Citation Nr: 21007251 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-36 387 DATE: February 9, 2021 ORDER Prior to March 1, 2017, an initial evaluation in excess of 10 percent for service-connected thoracolumbar spine strain is denied. As of March 1, 2017, an evaluation of 40 percent, and no more, is granted for service-connected thoracolumbar spine strain, subject to the statutes and regulations governing the payment of monetary benefits. As of September 7, 2016, an initial evaluation of 20 percent, and no more, is granted for service-connected right lower extremity peripheral neuropathy, subject to the statutes and regulations governing the payment of monetary benefits. As of October 18, 2018, an initial evaluation of 20 percent, and no more, is granted for service-connected left lower extremity radiculopathy, subject to the statutes and regulations governing the payment of monetary benefits. An initial compensable evaluation for pseudofolliculitis barbae is denied. REMANDED The claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to June 7, 2018 is remanded. FINDINGS OF FACT 1. Prior to March 1, 2017, the Veteran’s thoracolumbar spine strain was shown to have been productive of complaints of pain; but forward flexion has not been shown to be functionally limited to 60 degrees or less, a combined range of motion of the thoracolumbar spine has been greater than 120 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour have not been shown; and intervertebral disc syndrome with incapacitating episodes having a total duration of at least 2 weeks during a 12 month period has not been shown. 2. As of March 1, 2017, the Veteran’s thoracolumbar spine strain was shown to have been productive of pain and limitation of motion, with forward flexion to 10 degrees, but neither ankylosis of the entire thoracolumbar spine, nor intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during a 12-month period, has been shown. 3. As of September 7, 2016, the Veteran’s peripheral neuropathy, right lower extremity, is shown to have been productive of pain and some decreased sensation and strength, and moderate incomplete paralysis, but not moderately severe incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve. 4. As of October 18, 2018, the Veteran’s radiculopathy, left lower extremity, is shown to have been productive of pain with some decreased sensation and strength, and moderate incomplete paralysis, but not moderately severe incomplete paralysis, neuritis, or neuralgia, of the sciatic nerve. 5. The Veteran’s service-connected pseudofolliculitis barbae is not shown to have affected at least 5 percent of the entire body, or at least 5 percent of exposed areas, or to have required use of intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during a 12-month period. CONCLUSIONS OF LAW 1. Prior to March 1, 2017, the criteria for an initial evaluation in excess of 10 percent for service-connected thoracolumbar spine strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5237, 5242, 5243. 2. As of March 1, 2017, the criteria for an evaluation of 40 percent, and no more, for service-connected thoracolumbar spine strain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5237, 5242, 5243. 3. As of September 7, 2016, the criteria for an initial evaluation of 20 percent, and no more, for service-connected peripheral neuropathy, right lower extremity, were met. 38 U.S.C. §§ 1155, 5110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.124a, Diagnostic Codes 8520, 8620, 8720. 4. As of October 18, 2018, the criteria for an initial evaluation of 20 percent, and no more, for service-connected radiculopathy, left lower extremity, were met. 38 U.S.C. §§ 1155, 5110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.124a, Diagnostic Codes 8520, 8620, 8720. 5. The criteria for an initial compensable evaluation for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Code 7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In June 2019, the Veteran was afforded a hearing before the undersigned. In January 2020, the Board remanded these claims for additional development. Increased Initial Evaluations 1. Thoracolumbar spine strain. The Veteran asserts that he is entitled to an initial increased evaluation for his thoracolumbar spine strain. During a March 2017 hearing at the RO, the Veteran reported that he was receiving chiropractic care for pain management, and that he was told that he back would continue to worsen. His treatment has included nerve ablation in 2013. He has difficulty getting up, walking, sitting for long periods of time, and his back pain makes his job harder. There are days when he cannot move and he has to call into work and take a sick day. During his June 2019 hearing, the Veteran asserted that he had at least three incapacitating episodes in the past year, and three injections in the past