Citation Nr: 21074254 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 16-59 377 DATE: December 14, 2021 ORDER Entitlement to an initial rating higher than 20 percent for cervical spine degenerative arthritis (cervical spine disability) prior to June 10, 2021 is denied. Entitlement to a rating higher than 30 percent for cervical spine disability from June 10, 2021 is denied. Entitlement to a rating higher than 20 percent for residuals of a thoracic spine fracture with degenerative arthritis (thoracic spine disability) prior to June 10, 2021 is denied. Entitlement to a rating higher than 40 percent for residuals of a thoracic spine disability from June 10, 2021 is denied. Entitlement to a rating higher than 10 percent for right knee retropatellar pain syndrome (right knee disability) prior to June 10, 2021 is denied. Entitlement to a rating higher than 30 percent for right knee disability from June 10, 2021 is denied. Entitlement to a rating higher than 10 percent for left knee retropatellar pain syndrome (left knee disability) prior to June 10, 2021 is denied. Entitlement to a rating higher than 30 percent for left knee disability from June 10, 2021 is denied. Entitlement to an effective date earlier than June 10, 2021 for the assignment of a separate rating for right knee instability is denied. Entitlement to an effective date earlier than June 10, 2021 for the assignment of a separate rating for left knee instability is denied. Entitlement to a rating higher than 20 percent for right knee instability is denied. Entitlement to a rating higher than 20 percent for left knee instability is denied. Entitlement to an effective date for a separate rating for radiculopathy of the right upper extremity claimed as right arm disability associated with cervical spine degenerative arthritis with cervical strain and intervertebral disc syndrome (IVDS) prior to June 10, 2021 is denied. Entitlement to a rating higher than 40 percent for radiculopathy of the right upper extremity claimed as right arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS from June 10, 2021 is denied Entitlement to an effective date for a separate rating for radiculopathy of the left upper extremity claimed as left arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS prior to June 10, 2021 is denied. Entitlement to a rating higher than 30 percent for radiculopathy of the left upper extremity claimed as left arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS from June 10, 2021 is denied. Entitlement to an effective date for a separate rating for radiculopathy of the right lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2010 is denied. Entitlement to a rating higher than 20 percent for radiculopathy of the right lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2010 is denied. Entitlement to an effective date for a separate rating for radiculopathy of the left lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 is denied. Entitlement to a rating higher than 20 percent for radiculopathy of the left lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 is denied. Entitlement to an effective date for a separate rating for radiculopathy of the right lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 is denied. Entitlement to a rating higher than 20 percent for radiculopathy of the right lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 is denied. Entitlement to an effective date for a separate rating for radiculopathy of the left lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 is denied. Entitlement to a rating higher than 20 percent for radiculopathy of the left lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 is denied. REMAND Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. Prior to June 10, 2021, the Veteran's cervical spine disability was productive of forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees, and with no evidence of incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. 2. From June 10, 2021 the Veteran's cervical spine disability did not more nearly approximate unfavorable ankylosis of the entire cervical spine or demonstrate intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 3. Prior to June 10, 2021, the Veteran's thoracic spine disability was manifested by forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees, and with no evidence of incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. 4. From June 10, 2021 the Veteran's thoracic spine disability did not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine or demonstrate IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 5. Prior to June 10, 2021 the Veteran's right and left knee disabilities were not manifested by flexion limited to 30 degrees or worse; nor was limitation of extension to a compensable degree. 6. From June 10, 2021 the Veteran is in receipt of the maximum schedular rating under limitation of flexion of the right and left knees; limitation of extension is not shown to a compensable degree. 7. The preponderance of the evidence is against finding that the Veteran had separately ratable right and left knee instability associated with his service-connected right and left knee disabilities earlier than June 10, 2021. 8. From June 10, 2021 the Veteran's right and left knees were manifested by weakened movement and instability of station, recurrent subluxation or persistent instability requiring the use of a walker to ambulate. 9. The preponderance of the evidence is against finding that prior to June 10, 2021 the Veteran had separately ratable radiculopathy of the right and left upper extremities associated with his service-connected cervical spine disability. 10. From June 10, 2021, the Veteran's radiculopathy of the right and left upper extremities was manifest by moderate, wholly sensory radicular symptoms. 11. The preponderance of the evidence is against finding that prior to June 10, 2010 the Veteran had separately ratable radiculopathy of the right lower extremity (sciatic nerve) associated with his service-connected thoracic spine disability. 12. From June 10, 2010, the Veteran's radiculopathy of the right lower extremity (sciatic nerve) was manifest by moderate, wholly sensory radicular symptoms. 13. The preponderance of the evidence is against finding that prior to June 10, 2021 the Veteran had separately ratable radiculopathy of the left lower extremity (sciatic nerve) associated with his service-connected thoracic spine disability. 14. From June 10, 2010, the Veteran's radiculopathy of the left lower extremity (sciatic nerve) was manifest by moderate, wholly sensory radicular symptoms. 15. The preponderance of the evidence is against finding that prior to June 10, 2021 the Veteran had separately ratable radiculopathy of the right and left lower extremities (femoral nerve) associated with his service-connected thoracic spine disability. 16. From June 10, 2010, the Veteran's radiculopathy of the right and left lower extremities (femoral nerve) was manifest by moderate, wholly sensory radicular symptoms. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating higher than 20 percent for cervical spine disability prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (Codes) 5242-5243. 2. The criteria for entitlement to a rating higher than 30 percent for cervical spine disability from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Codes 5242-5243. 3. The criteria for entitlement to a rating higher than 20 percent for thoracic spine disability prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Codes 5242-5243. 4. The criteria for entitlement to a rating higher than 40 percent for residuals of a thoracic spine disability from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Codes 5242-5243. 5. The criteria for entitlement to a rating higher than 10 percent for right knee disability prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5260, 5261. 6. The criteria for entitlement to a rating higher than 30 percent for right knee disability from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5260, 5261. 7. The criteria for entitlement to a rating higher than 10 percent for left knee disability prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5260, 5261. 8. The criteria for entitlement to a rating higher than 30 percent for left knee disability from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Codes 5260, 5261. 9. The criteria for an effective date earlier than June 10, 2021 for the assignment of a separate rating for right knee instability are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 10. The criteria for an effective date earlier than June 10, 2021 for the assignment of a separate rating for left knee instability are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 11. The criteria for entitlement to a rating higher than 20 percent for right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Code 5257. 12. The criteria for entitlement to a rating higher than 20 percent for left knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Code 5257. 13. The criteria for entitlement to a separate rating for radiculopathy of the right upper extremity claimed as right arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8513. 14. The criteria for entitlement to a rating higher than 40 percent for radiculopathy of the right upper extremity claimed as right arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8513. 15. The criteria for entitlement to a separate rating for radiculopathy of the left upper extremity claimed as left arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS prior to June 10, 2021 have been not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8513. 