Citation Nr: 21007307 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-35 577A DATE: February 9, 2021 ORDER Entitlement to an initial rating of 20 percent, and no higher, for lumbosacral strain with degenerative arthritis and spinal stenosis is granted from August 24, 2015. Entitlement to initial ratings for lumbosacral strain with degenerative arthritis and spinal stenosis in excess of 10 percent prior to August 24, 2015, and in excess of 20 percent from that date, is denied. Entitlement to initial ratings for radiculopathy of the left lower extremity in excess of 10 percent prior to August 1, 2016, and in excess of 20 percent from that date, is denied. FINDINGS OF FACT 1. During the relevant period prior to August 24, 2015, the Veteran’s service-connected lumbar spine disability was not manifested by forward flexion limited to 60 degrees or less; a combined range of motion of 120 degrees or less; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour; ankylosis; or incapacitating episodes having a total duration of at least 2 weeks during a 12-month period. 2. During the period beginning August 24, 2015, the Veteran’s service-connected lumbar spine disability was manifested by pain severe enough to result in an abnormal gait, or by forward flexion greater than 30 degrees but not greater than 60 degrees, but was not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less, ankylosis of the thoracolumbar spine, or incapacitating episodes having a total duration of at least 4 weeks during a 12-month period. 3. During the relevant period prior to August 1, 2016, the Veteran’s radiculopathy of the left lower extremity was manifested by no worse than mild incomplete paralysis of the sciatic nerve. 4. During the period beginning August 1, 2016, the Veteran’s radiculopathy of the left lower extremity was manifested by no worse than moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating of 20 percent, and no higher, for lumbosacral strain with degenerative arthritis and spinal stenosis have been met from August 24, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5010-5243. 2. The criteria for entitlement to initial ratings in excess of 10 percent prior to August 24, 2015, and in excess of at 20 percent from that date for lumbosacral strain with degenerative arthritis and spinal stenosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5010-5243. 3. The criteria for entitlement to increased initial ratings for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.124a, Diagnostic Code 8520.   REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1979 to August 1981. In May 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. The Board remanded these issues in October 2019 with instructions to the Agency of Original Jurisdiction to afford the Veteran a VA examination to assess the current nature and severity of his lumbosacral strain with degenerative arthritis and spinal stenosis and his radiculopathy of the left lower extremity. The Veteran was provided with such an examination in January 2020. That examination is responsive to the October 2019 remand directives and provides the information required to render a decision on the issues on appeal. Accordingly, the Board finds that VA at least substantially complied with the October 2019 remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). A June 2017 rating decision granted the Veteran entitlement to a total disability rating based on individual unemployability (TDIU) from May 19, 2014. The period relevant to the increased rating issues on appeal is from May 19, 2014, through the present. Thus, the Veteran has been in receipt of a TDIU throughout the period relevant to the increased rating issues on appeal, and the issue of entitlement to a TDIU is not before the Board as part of those issues. See Rice v. Shinseki, 22 Vet. App. 447 (2009); Harper v. Wilkie, 30 Vet. App. 356 (2018). At the May 2019 Board hearing, the Veteran’s representative stated that the examiners who conducted the VA examinations prior to the Board hearing are “kind of notorious, in my circles, for underrating the veterans, and in this case, we think that he was underrated back then”, and that he felt the previous examinations did not fully reflect the severity of the disabilities at the time. However, neither the Veteran nor his representative has identified any particular misconduct by the VA examiners or any particular error in the VA examination reports of record. The Board has reviewed those examination reports, and finds no error in the conduct or recording of the examinations. As such, the Board finds no reason to discount or disregard the VA examinations in deciding the issues on appeal and concludes that VA has satisfied its duty to assist in providing the Veteran examinations. The Veteran and his representative have not raised any other issues with regard to the duty to notify or duty to assist as they pertain to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Increased Rating 1. Entitlement to increased initial ratings for lumbosacral strain with degenerative arthritis and spinal stenosis The Veteran seeks higher initial ratings for lumbosacral strain with degenerative arthritis and spinal stenosis. The applicable rating period is from May 19, 