six months. He said that he works as a contractor in a warehouse, and that he has difficulty bending, stooping, and kneeling. The RO has evaluated the Veteran’s back disability under Diagnostic Code (DC) 5237. Under 38 C.F.R. § 4.71a, DC 5237 and 5242, lumbosacral strain and degenerative arthritis of the spine are rated under the “General Rating Formula for Diseases and Injuries of the Spine.” The General Rating Formula provides that a 10 percent rating is warranted for: forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees, but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of height. An evaluation of 20 percent is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that an evaluation of 10 percent is warranted for intervertebral disc syndrome, with incapacitating episodes having a total duration of at least 1 weeks but less than 2 weeks during the past 12 months. Id. A 20 percent rating is warranted for IDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. Id. A 40 percent rating is warranted for IDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Id. A 60 percent rating is warranted for IDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Id. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court clarified that there is a difference between pain that may exist in joint motion as opposed to pain that actually places additional limitation of the particular range of motion. The Court specifically discounted the notion that the highest disability ratings are warranted under DCs 5261 and 5261 where pain is merely evident as it would lead to potentially “absurd results.” Id. at 10-11 (limiting the scope and application of its prior holding in Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991)). Functional loss due to pain is rated at the same level as functional loss where motion is impeded. See Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Pursuant to 38 C.F.R. § 4.59, painful motion should be considered limited motion, even though a range of motion may be possible beyond the point when pain sets in. See Powell v. West, 13 Vet. App. 31, 34 (1999). With regard to the history of the disability at issue, the Veteran’s service treatment records show that he was noted to have backache as early as 2010, following a MVA (motor vehicle accident) in March 2010 in which the car he was riding in was rear-ended. X-rays in May 2010 were unremarkable. A May 2012 MRI (magnetic resonance imaging study) contained an impression noting a disc bulge at L5-S1 with facet hypertrophy and ligamentum flavum thickening, and borderline central canal narrowing, and mild to moderate bilateral neural foraminal narrowing. In 2012, he underwent lumbar epidural steroid injections that did not provide long-term relief. He was then given bilateral lumbar facet joint blocks, with significant relief, followed by radiofrequency ablation. In November 2015, the RO granted service connection for thoracolumbar spine strain, evaluated as 10 percent disabling, with an effective date of September 23, 2015. The Veteran appealed the issue of entitlement to an initial evaluation in excess of 10 percent. In May 2020, the RO granted the claim, to the extent that it assigned a 40 percent evaluation with an effective date of January 24, 2020. Since this increase did not constitute a full grant of the benefit sought, the increased rating issue remains in appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). Prior to March 1, 2017. A VA back disability benefits questionnaire (DBQ), dated in November 2015, shows that the Veteran had forward flexion to 90 degrees, extension to 20 degrees, lateral flexion to 30 degrees, bilaterally, and rotation to 30 degrees, bilaterally. When functional loss was considered during flare-ups or following repetitive use, there was an additional loss of range of motion of five degrees in all planes except forward flexion, which had an additional loss of ten degrees (i.e., forward flexion was estimated to be limited to approximately 80 degrees during flare-ups). There was no guarding or muscle spasm of the thoracolumbar spine observed. There was no finding of an abnormal gait, abnormal spinal contour, scoliosis, reversed lordosis, or abnormal kyphosis. The Board finds that an initial evaluation in excess of 10 percent is not warranted. An evaluation in excess of 10 percent is not appropriate without evidence of forward flexion of the thoracolumbar spine is functionally limited to between 30 and 60 degrees, or evidence of the combined range of motion of the thoracolumbar spine is functionally limited to 120 degrees or less. The Veteran’s ranges of motion as found in his November 2015 VA examination have been discussed. This evidence does not show, nor is there any other evidence to show, that the criteria for a rating in excess of 10 percent have been met. With regard to the possibility