Citation Nr: 21073755 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 16-06 191 DATE: December 10, 2021 ORDER Prior to June 14, 2013, entitlement to a disability rating in excess of 20 percent for spinal stenosis with retained hardware, post-operative lumbar spine with bilateral degenerative joint disease (DJD) SI joints (back disability) is denied. From March 9, 2018, entitlement to a disability rating of 20 percent for a back disability is granted. From August 1, 2013 forward, entitlement to a disability rating in excess of 20 percent for a back disability is denied. Entitlement to a disability rating of 20 percent for left lower extremity radiculopathy is granted for the period from March 9, 2018 through August 5, 2021, and entitlement to a disability rating in excess of 20 percent for left lower extremity radiculopathy throughout the appeal is denied. Entitlement to an initial compensable (greater than 0 percent) disability rating for left hip flexion is denied. Entitlement to an initial disability rating of 10 percent for left hip extension is granted for the period from March 9, 2018 forward, and entitlement to an initial disability rating in excess of 10 percent for left hip extension throughout the appeal is denied. FINDINGS OF FACT 1. Prior to June 14, 2013, the Veteran's back disability was at worse characterized by forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. From August 1, 2013, the Veteran's back disability was at worst characterized by forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. At no point during the appeal period was it characterized by 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. 3. Throughout the appeal period, the Veteran's left lower extremity radiculopathy has been characterized by moderate incomplete paralysis of the sciatic nerve. It has never been characterized by moderately severe incomplete paralysis of the sciatic nerve. 4. Throughout the appeal period, the Veteran's left hip with limitation of flexion has been characterized by flexion limited to 95 degrees. It has not been characterized by flexion limited to 45 degrees. 5. Throughout the appeal period, the Veterans left hip with limitation of extension has been characterized by constant pain that caused additional functional loss. It has not been characterized by extension limited to 5 degrees. CONCLUSIONS OF LAW 1. Prior to June 14, 2013, the criteria have not been met for a disability rating in excess of 20 percent for a back disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5238. 2. From August 1, 2013, the criteria have not been met for a disability rating in excess of 20 percent for a back disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5238. 3. From March 9, 2018, the criteria have been met for a disability rating of 20 percent for a back disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5238. 4. Throughout the appeal, the criteria have not been met for a disability rating in excess of 20 percent for left lower extremity radiculopathy. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(a), 4.1, 4.3, 4.7, 4.124a, DC 8520. 5. From March 9, 2018 through August 5, 2021, the criteria have been met for a disability rating of 20 percent for left lower extremity radiculopathy. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321(a), 4.1, 4.3, 4.7, 4.124a, DC 8520. 6. The criteria have not been met for an initial compensable (greater than 0 percent) disability rating for left hip with limitation of flexion. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5252. 7. Prior to March 9, 2018, the criteria have not been met for an initial rating in excess of 10 percent for left hip with limitation of extension. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5251. 8. From March 9, 2018, the criteria have been met for a disability rating of 10 percent for left hip with limitation of extension. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5251. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1995 to June 1995 and also in March 2005. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In September 2013, the Veteran disagreed with this decision. In an April 2021 Correspondence, the Veteran wrote that she wished to cancel her hearing. The hearing request has been withdrawn. See 38 C.F.R. §§ 20.703, 20.704 (2016). This case was previously before the Board in June 2021 when it was remanded for additional development. The Board finds that there has been substantial compliance with its prior remand directives. See Stegall v. West, 11. Vet. App. 268 (1998). In a July 2013 rating decision, the RO granted a temporary 100 percent evaluation for the Veteran's back disability based on surgical or other treatment necessitating convalescence, effective June 14, 2013. From August 1, 2013, a 20 percent rating was assigned. Additionally, in the July 2013 rating decision, the RO increased the rating for the Veteran's left lower extremity radiculopathy from 10 percent to 20 percent, effective October 12, 2012. In a March 2018 rating decision, the RO decreased the Veteran's service-connected left hip with limitation of extension from 10 percent to a noncompensable (0 percent) rating, effective March 9, 2018. The RO also decreased the Veteran's back disability from 20 percent to 10 percent, effective March 9, 2018, as well as her left lower extremity radiculopathy from 20 percent to 10 percent, effective March 9, 2018. Finally, in an August 2021 rating decision, the RO increased the Veteran's left lower extremity radiculopathy from 10 percent to 20 percent, effective August 6, 2021. As these decisions do not constitute full grants, these issues remain on appeal. AB v. Brown, 6 Vet. App. 35, 39 (1993). During the period of the appeal, in an August 19, 2021 Rating Decision, the RO granted service connection for urinary incontinence. Therefore, that claim for service connection has been resolved and is no longer before the Board on appeal. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). INCREASED RATING Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. 1. Prior to June 14, 2013, entitlement to a disability rating in excess of 20 percent for a back disability is denied. 2. From June 14, 2013, entitlement to a disability rating in excess of 20 percent for a back disability is denied. As there is considerable overlap in the applicable evidence for the Veteran's claims, the Board will discuss them together. Legal Criteria Under DCs 5235 to 5243, a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a, DCs 5235 to 5243. A 40 percent rating is warranted for 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. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. The maximum 100 percent rating is warranted for unfavorable ankylosis of the entire spine. These ratings are assigned for the above criteria 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. Id. For VA compensation purposes, "unfavorable ankylosis" is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. Disabilities of the spine involving intervertebral disc syndrome (IVDS) are assigned under DC 5243, which provides that the disability is to be rated either under the General Rating Formula or alternatively under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in a higher evaluation. See 38 C.F.R. § 4.71a, Note. For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. See id. at Note (1). Effective February 7, 2021, the DCs pertaining to the lumbar spine were amended. For purposes of this decision, the applicable rating criteria for those DCs did not materially change. See 85 Fed. Reg. 76453 (Nov. 30, 2020) (as corrected at 85 Fed. Reg. 85523 (Dec. 29, 2020), as corrected at 86 Fed. Reg. 8142 (Feb. 4, 2021)). Consideration of a higher rating for functional loss, to include during flare-ups, due to the factors listed above is warranted for Diagnostic Codes predicated on limitation of motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy of disuse. 38 C.F.R. § 4.45. Pain itself does not constitute functional loss, and painful motion does not constitute limited motion for the purposes of rating under DCs pertaining to limitation of motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Pain indeed must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss. Id. Factual Background The Veteran contends that her back disability is more severe than the 20 percent disability rating assigned prior to June 14, 2013, and after August 1, 2013. The Veteran's back disability is rated under DC 5238. 38 C.F.R. § 4.71a, DC 5238, General Rating Formula for Diseases and Injuries of the Spine. As noted above, in a July 2013 rating decision, the RO granted a temporary 100 percent evaluation for the Veteran's back disability based on surgical or other treatment necessitating convalescence, effective June 14, 2013. From August 1, 2013, a 20 percent rating was assigned. In a March 2018 rating decision, the RO decreased the Veteran's back disability from 20 percent to 10 percent, effective March 9, 2018. Prior to June 14, 2013 In an April 2013 VA examination report, the Veteran was diagnosed with degenerative disc disease (DDD) of the lumbar spine. The Veteran stated that she continued to have pain in her lower back which radiated into her hips. The examiner noted that the Veteran had a history of lumbar fusion. The Veteran reported that she had pain all the time rather than this being flaring and remitting. The Veteran reported flare-ups characterized as being barely able to move if she exerted herself too much during the day. Initial range of motion (ROM) of the back was forward flexion to 60 degrees, extension to 20 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. The Veteran was able to perform repetitive-use testing and there was no change in her ROM. She had functional loss and/or functional impairment characterized as less movement than normal and pain on movement. The Veteran had no localized tenderness or pain on palpation. Additionally, she had no guarding or muscle spasm. The Veteran had radiculopathy symptoms in her left lower extremity. The Board notes that the issue of an increased rating for the Veteran's service-connected left lower extremity is on appeal and will be discussed below. Other than her left lower extremity radiculopathy, the Veteran had no other neurologic abnormalities or findings related to the back. The Veteran was not diagnosed with intervertebral disc syndrome (IVDS). She used a cane occasionally. Imagining studies were performed, arthritis was documented, but she did not have a vertebral fracture. The functional impact of the Veteran's back disability on her ability to work was characterized as "work with restriction of avoid heavy