16. The criteria for entitlement to a rating higher than 30 percent for radiculopathy of the left upper extremity claimed as left arm disability associated with cervical spine degenerative arthritis with cervical strain and IVDS from June 10, 2021 have been not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8513. 17. The criteria for entitlement to a separate rating for radiculopathy of the right lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2010 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8520. 18. The criteria for entitlement to a rating higher than 20 percent for radiculopathy of the right lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2010 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8520. 19. The criteria for entitlement to a separate rating for radiculopathy of the left lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8520. 20. The criteria for entitlement to a rating higher than 20 percent for radiculopathy of the left lower extremity (sciatic nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8520. 21. The criteria for entitlement to a separate rating for radiculopathy of the right lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8526. 22. The criteria for entitlement to an initial rating higher than 20 percent for radiculopathy of the right lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8526. 23. The criteria for entitlement to a separate rating for radiculopathy of the left lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS prior to June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8526. 24. The criteria for entitlement to a rating higher than 20 percent for radiculopathy of the left lower extremity (femoral nerve) associated with residuals of thoracic spine fracture and degenerative arthritis with lumbar strain and IVDS from June 10, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1990 to January 1995. These matters were before the Board of Veterans' Appeals (Board) in December 2020 and remanded to a Department of Veterans Affairs (VA) Regional Office (RO) for additional development. In an interim July 2021 rating decision service connection was granted for right and left shoulder impingement syndrome, right and left hip disabilities, right and left ankle achilles tendonitis with strain, bilateral plantar fasciitis, bilateral rib sprain, and right and left shin splints. As these service connection claims were granted in full, they are no longer before the Board for appellate consideration. In addition, the July 2021 rating decision granted service connection for right and left upper extremities radiculopathy, claimed as right and left arm disabilities, right and left lower extremities radiculopathy (sciatic nerve), right and left lower extremities radiculopathy (femoral nerve), and provided increased ratings for thoracic spine disability to 40 percent effective June 10, 2021, cervical spine disability to 30 percent effective June 10, 2021, and right and left knee disabilities to 30 percent each effective June 10, 2021 and assigned separate ratings of 20 percent each for right and left knees effective June 10, 2021. Regarding these claims, since the maximum benefit under the law has not been assigned, the claims remain in controversy. See AB v. Brown, 6 Vet. App. 3, 38 (1992). Regarding the claims decided herein with the exception of the knees (where other issues have been reasonably raised by the record due to assignment of a maximum rating) neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record regarding such claims. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). INCREASED RATINGS Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule). 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. In general, 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, consideration also must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, VA must consider functional loss caused by pain or other factors that could occur during flare-ups or after repeated use which may not be reflected on range-of-motion testing. 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.45, VA must also consider 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). Under 38 C.F.R. § 4.59, painful motion associated with joint or periarticular pathology typically warrants at least the minimum compensable rating for the affected joint. Id. at 36; see also Burton v. Shinseki, 25 Vet. App. 1 (2011). The United States Court of Appeals for Veterans Claims (Court) has held that "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." See Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Rather, pain may result in functional loss, but only if it limits the ability to "perform the normal working movements of the body with normal excursion, strength, speed, coordination, [or] endurance." Id. (quoting 38 C.F.R. § 4.40). Additionally, the Court, in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight bearing and, if possible, with range of motion measurements of the opposite undamaged joint. The Board observes that the Secretary of VA has recently amended that portion of 38 C.F.R. Part 4 which pertain to musculoskeletal disabilities. On February 7, 2021, in pertinent part, the provisions of 38 C.F.R. § 4.71a, Codes 5242, 5243, 5244, 5257 addressing degenerative disc disease, IVDS, traumatic paralysis, and recurrent subluxation or lateral instability were amended. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Codes 5242, 5257). 1. Entitlement to an initial rating higher than 20 percent for cervical spine disability prior to June 10, 2021 and 30 percent from that date 2. Entitlement to a rating higher than 20 percent for residuals of a thoracic spine disability prior to June 10, 2021 and 40 percent from that date The Veteran asserts that his spinal disabilities warrant higher ratings prior to and from June 10, 2021. Historically, a July 2021 rating decision increased the rating for cervical spine degenerative arthritis with cervical strain and IVDS from 20 percent to 30 percent effective June 10, 2021; and increased the rating for residuals, thoracic spine fractures and degenerative arthritis with lumbar strain and IVDS from 20 percent to 40 percent effective June 10, 2021. The changes to the musculoskeletal rating criteria effective February 7, 2021 under 38 C.F.R. § 4.71a, Codes 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under Code 5243 and all other intervertebral disc disabilities under 5242. As such, Code 5242 now reflects degenerative arthritis, degenerative disc disease other IVDS (also, see either Code 5003 or 5010); Code 5243 now reflects IVDS: assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses. The only other change to the regulations pertaining to rating the spine involved Code 5244, traumatic paralysis, which is not applicable in this case. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), a 20 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; or where forward flexion of the cervical spine is greater than 15 degrees, but not greater than 30 degrees; or where the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or where the combined range of motion of the cervical spine is not greater than 170 degrees; or where muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted where forward flexion of the cervical spine is 15 degrees or less; or where there is favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or where forward flexion of the thoracolumbar spine is limited to 30 degrees or less; or where there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Note 1 to this rating schedule states that any associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are to be evaluated separately under appropriate diagnostic codes. In the alternative, an evaluation can be assigned under the Formula for Rating IVDS Based on Incapacitating Episodes. IVDS is to be evaluated either under the new general rating formula for diseases and injuries of the spine or under the formula for rating IVDS based on incapacitating episodes, whichever method results in a higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. For intervertebral disc syndrome manifested by incapacitating episodes having a total duration of at least six weeks during the past 12 months, a 60 percent rating is warranted; with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted; and with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent rating is warranted. Note 1 of that code provides that, for purposes of evaluations under 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. Cervical Spine Prior to June 10, 2021 On March 2015 VA neck/cervical spine conditions, the Veteran report he has chronic neck pain as a result of being in a car accident in service. The neck pain has worsened over the years. He stated he has varying levels of pain, stiffness and decreased range of motion on a daily basis, but no longer has specific flare-ups. He experiences pain of the cervical spine. On range of motion testing, forward flexion was to 30 degrees, extension was to 40 degrees, right and left lateral flexion, and left lateral rotation were each to 30 degrees, and right lateral rotation was to 50 degrees. The Veteran's abnormal range of motion contributed to a functional loss in that he must rotate his body or use mirrors to see properly when driving and other activities that require head movements. Pain was noted on all ranges of motion and caused functional loss. There was no evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the neck/cervical spine. There was no additional loss of function or range of motion after three repetitions. Pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over time. There was localized tenderness of the cervical spine not resulting in abnormal gait or abnormal spinal contour. There was no muscle spasm or guarding. The Veteran described interference with sitting as an additional factor contributing