of a rating in excess of 10 percent under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, the November 2015 VA examiner stated that the Veteran does not have IVDS. There is no evidence to show that a physician ordered bed rest for his low back symptoms, and there is no objective evidence of incapacitating episodes within the meaning of the regulation. See Diagnostic Code 5243, Note 1. Accordingly, an initial evaluation in excess of 10 percent is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. With respect to possibility of entitlement to a rating in excess of 10 percent under 38 C.F.R. §§ 4.40 and 4.45, the Board has also considered whether an increased rating could be assigned on the basis of functional loss due to the Veteran’s subjective complaints of pain. DeLuca v. Brown, 8 Vet. App. 202, 204-206 (1995); VAGCOPPREC 9-98, 63 Fed. Reg. 56704 (1998). The November 2015 VA DBQ shows that when functional loss was considered during flare-ups or following repetitive use, there was a loss of range of motion of five degrees in all planes except forward flexion, which had a loss of ten degrees (i.e., forward flexion to 80 degrees). There was no guarding or muscle spasm of the thoracolumbar spine. There was no finding of an abnormal gait, abnormal spinal contour, scoliosis, reversed lordosis, or abnormal kyphosis. Private treatment reports from the Central Oklahoma Wellness Clinic (COWC), dated between April and May of 2016, show treatment for complaints of back pain. On examination, gait was normal. There were mild to moderate lumbar spine spasms. There were decreased ranges of motion in multiple planes (specific ranges of motion were not provided). X-rays of the lumbar and thoracic spines noted that there was no evidence of fracture, osseous pathology (excluding previously noted degenerative disc disease and spondylosis), or congenital bony abnormalities. There was a loss of disc heights and disc spacing at L5-S1. VA treatment records did not discuss the Veteran’s back disability. In summary, while there is some evidence of pain, and limitation of motion, the evidence does not otherwise show functional loss due to pain to warrant an initial evaluation in excess of 10 percent. Pain alone does not constitute a functional loss under VA regulations. Mitchell. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see also 38 C.F.R. § 4.40. Here, even considering the Veteran’s pain, he is shown to have had at least 80 degrees of flexion. Despite his complaints, when the range of motion findings, and the evidence showing functional loss are considered, to include the findings (or lack thereof) pertaining to neurologic deficits, muscle strength, and muscle atrophy, the Board finds that there is insufficient evidence of objective pain on motion, or any other functional loss, to warrant a rating in excess of 10 percent. The Board therefore finds that the criteria for an initial evaluation in excess of 10 percent are not shown to have been met, and the claim is denied. As of March 1, 2017. The Board finds that the criteria for a 40 percent evaluation are met as of March 1, 2017. A VA back DBQ, dated in March 2017, shows that the examination was performed on March 1, 2017. The Veteran had forward flexion to 10 degrees, extension to 10 degrees, lateral flexion to 10 degrees, bilaterally, and rotation to 5 degrees, bilaterally. This shows that the criteria for a 40 percent evaluation are met. The Board notes that it does not appear that the RO considered the March 2017 DBQ at any time, to include in its most recent supplemental statement of the case (SSOC). See April 2020 SSOC. As the criteria for a 40 percent evaluation have been met as of March 1, 2017, to this extent, the claim is granted. An evaluation in excess of 40 percent is not warranted. The General Rating Formula provides that an evaluation of 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that an evaluation of 60 percent rating is warranted for IDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. The March 2017 VA back DBQ shows that the examiner indicated that the Veteran does not have IVDS, or ankylosis. See also January 2020 VA back DBQ (same). A private X-ray of the thoracolumbar spine, dated in March 2017, was negative. The report notes that the vertebral bodies are in excellent anatomic alignment, that the intervertebral disc spaces are normal, and that all vertebral bodies demonstrate normal height. No abnormalities of curvature are seen. An X-ray of the lumbar spine contains an impression noting slight retrolisthesis at L5-S1 with an otherwise negative lumbosacral spine. A July 2018 MRI notes a posterior disc protrusion at L5-S1 with what appears to be a small posterior disc margin annulus fibrosus tear, and that there has been little change since May 2012. An August 2019 private report notes that there was no back pain. Strength