lifting, avoid prolonged standing, or walking." The VA examiner explained that while the Veteran was treated for urinary incontinence, that was not related to her back. The Board notes that the Veteran was granted service connection for urinary incontinence in an August 2021 rating decision. From August 1, 2013 In April 2014, the Veteran had a VA examination. However, ROM was not performed so the nature, severity, and duration of the Veteran's back disability could not be measured. Additionally, this examination did not conform to the requirements of Correia and Sharp, so it was inadequate for rating purposes. See Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board notes that the Veteran had a VA examination in December 2017. However, in the June 2021 decision, the Board determined that the December 2017 VA examination was inadequate for rating purposes. Even so, in this VA examination report, the Veteran reported flare-ups characterized by severe stabbing pain, difficulty putting weight on her left leg, inflammation caused abnormal pelvic, rectum, and hip pain, and nausea. She had no functional loss or impairment. Initial ROM was abnormal or outside of the normal range. Forward flexion was to 65 degrees, extension was to 20 degrees, right and left lateral flexion were to 30 degrees, and right and left lateral rotation were to 30 degrees. Pain was noted on the examination but did not result in or cause functional loss. The Veteran experienced pain during all motions. There was evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the left para lumbar. The Veteran was able to perform repetitive use testing and there was no additional loss of function or ROM. The Veteran was not examined immediately after repetitive use over time. The examiner noted that the Veteran's pain caused functional loss but was not able to describe this in terms of ROM. The examiner's reason was that the examination was not conducted during a flare-up. The Veteran had muscle spasm not resulting in an abnormal gait or abnormal spinal contour. She had no guarding. There were no additional factors contributing to her back disability. The Veteran was not diagnosed with ankylosis or IVDS. She used a cane occasionally. No imaging studies were performed. The functional impact of the Veteran's back disability was characterized as partial impairment of physical activities such as running, jumping, climbing, and walking long distances. In an August 2021 VA examination report, the Veteran was diagnosed with spinal stenosis with retained hardware, post-operative, lumbar spine with bilateral degenerative joint disease of the sacroiliac joints and associated left lower extremity radiculopathy. The Veteran noted constant daily sharp aching pain in her lower lumbar spine area. Pain radiated from her back to the front of her lower abdominal area. She also reported dull aching pain that radiated down to her left lower extremity, depending on physical activity, but was consistent throughout the day with tingling and burning sensations in her left foot. The Veteran noted lower back spasms about 3-4 times per week, especially when doing house chores and bending or sitting, and driving her car. She also had weakness in her left leg, and it felt weak while driving and sometimes felt that her leg (thigh) was giving out and her left foot dropped. The Veteran reported flare-ups characterized as "Anything I do at home such as cleaning and vacuuming or cooking causes my lower back pain to flare up, causes sharp pain in my lower back." She noted functional loss or functional impairment described as "When pain hits, I have to stop and rest throughout the day, each time up to 30 minutes until pain subsides." Initial ROM for the back was normal. Forward flexion was to 90 degrees, extension was to 30 degrees, right and left lateral flexion were to 30 degrees, and right and left lateral rotation were to 30 degrees. The VA examiner noted that the Veteran experienced pain during all ROM motions. Passive ROM testing was performed, and the results were also all normal. During ROM testing, the Veteran experienced pain during all motions. The VA examiner reported that there was evidence of pain with weight-bearing, active motion, and passive motion, that did not result in or cause functional loss. There was no objective evidence of crepitus. There was objective evidence of localized tenderness or pain on palpation characterized as mild lower lumbar and left paraspinous tenderness. The Veteran was able to perform repetitive use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. The Veteran was not examined immediately after repeated use over time. Pain significantly limited functional ability with repeated use over time. The VA examiner estimated that the Veteran's ROM after repeated use over time was normal. She reported chronic low back pain that did not cause additional functional loss after repeated use over time. The Veteran was not being examined during a flare-up. Pain significantly limited her functional ability with flare-ups. The VA examiner estimated that the Veteran's ROM during flare-ups was unchanged and was normal. The Veteran reported chronic low back pain that did not cause additional functional loss during or after flare-ups. The Veteran had localized tenderness and muscle spasm not resulting in abnormal gait or