Citation Nr: 21072985 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-10 233 DATE: December 7, 2021 ORDER Entitlement to an initial rating for lumbosacral strain in excess of 20 percent prior to January 27, 2020 and in excess of 40 percent thereafter is denied. Entitlement to an initial 50 percent rating, from January 3, 2013, for migraine headaches, is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to an initial rating in excess of 50 percent for migraine headaches is denied. Entitlement to an initial 10 percent rating, from January 3, 2013, for left knee patellofemoral pain syndrome, is granted, subject to controlling regulations governing the payment of monetary awards. Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is denied. Entitlement to an initial compensable rating, prior to November 21, 2019, and a rating in excess of 20 percent, since that date, for radiculopathy of sciatic nerve left lower extremity is denied. Entitlement to an initial compensable rating, prior to November 21, 2019, and a rating in excess of 20 percent, since that date, for radiculopathy of sciatic nerve right lower extremity is denied. FINDINGS OF FACT 1. Even in consideration of his complaints of pain, pain on motion, and functional loss, the Veteran's back disability did not manifest forward flexion of 30 degrees or less prior to January 27, 2020; and, he has not had ankylosis (or the functional equivalent of ankylosis) at any time since the effective date of service connection. 2. The evidence is at least evenly balanced as to whether, from the January 3, 2013 effective date of service connection, the Veteran's headaches have been manifested by frequent completely prostrating and prolonged attacks, productive of severe economic inadaptability and to the extent that medication ameliorated these symptoms, such amelioration cannot be considered. 3. From the January 3, 2013 effective date of service connection, the Veteran's left knee patellofemoral pain syndrome has been manifested by knee pain; even in consideration of his complaints of pain, pain on motion, and functional loss, the Veteran's left knee disability has not manifested flexion to 30 degrees or extension to 15 degrees; dislocated or removed semi-lunar cartilage; or recurrent subluxation or instability. 4. The Veteran's radiculopathy of sciatic nerve left lower extremity has been manifested by at most moderate incomplete paralysis since November 21, 2019. 5. The Veteran's radiculopathy of sciatic nerve right lower extremity has been manifested by at most moderate incomplete paralysis since November 21, 2019. CONCLUSIONS OF LAW 1. The criteria for an initial rating for lumbosacral strain in excess of 20 percent prior to January 27, 2020 and in excess of 40 percent thereafter are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for an initial 50 percent rating, but no higher, from January 3, 2013, for migraine headaches, are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8100. 3. The criteria for an initial 10 percent rating, but no higher, from January 3, 2013, for left knee patellofemoral pain syndrome, are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Codes 5257-5261. 4. The criteria for an initial compensable rating, prior to November 21, 2019, and in excess of 20 percent, since that date, for radiculopathy of sciatic nerve left lower extremity, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 5. The criteria for an initial compensable rating, prior to November 21, 2019, and in excess of 20 percent, since that date, for radiculopathy of sciatic nerve right lower extremity, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Marine Corps from March 2005 to January 2013. His awards include the Combat Action Ribbon. The appeal originates from an October 2013 decision of a Department of Veterans Affairs (VA) Regional Office. These matters were remanded by the Board in June 2019 for further development. Specifically, the Board instructed the agency of original jurisdiction (AOJ) to, among other things, obtain any outstanding VA and private treatment records and afford the Veteran VA examinations to assess the severity of his service-connected back, left knee, and headache disabilities. Pursuant to the Board's remand, the Veteran was asked to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records by way of a November 2019 letter. Copies of the authorization forms (VA Forms 21-4142a and 21-4142) were included with the letter. Also, all outstanding VA treatment records were obtained and associated with the claims file, and appropriate VA examinations were obtained in November 2019 and January 2020. It is noted that the remanded issues of service connection for right knee and sciatic nerve disabilities were granted in a July 2020 rating decision, and the right knee issue is no longer before the Board. Therefore, the AOJ substantially complied with the Board's pertinent remand instructions. See Dyment v. West, 13 Vet. App. 141, 146- 47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). As for characterization for the issues on appeal, the Board has included the separate issues of entitlement to higher initial ratings for left and right lower extremity radiculopathy of the sciatic nerves because these issues are being considered as part of the appeal for a higher initial rating for the service-connected back disability. See 