Citation Nr: 21005762 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 11-23 032 DATE: February 2, 2021 ORDER For the period prior to October 9, 2019, an increased 40 percent disability rating for a low back disability is granted. For the period from December 1, 2019 to December 4, 2019, an increased 40 percent disability rating for a low back disability is granted. For the period from December 1, 2019 onward, a disability rating in excess of 40 percent for a low back disability is denied. For the period prior to November 13, 2019, an increased 20 percent rating for radiculopathy of the right lower extremity sciatic nerve is granted. For the period from November 13, 2019 to August 15, 2020, an increased 40 percent rating for radiculopathy of the right lower extremity sciatic nerve is granted. For the period from August 16, 2020 onward, a rating higher than 20 percent for radiculopathy of the right lower extremity sciatic nerve is denied. For the period prior to March 7, 2016 a separate 20 percent rating for radiculopathy of the left lower extremity sciatic nerve is granted. For the period from March 7, 2016 to November 12, 2019, a separate 10 percent rating for radiculopathy of the left lower extremity sciatic nerve is granted. For the period from November 13, 2019 to August 15, 2020, a separate 40 percent rating for radiculopathy of the left lower extremity sciatic nerve is granted. For the period from August 16, 2020 onward, a separate 10 percent rating for radiculopathy of the left lower extremity sciatic nerve is granted. For the period from November 13, 2019 onward, a separate 10 percent rating for radiculopathy of the right lower extremity external cutaneus nerve of thigh is granted. For the period from November 13, 2019 onward, a separate 10 percent rating for radiculopathy of the left lower extremity external cutaneous nerve of thigh is granted. For the period from April 19, 2019 to October 6, 2019, special monthly compensation (SMC) at the housebound rate pursuant to 38 U.S.C.§ 1114(s) is granted. For the period from December 2, 2019 onward, special monthly compensation (SMC) at the housebound rate pursuant to 38 U.S.C.§ 1114(s) is granted. REMANDED The issue of entitlement to a total disability rating based on individual unemployability (TDIU) prior to April 19, 2019 is remanded. VETERAN’S CONTENTIONS The Veteran contends that his low back disability is more severe than as reflected by the ratings currently assigned. Specifically, the Veteran contends that he has stiffness, sleeplessness, numbness, difficulty going up and downstairs, and difficulty standing/sitting for long periods of time. FINDINGS OF FACT 1. For the period prior to October 9, 2019 and from December 1, 2019 to December 4, 2019, when considering additional functional loss due to flare-ups, the Veteran's low back disability manifested in limitation of forward flexion of the thoracolumbar spine to 30 degrees or less. 2. Throughout the entirety of the appeal period, the Veteran's low back disability has not been productive of unfavorable ankylosis of the thoracolumbar spine or unfavorable ankylosis of the entire spine. 3. Prior to November 13, 2019 the signs and symptoms associated with the Veteran's right lower extremity sciatic radiculopathy were best characterized as moderate in nature as there were objective findings of positive straight leg testing and decreased sensation in the right thigh/knees; there was no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation indicative of incomplete paralysis of higher severity. 4. For the period from November 13, 2019 to August 15, 2020, signs and symptoms associated with the Veteran’s right lower extremity sciatic radiculopathy were best characterized as moderately severe in nature as there were subjective findings of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness; there was no evidence of marked muscular atrophy. 5. Since August 16, 2020, the signs and symptoms associated with the Veteran’s right lower extremity sciatic radiculopathy are best characterized as moderate in nature as there are objective findings of right hip flexion, right knee extension, right ankle plantar flexion, right ankle dorsiflexion, and right great toe extension with active movement against some resistance; decreased sensation in the right upper anterior thigh, right thigh/knee, and right lower leg/ankle; and subjective findings of mild intermittent pain of the right lower extremity, mild paresthesias and/or dysesthesia of the right lower extremity, and mild numbness of the right lower extremity. There is no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation. 6. Prior to March 7, 2016, the signs and symptoms associated with the Veteran's left lower extremity sciatic radiculopathy were best characterized as moderate in nature as there were objective findings of positive straight leg testing, but no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation. 7. For the period from March 7, 2016 to November 12, 2019, the signs and symptoms associated with the Veteran's left lower extremity sciatic radiculopathy were best characterized as mild in nature as there were subjective findings of radiating pain, but no objective manifestations. 