abnormal spinal contour. She had no guarding. There were no additional factors contributing to the disability. The Veteran did not have muscle atrophy. As noted previously, while the Veteran has radiculopathy symptoms in her left lower extremity, those will be discussed below. The Veteran was not diagnosed with ankylosis or IVDS. She used a cane occasionally because of her back pain. Imaging studies were not performed. The impact of the Veteran's back disability on her ability to work was characterized as being unable to perform tasks that required prolonged standing or sitting, repetitive bending or lifting, or any tasks that required lifting above her head, pulling, pushing, crawling, or stooping. According to the VA examiner, these activities would aggravate her back condition and the Veteran may not be able to do these activities safely. For the Correia criteria, all the listed ROM testing was conducted to the extent practicable. This included active, passive, weight bearing, and non-weight bearing ROM. The Board notes that throughout the appeal period, the Veteran received medical treatment for her back. These treatment reports did not evaluate the nature, extent, and severity of her back disability during the appeal period. While not discussed specifically, the Board has reviewed them and taken them into consideration. Analysis Based on this evidence, the Board determines that prior to June 14, 2013, the assigned 20 percent rating for the Veteran's back condition fully contemplates her range of motion and all muscle spasm and gait symptoms. In the April 2013 VA examination report, it was noted that her forward flexion was at worst to 60 degrees. 38 C.F.R. § 4.71a, DC 5242-5235. Prior to June 14, 2013, the Veteran's back disability was never characterized by forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Additionally, she was never prescribed bed rest. Id. Prior to June 14, 2013, her symptoms do not approximate a disability rating in excess of 20 percent. Id. From August 1, 2013, the assigned 20 percent rating for the Veteran's back condition fully contemplates her range of motion and all muscle spasm and gait symptoms. The Board notes that in a March 2018 rating decision, the Veteran's back disability was reduced from 20 percent to 10 percent, effective March 9, 2018. Because of this, and because the December 2017 VA examination report was determined to be inadequate, the Board does not have a clear picture of the severity of the Veteran's back disability until the most recent August 2021 examination. Affording the Veteran the benefit of the doubt, the Board determines that from August 1, 2013, the Veteran's back disability more nearly approximated a 20 percent rating, which is what she had prior to her back operation. 38 C.F.R. § 4.71a, DC 5242-5235. After August 1, 2013, her back disability was never characterized by forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Additionally, she was never prescribed bed rest. Id. From August 1, 2013, her symptoms do not approximate a disability rating in excess of 20 percent. Id. Affording the Veteran the benefit of the doubt, the Board determines that the Veteran's back disability warrants a 20 percent rating for the entire period on appeal. 38 C.F.R. § 4.71a, DC 5242-5235. The Board finds that the April 2013, December 2017, and August 2021 VA examination reports, describing the Veteran's back symptoms, are the most probative evidence of record because the examiners reviewed the claims file and provided detailed rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board notes that some of these examinations might not be Correia and Sharp compliant. See Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). However, despite this, the Veteran's back symptoms have had a consistent trajectory throughout the appeal period, up until the August 2021 examination, which did conform to Correia and Sharp. Id. While the Veteran is competent (qualified) to observe her back symptoms, she does not have the training or credentials to determine the current nature, extent, and severity of those symptoms, as reflected by the applicable VA diagnostic criteria. Additionally, she does not have the training or credentials to determine the proper disability evaluations concerning her back disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board acknowledges the reports of constant pain associated with the Veteran's back disability. The provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 concerning functional loss due to pain, fatigue, weakness, lack of endurance, incoordination, and flare-ups have been considered in this analysis. See DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995), 38 C.F.R. § 4.71a, DC 5237-5243. However, the General Formula for disabilities of the spine expressly states that the criteria and ratings apply "with or without symptoms such as pain." See 38 C.F.R. § 4.71a, General Rating Formula. Because of this, the presence of pain is already considered within the currently assigned disability ratings. 68 Fed. Red. 51454 (Aug. 27, 2003) ("Pain is often the primary factor limiting motion, for example, and is almost always present where there is muscle spasm. Therefore, the evaluation criteria provided are meant to encompass and consider the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine."). The preponderance of the evidence is against a finding that the Veteran's back disability warrants a rating in excess of 20 percent prior to June 14, 2013, and in excess of 20 percent from August 1, 2013, and the claims must be denied. 