to his cervical spine disability. He had normal muscle strength. There was no muscle atrophy. Deep tendon reflexes and sensation to light touch were normal. There was no radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine. There was no IVDS of the cervical spine. X-rays show moderate degenerative disease at C6-C7 and minimal spondylosis. The diagnosis was degenerative arthritis of the cervical spine. The Veteran's neck/cervical spine disability impacts his ability to work in that he avoids heavy lifting and repetitive neck movements without breaks. Upon review, the Board finds that a preponderance of the evidence shows that prior to June 10, 2021 the Veteran is not entitled to the next higher 30 percent rating for his cervical spine disability. In order to warrant the 30 percent rating, the evidence must show forward flexion of the cervical spine to 15 degrees or less, or favorable ankylosis of the entire cervical spine. On the March 2015 VA neck examination, forward flexion was to 30 degrees, and no ankylosis of the spine was shown. The Veteran is competent to report on symptoms, and the Board has considered his complaints in reaching this decision. The Veteran is not competent, however, to determine whether his cervical spine disability meets the criteria for a higher rating. Even considering the Veteran's subjective complaints of pain, the evidence of record does not show any additional limitation of motion or functional impairment that would support a rating higher than 20 percent. Higher ratings are also available for IVDS. The evidence of record prior to June 10, 2021 shows that there is no evidence of treatment for incapacitating episodes, or that he has been prescribed bed rest by a physician. As such, for the period prior to June 10, 2021 a higher rating under Code 5243 is not warranted. At no time prior to June 10, 2021, have there been findings of ankylosis of the cervical spine. The Board notes that ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). See also 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5) (defining ankylosis as fixation of a joint in a particular position). Given the limitation of motion noted by VA examiner (including negative findings of ankylosis), the Board finds that at no time prior to June 10, 2021 has the Veteran's cervical spine disability met the criteria for a rating higher than 20 percent. The assigned 20 percent rating adequately contemplates the Veteran's level of impairment including consideration of functional loss due to pain on motion. As such, a higher rating is not warranted based on functional loss. Further, the Board observes, that prior to June 10, 2021, there was no evidence of neurological impairment to include bowel and bladder. As such, a separate rating for neurological impairment during this time period is not warranted. Cervical Spine from June 10, 2021 On the June 2021 VA-contract neck/cervical spine conditions examination, the Veteran reported that his neck/cervical spine disability has worsened. His current symptoms include chronic neck pain, weakness, numbness and tingling down both arms. He stated he has to hold his neck down because he has trouble holding it up. He has decreased range of motion. The Veteran reported having daily flare-ups of the cervical spine characterized by severe symptoms of sharp shooting and dull achy pain precipitated by reaching and lifting. During flare-ups, he experiences difficulty reaching, lifting, bending and standing. The Veteran's description of functional loss or functional impairment is as follows, "If I am lifting a gallon of milk, I tried to pick it up and put it on the counter and it all fell, if I drop a pen I can't reach for it and then I get stuck in that position, my pain is so bad I can't sleep, the sleep is so bad for several days it zonks me out. I can't turn." On range of motion testing all active and passive ranges of motion were to 5 degrees (forward flexion, extension, right and left lateral flexion and rotation). There was evidence of pain on weight-bearing, and active and passive motion. In addition, pain caused functional loss. The Veteran had difficulty reaching, lifting, bending and standing. There was objective evidence of crepitus. There was objective evidence of severe localized tenderness or pain on palpation of the posterior neck, trapezius. There was additional loss of function or range of motion after e repetitions. Factors causing functional loss are pain, fatigability, weakness, lack of endurance, and incoordination. The evidence suggest pain, fatigability, weakness, and lack of endurance significantly limits functional ability with repeated use over time and during flare-ups. The Veteran had guarding and muscle spasm of the cervical spine that results in abnormal gait or abnormal spine contour. Additional contributing factors of the Veteran's disability include interference with sitting and standing, disturbance of locomotion, less movement than normal, and weakened movement. Muscle strength testing revealed active movement against some resistance. There was no muscle atrophy. Deep tendon reflexes were hypoactive. He had decreased sensation to light touch, bilaterally. The Veteran had moderate constant radicular pain, bilaterally. He had severe intermittent radicular pain, paresthesias and/or dysesthesias and numbness, bilaterally. Upper radicular group involvement was indicated at C5/C6; and middle radicular group involvement was indicated at C7 nerve roots. Lower radicular group involvement was indicated at C8/T1 nerve roots. All abnormal neurological findings identified were due to radiculopathy. There was no ankylosis of the spine. The Veteran had IVDS of the cervical spine but had no episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He used a rollator constantly. There was no imaging evidence of a cervical vertebral fracture with loss of 50 percent or more of height. There were no other significant diagnostic test findings or results related to the neck/cervical spine that were reviewed in conjunction with the examination. The diagnoses were cervical strain, degenerative arthritis of the cervical spine, IVDS of the cervical spine and bilateral upper extremity radiculopathy. The examiner noted that cervical strain can cause wear and tear on the ligaments tendons and muscles leading to arthritis and deformities of the spine causing IVDS and arthritis which leads to compression of the nerves leading to radiculopathy. Cervical strain can lead to wear and tear on the muscles, tendons and ligaments leading to inflammation and degeneration of the spine causing arthritis. Upon review, the Board finds that from June 10, 2021, the criteria for a rating higher than 30 percent for cervical spine disability have not been met. As noted, under Code 5242 and the General Formula, the next higher 40 percent rating requires unfavorable ankylosis of the entire cervical spine. The evidence of record during the relevant period did not show that the Veteran's disability picture more nearly approximated these criteria. The June 2021 VA-contract neck/cervical spine examination report specifically noted there was no ankylosis of the spine and such was not otherwise shown by evidence of record during this period. Accordingly, from June 10, 2021 an increased rating higher than 30 percent is not warranted under Code 5242. Regarding the IVDS, the next higher 40 percent rating requires incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. The evidence of record during the relevant period did not show that the Veteran met this criterion. In this regard, as noted, the June 2021 VA-contract neck/cervical spine examination report, the Veteran had IVDS, but had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Other evidence during this period did not otherwise document incapacitating episodes of the duration required for the next higher rating under Code 5243. Accordingly, the Board finds that, from June 10, 2020, an increased rating in excess of 30 percent is not warranted under Code 5243 and the IVDS Formula. The Board specifically acknowledges the Veteran's lay reports of symptoms and that evidence of record demonstrated functional loss, functional impairment and flare-ups. Even considering such, the degree of additional limitation would not result in limitation of motion that more nearly approximates unfavorable ankylosis of the entire cervical spine. While the Board has considered 38 C.F.R. § 4.40 and § 4.45, the Board finds that a rating higher than 30 percent is not warranted for this period. In sum, the Board finds that, from June 10, 2021, the Veteran's cervical spine disability did not more nearly approximate unfavorable ankylosis of the entire cervical spine or IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. As such, the Board concludes that from June 10, 2021, the criteria for a rating higher than 30 percent for a cervical spine disability have not been met and, to this extent, the Veteran's claim is denied. Further, the Board is aware that separate ratings may be assigned for associated objective neurological abnormalities. Such separate ratings have already been assigned for bilateral upper extremity radiculopathy, and there is no competent evidence showing any other such abnormalities (e.g., bowel or bladder) for which separate ratings may be assigned. Thoracic Spine Prior to June 10, 2021 On March 2015 VA back/thoracolumbar spine conditions examination, the Veteran reported having varying levels of pain, stiffness and decreased range of motion of his thoracic spine on a daily basis. He stated that he has been able to avoid the majority of activities that use to lead to flare ups and takes pain relievers or rests if he feels the pain increasing with a specific activity. He did not report any flare-ups of the back/thoracolumbar spine. He reported having functional loss or functional impairment of the back/thoracolumbar spine due to pain. On range of motion testing of the back, forward flexion was to 90 degrees, and extension, right and left lateral flexion and rotation were each to 30 degrees. Pain was noted on all ranges of motion. Range of motion itself contributed to a functional loss in that the Veteran had difficulty bending, lifting, twisting, rising from a seated position, and prolonged standing. There was pain on weight bearing. There is objective evidence of localized tenderness noted in entire spine. There was no additional loss of function or range of motion after three repetitions. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability. The Veteran had localized tenderness that did not result in abnormal gait or abnormal spinal contour. He had normal muscle strength. His deep tendon reflexes and sensation to light touch were normal. He had a negative straight leg raising test. There was no radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine. He had no other neurologic abnormalities or findings related to his back/thoracolumbar spine disability such as bowel or bladder problems/pathologic reflexes. The Veteran did not have IVDS of the thoracolumbar spine. X-rays of the thoracic spine revealed minimal spondylosis. No definite fracture was shown. X-rays of the lumbar spine revealed no fracture and minimal spondylosis. The diagnoses were degenerative arthritis of the thoracolumbar spine and vertebral fracture. The Veteran's back/thoracolumbar spine disability impacted his ability to work in that he is limited to sedentary employment due to back pain. He worked out of his home to have the freedom to take breaks as needed to avoid flare ups. He discontinued working a "9-5" position due to flare ups and has been working at home since 2002. The examiner noted that he should avoid prolonged sitting, standing without breaks, avoid climbing, bending and lifting. On July 2016 VA-contract back conditions examination, the Veteran reported that the back pain had gotten worse to the point where he cannot get out of bed at times. He takes pain pills, wears a back brace and uses a cane. He described having flare-ups of back pain that leaves him paralyzed at time and unable to move. He reported he is unable to sit, stand and lift for long periods of time due to his back disability. His back disability prevents him from working, and he experiences chronic lower back pain that prevents him from turning left and right, and he has limited use of his arms and shoulders. On range of motion testing of the back, forward flexion was to 45 degrees and extension, right and left flexion and right and left rotation were each to 10 degrees. The Veteran's pain noted on examination causes functional loss with all ranges of motion. There was no evidence of pain with weight bearing. There was no additional loss of function or range of motion after 3 repetitions. Pain significantly limits functional ability with repeated use over time and with flare-ups. The Veteran did not have localized tenderness, guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing, deep tendon reflexes, and sensation to light touch were normal. There was no muscle atrophy. Straight leg raising test was negative. There was no radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine. There were no other neurological abnormalities of finds related to a thoracolumbar spine. The Veteran did not have IVDS of the thoracolumbar spine. The diagnoses were status post thoracic spine fractures and degenerative arthritis of the spine. The functional impact of the thoracolumbar spine was limited stooping and bending. Upon review, the Board finds that a preponderance of the evidence reveals the Veteran is not entitled to a rating higher than 20 percent prior to June 10, 2021. To meet the criteria for the next higher 40 percent rating, the range of flexion would have to be limited to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine under Code 5242, or under Code 5243 there would have to be IVDS with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. The Veteran is competent to report on symptoms, and the Board has considered his complaints in reaching this decision. The Veteran is not competent, however, to determine whether his thoracic spine disability meets the criteria for a higher rating. Prior to June 10, 2021, the record shows that the Veteran's thoracolumbar flexion on exam was found to be, at worst, to 45 degrees, with no evidence of further limitation following repetitive motion. The functional impact was described as essentially decreased physical activity. Although there were complaints of pain, there was no evidence of pain with weight bearing and no additional loss of function or range of motion after 3 repetitions. Furthermore, there was no evidence of muscle spasms or guarding severe enough to result in abnormal spinal contour or abnormal gait. Therefore, even considering loss due to pain after repetitive use, the Veteran is not entitled to an evaluation higher than 20 percent under the General Rating Formula for Diseases and Injuries of the Spine. As for functional loss during a flare-up, he described having flare-ups of back pain that leaves him paralyzed at time and unable to move. He described loss as being unable to sit, stand, and lift for long periods of time. He stated that his back disability prevents him from working, and he experiences chronic lower back pain that prevents him from turning left and right, and he has limited use of his arms and shoulders. This functional loss during a flare-up, however, does not more nearly approximate limitation of flexion to 30 degrees or less to warrant the next higher 40 percent rating for the period prior to June 10, 2021. Higher evaluations are also available for IVDS. Prior to June 10, 2021 the Veteran had not been diagnosed with IVDS. There is also no probative evidence of record of the Veteran seeking treatment for incapacitating episodes, or that he has been prescribed bed rest by a physician. Therefore, based on the probative evidence of record, the Veteran is not entitled to a rating higher than 20 percent for his thoracic spine disability prior to June 10, 2021. Further, the Board observes that, prior to June 10, 2021, there was no evidence of neurological impairment to include bowel and bladder. As such, a separate rating for neurological impairment during this time period is not warranted. Thoracic Spine from June 10, 2021 On June 2021 VA-contract back/thoracolumbar spine conditions examination, the Veteran reported worsening of his back disability. He had difficulty staying awake during the examination because he cannot sleep at night due to the pain. The examiner noted the Veteran is a high fall risk. He has current symptoms of chronic entire back pain, weakness, decreased range of motion, swelling, fall risk, and unsteady gait. He ambulates with a rollator. The Veteran described flare-ups as severe and occurring on and off all day, precipitated by bending, walking, standing, and sitting too long. He had difficulty walking, standing, sitting, bending, lifting, and carrying items. On range of motion testing, forward flexion, extension, right and left lateral flexion and rotation were all to 10 degrees. Pain was noted on all ranges of motion. There was evidence of pain on weight-bearing, and on active and passive motion. Pain caused the Veteran to have difficulty walking, standing, sitting, bending, lifting and carrying items. There was objective evidence of crepitus and severe localized tenderness or pain on palpation of the thoracolumbosacral paraspinal muscles. There was additional loss of function or range of motion after 3 repetitions. After 3 repetition each of the ranges of motion was to 8 degrees. Factors that caused functional loss were pain, fatigability, weakness, lack of endurance and incoordination. The evidence suggests that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time and during flare-ups. The Veteran has guarding and muscle spasm of the thoracolumbar spine that results in abnormal gait or abnormal spine contour. Additional contributing factors of the Veteran's disability include interference with sitting and standing, swelling, deformity, disturbance of locomotion, less movement than normal, weakened movement, and instability of station. Muscle strength testing revealed active movement against some resistance. There was no muscle atrophy. Deep tendon reflexes were hypoactive. He had decreased sensation to light touch, bilaterally. He had positive straight leg raising test. The Veteran has moderate constant radicular pain, bilaterally. He had severe intermittent radicular pain, paresthesias and/or dysesthesias and numbness, bilaterally. Femoral nerve involvement is indicated at L2-4; and sciatic nerve involvement is indicated at L4-5, S1-3. All abnormal neurological findings identified are due to radiculopathy. There is no ankylosis of the spine. The Veteran has IVDS of the thoracolumbar spine but has had no episodes of acute signs and symptoms due to IVDS that require bed rest prescribed by a physician and treatment by a physician in the past 12 months. He uses a brace and a rollator constantly. X-rays of the lumbar spine in December 2019 show mild multilevel disc degenerative changes of the lumbar spine with disc height loss and endplate osteophytosis and multilevel facet degenerative change. The diagnoses were degenerative disc disease other than IVDS, lumbosacral strain, IVDS, residuals of thoracic spine fractures and degenerative arthritis, and bilateral lower extremity radiculopathy. The Veteran's back disability impacts his ability to perform occupational tasks in that he has difficulty walking, standing, sitting, bending, lifting, and