Citation Nr: 21006350 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 10-41 397 DATE: February 3, 2021 ORDER Entitlement to a 10 percent evaluation, but no higher, for right lower extremity sciatic nerve radiculopathy from March 6, 2009, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an evaluation in excess of 10 percent for right lower extremity sciatic nerve radiculopathy prior to July 31, 2015, is denied. Entitlement to a 20 percent evaluation, but no higher, for right lower extremity sciatic nerve radiculopathy from July 31, 2015, to January 15, 2020, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an evaluation in excess of 40 percent for right lower extremity sciatic nerve radiculopathy from January 16, 2020, is denied. Entitlement to a separate evaluation of 20 percent, but no higher, from September 1, 2017, to January 15, 2020, for right lower extremity femoral radiculopathy is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an evaluation in excess of 30 percent for right lower extremity femoral nerve radiculopathy from January 16, 2020, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities is granted from September 10, 2011, subject to the laws and regulations governing the payment of monetary benefits. REMANDED Entitlement to separate compensable ratings for impairment of the external popliteal (common peroneal) nerve, internal popliteal (tibial) nerve, and posterior tibial nerve of the right lower extremity is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance or by reason of being housebound is remanded. FINDINGS OF FACT 1. Beginning March 6, 2009, to July 30, 2015, the Veteran’s right lower extremity sciatic nerve radiculopathy was manifested by no more than mild incomplete paralysis of the major extremity. 2. From July 31, 2015, to January 15, 2020, the Veteran’s right lower extremity sciatic nerve radiculopathy was manifested by no more than moderate incomplete paralysis. 3. From January 16, 2020, the Veteran’s right lower extremity sciatic nerve radiculopathy was not manifested by severe incomplete paralysis with marked muscular atrophy. 4. Beginning September 1, 2017, the Veteran’s right lower extremity femoral nerve radiculopathy was manifested by no more than moderate incomplete paralysis. 5. From January 16, 2020, the Veteran’s right lower extremity femoral nerve radiculopathy was not manifested by complete paralysis of the quadriceps extensor muscles. 6. From September 10, 2011, the Veteran’s service-connected disabilities prevented him from maintaining and securing substantially gainful employment. CONCLUSIONS OF LAW 1. Beginning March 6, 2009, the criteria for entitlement to a 10 percent initial rating (but no higher) for right lower extremity sciatic nerve radiculopathy have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8520 (2019). 2. From July 31, 2015, to January 15, 2020, the criteria for entitlement to a 20 rating for right lower extremity sciatic nerve radiculopathy have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520 (2019). 3. From January 16, 2020, the criteria for entitlement to a disability rating in excess of 40 percent for right lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520 (2019). 4. Beginning September 1, 2017, the criteria for entitlement to a 20 percent initial rating (but no higher) for right lower extremity femoral nerve radiculopathy have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526 (2019). 5. From January 16, 2020, the criteria for entitlement to a rating in excess of 30 percent for right lower extremity femoral nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526 (2019). 6. The criteria for entitlement to TDIU from September 10, 2011, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1983 to July 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2009 rating decision by the Department of Veterans Affairs (VA) that granted a noncompensable evaluation for neurological deficit to the right lower extremity. This case was remanded in February 2014, June 2017, and July 2018 for further development; it has since been reassigned to the undersigned Veterans Law Judge. Following the Board’s February 2014 remand, the Agency of Original Jurisdiction (AOJ) granted a 10 percent rating for neurological deficit to the right lower extremity in an August 2015 rating decision, effective July 31, 2015. A February 2016 rating decision assigned an effective date of January 11, 2011, for the 10 percent rating. The AOJ also granted TDIU in the August 2015 rating decision, effective August 16, 2012. This issue, however, remains on appeal because the grant did not encompass the entire period on appeal. See Harper v. Wilkie, 30 Vet. App. 356 (2018). The Board has accordingly added entitlement to TDIU prior to August 16, 2012, as an issue on appeal. Following the Board’s July 2018 remand, a June 2020 rating decision increased the rating for right lower extremity sciatic nerve radiculopathy to 40 percent, and granted service connection for right lower extremity femoral nerve radiculopathy, rated 30 percent, both effective January 16, 2020. Because higher ratings for these disabilities are assignable during the relevant time period and the Veteran is presumed to seek the maximum available benefit, the issues remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board must also consider entitlement to SMC when fairly raised by the record. See Akles v. Derwinski, 1 Vet. App. 118 (1991). The issue of entitlement to SMC based on the need for aid and attendance or by reason of being housebound has been raised by the record. The Board has accordingly added entitlement to SMC as an issue on appeal. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In evaluating the severity of a disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Rating Schedule recognizes that a single disability may result from more than one distinct injury or disease; however, rating the same disability or its manifestation(s) under different DCs - a practice known as pyramiding - is prohibited. See 38 C.F.R. § 4.14. In any claim for an increased rating, “staged” ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8520. (Neuritis and neuralgia of that group are evaluated under DCs 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is rated as 60 percent disabling. Complete paralysis, with the foot dangling and dropping, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated as 80 percent disabling. 38 C.F.R. § 4.124a, DC 8520. Paralysis of the anterior crural nerve (femoral) is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8526. (Neuritis and neuralgia of that group are evaluated under DCs 8625 and 8725.) 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 quadriceps extensor muscles is rated as 40 percent disabling. 38 C.F.R. § 4.124a, DCs 8526. The words “mild,” “moderate,” and “severe” as used in the various diagnostic codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. 1. A 10 percent initial rating (but no higher) for right lower extremity sciatic radiculopathy from March 6, 2009, is granted. 2. Entitlement to an evaluation in excess of 10 percent for right lower extremity sciatic nerve radiculopathy prior to July 31, 2015, is denied. The Veteran contends that he is entitled to higher ratings than those currently assigned. Factual Background A November 2008 private treatment record includes a diagnosis of bilateral neuroforamina stenosis. During a March 2009 VA examination, the Veteran reported pain and numbness radiating constantly into the right hip area and frequently down the right lateral leg into the right foot. The examiner noted pain radiation and sensory disturbances along the distal vertebral dermatome S1 on the right. During his neurological examination, recurrent numbness/pain/tingling involving the distal dermatome of the spinal nerve S1 on the right was noted. This recurred on a daily basis whenever he had to stand for 10 minutes or longer. During his motor examination, he was unable to stand on his toes; standing on his heels was possible for a short period but he was unable to walk on his toes or heels. Standing on the right leg was insecure. No significant muscle atrophy in the bilateral legs was noted. His reflexes were normal. Lasegue sign was positive on the right side. There was no evidence of weakness, especially in non-organic distribution; there was no evidence of sensory loss in stocking or glove pattern. His diagnosis was disc surgery and disc replacement at L5-S1 associated with daily recurring radiculopathy S1 on the right. A January 2011 private report revealed that, an outpatient neurologist was consulted due to persistent pain; this neurologist diagnosed post-nucleotomy syndrome as well as sensitive radicular compression syndrome at L5-S1 (right) on December 14, 2009. An April 2013 private record reveals positive Lasegue’s sign in the right lower extremity with no senso-motor deficits. The conclusion was low back pain generated by progressive degenerative disc disease L3/4 with L3 radiculopathy on the right. Legal Analysis As previously noted, the Veteran’s right lower extremity sciatic radiculopathy is currently evaluated as noncompensable prior to January 11, 2011; 10 percent disabling prior to January 16, 2020; and 40 percent disabling from that date. To warrant an increased compensable rating, the evidence would have to show that the Veteran’s sciatic radiculopathy was mild; to warrant a rating in excess of 10 percent, the evidence would have to show that the Veteran’s sciatic radiculopathy was moderate. Upon review of the record, the Board finds that the competent evidence of record indicates that the severity level of the Veteran’s right lower extremity sciatic nerve radiculopathy was no more than mild prior to July 31, 2015. The Board finds that the Veteran experienced mild right lower extremity sciatic radiculopathy primarily manifested by sensory disturbance and pain from the beginning of the appeal period (March 6, 2009) and therefore