3. Entitlement to a disability rating in excess of 20 percent for left lower extremity radiculopathy is denied. Legal Criteria Under DC 8520, for paralysis of the sciatic nerve, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. A 20 percent rating is assigned for moderate incomplete paralysis of the sciatic. Id. A 40 percent rating is assigned for moderately severe incomplete paralysis of the sciatic nerve. Id. A 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. Id. The maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve, characterized by the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Id. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the 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 bilateral, combine with application of the bilateral factor. Id. The terms "mild," "moderate," "moderately severe," and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence. 38 C.F.R. § 4.6. Factual Background The Veteran contends that her left lower extremity radiculopathy is more severe than the 20 percent disability rating assigned from October 12, 2012. Her left lower extremity radiculopathy is rated under DC 8520. 38 C.F.R. § 4.124a, DC 8520. As noted above, in a March 2018 rating decision, the RO decreased the Veteran's left lower extremity radiculopathy from 20 percent to 10 percent, effective March 9, 2018. In an August 2021 rating decision, the RO increased her left lower extremity radiculopathy from 10 percent back to 20 percent, effective August 6, 2021. In an April 2012 VA examination report, the Veteran was diagnosed with radiculopathy in the left buttock and left lower extremity. Her radiculopathy symptoms consisted of no constant pain in either lower extremity, no intermittent pain, no paresthesias and/or dysesthesias in the right lower extremity, severe paresthesias and/or dysesthesias in the left lower extremity, no numbness in the right lower extremity, and severe numbness in the left lower extremity. Muscle strength testing was normal. The Veteran did not have muscle atrophy. Reflex examination was normal. Sensory examination was normal, except for the left toes which was decreased. The Veteran had no trophic changes, and her gait was normal. The VA examiner characterized the severity of the Veteran's incomplete paralysis in her left sciatic nerve as mild. She used a walking stick occasionally. The functional impact of her left lower extremity radiculopathy was characterized as limiting how long she could sit or stand in one place. In an April 2013 VA examination report, the Veteran was diagnosed with left lower extremity radiculopathy. Her radiculopathy symptoms consisted of no constant pain in either lower extremity, no intermittent pain in the right lower extremity, moderate intermittent pain in the left lower extremity, no paresthesias and/or dysesthesias in either lower extremity, and no numbness in either lower extremity. The VA examiner indicated that the Veteran's left sciatic nerve was involved and characterized the severity of her radiculopathy as moderate. She had no muscle atrophy. The Veteran had no other neurologic abnormalities. In a December 2017 VA examination report, the Veteran was diagnosed with left lower extremity radiculopathy. Her radiculopathy symptoms consisted of no constant pain in the right lower extremity, moderate constant pain in the left, no intermittent pain in either lower extremity, no paresthesias and/or dysesthesias in the right lower extremity, mild paresthesias and/or dysesthesias in the left lower extremity, no numbness in the right lower extremity, and mild numbness in the left lower extremity. The VA examiner characterized the severity of the Veteran's left lower extremity radiculopathy as mild. She had no muscle atrophy. In an August 2021 VA examination report, the Veteran was diagnosed with left lower extremity radiculopathy. She noted constant sharp aching pain in her lower lumbar spine area. She stated that the pain radiated from back to front in her lower abdominal area. The Veteran also reported dull aching pain that radiated down to her left lower extremity depending on her physical activity, but was consistent throughout the day with tingling and burning sensations in her left foot. She reported weakness in her left leg, and that it would feel weak while walking and sometimes the leg (thigh) would give out and her foot would drop. The Veteran's radiculopathy symptoms consisted of no symptoms at all in the right lower extremity, moderate constant pain, moderate intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the left lower extremity. She had no muscle atrophy. The VA examiner characterized the severity of her incomplete paralysis of the sciatic nerve as moderate. She used a cane occasionally. The functional impact was characterized as partial impairment of physical activities of employment such as disturbance with prolonged sitting, standing, walking, running, jumping, climbing, bending, and lifting. The Board notes that throughout the appeal period, the Veteran received medical treatment for her lower extremity radiculopathy. These treatment reports did not evaluate the nature, extent, and severity of her left lower extremity radiculopathy during the appeal period. While not discussed specifically, the Board has reviewed them and taken them into consideration. Analysis Affording the Veteran the benefit of the doubt, based on the above evidence, the Board concludes that the Veteran's left lower extremity radiculopathy does not warrant a rating in excess of 20 percent for the entire appeal period. 