2014, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran’s lumbosacral strain with degenerative arthritis and spinal stenosis is currently rated at 10 percent prior to May 16, 2016, and at 20 percent from that date under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5243. A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional diagnostic code is shown after the hyphen. In this case, the Veteran’s service-connected lumbar spine disability is rated under Diagnostic Code 5010, which pertains to traumatic arthritis, with reference to Diagnostic Code 5243, which pertains to intervertebral disc syndrome (IVDS). Under Diagnostic Code 5010, traumatic arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Under Diagnostic Code 5243, IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine (General Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Under the General Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board concludes that the record supports a finding that a rating of 20 percent was warranted from August 24, 2015, the date on which the Veteran was first noted to have an antalgic gait due to pain from the service-connected lumbar spine disability. However, the preponderance of the evidence is against a rating in excess of 10 percent prior to August 24, 2015, or in excess of 20 percent from that date. For the period prior to August 24, 2015, the medical treatment records show that the Veteran walked with a steady, balanced gait in September 2014. At a January 2015 neurosurgery consultation, the Veteran reported progressively worsening back pain, but he had a normal gait. In May 2015, he had pain on palpation of the lumbar spine, but did not have bowel or bladder incontinence or saddle anesthesia. The medical treatment records do not show that the Veteran had incapacitating episodes, as defined in Note 1 for Diagnostic Code 5243, during the period prior to August 24, 2015. At a November 2015 VA examination, which is the earliest VA examination relevant to the appeal for higher initial ratings for the service-connected lumbar spine disability, the Veteran reported that his back hurts all of the time and that his pain symptoms are exacerbated when he makes the wrong movement. On examination, he had forward flexion to 80 degrees and a combined range of motion of 205 degrees. He had no additional loss of function or range of motion following repetitive-use testing. There was no evidence of pain on weight-bearing. The examiner opined that on repetitive use over time the Veteran’s lumbar spine forward flexion would decrease to 70 degrees and his combined range of motion would decrease to 170 degrees, but that the Veteran’s functional ability would not be significantly limited with flareups. The Veteran did not have ankylosis of the thoracolumbar spine. He also did not have guarding or muscle spasm of the thoracolumbar spine. The examiner indicated that the Veteran has IVDS, but that he did not have any episodes in the prior 12 months of acute signs and symptoms due to the IVDS that required bed rest prescribed by a physician. In view of the foregoing, the Board concludes that, during the period prior to August 24, 2015, the Veteran’s service-connected lumbar spine disability did not warrant an initial rating in excess of 10 percent because it was not manifested by forward flexion of 60 degrees or less; a combined range of motion of 120 degrees or less; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour; ankylosis; or incapacitating episodes having a total duration of at least 2 weeks during a 12-month period. The medical treatment records show that on August 24, 2015, the Veteran presented for a physical medicine and rehabilitation consultation with complaints of low back pain that can reach 10 out of 10 in severity. On examination, he did not have tenderness or effusion and his reflexes were normal, but his motor strength was limited, and his gait was markedly antalgic due to low back pain. He again had a markedly antalgic gait in November 2015. Affording the Veteran the benefit of the doubt, the Board finds that his markedly antalgic gait due to low back pain on August 24, 2015, is equivalent to muscle spasm or guarding severe enough to result in an abnormal gait such that a 20 percent initial rating was warranted under the General Formula from that date. Regarding entitlement to an initial rating in excess of 20 percent from August 24, 2015, the medical treatment records show that the Veteran had lumbar spine forward flexion to 70 degrees in February 2016. His lumbar spine range of motion was noted to be “normal throughout” in November 2016, March 2017, and May 2017. At a May 2016 VA examination, the Veteran reported that his back prevents him from lifting heavy objects and from walking, bending, or standing for prolonged periods. On examination, he had forward flexion to 60 degrees and had no additional loss of function or range of motion following repetitive-use testing. The examiner opined that on repetitive use over time and during flareups, the Veteran’s lumbar spine forward flexion would decrease to 55 degrees. The Veteran did not have ankylosis of the thoracolumbar spine. The examiner indicated that the Veteran did not have IVDS. At a December 2016 VA examination, the