Citation Nr: 21073918 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 17-48 897 DATE: December 13, 2021 ORDER Entitlement to a rating in excess of 10 percent for a lumbar spine disability prior to March 30, 2021; and in excess of 40 percent disabling since March 30, 2021 is denied. Entitlement to an earlier effective date of August 27, 2016 for an initial 10 percent rating for radiculopathy of the left lower extremity is granted. Entitlement to an earlier effective date than March 30, 2021 for an initial 10 percent rating for radiculopathy of the right lower extremity is denied. FINDINGS OF FACT 1. Prior to March 30, 2021, the probative evidence of record does not demonstrate forward flexion of the Veteran's thoracolumbar spine functionally limited to 60 degrees or less; nor that the Veteran's combined range of motion of the thoracolumbar spine was functionally limited to 120 degrees or less; nor was there evidence of severe muscle spasm or guarding resulting in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or its functional equivalent. 2. Since March 30, 2021, the probative evidence of record does not demonstrate ankylosis of the entire thoracolumbar spine or its functional equivalent. 3. Since August 27, 2016, the Veteran has experienced mild incomplete paralysis of his left lower extremity. 4. Prior to March 30, 2021, the Veteran did not experience mild incomplete paralysis of his right lower extremity. CONCLUSION OF LAW 1. The criteria for a rating in excess of 40 percent for a lumbar spine disability, to include a rating in excess of 10 percent prior to March 30, 2021, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 2. The criteria for an initial rating of 10 percent for radiculopathy of the left lower extremity have been met effective August 27, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, Diagnostic Code 8520. 3. The criteria for an initial rating of 10 percent for radiculopathy of the right lower extremity have not been met prior to March 30, 2021. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active-duty service from July 1983 to October 1983 and from August 2002 to August 2002. He also had over 19 years of service in the Army National Guard, from September 1989 to March 2009. This matter previously came before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in July 2017 by a Department of Veterans Affairs (VA) regional office (RO), which had denied an increased rating in excess of 10 percent for the Veteran's lower back condition. In September 2019, the Veteran testified at a hearing conducted before a Veterans Law Judge (VLJ) who has since retired from the Board. A transcript of that hearing is associated with the record. At the hearing, the Veteran testified that his back condition had worsened since his last VA exam in October 2016 and that he now experienced radiculopathy. Because the VLJ who had held the hearing retired, in March 2020 the Veteran was sent a letter offering him the opportunity to testify at a new hearing before a VLJ who would participate in the decision. See 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. The Veteran was provided 30 days to respond, but did not do so. Accordingly, the Veteran waived his right to another hearing. In June 2020, the Board remanded the case for further development to include obtaining a new VA examination of the Veteran's lumbar spine condition. Following that examination, the RO issued an April 2021 rating decision, which granted an increased rating of 40 percent for the Veteran's lumbar spine condition from March 30, 2021 (the date of the VA examination), and denied an evaluation in excess of 10 percent prior to March 30, 2021. The RO also granted ratings of 10 percent for right and left lower extremity radiculopathy, as neurological manifestations of the lumbar spine disability. The appeal has been returned to the Board for further appellate review. As a preliminary matter, the Board finds there has been substantial compliance with the June 2020 remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Although the RO awarded an increased rating of 40 percent for the Veteran's lumbar spine disability from March 30, 2021, which constitutes a partial grant of the issue on appeal, nevertheless the Veteran has not been awarded the highest possible evaluation under the schedular criteria for the duration of the period on appeal. As the Veteran is presumed to be seeking the maximum possible evaluation, and has not indicated his satisfaction with the award of the 40 percent rating or its effective date, the issue of increased rating for the lumbar spine condition remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). 1. Entitlement to an increased rating for a lumbar spine disability, rated as 10 percent disabling prior to March 30, 2021, and rated as 40 percent disabling since March 30, 2021. The Veteran filed a claim for increased rating of his lower back disability rating in August 2016. The VA granted an increased rating to 40 percent for the lumbar spine condition, effective March 30, 2021. The Board's evaluation below is limited to consideration of whether the evidence supports a rating in excess of 10 percent prior to March 30, 2021, and in excess of 40 percent thereafter. Legal Criteria for Increased Ratings Claims VA has adopted the Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally 38 C.F.R. Part IV. The Board determines the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 C.F.R. § 4.10. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Additionally, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, "staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The Board finds that staged ratings as indicated and discussed herein are warranted. Further, 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."). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Mitchell, 25 Vet. App. at 43. 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. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Diagnostic Criteria The Veteran's service-connected lower back condition is currently awarded a 40 percent rating pursuant to Diagnostic Code 5237, for lumbosacral strain. Back disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or, for Diagnostic Code 5243 only, the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. Here, given that the Veteran does not have a diagnosis of IVDS under Diagnostic Code 5243, but rather a diagnosis of lumbosacral strain under Diagnostic Code 5237, the General Rating Formula will be applied. Regardless, the General Rating Formula would result in the higher evaluation, as the Veteran has never reported and the records do not reflect physician-prescribed bed rest, a foundational requirement under the Formula for Rating IVDS. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, the General Rating Formula and its criteria including range-of-motion measurements were not changed. Under the General Rating Formula, a 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is 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 30 degrees or less or 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. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. 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. 38 C.F.R. § 4.71a, at Note 5. Unfavorable ankylosis, for VA compensation purposes, is a condition in which the entire cervical spine, or 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine at Note 5. Ankylosis can also mean the "functional equivalent" of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). Normal ranges of motion of the thoracolumbar spine are flexion from 0 to 90 degrees, extension from 0 to 30 degrees, lateral flexion from 0 to 30 degrees, and lateral rotation from 0 to 30 degrees. 38 C.F.R. § 4.71, Plate V. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under the appropriate diagnostic codes. Id. at Note 1. These are discussed in the next section of this decision. Evidence Here, there is no evidence to support a rating in excess of 10 percent prior to the March 2021 VA examination, and no evidence to support a rating in excess of 40 percent at any time during the period on appeal. In connection with his August 2016 claim for increased rating, the Veteran was afforded a VA examination of the lumbar spine in October 2016. His range of motion in forward flexion was found to be 80 degrees. His combined range of motion was 208 degrees. The Veteran was noted to have painful motion in flexion and extension and his spinal muscles were tender to palpation. The examiner indicated that pain, weakness, fatigability or incoordination do not significantly limit functional ability with repeated use. Muscle strength testing was normal. The examiner indicated the Veteran did not report flare-ups. The examiner indicated the Veteran did not have guarding or muscle spasms. The Veteran's 10 percent rating was continued and the Veteran timely appealed. In his August 2017 Notice of Disagreement, the Veteran stated he experienced "severe muscle spasms" and "limited range of motion," symptoms he contended occurred "from time to time" and "not on a constant basis." See VBMS, document labeled NOD, receipt date 8/14/2017, page 3 of 3. At the September 2019 Board hearing, the Veteran testified that his back was getting worse over time, that in his opinion it had gotten worse since the VA examination in October 2016, and that he was having increased problems with movement. He testified that he sometimes used a back brace, used heat and ice, and took 800 milligrams of ibuprofen for the pain. He testified that he experienced radicular pain shooting down the left leg, but not the right leg. He testified he experienced flare-ups of his back pain twice a week, but that he tried to work through the pain and used heating pads. He indicated he did not want to have surgery on his back. He reported being employed as a business services and facilities manager for a law firm. He reported exercise was difficult due to his back pain. In March 2021, the Veteran underwent another VA examination pursuant to the Board's remand directive. The Veteran was diagnosed with lumbosacral strain, degenerative arthritis, spinal stenosis, and bilateral lower extremity radiculopathy. The Veteran reported daily back pain and flare-ups with more severe pain occurring 3-4 times per month and lasting 2-4 days each time. He reported using medication daily to keep his pain at a tolerable level, as well as ice, heat, stretching exercises, and occasional use of a back brace. The Veteran reported functional limitations including difficulty sitting for long periods, walking long distances, pain with repetitive bending or lifting, and other activities. He reported intermittent pain shooting down both legs and daily back spasms. The Veteran indicated he was able to complete his employment requirements. The VA examiner conducted range-of-motion testing in active and passive range of motion, yielding identical measurements. Those initial range-of-motion measurements were 25 degrees in forward flexion, 20 degrees in extension, 25 degrees in right lateral flexion, 15 degrees in left lateral flexion, 25 degrees in right lateral rotation, and 30 degrees in left lateral rotation. Pain on both active and passive ranges of motion was exhibited in all planes of motion except with left lateral rotation. After repetitive use testing, an