38 C.F.R. § 4.124a, DC 8520. Her left lower extremity radiculopathy symptoms more closely approximated "moderate" incomplete paralysis of the sciatic nerve. While at times her radiculopathy symptoms have been characterized as "mild" and "severe," overall her disability picture more nearly approximates "moderate" symptoms as noted in the April 2013 and August 2021 VA examination reports. Id. The Veteran's symptoms did not more closely approximate "moderately severe" on a consistent basis. Id. As noted above, in a March 2018 rating decision, the RO decreased the Veteran's left lower extremity radiculopathy from 20 percent to 10 percent, effective March 9, 2018. In an August 2021 rating decision, the RO increased her left lower extremity radiculopathy from 10 percent back to 20 percent, effective August 6, 2021. Affording the Veteran the benefit of the doubt, the Board determines that the Veteran's left lower extremity radiculopathy symptoms warrant a 20 percent rating for the entire period on appeal. 38 C.F.R. § 4.124a, DC 8520. The Board finds that the April 2012, April 2013, December 2017, and August 2021 VA treatment reports, describing the Veteran's left lower extremity radiculopathy symptoms, are the most probative evidence of record because the examiners reviewed the claims file and provided detailed rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). While the Veteran is competent (qualified) to observe her radiculopathy symptoms, she does not have the training or credentials to determine the current nature, extent, and severity of those symptoms, as reflected by the applicable VA diagnostic criteria. Additionally, she does not have the training or credentials to determine the proper disability evaluations concerning her left lower extremity radiculopathy. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Because of this, a disability rating in excess of 20 percent for left lower radiculopathy is not warranted and the claim is denied. 4. Entitlement to an initial compensable (greater than 0 percent) disability rating for left hip flexion is denied. 5. Entitlement to an initial disability rating in excess of 10 percent for left hip flexion is denied. As there is considerable overlap in the applicable evidence for the Veteran's claims, the Board will discuss them together. Legal Criteria Under DC 5251, for limitation of extension of the thigh, a 10 percent rating is assigned for extension limited to 5 degrees. 38 C.F.R. § 4.71a, DC 5251. This is the only disability rating that can be assigned for this diagnostic code. Under DC 5251, for limitation of flexion of the thigh, a 10 percent rating is assigned for flexion limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5252. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 20 degrees. A 40 percent rating is assigned for flexion limited to 10 degrees. Id. Factual Background The Veteran contends that her left hip flexion is more severe than the initial noncompensable (0 percent) rating assigned under DC 5252. 38 C.F.R. § 4.71a, DC 5252. Additionally, she contends that her left hip extension is more severe than the initial 10 percent rating assigned under DC 5251. 38 C.F.R. § 4.71a, DC 5251. As noted previously, in a March 2018 rating decision, the RO decreased the Veteran's left hip extension from 10 percent to a noncompensable rating (0 percent), effective March 9, 2018. In an April 2012 VA examination report, the Veteran was not diagnosed with any left hip condition. In a June 2013 VA examination report, the Veteran was diagnosed with DJD-SI left hip. The examiner did not provide a response as to whether the Veteran experienced flare-ups. The left hip initial Rom was flexion to 90 degrees with objective evidence of painful motion beginning at 90 degrees, left hip extension ends greater than 5 degrees, abduction not lost beyond 10 degrees. Adduction not limited such that the Veteran could not cross her legs. Rotation not limited such that the Veteran could not toe-out more than 15 degrees. The Veteran was unable to perform repetitive-use testing. No explanation was given. She had functional loss and/or functional impairment characterized as less movement than normal, pain on movement, and interference with sitting, standing, and/or weight-bearing in her left hip. The Veteran had no localized tenderness or pain to palpation. She was not diagnosed with ankylosis. She did not have a malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The Veteran did not have a total hip joint replacement or any other type of hip surgery. She used a can occasionally. Imaging studies were performed, and degenerative or traumatic arthritis was documented. The VA examiner noted that functional impairment was characterized as having difficulty sitting in a car or getting into or out of a car repeatedly, or having to stand for extended periods of time. The Board notes that while the Veteran had a VA