Citation Nr: 21070278 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 12-06 700 DATE: November 23, 2021 ORDER Entitlement to a disability rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis is denied. FINDING OF FACT The Veteran's lumbosacral strain with degenerative disc disease and scoliosis has not been manifested by forward flexion of the thoracolumbar spine of 30 degrees or less or by ankylosis of the spine. CONCLUSION OF LAW The criteria for entitlement to an evaluation in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5243-5237. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1988 to December 1997. She also had a period of active duty for training from January 1988 to May 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2014, the appellant testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The Board remanded this matter for additional development in October 2014. In a June 2017 decision, the Board denied entitlement to an increased rating greater than 20 percent for the Veteran's service-connected lumbar spine disability. The Veteran appealed the Board's decision to the U.S. Court of Appeals for Veterans Claims (Court). In January 2018, the Court issued an Order granting a Joint Motion for Partial Remand (JMPR), which vacated the Board's June 2017 denial of the claim of entitlement to an increased rating for the Veteran's service-connected lumbar spine disability and remanded the claim to the Board for additional consideration. In May 2018, the Board again remanded this matter for additional development. In August 2019, and most recently in October 2020, the Board remanded this matter for additional development. The Board finds that the Regional Office (RO) substantially complied with the Board's remand instructions and an additional remand to comply with the Board's directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998). In October 2020, the Veteran was inadvertently sent a letter asking her if she wanted a second hearing. In November 2020, the Board transferred the Veteran's appeal to the hearing branch to confirm if the Veteran desired a hearing. In December 2020, the Veteran was scheduled for a hearing. In January 2021, the Veteran withdrew her request for a hearing, which was confirmed by her representative. In October 2021, the Veteran obtained new representation. The Veteran's representative requested a 30-day extension to review the record. The Board granted this request, by not issuing a decision prior to the expiration of the 30 days. The Board notes that the representative subsequently withdrew. The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Increased Rating Issues Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. 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). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.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. 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. Entitlement to an evaluation in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis The Veteran seeks a higher rating for lumbosacral strain with degenerative disc disease and scoliosis. The applicable rating period is from May 13, 2010, one year prior to the receipt of the claim, through the present. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (discussing the one-year "look-back" period for non-initial increased rating claims). The Veteran reported that during active duty she injured her lower back by falling off a warehouse truck. She returned to work immediately but, received treatment the next day. She reported that the pain never fully resolved, and she has had chronic back pain ever since. She indicated that her pain increases with activity. She recently had an incident where she fell, after losing her footing, and her back struck the corner of a concrete block, since then she has noticed numbness and tingling in both feet. In the October 2021 IHP, the Veteran contends that she has marked interference with her daily activities. She cannot sit more than a certain amount of time or stand for a certain amount of time or lift more than a certain amount of weight on a regular basis. The Veteran indicated that she continues to exude incapacitating attacks of pain; limited range of motion; additional loss of range of motion with repetitive movements; functional loss due to weakness; fatigability; incoordination or pain on movement of a joint; limitation of motion due to pain on use, including use during flare-ups. Ultimately, the Veteran contends that her disability picture is worse than currently rated. The Veteran's lumbosacral strain with degenerative disc disease and scoliosis IVDS (back disability) was previously rated under 38 C.F.R. § 4.71a, Diagnostic Code 5295-5292 and is currently evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5243-5237. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned. See 38 C.F.R. § 4.27. Both Diagnostic Codes applicable in this case direct that the disability be rated under the General Rating Formula for Diseases and Injuries of the Spine ("General Rating Formula"). As relevant in this case, under the General Formula, 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 rating is warranted for unfavorable ankylosis of the entire spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. 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. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.") Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Veteran's treatment records reflect that she has received physical therapy for her back. The records also indicate that her condition has been chronic, and her back pain has never fully resolved from her initial injury while in service. In a December 2010 back examination, the Veteran had a forward flexion to 40 degrees with objective evidence of pain at 30 degrees, and a combined range of motion of the thoracolumbar spine greater than 120 degrees. The examiner indicated that there was "no significant change in active range of motion following repeat testing X 3 against resistance and so no additional loss of range of motion is recommended for the thoracolumbar spine due to painful motion, weakness, impaired endurance, incoordination, or instability." The Veteran's x-ray revealed mild loss of lordosis. Mild degenerative change at thoracolumbar junction. Less than five-degree levoscoliosis. Mild narrowing of the disc space at L5-S1 is likely developmental. The examiner also noted that there was no evidence of lumbosacral radiculopathy or tenderness and muscle spasms severe enough to result in abnormal gait. The examiner also noted that there was no scoliosis. In a June 2012 back examination, the Veteran had a forward flexion to 90 degrees with objective evidence of pain at 30 degrees, and a combined range of motion of the thoracolumbar spine greater than 120 degrees. The Veteran was able to perform repetitive use testing with 3 repetitions and had a forward flexion to 90 degrees. The Veteran had additional limitation in range of motion consisting of less movement than normal and pain on movement. The Veteran had moderate to severe tenderness to palpitation over lower midline thoracic and lumbar midline spine, diffuse tenderness over bilateral LS paraspinal muscles. The examiner also noted that the Veteran had guarding and/or muscle spasms present but did not result in abnormal gait or spinal contour. The Veteran did not have muscle atrophy, symptoms of radiculopathy, invertebral disc syndrome (IVDS), and did not use any assistive device. The examiner indicated that the Veteran reported moderate to severe decrease in daily function/activity/work secondary to severe pain with movement or activity. The Veteran reported that she is not working but is applying for different jobs. The examiner also noted that the Veteran did not put forth much effort during the examination. Specifically, the examiner stated, Overall, vague symptoms of lower back with hyper exaggerated diffuse lower back pain on exam does not match review of history in cfile and it is my opinion that most of the Veteran's pain is exacerbated by other psychogenic sources. The lower back exam today was largely normal with the exception of diffuse lower back pain and mild dec in range of motion; [however,] the Veteran wasn't willing to provide good effort on the exam today. Review of complete cfile and past xray results support mild lumbar scoliosis, DDD of LS spine, and LS strain. In June 2014, the Veteran testified at a Board hearing. She stated that she cannot play ball like she used to, cannot walk like she used to, can't drive, her feet fall asleep. The Veteran testified that when she has a flare-up, she cannot do anything, "I just, my, my back like it in flames on the bottom...and then I have to stay in bed and then all patches and medications for a couple of day and then I can get back up." The Veteran also testified that she has trouble going up and down stairs and can only lift approximately five pounds. She can only walk about a quarter of a mile. She testified that she loses sensation in her feet and legs after sitting for 30 minutes. In a March 2015 back examination, the Veteran had a forward flexion to 90 degrees and a combined range of motion of the thoracolumbar spine greater than 120 degrees. The examiner explained that the Veteran's range of motion, that exceeded the normal range of motion was normal for the Veteran because she is more flexible than average. The examiner noted that pain was exhibited in forward flexion and extension, but there was no pain with weight bearing. The Veteran had no additional loss of function or range of motion following repetitive-use testing. The examiner noted that the Veteran did not have any guarding or muscle spasms, had normal strength, no muscle atrophy, no neurological abnormalities, no intervertebral disc syndrome, and no requirement of assistive device. The examiner explained that, The Veteran has normal gait, without assistive devices, performs toe heel and tandem ambulation adequately. Performs 3 partial squats without fatigue. No scoliosis noted on physical exam. No objective tenderness on exam. Reflexes 2/4. Sensation intact lower extremities to monofilament testing. Babinski downgoing toes. Vibration sense to tuning fork grossly intact. The examiner indicated that the Veteran did not report any flare-ups and indicated that her functional loss included pain. The examiner stated that the Veteran's records did not show any doctor-prescribed bedrest for low back pain in the past 12 months. There is also no evidence of ankylosis. As to the flare-ups, the examiner noted that the Veteran responded "yes" to flares, but her definition of what a flare-up is different than the examiners, but the examiner attempted to explain it to her. After the explanation, the Veteran reported that in the last year she has worse pain in her lower back and in her left groin, when she gets out of bed in the morning, and it lasts for 10 minutes, and it causes her to stop what she is doing to let it pass. The examiner indicated that the Veteran had received