Citation Nr: 21071758 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 12-20 337 DATE: December 1, 2021 ORDER Entitlement to an initial 20 percent rating for a lumbar spine disability prior to November 30, 2012 is granted. Entitlement to an initial rating in excess of 20 percent for a lumbar spine disability is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, prior to November 30, 2012, his lumbar spine disability resulted in 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. The Veteran's lumbar spine disability has not resulted in, or more closely approximated, forward flexion of the thoracolumbar spine of 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, at any time during the period on appeal. CONCLUSIONS OF LAW 1. Prior to November 30, 2012, the criteria for an initial 20 percent rating for a lumbar spine disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5237. 2. The criteria for an initial rating in excess of 20 percent for a lumbar spine disability have not been met at any time during the period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1965 to August 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in April 2019, November 2020, and July 2021 for additional development. As the actions specified in the most recent remand have been substantially completed, this matter has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Duties to Notify and Assist With respect to the Veteran's claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A; 38 C.F.R. § 3.159. The Veteran has not advanced any procedural arguments in relation to VA's duties to notify and assist; therefore, the Board will proceed with appellate review. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). Increased Rating Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; see generally 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when making disability determinations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). When the factual findings show distinct time periods during which the veteran exhibited symptoms of disability and such symptoms warrant different disability ratings, staged ratings may also be assigned. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Entitlement to an initial rating in excess of 10 percent for a lumbar spine disability prior to November 30, 2012, and in excess of 20 percent thereafter The Veteran's service-connected lumbar spine disability is currently rated 10 percent disabling prior to November 30, 2012, and 20 percent disabling thereafter. The Veteran generally contends that the ratings assigned to his lumbar spine disability do not accurately reflect the severity of his disability and its associated symptoms throughout the entire appeal period. The Board notes that the appeal period begins April 7, 2009, which is the effective date of the grant of service connection for the lumbar spine disability. Disabilities of the spine are rated under a General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) (encompassing Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes). The General Rating Formula stipulates, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, that the following ratings, in pertinent part, will apply: A 20 percent rating is assigned where there is 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; 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 assigned for forward flexion of the thoracolumbar spine of 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. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. For VA compensation purposes, unfavorable ankylosis is a condition in which 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. 38 C.F.R. § 4.71a, General Rating Formula, Note (5). The Veteran's lumbar spine disability may alternatively be rated under the Formula for Rating IVDS Based on Incapacitating Episodes, if doing so would result in a higher evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Formula for Rating IVDS Based on Incapacitating Episodes stipulates that, when there is disc herniation with compression and/or irritation of the adjacent nerve root, the following ratings, in pertinent part, will apply: A 20 percent rating is assigned with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is assigned with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A maximum 60 percent rating is assigned with incapacitating episodes having a total duration of at least six weeks during the past 12 months. For purposes of assigning an evaluation under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). When evaluating disabilities of the musculoskeletal system predicated on limitation of motion, 38 C.F.R. § 4.40 allows for consideration of functional loss due to factors such as pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, deformity, or atrophy of disuse. The diagnostic codes pertaining to range of motion do not subsume sections 4.40 and 4.45, and the rule against pyramiding does not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during periods of flare-up. See DeLuca, 8 Vet. App. at 206; see also Johnson v. Brown, 9 Vet. App. 7 (1996). In determining if a higher rating is warranted on this basis, it is important to note that pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Similarly, painful motion alone does