8. For the period from November 13, 2019 to August 15, 2020, the signs and symptoms associated with the Veteran's left lower extremity sciatic radiculopathy were best characterized as moderately severe in nature as there were subjective findings of severe numbness, but no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation. 9. Since August 16, 2020, the signs and symptoms associated with the Veteran's left lower extremity sciatic radiculopathy are best characterized as mild as there are subjective findings of radiating pain but no objective manifestations. 10. Since November 13, 2019, the signs and symptoms associated with the Veteran's the right lower extremity external cutaneous nerve radiculopathy are best characterized as severe in nature as there are subjective findings of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness; this is the highest available rating for the external cutaneous nerve of thigh. 11. Since November 13, 2019, the signs and symptoms associated with the Veteran's the left lower extremity external cutaneous nerve radiculopathy are best characterized as severe in nature as there are subjective findings of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness; this is the highest available rating for the external cutaneous nerve of thigh. 12. VA awarded the Veteran a TDIU based solely on his service-connected major depressive disorder for the period from April 19, 2019 onward. The Veteran also has an additional disability rated at 60 percent or higher during this time period (low back disability and associated bilateral lower extremity radiculopathy). As such, the statutory criteria for an award of SMC at the housebound rate are met for the period from April 19, 2019 to October 6, 2019 and from December 2, 2019 onward. (The Veteran had already been awarded SMC at the housebound rate by the Agency of Original Jurisdiction based on the assignment of a temporary total rating for the low back disability and additional disability rated at 60 percent or higher, for the period from October 7, 2019 to December 1, 2019). CONCLUSIONS OF LAW 1. For the period prior to October 9, 2019, the criteria for an increased disability rating of 40 percent for a low back disability are met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.10, 4.14, 4.2, 4.21, 4.25 4.40, 4.7 38 C.F.R. § 4.71a, Diagnostic Code 5242-5238. 2. For the period from December 1, 2019 to December 4, 2019, the criteria for an increased disability rating of 40 percent for a low back disability are met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.10, 4.14, 4.2, 4.21, 4.25 4.40, 4.7 38 C.F.R. § 4.71a, Diagnostic Code 5242-5238. 3. For the period from December 5, 2019 onward, the criteria for a disability rating in excess of 40 percent for a low back disability are not met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.10, 4.14, 4.2, 4.21, 4.25 4.40, 4.7 38 C.F.R. § 4.71a, Diagnostic Code 5242-5238. 4. For the period prior to November 13, 2019, the criteria for an increased 20 percent rating for radiculopathy of the right lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 5. For the period from November 13, 2019 to August 15, 2020, the criteria for an increased 40 percent rating for radiculopathy of the right lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 6. For the period from August 16, 2020 onward, the criteria for a rating higher than 20 percent for radiculopathy of the right lower extremity sciatic nerve are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 7. For the period prior to March 7, 2016, the criteria for a separate 20 percent rating for radiculopathy of the left lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 8. For the period from March 7, 2016 to November 12, 2019, the criteria for a separate 10 percent rating for radiculopathy of the left lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 9. For the period from November 13, 2019 to August 15, 2020, the criteria for a separate 40 percent rating for radiculopathy of the left lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 10. For the period from August 16, 2020 onward, the criteria for a separate 10 percent rating for radiculopathy of the left lower extremity sciatic nerve are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 11. For the period from November 13, 2019 onward, the criteria for a separate 10 percent rating for radiculopathy of the right lower extremity external cutaneous nerve of thigh are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8529. 12. For the period from November 13, 2019 onward, the criteria for a separate 10 percent rating for radiculopathy of the left lower extremity external cutaneous nerve of thigh are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8529. 13. For the period from April 19, 2019 to October 6, 2019, the statutory criteria for special monthly compensation (SMC) at the housebound rate are met. 38 U. S.C. §§ 1114(s), 5107(b); 38 C.F.R. §§ 3.102, 3.350. 14. For the period from December 2, 2019 onward, the statutory criteria for special monthly compensation (SMC) at the housebound rate are met. 38 U. S.C. §§ 1114(s), 5107(b); 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1987 to February 1990. These matters come to the Board of Veterans' Appeals (Board) on appeal from a February 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. Jurisdiction is currently with the RO in Buffalo, New York. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in March 2019 and a transcript of the hearing has been associated with the claims file. Prior to this hearing, the Veteran testified before Veterans Law Judge Skaltsounis, in June 2018. At the March 2019 hearing, the Veteran expressly waived his right to testify before a third Veterans Law Judge. These matters were previously before the Board at which time they were remanded for further development. The issue of entitlement to a TDIU prior to April 19, 2019 has been raised by the evidence of record, to include as part and parcel of the increased rating claim. Thus, it is presently in appellate status before the Board. See Rice v. Shinseki, 22 Vet. App. 447 (2009).   1. Increased Rating Disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. The Board has considered whether separate ratings for different periods of time are warranted based on the facts, which is a practice of assigning ratings that is referred to as "staging the ratings." Fenderson v. West, 12 Vet. App. 119 (1999). The criteria for rating all disabilities of the spine are set forth in 38 C.F.R. § 4.71a, which provides that spine disabilities are to be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine (General Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Under the IVDS Formula, a spine disability is rated based on the presence of incapacitating episodes, which are periods of acute signs and symptoms due to IVDS that require bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, IVDS Formula. The General Formula for rating a disability of the spine provides in pertinent part: With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, 10 percent evaluation 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 evaluation 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 is 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 evaluation 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 evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine; and a 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Formula. Under the General Formula, associated neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are evaluated separately under the appropriate diagnostic codes. Id. at Note (1). Here, after reviewing all of the clinical evidence and subjective complaints, the Board finds that the record is absent evidence of incapacitating episodes, and thus, the Veteran's low back disability must be evaluated under the General Rating Formula. Turning to the General Rating Formula, the Veteran's low back disability is currently rated 20 percent disabling prior to October 9, 2019 under 38 C.F.R. § 4.71a Diagnostic Codes 5239-5243. The Veteran was assigned a temporary total rating for his low back disability from October 9, 2019 to November 30, 2019 under 38 C.F.R. § 4.30. The Veteran’s low back disability is currently rated 20 percent disabling from December 1, 2019 to December 4, 2019 and 40 percent thereafter under 38 C.F.R. § 4.71a Diagnostic Codes 5239-5243. As a 100 percent rating is the maximum payable, the period from October 9, 2019 to November 30, 2019 is not for consideration in this appeal. After a review of the evidence of record, the Board finds that for the period prior to October 9, 2019 and the period from December 1, 2019 to December 4, 2019, the signs and symptoms associated with the Veteran’s low back disability best approximated forward flexion of the thoracolumbar spine to 30 degrees or less; entitling him to a disability rating of 40 percent. In this regard, the Veteran testified during the March 2019 Board hearing that he had been experiencing flare-ups for a long time but masked it with alcohol. April 2009 East Liverpool CBOC records document chronic lower back which flared up at times. During a December 2019 VA spine examination, the Veteran reported flare-ups occurring with laying down for prolonged periods of time, sitting for prolonged periods of time, and repetitive motions of the low back. The examiner indicated that during a flare-up the Veteran’s forward flexion would be limited to 0 to 10 degrees and extension to 0 to 5 degrees. The examiner also indicated that the Veteran did not have ankylosis. During an August 2020 VA spine examination, the Veteran reported flare-ups resulting in severe back pain, numbness, and paresthesias in right lower extremity. The examiner indicated that during a flare-up the Veteran’s forward flexion would be limited to 0 to 5 degrees and extension 0 to 5 degrees. The examiner also indicated that the Veteran did not have ankylosis. Based on the foregoing evidence, and resolving all doubt in favor of the Veteran, the Board finds that the Veteran's low back disability was productive of forward flexion limited to 30 degrees or less for the period prior to October 9, 2019 and from December 1, 2019 to December 4, 2019. See 38 C.F.R. § 3.102. The Veteran testified during the March 2019 Board hearing that he had been experiencing flare-ups for a long time, but masked it with alcohol; April 2009 East Liverpool CBOC records document chronic lower back pain which flared up at time; during the December 2019 and August 2020 VA spine examinations the Veteran reported flare-ups. The December 2019 VA examiner indicated that during a flare-up the Veteran’s forward flexion was limited to 0 to 10 degrees