Citation Nr: 21073437 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 13-03 283A DATE: December 8, 2021 ORDER The claim for an initial rating of 20 percent, but not higher, for degenerative changes of the lumbar spine is granted. The claim for a higher initial rating for right leg radiculopathy, rated as 10 percent disabling from August 6, 2010 to January 7, 2021 and 20 percent disabling from January 8, 2021, is granted. The claim for a higher initial rating for left leg radiculopathy, rated as 10 percent disabling from August 6, 2010 to January 7, 2021 and 20 percent disabling from January 8, 2021, is granted. The claim for an initial rating higher than 10 percent for right hip degenerative arthritis is denied. The claim for an initial rating of 10 percent, but not higher, for right thigh limitation of rotation (previously limitation of abduction) from August 6, 2010 is granted. The claim for an initial compensable rating for right thigh limitation of extension is denied. The claim for an initial rating higher than 10 percent for left hip arthritis is denied. The claim for an initial rating of 10 percent, but not higher, for left thigh limitation of rotation from August 6, 2010 is granted. The claim for a rating higher than 10 percent for right wrist carpal tunnel syndrome is denied. The claim for a rating higher than 10 percent for left wrist carpal tunnel syndrome is denied. FINDINGS OF FACT 1. The Veteran's lumbar spine disability manifests orthopedic impairment with pain, forward flexion limited to 40 degrees or better, muscle spasms and guarding, and without ankylosis or incapacitating episodes requiring bed rest prescribed by a physician having a total duration of at least four weeks but less than six weeks. 2. The Veteran's right leg radiculopathy manifests neurological impairment with pain and numbness that most nearly approximates mild incomplete paralysis of the sciatic nerve from August 6, 2010 to January 7, 2021 and moderate incomplete paralysis of the sciatic nerve from January 8, 2021. 3. The Veteran's left leg radiculopathy manifests neurological impairment with pain and numbness that most nearly approximates mild incomplete paralysis of the sciatic nerve from August 6, 2010 to January 7, 2021 and moderate incomplete paralysis of the sciatic nerve from January 8, 2021. 4. The Veteran's degenerative arthritis of the right hip manifests limitation of flexion to 75 degrees without ankylosis, a flail joint, or impairment of the femur. 5. The Veteran's right hip disability manifests impairment of the thigh with limitation of rotation that most nearly approximates an inability to toe-out more than 15 degrees with consideration of all functional factors. 6. The Veteran's right hip disability manifests noncompensable limitation of extension to 15 degrees. 7. The Veteran's arthritis of the left hip manifests limitation of flexion to 125 degrees without ankylosis, a flail joint, or impairment of the femur. 8. The Veteran's left hip disability manifests impairment of the thigh with limitation of rotation that most nearly approximates an inability to toe-out more than 15 degrees with consideration of all functional factors. 9. The Veteran's right carpal tunnel syndrome manifests incomplete paralysis of the right median nerve that most nearly approximates mild. 10. The Veteran's left carpal tunnel syndrome manifests incomplete paralysis of the left median nerve that most nearly approximates mild. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 20 percent, but not higher, for degenerative changes of the lumbar spine are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.45, 4.71a, Diagnostic Codes 5235-5243 (2020 & 2021). 2. The criteria for higher initial ratings for right leg radiculopathy, rated as 10 percent disabling from August 6, 2010 to January 7, 2021 and 20 percent disabling from January 8, 2021, but not higher, are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.123, 4.124, 4.124a, Diagnostic Code 8520. 3. The criteria for higher initial ratings for left leg radiculopathy, rated as 10 percent disabling from August 6, 2010 to January 7, 2021 and 20 percent disabling from January 8, 2021, but not higher, are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.123, 4.124, 4.124a, Diagnostic Code 8520. 4. The criteria for an initial rating higher than 10 percent for right hip degenerative arthritis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.59, 4.71a, Diagnostic Codes 5003, 5250, 5252, 5254, 5255 (2020 & 2021). 5. The criteria for an initial 10 percent rating, but not higher, for right thigh limitation of rotation (previously limitation of abduction) from August 6, 2010 are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5253 (2020 & 2021). 6. The criteria for an initial compensable rating for right thigh limitation of extension are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5251 (2020 & 2021). 7. The criteria for an initial rating higher than 10 percent for left hip arthritis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.59, 4.71a, Diagnostic Codes 5003, 5250, 5252, 5254, 5255 (2020 & 2021). 8. The criteria for an initial 10 percent rating, but not higher, for left hip limitation of rotation from August 6, 2010 are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5253 (2020 & 2021). 9. The criteria for a rating higher than 10 percent for right wrist carpal tunnel syndrome are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8515. 