not constitute limited motion for the purposes of rating under the diagnostic codes pertaining to limitation of motion. Id. However, pain may result in functional loss if it limits the ability to perform normal movements of the body with normal excursion, strength, speed, coordination, or endurance, as provided in 38 C.F.R. § 4.40. Id. at 38. Functional loss caused by pain must be rated at the same level as if that functional loss were caused by some other factor, for example, deformity, adhesion, atrophy, tendon tie-up, see 38 C.F.R. §§ 4.40, 4.45, that actually limited motion. Id. at 37. Turning to the relevant evidence of record, the Board notes that the pertinent lay evidence includes statements by the Veteran attesting to the functional impact of his lumbar spine disability, such as experiencing constant pain and decreased mobility. The record also contains a buddy statement from the Veteran's coworker, who stated that he has observed the Veteran having difficulty stooping and climbing a ladder, and having to lie down to alleviate muscle spasms in his back. In another statement, the Veteran's daughter stated that she has to drive the Veteran places and help him with household chores due to his back pain. The Veteran, his coworker, and his daughter are competent to report such lay observable symptoms and functional impacts. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Washington v. Nicholson, 19 Vet. App. 362 (2005). A March 2005 VA x-ray report revealed the Veteran's lumbar spine to have minimal scoliosis. At an August 2008 VA primary care visit, the Veteran reported having a flare-up of low back pain so severe that he could not walk and having constant pain for the past seven days. He told the treating physician that these flare-ups occur every four or five months. The physician noted the Veteran's lumbar spine to have full range of motion but a "loss of lordosis." Although this evidence is dated outside the appeal period, the Board notes that it is useful in order to evaluate the current severity of the Veteran's disability in relation to its history. See 38 C.F.R. § 4.1; Schafrath, 1 Vet. App. at 594. The Veteran underwent a VA spine examination in June 2009. Upon examination, he reported experiencing constant aching pain in his lumbar spine, with flare-ups occurring at least once per day and lasting a few minutes in duration. Flare-ups are precipitated by bending or heavy lifting, which cause his back to "lock up." They are alleviated with rest, ice, heat, and pain medications. The examiner noted that the Veteran has the same range of motion during flare-ups but with increased pain. Functional effects were described as limited mobility, only being able to walk one-quarter mile, the occasional use of crutches, and difficulty performing activities requiring bending, such as tying shoelaces, or prolonged sitting, such as driving. On physical examination, the examiner recorded normal alignment, symmetry, and curvature of the spine. However, the Veteran was noted to have an abnormal gait due to walking with a limp because of lower back pain. Range of motion testing revealed forward flexion to 80 degrees, with pain at 60 degrees. He had full range of motion in all other planes. The examiner noted that pain causes additional functional limitation. There was objective evidence of tenderness, but not muscle spasm, deformity, scoliosis, kyphosis, postural abnormalities, fixed deformities (such as ankylosis), or abnormalities of musculature. An April 2012 VA treatment record documents the Veteran's report of experiencing a new type of pain in his lumbar spine, which he described as a sharp stabbing pain in the center of the low lumbar spine of unknown origin. He reported that this pain had occurred two to three times per week during the last month. The VA physician remarked that these episodes sounded like muscle spasms. The Veteran was afforded a VA back conditions examination in May 2012. Upon examination he described experiencing constant low back pain, with flare-ups occurring with prolonged walking, standing, or driving. Range of motion testing revealed forward flexion to 80 degrees and extension to 25 degrees. Lateral flexion and lateral rotation in both directions were within normal limits. He was able to perform three repetitions with no additional limitation in range of motion, but there was functional loss due to pain on movement. There was no localized tenderness or pain on palpation, guarding, or muscle spasms in the thoracolumbar spine. Muscle strength, reflexes, and sensation to light touch testing were all normal. The Veteran had lower extremity radiculopathy; however, no other neurological abnormalities were documented. The Veteran was noted to have IVDS, with incapacitating episodes over the past 12 months less than one week in total duration. The Veteran underwent another VA back conditions examination in November 2012. At the examination, the Veteran reported chronic aching low back pain. He rated his usual pain to be "4 or 5 out of 10." He described experiencing stiffness in his back, especially in the morning, having difficulty getting in and out of a chair, and flare-ups with increased symptoms due to prolonged sitting or standing, repetitive bending, or twisting. The examiner indicated that the Veteran