Citation Nr: 21072431 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 15-18 841A DATE: December 3, 2021 ORDER Entitlement to service connection for residuals of head trauma is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for bowel and bladder neurological disability is denied. Entitlement to a rating in excess of 10 percent for a right knee disability is denied. Entitlement to a 10 percent rating, but not more, for right knee instability is granted. Entitlement to a rating in excess of 10 percent for left knee disability is denied. Entitlement to a rating 10 percent rating, but not more, for left knee instability is granted. Entitlement to a 20 percent rating, but not more, prior to October 13, 2020, for right lower extremity neuropathy is granted. Entitlement to a 40 percent rating, but not more, on and after October 13, 2020, for right lower extremity neuropathy is granted. Entitlement to a 20 percent rating, but not more, prior to October 13, 2020, for left lower extremity is granted. Entitlement to a 40 percent rating, but not more, on and after October 13, 2010, for left lower extremity radiculopathy is granted. INTRODUCTION The Veteran served on active duty from May 1995 to July 1995 and from May 1998 to May 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. In May 2019, the Board remanded the above-captioned claims for further development. After the issuance of a July 2020 supplemental statement of the case, the appeal was remitted to the Board for further appellate review. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has residuals of head trauma at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that erectile dysfunction began during active service, is otherwise related to an in-service injury or disease, and is not secondary to a service-connected disability. 3. The preponderance of the evidence is against finding that bowel and bladder neurological disabilities began during active service, is otherwise related to an in-service injury or disease, and is not secondary to a service-connected disability. 4. The Veteran's right knee disability is not manifested by or more nearly approximates limitation of flexion to 30 degrees. 5. The Veteran's right knee disability is not manifested by or more nearly approximates limitation of extension to 10 degrees. 6. The Veteran's right knee disability is manifested by slight instability or subluxation, but not moderate or severe, throughout the pendency of this appeal. 7. The Veteran's left knee disability is not manifested by or more nearly approximates limitation of flexion to 30 degrees. 8. The Veteran's left knee disability is not manifested by or more nearly approximates limitation of extension to 10 degrees. 9. The Veteran's left knee disability is manifested slight instability or subluxation, but not moderate or severe, throughout the pendency of this appeal. 10. Prior to October 13, 2020, the Veteran's right lower extremity radiculopathy is manifested by or more nearly approximates moderate incomplete paralysis of the sciatic nerve. 11. On and after October 13, 2020, the Veteran's right lower extremity radiculopathy has been productive of or more nearly approximates moderately severe incomplete paralysis of the sciatic nerve. 12. Prior to October 13, 2020, the Veteran's left lower extremity radiculopathy is manifested by or more nearly approximates moderate incomplete paralysis of the sciatic nerve. 13. On and after October 13, 2020, the Veteran's left lower extremity radiculopathy has been productive of or more nearly approximates moderately severe incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of head trauma are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for erectile dysfunction are not met, to include on a secondary basis. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for bowel and bladder neurological disability are not met, to include on a secondary basis. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for a rating in excess of 10 percent for right knee extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 5. The criteria for a rating in excess of 10 percent for left knee extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 6. The criteria for a separate 10 percent rating, but not more, for right knee instability have been met throughout the appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 7. The criteria for a separate 10 percent rating, but not more, for left knee instability have been met throughout the appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 8. The criteria for a 20 percent rating, prior to October 13, 2020, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 3.102, 3.400, 4.124a. Diagnostic Code 8520. 9. The criteria for a 40 percent rating, but not more, on and after October 13, 2020, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 3.102, 3.400, 4.124a. Diagnostic Code 8520. 10. The criteria for a 20 percent rating, prior to October 13, 2020, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 3.102, 3.400, 4.124a. Diagnostic Code 8520. 11. The criteria for a 40 percent rating, but not more, on and after October 13, 2020, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 3.102, 3.400, 4.124a. Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In May 2019, the Board remanded the Veteran's claims for additional development. Therein, the Board directed the RO to obtain any relevant treatment records that have not already been associated with the claims file and provide the Veteran with VA examinations. In October 2019 and September 2020, the Veteran's updated VA treatment records were associated with the claims file. Further, the requested VA examinations occurred in November 2019. Thereafter, the RO re-adjudicated the Veteran's claims, issued a July 2020 supplemental statement of the case, and remitted the appeal to the Board for further appellate review. Thereafter, in an October 2020 rating decision, the RO increased the ratings assigned to the Veteran's right and left lower extremity radiculopathy from 10 percent to 20 percent, effective October 13, 2020. Because these decisions do not grant the maximum benefits sought on appeal and the Veteran did not otherwise limit his appeal to the granted benefits, the claims remain pending before VA. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board finds that the RO substantially complied with the May 2019 remand directives and, thus, a remand for corrective actions is not required. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Veteran asserts that he incurred residuals of head trauma during his active duty. The Veteran also asserts that he incurred erectile dysfunction and bowel and bladder problems as a result of his active duty or that these disabilities are neurological abnormalities associated with his service-connected intervertebral disc syndrome. See 38 C.F.R. § 4.71A, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). With respect to the Veteran's erectile dysfunction and bowel and bladder neurological disability, according to Note (1) of the General Rating Formula for Disease and Injuries of the Spine, when evaluating a service-connected spine disability, the rater is directed to evaluate any associated neurological abnormalities associated with the service-connected spine disability under an appropriate diagnostic code. Thus, the operative question is whether the claimed disability is a neurological abnormality associated with the service-connected disability. Residuals of Head Trauma The Veteran asserts that he currently experiences residuals of head trauma that occurred during his active duty. Specifically, the Veteran states that he sustained head trauma during numerous parachute jumps. Indeed, the Veteran's DD 214 indicates that he was awarded Parachutist Badge. Consequently, the Board finds the Veteran's statements and September 2018 testimony as to in-service head trauma due to parachute jumps to be credible. The salient question presented by the Veteran's claim is, thus, whether he experiences any residuals to the in-service head trauma. Pursuant to the May 2019 remand, the Veteran was provided a November 2019 VA examination to assess the presence and nature of any head trauma residuals. After reviewing the evidence of record, interviewing the Veteran as to the onset and course of his symptoms, and administering a clinical evaluation, the examiner determined that the Veteran does not experience residuals of trauma or residuals of a traumatic brain injury. The examiner observed that a diagnosis of multiple sclerosis was rendered in December 2011, and the examiner opined that this condition had progressed since then. According to the examiner, the symptoms the Veteran associated with head injury residuals were due to his multiple sclerosis. Further, with respect to brain lesions revealed by prior imaging studies, the examiner stated that they were "stable white matter lesions secondary to demyelinating disease" (multiple sclerosis is a demyelinating disease). The Board acknowledges the Veteran's sincere belief that he experiences residuals of head trauma. The Board notes that the Veteran is competent to report observable symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). However, his assertions as to the presence of diagnosable residuals of head trauma are not competent, as such an opinion requires specialized medical expertise which falls outside the realm of the common knowledge of a layperson. This is especially true given the presence of other possibilities, such as multiple sclerosis. The evidence of record does not demonstrate that the Veteran possesses the ability, knowledge, or experience to provide competent diagnostic opinions of such. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Veteran's assertions do not constitute competent evidence in this case. The evidence of record is negative for other probative opinions addressing the presence of head trauma residuals. Given the evidence discussed above, there is no current diagnosis of head injury residuals. As a result, the Board finds that the preponderance of the evidence is against the claim. Consequently, service connection for residuals of head trauma must be denied. In making this determination, the Board acknowledges that the Veteran withdrew a claim of entitlement to service connection for multiple sclerosis, which was effectuate by the Board in May 2019. Thus, re-captioning the claim on appeal as entitlement to service connection for multiple sclerosis is not warranted. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Erectile Dysfunction and Bowel and Bladder Neurological Disability The Veteran asserts that his erectile dysfunction and bowel and bladder disability were incurred during service or were caused or aggravated by a service-connected disability. Specifically, regarding service connection on a secondary basis, the Veteran asserts that these disabilities are either neurological abnormalities associated with his service-connected intervertebral disc syndrome or resulted from medication prescribed to treat his service-connected adjustment disorder with depression and anxiety. The evidence of record includes current diagnoses of erectile dysfunction and bowel and bladder dysfunction. According to a June 2013 VA examination, no bowel problem or intestinal problem was diagnosed; bladder dysfunction was not addressed. In September 2015, the Veteran underwent a VA examination with a primary purpose of assessing his service-connected intervertebral disc syndrome. The examiner determined that right and left lower extremity radiculopathy was associated with his intervertebral disc syndrome. When addressing whether the Veteran's intervertebral disc syndrome was manifested by other neurologic abnormalities, the examiner indicated no (an "X" in a box adjacent to "No"). In November 2019, the Veteran underwent VA examinations specifically to assess the nature and etiology of his erectile dysfunction and bowel and bladder neurological disability. The examiner reviewed the evidence of record, interviewed the Veteran, and administered clinical evaluations. Ultimately, the examiner rendered diagnoses of neurogenic bladder, benign prostatic hypertrophy with residual voiding dysfunction, and erectile dysfunction. The examiner opined that the Veteran's neurogenic bladder and erectile dysfunction were etiologically related to his nonservice-connected benign prostatic hypertrophy and multiple sclerosis. In a separate examination report, the examiner stated that multiple sclerosis "affects the bowel and bladder as well as causing erectile dysfunction. These associations have been well[-]demonstrated in multiple research studies." The examiner then provides hyperlinks to two supporting articles from the National Institutes of Health. The examiner also opined that the Veteran's neurogenic bladder and erectile dysfunction are not secondary to his service-connected intervertebral disc syndrome or adjustment disorder, but, again, were due to multiple sclerosis and benign prostatic hypertrophy. In November 2019, the Veteran underwent a VA examination to assess the severity of service-connected intervertebral disc syndrome. An aspect of this examination requested that the examiner identify any neurological abnormalities related to the spine disability. The examiner indicated there were none (an "X" in a box adjacent to "No"). The Board acknowledges the Veteran's sincere belief that his erectile dysfunction and bowel and bladder disability are service related or related to a service-connected disability. The Board notes that the Veteran is competent to report observable symptoms. See Layno, 6 Vet. App. at 469. However, his assertions as to etiology are not competent, as such an opinion requires specialized medical expertise which falls outside the realm of the common knowledge of a layperson. This is especially true given the presence of other etiological possibilities, such as multiple sclerosis. The evidence of record does not demonstrate that the Veteran possesses the ability, knowledge, or experience to provide competent etiological opinions of such. Jandreau, 492 F.3d at 1377. Consequently, the Veteran's assertions do not constitute competent evidence in this case. The evidence of record is negative for other probative opinions addressing the etiology of the Veteran's erectile dysfunction or bowel and bladder disability. The Board finds that the preponderance of the evidence is against the claims. Consequently, service connection for erectile dysfunction and bowel and bladder neurologic disability must be denied. Increased Ratings The Veteran asserts that he is entitled to ratings in excess of those already assigned to his right and left knee disabilities, as well as his right and left lower extremity radiculopathy. Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. However, pyramiding, or evaluating the same manifestation of a disability under different diagnostic codes, is to be avoided. See 38 C.F.R. § 4.14. Thus, separate ratings under different diagnostic codes are only permitted if, those separate ratings are assigned based on manifestations of the Veteran's disability that are separate and apart from manifestations for which the Veteran has already been rated. See Esteban v. Brown, 6 Vet. App. 259, 261 (1994). Separate ratings may be awarded so long as assignments of separate ratings would not result in compensating the Veteran twice for the same symptom. Lyles v. Shulkin, 29 Vet. App. 107 (2017). Knees On June 16, 2016, VA received the Veteran's claims of entitlement to increased ratings for his service-connected right and left knee disabilities. Throughout the pendency of this appeal, the Veteran's right and left knee disability has each been assigned a 10 percent rating based on limitation of flexion. 38 C.F.R. § 4.71A, Diagnostic Code 5260. Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), instability and recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of motion of the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees, and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Ratings can be assigned when a knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. In this case, the evidence does not reflect, and the Veteran does not allege, that he has any meniscal disability. As such, these diagnostic codes are not for application. Ratings can be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). In this case, the evidence does not reflect, and the Veteran does not allege, that he has tibia or fibula impairment, genu recurvatum, or ankylosis of the knee. As such, those diagnostic codes are not for application. Ratings can be assigned for knee instability or subluxation under Diagnostic Code 5257. 38 C.F.R. § 4.71a. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a, including Diagnostic Code 5257, were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 30, 2020). Prior to February 7, 2021, the Board will consider the old version of the diagnostic code only; however, for the period beginning February 7, 2021 the Board will consider both the old and amended version of the diagnostic code and rate based on whichever is most favorable to the Veteran. Prior to the regulatory change, recurrent subluxation and lateral instability of the knee warranted a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2020). "Slight," as relevant to a physical condition, is defined as "small of its kind or in amount." Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed February 8, 2021). It is similar to "mild," which is defined as "not severe" or temperate; with "Temperate" being defined as "keeping or held within limits" and "not extreme or excessive." "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect." Id. "Severe" is defined as "very painful or harmful" or "of a great degree." Id. Within the context of the old version of Diagnostic Code 5257, which established a successive, tiered rating structure, "severe" represented the highest or most extreme level of disability. As of February 7, 2021, Diagnostic Code 5257 contains two sections for rating other impairment of the knee. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The first is for recurrent subluxation or instability. The second is for patellar instability. Regarding recurrent subluxation and instability, a compensable rating requires persistent instability. Id.; see also 38 C.F.R. § 4.31. "Persistent" is defined as "continuing or inclined to persist in a course" with "continuing" defined as "constant" and "persist" defined as "to continue to exist." Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed February 8, 2021). Under these criteria, a 30 percent rating is assigned with unrepaired or failed repair of complete ligament tear which causes persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. A 20 percent rating is assigned with either (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation, or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 10 percent rating is assigned for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability without a prescription from a medical provider for an assistive device or bracing for ambulation. Regarding patellar instability, a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker warrants a 30 percent rating, which is the highest allowable rating for patellar instability. A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace, cane, or walker warrants a 20 percent rating. A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker warrants a 10 percent rating. The patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Id. at Note (2). Range of motion testing was performed during VA examinations in September 2015 and November 2019. At worst, the Veteran's right knee range of motion was from zero degrees of extension to 90 degrees of flexion. With respect to his left knee, at worst, his range of motion was from zero degrees of extension to 110 degrees of flexion. At the examinations, the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed by the examiners, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. At the September 2015 examination, the Veteran denied flare-ups. The examiner indicated that the Veteran was being evaluated immediately after repetitive use over time, and that "pain, weakness, fatigability, or incoordination do not limit functional ability when both knees are used repeatedly over time." During the October 2019 examination, the Veteran endorsed flare-ups consisting of increased pain and swelling, right knee worse than left. Notably, the October 2019 examiner estimated right knee range of motion during flare-up and after repetitive use over time would be, at worst, 80 degrees of flexion and zero degrees of extension. Left knee range of motion during flare-ups and after repetitive use over time would be, at worst, 100 degrees of flexion and zero degrees of extension. The examiner stated that the evaluation was not being conducted during a flare-up or immediately after repetitive use over time, but that these reduced range of motion estimations were consistent with the Veteran's