Citation Nr: 21005545 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 12-27 616A DATE: February 1, 2021 ORDER Entitlement to a rating of 40 percent for lumbar strain with degenerative joint disease (DJD) status post right side L2-L3 laminectomy is granted. Entitlement to a rating in excess of 20 percent for right-sided cervical spondylosis, status post anterior cervical decompression and fusion is denied. Entitlement to an effective date prior to May 15, 2014, for the assignment of a separate 10 percent rating for right lower extremity radiculopathy is denied. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is denied. Entitlement to a separate rating for right upper extremity radiculopathy is denied. Entitlement to a separate rating for left upper extremity radiculopathy is denied. Entitlement to a separate rating for left lower extremity radiculopathy is denied. FINDINGS OF FACT 1. The lumbar spine disability was manifested by limitation of motion from pain (on active motion and even while at rest) and has been found to more nearly approximate forward flexion of the thoracolumbar spine of 30 degrees or less. 2. The cervical spine disability was manifested by forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 3. The Veteran was not diagnosed with right lower extremity radiculopathy until May 15, 2014. 4. Right lower extremity radiculopathy was manifested by mild, incomplete paralysis of the external popliteal nerve (common peroneal). 5. Additional objective neurological abnormalities associated with the Veteran’s service-connected lumbar spine and cervical spine disabilities, to include right upper extremity radiculopathy, left upper extremity radiculopathy, and left lower extremity radiculopathy, have not been shown in the evidence of record. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 40 percent rating, but no higher, for the lumbar spine disability have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010-5242 (2020). 2. The criteria for entitlement to a rating in excess of 20 percent for the cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5241 (2020). 3. The criteria for entitlement to an effective date prior to May 15, 2014, for the assignment of a separate 10 percent rating for right lower extremity radiculopathy have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.155, 3.157, 3.400 (2014 & 2020). 4. The criteria for entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8521 (2020). 5. The criteria for entitlement to a separate rating for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.71a, 4.124a (2020). 6. The criteria for entitlement to a separate rating for left upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.71a, 4.124a (2020). 7. The criteria for entitlement to a separate rating for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.71a, 4.124a (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1972 to June 1974, from December 1977 to December 1980, and from September 1981 to September 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in October 2009 and August 2016. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in August 2015. A transcript of that hearing is associated with the electronic claims file. The Board remanded these matters for additional development in September 2015, May 2017, and April 2018. The agency of original jurisdiction (AOJ) was informed of the Veteran’s death in September 2018 and his surviving spouse filed a motion for substitution as the appellant in the place of the Veteran. In April 2020, the AOJ determined that the Veteran’s surviving spouse, referred to as the appellant, qualified as a proper substituted claimant and was therefore substituted for the deceased Veteran for the purpose of pursuing the above-referenced claims. 1. Entitlement to a rating in excess of 10 percent for lumbar spine disability Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2020). The Veteran was awarded a 10 percent evaluation for his service-connected lumbar spine disability under Diagnostic Codes 5010-5242. The appellant seeks a higher rating. The hyphenated diagnostic code indicates that traumatic arthritis under Diagnostic Code 5010 is the service-connected disorder, and degenerative arthritis of the spine under Diagnostic Code 5242, is the residual condition. 38 C.F.R. § 4.27 (2020). Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the ranges of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id at Note 2 (See also Plate V.). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The Board notes that the spine has no opposite joint. 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 flare-ups from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence, including findings contained in VA examination reports dated in June 2009, September 2012, June 2016, and May 2018, VA treatment records, SSA records, and private treatment records, warrants the assignment of a 40 percent rating, but no higher, for the Veteran’s lumbar spine disability. The Board acknowledges the Veteran’s lay reports of lumbar spine symptoms and functional loss with contributing factors identified as pain, pain on movement, disturbance of locomotion, weakened movement, excess fatigability, incoordination, interference with sitting/standing/weight-bearing, and pain during repetitive use over time. For example, the June 2009 VA examiner noted a history of fatigue, decreased motion, stiffness, weakness, spasms, and pain. The June 2009 and September 2012 VA examiners clearly documented at what