carrying items. The examiner noted that spinal fractures can lead to chronic wear and tear of the back muscles leading to lumbar strain and arthritis (degenerative joint disease and degenerative disc disease) which leads to deformities of the spine leading to compression of the nerves of the spine causing radiculopathy and IVDS. Upon review, the Board finds that, from June 2021, the criteria for a rating higher than 40 percent for thoracic spine disability have not been met. Under Code 5242 and the General Formula, the next higher 50 percent rating requires unfavorable ankylosis of the entire thoracolumbar spine. The evidence of record during the relevant period does not show that the Veteran's disability picture more nearly approximated these criteria, and, in this regard, the June 2021 VA-contract back examination specifically notes there is no ankylosis of the spine. Accordingly, the Board finds that, from June 10, 2020, an increased rating higher than 40 percent is not warranted under Code 5242 and the General Formula. The Board specifically acknowledges the Veteran's lay reports of symptoms and that evidence of record demonstrated functional loss, functional impairment and flare-ups. Even considering such, however, the degree of additional limitation would not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine. As such, while the Board has considered 38 C.F.R. § 4.40 and § 4.45, the Board finds that a rating higher than 40 percent is not warranted for this period. Accordingly, the Board finds that from June 10, 2021, the Veteran's thoracic spine disability picture did not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine. The Board therefore concludes that from June 10, 2021, the criteria for a rating higher than 40 percent for thoracic spine disability have not been met and, to this extent, the Veteran's claim is denied. Further, the Board is aware that separate ratings may be assigned for associated objective neurological abnormalities. Such separate ratings have already been assigned for bilateral lower extremity radiculopathy, and there is no competent evidence showing any other such abnormalities (e.g., bowel or bladder) for which separate ratings may be assigned. The Board notes that in this instance, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. Bilateral Knee Disability The Veteran contends that his right and left knee disabilities are more severe than contemplated by the assigned 10 percent rating for each knee prior to June 10, 2021 and the assigned 30 percent rating for each knee from June 10, 2021. Moreover, a July 2021 rating decision assigned 20 percent ratings for right and left knee instability effective June 10, 2021. The Veteran underwent VA-contract knee examinations in July 2016 and June 2021. At the July 2016 VA-contract knee and lower leg conditions examination, the Veteran reported that his right and left knee disabilities have gotten worse to the point where he cannot get out of bed; he takes pain medication and use braces and a cane. He reported flare-ups of the right and left knees as pain "coming and going," but flare-ups take the pain to another level. He stated he is unable to sit, bend, stand, or lift for long periods, which prevents him from working. On range of motion testing of the right and left knees, flexion was to 120 degrees for each knee and extension was to 0 degree for each knee. Pain noted on range of motion testing causes functional loss. There was no evidence of pain with weight bearing. There was objective evidence of crepitus of the knees. There was no additional loss of function or range of motion after 3 repetitions of each knee. Right and left knee pain significantly limits functional ability with repeated use over time and during flare-ups. He had normal muscle strength bilaterally. There was no muscle atrophy or ankylosis. Joint stability testing revealed normal results. There was no joint instability of the knees. The Veteran did not have recurrent patellar dislocation, shin splints, stress fractures or any other tibial or fibular impairment. He has never had a meniscus condition. He uses a cane regularly. There is no degenerative or traumatic arthritis documented for the knees. X-rays show normal right and left knees. The diagnoses are right and left knees retropatellar pain syndrome. The Veteran described functional impact of each knee as limited standing and walking. On June 2021 VA-contract knee and lower leg examination, the Veteran reported a progressive worsening of his right and left knee disabilities. He has current symptoms of chronic bilateral knee pain, weakness and instability. He reported severe flare-ups characterized as sharp shooting and stabbing pain and burning sharp pain of the shins that occur on and off daily. The precipitating factors are bending, walking, standing, and sitting too long. He has difficulty walking, standing, sitting, bending, lifting and carrying items. He describes functional loss or functional impairment with walking, standing, sitting, bending, lifting, and carrying items. He reported a history of instability or recurrent subluxation of the knee. He stated his legs buckle when he walks with his rollator, and he cannot stand too long. He stated that it is hard to get up from sitting, he cannot lift anything, and he falls. He reported a history of effusion of the knees. On active and passive range of motion testing flexion of the right and left knees was to 15 degrees and extension was to zero degrees. There was evidence of pain on weight-bearing, non-weight-bearing, active and passive motion, on rest or non-movement, and causes functional loss. The Veteran has difficulty walking, standing, sitting, bending, lifting, and carrying items. There was objective evidence of crepitus. There was additional loss of function or range of motion after 3 repetitions. Factors that caused functional were pain, fatigability, weakness, lack of endurance and incoordination, bilaterally. Evidence suggests pain, fatigability, weakness, lack of endurance, or incoordination significantly limits functional ability with repeated use over time and during flare-ups. Additional contributing factors of disability were interference with standing, disturbance of locomotion, less movement than normal, weakened movement, and instability of station. The Veteran has difficulty walking, standing, sitting, bending, lifting, and carrying items. There was no muscle atrophy or ankylosis of either knee. There was recurrent subluxation or persistent instability in both knees. The Veteran uses a walker to ambulate. He had treatment for bilateral shin splints for less than 12 consecutive months. There was no diagnosed meniscus condition or surgical procedure. The diagnoses were right and left shin splints, left and right retropatellar pain syndrome, and bilateral knee instability. The Veteran's bilateral knee disability impacts his ability to perform occupational task in that he has difficulty walking, standing, sitting, bending, lifting, and carrying items. The examiner noted that retropatellar pain syndrome can lead to chronic wear and tear leading to shin splints and instability due to laxity inflammation of the tendons, muscles, and ligaments. 3. Entitlement to ratings higher than 10 percent each for right and left knee disabilities prior to June 10, 2021 4. Entitlement to ratings higher than 30 percent each for right and left knee disabilities from June 10, 2021 The Veteran seeks higher ratings for his bilateral knee disability prior to and from June 10, 2021 based on his report of progressive worsening of his knees. His right and left knee disabilities are rating under 38 C.F.R. § 4.71a, Code 5260 (limitation of leg flexion). Under Code 5260, flexion limited to 45 degrees warrants a 10 percent rating, limitation of flexion to 30 degrees warrants a 20 percent rating, and a 30 percent rating requires flexion limited to 15 degrees. Under Code 5261, extension limited to 5 degrees warrants a 0 percent rating; extension limited to 10 degrees warrants a10 percent rating; extension limited to 15 degrees warrants a 20 percent rating; extension limited to 20 degrees warrants a 30 percent rating; extension limited to 30 degrees warrants a 40 percent rating; and extension limited to 45 degrees warrants a 50 percent rating. For rating purposes, normal range of motion of the knee is from zero to 140 degrees. See 38 C.F.R. § 4.71a, Plate II. Separate evaluations may be assigned for compensable limitation of flexion and extension of the same joint. See VAOPGCPREC 09-2004 (September 17, 2004). Ten Percent Prior to June 10, 2021 The Board finds that the preponderance of the evidence is against the claims for ratings higher than 10 percent for the right and left knee disabilities based on limited motion at any time prior to June 10, 2021. At no time prior to that date has either of the Veteran's knees reflected motion limited to 45 degrees of flexion to support even a 10 percent rating under Code 5260. Rather, at worst, the Veteran exhibited flexion in both knees limited to 120 degrees. See VA-contract examination report dated July 2016. A higher or separate rating for limitation of extension is also not warranted for the period prior to June 10, 2021 as the Veteran's knees never reflected motion limited to 10 degrees of extension to support a 10 percent rating under Code 5261. Rather, bilateral extension was normal on examination in July 2016. Range of motion measurements are not documented in VA treatment records in the Veteran's claims file. Consideration has been given to left and right knee functional impairment and effects of pain on functional abilities prior to June 10, 2021. The Board acknowledges the Veteran's statements during VA examination and treatment regarding functional impairment caused by