10. The criteria for a rating higher than 10 percent for left wrist carpal tunnel syndrome are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8515. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 2007 to August 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2010 and November 2014 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in September 2015 and April 2018 when the issues on appeal were remanded for additional development. The case has now returned to the Board for further appellate action. The claims for increased ratings for radiculopathy of the right and left lower extremities are also part of the current appeal before the Board, despite the lack of a perfected appeal from the Veteran. The criteria for the evaluation of disabilities of the spine provide that associated objective neurological abnormalities are separately rated and are a component of the underlying spinal condition. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5343. Therefore, the disability ratings assigned for radiculopathy of the lower extremities are part and parcel of the increased rating claim for the underlying low back disability and are also before the Board. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). For disabilities evaluated based on limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. DeLuca v. Brown, 8 Vet. App. 202 (1995); Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59; see also Chavis v. McDonough, 34 Vet. App. 1 (2021) (ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. 1. Entitlement to a higher initial rating for degenerative changes of the lumbar spine, currently rated as noncompensably disabling prior to January 8, 2021 and 20 percent disabling thereafter. 2. Entitlement to a higher initial rating for radiculopathy of the right leg, currently rated as noncompensably disabling from April 30, 2018 to January 7, 2021 and 20 percent disabling from January 8, 2021. 3. Entitlement to a higher initial rating for radiculopathy of the left leg, currently rated as noncompensably disabling from April 30, 2018 to January 7, 2021 and 20 percent disabling from January 8, 2021. Service connection for degenerative changes of the lumbar spine was granted in the August 2010 rating decision on appeal with an initial noncompensable (0 percent) evaluation assigned effective August 6, 2010. An increased 20 percent evaluation was awarded in a June 2021 rating decision effective January 8, 2021. Service connection for neurological impairment associated with the lumbar spine disability was awarded in April 2019, when separate noncompensable ratings for radiculopathy of the right and left legs were assigned effective April 30, 2018. Increased ratings for radiculopathy were later granted in August 2021, when separate 20 percent evaluations were assigned from January 8, 2021. The Veteran contends that higher initial ratings are warranted for the orthopedic and neurological impairment associated with his low back disability as he experiences severe pain and functional limitations. The Board will first address the orthopedic impairment associated with the service-connected low back disability. The Veteran's degenerative changes of the lumbar spine are currently rated as noncompensably disabling from August 6, 2010 to January 7, 2021 and 20 percent disabling from January 8, 2021. The disability is rated under Diagnostic Code 5242 (formerly characterized as degenerative arthritis of the spine and currently degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome). Diagnostic Code 5242 utilizes the general rating formula for rating diseases and injuries of the spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Under the general rating formula, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply. A 10 percent disability rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is 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 evaluation is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine and a maximum 100 percent evaluation is warranted if there is unfavorable ankylosis of the entire spine. Id. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar or entire spine is fixed in flexion or extension and the ankylosis results in certain enumerated impairments. 38 C.F.R. § 4.71a, General Formula for Rating Diseases and Injuries of the Spine, Note (5). After review of the evidence, the Board finds that a rating of 20 percent, but not higher, is warranted for the orthopedic impairment resulting from the Veteran's low back disability throughout the initial claims period from August 6, 2010. Forward flexion of the spine was most limited in August 2009, during an in-service orthopedic examination when it measured to 40 degrees. Range of motion of the lumbar spine improved somewhat after separation, but flexion was still limited to 45 degrees at a VA neurosurgery consultation in May 2012 and to 60 degrees at a January 2021 VA examination. Although flexion and the combined range of motion of the lumbar spine was occasionally noted as full, for example, during an April 2010 VA examination, the Board notes that the Veteran has consistently complained of low back pain, muscle spasms, and guarding throughout the claims period. With consideration of all relevant functional factors, the Board finds that an initial 20 percent evaluation is appropriate from August 6, 2010, the original date of service connection. A rating higher than 20 percent is not warranted as the record does not establish