Citation Nr: 21071244 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 16-27 756 DATE: November 30, 2021 ORDER Entitlement to an initial rating greater than 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine, is denied. Entitlement to a rating greater than 20 percent from June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine, is denied. Entitlement to an initial rating greater than 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine, is denied. Entitlement to a rating greater than 20 percent from June 3, 2021, for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine, is denied. FINDINGS OF FACT 1. For the period prior to June 3, 2021, the Veteran's cervical spine disability was not manifested by forward flexion of the cervical spine to 30 degrees or less, a combined range of motion of 170 degrees or less, 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. 2. For the period from June 3, 2021, the Veteran's cervical spine disability is not manifested by forward flexion of the cervical spine to 15 degrees or less or ankylosis of the cervical spine. 3. For the period prior to June 3, 2021, the Veteran's lumbar spine disability was not manifested by forward flexion of the thoracolumbar spine to 60 degrees of forward flexion or less, combined motion to 120 degrees or less, 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. 4. For the period from June 3, 2021, the Veteran's lumbar spine disability is not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less or ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for a rating in excess of 20 percent from June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5242. 3. The criteria for a rating in excess of 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DCs 5242, 5243. 4. The criteria for a rating in excess of 20 percent for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DCs 5242, 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Air Force from September 1976 to September 1992 and in the United States Army from May 2009 to September 2010 and from December 2010 to October 2012 with service in Kuwait/Iraq and Afghanistan. These matters come before the Board of Veterans' Appeals (Board) from a May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the increased rating claims in March 2021 for additional development. The additional development having been completed the matter again is before the Board. The remand also included multiple other issues, but these issues were granted in full in a September 2021 rating decision. As such, those issues will not be addressed herein. In addition, the September 2021 rating decision granted entitlement to increased ratings for the cervical and lumbar spine disabilities, assigning separate 20 percent ratings both effective June 3, 2021. Increased Rating 1. Entitlement to an initial rating greater than 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine 2. Entitlement to an initial rating greater than 20 percent from June 3, 2021, for degenerative joint disease and degenerative disc disease, cervical spine 3. Entitlement to an initial rating greater than 10 percent prior to June 3, 2021, for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine 4. Entitlement to an initial rating greater than 20 percent from June 3, 2021, for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome, lumbar spine Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate DCs identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. VA must consider whether the Veteran is entitled to "staged" ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal. The evaluation 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 DCs 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). The Veteran's cervical spine disability is rated under DC 5242 (for degenerative arthritis of the spine) while her low back disability originally was rated under DC 5242, but from June 3, 2021, is rated under DC 5242 for intervertebral disc syndrome of the thoracolumbar spine. She has alleged in the past that a 20 percent rating was warranted for the neck and back disabilities, each of which was awarded in the September 2021 rating decision, effective June 3, 2021. As the foregoing did not represent a complete grant of benefits for any time period on appeal and the Veteran had not expressly indicated a desire to withdraw any aspect of the issues on appeal the Board will proceed with adjudication of the claims based on her original assertions that the disabilities were more severe than rated by VA. The General Rating Formula for Diseases and Injuries of the Spine provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees. A 20 percent disability 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, for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent disability rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine; or, unfavorable ankylosis of the entire cervical spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Notes appended to the rating formula for diseases and injuries of the spine specify that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. Id., Note (2). Provided, however, that, in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion generally recognized by VA. Id., Note (3). Further, the term "combined range of motion" refers to "the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation"; provided, however, that the aforementioned normal ranges of motion for each component of spinal motion, as recognized by VA, are the maximum that can be used for calculation of the combined range of motion, and each range of motion measurement is to be rounded to the nearest five degrees. Id., Notes (2) and (4). Note (5) provides that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6) provides that disabilities of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Id. These criteria are to be applied irrespective of whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area of the spine, id, and they "are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine." 68 Fed. Reg. 51,455 (August 27, 2003) (Supplementary Information). Spine conditions rated under DC 5243, for intervertebral disc syndrome, may be rated alternatively based on incapacitating episodes. The criteria provide for a 10 percent rating where intervertebral disc syndrome is manifested with incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent rating was warranted where incapacitating episodes have a total duration of at least two weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted where incapacitating episodes have a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months. "Incapacitating episodes" was defined in Note (1) as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2) also allowed the Veteran to be rated separately for musculoskeletal and neurological manifestations under appropriate DCs if it would result in a higher combined evaluation for the disability. Effective February 7, 2021, 38 C.F.R. § 4.71a was revised, including DCs 5242 and 5243. Relevant to the low back and neck claims, DC 5242 was revised from "degenerative arthritis of the spine" to "degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome" and DC 5243 was received from "intervertebral disc syndrome" to "intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses. Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25." The Veteran's cervical spine disability has consistently been rated under DC 5242. The Board notes that the Veteran's low back disability was rated under DC 5242 until June 3, 2021, from which time she is rated under DC 5243. The Veteran has been diagnosed with intervertebral disc syndrome of the thoracolumbar spine during the appellate time period. The Veteran does not have incapacitating episodes due to her low back disability sufficient to warrant a compensable rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In light of the foregoing, the Board's analysis will focus primarily on the General Rating Formula for Diseases and Injuries of the Spine. In March 2013, the Veteran sought treatment for upper back and neck pain, as well as tenderness in the low back. Standing or sitting for too long made the pain worse. On examination, the cervical spine "juts straight almost in reverse lordosis." There was moderate tightness in the upper trapezius muscles and other areas of the spine. In November 2013, the Veteran underwent a VA back examination. She had not received any treatment for the back since separation from service and was working as a computer programmer at present. The Veteran reported flare-ups when sitting or standing for 20 minutes with aching in the back. She was experiencing a flare-up at the time of examination. Thoracolumbar range of motion testing showed forward flexion to 80 degrees, with pain onset at 80 degrees; and extension, right and left lateral flexion and rotation to 30 degrees or more, with no objective pain. There was no further loss of motion with repetitive motion. There was functional loss due to less movement than normal. Muscle strength was normal with normal reflexes and sensation. The back disability did not have any functional impact on her ability to work. In November 2013, the Veteran was afforded a VA neck examination. The Veteran reported flare-ups due to overuse and cold, but was not having a flare-up at the time of examination. Cervical range of motion testing showed forward flexion, extension, and right and left lateral flexion to 45 degrees or more, with no objective evidence of painful motion; and right and left lateral rotation to 80 degrees or more, with no objective evidence of painful motion. There was no further loss of motion with repetitive motion testing. There was guarding or muscle spasm, but muscle strength was normal and there was no muscle atrophy. Reflexes were normal, as was sensation. The cervical spine disability did not impact the Veteran's ability to work. In May 2014, the Veteran reported severe neck pain leading to migraines. In June 2014, the Veteran reported increased back pain, but improving neck pain. In July 2014, the Veteran's back pain had been consistent following pool and traction therapy. On examination, there was pain with trunk range of motion and tenderness to palpation. In September 2014, the Veteran's neck range of motion was good, but slightly restricted. In October 2014, the Veteran described generally decreasing low back pain, but