examination in April 2014, ROM was not tested because the Veteran had received a prolotherapy injection in her SI joint prior. She reported that she could not to any ROM because of pain. The Board notes that the Veteran had a VA examination in February 2018. However, in the June 2021 decision, the Board determined that the February 2018 VA examination was inadequate for rating purposes. In this VA examination report, the Veteran was diagnosed with DJD left hip, with limitation of extension and flexion. She noted that her left hip pain was associated with prolonged lying down, sitting, walking, and standing. The Veteran stated that her pain worsened with increased activity. The Veteran did not report any flare-ups in her left hp. She had functional loss or functional impairment characterized as being unable to sit, stand, lie down, or walk for long periods of time. The Veteran had to constantly change positions. Initial left hip ROM was abnormal or outside of the normal range. Flexion was to 95 degrees, extension was to 10 degrees, abduction was to 20 degrees, adduction was to 10 degrees, external rotation was to 20 degrees, and internal rotation was to 25 degrees. Adduction was limited such that the Veteran could not cross her legs. Pain was noted on examination and caused functional loss during external rotation and internal rotation. There was no objective evidence of localized tenderness or pain to palpation. There was evidence of pain with weight bearing, but no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing and there was no additional loss of function or ROM. The VA examination was not conducting during a flare up. The VA examiner was unable to say without speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time or during a flare up. The rationale for both was that "There is no conceptual or empirical basis for making such a determination without directly observing function under these conditions." The VA examiner was unable to estimate ROM. There were no additional factors that contributed to the Veteran's left hip disability. She had no muscle atrophy and no ankylosis. The Veteran had no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. She used a cane regularly. Arthritis was documented in the left hip. The VA examiner noted that the Veteran's left hip disability would impact her ability to work. This was characterized as constant left hip pain associated with prolonged lying down, sitting, walking, and standing. For the Correia criteria, there was objective evidence of pain on passive ROM. There was no objective evidence of pain when the joint was used in non-weight bearing. The Veteran's opposing joint was undamaged with no examination abnormalities. In an August 2021 VA examination report, the Veteran was diagnosed with DJD left hip with limitation of flexion. She stated that she still had stabbing pain in her left groin area about once a week, usually doing repetitive movements such as standing washing dishes, vacuuming, or during any twisting motion. The Veteran noted that she had to stop doing that activity and rest for about 10-15 minutes until the stabbing pain subsided. She stated that she did not take any pain medication. The Veteran reported flare-ups characterized as "any repetitive movement causes stabbing pain in my left hip or groin area." She noted functional loss or functional impairment characterized as "I cannot do my housework when stabbing pain in my hip occurs. I cannot stand or walk for too long." Initial left hip ROM was abnormal or outside of the normal range. ROM did not contribute to functional loss. Active ROM was flexion endpoint to 95 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 25 degrees, external rotation to 50 degrees, and internal rotation to 40 degrees. The Veteran exhibited pain during all active ROM motions. Limitation in adduction prevented the Veteran from crossing her legs. Passive ROM was the same as active ROM. Flexion endpoint to 95 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 50 degrees, and internal rotation to 40 degrees. The Veteran exhibited pain during all passive ROM motions. The VA examiner noted that the Veteran's limitation in passive adduction did not prevent her from crossing her legs. There was evidence of pain during weight-bearing, active motion, and passive motion. There was no objective evidence of crepitus, but there was objective evidence of localized tenderness or pain to palpation characterized as moderate tenderness in the left groin and posterior buttock. The Veteran was able to perform repetitive-use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. The Veteran was not examined immediately after repeated use over time. Pain and weakness significantly limited functional ability with repeated use over time. Estimated ROM was unchanged from initial active and passive ROM. The Veteran reported chronic intermittent left hip pain that did not cause additional functional loss after repeated use over time. Limitation in adduction after repeated use over time did not prevent the Veteran from crossing her legs. The examination was not conducted during a flare-up. Pain and weakness significantly limited functional ability with flare-ups. Estimated ROM was unchanged from initial active and passive ROM. The Veteran reported chronic intermittent left hip pain that did not cause