his knees. The Board also acknowledges that the July 2016 VA examiner noted pain on range of motion testing caused functional loss, and right and left knee pain significantly limited functional ability with repeated use over time and during flare-ups. The functional impairment and effects of pain exhibited by the service-connected left and right knee disabilities prior to June 10, 2021 have already been considered by the RO in the assignment of the 10 percent ratings. The Veteran's limitation of left and right knee motion has not risen to a higher level under Code 5260 or a compensable level under Code 5261. Thus, the 10 percent ratings presently assigned prior to June 10, 2021 contemplate the functional impact arising from the objective findings and the Veteran's subjective complaints of painful motion. There is no ankylosis or meniscal involvement shown (Codes 5256 and 5258). Accordingly, a higher or separate rating based on limitation of flexion and extension is not warranted prior to June 10, 2021. Thirty Percent from June 10, 2021 The Veteran's service-connected right and left knee disabilities have each been assigned the highest rating available under Code 5260 for the period from June 10, 2021. There is no basis to consider whether higher schedular disability ratings may be assigned. A higher or separate rating for limitation of extension is not warranted for the period from June 10, 2021 as the Veteran's knees during that period never reflected motion limited to 10 degrees of extension to support a 10 percent rating under Code 5261. Rather, bilateral extension was normal on examination in June 2021. Range of motion measurements are not documented in VA treatment records in the Veteran's claims file. The Board has also considered the other diagnostic codes pertaining to the knees and legs. The Veteran does not have any meniscal condition of the type contemplated by Codes 5258 and 5259, there is no probative indication of right and left knee ankylosis, or impairment of the tibia or fibula. Thus, there are no other potentially applicable diagnostic codes under which higher or separate ratings could be assigned. The Board notes that in this instance, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. Separate Ratings 5. Entitlement to an effective date prior to June 10, 2021 for the assignment of separate ratings for right and left knee instability Separate ratings have been assigned for right and left knee instability associated with the service-connected right and left knee disabilities, with effective dates of June 10, 2021, the date of the examination showing diagnoses of bilateral knee instability. The Board must determine whether the Veteran is entitled to a date earlier than June 10, 2021 for such disabilities. The effective date of a claim for an increased rating is the earliest date as of which it is factually ascertainable based on all evidence of record that an increase in disability had occurred if a claim is received within 1 year from such date, otherwise, it is the date of receipt of claim. 38 C.F.R. § 3.400(o). If the increase occurs after the claim is filed, the effective date shall be the date the increase occurred. 38 C.F.R. § 3.400(o)(2); Harper v. Brown, 10 Vet. App. 125, 126 27 (1997). Regarding right and left knee instability, historically, a May 1996 rating decision established service connection for bilateral retropatellar pain syndrome with a 10 percent rating effective January 19, 1995. Medical evidence of record that supported that decision included a July 1995 VA general medical examination report and a December 1995 private orthopedic examination report, and both were negative for any knee instability. In a November 1998 rating decision (notice sent December 1998) the 10 percent rating for bilateral retropatellar pain syndrome was continued. An October 1998 VA joints examination report, of record at the time of the decision was negative for any knee instability. It was noted that there was no evidence of medial or lateral collateral ligament laxity. By rating decision in October 2000 (notice sent November 2000) the 10 percent rating for bilateral retropatellar pain syndrome was discontinued effective August 30, 2000, and service connection was granted for left and right knee retropatellar pain syndrome and assigned ratings of 10 percent each effective August 31, 2000. An October 2000 VA fee-based examination report was negative for any knee instability. A September 2016 rating decision continued ratings of 10 percent each for left and right knee retropatellar pain syndrome. The Veteran timely appealed that rating decision. Medical evidence of record at the time of that decision included a July 2016 VA-contract knee examination report and VA outpatient treatment records, which are negative for any knee instability. In December 2020 the Board remanded the knee claims rated 10 percent each for further development. Pursuant to a Board remand directive a VA-contract knee examination was conducted in June 2021 and bilateral knee instability was diagnosed. In a July 2021 post-remand rating decision separate ratings of 20 percent each were assigned for right and left knee instability effective from June 10, 2021, the date of the examination showing diagnoses of left and right knee instability. Here, the Board concludes that the preponderance of the evidence is against an effective date earlier than June 10, 2021 for the assignment of separate ratings for right and left knee instability, because it was not factually ascertainable prior to that date that the Veteran had separately ratable right and left knee instability. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The Board accepts that the Veteran is competent to report his symptoms of his legs buckling when he walks with his rollator. However, the medical evidence before the June 2021 VA-contract knee examination consistently showed that the Veteran did not have instability of the right and left knees. Consequently, the Board assigns greater probative value to the VA-contract examination report and the contemporaneous VA treatment reports of record that are negative for any instability of the knees. The Board can find no basis to assign an effective date earlier than June 10, 2021 for the award of separate ratings for right and left knee instability. There is no doubt to resolve. 38 U.S.C. § 5107(b). 6. Entitlement to a rating higher than 20 percent each for right and left knees instability As a result of the June 10, 2021 examination, the Veteran was awarded separate ratings for right and left knee instability associated with his service-connected right and left knee disabilities under Code 5257. (See July 2021 Rating Decision). During the pendency of this appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the regulatory amendments, under Code 5257 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, Code 5257. According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "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 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). After the February 7, 2021 regulatory change, under Code 5257 for recurrent subluxation or instability, 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 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). As a result of the June 10, 2021 examination, the Veteran was awarded separate ratings for right and left knee instability associated with his service-connected right and left knee disabilities under Code 5257. (See July 2021 Rating Decision). As discussed above, the evidence does not support entitlement to an effective date earlier than June 10, 2021 for right and left knee instability. Here, the Board will determine whether the Veteran is entitled to a rating higher than the 20 percent each assigned for right and left knee disabilities for the period. While right and left knee instability is shown in the June 2021 VA-contract examination report, the Board finds that the preponderance of the evidence is against ratings higher than 20 percent under Code 5257. The Veteran's lay statements that his legs sometimes buckle when walking with his rollator are credible to establish that he has some instability, and his statements are supported by positive instability tests on examination. However, the objective medical evidence of record supports that the Veteran's instability is moderate in nature, which is consistent with the 20 percent ratings under Code 5257. Even under the regulatory changes that went into effect on February 7, 2021, the Veteran's symptoms, as shown on the June 10, 2021 VA-contract examination, correspond with 20 percent ratings. That is, his bilateral knee recurrent instability and use of a walker meet the new diagnostic criteria for 20 percent ratings, and no higher. The Board finds that the preponderance of the evidence is against ratings higher than 20 percent for the Veteran's right and left knee disabilities under the old and amended criteria from June 10, 2021. The Board has carefully considered the Veteran's reports about instability since June 2021 and find overall that the lay and medical evidence indicates that his instability symptoms do not suggest the presence of symptoms more nearly approximating severe recurrent subluxation or lateral instability; or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing both an assistive device and bracing for ambulation, to warrant the next higher 30 percent rating for each knee under either the old or amended criteria. Accordingly, the Board finds that the preponderance of the evidence is against finding that ratings higher than 20 percent each for right and left knee instability under either the old or amended criteria under Code 5257. In denying such ratings, 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. 