in the lower extremities was 5/5, with normal sensation, reflexes and gait. An associated X-ray for the lumbar spine was negative. Private treatment reports, dated between October and November of 2018, show treatment for low back pain that included epidural injections. The findings note normal motor and sensory examinations, a normal gait, a limitation of motion, and normal curvature of the spine. The assessments note intervertebral disc disorders with radiculopathy. There is no evidence to show that the Veteran has ankylosis of the entire thoracolumbar spine or a disability picture comparable thereto. DC 5237; General Rating Formula. There is no evidence to show that the Veteran has intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during a 12-month period. See Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Accordingly, as of March 1, 2017, an evaluation in excess of 40 percent is not warranted under DCs 5242 or 5243. Consideration has been given to the Veteran’s complaints of pain and functional loss of the lumbar spine. DeLuca; VAGCOPPREC 9- 98. However, the Board finds that the provisions pertaining to functional loss do not apply, as the Veteran is currently in receipt of the highest evaluation possible based on a limitation of motion code. Johnston v. Brown, 10 Vet. App. 80 (1997). 2. Bilateral lower extremity radiculopathy. In December 2016, the RO the RO granted service connection for peripheral neuropathy of the right lower extremity, evaluated as 10 percent disabling, with an effective date for service connection of September 7, 2016. In December 2018, the RO increased the Veteran’s evaluation to 20 percent, with an effective date of June 7, 2018. In May 2020, the RO granted service connection for left lower extremity radiculopathy, evaluated as 10 percent disabling prior to January 24, 2020, and as 20 percent disabling thereafter. The assigned date of service connection was October 18, 2018. As these grants arose out of the course of the Veteran’s appeal for an initial increased evaluation for his back disability, the issues of initial increased evaluations for right lower extremity peripheral neuropathy and left lower extremity radiculopathy are deemed to be a part of his appeal. The Veteran’s right lower extremity peripheral neuropathy and left lower extremity radiculopathy have been evaluated under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8520. The criteria for evaluating the severity or impairment of the sciatic nerve is set forth under Diagnostic Codes 8520, 8620, and 8720. Under DC 8520, a 10 percent rating requires mild incomplete paralysis of the sciatic nerve. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. Id. A 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. Id. Diagnostic Codes 8620 and 8720 address the criteria for evaluating neuritis and neuralgia of the sciatic nerve, respectively. The criteria are consistent with the criteria for evaluating degrees of paralysis as set forth above. 38 C.F.R. § 4.124a, DC’s 8520, 8620, 8720. A note in the Rating Schedule pertaining to “Diseases of the Peripheral Nerves” provides that the term “incomplete paralysis” indicates a degree of lost or impaired function which is substantially less than that which results from complete paralysis of these nerve groups, whether the loss is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, DC’s 8510 through 8540. Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia of a peripheral nerve characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. The term incomplete paralysis, with peripheral nerve injuries, 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 should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124. The words “slight,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of terminology such as “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. By history, a VA peripheral nerves DBQ, dated in January 2016, notes that there were no complaints of constant pain, intermittent pain, paresthesias or dysesthesias, or numbness in either lower extremity. Strength was normal in the bilateral lower extremities. Reflexes were normal (2+) in the bilateral lower extremities. A sensory examination was normal (2+) in the bilateral lower extremities. Gait was normal. A lower extremity disorder was not diagnosed. Reports from COWC, dated between April and May of 2016, note that the Veteran’s gait was normal. A VA peripheral nerves DBQ, dated in December 2016, notes complaints of shooting pain and numbness in his right leg. There was no complaint of constant pain, intermittent pain, or paresthesias or dysesthesias in the right lower extremity. The Veteran report moderate numbness in his right lower extremity. On examination, strength of right knee extension and right ankle plantar flexion and dorsiflexion, was normal. Reflexes were normal (2+) at the