additional reduction in forward flexion to 20 degrees was noted, as well as a reduction in extension to 10 degrees. Pain was noted to significantly limit functional ability with repeated use over time and during flare-ups. The examiner estimated the range of motion of the back after repeated use over time, and during flare-ups, would be further reduced to 15 degrees in forward flexion, to 5 degrees in extension, to 20 degrees in right lateral flexion, to 10 degrees in left lateral flexion, and to 20 degrees in right and left lateral rotation. The Veteran was observed to have localized tenderness, pain, guarding, and muscle spasms, which did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal; no atrophy was noted. The examiner indicated there was no ankylosis of the spine. Turning to the Veteran's medical treatment records, the Board notes that they contain consistent reports of chronic back pain. However, the medical records do not contain any demonstrable range-of-motion measurements. The Veteran's lay statements and testimony also describe significant pain, but similarly fail to establish that his range of motion was limited by that pain (or other factors) to such a degree as to warrant an increased rating in excess of 10 percent prior to the March 2021 examination. Post-2017 Rochester VA medical records were associated with the record per the Board's remand directive, but upon review there is still no indication of range of motion measurements. For example, an April 2017 note reflects a musculoskeletal examination was done and notes only low back pain with flexion and extension. A September 2017 note reflects the Veteran's report of "more problems with his back recently with pain shooting down both legs." That note comments that his "forward flexion side to side [is] markedly limited due to back discomfort." However, no range-of-motion measurements were taken. A March 2018 note indicated a recent flare of back pain and the Veteran's complaint that his back pain was limiting his ability to be active. A December 2018 note indicates lumbar back pain rated at 5 out of 10 on the pain scale, but no leg pain, numbness, or tingling. A record dated September 2019 notes "chronic back pain radiating into his legs ... worse in AM and improved during the day most times." An October 2019 record notes chronic, radiating back pain, states that the Veteran ambulates without assistance, and notes he was experiencing slight left paravertebral spasm. A March 25, 2020 note states, "no impairment of function ... frequent pain in his lower back." The March 2020 record continues, "He is taking Robaxin daily and doing ok but still in pain." No mention is made of radicular symptoms such as numbness or tingling. No range-of-motion measurements were taken or reflected at any of these appointments, nor were any annotations made reflecting an observed reduction or limitation in his range of motion aside from the September 2017 note vaguely referencing "markedly" limited ranges of motion due to discomfort. The only other potential reference to the Veteran's range of motion is a Wilson Health Center record from September 2017 (the same month in which the "markedly" reduced range of motion was noted), in which the Veteran reported aching back pain and tenderness, and the medical provider annotated, "pertinent negatives include abdominal pain, bladder dysfunction, bladder incontinence, bowel retention, decreased mobility, numbness, rash, tingling in the legs and weakness" (emphasis added). That is to say, the medical provider appears to have indicated that the Veteran did not have (or did not report) any of those symptoms, including decreased mobility due to back pain. Analysis The probative evidence of record does not demonstrate that prior to the March 2021 examination, there was evidence of severe muscle spasm or guarding resulting in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, that could warrant an increased rating in excess of 10 percent prior to that time. Although the Veteran reported muscle spasms prior to March 30, 2021, and was prescribed a methocarbamol to treat muscle spasms, there is no evidence that the Veteran experienced such severe muscle spasm or guarding so as to result in an abnormal gait or abnormal spinal contour as contemplated by the criteria for a 20 percent rating. The Board also notes that the March 2021 VA examination similarly did not indicate the Veteran experienced muscle spasm or guarding so severe as to result in abnormal gait or abnormal spinal contour. Regarding range of motion, although one record in September 2017 comments on markedly limited range of motion, there were no range of motion measurements taken, nor was any quantifiable reduction noted by the provider (such as, for example, a notation that the Veteran could only bend halfway or two-thirds). A record the same month seems to indicate no limitation of motion. Of course, if the evidence of differing range-of-motion measurements were in equipoise, with one supporting an increased rating prior to March 2021 and one not, the benefit of the doubt would go to the Veteran. Here, however, there are no measurements at all. The specific clinical measures of ranges of motion, including examiners' findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran's general reports of pain and limitation of function and mobility. Therefore, as there is no evidence of limitation of range of motion that could satisfy the criteria for a 20 percent (or a 40 percent) rating prior to the March 2021 examination, and no evidence of severe muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour, a rating in excess of 10 percent is not warranted prior to the