7. Entitlement to an initial rating higher than 40 percent for radiculopathy of the right upper extremity from June 10, 2021, and the question of a separate rating prior to that date 8. Entitlement to an initial rating higher than 30 percent for radiculopathy of the left upper extremity from June 10, 202l, and the question of a separate rating prior to that date The Veteran's radiculopathy in the right and left upper extremities is rated under Code 8513. His right upper extremity is currently rated 40 percent and his left upper extremity is currently rated 30 percent, both effective June 10, 2021. The Veteran is right handed, so his major side is his right side, and his minor side is his left side. Code 8513 provides ratings for paralysis of all radicular groups of nerves. Code 8513 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 70 percent disabling on the major side and 60 percent on the minor side. Complete paralysis of all radicular groups is rated 90 percent disabling on the major side and 80 percent on the minor side. The preface to 38 C.F.R. § 4.124a states that when the involvement is wholly sensory, the rating should be for the mild, or at the most, the moderate degree. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board observes that the words "mild," "moderate," and "severe" as used in the various codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Prior to June 10, 2021 Regarding bilateral upper and lower radiculopathy, the VA examination of the neck/cervical and back/thoracolumbar spine in March 2015 were negative for radiculopathy. The examination reports indicate the Veteran had no radicular pain or any other signs or symptoms due to radiculopathy. The examiner noted the Veteran's complaints of bilateral shoulder pain with lifting and commented that it was not consistent with radiculopathy. On July 2016 VA-contract back conditions examination, there was no radicular pain or any other signs or symptoms due to radiculopathy. VA outpatient treatment records for the period prior to June 10, 2021 are also negative for any signs or symptoms due to radiculopathy. Here, the Board concludes that the preponderance of the evidence is against an effective date earlier than June 10, 2021 for the assignment of separate ratings for right and left upper extremity radiculopathy because it was not factually ascertainable prior to that date that the Veteran had such radiculopathy. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The Board accepts that the Veteran is competent to report his symptoms of experiencing numbness and tingling down both arms. However, there is no medical evidence of radiculopathy of the upper extremities prior to June 10, 2021, and the Veteran, lacking medical training and credentials, is not competent to ascertain that numbness or tingling represent a diagnosis of radiculopathy. Consequently, the Board assigns greater probative value to the VA-contract examination report and the contemporaneous VA treatment reports of record. The Board can find no basis to assign an effective date earlier than June 10, 2021 for the award of separate ratings for right and left upper extremity radiculopathy. There is no doubt to resolve. 38 U.S.C. § 5107(b). From June 10, 2021 In June 2021, the Veteran underwent a VA-contract examination of his neck/cervical spine. In the examination report it was indicated that the Veteran's dominant hand was his right hand. The Veteran reported chronic neck pain, weakness, numbness and tingling down both arms. The Veteran was diagnosed with having cervical spine degenerative arthritis with cervical strain and IVDS with bilateral upper extremity radiculopathy. The examiner noted that cervical strain can cause wear and tear on the ligaments tendons and muscles leading to arthritis and deformities of the spine causing IVDS and arthritis which leads to compression of the nerves leading to radiculopathy. The examiner indicated the Veteran had moderate constant pain in the right and left upper extremities. There was severe intermittent pain, paresthesias and/or dysesthesias and numbness in the right and left upper extremities. There were no other signs or symptoms of radiculopathy. There was involvement of the C5/C6, C7, and C8/T1 nerve roots in both the right and left upper extremities. The examiner noted that all abnormalities are due to radiculopathy. No other neurologic abnormalities were found that were related to the Veteran's cervical spine. Having reviewed the evidence of record, the Board finds that ratings higher than 40 percent for right upper extremity radiculopathy and 30 percent for left upper extremity radiculopathy are not warranted, as the medical evidence from the June 2021 VA-contract examination show the manifestations of the Veteran's radiculopathy have been wholly sensory, and thus "moderate" in nature at most for rating purposes. Since the evidence shows the Veteran's right and left upper extremities radiculopathy more nearly approximates moderate impairment, higher ratings are not for application. These claims are denied. 9. Entitlement to initial rating higher than 20 percent for radiculopathy of the right lower extremity of the sciatic nerve beginning June 10, 2010, and the question of a separate rating prior to that date The Veteran's radiculopathy of the right lower extremity of the sciatic nerve is currently rated 20 percent effective from June 10, 2010 under Code 8520. Initially, the Board points out that it appears the June 10, 2010 effective date may represent a typographical error. The RO"s July 2021 "REASONS FOR DECISION" section notes "An evaluation of 20 percent is assigned from June 10, 2010. The effective date is the date the medical evidence shows a diagnosis of radiculopathy, right lower extremity (sciatic nerve)...The findings in the VA contract examination results, dated June 10, 2021, are included in the evaluation that is detailed below." Nevertheless, this question of error is not before the Board at this time, and the Board will proceed with this case under the understanding that June 10, 2010 is the effective date at issue. Under Code 8520 (sciatic nerve impairment), complete paralysis of the sciatic nerve is demonstrated when the foot dangles and drops, when there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. This is evaluated as 80 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is evaluated as 60 percent disabling. Moderately severe paralysis is evaluated as 40 percent disabling. Moderate paralysis merits a 20 percent evaluation, and mild paralysis warrants a 10 percent rating. 38 C.F.R. § 4.124a Code 8520. Prior to June 10, 2010 Regarding radiculopathy of the right lower extremity sciatic nerve, medical evidence of record prior to June 10, 2010 includes a July 1995 VA general medical examination report which reveals no neurological abnormalities including no radicular signs or symptoms. On September 1998 VA spine examination, objective findings show the Veteran had no evidence of sensory changes in either the T11-T12 dermatomes, or motor or sensory deficits of both lower extremities. The examiner noted the Veteran did not appear to have any neurologic deficits or evidence of significant pathology in his thoracolumbar or lumbar spine. In May 2000 the Veteran was seen at a VA outpatient internal medicine clinic for chronic mid back pain. It was noted he had no radicular symptoms. In October 2000 a neurologic examination was normal during a VA fee-based back examination; and there was no mention of radiculopathy. On October 2002 VA fee-based examination, the examiner noted as part of the diagnosis that there was no evidence of radiculopathy, and a neurological examination was unremarkable. Here, the Board concludes that the preponderance of the evidence is against finding that a separate rating for radiculopathy of the right lower extremity sciatic nerve prior to June 10, 2010 is warranted. The Board accepts that the Veteran is competent to report his symptoms of pain in the legs. However, to the extent that he reports pain in the legs as a sign of radiculopathy, as in the October 2002 VA fee-based examination report, the Board finds this is not probative in view of the resultant diagnosis that there was no radiculopathy. Consequently, the Board assigns greater probative value to the VA fee-based examination report and the contemporaneous VA treatment reports of record that are negative for any lower extremity radiculopathy. The Board can find no basis to assign a separate rating prior to June 10, 2010 for the right lower extremity sciatic nerve. There is no doubt to resolve. 