grants a 10 percent initial rating for right lower extremity sciatic radiculopathy from that date. This is based on the Veteran’s report of pain and numbness radiating constantly into his right hip and down the right lateral leg into his foot and the March 2009 VA examiner’s notation of sensory disturbances along the distal vertebral dermatome S1 on the right and the Veteran’s inability to stand on his toes. Prior to July 31, 2015, however, the Board concludes that the most probative evidence of record is against a finding that this disability was manifested by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis and that, therefore, the level of impairment is most analogous to mild incomplete paralysis. Accordingly, a rating in excess of 10 percent for right lower extremity sciatic radiculopathy prior to July 31, 2015, is not warranted. 3. Entitlement to a 20 percent evaluation, but no higher, for right lower extremity sciatic nerve radiculopathy from July 31, 2015, to January 15, 2020, is granted. 4. Entitlement to an evaluation in excess of 40 percent for right lower extremity sciatic nerve radiculopathy from January 16, 2020, is denied. 5. Entitlement to a separate evaluation of 20 percent, but no higher, from September 1, 2017, to January 15, 2020, for right lower extremity femoral nerve radiculopathy is granted. 6. Entitlement to an evaluation in excess of 30 percent for right lower extremity femoral nerve radiculopathy from January 16, 2020, is denied. Factual Background A July 31, 2015, VA peripheral neuropathy examination revealed moderate L-spine related incomplete paralysis of the right extremity, mainly pain and weakness induced without evidence of muscle atrophy and reflex loss. Symptoms included moderate constant pain, paresthesias/dysesthesias, numbness, and severe intermittent pain with electricity sensations in the legs. Muscle strength testing was normal on knee extension and showed active movement against some resistance in the ankle plantar flexion and dorsiflexion. There was decreased sensation in the thigh/knee, lower leg/ankle, and foot/toes. No trophic changes were noted. The Veteran’s gait was abnormal due to a bilateral limp, left greater than right, that was predominantly vertebragen. This examination report included a checklist for identification of each individual nerve manifesting impairment in this case. The examiner completed the checklist with markings that indicated “moderate” incomplete paralysis of the sciatic nerve; the Veteran’s femoral nerve was normal. [Other nerves were evaluated and are discussed in the Remand portion below. The Board also notes here that the same examiner conducted the July 2015, September 2017, and January 2020 VA back and peripheral nerves examinations.] A July 31, 2015, VA back examination revealed normal reflexes. Sensory exam was normal for the upper anterior thigh (L2) and thigh/knee (L3/4), but decreased in the lower leg/ankle (L4/L5/S1) and foot/toes (L5). Straight leg raise test was positive. Severe constant pain and moderate paresthesias/dysesthesias and numbness were noted in the right lower extremity. The Veteran did not have muscle atrophy. The examiner concluded that the Veteran had moderate radiculopathy of the sciatic nerve and experienced electricity-like pain sensations in his legs. The Veteran could sit for 30 minutes with constant leg pain. He could stand leaning onto something with his cane for 30 minutes; free standing was possible for three to four minutes only. Aided, he could walk 50 yards at a time. The Veteran’s wife drove him to the appointment since he could no longer drive. His wife helped to undress and dress him. Both the examiner and the Veteran’s wife had to help him get back up from the examination desk. The examiner determined that his right-sided radicular pain increased; the Veteran had new sciatic nerve (and branch) lesions with incomplete paralysis of moderate severity. A September 1, 2017, VA peripheral nerves examination revealed moderate right lower extremity radiculitis. The Veteran had radiculopathic pain with sensory disturbances traveling along the femoral and sciatic nerves down to the toes. The nerve pains with sensory disturbances and numbness in the legs are constantly present. Symptoms included moderate constant pain, paresthesias and/or dysesthesias, and numbness, and severe intermittent pain. Muscle strength testing was normal. No muscle atrophy and no trophic changes were noted. The Veteran’s reflex exam was normal for the right extremities. He had decreased sensation with electricity misperceptions in his leg. His gait was abnormal due to a bilateral limp, left greater than right. The examiner completed the checklist for identification of each individual nerve manifesting impairment and found mild incomplete paralysis of the sciatic nerve; the femoral nerve was normal. [Other nerves were evaluated and are discussed in the Remand portion below.] On September 1, 2017, VA back examination, the Veteran’s reflexes