38 C.F.R. § 4.71A , General Rating Formula for Diseases and Injuries of the Spine, Note (1) (providing that associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code). Chavis v. McDonough, 34 Vet. App. 1, 15-18 (2021) (radiculopathy need not be separately appealed to be considered part of a claim for a higher rating for the spine). Higher Initial Ratings Disability ratings are determined by comparing a veteran's present symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point, if any, at which such factors cause functional impairment. Moreover, the joints involved should be tested for pain on both active and passive motion, in weight bearing and non weight-bearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016); Mitchell v. Shinseki, 25 Vet. App. 32, 43-4 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. The criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis. See Chavis v. McDonough, 34 Vet. App. 1 (2021). Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. Therefore, the Board will consider the Veteran's claim under the former criteria prior to February 7, 2021, and both the former and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. 1. Entitlement to an initial rating for lumbosacral strain in excess of 20 percent prior to January 27, 2020 and in excess of 40 percent thereafter. The Veteran's back disability is rated under Diagnostic Code 5237 under the General Rating Formula for Diseases and Injuries of the Spine. 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, a 40 percent rating requires unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating requires unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating requires unfavorable ankylosis of the entire spine. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Code 5237 was not substantively changed. Changes to Diagnostic Code 5243, which pertains to intervertebral disc syndrome (IVDS), arguably creates a more restrictive application as it now directs to assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root, and to otherwise assign diagnostic code 5242 for all other disc diagnoses. However, it is again noted that the General Rating Formula for Diseases and Injuries of the Spine and the Formula for Rating IVDS Based on Incapacitating Episodes did not change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 32000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In this regard, the Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the agency of original jurisdiction. In Disabled American Veterans v. Sec. of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit specifically upheld the validity of 38 C.F.R. § 19.9(b)(2) (now as noted renumbered as 38 C.F.R. § 20.904(d)(2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the claim. Based on the evidence, including the September 2013, November 2019, and January 2020 VA examinations, the Veteran is not entitled to an initial rating in excess of 20 percent prior to January 27, 2020. He did not have forward flexion of 30 degrees or less during this period. His forward flexion was limited to, at worst, 55 degrees in September 2013, including consideration of repetitive use, repeated use over time, passive use, and flareups. While the January 2020 examination found forward flexion of 25 degrees with repeated use over time, it does not indicate when this limitation arose to support an increased rating earlier in the appeal. The Veteran has also not had ankylosis or the functional equivalent of ankylosis at any time during the appeal. The examiners specifically found that he did not have a diagnosis of ankylosis. He neither contends, nor does the record show, that his back disability produces symptoms approximating ankylosis. Indeed, he has repeatedly been shown to have at least some range of motion despite his assertions of worsening symptoms. The United States Court of Appeals for Veterans Claims (Court) has established that reports of flareups of symptomatology must be considered. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Guidance on how to evaluate flareups has not been particularly clear. However, the Board finds overall wisdom in Mitchell. Flareups must be quantifiable and result in limitation of motion or function beyond that contemplated by the already provided evaluation. In addition, because there is a regulation addressing stabilization of ratings, the flareup must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time. With that in mind, consideration has been given to the Veteran's reports of experiencing flareups of back symptoms. The contemporaneous treatment records contain little, if any, findings pertaining to flareups, much less information regarding his functional ability during a flareup or after repeated use over time. The additional limitation (functional loss) experienced by the Veteran due to pain was accounted for by the examiners when determining his ranges of motion (including during flareups). As to his reports of pain, lack of endurance, stiffness, and similar complaints, the evidence does not demonstrate additional functional limitation more closely approximating the criteria for a higher rating. Overall, the Board finds that the reported and observed functional impairments following repeated use over time and during flare ups have not been so severe, frequent, and/or prolonged to warrant a rating higher than 20 percent prior to January 27, 2020 or a rating higher than 40 percent since that time. In other words, even considering functional impairment due to pain and other factors, the Veteran's symptoms have not been shown to be so disabling as to actually or effectively result in limitation of motion of the thoracolumbar spine to 30 degrees or less at any time prior to January 27, 2020, or the functional equivalent of ankylosis at any time during the claim period. Therefore, the Board finds that the currently assigned ratings for the back disability adequately contemplate the documented and reported functional limitations. Mitchell, supra. Accordingly, an initial rating in excess of 20 percent prior to January 27, 2020 and in excess of 40 percent thereafter is not warranted. 