Citation Nr: 21006519 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 12-07 987 DATE: February 4, 2021 ORDER Entitlement to a 20 percent rating prior to August 2, 2010, for sciatic neuropathy of the right lower extremity is granted. Entitlement to a 20 percent rating prior to August 2, 2010, for sciatic neuropathy of the left lower extremity is granted. Entitlement to a rating in excess of 20 percent prior to October 18, 2019, for sciatic neuropathy of the right lower extremity is denied. Entitlement to a rating in excess of 20 percent prior to October 18, 2019, for sciatic neuropathy of the left lower extremity is denied. Entitlement to a rating in excess of 40 percent from October 18, 2019, for sciatic neuropathy of the right lower extremity is denied. Entitlement to a rating in excess of 40 percent from October 18, 2019, for sciatic neuropathy of the left lower extremity is denied. Entitlement to a rating in excess of 20 percent prior to October 18, 2019, for femoral neuropathy of the right lower extremity is denied. Entitlement to a rating in excess of 20 percent prior to October 18, 2019, or 40 percent thereafter for femoral neuropathy of the left lower extremity is denied. Entitlement to a rating in excess of 30 percent from October 18, 2019, for femoral neuropathy of the right lower extremity is denied. Entitlement to a rating in excess of 30 percent from October 18, 2019, for sciatic neuropathy of the left lower extremity is denied. FINDINGS OF FACT 1. There was not an objective worsening of the sciatic impairment of either lower extremity as of August 2, 2010. 2. Prior to August 2, 2010, the sciatic neuropathies result in at worst moderate impairment of each lower extremity prior to October 18, 2019, and moderately severe impairment of each lower extremity from October 18, 2019. 3. The femoral neuropathy of each extremity results in at worst moderate impairment of each lower extremity prior to October 18, 2019, and severe thereafter. CONCLUSIONS OF LAW 1. The criteria for a 20 percent rating for sciatic impairment of the right lower extremity prior to August 2, 2010, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 2. The criteria for a 20 percent rating for sciatic impairment of the left lower extremity prior to August 2, 2010, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 3. The criteria for a rating in excess of 20 percent rating prior to October 18, 2019, or 40 percent thereafter for sciatic impairment of the right lower extremity have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 4. The criteria for a rating in excess of 20 percent rating prior to October 18, 2019, or 40 percent thereafter for sciatic impairment of the left lower extremity have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 5. The criteria for a rating in excess of 20 percent rating prior to October 18, 2019, or 30 percent thereafter for femoral impairment of the right lower extremity have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8526. 6. The criteria for a rating in excess of 20 percent rating prior to October 18, 2019, or 30 percent thereafter for femoral impairment of the left lower extremity have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1966 to January 1968. Increased Rating The term “incomplete paralysis” with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. The regulations state that, if the involvement is only sensory, the rating should be for the mild or, at most, the moderate degree of incomplete paralysis. 38 C.F.R. § 4.124a. Complete paralysis of the sciatic nerve warrants an 80 percent evaluation; with complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. Incomplete paralysis of the sciatic nerve warrants a 60 percent evaluation if it is severe with marked muscular dystrophy, a 40 percent evaluation if it is moderately severe, a 20 percent evaluation if it is moderate, or a 10 percent evaluation if it is mild. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Complete paralysis of the femoral nerve warrants a 40 percent rating, with paralysis of the quadriceps extensor muscles. Incomplete paralysis of the femoral nerve warrants a 30 percent rating if it is severe, a 20 percent rating if it is moderate, and a 10 percent rating if it is mild. 38 C.F.R. § 4.124a, Diagnostic Code 8526. Words such as “mild,” “moderate” and “severe” are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. Sciatic Nerve In its October 2019 decision, the Board granted a 20 percent rating for sciatic impairment of each lower extremity for the period prior to January 31, 2013. In a November 2019 rating decision, VA implemented the Board grant and assigned an effective date of August 2, 2010, for the award of a 20 percent rating for each lower extremity. This appeal stems from a February 11, 2009, claim. Resolving all doubt, the Board finds the 20 percent rating for impairment of the sciatic nerve should include the period of the claim prior to August 2, 2010, based on the absence of evidence of a significant worsening of the condition as of August 2, 2010 and histories of “longstanding” symptoms. Thus, the Board will consider entitlement to a rating in excess of 20 percent prior to October 18, 2019. The Board finds a rating in excess of 20 percent is not warranted at any time for the sciatic neuropathy of either lower extremity. Specifically, the Board finds the record does not suggest the presence of worse than moderate impairment of either sciatic nerve. The record includes VA and private treatment records and VA examination records dated in June 2009, August 2010, January 2012, January and November 2013, and April 2017. The Board acknowledges that the record reveals the Veteran’s histories of symptoms including weakness, pain, and insensation, including the November 2013 history of severe paresthesias and/or dysesthesias. Clinical evaluation reveals normal or near-normal (4/5) motor strength, intact albeit intermittently diminished sensation, and generally intact deep tendon reflexes, and the record indicates that there is no chronic absence or even diminution of reflex or sensation or impairment of gait. Furthermore, the VA examination records dated during this period reveal assessments of mild or moderate impairment, which the Board finds is consistent with the clinical findings reported in the examination and treatment records. The Board acknowledges that an April 2010 private treatment record reveals the Veteran’s history of frequent loss of balance and occasional falls. The record indicates that the Veteran has multiple disabilities affecting stability and the lower extremities, however, and the Board finds the clinical neurological findings are more probative than the April 2010 history in determining the severity of the sciatic neuropathies during this period. From October 18, 2019, the sciatic neuropathies are each rated at 40 percent. Review of the record, which includes October 2019 and October 2020 VA examination records, report findings of no atrophy. There are no findings of marked atrophy during this period. In the absence of evidence of marked atrophy, a higher rating is not warranted under Diagnostic Code 8520 for either lower extremity during this period. Femoral Nerve From January 31, 2013, to October 18, 2019, the Veteran is assigned a 20 percent rating for femoral nerve impairment. The Board finds a rating in excess of 20 percent is not warranted at any time for the femoral neuropathy of either lower extremity. Specifically, the Board finds the record does not suggest the presence of more than moderate impairment of either femoral nerve. The record includes VA and private treatment records and VA examination records dated in January and November 2013 and April 2017. The record reveals the Veteran’s histories of symptoms including weakness, pain, and insensation, including the November 2013 history of severe paresthesias and/or dysesthesias. The Veteran otherwise reports mild to moderate symptoms, however, and clinical evaluation reveals normal or near normal (4/5) motor strength, intact albeit intermittently diminished sensation, and generally intact deep tendon reflexes, and the record indicates that there is no chronic absence or even diminution of reflex or sensation or impairment of gait. Furthermore, the VA examination records dated during this period reveal assessments of mild or moderate impairment, which the Board finds is consistent with the clinical findings reported in the examination and treatment records. From October 18, 2019, the Veteran is assigned a 30 percent rating for femoral nerve impairment. The 30 percent rating currently assigned is the maximum rating available for incomplete paralysis of either femoral nerve. There is no evidence of complete paralysis. The record does not suggest the existence of any symptoms not contemplated by the current rating. Thus, a higher rating is not warranted at any time from October 18, 2019. Joshua Castillo Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Snyder, 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.