were normal. Sensory exam showed decreased sensation in the upper anterior thigh (L2), thigh/knee (L3/4), lower leg/ankle (L4/L5/S1), and foot/toes (L5). Electricity sensations were noted to radiate through his leg. Moderate constant and dull pain and numbness, and severe intermittent pain and paresthesias and/or dysesthesias, were noted in the right lower extremity. The examiner concluded that the Veteran had moderate radiculopathy of the sciatic and femoral nerves. The examiner also noted that the distal dermatomes L3 on the right thigh and of the nerve roots L5 and S1 on the lower leg and feet were hypalgesic. The Veteran scratched the hypalgesic skin of the thigh with a fingernail brush because of the constant feeling of tingling, tickling, and numbness. The Veteran was able to sit for 30 to 40 minutes at a time with radiating pain to the legs down to his feet. He could stand leaning onto something and with his cane for 15 minutes; free standing was only possible for three to four minutes. Aided, he could walk 50 yards at a time. A January 16, 2020, VA peripheral nerves examination included a diagnosis of severe right lower extremity radiculitis. The Veteran had radiculopathic pain with sensory disturbances traveling along the femoral and sciatic nerves down to the toes. Both legs feel unstable all the time and the Veteran drags his legs and stumbles often. The lumbar/lumbosacral radiculopathic nerve pains with sensory disturbances and numbness in his legs are constantly present. He has severe constant and intermittent pain, paresthesias and/or dysesthesias, and numbness. Muscle strength testing revealed normal strength in ankle plantar flexion; there was active movement against some resistance on knee extension and ankle dorsiflexion. No vertebragenic atrophy was noted. Hypoactive reflexes were noted in his knee and ankle; he had decreased sensation in his upper anterior thigh (L2), thigh/knee (L3/4), lower leg/ankle (L4/L5/S1), and foot/toes (L5). The sensation in his feet was “almost gone.” No trophic changes were noted. The Veteran had a bilateral limp and walked with a cane or two walking sticks. The examiner completed the checklist for identification of each individual nerve manifesting impairment and found mild incomplete paralysis of the sciatic and femoral nerves. [Other nerves were evaluated and are discussed in the Remand portion below.] The examiner submitted an additional document outlining the Veteran’s right leg nerve deficits in detail. He stated that the Veteran’s condition had “significantly worsened” since he was last seen on September 1, 2017. A new CAT scan study reveals additional structural changes that resulted in nerve root compromise / irritation of the femoral and sciatic nerve roots. The Veteran experiences severe sensory impairment with constant right leg pain (even at rest), dysesthesias, and numbness involving the right leg, foot, and toes. He also experiences moderate to severe motor impairment affecting both the femoral and sciatic nerves on the right side. The examiner determined that the Veteran is not completely housebound yet, but is not very far away from it anymore. The January 16, 2020, VA back examiner determined that the Veteran had severe radiculopathy of the femoral and sciatic nerves, noting that the Veteran scratches the hypalgesic skin of his thighs with a fingernail brush because of the constant feeling of tingling, tickling, and numbness. On muscle strength testing, the Veteran’s foot abduction and adduction revealed active movement against gravity; ankle dorsiflexion, hip flexion, and knee flexion and extension all revealed active movement against some resistance. Ankle plantar flexion and great toe extension showed normal strength. No vertebragenic muscle atrophy was noted. Straight leg raise test was positive. Legal Analysis – Right Lower Extremity Sciatic Nerve Radiculopathy Upon review of the evidence, the Board finds that the evidence supports a 20 percent evaluation, but no higher, for right lower extremity sciatic nerve radiculopathy from July 31, 2015, to January 15, 2020; the evidence does not support an evaluation in excess of 40 percent from January 16, 2020. The competent evidence of record indicates that, beginning July 31, 2015, the severity level of the Veteran’s right lower extremity sciatic radiculopathy was moderate. Indeed, the July 2015 and September 2017 VA peripheral nerves examiners assessed sciatic radiculopathy as moderate. The July 2015 VA peripheral nerves examiner noted normal muscle strength testing on knee extension and active movement against some resistance in the ankle plantar flexion and dorsiflexion. No trophic changes or muscle atrophy were noted. The Veteran’s gait was not normal due to a bilateral limp, left greater than right, that was predominantly vertebragen. The September 2017 VA peripheral nerves examiner noted sensory disturbances traveling along the sciatic nerve down to the toes that were constantly present. However, muscle strength