and the August 2020 VA examiner indicated that during a flare-up the Veteran’s forward flexion was limited to 0 to 5 degrees. As stated above, a 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Accordingly, an increased disability rating of 40 percent is warranted for the period prior to October 9, 2019, and from December 1, 2019 to December 4, 2019. A rating in excess of 40 percent is not warranted for the period prior to October 9, 2019, from December 1, 2019 onward. In order to warrant a rating higher than 40 percent for the orthopedic manifestations of the Veteran's low back disability under the General Rating Formula, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine, or unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. In this regard, there is no objective medical evidence of ankylosis in the claims file. The Veteran's VA treatment records do not indicate that the Veteran was diagnosed with ankylosis or that his spine was fixed in an unfavorable position. During the December 2019 and August 2020 VA examinations, the examiner indicated that the Veteran did not have ankylosis. Significantly, neither the Veteran, nor the representative have raised any assertion that the Veteran's low back disability is manifested by ankylosis. In short, the evidence of record does not reflect a diagnosis of ankylosis or that the Veteran's spine was fixed in an unfavorable position. As entitlement to a higher disability rating turns on a showing of unfavorable ankylosis of the thoracolumbar spine, or unfavorable ankylosis of the entire spine, a higher rating for the orthopedic manifestations of the Veteran's low back disability is simply not warranted. In making the above determinations, the Board considered Correia v. McDonald, 28 Vet. App. 158 (2016). However, a 40 percent rating is the maximum schedular rating available for limitation of motion of the thoracolumbar spine under the General Rating Formula, to include the functional equivalent of limitation of motion. Therefore, the Board finds that Correia is inapplicable. Next the Board considers whether higher ratings are warranted for neurologic abnormalities associated with the Veteran's low back disability. The Board notes that the Veteran is already in receipt of a separate 10 percent disability rating for radiculopathy of the left lower extremity prior to August 16, 2020 and a 20 percent disability rating thereafter under 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Code 8520 rates incomplete or complete paralysis of the sciatic nerve, a 10 percent evaluation is assigned for mild incomplete paralysis, a 20 percent evaluation is assigned for moderate incomplete paralysis, a 40 percent evaluation is assigned for moderately severe incomplete paralysis, a 60 percent evaluation is assigned for severe incomplete paralysis, with marked muscular atrophy, and an 80 percent evaluation is assigned for complete paralysis; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Diagnostic Code 8521 rates incomplete or complete paralysis of the external popliteal nerve (common peroneal), a 10 percent evaluation is assigned for mild incomplete paralysis, a 20 percent evaluation is assigned for moderate incomplete paralysis, a 30 percent evaluation is assigned for severe incomplete paralysis, and a 40 percent evaluation is assigned for complete paralysis; 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. Diagnostic Code 8529 rates incomplete or complete paralysis of the external cutaneous nerve of thigh. A noncompensable rating is assigned for mild or moderate paralysis, and a 10 percent rating is assigned for severe to complete paralysis. The terms "mild," "moderate," and "severe" are not defined. Rather than applying a mechanical formula, the Board must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. 38 C.F.R. §§ 4.2, 4.6. After review of the evidence, the Board finds the Veteran's radiculopathy approximated moderate incomplete paralysis of the right lower extremity sciatic nerve, entitling him to a disability rating of 20 percent prior to November 13, 2019; approximated moderately severe incomplete paralysis of the right lower extremity sciatic nerve, entitling him to a disability rating of 40 percent from November 13, 2019 to August 15, 2020; and approximated moderate incomplete paralysis of the right lower extremity sciatic nerve entitling him to a disability rating of no higher than 20 percent from August 16, 2020 onward. The Veteran’s low back disability has also been productive of left lower extremity radiculopathy, which approximated moderate incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 20 percent prior to March 7, 2016; approximated mild incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 10 percent from March 7, 2016 to November 12, 2019; approximated moderately severe incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 40 percent from November 13, 2019 to August 15, 2020; and approximated mild incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 10 percent from August 16, 2020 onward. The Veteran has also experienced bilateral lower extremity radiculopathy of the external cutaneous nerves, each best approximated as severe incomplete paralysis from November 13, 2019 onward. In this regard, the evidence of record includes a December 2009 VA examination report in