Veteran reported that he has spasms, cannot walk very far, cannot go up ladders, and cannot carry more than 10 pounds due to his service-connected lumbar spine disability. On examination, he had forward flexion to 65 degrees and had no additional loss of function or range of motion following repetitive-use testing. The examiner declined to provide an opinion as to whether the Veteran would have additional functional loss over a period of time or during a flareup because he would need to be present on such occasions to objectively measure any change from baseline functioning. The Veteran did not have ankylosis of the thoracolumbar spine. The examiner indicated that the Veteran has IVDS, but that he did not have any episodes of acute signs and symptoms due to the IVDS in the prior 12 months that required bed rest prescribed by a physician. At the January 2020 VA examination, the Veteran reported that he has constant pain and stiffness due to his service-connected lumbar spine disability. His symptoms wax and wane with repetitive use, prolonged weightbearing activities, and environmental weather changes. He did not report flareups. On examination, he had forward flexion to 35 degrees and had no additional loss of function or range of motion following repetitive-use testing. The examiner considered the Veteran’s complete history and current subjective complaints along with the available records and found no basis to conclude the Veteran would have additional functional loss or loss of motion upon repetitive use over time. The Veteran did not have ankylosis of the thoracolumbar spine. The examiner indicated that the Veteran has IVDS, but that he did not have any episodes of acute signs and symptoms due to the IVDS in the prior 12 months that required bed rest prescribed by a physician. In view of the foregoing, the Board concludes that, during the period beginning August 24, 2015, the Veteran’s service-connected lumbar spine disability did not warrant an initial rating in excess of 20 percent because it was not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less, ankylosis of the thoracolumbar spine, or incapacitating episodes having a total duration of at least 4 weeks during a 12-month period. The Board notes that the January 2020 VA examination report does not include passive range-of-motion measurements and does not specify range of motion with and without weight-bearing. See Correia v. McDonald, 28 Vet. App. 158 (2016). The fundamental issue in view of Correia is that VA examinations must include adequate joint testing for pain. Generally, active range-of-motion testing produces more restrictive results than passive range-of-motion testing because passive range-of-motion testing requires the physician to force the joint through its motions, including past the point where the Veteran could move on his own. There is also no indication that range-of-motion testing was performed other than on weight-bearing, which is generally more restricted than nonweight-bearing. Therefore, there is no prejudice to the Veteran in relying on a VA examination that involved testing of active range of motion on weight-bearing because such results tend to produce the most severe scenario for impairment and thus would support the highest possible rating. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain and loss of motion. However, in view of the medical evidence summarized above, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran’s description of how frequent and severe the flareups are would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine of 30 degrees or less or in ankylosis of the thoracolumbar spine. Regarding neurological impairment, the Veteran has already been granted service connection for radiculopathy of the right and left lower extremities and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his service-connected lumbar spine disability. In that regard, the Veteran testified at the May 2019 Board hearing that he has had urinary incontinence, bowel incontinence, and sexual dysfunction due to his service-connected lumbar spine disability. The January 2020 VA examiner was asked to provide an opinion as to whether the Veteran has bladder or bowel dysfunction or sexual dysfunction that may be considered a neurologic abnormality of the service-connected lumbar spine disability. The January 2020 VA examiner explained that the Veteran does not have bowel or bladder incontinence because, according to the Veteran’s own explanation, although he has urinary dribbling after urination, he is able to control his bladder and rectal functioning and does not require the use of a diaper due to fecal or urinary incontinence. The examiner also explained that the Veteran has penile sensation and cutaneous sensation, which the Board interprets as meaning that the Veteran does not have erectile dysfunction as a neurologic abnormality associated with the service-connected lumbar spine disability. The Board finds the examiner’s statements to be probative in indicating that the Veteran does not have neurologic abnormalities of bowel or bladder impairment or sexual dysfunction that are ratable as part of the service-connected lumbar spine disability. The examiner provided the statements based on the Veteran’s reported medical history and current symptoms and on examination of the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). The Veteran’s assertions that he has such neurologic abnormalities are not probative and do not weigh against the examiner’s statements because he has not been shown to be competent to render such medical judgments. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board observes that the January 2020 VA examiner explained that the Veteran’s erectile dysfunction may be caused by opiates and other depressive medications that the Veteran takes to treat pain, including the pain from his service-connected lumbar spine disability. Such statements raise the possibility that the Veteran’s erectile dysfunction may be secondary to his service-connected lumbar spine disability. However, the issue of entitlement to service connection for erectile dysfunction on a secondary basis, to include as due to medications taken for the service-connected lumbar spine, is beyond the scope of the issue on appeal and may not be considered in this decision. The Board acknowledges that the Veteran has submitted a Back Conditions Disability Benefits Questionnaire (DBQ) and a Peripheral Nerves Conditions DBQ that are each dated in May 2019, along with a June 2019 statement from the physician who conducted those examinations. However, the Board cannot accept the May 2019 DBQs or the June 2019 statement as accurate representations of the nature and severity of the Veteran’s service-connected lumbar spine disability and radiculopathy of the left lower extremity due to inconsistencies within those documents and due to the physician’s apparent advocacy on behalf of the Veteran, as he argues that the Veteran is entitled to specific percentage ratings under the Schedule. For example, the physician indicates in the Back Conditions DBQ that the Veteran had incapacitating episodes due to intervertebral disc syndrome for at least 1 week but less than 2 weeks in the prior 12 months. However, in his statement the physician says that the Veteran has incapacitating episodes on an average of 1 per week, then argues that the Veteran should be given a 60 percent rating based on such findings. Similarly, in the Peripheral Nerves Conditions DBQ, the physician assesses the Veteran’s left lower extremity radicular symptoms as no worse than moderate in severity and describes the condition overall as mild, but then in his statement opines that the radiculopathy of the left lower extremity “is moderately severe and entitled to a 40% rating”. The Back Conditions DBQ indicates that the Veteran had reduced strength of 4 out of 5 throughout the left lower extremity, but the Peripheral Nerves Conditions DBQ indicates that the Veteran had full strength of 5 out of 5 in the left lower extremity on knee extension, ankle plantar flexion, and ankle dorsiflexion. The Board further notes that the Back Conditions DBQ is also inadequate for decision-making purposes because it expresses the Veteran’s range-of-motion measurements as percentages of loss rather than in terms of degrees, as required under the relevant diagnostic code. See 38 C.F.R. § 4.71a, Diagnostic Code 5010-5243. Because of those inadequacies, the Board will not consider the DBQs and the statement in determining the appropriate rating for the Veteran’s service-connected lumbar spine disability and radiculopathy of the left lower extremity. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected lumbar spine disability, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). In summary, the Board finds that the criteria for entitlement to an initial rating of 20 percent, and no higher, were met from August 24, 2015. However, the criteria for entitlement to initial ratings in excess of 10 percent prior to August 24, 2015, and in excess of 20 percent from that date have not been met. To the extent the Veteran seeks initial ratings higher than those assigned previously and assigned in this decision, the preponderance of the evidence is against the appeal, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to increased initial ratings for radiculopathy of the left lower extremity The Veteran seeks higher initial ratings for radiculopathy of the left lower extremity. The applicable rating period is from November 2, 2015, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. The Veteran’s radiculopathy of the left lower extremity is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520, which pertains to paralysis of the sciatic nerve. Under those 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 dangles and drops, 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. 