treatment from her doctor, and the doctor told her she thought it was constipation because the pain is relieved by a bowel movement. The examiner explained that the Veteran's condition as it was explained, would not be a flare-up of her low back condition. The examiner stated, In summary, the Veteran has had physical therapy and new muscle relaxant medication which has improved her back symptoms. Her foot numbness is not a radicular pattern and straight leg testing is negative. There is no indication of new radiculopathy. Her ROM's were improved after the physical therapy. She was able to work a job fulltime, on her feet most of the time, able to drive herself and to walk 2 miles through the day by her estimate, without missing any work for the last 6 mos. She did not leave the job due to her back disability. Her prior scoliosis was mild and diagnosed by xray and since later xrays do not find it, the scoliosis diagnosed was at least as likely not scoliosis but a positioning artifact due to technique in shooting the xray. The examiner also addressed the Veteran's June 2014 Board hearing testimony by stating that the Veteran reported constant back pain rated at 5-6/10, and when asked about incapacitation the Veteran reported that she has worse back pain if she mows the lawn. The Veteran also reported that she could only walk a 1/4 mile and sitting caused her to lose sensation in her legs. The examiner also noted that the hearing occurred before her most recent physical therapy and medication change, which has helped. In a January 2019 back examination, the Veteran had a forward flexion to 50 degrees and a combined range of motion of the thoracolumbar spine greater than 120 degrees. The examiner noted that the Veteran has pain and functional loss due to that pain. There is also evidence of weightbearing pain, but the examiner noted that there is no evidence of pain when the spine is in a non-weight bearing position. The examiner stated that the Veteran has reported an achy burning sensation when responding to evidence of localized tenderness or pain on palpation. The Veteran had no additional loss of function or range of motion following repetitive-use testing. The examiner indicated that he was unable to determine if pain, weakness, fragility or incoordination would significantly limit functional ability with repeated use over a period of time, without speculating. The examiner's rationale was that there is "no conceptional or empirical basis for making such a determination without directly observing function under these conditions. In addition, there is a lack of supporting objective documentation in the file." The examiner further explained that for this specific Veteran there is "no persistent evidence of record, considered to be valid or reproducible for rating purposes, that indicates a loss of function during these conditions." The Veteran reported that since her initial injury to her lower back that the back pain continues to get worse, and she has decreased range of motion along with getting stuck at times. She stated that she will bend over and get stuck and have a difficult time getting back to vertical. The Veteran reported that she does not have any flare-ups. However, the Veteran reported that she has trouble bending over, lifting and carrying weight, squatting, and kneeling due to pain. The examiner indicated that the Veteran does not have any guarding or muscle spasms, muscle atrophy, radiculopathy, ankylosis, IVDS, and does not require any use of assistive devices. The examiner noted that passive range of motion testing was not performed because it is not feasible to do this in a safe and reasonable manner. In a November 2019 back examination, the Veteran had a normal overall range of motion, but had objective pain on forward flexion at 45 degrees. Thus, the Veteran had a combined range of motion of the thoracolumbar spine greater than 120 degrees. The examiner noted that the Veteran had pain noted on exam, but the pain does not result in/cause functional loss. The Veteran indicated that she had flare-ups but explained that in about 2003 "she had an episode of severe low back pain and she required 6 weeks of time off of work. This was due to an assault while working at a prison." The Veteran denies having any flare ups since that time or having any debilitating episodes more recently. The examiner indicated that the Veteran has mild pain in the left mid and lower back due to strain. There is evidence that the Veteran has pain with weightbearing, but no objective evidence of pain on non-weight bearing. The Veteran had no additional loss of function or range of motion following repetitive-use testing. However, the Veteran has pain and a lack of endurance after repeated use over time. The examiner noted that the Veteran does not have any guarding or muscle spasms, no muscle atrophy, radiculopathy, ankylosis, neurologic abnormalities, IVDS, or requirement for assistive devices. The examiner evaluated the December 2010 x-rays and compared it to the November 2019 x-rays and remarked that, "Thoracic spine: Vertebrae and discs arc normal in height and alignment with no fractures or subluxations or significant arthritic changes. Lumbar spine: Bones, joints, and soft tissues are within normal limits." The functional impact of the Veteran's condition may preclude or reduce the duration the Veteran can repetitively lift objects, bend, or twist. The examiner noted that passive range of motion testing cannot be performed or is not medically appropriate. In a September 