the presence of ankylosis or forward flexion of the thoracolumbar spine that most nearly approximates 30 degrees or less. As noted above, the Veteran manifests limitation of spinal motion that is properly contemplated by a 20 percent evaluation. There is no medical or lay evidence indicating that the Veteran's thoracolumbar spine is ankylosed, and treatment records and VA examinations dated throughout the claims period demonstrate that the Veteran has retained some useful motion of his spine. The Board has considered whether an increased rating is appropriate based on functional factors, but notes that the Veteran never manifested any additional loss of motion following repetitive testing, to include during VA examinations in April 2010 and January 2021. The current 20 percent rating assigned the low back disability contemplates his reports of difficulties with walking, standing, and postural limitations due to low back pain, and he has clearly retained some useful motion of the thoracolumbar spine without ankylosis. An initial rating higher than 20 percent is therefore not warranted based on limitation of motion or ankylosis. An increased rating is also possible under the criteria pertaining to intervertebral disc syndrome under 38 C.F.R. § 4.71a, Diagnostic Code 5243. The pre-February 2021 version of Diagnostic Code 5243 provides that intervertebral disc syndrome is rated either under the general rating formula or the formula for rating intervertebral disc syndrome based on incapacitating episodes, whichever method results in a higher evaluation. Under the current version of Diagnostic Code 5243, this code is only assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root. Diagnostic Code 5242 is assigned for all other diagnoses. 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2020 & 2021). As the diagnostic code changes occurred during the pendency of this appeal, the Board may still apply the former version of Diagnostic Code 5243 and use it as the basis for a higher initial rating. The Veteran's service-connected disability includes multiple findings of degenerative, bulging, and herniated lumbar discs, and the Board therefore finds that Diagnostic Code 5243 is for application in this case. Under Diagnostic Code 5243, a 40 percent evaluation contemplates incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months. An "incapacitating episode" is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bedrest prescribed by a physician and treatment by a physician. Associated objective neurological abnormalities (e.g., bladder and bowel impairment) are to be evaluated separately. The record does not establish that the Veteran's low back disability manifests incapacitating episodes that warrant a higher rating in accordance with 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Veteran has not reported receiving any doctor-prescribed bed rest, but review of his treatment records from the VA Medical Center (VAMC) shows multiple visits to the emergency department (ED) for exacerbations of low back pain throughout the claims period, with doctor-prescribed periods of rest recommended on two occasions. In June 2011, the Veteran was seen at the ED with complaints of severe and constant low back pain radiating to the right thigh. He was treated with medication and "ordered to rest at home the next week." Similarly, in March 2013, the Veteran was again treated at the VAMC ED for an exacerbation of low back pain and was told to return home and rest for three days. Thus, while treatment records document two instances of bed rest prescribed by a physician, these episodes clearly do not establish incapacitating episodes having a total duration of at least four weeks and less than six weeks during any 12-month period. As such, a rating higher than 20 percent is not warranted under Diagnostic Code 5243 at any time during the initial claims period. The Veteran's orthopedic impairment of the lumbar spine is appropriately rated as 20 percent disabling throughout the initial claims period. While a rating in excess of 20 percent is not warranted for the orthopedic component of this disability, the general rating formula provides for separate ratings for neurologic manifestations of a back disability. The Board finds that higher initial ratings for the neurological impairment associated with the lumbar spine disability are warranted. Disability involving a neurological disorder is ordinarily rated in proportion to the impairment of motor, sensory, or mental function. When the involvement is wholly sensory, the rating should be for the mild, or, at most, the moderate degree. 38 C.F.R. §§ 4.120, 4.124a. Neurological impairment of the sciatic nerve is rated under Diagnostic Code 8520 for paralysis of the sciatic nerve. Under this code, a 10 percent rating is assigned for mild incomplete paralysis, while a 20 percent rating is assigned for moderate incomplete paralysis, a 40 percent rating is assigned for moderately severe incomplete paralysis, and a 60 percent rating is assigned for severe incomplete paralysis. Complete paralysis of the nerve with foot dangles and drops, no active movement possible of the muscles below the knee, flexion of the knee weakened or (very rarely) lost is rated 80 percent disabling. The Board finds that the Veteran's radiculopathy of the right and left legs warrants initial 10 percent ratings consistent with mild incomplete paralysis prior to January 8, 2021, while increased 20 