right knee and ankle. Gait was abnormal due to back pain. The Veteran does not use any assistive devices as a normal mode of locomotion. The examiner characterized the Veteran’s right sciatic nerve as having moderate incomplete paralysis. There was no impact on the Veteran’s ability to work. The diagnosis was neuropathy, right lower extremity. A VA peripheral nerves DBQ, dated in September 2018, notes complaints of moderate constant pain, dysesthesias and/or paresthesias, and numbness, in all four extremities. Strength was normal in the bilateral ankles on planter flexion and dorsiflexion, and on bilateral knee extension. Reflexes were hypoactive (1+) at the bilateral knees and ankles. Sensation was decreased in the bilateral lower extremities. Gait was normal. There was no muscle atrophy. There was moderate incomplete paralysis of the bilateral sciatic nerves. A VA knee and lower leg DBQ, dated in September 2018, shows that the Veteran’s bilateral knee strength was 5/5 on flexion and extension. There was no muscle atrophy. Sensation was normal at the right anterior upper thigh (L2) and decreased at the right thigh/knee (L3/4), at the right lower leg and ankle (L4/L5/S1), and at the right foot and toes (L5). Private treatment reports, dated between October and November of 2018, note radiculopathy, with complaints of moderate to severe pain going down the front and back of the legs to the knees, and foot numbness after 15 minutes of sitting. The Veteran also complained of muscle weakness of his extremities. The findings note normal motor and sensory examinations, and a normal gait. A VA back DBQ, dated in January 2020, notes complaints that include excruciating burning shooting pain in both legs four times a year, lasting one to three days. The Veteran complained of moderate bilateral constant pain in his lower extremities, moderate bilateral paresthesias and/or dysesthesias, and moderate bilateral numbness, but no intermittent pain. On examination, strength of bilateral knee extension, bilateral ankle plantar flexion and dorsiflexion, and bilateral great toe extension, was 4/5. There was no muscle atrophy. Reflexes were absent at the bilateral knees and ankles. Sensation was absent at the bilateral anterior upper thighs (L2) and bilateral thighs/knees (L3/4), absent at the left lower leg and ankle (L4/L5/S1), and decreased at the right lower leg and ankle (L4/L5/S1) and bilateral foot and toes (L5). The examiner characterized the severity of the radiculopathy in each lower extremity as moderate. The Veteran reported losing two to four weeks of work due to his symptoms in the past 12 months. The impact of thoracolumbar spine strain, lumbar disc protrusion and bilateral lower extremity radiculopathy on the Veteran’s ability to work is that he has difficulty with prolonged sitting, prolonged standing, lifting and bending. Right lower extremity. The Board finds that the evidence is sufficient to show that the Veteran’s service-connected peripheral neuropathy of the right lower extremity has been productive of moderate incomplete paralysis of the sciatic nerve since the date of service connection, and that an initial evaluation of 20 percent is warranted as of September 7, 2016. The December 2016 peripheral nerves DBQ shows that the examiner characterized the Veteran’s right lower extremity sciatic nerve impairment as “moderate.” The use of such terminology by VA examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue; all evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. In this case, the examiner’s characterization is consistent with the Veteran’s complaints of moderate numbness in his right lower extremity. Therefore, affording the Veteran the benefit of all doubt, the evidence is at least in equipoise, and the Board finds that the criteria for an initial 20 percent evaluation are met under DC 8520 as of the effective date for service connection, September 7, 2016. To this extent, the claim is granted. An evaluation in excess of 20 percent is not warranted. The evidence is insufficient to show that the Veteran’s peripheral neuropathy of the right lower extremity has been manifested by moderately severe incomplete paralysis of the sciatic nerve, such that a rating in excess of 20 percent is warranted under DC 8520. The Veteran has been shown to have between 4/5 and 5/5 strength in his right lower extremity. There are no findings of muscle atrophy. Deep tendon reflexes are shown to have been between “0” and 2+. No trophic changes were noted. The December 2016, September 2018 and January 2020 VA examiners all characterized the severity of the Veteran’s incomplete paralysis of the sciatic nerve as “moderate.” This most closely corresponds to no more than a 20 percent rating under DC 8520. When the examiners’ characterizations are considered together with all of the findings as to the Veteran’s