38 U.S.C. § 5107(b). From June 10, 2010 On March 2013 VA-contract back conditions examination, the Veteran had no radicular pain or any other signs or symptoms due to radiculopathy. His deep tendon reflexes, and sensation to light touch were normal and he had a negative straight leg raising test. VA examination of the back/thoracolumbar spine in March 2015 were negative for radiculopathy. The examination reports indicate the Veteran had no radicular pain or any other signs or symptoms due to radiculopathy. On July 2016 VA-contract back conditions examination, there was no radicular pain or any other signs or symptoms due to radiculopathy. In June 2021 the Veteran had a VA outpatient treatment telephone follow-up. His chief complaint was low back pain. He described intermittent daily low to mid back aching pain that radiates to the back of the leg to the knees bilaterally and intermittently to the feet. He stated that the pain increases with walking and decreases with rest. In June 2021, the Veteran underwent a VA-contract examination of his back/thoracolumbar spine. The Veteran reported chronic back pain, weakness, decreased range of motion, swelling, fall risk and unsteady gait. The Veteran was diagnosed with having degenerative disc disease other than IVDS, lumbosacral strain, IVDS, residuals of thoracic spine fractures and degenerative arthritis, and bilateral lower extremity radiculopathy. The examiner noted that spinal fractures can lead to chronic wear and tear of the back muscles leading to lumbar strain and arthritis (degenerative joint disease and degenerative disc disease) which leads to deformities of the spine leading to compression of the nerves of the spine causing radiculopathy and IVDS. The examiner indicated the Veteran had moderate constant pain in the right lower extremity. There was severe intermittent pain, paresthesias and/or dysesthesias and numbness in the right lower extremity. There were no other signs or symptoms of radiculopathy. There was involvement of the L4/L5/S1/S2/S3 nerve roots of the sciatic nerve in the right lower extremity. The examiner noted that all abnormalities are due to radiculopathy. No other neurologic abnormalities were found that were related to the Veteran's thoracolumbar spine. Having reviewed the evidence of record, including the Veteran's lay statement, the Board finds the Veteran's right lower extremity radiculopathy of the sciatic most nearly approximates the moderate impairment warranting a rating no higher than the 20 percent currently assigned for right lower extremity sciatica for the period from June 10, 2010. As the medical evidence from the June 2021 VA examination shows, the manifestations of the Veteran's radiculopathy of the right lower extremity of the sciatic has been wholly sensory, and "moderate" in nature at most as defined by VA regulations. Therefore, the right lower extremity radiculopathy has resulted in no more than moderate incomplete paralysis of the sciatic nerve. There is no evidence in the record that indicates the Veteran experienced symptoms equivalent to moderately-severe incomplete paralysis in the right lower extremity of the sciatic nerve to warrant the next higher rating under the appropriate diagnostic code. There is no doubt to resolve. 38 U.S.C. § 5107(b). 10. Entitlement to an initial rating higher than 20 percent for radiculopathy of the left lower extremity of the sciatic nerve from June 10, 2021, and the question of a separate rating prior to that date 11. Entitlement to initial ratings higher than 20 percent for radiculopathy of the right and left lower extremities of the femoral nerve from June 10, 2021, and the question of a separate rating prior to that date The Veteran's radiculopathy of the left lower extremity of the sciatic nerve and right and left lower extremities of the femoral nerve is currently rated 20 percent each effective from June 10, 2021 under Code 8520 for the sciatic nerve and Code 8526 for the femoral nerve. Under Code 8520 (sciatic nerve impairment), complete paralysis of the sciatic nerve is demonstrated when the foot dangles and drops, when there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. This is evaluated as 80 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is evaluated as 60 percent disabling. Moderately severe paralysis is evaluated as 40 percent disabling. Moderate paralysis merits a 20 percent evaluation, and mild paralysis warrants a 10 percent rating. 38 C.F.R. § 4.124a Code 8520. Under Code 8526 (femoral nerve impairment), complete femoral nerve paralysis warrants the assignment of a 40 percent rating and contemplates paralysis of quadriceps extensor muscles. Severe incomplete paralysis warrants a 30 percent rating. Moderate incomplete paralysis warrants a 20 percent rating. Mild incomplete paralysis warrants a 10 percent rating. 38 C.F.R. § 4.124a, Code 8526. Prior to June 10, 2021 Regarding radiculopathy of the left lower extremity sciatic nerve and bilateral lower extremity femoral nerve, a VA examination of the back/thoracolumbar spine in March 2015 was negative for radiculopathy. The examination reports indicate that the Veteran had no radicular pain or any other signs or symptoms due to radiculopathy. On July 2016 VA-contract back conditions examination, there was no radicular pain or any other signs or symptoms due to radiculopathy. VA outpatient treatment records for the period prior to June 10, 2021 are also negative for any signs or symptoms due to radiculopathy, including of the lower extremities. Here, the Board concludes that the preponderance of the evidence is against finding that separate ratings for radiculopathy of the left lower extremity sciatic nerve and right and left lower extremities of the femoral nerve prior to June 10, 2021 are warranted. The Board accepts that the Veteran is competent to report his symptoms of pain. However, to the extent that such pain may be related to the claimed radiculopathy, on examination during the period under consideration, the Veteran's results for sensation to light touch testing were normal bilaterally. Results from his straight leg raising test was negative and there were no signs or symptoms due to radiculopathy. This reflects that the Veteran did not experience radiculopathy of the left lower extremity sciatic nerve and right and left lower extremities of the femoral nerve prior to June 10, 2021. Consequently, the Board assigns greater probative value to the VA and VA-contract examination reports and the contemporaneous VA treatment reports of record that are negative for any lower extremity radiculopathy. The Board can find no basis to assign separate ratings prior to June 10, 2021 for left lower extremity sciatic nerve and right and left lower extremities of the femoral nerve radiculopathy. There is no doubt to resolve. 38 U.S.C. § 5107(b). From June 10, 2021 In June 2021, the Veteran underwent a VA-contract examination of his back/thoracolumbar spine. The Veteran reported chronic back pain, weakness, decreased range of motion, swelling, fall risk and unsteady gait. The Veteran was diagnosed with having degenerative disc disease other than IVDS, lumbosacral strain, IVDS, residuals of thoracic spine fractures and degenerative arthritis, and bilateral lower extremity radiculopathy. The examiner noted that spinal fractures can lead to chronic wear and tear of the back muscles leading to lumbar strain and arthritis (degenerative joint disease and degenerative disc disease) which leads to deformities of the spine leading to compression of the nerves of the spine causing radiculopathy and IVDS. The examiner indicated the Veteran had moderate constant pain in the right and left lower extremities. There was severe intermittent pain, paresthesias and/or dysesthesias and numbness in the right and left lower extremities. There were no other signs or symptoms of radiculopathy. There was involvement of the L2/L3/L4 nerve roots of the femoral nerve, and L4/L5/S1/S2/S3 nerve roots of the sciatic nerve in both the right and left lower extremities. The examiner noted that all abnormalities are due to radiculopathy. No other neurologic abnormalities were found that were related to the Veteran's thoracolumbar spine. Having reviewed the evidence of record, including the Veteran's lay statement, the Board finds the Veteran's left lower extremity radiculopathy of the sciatic and right and left lower extremities radiculopathy of the femoral nerves most nearly approximates the moderate impairment warranting ratings no higher than the 20 percent for each currently assigned. As the medical evidence from the June 2021 VA examination shows, the manifestations of the Veteran's radiculopathy of the left lower extremity of the sciatic and right and left lower extremities of the femoral nerves have been wholly sensory, and "moderate" in nature at most as defined by VA regulations. In each instance, moderate findings equate to the assigned 20 percent evaluations. As such, the appeal must be denied as to these claims. There is no doubt to resolve. 38 U.S.C. § 5107(b). REASONS FOR REMAND Entitlement to TDIU As indicated in the most recent September 2021 rating decision, the Veteran has a significant number of interrelated service-connected disabilities. Among these, he is in receipt of a 70 percent evaluation for somatic symptom disorder. He is also service connected for cervical and thoracic spine disorders; multiple associated radiculopathy, hip, and, shoulder disorders; and several knee disorders. See Bradley v. Peake, 22 Vet. App. 280, 293 (2008) (holding that a grant of TDIU based on a single disability constitutes a totally rated service-connected disability for purposes of section 1114(s)). See also Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). In this case, the Veteran completed four years of college education. He reportedly last worked as a counselor 30 to 40 hours per week in 2002. It is noted that he volunteered as a dispatcher for a trucking company 2 hours per week in 2009. See January 2016 Veteran's Application for Increased Compensation Based on Unemployability. On VA back examination in March 2015, the examiner noted that the Veteran is limited to sedentary employment due to his back pain. He now works out of his home to have the freedom to take breaks as needed to avoid flare-ups. He discontinued working a "9-5" position due to flare ups and has been working at home since 2002. Given this information, and the fact that the Veteran has not furnished updated employment information since January 2016, the Board finds that such information should be obtained before a decision on the TDIU claim is made. Accordingly, this case is REMANDED for the following action: Contact the Veteran to have him fill out an updated VA Form 21-8940 as to his employment history and status. Upon its receipt, take any additional development action deemed necessary based upon the information provided. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, 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.