percent ratings are appropriate for moderate incomplete paralysis thereafter. The appropriate effective date for the award of a separate ratings is August 6, 2010the same effective date for the original award of service connection for the underlying lumbar spine disability. The Veteran has consistently complained of radiating pain and numbness in the lower extremities associated with his low back condition since active duty. In April 2009, he reported injuring himself seven months earlier and experiencing severe lower back pain with numbness and pain to the right buttock and leg. Although the Veteran denied any specific neurological complaints at the April 2010 VA examination, three months later, while still on active duty, he reported experiencing low back pain radiating to both legs. VA and private treatment records document similar complaints of radiating pain and numbness affecting both lower extremities since that time, and the Board therefore finds that separate ratings are warranted for neurological impairment of the legs since August 6, 2010. Prior to January 8, 2021, the Veteran's neurological impairment most nearly approximated incomplete paralysis of the sciatic nerves that was mild. As noted above, the Veteran consistently complained of radiating pain and numbness in the lower extremities, but there is little objective evidence of neurological impairment during this period. Neurological examination of the legs was normal at the April 2010 VA examination, as well as during a May 2013 VAMC physical medicine and rehabilitation evaluation. Neuroforamina narrowing was noted following a February 2018 lumbar MRI, but this represents one of the only objective indications of nerve root impairment during the claims period. Given the lack of objective evidence of neurological impairment and the Veteran's reports limiting the manifestations of his radiculopathy to impairments that are sensory in nature, the Board finds that a 10 percent evaluation is appropriate for mild incomplete paralysis of the bilateral sciatic nerves prior to January 8, 2021. From January 8, 2021, the Board finds that the current 20 percent ratings for bilateral radiculopathy are appropriate. The January 2021 VA examination report documents the Veteran's complaints of pain, numbness, and paresthesias, with decreased sensation observed upon physical examination. No other neurological impairment was noted by the examiner, as the Veteran's lower extremities manifested full muscle strength, normal and full reflexes, and no weakness. The examiner concluded that the Veteran's radiculopathy most nearly approximated moderate incomplete paralysis of the sciatic nerves. The Board therefore finds that 20 percent evaluations for moderate neurological impairment of the lower extremities are appropriate from January 8, 2021. In sum, the Veteran's service-connected lumbar spine disability warrants a 20 percent initial evaluation for orthopedic impairment. Separate ratings are also appropriate for associated radiculopathy, with both the right and left legs rated as 10 percent disabling from August 6, 2010 to January 7, 2021, with increased 20 percent ratings from January 8, 2021. The Board has considered whether there is any other schedular basis for granting higher ratings other than those discussed above, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against any other increased ratings. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. 4. Entitlement to an initial rating higher than 10 percent for right hip degenerative arthritis. 5. Entitlement to an initial compensable rating for right thigh limitation of abduction. 6. Entitlement to an initial compensable rating for right thigh limitation of extension. 7. Entitlement to an initial rating higher than 10 percent for left hip arthritis. Service connection for degenerative arthritis of the right hip and arthritis of the left hip was awarded in the August 2010 rating decision on appeal. Initial noncompensable evaluations were assigned effective August 6, 2010. In June 2021, service connection was also granted for additional disabilities of the right hip: limitation of abduction and limitation of extension. Each condition was assigned a noncompensable evaluation from January 8, 2021. Most recently, in August 2021, the Veteran's right and left arthritis ratings were increased to 10 percent from August 6, 2010, the original date of service connection. Thus, the Veteran is in receipt of 10 percent evaluations for arthritis of each hip, as well as two noncompensable evaluations for limitation of abduction and extension of the right hip. He contends that higher initial ratings are warranted for his hip disabilities due to pain and functional impairment. As a preliminary matter, the Board notes that the Veteran has never manifested ankylosis of the either hip and none of the medical evidence (including X-rays, VA examinations, and treatment records) demonstrates the presence of ankylosis. VA examiners in April 2010 and January 2021 both specifically found that the Veteran's hips were not ankylosed, and the Veteran does not contend that he has lost all useful motion of his hips. Similarly, there is also no evidence of a flail joint of the hip or impairment of the femur with any nonunion, malunion, or fracture. The Board therefore finds that Diagnostic Codes 5250, 5254, and 5255, pertaining to hip ankylosis, a flail joint, and impairment of the femur are not for application in this case and will