right lower extremity symptoms, the Board concludes that the criteria for an initial evaluation in excess of 20 percent under DC 8520 have not been met. Left lower extremity. The Board finds that the evidence is sufficient to show that the Veteran’s service-connected radiculopathy of the left lower extremity has been productive of moderate incomplete paralysis of the sciatic nerve since the date of service connection, and that an initial evaluation of 20 percent is therefore warranted as of October 18, 2018. Although the September 2018 VA peripheral nerves DBQ is dated prior to the effective date for service connection, the Board will treat the findings as established as of the date of service connection, which was granted shortly after the September 2018 VA examination was performed. The September 2018 peripheral nerves DBQ shows that the examiner characterized the Veteran’s radiculopathy of his left lower extremity sciatic nerve as “moderate.” Although the use of such terminology by VA examiners is not dispositive of an issue, see 38 C.F.R. §§ 4.2, 4.6, in this case, the examiner’s characterization is sufficiently supported by the associated findings in the DBQ. The September 2018 peripheral nerves DBQ shows that the Veteran reported having moderate constant pain, dysesthesias and/or paresthesias, and numbness, in all four extremities. Reflexes were decreased/hypoactive (1+) at the bilateral knee and ankles. Sensation was decreased in the bilateral lower extremities. Accordingly, affording the Veteran the benefit of all doubt, the evidence is at least in equipoise, and the Board finds that the evidence is sufficient to show moderate incomplete paralysis of the left sciatic nerve. To this extent, the claim is granted. See 38 C.F.R. § 4.124a, DC 8520. An evaluation in excess of 20 percent is not warranted. The evidence is insufficient to show that the Veteran’s radiculopathy of the left lower extremity has been manifested by moderately severe incomplete paralysis of the sciatic nerve, such that a rating in excess of 20 percent is warranted under DC 8520. The Veteran has been shown to have between 4/5 and 5/5 strength in his left lower extremity. There are no findings of muscle atrophy. Deep tendon reflexes are shown to have been between “0” and 1+. The September 2018 and January 2020 VA examiners both characterized the severity of the Veteran’s incomplete paralysis of the sciatic nerve as moderate. This most closely corresponds to no more than a 20 percent rating under DC 8520. When the examiner’s characterizations are considered together with all of the findings as to the Veteran’s left lower extremity symptoms, the Board concludes that the criteria for an initial evaluation in excess of 20 percent under DC 8520 have not been met. Conclusion. For both the right lower extremity and the left lower extremity, the Board concludes that the evidence does not demonstrate that the Veteran’s right lower extremity disability, or left lower extremity disability, is shown to have been manifested by moderately severe incomplete neuritis or neuralgia of the sciatic nerve, such that an initial evaluation in excess of 20 percent is warranted under DCs 8620 or DC 8720. There is no evidence of neuritis or neuralgia in either lower extremity. The Board therefore finds that it is not shown that the Veteran’s service-connected right lower extremity disability, or his left lower extremity disability, has resulted in moderately severe neuritis or neuralgia of the sciatic nerve. A rating in excess of 20 percent for the right lower extremity, or the left lower extremity, is therefore not warranted under DC’s 8620 or 8720. 3. Pseudofolliculitis barbae. With regard to the history of the disability in issue, the Veteran’s service treatment records show that he was diagnosed with pseudofolliculitis barbae. In November 2015, the RO granted service connection for pseudofolliculitis barbae (PFB), evaluated as noncompensable, with an effective date of April 23, 2015. The Veteran asserts that he is entitled to an initial compensable evaluation for his pseudofolliculitis barbae. During his June 2019 hearing, the Veteran asserted that he uses cream twice a day, and oral steroids for his condition since a bad flare-up of his symptoms four years’ before. He said that he only uses the steroid when his condition is “really bad” and that he will take three pills a day for 21 days. His breakouts are a mixture of eczema and pseudofolliculitis. He estimated this happened four to five times a year and that his breakouts involved about 80 percent of his face. He breaks out at time due to exposure to dust and other allergens at his job. He said that his condition was unchanged from 2017. The RO has rated the Veteran’s pseudofolliculitis barbae under Diagnostic Code 7806. Under Diagnostic Code 7806, a noncompensable rating is warranted when less