has significant fatigability and lack of endurance due to his back condition. Bladder or bowel incontinence were not found. Range of motion testing revealed full range of motion in all planes. The Veteran was able to perform three repetitions with no additional loss in range of motion, but there was functional loss due to weakened movement, excess fatiguability, pain on movement, and interference with sitting, standing, and/or weight-bearing. The examiner noted tenderness in the paraspinal musculature bilaterally in the lumbosacral spine region. Straightening of lumbar lordosis was evident, but with no obvious scoliosis or kyphosis. Muscle spasm and guarding was severe enough to result in abnormal spinal contour. Muscle strength, reflexes, and sensation to light touch testing were all normal. The Veteran had radiculopathy of the lower extremities; however, no other neurological abnormalities were found. IVDS was not found. The Veteran was not found to require the use of an assistive device. VA treatment records from 2013 to 2017 document that the Veteran sought regular treatment for his lumbar spine disability, consistently reporting chronic pain, muscle spasms, and periods of flare-up with increased pain. His VA physicians consistently found him to have normal, unassisted gait and posture, with only one notation in May 2017 of ataxic gait and balance due to back pain. Although radicular symptoms were frequently noted in his lower extremities, findings were always negative for bowel or bladder incontinence. In a June 2015 orthopedic clinic note, the Veteran was found to have forward flexion to 40 degrees. The Veteran underwent another VA back conditions examination in December 2019. He reported experiencing daily low back pain with bending or other movements of the lumbar spine and prolonged walking. The Veteran did not report experiencing flare-ups. Functional loss was noted due to being unable to bend or lift heavy objects. Range of motion testing revealed forward flexion to 50 degrees with pain noted on examination that causes functional loss in all planes. There was no additional loss of function or range of motion after three repetitions. Because the Veteran denied experiencing flare-ups, the examiner did not provide an opinion as to whether pain, weakness, fatiguability, or incoordination cause functional loss with flare-ups. The Veteran did not have muscle spasm or guarding. There was no muscle atrophy or ankylosis. The Veteran had radiculopathy of the lower extremities; however, no other neurological abnormalities were found. IVDS was not found. The Veteran did not require the use of an assistive device. The Veteran was afforded another VA examination in November 2020. Upon examination, the Veteran reported functional loss due to decreased ability to perform activities of daily living due to his chronic low back pain. However, he denied experiencing flare-ups. Range of motion testing revealed flexion to 70 degrees. Pain was noted at all planes that caused functional loss. There was no additional loss of function or range of motion after three repetitions. The examiner determined that pain, weakness, fatiguability, or incoordination would not be expected to limit functional ability with repeated use over time. Because the Veteran denied experiencing flare-ups, the examiner did not provide an opinion as to functional loss with flare-ups. The Veteran did not have muscle spasm or guarding. There was no muscle atrophy. The Veteran did not have radiculopathy or any other neurological abnormalities. There was no ankylosis. IVDS was not found. The Veteran did not require the use of an assistive device. In a supplemental medical opinion, the VA examiner declined to estimate the extent of any additional loss of range of motion after repetitive use over time, stating that it is not possible to give this data in the absence of examining the Veteran during such conditions. In this regard, the examiner explained that while "it is assumed that the exam findings would be worse during a flare or after repetitive use over time, the degree of worsening would not be known without an exam. Thus, this would require speculation and the potential for underestimating or overestimating the change." Finally, the Veteran underwent another VA back conditions examination in September 2021. Upon examination, he reported that he was currently experiencing a flare-up of pain after "throwing his back out" yesterday while working on his car after repetitive bending, lifting, and reaching. His described his current symptoms as constant lower back pain with intermittent muscle spasms and lower extremity radiculopathy. He stated that his flare-ups have progressed in frequency and duration. The Veteran stated that he experiences a flare-up approximately once per month, usually precipitated by activities such as bending or lifting, and that they last from three to six days. His flare-ups are characterized by increased pain, tightness, and muscle spasm. Veteran reported functional loss due to increased lower back pain, avoidance of certain activities that exacerbate his back pain, such as prolonged standing or walking, and difficulty with getting up from seated or laying position. Range of motion testing revealed forward flexion to 35 degrees with pain exhibited at