with some recent increase in pain. In April 2015, the Veteran reported that she could not run due to back pain and that her back hurt if she walked for too long. At that time, she also reported neck pain. In April 2016, the Veteran was afforded a VA neck examination. The Veteran had worked as a computer programmer until retiring in March 2014. She lived on a 40 acre farm with goats, cows, horses, and chickens. She spent 3 to 6 hours a day working on her farm, during which she walked 2 miles per day and rode a horse once or twice per month. The Veteran could lift from the floor and carry 25 pounds across the room. She had difficulty lifting one gallon of liquid above her head. The Veteran had daily neck and low back pain. She also could ascend and descend 3 flights of stairs. The Veteran denied neck flare-ups. There was functional loss with worsened neck pain with psychological tension, driving for over 1 hour, and sleeping on her side. Cervical spine range of motion testing showed forward flexion to 45 degrees; extension and right and left lateral flexion to 40 degrees; and right and left lateral rotation to 60 degrees. There was noted pain on examination that caused functional loss. There was no further loss of motion or function with repetitive motion testing. Muscle strength was normal and there was no muscle atrophy. Reflexes and sensation were normal and there was no ankylosis. The Veteran's neck disability affected her ability to work in that the neck problems precluded her current activities on the farm, but did not otherwise restrict her from light or sedentary occupations. In April 2016, the Veteran underwent a VA back examination. The Veteran reported chronic daily back and right buttock pain and occasional upper thigh pain. The back pain was worse if she stooped for over 2 minutes, stood for 5 to 10 minutes, squat, or lift over 25 pounds. She walked with a symmetrical gait and could sit and rise from a chair with no difficulty. A half squat caused back pain and she could reach her fingers 10 inches from her toes. There was no deformity or tenderness to the thoracolumbar spine. The Veteran had full range of motion of the thoracolumbar spine with no limitation. She had normal strength, sensation, and reflexes in the lower extremities. There was no muscle atrophy. The low back disability impacted the Veteran's ability to work in that she could stoop for only 2 minutes, stand for 5 to 10 minutes, squat, or lift over 25 pounds. The Veteran was able to run her farm if she paced herself. The back disability did not restrict the Veteran from light or sedentary occupations. In her March 2017 substantive appeal, the Veteran contended that a 20 percent rating was warranted. In August 2017, the Veteran described neck pain that was alleviated with over-the-counter medication and stretching. In October 2019, the Veteran requested acupuncture for neck and back pain after a recent injury painting in an awkward position 2 weeks previously. The Veteran described relatively constant ongoing pain levels of 5 to 6 out of 10, with aggravation from forward flexion, first thing in the morning, and standing on hard surfaces for more than 5 to 10 minutes. In January 2020, the Veteran reported reduction of low back pain after acupuncture, with very little current pain. The Veteran continued to have neck and shoulder pain that was 3 out of 10. During her January 2021 Board hearing, the Veteran contended that a 20 percent rating was warranted based on lordosis of the spine and "I do clearly have a lordosis a reverse lordosis in my neck, and a lordosis in my back." She also attributed problems with migraines to her neck disability. The Veteran described range of motion due to pain in the neck and difficulty looking over her shoulder. In February 2021, the Veteran reported that the combination of acupuncture, chiropractic services, and massage had relieved the Veteran's pain that she continued to rate as 2 to 3 out of 10. In March 2021, the Veteran reported that her back pain had decreased to 1 to 2 out of 10 without medication. The Veteran underwent a VA cervical spine examination on June 3, 2021. Since August 2019, the Veteran reported that she had been going to a chiropractor weekly. In September 2020, she started acupuncture. The Veteran reported having a hard time sleeping at night, with a pain level of 6 out of 10. She had stiffness across the shoulders, as well as headaches and pressure in the ears due to the neck problems. The Veteran denied any cervical spine flare-ups. There was functional loss or impairment due to pain with prolonged computer use. She was unable to tilt her neck for a prolonged period. Looking up or down for a prolonged period caused pain. The decreased range of motion of the cervical spin limited bending and turning the neck from side to side. Testing of the cervical spine showed forward flexion, extension, and right and lateral flexion to 35 degrees and right and left lateral rotation was to 50 degrees. Pain was noted with all motion. Passive range of motion testing was not done due to the risk of further injury. Following repetitive use testing there was no further loss of motion. With repeated loss over time, the examiner estimated that