now turn to the rating criteria pertaining to arthritis and limitation of motion. The former and current versions of the criteria pertaining to rating the hip based on limitation of motion are identical. Normal ranges of motion of the hip are for flexion from 0 degrees to 125 degrees and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the hip or thigh may be rated under Diagnostic Code 5250 (ankylosis of the hip), Diagnostic Code 5251 (limitation of extension), 5252 (limitation of flexion), or Diagnostic Code 5253 (impairment of the thigh). The Veteran's arthritis of the right and left hips is currently rated as 10 percent disabling throughout the initial claims period under Diagnostic Code 5003-5252. In this case, the hyphenated diagnostic code indicates that the Veteran's hips are rated for degenerative arthritis (Diagnostic Code 5003) resulting in limitation of flexion (Diagnostic Code 5252). The current 10 percent ratings were also assigned in accordance with 38 C.F.R. § 4.59 which provides for a minimum compensable rating with evidence of painful joints. In other words, the RO determined that the Veteran did not manifest compensable limitation of flexion in the hips, but as he experienced painful motion of the hip joints, a 10 percent rating, the minimum compensable rating possible under Diagnostic Code 5252, was warranted. 38 C.F.R. § 4.59 does not provide any mechanism for a rating higher than 10 percent. Diagnostic Code 5003 pertaining to degenerative arthritis also does not provide for a rating higher than 10 percent without X-ray evidence of multiple joint involvement. 38 C.F.R. § 4.71, Diagnostic Code 5003. As the Veteran's service-connected arthritis affects each hip individually, a higher rating is not possible under Diagnostic Code 5003. Turning to Diagnostic Code 5252, flexion of the hips was most limited at the January 2021 VA examination when the right hip measured to 75 degrees and the left hip measured to 125 degrees. The Veteran did not manifest any additional loss of flexion with repetitive testing and did not report experiencing any flare-ups of symptoms with use of his hips. Thus, the Veteran manifests flexion of the right hip to 75 degrees and the left hip to 125 degrees, even with consideration of functional factors. This level of impairment is not compensable under Diagnostic Code 5252. Thus, ratings higher than 10 percent are not warranted for limitation of flexion under Diagnostic Code 5252, 38 C.F.R. § 4.59, or Diagnostic Code 5003 for arthritis. The Veteran is also in receipt of a separate noncompensable evaluation for the right hip based on limitation of abduction under Diagnostic Code 5253 for impairment of the thigh. Under this diagnostic code, a 10 percent rating will be assigned for limitation of rotation where the individual cannot toe-out more than 15 degrees on the affected leg, or for limitation of adduction where the individual cannot cross the legs. A 20 percent rating will be assigned for limitation of abduction where there is motion lost beyond 10 degrees. 38 C.F.R. § 4.71, Diagnostic Code 5253. The Board finds that separate 10 percent evaluations are warranted under Diagnostic Code 5253 for impairment of the thigh for both hips from the original date of service connection: August 6, 2010. Treatment records dating back to the Veteran's period of active service document impairment to rotation of the hips, and in July 2010, he was found to have no joint rotation in the left hip. At that time, rotation of both hips was painful. Although the Veteran's demonstrated hip rotation greater than 15 degrees for both hips at the most recent VA examination in January 2021, with consideration of his complaints of pain and with the resolution of any doubt in his favor, the Board finds that 10 percent ratings are warranted throughout the initial claims period for the right and left hips under Diagnostic Code 5253 for limitation of rotation. Higher ratings are not appropriate under this diagnostic code as the Veteran has retained his ability to abduct both thighs and hips beyond 10 degrees, as demonstrated during VA examinations in April 2010 and January 2021. Finally, the Veteran's right hip is also assigned a separate noncompensable rating for impairment to extension under Diagnostic Code 5251. This diagnostic code provides a 10 percent disability rating for extension of the thigh that is limited to 5 degrees. 38 C.F.R. § 4.71a. Extension of the right thigh was most limited at the January 2021 VA examination when it was measured to 15 degrees. This measurement was made with consideration of functional factors such as complaints of pain, repetitive motion, and based on the Veteran's reports. Thus, the limitation of right thigh extension manifested by the Veteran at the January 2021 VA examination is noncompensable under Diagnostic Code 5251. With respect to the left hip and thigh, there is no medical or lay evidence of limited extension during the initial claims period and a separate rating under Diagnostic Code 5251 is not appropriate. In sum, the Veteran's right and left hip arthritis is properly rated as 10 percent disabling throughout the initial claims period for painful limitation of flexion under 38 C.F.R. § 4.59 and Diagnostic Code 5003-5252. Separate 10 percent ratings are also appropriate for both hips throughout the initial claims period under Diagnostic Code 5253 for limitation of rotation. Lastly, a separate noncompensable evaluation is assigned for the