all planes. Pain caused functional loss. The Veteran stated that he typically has more range of motion of his lower back than displayed on examination due to his current flare-up. Passive range of motion was not performed due to concerns with causing additional pain or injury to the Veteran. The examiner noted that the Veteran was not able to perform repetitive use testing with at least three repetitions due to "suboptimal effort." Because the examination was being conducted during a period of flare-up, the examiner was able to determine that pain and limited range of motion cause functional loss with flare-ups, with forward flexion limited to 35 degrees. The examiner also determined that pain and lack of endurance cause functional loss after repeated use over time, with forward flexion limited to 35 degrees. There was no ankylosis of the spine. IVDS was not noted. The Veteran had radiculopathy of the lower extremities; however, no other neurological abnormalities were found. The Veteran does not require an assistive device. In a supplemental medical opinion, the VA examiner stated that there is no evidence in the medical record to indicate the presence of lumbar ankylosis or the functional equivalent at any time from 2009 to the present, noting that range of motion measurements were always provided in each VA examination since 2009. The examiner also remarked that the Veteran reported during the examination that his flare-ups have progressed and become more frequent over the past few years. The Veteran was unable to provide an accurate estimation of the frequency or duration flare-ups since 2009. However, he stated that over the past 12 months, he has experienced a flare-up of lower back pain at least once per month that lasted three to six days. His flare-ups are usually precipitated by activity such as bending or lifting and are alleviated by rest and pain medication. The examiner therefore remarked that an opinion as to the extent of functional loss during flare-ups throughout the duration of the appeal cannot be determined without resorting to speculation due to the Veteran's inability to recall details of that information and a lack of medical documentation. Upon review of the medical evidence, the Board acknowledges that some of the VA examiners throughout the appeal period did not attempt to estimate additional loss of range of motion during flare-ups per Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). However, the Board finds that remanding once again for additional development to remedy this would only serve to further delay the Veteran's claim. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); see also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). As outlined above, the Board finds that the respective examination reports contain sufficient evidence regarding the frequency, severity, and duration of the Veteran's increased level of pain during flare-ups per his own reports. The Board finds such information pertinent and useful when evaluating the overall disability picture concerning the Veteran's lumbar spine disability. As noted above, the Veteran's lumbar spine disability is currently rated 10 percent disabling prior to November 30, 2012. To qualify for a higher rating of 20 percent, the Veteran must demonstrate 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; or incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. Review of the objective medical evidence does not show the Veteran to have forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or incapacitating episodes having a total duration of at least two weeks but less than four weeks, at any time prior to November 30, 2012. However, the Board finds that it is at least as likely as not that the Veteran's lumbar spine disability resulted in muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour prior to November 30, 2012. In this regard, a 2005 x-ray report showed the Veteran's lumbar spine to have scoliosis. The presence of an abnormal spinal contour was still evident in August 2008, within one year of the appeal period, when a VA physician found the Veteran's lumbar spine to have a loss of lordosis. Finally, at the June 2009 VA examination, the Veteran was noted to have an abnormal gait due to walking with a limp because of his lower back pain. In light of the above, and after resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran's lumbar spine disability caused muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour prior to November 30, 2012. As such, an initial 20 percent rating is warranted for the lumbar spine disability from April 7, 2009, the effective date of the grant of service connection. Next, the Board has considered whether the next higher rating of 40 percent can be assigned for the lumbar spine disability at any time during the appeal period. To qualify for a 40 percent rating, the Veteran must demonstrate forward flexion of the thoracolumbar spine of 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, at any time during the appeal period. Review of the objective medical evidence does not show, at any time, forward flexion of the thoracolumbar spine of 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or incapacitating episodes having a total duration of at least four weeks but less than six weeks. In