additional function loss during or after flareups. Limitation in adduction during flare-ups did not prevent the Veteran from crossing her legs. The VA examiner noted that there were no additional factors that contributed to this disability. The Veteran did not have muscle atrophy or ankylosis. She had no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. She had no surgeries involving her left hip. She used a cane occasionally. Imaging studies were not performed. The examiner noted that the Veteran's left hip would impact her ability to work. This was characterized as being unable to perform tasks that required prolonged standing, prolonged walking, any degree of running, or any tasks that required crawling, squatting, or stooping. According to the examiner, these activities would aggravate her left hip condition and the Veteran may not be able to perform these activities safely. Concerning the Correia criteria, ROM testing was conducted to the extent practicable in the involving joint disabilities during active, passive, weight bearing, and on-weight bearing ROMs. The Board notes that throughout the appeal period, the Veteran received medical treatment for her left hip. These treatment reports did not evaluate the nature, extent, and severity of her hip disability during the appeal period. While not discussed specifically, the Board has reviewed them and taken them into consideration. Analysis Based on the above evidence, the Board concludes that the Veteran's left hip flexion does not warrant a compensable (greater than 0 percent) rating at any time during the appeal period. 38 C.F.R. § 4.71a, DC 5252. Her left hip flexion was limited to 95 degrees. Under DC 5252, this does not warrant a 10 percent rating. Id. The Board notes that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Veteran's left hip symptoms did not more closely approximate flexion limited to 30 degrees. Id. Additionally, affording the Veteran the benefit of the doubt, the Board concludes that the Veteran's left hip extension does not warrant a rating in excess of 10 percent at any time during the appeal period. 38 C.F.R. § 4.71a, DC 5251. Her left hip extension was limited to 30 degrees. This is not enough for a 10 percent rating under DC 5251. Id. However, the Veteran's reports of constant pain associated with her left hip extension caused additional functional loss. Because of this, the Board finds that the Veteran is entitled to a 10 percent rating under the provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 concerning functional loss due to pain, fatigue, weakness, lack of endurance, incoordination, and flare-ups. See DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995), 38 C.F.R. § 4.71a, DC 5251. The Veteran does not have extension limited to 5 degrees. Id. Under DC 5251, a disability rating higher than 10 percent is not possible. Id. As noted above, in a March 2018 rating decision, the RO decreased the Veteran's left hip extension from 10 percent to a noncompensable (0 percent) rating, effective March 9, 2018. Affording the Veteran the benefit of the doubt, the Board determines that the Veteran's left hip extension symptoms warrant a 10 percent rating for the entire period on appeal. 38 C.F.R. § 4.71a, DC 5251. The Board finds that the June 2013, February 2018, and August 201 VA examination reports, describing the Veteran's left hip symptoms, are the most probative evidence of record because the examiners reviewed the claims file and provided detailed rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board notes that some of these examinations might not be Correia and Sharp compliant. See Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). However, despite this, the Veteran's left hip symptoms have had a consistent trajectory throughout the appeal period, up until the August 2021 examination, which did conform to Correia and Sharp. Id. While the Veteran is competent (qualified) to observe her left hip symptoms, she does not have the training or credentials to determine the current nature, extent, and severity of those symptoms, as reflected by the applicable VA diagnostic criteria. Additionally, she does not have the training or credentials to determine the proper disability evaluations concerning her left hip flexion and extension. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Because of this, an initial compensable disability rating is not warranted for the Veteran's left hip flexion and an initial disability rating in excess of 10 percent is not warranted for her left hip extension. These increased rating claims are denied. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Board notes that the Veteran was granted a total disability rating based on individual unemployability in an April 2014 rating decision. The Board is sympathetic to the Veteran's reports and understands that her back condition, left lower extremity radiculopathy, and left hip disabilities have significant effects on her daily life. However, her symptoms more nearly approximate the assigned ratings in this decision. (Continued on the next page) The Board also notes that this decision does not leave the Veteran without recourse. If her disabilities should worsen in the future, she is free to file claims for increased disability ratings at that time. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.