2020 back examination, the Veteran had a forward flexion to 70 degrees and a combined range of motion of the thoracolumbar spine greater than 120 degrees. The examiner noted that pain was noted on the exam but does not result in/cause functional loss. There is also evidence of pain during weight bearing but not during non-weight bearing testing. There is evidence of localized tenderness or pain that is mild in severity in the bilateral lower back due to strain. The Veteran had no additional loss of function or range of motion following repetitive-use testing. However, repeated use over time testing resulted in pain and lack of endurance. The Veteran reported that she had flare-ups, she explained that in about 2003 "she had an episode of severe low back pain and she required 6 weeks of time off of work. This was due to an assault while working at a prison." She also reported functional loss such as avoids heavy or repetitive lifting, bending, or twisting. The examiner noted that pain, weakness, fatigability or incoordination does not significantly limit the Veteran's functional ability during flare-ups. The examiner was asked to provide any additional diagnoses or if the established diagnosis has changed. The examiner stated, "DDD is progressive and commonly leads to degenerative arthritis due to the spine joint dysfunction. Also, scoliosis and DDD lead to muscle overcompensation leading to chronic strain such as the thoracic strain found today." The examiner noted that the Veteran does not have any guarding or muscle spasms, no muscle atrophy, radiculopathy, ankylosis, neurologic abnormalities, or IVDS. However, the Veteran uses a cane as an assistive device for her knee and back conditions. The examiner noted there was no passive of range of motion testing for the back, because the test cannot be performed or is not medically appropriate. In September 2020, the Veteran also underwent a peripheral nerve examination. The examiner indicated that the Veteran does not have a peripheral nerve condition or peripheral neuropathy. The Veteran reported falling and striking her middle low back on the corner of some concrete. Since that incident, the Veteran has had constant tingling in both of her feet with intermittent numbness. The examiner indicated that the Veteran has normal strength, normal reflex, normal sensory, no trophic changes, and her gait is normal. The Veteran's upper and lower extremity evaluations were normal. The examiner remarked that there is insufficient objective evidence with which to render a diagnosis. In January 2021, the Veteran had an x-ray for her cervical spine. The opinion indicated, "Normal except for neck tilting to the right at the cervicothoracic junction which may be reflective of lower thoracic/lumbar scoliosis or muscle spasm." The Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, including additional pain after repetitive use, and a lack of endurance. The Board also acknowledges the Veteran's representative's contention that the Veteran may have pushed through the pain, and hence showed a higher range of motion, than she should have shown, because she performed while in pain. The Board also acknowledges that the Veteran's representative reiterated that the Veteran suffered additional loss of range of motion, in the October 2021 IHP but provided no actionable details. The Board considered the Veteran's contention that she had flare-ups, and she testified during the June 2014 hearing that they occurred multiple times a day. The evidence in the record demonstrates that she had flare-ups after she was assaulted at the prison, but she has denied having flare-ups explicitly during each of the following VA back examinations. The Veteran mentioned flare-ups in passing in the October 2021 IHP however, she did not indicate if these were new flare-ups, or if she was referring to the flare-ups, she mentioned in the September 2020 VA examination, that have not occurred since 2003. Thus, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The Veteran's medical treatment records do not show such limitations during that period. The Board acknowledges the Veteran's contentions during the June 2014 Board hearing that she has flare-ups and cannot do anything until they pass. She cannot cut the grass because of her back. The Veteran indicated that, "I have to stay in bed and then all patches and medications for a couple of days and then I can get back up." She also had difficulty going up and down stairs and lifting heavy objects. The Board also acknowledges that the Veteran has indicated that she can work for 15-20 minutes and then needs to sit down and can walk less than a quarter of a mile, and that she reported that she has pain radiating down her legs, and she loses sensation in her feet while sitting after approximately 30 minutes. She reported constant weakness, and stiffness and fatigue in her back, and spasms after repeated exercises. Again, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Accordingly, a disability rating greater than the currently assigned rating is not warranted on this basis. The Board considered the Veteran's contention that she became incapacitated after cutting the grass. The Board notes, that according to the Veteran's medical records she has not received any doctor-prescribed bedrest for low back pain in the past 12 months. See March 2015 VA examination, September 2020 VA examination. The Veteran again contended in her October 2021 IHP that she has incapacitating attacks of pain. However, there is no evidence in the record