statements describing functional loss. For the Veteran's right knee, the additional function loss was due to pain, fatigue, weakness, lack of endurance, and incoordination. For his left knee, the additional functional loss was attributed to pain. The Board finds that the range of motion findings on examination depict the estimated range of motion during a flare-up or after repetitive use over time. While given the opportunity to describe functional limitation related to the disability, the Veteran's statements do not show the requisite limitation of motion necessary for a higher rating for limitation o flexion or a separate rating for limitation of extension. Treatment records do not show greater limitation of motion than the examination findings. Given the above, a higher rating for limitation of flexion or separate rating for limitation of extension is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5260, 5261. Throughout the pendency of this appeal, the Veteran has asserted that his right and left knee disabilities are manifested by instability and/or subluxation. Notably, there are specific medical tests that are designed to reveal instability of the joints. These tests were administered by medical professionals in this case during the September 2015 and October 2019 VA examinations and revealed no instability. Given the tests performed are generally recognized in the medical community as diagnostic for instability, the results are afforded high probative value. With that said, however, in addressing additional factors contributing to the Veteran's disability, the October 2019 examiner observed that the Veteran's right knee osteoarthritis "causes pain and instability," and that buckling and falls results from right knee weakness. Indeed, the examiner characterized the Veteran's right hamstring and quadriceps as "noticeably atrophied." The examiner also noted that the Veteran constantly utilized a cane and occasionally used a walker to assist with ambulation due to right knee weakness due to osteoarthritis. Further, with respect to additional contributing factors to left knee disability, the examiner noted disturbance of locomotion, interference with standing, and pain with prolonged weight bearing. These findings conflict with the result of the stability testing and, thus, reduce the probative value of the September 2015 and October 2019 VA examinations in this respect. In this case, the Board finds the Veteran's reports of right and left knee instability competent and credible. See English v. Wilkie, 30 Vet. App. 347 (2018). He has testified that his right and left knee instability has been present throughout the appeal period. Accordingly, the Board finds that throughout the appeal period, based on the Veteran's competent and credible testimony, that his right and left knee disability is manifested by slight recurrent subluxation or lateral instability. Resolving all reasonable doubt in favor of the Veteran, the Board finds that the criteria for separate 10 percent ratings are warranted for right and left knee instability throughout the appeal period. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Regarding the version of Diagnostic Code 5257 in effect prior to February 7, 2021, a higher is not warranted as the preponderance of the evidence is against finding the presence of moderate or severe lateral instability or recurrent subluxation. While the September 2015 and October 2019 VA examinations reveal the presence of some bilateral knee instability, as determined immediately above, the specific tests administered to assess instability were negative. The Board finds that it is reasonable to expect that moderate or severe knee instability would be detected by these tests. Moreover, the examiner also attributed a portion of the instability to the Veteran's non-service-connected multiple sclerosis. For these reasons, a rating in excess of 10 percent is not warranted for either his right or left knee instability. Regarding the version of Diagnostic Code 5257 in effect since February 7, 2021, in order for a rating in excess of 10 percent to be warranted, the preponderance of the evidence must show or more nearly approximate the following: for a 20 percent rating (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, with both requiring a prescribed assistive device or bracing for ambulation. For 30 percent, an unrepaired or failed repair of complete ligament tear causing persistent instability and that a medical provider proscribes both an assistive device and bracing for ambulation. The evidence of record consistently demonstrates that the Veteran's right and left knee disability are not manifested by a sprain or ligament tears (regardless of severity), and that the Veteran has not undergone a right or left knee surgical procedure. Consequently, the Board finds that a rating in excess of 10 percent is not warranted on and after February 7, 2021, under the revised rating criteria for Diagnostic Code 5257. Lower Extremity Radiculopathy Prior to October 13, 2020, separate 10 percent ratings have already been assigned to the Veteran's right and left lower extremity radiculopathy, while separate 20 percent ratings have been on and after October 13, 2020. Sciatic nerve neurological manifestations are rated