations (and complete absence of intermittent pain and paresthesias and/or dysesthesias, the clinician indicated that the overall severity of radiculopathy was mild. Applying the criteria of Diagnostic Code 5237-8520, the severity of right and left lower extremity remained mild, more precisely as mild incomplete paralysis, clearly within the ambit of a 10 percent rating. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, 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.