forward flexion, extension, and right and lateral flexion would be 30 degrees and right and left lateral rotation would be to 40 degrees. There was tenderness to palpation, but no muscle spasm or guarding. Muscle strength was normal and there was no muscle atrophy. Reflexes and sensation were normal. There was no ankylosis. The Veteran had no neurologic abnormalities. There was no intervertebral disc syndrome. The Veteran used no assistive devices. The functional impact on the Veteran's ability to work was that he had limitation to working on computers, had prolonged tingling and hyperextension, and problems with repeated turning of the neck from side to side. The Veteran's June 3, 2021 VA back examination report included her reports of worsening since the last examination. The Veteran could not bend for over 2 minutes, sit or stand for prolonged periods of time, get comfortable in her sleep, had pain of 5 out of 10 all the time, intermittent sciatica, pain from the buttock to thigh posterior, and numbness in her feet. The Veteran reported flare-ups twice a month lasting a few hours that was severe in nature. There was functional loss that affected running, prolonged walking, prolonged standing, and an inability to garden. Thoracolumbar range of motion testing showed forward flexion to 50 degrees and the remaining planes of motion to 20 degrees each. There was pain in all planes of motions. Repetitive motion testing did not result in further loss of motion, but with repeated use over time was estimated to be 40 degrees of forward flexion and 15 degrees in the other planes of motion. During flare-ups, the examiner estimated that motion would be further reduced to 35 degrees of forward flexion and 10 degrees in all other planes of motion. There was tenderness to palpation, but no muscle spasm or guarding. Other factors contributing to disability were interference with sitting, standing, and locomotion, as well as less movement than normal. Muscle strength was normal with no muscle atrophy. Reflexes were normal, but there was decreased sensation in the right lower leg / ankle and foot / toes. There was evidence of right lower extremity radiculopathy (for which the Veteran is separately service connected). There was no ankylosis or neurologic abnormalities. The Veteran had intervertebral disc syndrome, but he had no symptoms in the past 12 months requiring bed rest prescribed by a physician and treatment by a physician. There was functional impact on the Veteran's ability to work due to limitations to frequent bending, lifting, carrying heavy objects, and prolonged sitting or standing. Later in June 2021, the Veteran reported that acupuncture helped manage her pain and that she no longer had radiation into the buttocks or ischial tuberosity. Cold weather exacerbated the old arthritis. In addition, the Veteran needed Tylenol once a week in addition to the acupuncture. Cervical Spine The Board finds that a rating greater than 10 percent prior to June 3, 2021, and greater than 20 percent from that date for degenerative joint disease and degenerative disc disease of the cervical spine is not warranted for any period on appeal. For the period prior to June 3, 2021, the Veteran at no time had range of cervical spine forward flexion to less than 30 degrees or total range of motion to less than 170 degrees. Testing showed normal muscle strength and no muscle atrophy. The Board acknowledges the Veteran's argument that she had an abnormal spinal contour that should be sufficient for a 20 percent rating, but the medical evidence does not demonstrate muscle spasm or guarding severe enough to cause an abnormal gait or the abnormal spinal contour. There is no basis in the applicable DC to assign a higher rating prior to June 3, 2021. For the period from June 3, 2021, the Veteran does not have forward flexion to less than 15 degrees or ankylosis of the cervical spine, even accounting for increased loss of motion with repetitive use over time. As such, there is no basis under DC 5242 to assign a higher rating for the period from June 3, 2021. As noted above, the Veteran does not have intervertebral disc syndrome of the cervical spine and, as such, a higher rating under DC 5243 is not for contemplation. Separate ratings for neurological manifestations may be warranted under 38 C.F.R. § 4.124a if supported by objective medical evidence. In this regard, the RO has granted entitlement to service connection for migraine headaches and assigned a 30 percent rating for the entire appellate time period. The Veteran has not appealed the rating assigned for the migraines. As such, no further discussion of these problems is warranted herein. The Veteran has no other neurological problems associated with the cervical spine disability. The Veteran's functional loss was considered. 