that the Veteran was prescribed bedrest by a physician. The Board also considered the Veteran's contention that she had flare-ups every morning, and that her doctor indicated that these flare-ups were most likely caused by constipation, because she felt better after relieving herself. The March 2015 VA examiner indicated that he had to explain what a flare-up consisted of because the Veteran's descriptions were not considered flare-ups of her low back condition. After the explanation, the Veteran reported that in the last year she has worse pain in her low back and in her left groin, when she gets out of bed in the morning, and it lasts for 10 minutes, and it causes her to stop what she is doing to let it pass. The examiner explained that the Veteran's condition as it was explained, would not be a flare of her low back condition. The March 2015 VA examiner also indicated that post hearing, the Veteran had physical therapy and was prescribed a new muscle relaxant that improved her back symptoms. In addition, the Board considered that the January 2019, November 2019, and September 2020 VA examiners stated, that either the Veteran does not report flare-ups or the Veteran's reports of flare-ups were regarding a 2003 episode where she had severe low back pain and that she required 6 weeks of time off of work, and this was due to an assault, while she was working at a prison. These examiners also indicated that the Veteran has denied flare-ups since that time or any debilitating episodes more recently. In addition, there is no indication in the record that the Veteran had ankylosis of any portion of the spine. Under Diagnostic Code 5243, a higher rating of 40 percent is not warranted unless there is ankylosis of the spine. Ankylosis is the "immobility and consolidation of a joint due to disease, injury, surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). The Veteran's forward flexion has been greater than 30 degrees throughout the appeal period and there is no evidence of ankylosis of the thoracolumbar spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran reported that she recently fell when she lost her footing and fell onto her back striking the corner of a concrete block. After this fall she noticed numbness and tingling in both of her feet. In September 2020, the Veteran underwent a peripheral nerves examination. The examiner did not diagnose the Veteran with any peripheral nerve condition or peripheral neuropathy. The Veteran did not have any symptoms of any peripheral nerve condition, had normal strength reflexes, and sensory. The Veteran did not have any tropic changes and her gait was normal. Additionally, the Veteran's upper and lower extremity nerve and radicular groups were normal. The examiner noted that there is insufficient subjective evidence to render a diagnosis. This is consistent with the Veteran's VA examinations, none of which indicated the Veteran had any neurological impairment. The Board also considered the Veteran's representative's contention that the Veteran should be entitled to separate ratings for her DDD and scoliosis. See April 2021 IHP. However, the Veteran's scoliosis is contemplated in Diagnostic Code 5237, as it is explicitly included in the general rating formula for diseases and injuries of the spine. The Board also considered the changes within the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a that were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020), and the changes do not affect the Veteran's claims. The Board considered evaluating the Veteran's degenerative disc disease other than intervertebral disc syndrome under Diagnostic code 5242 and concluded that after evaluating the Veteran's DDD under Diagnostic Code 5003, the Veteran would not receive a higher rating. Under Diagnostic Code 5003, arthritis is rated on the basis of the limitation of motion of the affected joint. When the limitation of motion of the affected joint is noncompensable under the appropriate diagnostic code, a rating of 10 percent is applied to each affected major joint. 38 C.F.R. § 4.71(a), Diagnostic Code 5003. For the purpose of rating a disability from arthritis, the lumbar vertebrae are considered a group of minor joints, ratable on parity with major joints. 38 C.F.R. § 4.45(f). As the Veteran's limitation of motion is compensable under Diagnostic Code 5242, Diagnostic Code 5003 will not be considered further herein. Specifically, note (1) reveals that, the 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Thus, the Veteran would not be entitled to separate ratings for DDD and scoliosis because scoliosis is awarded under both Diagnostic codes 5237 and 5242. The Board is sympathetic, that the Veteran's back disability has an adverse effect on her life. However, her disability picture is currently rated correctly. Her representative mentioned each criterion listed, but did not specifically allege any criteria, that has not already been considered. To warrant a higher rating, the Veteran would need to demonstrate that her forward flexion is less than 30 degrees, or has ankylosis, or has prescribed bedrest from a physician in order to obtain a higher disability rating. Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues considered in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Based on the foregoing, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis. 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, Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist, 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.