testing and reflexes were normal. There was no muscle atrophy and no trophic changes. The Board acknowledges that the Veteran uses two walking sticks or a cane for ambulation, but the July 2015 and September 2017 VA examiners attributed these limitations to his lumbar condition and related pain, not the radiculopathy. The Board therefore finds that the symptoms that limit mobility are attributable to his service-connected orthopedic injuries. During both examinations, the examiner considered the Veteran’s statements regarding his associated numbness, tingling, and pain and evaluated those symptoms to be at most moderate in severity. The Board does not find that these symptoms and decreased sensation rise to the level of moderately severe impairment prior to January 16, 2020. Beginning January 16, 2020, the Board finds that the competent evidence of record indicates that the severity level of the Veteran’s right lower extremity sciatic radiculopathy is no more than moderately severe. In this regard, the medical evidence affirmatively shows that the Veteran does not experience complete paralysis of the sciatic nerve, and the Veteran does not report symptomatology consistent with complete paralysis, e.g., the foot dangles and drops, no active movement possible of muscles below the knee, or lost or weakened knee flexion. As the medical evidence also shows no marked muscular atrophy, a rating higher than the currently assigned 40 percent is not warranted. The Veteran’s belief that he is entitled to higher ratings than those currently assigned for his right lower extremity sciatic nerve radiculopathy is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. Legal Analysis – Right Lower Extremity Femoral Nerve Radiculopathy The Veteran’s right lower extremity femoral nerve radiculopathy is currently evaluated as 30 percent disabling from January 16, 2020. Upon review of the evidence, the Board finds that the first medical evidence of record showing involvement of the femoral nerve came during the September 1, 2017, VA back and peripheral nerves examinations. The Board is aware that the September 2017 peripheral nerves examiner completed the checklist for identification of each individual nerve manifesting impairment and found the femoral nerve to be normal. However, that same examiner stated that, compared to the July 2015 VA exam, the Veteran’s back-related peripheral nerve conditions “have increased significantly” with consistent resting pain in his entire back traveling to his legs. Additionally, during the September 2017 VA back exam, that same examiner stated that the Veteran had moderate radiculopathy involving the femoral nerve. Accordingly, and based on the foregoing, the Board finds that the evidence supports a 20 percent evaluation, but no higher, from September 1, 2017, for right lower extremity femoral nerve radiculopathy. Beginning January 16, 2020, the Board finds that the competent evidence of record indicates that the severity level of the Veteran’s right lower extremity femoral nerve radiculopathy is no more than severe. In this regard, the medical evidence affirmatively shows that the Veteran does not experience complete paralysis of the femoral nerve, and he does not report symptomatology consistent with complete paralysis of the quadriceps extensor muscles. As the medical evidence also shows no complete paralysis, a rating higher than the currently assigned 30 percent from January 16, 2020, is not warranted. In sum, the Board finds that an initial disability rating of 10 percent, but no higher, is warranted effective March 6, 2009, and a 20 percent rating, but no higher, is warranted effective January 31, 2015, for right lower extremity sciatic radiculopathy. The preponderance of the evidence is against the claim for an initial compensable rating in excess of 40 percent for right lower extremity sciatic nerve radiculopathy from January 16, 2020. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Finally, an initial disability rating of 20 percent, but no higher, is warranted effective September 1, 2017, for right lower extremity femoral nerve radiculopathy; the preponderance of the evidence is against the claim for an initial compensable rating in excess of 30 percent from January 16, 2020. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to a TDIU is granted from September 9, 2011. TDIU may be assigned where the schedular rating is less than total when the Veteran is unable to secure or follow substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In order to meet the schedular criteria for entitlement, the Veteran must have either: (i) one disability rated at 60 percent or more; or (ii) two or more disabilities, with at least one disability rated at 40 percent or more and sufficient additional disability bringing the combined rating to at least 70 percent. 