which the examiner indicated that the Veteran reported pain in his back and left leg beginning in 1997 and back pain radiating to the right leg. The examiner also indicated that the Veteran reported numbness and weakness. Reflex testing, sensory, and motor function was normal. However, straight leg raising testing was positive. The evidence of record includes a March 2016 VA examination report in which the examiner indicated that the Veteran did not have muscle atrophy. Straight leg raising testing was negative. Reflex examination and muscle strength testing were normal. Sensory testing revealed decreased sensation in the right thigh/knees. The examiner indicated that the Veteran reported mild intermittent pain of the right lower extremity, mild paresthesias and/or dysesthesia of the right lower extremity, and mild numbness of the right lower extremity. The examiner indicated that the Veteran’s radicular symptoms of the right lower extremity best approximated mild incomplete paralysis of the femoral nerve. The examiner indicated that the left lower extremity was not affected. The evidence of record also includes a November 2019 VA examination report in which the examiner indicated that the Veteran did not have muscle atrophy or trophic changes. Reflex and sensory examinations were normal. The Veteran reported severe constant pain of the right lower extremity and moderate constant pain of the left lower extremity, severe intermittent pain of the right lower extremity and moderate intermittent pain of the left lower extremity, severe paresthesias and/or dysesthesias of the right lower extremity and moderate paresthesias and/or dysesthesias of the left lower extremity, and moderate numbness of the right lower extremity and severe numbness of the left lower extremity. The examiner indicated that the Veteran’s radicular symptoms of the right lower extremity best approximated mild incomplete paralysis of the sciatic nerve, mild incomplete paralysis of the external popliteal (common peroneal) nerve, and mild incomplete paralysis of the external cutaneous nerve of the thigh. The examiner indicated that the Veteran’s radicular symptoms of the left lower extremity best approximated mild incomplete paralysis of the sciatic nerve, mild incomplete paralysis of the external popliteal (common peroneal) nerve, and mild incomplete paralysis of the external cutaneous nerve of the thigh. The evidence of record additionally includes a December 2019 VA examination report in which the examiner indicated that the Veteran did not have muscle atrophy. Straight leg raising testing was negative. Reflex examination, sensory examination, and muscle strength testing were normal. The examiner indicated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. Finally, the evidence of record includes an August 2020 VA examination report in which the examiner indicated that the Veteran did not have muscle atrophy. Straight leg raising testing was negative. Reflex examination was normal. Muscle strength testing revealed right hip flexion, right knee extension, right ankle plantar flexion, right ankle dorsiflexion, and right great toe extension with active movement against some resistance. Sensory testing revealed decreased sensation in the right upper anterior thigh, right thigh/knee, and right lower leg/ankle. The examiner indicated that the Veteran reported mild intermittent pain of the right lower extremity, mild paresthesias and/or dysesthesia of the right lower extremity, and mild numbness of the right lower extremity. The examiner indicated that the Veteran’s radicular symptoms of the right lower extremity best approximated mild incomplete paralysis of the sciatic nerve. The examiner indicated that the left lower extremity was not affected. Based upon the above, the Board finds that the Veteran's radiculopathy approximated moderate incomplete paralysis of the right lower extremity sciatic nerve, entitling him to a disability rating of 20 percent prior to November 13, 2019. The nature of the Veteran's radiculopathy symptoms of right lower extremity sciatic nerve were moderate as there were objective findings of positive straight leg testing, and decreased sensation in the right thigh/knees. The Veteran is not entitled to a rating higher than 20 percent because there was no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation indicative of incomplete paralysis of greater severity. Comparatively, for the period from November 13, 2019 to August 15, 2020, the Veteran’s radiculopathy best approximated moderately severe incomplete paralysis of the right lower extremity sciatic nerve, entitling him to a disability rating of 40 percent. The nature of the Veteran’s radiculopathy signs and symptoms during this period were moderately severe as there were subjective findings of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness. The Veteran is not entitled to a rating higher than 40 percent for this period because there was no evidence of marked muscular atrophy. Finally, for the period since August 16, 2020, the Veteran’s radiculopathy has best approximated moderate incomplete paralysis of the right lower extremity sciatic nerve entitling him to a disability rating of no higher than 20 percent. The nature of the Veteran's radiculopathy signs and symptoms are best characterized as moderate