March 2021 VA examination. Although the Board is sympathetic to the Veteran's heightened and reported levels of pain and discomfort, the Veteran has not demonstrated that the criteria under the General Rating Formula for a higher rating have been met prior to the March 2021 VA examination. Nor does the evidence support a rating higher than 40 percent disabling at any time during the period on appeal. Much of the Veteran's reports of back pain included radicular pain, which has now been separately evaluated and rated by the RO. The Veteran's ranges of motion of the thoracolumbar spine are firmly within the 40 percent rating criteria, even considering the examiner's estimated additional reduction during flare-ups and after repetitive use testing. The next higher rating under the General Rating Formula is a 50 percent rating for unfavorable ankylosis. The Veteran has never contended he has ankylosis of the spine or symptoms associated therewith, and he has never been diagnosed with ankylosis of the spine. Ankylosis can also mean the "functional equivalent" of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). However, even when considering the functional limitations during a flare-up, which the Veteran has described as slowing him down "quite a bit" and requiring limitation of activity, the Veteran's symptoms do not more nearly approximate fixation of a spinal segment in neutral position (zero degrees). Thus, a higher rating of 50 percent is not warranted. 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. Although the March 2021 VA examiner thoroughly addressed flare-ups, the October 2016 examiner did not assess additional range of motion lost during flare-ups because the Veteran did not assert such symptomology. The October 2016 examiner did perform repetitive use testing and indicated that the Veteran did not suffer additional functional limitations after repetitive use. The Board has considered the Veteran's complaints and found the Veteran's range of motion and symptomology including reported flare-ups to be consistent with the currently assigned ratings. Thus, the evidence does not show that even during flare-ups, the Veteran's range of motion or symptomology approximate a greater degree of loss of range of motion. While the Veteran reported pain, functional loss, and a great deal of difficulty with movement during flare-ups, flare-ups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flare-ups must be of such duration and frequency as to establish that the overall impairment is more severe than currently evaluated. Here, the Veteran's statements do not show that any flare-ups or repeated use over time have additionally limited his function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted, above what the Board has already found. The disability ratings assigned herein already indicate a significant impact on the Veteran's functional ability and recognize his enduring pain and his limited and painful range of motion. The critical question, however, is whether the problems he has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for a further increased rating of the Veteran's lower back disability and the benefit of the doubt doctrine is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Radiculopathy of the left lower extremity 3. Radiculopathy of the right lower extremity Through an April 2021 rating decision, the Veteran was assigned 10 percent ratings for radiculopathy of the sciatic nerves of his bilateral lower extremities, each effective March 30, 2021. As explained above, in addition to the back ratings, the Rating Schedule directs that any associated objective neurological abnormalities, such as radiculopathy, are to be evaluated separately under an appropriate diagnostic code. See General Rating for Diseases and Injuries of the Spine, at Note 1. Disability ratings with respect to neurological conditions ordinarily are assigned in proportion to the impairment of motor, sensory, or mental function. 38 C.F.R. § 4.124a. The Veteran's sciatic radiculopathy of the bilateral lower extremities is rated under Diagnostic Code 8520 for paralysis of the sciatic nerve. Under this code, a 10 percent rating is warranted for mild incomplete paralysis. A 20 percent rating is warranted for moderate incomplete paralysis. A 40 percent rating is assigned for moderately severe incomplete paralysis. A 60 percent rating is assigned for severe incomplete paralysis with marked muscular atrophy. An 80 percent rating is for application where there is complete paralysis of the sciatic nerve (i.e., the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost). 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). Evidence At the Veteran's October 2016 VA examination, the Veteran reported pain in his low back that traveled down to his left leg. He denied bowel or bladder control issues. The examiner noted negative straight leg raise test bilaterally, which is a test used to assess nerve root irritation by reproducing radiating leg pain. The examiner indicated symptoms of mild left lower extremity intermittent pain, and involvement of the left femoral nerve roots, but noted the Veteran was "not affected" by right or left sided radiculopathy. In a November 2016 addendum to the VA examination, the examiner concluded that the Veteran's reports of transient leg pain occurring 2-3 times per month was not consistent with radicular pain, but rather "more consistent with referred pain of the lumbar spine or spasm." A VA treatment record dated September 27, 2017 reflects the Veteran's complaints of pain shooting down both legs. At that appointment, a straight leg raise test was conducted which found the result to be worse on the