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 Veteran’s medical treatment records reflect that he has reported radiating pain in his left lower extremity. The medical treatment records do not otherwise include descriptions from medical sources of the relative severity of the Veteran’s sciatic nerve radiculopathy of the left lower extremity and do not reflect that the Veteran has experienced the sort of symptoms indicative of complete paralysis of the sciatic nerve, as described under Diagnostic Code 8520. Relevant to the period prior to August 1, 2016, at the November 2015 VA examination, the Veteran had full 5 out of 5 muscle strength, normal reflexes, and normal sensation in the left lower extremity. He reported mild constant and intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness in the left lower extremity. The examiner indicated that the Veteran’s left sciatic nerve radiculopathy was mild overall. At the May 2016 VA examination, the Veteran had full 5 out of 5 muscle strength, normal reflexes, and normal sensation in the left upper thigh, thigh, knee, and lower leg/ankle, but decreased sensation in the left foot/toes. He reported mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the left lower extremity. The examiner indicated that the Veteran’s left sciatic nerve radiculopathy was mild overall. Based on the evidence of record, the Board finds that the criteria for an initial rating in excess of 10 percent for radiculopathy of the left lower extremity prior to August 1, 2016, have not been met. The medical treatment records show that the Veteran reported radiating pain. The VA examination reports show that the Veteran had mild to moderate pain, paresthesias and/or dysesthesias, and numbness, but he had full strength and normal reflexes in the left lower extremity. Although the Veteran reported up to moderate symptoms, the VA examiners both opined that the Veteran’s radiculopathy was no worse than mild in severity on the left. The examiners’ use of the term “mild” is not dispositive of the issue. However, the Board finds that use to be persuasive in view of the other evidence of record regarding the Veteran’s pain and sensory deficits, and concludes that the Veteran’s sciatic nerve radiculopathy of the left lower extremity was most appropriately characterized as no worse than mild in severity during the period prior to August 1, 2016, such that an initial rating in excess of 10 percent was not warranted. Relevant to the period beginning August 1, 2016, at the December 2016 VA back conditions examination, the Veteran had 4 out of 5 muscle strength and hypoactive or absent reflexes, but normal sensation in the left lower extremity. He reported severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left lower extremity. The examiner indicated that the Veteran’s left sciatic nerve radiculopathy was moderate overall. In a separate peripheral nerves conditions DBQ, the December 2016 VA examiner indicated that the Veteran’s radiculopathy of the left lower extremity is comparable to moderate incomplete paralysis. At the January 2020 VA examination, the Veteran had full 5 out of 5 muscle strength, normal knee reflexes, and normal sensation in the left lower extremity, but absent reflexes at the left ankle. He reported moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left lower extremity. The examiner indicated that the Veteran’s left sciatic nerve radiculopathy was moderate overall. Based on the evidence of record, the Board finds that the criteria for an initial rating in excess of 20 percent for radiculopathy of the left lower extremity during the period beginning August 1, 2016, have not been met. The medical treatment records show that the Veteran reported radiating pain. The VA examination reports show that the Veteran reported mild to severe pain, paresthesias and/or dysesthesias, and numbness, and he had decreased muscle strength and sensation and decreased or absent reflexes in the left lower extremity. Although the Veteran reported up to severe symptoms, the VA examiners both opined that the Veteran’s radiculopathy was no worse than moderate in severity on the left. The examiners’ use of the term “moderate” is not dispositive of the issue. However, the Board finds that use to be persuasive in view of the other evidence of record regarding the Veteran’s pain and sensory deficits, and concludes that the Veteran’s sciatic nerve radiculopathy of the left lower extremity was most appropriately characterized as no more than mild in severity during the period beginning to August 1, 2016, such that an initial rating in excess of 20 percent was not warranted. The Board again acknowledges the May 2019 DBQs and the June 2019 medical statement submitted by the Veteran, but finds them to be unreliable indicators of the severity of the Veteran’s radiculopathy of the left lower extremity due to inconsistencies within those documents and due to the physician’s apparent advocacy on behalf of the Veteran. Because of those inadequacies, the Board will not consider the DBQs and the statement in determining the appropriate rating for the Veteran’s service-connected radiculopathy of the left lower extremity. Neither the Veteran nor his representative has raised any other issues with regard to the ratings for the service-connected radiculopathy of the left lower extremity, nor have any other such issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. The Board therefore finds that the criteria for entitlement to initial ratings for radiculopathy of the left lower extremity in excess of 10 percent prior to August 1, 2016, and in excess of 20 percent from that date have not been met. As the preponderance of the evidence is against the assignment of higher initial ratings, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. 49.. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.