than 5 percent of the entire body or less than 5 percent of exposed areas are affected; and, no more than topical therapy is required during the past 12-month period. A 10 percent rating is warranted when at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas are affected; or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of less than six weeks during the past 12-month period. Id. In Johnson v. McDonald, 27 Vet. App. 497 (2016), the Court of Appeals for Veterans Claims held that topical use of either corticosteroids or other immunosuppressive drugs is considered “systemic” therapy for purposes of rating under DC 7806. Thereafter, the United States Court of Appeals for the Federal Circuit (Federal Circuit) reversed this decision and determined that “constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs” under Diagnostic Code 7806 is generally not inclusive of topical corticosteroids. Johnson v. Shulkin, 862 F.3d 1351, 1352 (Fed. Cir. 2017). The Federal Circuit found that “systemic therapy” meant “treatment pertaining to or affecting the body as a whole,” while topical therapy meant “treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied.” Id. at 1355 (citation omitted). The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole. Id. Thus, in a given case, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances. Following the Federal Circuit’s decision, the Court of Appeals for Veterans Claims again addressed “systemic therapy” in the context of topical treatment in Burton v. Wilkie, 30 Vet. App. 286 (2018). The Burton Court stated that, when considering topical therapy as systemic therapy, the Federal Circuit’s Johnson decision was not limited to situations involving large-scale application of topical treatment. Id. at 291. Rather, the Court held that there are at least 2 other potential ways of showing that a topical treatment is systemic: (1) the method by which the topical treatment works, and (2) its side effects. Id. A VA skin diseases DBQ, dated in October 2015, shows that the Veteran reported a history of pseudofolliculitis barbae on his face since 2006. In response to the question of whether the Veteran’s skin conditions caused scarring (regardless of location), or disfigurement of the head, face or neck, the examiner indicated “no.” The DBQ notes the following: There are no benign or malignant skin neoplasms. He does not have any systemic manifestations due to any skin diseases. He has not been treated with oral or topical medications in the past 12 months for any skin condition. He has not had any treatments or procedures other than systemic or topical medications in the past 12 months for exfoliative dermatitis or papulosquamous disorders. He has not had any debilitating or non-debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis in the past 12 months. On examination, the Veteran did not have dermatitis, eczema, bullous disorder, infections of the skin, cutaneous manifestations of collagen-vascular disease, or papulosquamous disorder, acne, chloracne, vitiligo, alopecia, hyperhidrosis, or benign or malignant neoplasm or metastasis. The Veteran has pseudofolliculitis barbae on his face that covers the area of the beard which is less than five percent of exposed area with no effect on unexposed area. There is no impact on his ability to work. A color photograph of the Veteran is associated with the DBQ. A treatment report, dated in May 4, 2017, shows treatment for a complaint of a two-day history of an itchy facial rash, and that “he has never had this before.” The report notes that he has erythematous, scaly papules to forehead, glabellar area, nose, cheeks, chin, neck, chest, and bilateral upper extremities. This looks like an eczematous process, perhaps due to something he came in contact with at work. He was provided with Prednisone and cream for his face. A June 8, 2017 report shows that the Veteran reported that oral steroids and HC (hydrocortisone) 2.5 percent cream completely cleared his dermatitis. He has no dermatitis of his face, bilateral upper extremities or bilateral lower extremities. He tends to break out and get itchy when he gets overheated, which is often, since he works in a warehouse. He was advised to shower as soon as possible after sweating, using good antibacterial soap. A VA skin diseases DBQ, dated in January 2020, shows that the Veteran reported that he cannot shave, and that he uses Cortisone and Prednisone. He said that he used Prednisone pills for dry skin, with a notation of total duration of use less than six weeks. He gets razor bumps and ingrown hairs on his face. He uses a clipper and goes to a barber once a month. The examiner indicated that he had used 2.5 percent topical Cortisone cream in the past month with a total duration of less than six weeks, with another notation of constant or near-constant use of Cortisone cream. He