Citation Nr: 21073823 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 18-00 608 DATE: December 10, 2021 ORDER Entitlement to an increased rating in excess of 10 percent for left knee degenerative joint disease, limitation of flexion, is denied. Entitlement to a separate rating of 10 percent, but not more, for left knee instability, effective April 20, 2015, is granted. Entitlement to an increased rating in excess of 10 percent prior to September 6, 2016, and in excess of 40 percent thereafter, for degenerative arthritis of the lumbar spine is denied. Entitlement to a separate rating of 10 percent, but not more, for intermittent right side S1 radiculopathy, effective April 20, 2015, is granted. FINDINGS OF FACT 1. The Veteran's left knee degenerative joint disease, limitation of flexion, is manifest by no worse than flexion limited to 45 degrees. 2. The Veteran's service-connected left knee degenerative joint disease caused mild lateral instability from April 20, 2015 onward. 3. Before September 6, 2016, the Veteran's degenerative arthritis of the lumbar spine was manifest by no worse than flexion limited to 80 degrees and a combined range of motion of 225 degrees. 4. Beginning September 6, 2016, the Veteran's degenerative arthritis of the lumbar spine was manifest by no worse than flexion limited to 15 degrees and a combined range of motion of 85 degrees, reduced to forward flexion of 5 degrees and combined range of motion of 25 degrees during flare ups. 5. The Veteran's service-connected degenerative arthritis of the lumbar spine caused mild incomplete paralysis of the sciatic nerve from April 20, 2015 onward. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left knee degenerative joint disease, limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 2. The criteria for a separate rating of 10 percent, but not more, for left knee lateral instability, have been met from April 20, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 3. The criteria for a rating in excess of 10 percent prior to September 6, 2016 and in excess of 40 percent thereafter for degenerative arthritis of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5237, 5242. 4. The criteria for a separate rating of 10 percent, but not more, for mild incomplete paralysis of the sciatic nerve have been met from April 20, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Navy from March 1979 to March 1999. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision by the Department of Veterans Affairs (VA); this case is in VA's legacy appeals system. In March 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record. 1. Entitlement to an increased rating in excess of 10 percent for left knee degenerative joint disease The Veteran contends that he is entitled to a higher rating because his current rating does not fully compensate for the severity of this left knee degenerative joint disease (DJD) symptoms. The Veteran's left knee DJD has been rated under Diagnostic Codes (DC) 5010 and 5260. The original rating under DC 5010 was based on noncompensable limitation of motion caused by x-ray confirmed left-knee DJD. 38 C.F.R. § 4.71a. The change to DC 5260 was based on compensable limitation of flexion. Under DC 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. 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. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left knee DJD. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, weakness, and limited flexibility. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he has trouble sitting or standing for extended times and has to use a brace and cane would not result in limitation of motion more nearly approximating flexion limited to 30 degrees. VA provided examinations to determine the severity of the Veteran's left knee DJD in September 2015, September 2016, and October 2020. In September 2015, the Veteran's left knee had flexion to 135 degrees and extension to 0 degrees. He denied flare ups or further functional loss after repeated use over time. In September 2016 the Veteran's left knee had flexion to 75 degrees and extension to 0 degrees. The Veteran reported increased symptoms during flare ups and after repeated use over time, but the examiner did not provide an estimate of how this manifested in further reduced range of motion. In October 2020, the Veteran's left knee had flexion to 90 degrees and extension to 0 degrees. The Veteran denied flare ups but stated that his pain increased with repeated use over time. The examiner opined that after repeated use over time the Veteran's pain would reduce left knee flexion to 45 degrees with extension to 0 degrees. While it is possible that the Veteran's left knee flexion after repeated use over time was just as limited when he described it in September 2016, it is not likely that it was significantly worse, as he never described it getting better, only progressively worse. Therefore, the preponderance of the evidence shows that the Veteran's left knee DJD manifested as no worse than flexion limited to 45 degrees. This does not warrant a rating greater than 10 percent under DC 5260. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Separate ratings are not appropriate under DC 5256 for ankylosis, DC 5258 for locking, pain, and effusion caused by dislocated semilunar cartilage, DC 5259 for symptomatic removal of semilunar cartilage, DC 5261 for limitation of extension, DC 5262 for impairment of the tibia and fibula, or DC 5263 for genu recurvatum because the Veteran does not have these diagnoses and he has had full extension for the entire period on appeal. A separate rating under DC 5257 for other impairment of the knee is addressed in a separate section below. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for limitation of flexion caused by left knee DJD. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to service connection for left knee instability The Veteran is seeking a separate rating for left knee instability caused by his left knee DJD. Under Diagnostic Code 5257, for other impairment of the knee, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg. The amended Diagnostic Code 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability. For recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for 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. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A maximum 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) provides that, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) provides that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as a surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). VA provided examinations in September 2015, September 2016, and October 2020 to determine the severity of the Veteran's left knee DJD. Objective testing by each VA examiner showed normal stability with all related testing within normal limits. However, each examiner also acknowledged that the Veteran had to use a left knee brace. This brace has been prescribed by a VA provider since at least January 2013. The Veteran's has also consistently reported left knee instability in his lay statements over the entire period on appeal. Because objective testing cannot be found categorically more probative than lay evidence in establishing the presence of lateral instability, and the Veteran's constant use of a prescribed left knee brace tends to support his statements regarding the presence of left knee instability, the Board resolves all reasonable doubt in favor of the Veteran and finds that he has had left knee lateral instability for the entire period on appeal. However, as all objective medical testing has shown normal stability in the left knee, and the Veteran's instability appears to be controlled with use of a brace, the Board finds that it is of mild severity. The Board finds that application of the updated DC 5257 would not justify a rating in excess of 10 percent for left knee instability. The Board has carefully considered the Veteran's reports about having left knee instability, sometimes falling when it gives out, and constantly using a prescribed knee brace. English, 30 Vet. App. 347, 352-53. However, overall, the lay and medical evidence indicates that the Veteran does not have a left knee sprain, left knee ligament tear, or a history of surgery to repair a left knee patellofemoral complex condition. At least one of those three is required to meet the criteria for a 20 percent or higher rating under the updated DC 5257. In conclusion, the Board finds that a separate 10 percent rating, but not more, for mild left knee lateral instability, is warranted for the entire period on appeal. In denying a higher rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to an increased rating in excess of 10 percent prior to September 6, 2016 and in excess of 40 percent thereafter for degenerative arthritis of the lumbar spine The Veteran contends that he is entitled to a rating greater than 20 percent before September 6, 2016 and greater than 40 percent thereafter because his current ratings do not fully recognize or compensate for the severity of his symptoms. From December 12, 2013 to September 5, 2016, the Veteran's spine disability was rated under 38 C.F.R. § 4.71a, DC 5237 for lumbosacral or cervical strain. Beginning September 6, 2016, his spine disability has been rated under DC 5242 for degenerative arthritis, degenerative disc disease other than intervertebral disc disease. Both of these are rated using the General Rating Formula for Diseases and Injuries of the Spine (General Formula). Under the General Formula, a 10 percent rating is warranted 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 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 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. 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. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. At the March 2020 Board hearing, the Veteran testified that he has been unable to bend his back since sometime in 2015 and that his current 40 percent rating should be effective from October 22, 2015, the date he filed a notice of disagreement with his assigned 20 percent rating. He testified that there had been no worsening in his condition between October 2015 and the current effective date of September 6, 2016. VA provided examinations to determine the severity of the Veteran's spine disability in September 2015, September 2016, and October 2020. In September 2015, the Veteran's thoracolumbar spine had forward flexion to 80 degrees and combined range of motion of 225 degrees with no change after three repetitions. He did not report flare ups or functional loss after repeated use over time. In September 2016, the Veteran's thoracolumbar spine had forward flexion to 30 degrees and combined range of motion of 80 degrees with no change after three repetitions. The examiner did not attempt to determine whether and to what extent there was further functional loss during flare ups or after repeated use over time. In October 2020, the Veteran's thoracolumbar spine had forward flexion to 15 degrees and combined range of motion of 85 degrees with no change after three repetitions. The Veteran described increased pain during daily flare ups and with repeated use over time, especially while standing at his job. The examiner opined that this would cause further functional loss, reducing forward flexion to 5 degrees and combined range of motion to 25 degrees during a flare up. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for lumbar strain before September 6, 2016. The Board acknowledges the Veteran's lay reports that his symptoms were the same from October 22, 2015 until September 6, 2016, and that there was functional loss due to pain, worse during flare-ups after repetitive use over time, making it difficult to bend, lift, or stand or sit for extended periods. However, the Board finds that the objective medical evidence of record does not support the Veteran's statement that his symptoms were identical from October 2015 to September 2016. The Veteran reported worsening symptoms when filing his claim in April 2015. His September 2015 VA examination showed significant worsening compared to a previous examination in December 2013 but would only have justified a 10 percent rating. Nothing in his medical treatment records, which consistently document his complaints of back pain and related symptoms, indicates an increase in October 2015. The Board finds that the objective measurements of the September 2015 VA examiner, made very close in time to the October 2015 notice of disagreement, is the most probative evidence of record regarding the severity of the Veteran's symptoms during this time period. While the Veteran is competent to report these lay observable symptoms, the Board finds that contemporaneous medical records are more reliable and therefore more probative than testimony taken several years after the fact. The Board therefore finds that before September 6, 2016, the Veteran's spine disability symptoms did not more nearly approximate forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The evidence shows that from September 6, 2016 onward, the Veteran's lumbar spine at best had forward flexion to 30 degrees and combined range of motion of 80 degrees. By October 2020 forward flexion was reduced to 15 degrees and combined range of motion was 85 degrees, and during flare ups it forward flexion could be reduced to 5 degrees with combined range of motion of 25 degrees. However, even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate fixation of a spinal segment in neutral position (zero degrees). Even at his most limited, the Veteran has some flexion of his thoracolumbar spine, as opposed to an ankylosed spine which is immobile and fixed in place. Even considering the significant impairment caused by flare ups, the Veteran's spine disability symptoms do not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been granted service connection for femoral and sciatic nerve neuropathy of the bilateral lower extremities and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. The issue of an earlier effective date for the grant of a separate rating for right side S1 radiculopathy is addressed in the section below. 4. Entitlement to a separate compensable rating for intermittent right side S1 radiculopathy, prior to October 5, 2020 The Veteran was seeking a separate compensable rating for right side S1 radiculopathy. A December 2020 rating decision granted this, as radiculopathy of right lower extremity (sciatic nerve), effective October 5, 2020. The Veteran contends that his right side S1 radiculopathy manifested to a compensable level as early as his original filing date of April 20, 2015 and the separate rating should be granted as of that date. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The Veteran's right side S1 radiculopathy manifested as intermittent pain as early as April 1999, when the Veteran was first granted service connection for his low back strain and intermittent right side S1 radiculopathy. Since that time, the Veteran's treatment records show complaints of the same symptoms. VA provided examinations to determine the severity of the Veteran's spine disability, to include any associated radiculopathy, in September 2015, September 2016, and October 2020. The September 2015 and September 2016 examiners noted the Veteran's complaints of radicular pain but did not observe radicular symptoms on examination. The October 2020 examiner noted bilateral leg decreased sensation to light touch, right leg constant moderate pain, and left leg moderate numbness, which the Veteran described as slowly worsening over the past several years. The examiner diagnosed moderate bilateral leg radiculopathy involving the sciatic and femoral nerves. The report indicated that the S1 vertebrae was involved with the sciatic nerve. Before October 5, 2020, the evidence of record did not show impairment of motor function or sensory disturbance. The September 2016 examiner noted the absence of deep tendon reflexes in the bilateral knees and ankles, but this was not a symptom the Veteran ever complained of and it is not noted anywhere else in the record, including the September 2015 and October 2020 examinations. The Veteran's primary complaint has always been intermittent pain radiating from his back down his right leg, increasing to constant pain as reflected in the October 2020 examination. The evidence does not show any trophic changes, muscle atrophy, or symptoms of complete paralysis of the sciatic nerve. Based on the above, the Board finds that the Veteran's right side S1 radiculopathy manifested as partial incomplete paralysis of the sciatic nerve from April 20, 2015, and the Veteran is entitled to a separate disability rating for this condition from that date. Before October 5, 2020, the disability was primarily manifest by intermittent pain radiating down the right leg, with some indication of possible temporary loss of reflexes. The Board also finds that the most probative evidence of record is against a finding that the disability was manifest by impairment of motor functions, trophic changes, sensory disturbance, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis of the sciatic nerve. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence supports the Veteran's claim for a separate 10 percent rating, but not more, for right side S1 radiculopathy, now service connected as right lower extremity radiculopathy (sciatic nerve), effective April 20, 2015. In denying a higher rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.