as there are objective findings of right hip flexion, right knee extension, right ankle plantar flexion, right ankle dorsiflexion, and right great toe extension with active movement against some resistance; and decreased sensation in the right upper anterior thigh, right thigh/knee, and right lower leg/ankle. Subjective findings included mild intermittent pain, mild paresthesias and/or dysesthesia, and mild numbness. The Veteran is not entitled to a rating higher than 20 percent because there is no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation indicative of incomplete paralysis of greater severity. Turning to the left lower extremity, the Veteran’s sciatic radiculopathy is best approximated by moderate incomplete paralysis, entitling him to a disability rating of 20 percent prior to March 7, 2016. The nature of the Veteran's radiculopathy signs and symptoms during this period are best characterized as moderate as there were objective findings of positive straight leg testing. The Veteran is not entitled to a rating higher than 20 percent because there was no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation indicative of incomplete paralysis of greater severity. Comparatively, for the period from March 7, 2016 to November 12, 2019, the Veteran’s radiculopathy best approximated mild incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 10 percent. The nature of the Veteran’s radiculopathy signs and symptoms are best characterized as mild during this period as there were subjective findings of radiating pain. The Veteran is not entitled to a rating higher than 10 percent because the findings were wholly subjective - there were no objective manifestations. Next, for the period from November 13, 2019 to August 15, 2020, the Veteran’s left sciatic radiculopathy best approximated moderately severe incomplete paralysis of the left lower extremity sciatic nerve, entitling him to a disability rating of 40 percent. The nature of the Veteran's radiculopathy signs and symptoms of the left lower extremity sciatic nerve are best characterized as moderately severe during this period as there were subjective findings of severe numbness. The Veteran is not entitled to a rating higher than 40 percent for this period because there was no evidence of trophic changes, muscle atrophy, absent reflexes, or absent sensation indicative of incomplete paralysis of higher severity. Finally, for the period since August 16, 2020, the Veteran’s left sciatic radiculopathy best approximated mild incomplete paralysis, entitling him to a disability rating of 10 percent. The nature of the Veteran’s radiculopathy signs and symptoms of the left lower extremity sciatic nerve are mild as there are subjective findings of radiating pain. The Veteran is not entitled to a rating higher than 10 percent because the findings are wholly subjective - there are no objective manifestations. Since November 13, 2019, the Veteran’s low back disability has also been productive of radiculopathy affective the bilateral external cutaneus nerves, entitling him to separate disability ratings of 10 percent from November 13, 2019 onward. The nature of this radiculopathy is best characterized as severe as there are subjective findings of severe constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness. The Veteran is not entitled to ratings higher than 10 percent as this is the highest available rating for the external cutaneous nerve of thigh. The Veteran's private and VA medical records are void of any evidence that contradicts the above assigned staged ratings. The Board acknowledges that the December 2019 VA examiner indicated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. However, the Board finds that this examination is inconsistent with the evidence of record which otherwise indicates that the Veteran has had radicular symptoms or signs throughout the period on appeal and is of lower weight. The Board also acknowledges that the November 2019 VA examiner determined that the Veteran's back disability was also productive of radiculopathy of the right and left lower extremity external popliteal (common peroneal) nerves, but finds that separate ratings for the impairment of this nerve may not be awarded due to the application of the amputation rule. See 38 C.F.R. § 4.68. The amputation rule provides that the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. Id. With the assignment of 40 percent disability ratings for the sciatic nerves and 10 percent disability rating for the external cutaneous nerves of thigh, the combined rating for the neurological impairment affecting the right lower extremity is 50 percent from November 13, 2019 to August 15, 2020 and the combined rating for the neurological impairment affecting the left lower extremity is 50 percent from November 13, 2019 to August 15, 2020. See 38 C.F.R. § 4.25. In order to warrant a combined rating of 60 percent or higher (which would be the result if separate ratings for the right lower extremity and left lower extremity external popliteal nerves were assigned), the disability must be commensurate with at least amputation at the upper third of the leg, one-third of the distance from the perineum to the knee, or be tantamount to amputation at the thigh, with loss of extrinsic pelvic girdle muscles. See 38 C.F.R. § 