left side compared to the right. The Veteran subsequently reported worsening symptoms at the September 2019 hearing, including symptoms of radicular pain shooting down the left leg. At the Veteran's March 2021 VA examination, the clinician found sciatic radiculopathy of the bilateral lower extremities despite a negative straight leg raising test. In support, the clinician noted the Veteran complained of left leg radicular pain 2-3 times per month, which he described as a brief, shooting pain. He denied bowel or bladder control issues. The examiner noted radicular symptoms including intermittent pain bilaterally, as well as bilateral paresthesias and/or dysesthesias and numbness. The AOJ found mild sciatic radiculopathy to be present based on the March 30, 2021 VA examination and awarded service connection from that date. Analysis After considering the above, the Board finds there is evidence of left lower extremity radiculopathy at the October 2016 VA examination. The principal symptoms described by the Veteran (shooting pain down the leg 2-3 times per month) are the same symptoms described at the March 2021 VA examination, for which a diagnosis of bilateral radiculopathy was conferred. Although the VA examiner's November 2016 addendum opinion indicated the symptoms described were not radicular in nature, the Board finds that the other evidence of record supports a finding that they were, especially in light of the subsequent diagnosis based on very similar reported symptomatology. Given that the left lower extremity radiculopathy existed at the October 2016 VA examination, the Board concludes it likely existed at the time of the August 2016 claim for increase as well (which, as discussed, encompasses neurological manifestations). Therefore, with respect to the left lower extremity radiculopathy, the Board finds that an earlier effective date of August 27, 2016the date of receipt of the Veteran's claim for increaseis warranted. As for the right side, the Board finds that the evidence does not support an earlier effective date for the Veteran's right lower extremity radiculopathy. The evidence is inconsistent as to the Veteran's symptoms on the right side. While he reported bilateral lower extremity pain in September 2017, some subsequent medical records are negative for radicular symptoms. The Veteran also denied experiencing right-sided radicular symptoms at the September 2019 hearing. No diagnosis was assessed until the March 2021 VA examination. The record contains accounts of the Veteran's neurological symptoms commonly associated with radiculopathy, but the condition was not diagnosed or addressed with any degree of certainty. This leaves the Board to only draw inferences as to the symptoms and effects related to the Veteran's right lower extremity, and rely on its own lay opinion to find the onset of the condition, which it is forbidden from doing. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board therefore concludes the evidence of record as a whole is against a finding for an earlier effective date prior to March 30, 2021 for the grant of service connection for right lower extremity radiculopathy. As to the evaluation of the severity of the Veteran's bilateral radiculopathy, the Board does not find that the neurological or other objective manifestations of the Veteran's radiculopathy approximate moderate incomplete paralysis consistent with a 20 percent rating. The Board again notes that in assigning a severity for radiculopathy, when the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The Veteran's March 2021 VA examination contains the most severe symptomology noted in any of the Veteran's records or prior examinations: moderate intermittent pain bilaterally, moderate paresthesias or dysesthesias of the right lower extremity, mild paresthesias or dysesthesias of the left, moderate numbness of the right and mild numbness of the left. The Board has considered whether these symptoms warrant an increased 20 percent rating, but finds that they do not because the radicular symptoms are noted to be relatively infrequent, occurring at most several times per month and lasting a short duration. Further, less severe objective findings are noted in the Veteran's medical records and reported in his own statements. The greater emphasis throughout his treatment history has been on his substantial mechanical back pain and attendant limited range of motion and functionality. The Board also does not find a greater degree of impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, pain, muscle atrophy or paralysis (i.e. objective findings) that would warrant a higher rating. The disability evaluations assigned by VA adequately recognize the Veteran's symptoms and indicate a significant impact on his functional ability. The critical question in this case, however, is whether the symptoms he has described meet an even higher level of disability evaluation under the rating criteria. For reasons cited above, the Board finds they do not. His symptoms bilaterally are commensurate with an evaluation of mild incomplete paralysis of the sciatic nerve. (continued on the next page) Thus, in consideration of the above, the Board finds that the Veteran's radiculopathy of the left lower extremity warrants an initial 10 percent rating effective August 27, 2016. No earlier effective date is warranted for the 10 percent rating of radiculopathy of the right lower extremity. The Board finds the benefit of the doubt doctrine to be inapplicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. I. M. Hitchcock Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Medley, Associate 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.