this regard, the VA examination reports of record clearly reflect that the Veteran's forward flexion was limited, at its worst, to 35 degrees. See September 2021 VA examination report. Moreover, the Veteran has not been found to have ankylosis of the spine, or its functional equivalent, at any time. In this regard, range of motion testing throughout the entire duration of the appeal revealed the Veteran to have the ability to move his spine to some degree of forward flexion and extension. His spine has never been shown to be fixed at zero degrees in any plane. In fact, the September 2021 VA examiner confirmed the absence of ankylosis of the thoracolumbar spine in his medical opinion. Finally, with regard to incapacitating episodes, the Veteran was only documented to have one period of an incapacitating episode, however, it lasted less than one week in duration. See May 2012 VA examination report. As such, the Board finds that the preponderance of the evidence is against assigning a higher, 40 percent rating under the relevant rating criteria at any time during the appeal period. The Board has further considered whether factors including functional impairment and pain as addressed under 38 C.F.R. §§ 4.40 and 4.45 would warrant a higher rating. See DeLuca, 8 Vet. App. at 202. In this regard, the Board has considered the Veteran's descriptions of the additional functional impairment he experiences during periods of flare-up. He has competently described throughout the appeal period experiencing frequent episodes of increased pain, and sometimes stiffness, after periods of repetitive movement or after prolonged standing, sitting, lifting, or walking. However, there is nothing in the record, including the Veteran's own statements, to suggest these periods of increased symptomatology result in a disability picture that more nearly approximates the criteria for a 40 percent, or higher, rating. In this regard, functional loss is not shown beyond what is already contemplated by the currently-assigned 20 percent rating at any time. Notably, the Veteran was experiencing a period of flare-up upon VA examination in September 2021 and he was still able to achieve forward flexion to 35 degrees. He informed the examiner at that time that his flare-ups have progressed in frequency and severity, which suggests that the flare-up he was experiencing in September 2021 was more severe than the flare-ups he experienced at any other time during the duration of the appeal. As such, the Board finds that the Veteran's lumbar spine symptomatology during flare-ups and after repeated use over time is already fully contemplated by the currently-assigned 20 percent disability rating, and an increased rating cannot be assigned under this basis. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 204-07. Finally, the Board notes that all other potentially applicable diagnostic codes have been considered, but finds that no additional higher or separate ratings under a different diagnostic code can be applied in this case. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Notably, the Veteran is already compensated for his radicular symptoms associated with the lumbar spine as he is in receipt of separate disability ratings for radiculopathy of the bilateral lower extremities. No other neurological abnormalities associated with the lumbar spine have been identified. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). In reaching the above conclusions, the Board acknowledges that the Veteran sincerely believes that his lumbar spine disability is more severe than his currently-assigned rating reflects. In statements to VA and his examiners, the Veteran has reported that he suffers from constant pain in the lumbar spine that increases in severity with activities such as heavy lifting and prolonged walking, standing, or sitting, and that these symptoms interfere with his ability to perform activities of daily living. The Veteran is competent to testify to the presence of observable symptoms, such as experiencing an increased level of pain. See Layno v. Brown, 6 Vet. App. 465 (1994). However, he is not competent to report that his lumbar spine disability is of sufficient severity to warrant a higher rating under the rating schedule, as such an opinion requires specialized medical expertise which falls outside the realm of the common knowledge of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board sympathizes with the Veteran that his lumbar spine disability significantly impacts his quality of life. However, it must rely on the medical evidence of record to assign the appropriate disability rating, and therefore, accords the objective medical findings greater weight than subjective complaints of increased symptomatology. (Continued on next page) In summary, for the reasons set forth, the Board finds that entitlement to an initial rating of 20 percent for the lumbar spine disability is warranted prior to November 30, 2012. However, an initial rating in excess of 20 percent is not warranted at any time during the period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). To the extent the Board denied entitlement to an increased rating, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Melissa Barbee, 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.