2. Entitlement to an initial compensable rating for migraine headaches prior to November 21, 2019 and in excess of 50 percent thereafter. The Veteran's migraine disability is rated under Diagnostic Code 8100. Under this diagnostic code, a 10 percent rating requires characteristic prostrating attacks averaging one in two months over last several months. A 30 percent rating requires characteristic prostrating attacks occurring on an average once a month over last several months. A 50 percent rating requires very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Court has held that "nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50% rating," and that "[i]f 'economic inadaptability' were read to import unemployability, the appellant, if he met the economic-inadaptability criterion, would then be eligible for a rating of total disability based on individual unemployability resulting from a service-connected disability (TDIU) rather than just a 50% rating." Pierce v. Principi, 18 Vet. App. 440, 446 (2004). In Pierce, the Court explained that where the Board refused to award a 50 percent disability rating for a headache disorder without discussing the "interplay" among the regulations found at 38 C.F.R. § 4.3 (reasonable doubt resolved in favor of claimant), 38 C.F.R. § 4.7 (higher possible evaluation applies "if disability picture more nearly approximates the criteria for that rating[;] otherwise, the lower rating will be assigned"), and 38 C.F.R. § 4.21 (all the elements specified in a disability grade need not necessarily be found although "coordination of rating with impairment of function will, however, be expected in all instances"), the Board committed reasons or bases error. Id. at 445. In addition, the Court acknowledged the Secretary's concession that the phrase "productive of severe economic inadaptability" in DC 8100 should be construed as either "producing" or "capable of producing" severe economic inadaptability. Id. However, in Johnson v. Wilkie, 30 Vet. App. 245 (2018), the Court clarified that the criteria of DC 8100 are successive, and 38 C.F.R. §§ 4.7 and 4.21 are not for application. The phrase "characteristic prostrating attacks" is used in the criteria corresponding to a 10 percent rating under Diagnostic Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." See Holmes v. Wilkie, 33 Vet. App. 67 (2020). Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. Id. The criteria for migraine headaches under Diagnostic Code 8100 contemplate all manifestations of that condition, including non-headache symptoms such as dizziness, mood swings, sleep impairment, and nausea. Id. The rating of headaches or migraines under Diagnostic Code 8100 focuses on "attacks." It is the frequency, duration, severity, and economic impact of these attacks that differentiate the levels of disability in Diagnostic Code 8100. Id. All symptoms experienced as a result of migraine attacks should be considered and rated based on the frequency, severity, and economic impact of the attacks. Based on the evidence, including the September 2013, November 2019, and January 2020 examinations, the Board finds that the evidence is at least evenly balanced as to whether a 50 percent rating is warranted for migraine attacks since the January 3, 2013 effective date of service connection. The Board acknowledges that the September 2013 VA examination report indicates that the Veteran did not have any characteristic prostrating attacks of headache pain. However, he reported during the examination that he experienced spontaneous instances of right-sided headache pain lasting a few seconds, as well as intermittent moderate bilateral occipital dull pressure-like headaches occurring twice a week and lasting 15 minutes to two hours at a time, for which he rarely took medication, with sensitivity to light. While he stated that the headaches limited prolonged focus and concentrating, he was capable of performing all activities of daily living. Moreover, in his July 2014 notice of disagreement, the Veteran specified that his headaches were severe enough that they would "stop [him] dead in [his] tracks" and that he was unable to "do anything" until a headache was over. Moreover, the November 2019 and January 2020 examinations do indicate characteristic prostrating attacks. The Board also acknowledges that the Veteran was employed as an HVAC technician from the outset of the appeal until approximately mid-2017. See December 2018 Resume. At the same time, he earned a Bachelor of Science in Information Technology (graduating in December 2018 with high marks) as well as seven technical certifications through the end of 2019. See September 2018 VR&E General; November 2019 VA Examination; April 2020 Statement. Overall, the Board finds that the evidence is at least evenly balanced as to whether the Veteran's service-connected headaches have been manifested by frequent completely prostrating and prolonged attacks of headache pain that result in severe economic inadaptability during the entire period from the January 3, 2013 effective date of service connection. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, an initial 50 percent rating is warranted for his migraine headaches, from January 3, 2013. This is the maximum possible schedular rating under DC 8100. 3. Entitlement to an initial rating for left knee patellofemoral pain syndrome in excess of 0 percent prior to November 21, 2019 and in excess of 10 percent thereafter. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Codes 5258, 5259, 5260, and 5261 were not substantively changed. Diagnostic Code 5257 was substantively changed and is discussed in further detail below. The Veteran's left knee disability is rated under Diagnostic Code 5260 for limitation of flexion of the leg. Under this diagnostic code, a noncompensable rating is assigned when flexion is limited to 60 degrees. A 10 percent rating requires flexion limited to 45 degrees. A 20 percent rating requires flexion limited to 30 degrees. Diagnostic Code 5257 addresses other impairment of the knee. Prior to February 7, 2021, a 10 percent rating required slight recurrent subluxation or lateral instability. From February 7, 2021, for recurrent subluxation or instability under Diagnostic Code 5257, a 10 percent rating requires 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 (e.g., cane(s), crutch(es), walker) or bracing for ambulation. From February 7, 2021, for patellar instability under Diagnostic Code 5257, a 10 percent rating requires 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. Diagnostic Code 5258 assigns a 20 percent rating for dislocated semilunar cartilage with episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 assigns a 10 percent rating for removal of symptomatic semilunar cartilage. Diagnostic Code 5261 addresses limitation of extension of the leg. A noncompensable rating is assigned when extension is limited to 5 degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating requires extension limited to 15 degrees. In claims for higher ratings for musculoskeletal disabilities, where a veteran has a noncompensable rating and complains of pain on motion, the veteran may be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59 ; Burton v. Shinseki, 25 Vet. App. 1 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the Court held that under 38 C.F.R. § 4.59, "the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint," and it explained that 38 C.F.R. § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that 38 C.F.R. § 4.59 does not require "objective" evidence, but can be satisfied with lay and other non-medical evidence. Id. at 429. The provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton, supra; Id. Moreover, the plain language of § 4.59 indicates that it is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable, or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is being evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). Based on the evidence, including September 2013, November 2019, and January 2020 examinations, the Board finds that an initial 10 percent rating, but no higher, is warranted for the Veteran's service-connected left knee disability, from the January 3, 2013 effective date of service connection. The evidence indicates that during the entire claim period from the January 3, 2013 effective date of service connection, the Veteran's service-connected left knee disability has manifested by left knee pain, to include after prolonged walking and with climbing and going down ladders. In light of the evidence of actual left knee pain which has resulted in functional impairment, and the Court's holding in Petitti, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that the minimum, compensable rating for the knee (i.e.,10 percent) is warranted for the service-connected left knee disability, from the January 3, 2013 effective date of service connection. See Petitti, 27 Vet. App. at 424-30; Burton, 25 Vet. App. at 3-5; 38 C.F.R. § 4.71A, DC 5260. The Board also finds that the Veteran is not entitled to an initial rating in excess of 10 percent for his left knee disability at any time during the claim period. He has not had flexion to 30 degrees or extension to 10 degrees. At worst, he has had limitation of flexion to 100 degrees during flareups with 0 degrees of extension (normal), including consideration of repetitive use, repeated use over time, and passive use. Such does not approximate limitation of motion required for even a noncompensable rating based on flexion or extension. With respect to a meniscal condition, the Veteran neither contends nor has he been found to have dislocated or removed semilunar cartilage. As to subluxation or instability, the Board notes his description of fear of instability while climbing ladders or stairs. See October 2014 NOD. However, these reports are vague and do not appear to specify actual symptoms of instability. While the September 2013 