has not had any treatments or procedures other than systemic or topical medications in the past 12 months for any skin condition. On examination, a few papules were noted on the right and left sides of the face. The Veteran did not have acne, chloracne, vitiligo, scarring alopecia, alopecia areata, hyperhidrosis, chronic urticaria, primary cutaneous vasculitis, erythroderma (exfoliative dermatitis), erythema multiforme, or benign or malignant neoplasm or metastases. There was no scarring (regardless of location), or disfigurement of the head, face or neck. The examiner noted that in 2017, the Veteran had been given Prednisone for 14 days. He was also prescribed HC 2.5 percent cream to use on his face and Clotrimazole 1 percent cream in case it flared again. In follow-up treatment an eczematous process was not noted, therefore a separate diagnosis is not warranted. The examiner determined that the total body area was not affected. Less than five percent of exposed areas were affected. The diagnosis was pseudofolliculitis barbae. There was no impact on his ability to work. The Board finds that an initial compensable rating is not warranted. There is no evidence of record indicating that at least five percent of the Veteran’s body or at least five percent of exposed areas were affected by his service-connected condition. There is no evidence to show that he took intermittent systemic therapy or immunosuppressive drugs for treatment of his skin disorder. In this regard, he received treatment for an that included Prednisone pills, a corticosteroid, for 14 days in 2017. However, his symptoms involved most of his upper body, they resolved within about a month, and the evidence does not indicate that they were related to pseudofolliculitis barbae. To the extent that the Veteran is shown to use Prednisone cream, this appears to be topical medication applied to a particular surface area, i.e., his face. There is no evidence indicating that it pertains to or affect the body as a whole, or that it is a systemic therapy. Johnson. There is no evidence discussing the method by which it works or its side effects to show that it is systemic therapy. Burton. Accordingly, the criteria for an initial compensable rating under DC 7806 are not shown to have been met, the preponderance of the evidence is against the claim, and the claim must be denied. REASONS FOR REMAND During the course of this appeal, the Veteran reasonably raised the issue of entitlement to a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Under the circumstances, the time period in issue begins with the filing of his claims for service connection for a back disability and a skin disability in September 2015. See 38 C.F.R. § 3.400. Service connection is currently in effect for: dysthymic disorder, evaluated as 70 percent disabling, obstructive sleep apnea, evaluated as 50 percent disabling, thoracolumbar spine strain, evaluated as 40 percent disabling, allergic rhinitis with polyps, evaluated as 30 percent disabling, cervical strain, evaluated as 20 percent disabling, radiculopathy of the right upper extremity, evaluated as 20 percent disabling, radiculopathy of the left upper extremity, evaluated as 20 percent disabling, peripheral neuropathy of the left lower extremity, evaluated as 20 percent disabling, peripheral neuropathy of the right lower extremity, evaluated as 20 percent disabling, tinnitus, evaluated as 10 percent disabling, right hip bursitis, evaluated as 10 percent disabling, right knee meniscus arthroscopy, evaluated as 10 percent disabling, and right hip bursitis with loss of flexion, pseudofolliculitis barbae, and residual right knee scar, all evaluated as noncompensable. As of December 8, 2015, the Veteran’s combined evaluation is 70 percent; as of June 7, 2016, it was increased to 100 percent. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (a TDIU issue is moot where a 100 percent schedular rating is in effect). The Board’s instant decision will require a recalculation of his combined rating on remand, to determine the relevant time period in issue. Id. A VA unemployability statement is associated with the January 2020 back DBQ, which shows that it was determined that it is at least as likely as not that the Veteran is able to perform sedentary work due to his service-connected back disability. In June 2020, the Veteran submitted a job description for senior supply technician. At that time the Veteran also submitted a leave report from his job covering the period from December 2015 to August 2016, and a statement from his supervisor. Accordingly, the claim for a TDIU prior to June 7, 2018 should be adjudicated. The matters are REMANDED for the following action: Adjudicate the issue of a TDIU prior to June 7, 2018. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S.E., 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.