degree objective evidence of painful motion began in all ranges of lumbar spine motion. The examiners further found that there was no additional limitation in range of motion following repetitive use testing. While the June 2016 VA examiner noted that pain caused functional loss, he found it was impossible to state without undue speculation, whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups or with repetitive use over time. In the May 2018 VA examination report, the Veteran complained of functional loss, noting that he could not walk for more than few feet, stand for more than four or five minutes, or move his back in any direction. The examiner detailed that the Veteran exhibited pain on active motion and non-weight-bearing (pain while at rest). The examiner listed pain and disturbance of locomotion as causes of functional loss, noting that all planes of range of motion exhibited pain. However, the examiner was unable to test range of motion and functional limitation, as the Veteran declined range of motion testing due to severity of pain. The examiner did note that the examination findings were medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. While acknowledging that pain significantly limited functional ability with repeated use over time, the examiner indicated that it would only be speculative to report additional range of motion loss when the Veteran was not being evaluated after repetitive use over time. The examiner also attempted to record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing. Again, the Veteran declined range of motion testing due to severity of pain. The Veteran consistently denied having flare-ups that impacted the function of the lumbar spine throughout the appeal period. There was also no noted atrophy, decreased strength, or ankylosis. He reported use a TENS unit for back pain as well as a walker then an electric wheelchair to limit movement with associated pain due in part to his service-connected lumbar spine disability as well as an unrelated lung disorder. Based on the foregoing, the assignment of a 40 percent rating for the Veteran’s lumbar spine disability is warranted. Considering the Veteran’s credible lay assertions of lumbar spine symptoms (specifically pain limiting range of motion) and the May 2018 examiner’s conclusion that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time, the Board has determined that the degree of additional limitation reflected by those statements and findings was shown to result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine of 30 degrees or less. However, entitlement to an evaluation in excess of 40 percent is not warranted, as the Veteran was not shown to exhibit unfavorable ankylosis of the entire thoracolumbar spine or of the entire spine during the appeal period. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. Evidence of record does reflect findings of multilevel degenerative disc disease and IVDS, but it was not shown to be causally related to the Veteran’s service-connected lumbar strain disability. Even so, he did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician during the appeal period. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been awarded service connection for right lower extremity radiculopathy and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his lumbar spine disability (as will be discussed in more detail below). The Board acknowledges that the Veteran is competent to report observable symptoms such as pain, weakness, and reduced motion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not, however, competent to identify a specific level of disability. Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by VA medical professionals who have examined him. The medical findings adequately address the criteria under which the disability is evaluated and clearly demonstrate the degree of impairment attributable to the service-connected disability. The Board accords these findings greater weight than the Veteran’s complaints as to lumbar spine symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). In this case, evidence of record showed no distinct periods of time during the appeal period when the Veteran’s service-connected lumbar spine disability varied to such an extent that a rating greater or less than the 40 percent rating currently assigned would be warranted. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In sum, the Board concludes that the symptomatology noted in the medical and lay evidence has been adequately addressed by the current rating and that the Veteran’s service-connected lumbar spine disability residuals do not meet the applicable criteria for the assignment of an evaluation in excess of the 40 percent rating assigned. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the assignment of an evaluation in excess of 40 percent for the Veteran’s lumbar spine disability, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). 2. Entitlement to a rating in excess of 20 percent for cervical spine disability The Veteran has been awarded a 20 percent evaluation for his service-connected cervical spine disability under Diagnostic Code 5241 for spinal fusion. The appellant seeks a higher rating. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees; extension is zero to 45 degrees; left and right lateral flexion are zero to 45 degrees; and left and right lateral rotation are zero to 80 degrees. The normal combined range of motion of the cervical spine is 340 degrees. Id. at Note (2), Plate V. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. 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). The Board finds that the preponderance of the evidence, including findings contained in VA examination reports dated in June 2009, September 2012, June 2016, and May 2018, VA treatment records, SSA records, and private treatment records, is against the assignment of a rating in excess of 20 percent for the Veteran’s cervical spine disability. The Board acknowledges the Veteran’s lay reports of cervical spine symptoms and functional loss with contributing factors identified as pain, pain on motion, less movement than normal, weakened movement, excess fatigability, incoordination, and pain while lying down. For example, the June 2009 VA examiner noted a history of fatigue, decreased motion, stiffness, weakness, spasms, and pain. The June 2009 and September 2012 VA examiners clearly documented at what degree objective evidence of painful motion began in all ranges of cervical spine motion. The examiners further found that there was no additional limitation in range of motion following repetitive use testing. While the June 2016 VA examiner noted that pain caused functional loss, he found it was impossible to state without undue speculation, whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups or with repetitive use over time. The examiner was unable to perform repetitive use testing, as the Veteran would not try to laterally flex because of fear of pain. In the May 2018 VA examination report, the Veteran complained of functional loss, noting he had neck pain and was limited in bending/twisting his neck. The examiner detailed that the Veteran exhibited pain with active motion and on non-weight-bearing (pain while at rest). The examiner listed pain as the cause of functional loss, noting that all planes of range of motion exhibited pain. However, the examiner was unable to test range of motion and functional limitation, as the Veteran declined range of motion testing due to severity of pain. While acknowledging that pain significantly limited functional ability with repeated use over time, the examiner indicated that it would only be speculative to report additional range of motion loss when the Veteran was not being evaluated after repetitive use over time. The examiner also attempted to record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing. Again, the Veteran declined range of motion testing due to severity of pain. In addition, the Veteran consistently denied having flare-ups that impacted the function of the cervical spine throughout the appeal period. There was also no noted atrophy, decreased strength, or ankylosis. However, even considering the Veteran’s lay reports of cervical spine symptoms and noted functional loss, the degree of additional limitation reflected by those statements and findings was simply not shown to result in limitation of motion more nearly approximating forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. Consideration has also been given to assigning a rating under the Formula for Rating IVDS Based on Incapacitating Episodes. The Veteran does have IVDS but has 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 during the appeal period. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his cervical spine disability (as will be discussed in more detail below). The Board acknowledges that the Veteran is competent to report observable symptoms such as pain and reduced motion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not, however, competent to identify a specific level of disability. Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by VA medical professionals who have examined him. The medical findings adequately address the criteria under which the disability is evaluated and clearly demonstrate the degree of impairment attributable to the service-connected disability. The Board accords these findings greater weight than the Veteran’s complaints as to cervical spine symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Accordingly, the Veteran’s contention that he is entitled to an increased evaluation for his cervical spine residuals is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings in the VA examination reports than to the Veteran’s general belief that he was entitled to a higher rating. In this case, evidence of record showed no distinct periods of time during the appeal period when the Veteran’s service-connected cervical spine disability varied to such an extent that a rating greater or less than the 20 percent rating currently assigned would be warranted. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In sum, the Board concludes that the symptomatology noted in the medical and lay evidence has been adequately addressed by the current rating and that the Veteran’s service-connected cervical spine disability residuals do not meet the applicable criteria for an evaluation in excess of the 20 percent rating assigned. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s increased rating claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). 3. Entitlement to an effective date prior to May 15, 2014, for the assignment of a separate 10 percent rating for right lower extremity radiculopathy The general rule with respect to the effective date of an award of increased compensation is that the effective date of award, “shall not be earlier than the date of receipt of the application thereof.” 