examiner noted "evidence of inducible pain from patellar subluxation of the left knee with movement," the Veteran himself denied symptoms of locking or giving out. Contemporaneous treatment records and lay statements do not indicate subluxation prior to or following the examination. The November 2019 and January 2020 examinations reflect that joint stability testing was normal for the knee with no subluxation found. The evidence is too uncertain to support the assignment of a separate rating for recurrent subluxation under Diagnostic Code 5257. Though subluxation was found at the September 2013 examination, it is not reflected prior to or following this time in the appeal even considering both the medical and lay evidence. In the absence of additional information delineating the history and manifestations of subluxation, it would be speculative for the Board to assign a separate rating. Consideration has also been given to the Veteran's reports of experiencing flareups of the left knee. The contemporaneous treatment records contain little, if any, findings pertaining to flareups, functional ability during a flareup, or after repeated use over time. The additional limitation (functional loss) experienced by the Veteran due to pain was accounted for by the examiners when determining his ranges of motion (including during flareups). As to his reports of pain, stiffness, clicking, and similar complaints, the evidence does not demonstrate additional functional limitation more closely approximating the criteria for a higher rating. Therefore, the Board finds that a 10 percent rating for the left knee disability adequately contemplates the documented and reported functional limitations. Mitchell, supra. Accordingly, an initial 10 percent rating, but no higher, from January 3, 2013, for left knee patellofemoral pain syndrome, is warranted. 4. Entitlement to an initial compensable rating, prior to November 21, 2019, and a rating in excess of 20 percent, since that date, for radiculopathy of sciatic nerve left lower extremity. 5. Entitlement to an initial compensable rating, prior to November 21, 2019, and in excess of 20 percent, since that date, for radiculopathy of sciatic nerve right lower extremity. The Veteran's lower extremity radiculopathies are rated under Diagnostic Code 8520 for paralysis of the sciatic nerve. A 10 percent rating requires mild incomplete paralysis. A 20 percent rating requires moderate incomplete paralysis. A 40 percent rating requires moderately severe incomplete paralysis. A 60 percent rating requires severe incomplete paralysis with marked muscular atrophy. An 80 percent rating requires complete paralysis, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Words such as "moderate," "moderately severe," and "severe" are not defined in the Rating 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. Use of terminology such as "severe" by VA examiners and others, although 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. Based on the evidence, including the September 2013, November 2019, and January 2020 examinations, the Veteran is not entitled to initial compensable ratings, prior to November 21, 2019, or ratings in excess of 20 percent, since that date, for his radiculopathies. During the September 2013 VA back examination, lower extremity muscle strength, reflexes, and sensation were all normal, straight leg raise testing was negative bilaterally, and the Veteran did not experience any radicular pain or any other signs or symptoms due to radiculopathy. In November 2019, reflexes of the knees and ankles were hypoactive, but with normal sensory exam. Straight leg raising was positive with involvement of nerve roots L4/L5/S1/S2/S3. The examiner indicated that there was mild intermittent pain, paresthesias and/or dysesthesias, and numbness of the lower extremities. There were no other abnormalities. In January 2020, reflex and sensory exam of the lower extremities was normal and straight leg raising was negative. The examiner did not make a finding of radiculopathy. In a separate opinion, the examiner explained that radiculopathy was not found on examination and that neurologic exam was normal indicating no deficit. Beyond claiming entitlement to increased ratings and complaining of radicular pain, the Veteran has not offered evidence suggesting that his radiculopathies warrant compensable ratings prior to November 21, 2019 or result in moderately severe (or higher) severity at any time since that date. See September 2021 Appellate Brief. The November 2019 examiner specified that the radiculopathies of the sciatic nerve group were of a mild severity (which is actually consistent with the lower rating of 10 percent), while the January 2020 examiner found no radicular symptoms per neurologic testing. Accordingly, the initial compensable ratings, prior to November 21, 2019, and ratings higher than 20 percent, since that date, are not warranted. (CONTINUED ON NEXT PAGE) 6. Additional Considerations As a final point, the Board notes that in conjunction with the higher rating matters decided herein, no other related issues have been raised by the Veteran or his representative, and no other such issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Brian J. Elwood Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alhinnawi 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.