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The Veteran's current ratings are intended to compensate her for any functional limitation experienced as a result of the neck problems, specifically, the pain, weakness, and other problems experienced after repetitive motion. The Veteran certainly has pain during much or all of her range of motion, but she has no evidence of muscle atrophy, which demonstrates that she is able to use his back in close to a normal manner, including duration of use, and that she, in fact, does so. See 38 C.F.R. § 4.40 (noting that, "A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like."). The Board acknowledges the notations of prior VA examiners that the Veteran's neck problems limit her ability to work on her farm. Again, the physical limitations imposed as a result of the Veteran's neck disability are contemplated in the current ratings. In summary, for the reasons and bases set forth above, the Board concludes that increased ratings greater than those currently assigned are not warranted for any period on appeal. Lumbar Spine The Board finds that a rating greater than 10 percent prior to June 3, 2021, and greater than 20 percent from that date for degenerative joint disease and degenerative disc disease with intervertebral disc syndrome of the lumbar spine for any period on appeal. For the period prior to June 3, 2021, the Veteran at no time had range of thoracolumbar spine forward flexion to less than 60 degrees or total range of motion to 120 degrees or less. Testing showed normal muscle strength and no muscle atrophy. The Board acknowledges the Veteran's argument that she had an abnormal spinal contour that should be sufficient for a 20 percent rating, but the medical evidence does not demonstrate muscle spasm or guarding severe enough to cause an abnormal gait or abnormal spinal contour. There is no basis in the applicable DC to assign a higher rating prior to June 3, 2021. For the period from June 3, 2021, the Veteran does not have forward flexion to less than 30 degrees or favorable ankylosis of the thoracolumbar spine, even accounting for increased loss of motion with repetitive use over time. As such, there is no basis under DC 5242 to assign a higher rating for the period from June 3, 2021. As noted above, the Veteran has diagnosed intervertebral disc syndrome, thus potentially raising the possibility of a rating under DC 5243. The Veteran has had no incapacitating episodes for VA purposes during the appellate time period and, as such, a higher rating under DC 5243 is not warranted. Similarly, the Veteran is not entitled to a greater rating under any other DC for either the period prior to June 3, 2021, or from that date. Under DC 5003 degenerative arthritis, when established by x-ray findings, will be rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate DCs, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. In this case, even with a current diagnosis of degenerative arthritis, a separate rating under DC 5003 would not be warranted. The Veteran's current ratings, as discussed above, are based on pain on movement and a separate rating under DC 5003 would be for the same symptomatology. As separate ratings may not be assigned for the same symptomatology, a separate 10 percent rating under DC 5003 for the Veteran's painful motion is not warranted for any period on appeal. Separate ratings for neurological manifestations may be warranted under 38 C.F.R. § 4.124a if supported by objective medical evidence. In this case, the Veteran is rated separately for right lower extremity radiculopathy and she has not expressed disagreement with the separate rating assigned for that disability. As such, further consideration of that claim herein is not necessary. As noted, Note 1 of the General Rating Formula for Diseases and Injuries of the Spine also provides for evaluating any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate DC. In this case, the Veteran consistently has denied related bowel or bladder problems. The Board notes that the Veteran's functional loss was considered, as the medical evidence shows that the Veteran has consistently complained of pain in the back. 38 C.F.R. §§ 4.40, 4.45. The evidence indicates that the Veteran has had ranges of motion on testing that are consistent with the current ratings assigned for the respective time periods, even when accounting for further limitation with repetitive use over time and/or during flare-ups. Again, the current ratings assigned contemplate the Veteran's pain and associated difficulties. The current evaluations contemplate limitation of flexion to 61 degrees prior to June 3, 2021, and to 31 degrees from that date. There is no suggestion of such limitations. Moreover, as noted above, the Veteran does not have muscle atrophy, which suggests that she is able to use her back in close to a normal manner and, in fact, does so. See 38 C.F.R. § 4.40. As such, a higher rating based on functional loss is not warranted for any period on appeal. As shown above, and as required by Schafrath, 1 Vet. App. at 594, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the Veteran. Accordingly, the preponderance of the evidence is against assignment of an increased disability rating for the Veteran's service-connected low back disability for any period on appeal. The Board has considered whether further staged ratings were appropriate in the present case but concludes that the current ratings most closely reflect the Veteran's disability and that further staged ratings are not warranted for any period on appeal. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.