38 C.F.R. § 4.16(a). For the purpose of determining entitlement to a schedular TDIU, disabilities resulting from a common etiology or resulting from a single accident are considered as one disability. Id. During the course of the appeal, the issue of entitlement to TDIU was granted, effective August 16, 2012, the date the Veteran filed a claim for TDIU. See August 2015 rating decision. While this may appear to be a full grant of the benefits sought on appeal, it is only a partial grant, because the Veteran could still be entitled to TDIU prior to August 16, 2012, since the appeal period currently before the Board for an increased rating for right lower extremity radiculopathy begins March 6, 2009. See Harper, 30 Vet. App. at 356. The Veteran meets the schedular criteria for entitlement to TDIU throughout the appeal period. According to his VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, his last date of employment was September 9, 2011. The Social Security Administration (SSA) found that the Veteran was disabled from September 9, 2011, due to arthropathies and disorders of the back. See September 2012 SSA determination. While not binding, the Board finds the SSA determination to be persuasive and positive evidence in favor of the claim. A January 2011 private orthopedist determined that a number of service-connected disabilities do not “allow for ability to work anymore.” His therapy resistant back pains as well as pain in the lower extremities and related limitation of ability to walk are caused by his professional strain and continuing to work will increase the symptoms. Given the Veteran’s symptoms, the opinions by the private examiners, and the SSA determination, the Board finds that the Veteran’s service-connected disabilities prevent him from securing and following substantially gainful occupation, and TDIU is warranted from September 10, 2011, but no earlier, because that is the date he stopped working full-time. REASONS FOR REMAND 8. Entitlement to separate compensable ratings for impairment of the external popliteal (common peroneal) nerve, internal popliteal (tibial) nerve, and posterior tibial nerve of the right lower extremity is remanded. Significantly, the July 2015 VA examiner completed the checklist for identification of each individual nerve manifesting impairment in this case. In addition to the markings for sciatic and femoral nerves addressed above, the examiner completed the checklist with markings that indicate “moderate” incomplete paralysis of the external popliteal nerve and “mild” incomplete paralysis of the internal popliteal nerve. During the September 2017 VA examination, the examiner found “mild” incomplete paralysis of the external popliteal, internal popliteal, and posterior tibial nerves. During the January 2020 VA examination, he found “moderate” incomplete paralysis of the external popliteal and internal popliteal nerves and “mild” incomplete paralysis of the posterior tibial nerve. Paralysis of these nerves may be rated under 38 C.F.R. § 4.124a, DCs 8521, s8524, and 8525, respectively. The Board has considered whether the impairment attributable to impairment of these nerves may be contemplated in the rating already assigned under DC 8520 or 8526 for paralysis of the sciatic and femoral nerves, respectively, such that separate ratings for the other nerves could potentially be prohibited as pyramiding. 38 C.F.R. § 4.14. However, the evidence in this particular case does not allow the Board (limited to its lay sensibilities and reliant upon competent medical evidence) to make this determination with adequately informed clarity. The Board takes judicial notice of the fact (without relying upon the information for any binding determination in this case) that the identified nerves involve branches of the sciatic nerve such that some degree of overlapping symptomatology / impairment may be suggested. However, it is not clear that assignment of separate ratings for multiple nerve involvement is necessarily inappropriate in this case. The Board observes that it is a matter of public record that the Court, albeit in a non-precedential manner, has noted that there are situations where, for example, “compensating the appellant’s sciatic nerve symptoms separately [from external popliteal (common peroneal) nerve symptoms] would appear to not run afoul [of] the rule against pyramiding” and that there are “no special instructions in the regulation that would prohibit separate evaluations under DCs 824, 8525, 8624, 8625, or 8620.” 38 C.F.R. § 4.14 (2015).” Defazio v. McDonald, 2015 U.S. App. Vet. Claims LEXIS 1304 (U.S. App. Vet. Cl. Sept. 28, 2015) (non-precedential); Johnson v. Wilkie, 2018 U.S. App. Vet. Claims LEXIS 588 (U.S. App. Vet. Cl. April 30, 2018) (non-precedential). The medical evidence currently of record does not make clear whether any manifestations of impairment attributable to one or more of the other peripheral nerves may be compensably distinct from the manifestations contemplated by the ratings already assigned for the sciatic nerve impairment. The Board finds that a remand is warranted to obtain a competent medical opinion to determine whether the incomplete paralysis of any of the other involved peripheral nerves of the right lower extremity (other than the sciatic nerve) manifests in impairment that is entirely distinct from (neither duplicative nor overlapping) the impairment attributed to the paralysis of the sciatic nerve as part of the disability resulting from the service-connected spinal pathology. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 9. Entitlement to SMC based on the need for aid and attendance or by reason of being housebound is remanded. The January 2020 VA examination notes that the Veteran is unable to move. Other parts of the examination note that he is able to move with two walking sticks or a cane. The examiner noted that the Veteran “is not completely housebound yet[,] but he is not very far away from it anymore.” Based on foregoing, the Board finds that an examination is required. Additionally, TDIU rating based on a single disability is permitted to satisfy the statutory requirement of a 100 percent rating to be entitled to statutory housebound SMC. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i); Bradley v. Peake, 22 Vet. App. 280, 293 (2008). Based on the decision above, the Veteran has been granted TDIU since September 10, 2011. Thus, an opinion regarding the occupational impairment caused by each service-connected disability is necessary to determine whether the Veteran’s TDIU can be predicated on an individual disability. Accordingly, the case is REMANDED for the following actions: 1. Forward the Veteran’s claim file to the author of the VA peripheral nerves examinations (or another appropriate specialist) for a medical opinion, with examination only if deemed necessary, addressing the nature and etiology of the Veteran’s right lower extremity neurological deficits. The VA examiner is asked to review the claim file and address the following: The July 2015, September 2017, and January 2020 VA peripheral nerves examination reports identified mild or moderate incomplete paralysis of several different right lower extremity nerves (“Sciatic Nerve”; “External popliteal (common peroneal) nerve”; “Internal popliteal (tibial) nerve”; and “Posterior tibial nerve”). The Veteran is currently in receipt of disability compensation for right lower extremity neurological impairment based upon mild incomplete paralysis of the sciatic nerve prior to July 31, 2015; moderate incomplete paralysis of the sciatic nerve prior to January 16, 2020; and moderately severe paralysis of the sciatic nerve thereafter, but additional compensation might be warranted if the noted impairment of one or more of the other identified nerves manifests in impairment that is entirely distinct from (neither duplicative nor overlapping) the impairment attributed to the paralysis of the right sciatic nerve. Please identify any impairment/symptomatology of any right lower extremity nerve found to be affected by incomplete paralysis (including those indicated in the July 2015, September 2017, and January 2020 VA examination reports) where such impairment / symptomatology is entirely distinct from (neither duplicative nor overlapping) the impairment from the paralysis of the right sciatic nerve. 2. Thereafter, arrange for an aid and attendance examination of the Veteran. The examiner must review the entire record (including this remand) in conjunction with the examination and note such review was conducted. In addition, the examiner should opine as to the following: (a) Is it at least as likely as not (50% or greater probability) that the Veteran is in need of regular aid and attendance from another individual due to his service-connected disabilities? Specifically, is he unable to dress or undress himself, or to keep himself ordinarily clean and presentable; need frequent adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disabilities cannot be done without aid; unable to feed himself through loss of coordination of upper extremities or through extreme weakness; unable to attend to the wants of nature; or does he have incapacity, physical or mental, which requires care or assistance on a regular basis for protection from hazards or dangers from the daily environment due to his service-connected disabilities? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran is permanently housebound due to his service-connected disabilities? Specifically, is he substantially confined to his dwelling and the immediate premises on account of his service-connected disabilities, and it is certain that the disability or disabilities and resultant confinement will continue throughout his lifetime? (c) If the Veteran is in need of aid and attendance due to service-connected disabilities, at what time did such need arise? Please explain why (d) The examiner should describe any and all occupational impairment produced by each service-connected disability. 3. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Matta, 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.