38 U.S.C. § 5110(a) (2012). The effective date for an award of increased compensation will be the date of receipt of claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(o)(1). An exception to that rule applies, however, where the evidence demonstrates that a factually ascertainable increase in disability occurred within the one-year period preceding the date of receipt of a claim for increased compensation. If an increase in disability occurred within one year prior to the date of receipt of the claim, the increase is effective as of the date the increase was “factually ascertainable.” If the increase occurred more than one year prior to date of receipt of the claim, the increase is effective the date of receipt of the claim. If the increase occurred after the date of receipt of the claim, the effective date is the date of increase. 38 U.S.C. § 5110(b)(2) (2012); 38 C.F.R. § 3.400(o)(1)(2); Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC12-98 (1998). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized formal and informal claims. The amendments also, inter alia, eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155 (2015). The amended regulations, however, apply only to claims filed on or after March 24, 2015. As this claim was initiated prior to that date, the former regulations apply. Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. An informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (2014). In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b) (2014). The date of outpatient or hospital examination or date of admission to a VA hospital will be accepted as the date of receipt of a claim when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b) (2014). In a September 2012 VA spine examination report, the examiner noted that although the Veteran complained of radicular pain, the physical examination findings were negative for objective evidence of radiculopathy. Straight leg raising testing was negative with normal reflex and sensory test findings. On October 2, 2012, VA received a claim for a separate rating for neurological abnormalities or radiculopathies associated with service-connected lumbar spine and cervical spine disabilities. VA treatment records detailed that electromyography (EMG)/nerve conduction velocity (NCV) testing was conducted in February 2014. The results of the study were essential normal with no evidence of acute lumbar or sacral radiculopathy involving the right lower extremity. Private treatment records from Tift Regional Medical Center contained a treatment report dated on May 15, 2014, wherein the Veteran complained of right-side hip and leg pain. The examiner clearly diagnosed L2-L3 right lumbar radiculopathy. In an August 2016 rating decision, the AOJ awarded a separate 10 percent rating for radiculopathy of the right lower extremity, effective May 15, 2014, the earliest date a diagnosis of right lower extremity radiculopathy was factually evidenced. The appellant seeks an effective date for this rating prior to May 15, 2014. The proper effective date for the award of the separate 10 percent rating for right lower extremity radiculopathy is May 15, 2014, or the date that entitlement arose. The private treatment record dated on May 15, 2014, was the first medical evidence of record showing a diagnosis of right lower extremity radiculopathy with objective neurological impairment. Based on the foregoing, the assignment of an effective date prior to May 15, 2014, for the separate 10 percent rating for right lower extremity radiculopathy is legally precluded. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400(o) (2020). 4. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy The Veteran was awarded an initial 10 percent evaluation for his service-connected right lower extremity radiculopathy under Diagnostic Code 8521. The appellant seeks a higher initial rating. Paralysis of the external popliteal nerve (common peroneal) is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8521. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8621and 8721). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis of the external popliteal nerve (common peroneal) is characterized by foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened, anesthesia covers entire dorsum of foot and toes and is rated as 40 percent disabling. Id. 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 on 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 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 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). Based on the evidence of record, including findings contained in VA examination reports dated in June 2016 and May 2018, VA treatment records, SSA records, and private treatment records, the Board has determined that the disability is primarily manifested by constant numbness, intermittent tingling, radiating pain from the low back to the right lower extremity, absent deep tendon reflexes in the right knee, hypoactive reflexes in the right ankle, and absent sensation to light touch in the upper anterior thigh. There were no findings concerning gait, trophic changes, or muscle atrophy. Private treatment notes dated in July 2016 detailed findings of lumbar neuritis and complaints of low back pain that radiated to the right leg. A December 2016 VA EMG/NCV report noted chronic neurogenic changes on the right L5 innervated but concluded that there was no evidence of acute lumbar/sacral radiculopathy. The May 2018 VA examiner noted right lower extremity radicular symptoms of moderate, intermittent pain, mild numbness, mild paresthesias, and right L4 nerve root involvement, concluding that the Veteran had mild right lower extremity radiculopathy. Thus, the Board finds that the most probative evidence of record is against a finding that the disability was manifested by a level of impairment more than that analogous to mild, incomplete paralysis. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. The Board acknowledges that the Veteran is competent to report observable symptoms such as radiating pain, tingling, numbness, and paresthesias. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not, however, competent to identify a specific level of disability. Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by VA medical professionals who have examined him. The medical findings adequately address the criteria under which the disability is evaluated and clearly demonstrate the degree of impairment attributable to the service-connected disability. The Board accords these findings greater weight than the Veteran’s complaints as to right lower extremity radiculopathy symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Accordingly, the Veteran’s contention that he is entitled to an initial evaluation for his right lower extremity radiculopathy residuals is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings in the VA examination reports than to the Veteran’s general belief that he is entitled to a higher rating. In this case, evidence of record showed no distinct periods of time during the appeal period when the Veteran’s service-connected right lower extremity disability varied to such an extent that a rating greater or less than the initial 10 percent rating currently assigned would be warranted. Fenderson v. West, 12 Vet. App. 119, 126 (1999). In sum, the Board concludes that the symptomatology noted in the medical and lay evidence has been adequately addressed by the current rating and that the Veteran’s service-connected right lower extremity radiculopathy residuals do not meet the applicable criteria for an initial evaluation in excess of the 10 percent rating assigned. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s initial rating claim, the doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). 5. Entitlement to a separate rating for right upper extremity radiculopathy 6. Entitlement to a separate rating for left upper extremity radiculopathy 7. Entitlement to a separate rating for left lower extremity radiculopathy The Veteran sought separate ratings for radiculopathy of the right upper extremity, left upper extremity, and left lower extremity. Under the General Rating Formula for Diseases and Injuries of the Spine, any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 1. Diagnostic Codes 8510-8730 address ratings for paralysis of the peripheral nerves affecting the upper and lower extremities as well as for neuritis and neuralgia. 38 C.F.R. § 4.124a, Diagnostic Codes 8510-8730. During the appeal period, there have been no objective findings of radiculopathy of the right upper extremity, left upper extremity, or left lower extremity in the evidence of record, including VA examination reports dated in June 2009, September 2012, June 2016, and May 2018, VA treatment records, SSA records, and private treatment records. The Board is cognizant that the record contains complaints of radiating pain to the left lower extremity and bilateral upper extremities, tingling in the hands, and numbness and paresthesias in the upper extremities. While there were isolated findings of absent sensation to touch of the upper anterior left thigh, hypoactive reflexes in the left lower extremity and bilateral upper extremities, and decreased sensation in the hands/fingers, the record contains negative straight left leg raising tests as well as multiple normal reflex and sensory findings in the left lower extremity and bilateral upper extremities. There were also VA EMG/NCV testing reports dated in June 2010, February 2014, and December 2016 that detailed no evidence of acute cervical or lumbar radiculopathies. Left upper extremity carpal tunnel syndrome was found to be unrelated to service. VA examiners repeated indicated that although there were radiculopathy symptoms reported, there was no objective evidence of radiculopathy or other neurological abnormalities found on physical examination of the claimed extremities. Accordingly, a preponderance of the evidence is against the assignment of any separate compensable ratings for radiculopathy of the right upper extremity, left upper extremity, and left lower extremity. The Board is cognizant of the Veteran’s reports of symptoms of radiculopathy. However, the Board finds these statements are not competent evidence in terms of making a diagnosis of radiculopathy. In this case, the diagnosis of radiculopathy is something that goes beyond mere observation. It requires medical training and knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board finds that the statements by the Veteran that purport to suggest that a diagnosis of radiculopathy is appropriate are of limited to no probative weight because they are not competent evidence. In sum, the Board concludes that the symptomatology noted in the medical and lay evidence does not meet the applicable criteria for the assignment of any additional separate disability ratings for radiculopathy of the right upper extremity, left upper extremity, and left lower extremity. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. D. Deane, 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.