right hip based on limitation of extension under Diagnostic Code 5251 from January 8, 2021. The Board has considered whether there is any other schedular basis for granting higher ratings, but has found none. The Board has also considered the statements of the Veteran. The Veteran has described experiencing pain of both hips with limitation of motion that impairs his ability to walk, stand, and crouch and lift heavy objects from the floor. The type of impairment reported by the Veteran is contemplated by the multiple ratings assigned his hip disabilities, to include pain and limitation of motion of the hips in various directions. In determining the appropriate ratings for the hips, the Board has also considered functional factors such as those reported by the VA examiners, to include impairment associated with repetitive motion and flare-ups of symptoms. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claims for any additional increased ratings. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. 8. Entitlement to a rating higher than 10 percent for right wrist carpal tunnel syndrome. 9. Entitlement to a rating higher than 10 percent for left wrist carpal tunnel syndrome. Service connection for right and left wrist carpal tunnel syndrome was awarded in an August 2010 rating decision. Initial 10 percent evaluations were assigned for each upper extremity effective August 6, 2010. The November 2014 rating decision on appeal continued the 10 percent ratings. The Veteran contends that higher ratings are warranted as his carpal tunnel syndrome causes severe daily pain. The Veteran's carpal tunnel syndrome is rated by analogy under Diagnostic Code 8599-8515 as paralysis of the median nerves. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. The hyphenated disability will be rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27. In this case, the use of a diagnostic code ending in "99" indicates that the service-connected disability is closely related to the peripheral nerves generally, and paralysis of the median nerve specifically. Under Diagnostic Code 8515, mild incomplete paralysis of the median nerve is rated 10 percent disabling on the major side and 10 percent on the minor side; moderate incomplete paralysis is rated 30 percent disabling on the major side and 20 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the median nerve, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb at right angles to palm; flexion of wrist weakened; pain with trophic disturbances, is rated 70 percent disabling on the major side and 60 percent on the minor side. The Veteran is right-hand dominant, and his right wrist is therefore evaluated under the "major" ratings, while his left wrist is considered "minor." 38 C.F.R. § 4.124a, Diagnostic Code 8515. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board finds that the Veteran's right and left carpal tunnel syndrome is appropriately rated as 10 percent disabling throughout the claims period. The evidence during this period establishes that the presence of subjective symptoms of numbness, pain, and paresthesia in the wrists and fingers with little functional impairment. The Veteran has consistently denied experiencing any weakness of the upper extremities associated with carpal tunnel syndrome, and he demonstrated full muscle strength and reflexes upon VA examinations in November 2014 and January 2021. Additionally, a nerve conduction study performed at the VAMC in September 2017 did not demonstrate any electrodiagnostic evidence of right median entrapment neuropathy as shown in carpal tunnel syndrome. Sensory examination of the upper extremities was also normal aside from the January 2021 VA examination when some decrease in sensation was noted in the forearms and fingers. The November 2014 and January 2021 VA examiners also specifically found that the Veteran's carpal tunnel syndrome most nearly approximated mild incomplete paralysis of the median nerves. In February 2018 at the VAMC, the Veteran reported increased symptoms of tingling and pain in his bilateral hands during the previous three to four months. He stated that it was impacting his ability to perform his duties as a police officer and draw his weapon. The Veteran also reported that he had trouble grasping objects and had some pain with range of motion of the wrists. Although these symptoms are more severe than those previously reported by the Veteran, the Board finds that they cannot serve as the basis for a higher rating as they were not associated with the service-connected carpal tunnel syndrome. Instead, the Veteran was diagnosed with wrist and hand sprains to account for his symptoms by his provider at the VAMC. His condition also appears to have resolved, as he once again denied experiencing any functional impairment due to his wrists and carpal tunnel syndrome during the January 2021 VA examination. Therefore, the Board finds that the Veteran's 2018 symptoms do not support a higher rating for his bilateral carpal tunnel syndrome. In sum, the Veteran's carpal tunnel syndrome warrants 10 percent evaluations for each upper extremity throughout the claims period. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claims for higher schedular ratings. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. J.N. Moats Acting Veterans Law Judge Board of Veterans' Appeals M. Riley, Attorney for the Board Department of Veterans Affairs 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.