under Diagnostic Code 8520, 8620, or 8720 as, respectively, paralysis, neuritis or neuralgia of the sciatic nerve. Complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Incomplete paralysis of the sciatic nerve warrants a 60 percent evaluation if it is severe with marked muscular dystrophy, a 40 percent evaluation if it is moderately severe, a 20 percent evaluation if it is moderate or a 10 percent evaluation if it is mild. The preface to 38 C.F.R. § 4.124a states, when the involvement is wholly sensory, the rating should be for the mild, or at the most, the moderate degree. In addition, the preface states that the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. The Board acknowledges that the terms "mild," "moderate," and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The use of terminology such as "moderate" or "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board notes, for reference and illustrative purposes only, that the definitions for "mild" includes not very severe. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). The Board also notes that a synonym for "mild" is "slight" and definitions for "slight" includes small in size, degree, or amount. Id. at 1038. The definitions for "moderate" includes of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions for "severe" includes extremely intense. Id. at 1012. It is also noted that the term "moderately severe" includes impairment that is considered more than "moderate" but not to the extent as to be considered "severe." In September 2015, the Veteran was afforded a VA examination for his back disability, which included an assessment of neurological abnormalities. A sensory examination revealed decreased foot/toe sensation, bilateral. With respect to radiculopathy, the examiner noted bilateral, mild, intermittent pain, usually dull; bilateral, mild, paresthesias and/or dysesthesias; and bilateral, mild numbness. The examiner stated that this indicated L4/L5/S1/S2/S3 nerve root involvement. The examiner assessed the severity of the Veteran's radiculopathy as mild, bilaterally. In November 2019, the Veteran underwent another VA examination to assess the severity of his back disability. During the examination, the Veteran reported pain that travelled from his back down into his right thigh, behind his right knee, and his left posterior thigh. He also endorsed numbness with sitting, worse in his feet. A reflex examination revealed hypoactive responses (+1) in his knees and ankles. A sensory examination showed decreased sensation in his lower legs/ankles and feet/toes, bilaterally. Intermittent, mild pain associated with radiculopathy was observed in the Veteran's lower extremities, bilaterally, as was bilateral, mild, paresthesias and/or dysesthesias; and bilateral, moderate numbness. This examiner opined that this indicated L4/L5/S1/S2/S3 nerve root involvement, assessing the severity as mild, bilaterally. In light of the above medical evidence and the Veteran's report of radicular pain, decreased sensation, and mild-moderate numbness, and use of medication, the Board finds that the evidence prior to October 13, 2020, shows that the Veteran's right and left lower extremity radiculopathy is manifested by or more nearly approximates moderate incomplete paralysis of the sciatic nerve. Accordingly, separate 20 percent ratings are warranted for the Veteran's right and left lower extremity radiculopathy. Prior to October 13, 2020, a higher rating of 40 percent is not warranted as the Veteran's bilateral lower extremity radiculopathy has resulted in no more than moderate incomplete paralysis of the sciatic nerve. On October 13, 2020, the Veteran underwent a VA examination to evaluate the severity of his service-connected back disability. The Veteran reported that his pain had progressively worsened and radiated into bilateral lower extremities. He endorsed ongoing numbness and weakness. Results from reflex and sensory examinations mirrored those from the November 2019 VA examination. The examiner determined that the Veteran was experiencing constant, severe pain, which may be excruciating at times, as well as bilateral, severe paresthesias and/or dysesthesias, bilaterally, and bilateral lower extremity numbness. The examiner opined that this indicated L4/L5/S1/S2/S3 nerve root involvement, assessing the severity as moderate, bilaterally. The results of the October 13, 2020 VA examination demonstrated that the severity of the Veteran's right and left lower extremity radiculopathy has worsened. Consequently, the Board finds that the evidence on and after October 13, 2020, shows that the Veteran's right and left lower extremity radiculopathy is manifested by or more nearly approximates moderately severe incomplete paralysis of the sciatic nerve. As such, separate 40 percent ratings are warranted for the Veteran's right and left lower extremity radiculopathy. On and after October 13, 2020, a higher rating of 60 percent is not warranted as the Veteran's bilateral lower extremity radiculopathy do not meet or more nearly approximate severe incomplete paralysis of the sciatic nerve with marked muscular dystrophy more than moderate. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean G. Pflugner, 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.