4.71a, Diagnostic Codes 5162-5164, providing for 60 percent disability ratings. Here, the evidence does not support such findings. VA examiners found that the Veteran would not be equally well-served with amputation and prosthesis. Throughout the period on appeal, muscle strength testing and reflexes were either normal or slightly diminished, sensation was decreased but not absent, and there was no evidence of trophic changes or muscle atrophy. Given the absence of findings supportive of a conclusion that the Veteran would be equally well-served with amputation and prosthesis, the Board cannot conclude that the assignment of 60 percent ratings or higher under Diagnostic Codes 5160-5164 is warranted. To the extent that the Board, in this decision, has awarded a combined 50 percent rating for the right lower extremity neurological impairment from November 13, 2019 to August 15, 2020 and left lower extremity neurological impairment from November 13, 2019 to August 15, 2020, the Board notes that the evidence does not clearly demonstrate that the impairment in this case is even commensurate with the level of disability contemplated by the assignment of 40 percent disability ratings based on amputation, namely amputation at the lower level, permitting prosthesis, forefoot amputation proximal to metatarsal bones (more than one-half of metatarsal loss), or foot, loss of use of. See 38 C.F.R. § 4.71a, Diagnostic Codes 5165, 5166, and 5167. Nevertheless, given the severity of the impairment of the nerves from November 13, 2019 to August 15, 2020, the Board resolves doubt in the Veteran's favor, and finds that the criteria for 50 percent ratings are met. As a combined rating of 60 percent or higher may not be awarded in this case, the Board may not evaluate the severity of the impairment of the right lower extremity external popliteal nerve (common peroneal) or left lower extremity external popliteal nerve (common peroneal), despite that such impairment has been determined to be related to the service-connected back disability. The Board considered assigning separate ratings for the external popliteal nerve (common peroneal) effective August 16, 2020 when the combined rating for the neurological impairment affecting the right lower extremity decreased to 30 percent and the combined rating for the neurological impairment affecting the left lower extremity decreased to 20 percent. However, the Board notes that the August 2020 VA examiner only indicated that the sciatic nerve was affected. 2. Special Monthly Compensation (SMC) VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to SMC under 38 U.S.C. § 1114. See Bradley, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"). SMC is payable where the veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the Veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 U. S.C. § 1114(s); 38 C.F.R. § 3.350(i).   Subsection 1114(s) requires that a disabled Veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114(s) benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. In this case, the Board notes that the Veteran is already in receipt of SMC for the period from October 7, 2019 to December 1, 2019 under 38 U.S.C. § 1114, subsection (s) on account of a single service-connected disability rated as 100 percent and additional service-connected disability or disabilities, independently ratable at 60 percent or more. VA awarded the Veteran a TDIU based solely on his service-connected major depressive disorder for the period from April 19, 2019 onward. For SMC purposes, this disability satisfies the requirement of a "service-connected disability rated as total." See Buie v. Shinseki, 24 Vet. App. 242, 251 (2011); see also Bradley v. Peake, 22 Vet. App. 280, 293 (2008). As a result of the above grant, the Veteran also has additional disability rated at 60 percent or higher during this time period (low back disability and radiculopathy). Thus, in light of the Court's decisions in Bradley and in Buie, entitlement to SMC at the housebound rate under 38 U. S.C. § 1114(s) is granted for the period from April 19, 2019 to October 6, 2019 and from December 2, 2019 onward. REASONS FOR REMAND Entitlement to a TDIU prior to April 19, 2019 is remanded. With regard to the Veteran's TDIU claim for the period prior to April 19, 2019, the evidence of record indicates that the Veteran held additional employment including employment at Cornell University as a chef in 2010, 2011, or 2012 and as a housekeeper in 2012 or 2013. The Veteran's employment history and all other factors which have a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b). Therefore, a remanded is necessary to obtain clarification/additional information regarding the Veteran's employment history so that the Board can accurately ascertain whether the Veteran was gainfully employed prior to April 19, 2019. This matter is REMANDED for the following actions: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment and employment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Contact the Veteran and ask him to supply additional employment information, including employment dates and income. Specifically, he should be asked to address any employment at Cornell University as a housekeeper or chef in 2010, 2011, 2012, and/or 2013. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.