Citation Nr: 21007811 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 11-10 453 DATE: February 10, 2021 ORDER Entitlement to an initial compensable rating for neurodermatitis is denied. Entitlement to a rating in excess of 10 percent for prior to March 1, 2011, in excess of 20 percent from March 1, 2011 to February 5, 2015, and in excess of 40 percent beginning February 5, 2015 for L4-L5 and L5-S1 posterior spondylosis and left paracentral herniated nucleus pulposus and degenerative disc disease, hereinafter “lumbar spine disorder” is denied. Entitlement to a rating in excess of 10 percent prior to March 1, 2011, and in excess of 20 percent thereafter, for C5-C6, C6-C7 posterior spondylosis, cervical disc protrusion and degenerative disc disease, hereinafter “cervical spine disorder,” is denied. FINDINGS OF FACT 1. The Veteran’s neurodermatitis affects less than five percent of the entire body and less than five percent of exposed areas and has not involved treatment from corticosteroids or other immunosuppressive drugs approximating systemic therapy. 2. For the appeal period prior to March 1, 2011, the Veteran’s lumbar spine disorder was manifested by, at worst, forward flexion of the thoracolumbar spine to 70 degrees with a combined range of motion of 202 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, intervertebral disc syndrome (IVDS) requiring medically prescribed bedrest, associated objective neurological abnormalities other than right lower extremity radiculopathy or ankylosis. 3. For the appeal period from March 1, 2011 to February 5, 2015, the Veteran’s lumbar spine disorder was manifested by, at worst, forward flexion of the thoracolumbar spine to 40 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without IVDS requiring medically prescribed bedrest, associated objective neurological abnormalities other than right lower extremity radiculopathy or ankylosis. 4. For the appeal period beginning on February 5, 2015, the Veteran’s lumbar spine disorder did not manifest in ankylosis. 5. For the appeal period prior to March 1, 2011, the Veteran’s cervical spine disorder was manifested by, at worst, forward flexion of the cervical spine to 35 degrees and a combined range of motion of 210 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, IVDS requiring medically prescribed bedrest, associated objective neurological abnormalities or ankylosis of the spine. 6. For the appeal period beginning March 1, 2011, the Veteran’s cervical spine disorder was manifested by, at worst, forward flexion of the cervical spine to 30 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis of the spine. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial compensable rating for neurodermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.118, Diagnostic Code 7806. 2. The criteria for a rating in excess of 10 percent for prior to March 1, 2011, in excess of 20 percent from March 1, 2011 to February 5, 2015, and in excess of 40 percent beginning February 5, 2015, for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5242. 3. The criteria for a rating in excess of 10 percent for prior to March 1, 2011, in excess of 20 percent thereafter, for a cervical spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1974 to September 1976, July 1980 to June 1986, and February 2003 to July 2004, to include service in Southwest Asia. These matters come to the Board of Veterans’ Appeals (Board) on appeal from March 2009 and September 2009 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) San Juan, Puerto Rico. Jurisdiction of this appeal is currently with the RO in San Juan, Puerto Rico. This case was most recently before the Board in February 2018, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Increased Rating Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 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. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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 concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran’s case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claims. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). 1. Neurodermatitis The Veteran asserts that he is entitled to a higher initial rating for his neurodermatitis as his symptoms are more severe than contemplated by the currently assigned rating. In that regard, in a November 2016 VA Form 21-4138 Statement in Support of Claim, the Veteran asserted that he itches all over his body, to include his nostrils. The Veteran’s neurodermatitis is currently rated as noncompensable under 38 C.F.R. § 4.118, Diagnostic Code 7806. The applicable rating criteria for skin disorders, found at 38 C.F.R. § 4.118, were amended effective August 13, 2008. See 83 Fed. Reg. 32,592 (July 13, 2018). “VA’s intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied.” 83 Fed. Reg. 32,592 (July 13, 2018). Under the new criteria, a note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, “systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.” Diagnostic Code 7806 continues to apply to dermatitis or eczema, but is rated under the general rating formula for the skin. Under the new criteria, a 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least five percent, but less than 20 percent, of the entire body affected; or at least five percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted where at least one of the following is present: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Under the former criteria, a 10 percent rating is warranted for at least five percent, but less than 20 percent, of the entire body, or at least five percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating applies where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating applies where more than 40 percent of the entire body or more than 40 percent of exposed areas are affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs is required during the past 12-month period. With regard to the meaning of “systemic therapy” prior to the new definition of the term in the revised criteria, the Court in Johnson v. McDonald, 27 Vet. App. 497, 505 (2016) held that use of a topical steroid constituted “systemic therapy” within the meaning of Diagnostic Code 7806. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the 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. The Federal Circuit found that “systemic therapy” means “treatment pertaining to or affecting the body as a whole,” whereas topical therapy means “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.” Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. 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, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, 30 Vet. App. 286 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects. The Veteran’s claim in this case was pending prior to the August 13, 2018 effective date of the new criteria, and therefore the Board will consider both the old and new criteria and apply the more favorable. However, the Federal Circuit’s interpretation of the term “systemic therapy” in the old criteria applies throughout the entire period prior to the August 13, 2018 effective date of the new criteria. Rivers v. Roadway Express, 511 U.S. 298, 312-13 (1994) (“[j]udicial construction of a statute [or regulation] is an authoritative statement of what the statute [or regulation] meant before as well as after the decision of the case giving rise to that construction”); Jordan v. Nicholson, 401 F.3d 1296, 1298-99 (Fed. Cir. 2005) (a new interpretation of a statute retroactively affects decisions still open on direct review); Threatt v. McDonald, 28 Vet. App. 56, 63 (2016) (noting the “normal principle at this Court that judicial decisions operate retrospectively”). Turning to the evidence of record, at a March 2011 VA examination, the Veteran reported he continued to experience itching that resulted in difficulty with sleeping and without skin rash. He reported the condition was constant. There was no skin rash and no systemic symptoms shown. Upon physical examination, the examiner found less than five percent of the total body area was affected. There were no skin rash or other skin lesions seen on examination. The examiner diagnosed neurodermatitis. At a December 2018 VA examination, the Veteran reported current symptoms included skin itching on face, body, and extremities; and that he treated with a topical steroid, antihistamines, and antifungals. He reported the itching was intense and intermittent, and not related to a visible skin manifestation (rash). He treated with several topical steroids, antihistamines, and antifungals with varying degrees of improvement; and reported the condition had not resolved, and interfered with sleep due to itching. In the past twelve months, the Veteran had been treated with constant or near-constant topical hydrocortisone for his neurodermatitis; and had used oral antihistamines for six weeks or more, but not constant. He also used topical Ketoconazole for six weeks or more, but not constant. He did not have any treatments or procedures other than systemic or topical medications in the past twelve months for any skin condition. Upon physical examination, the examiner found there was none of the total body nor exposed body area affected by the Veteran’s neurodermatitis. There were no visible lesions on examination, and the Veteran was asymptomatic. The skin condition did not cause scarring, or disfigurement of the head, face, or neck. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner noted the Veteran’s neurodermatitis did not impact his ability to work. Additionally, the examiner noted the Veteran’s skin condition was “mild.” A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his neurodermatitis. A review of the treatment notes of record does not show the Veteran to have symptoms of a skin disability worse than those reported at the VA examinations of record. The Board finds that the Veteran is not entitled to an initial compensable rating for his neurodermatitis throughout the period on appeal. In this regard, the Board notes that while the Veteran was prescribed topical antifungal cream, oral antihistamines, and other topical cream for treatment of his skin disorder, there is no evidence that his treatment resulted in “systemic therapy” to support a compensable rating. Although the use of the topical corticosteroid was used “constant or near-constant,” it was applied to less than five percent of his entire body. This more closely approximates “topical therapy” as the corticosteroid used pertains to a certain area of the Veteran’s skin and affects only the area to which it is applied. Such treatment has not been administered on a large enough scale such that it affected the Veteran’s body as a whole. As noted above the affected area is less than five percent of exposed skin and less than five percent of the entire body. Accordingly, an initial compensable rating is not warranted for dermatitis under the old or new criteria pertaining to the skin. The Veteran’s belief that he is entitled to a higher initial rating for his neurodermatitis 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 report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. Ultimately, on objective examination, his dermatitis was shown to affect less than five percent of his total body, less than five percent of the total exposed area, and did not require the use of “systemic therapy.” Moreover, to the extent that the Veteran alleges that he is entitled to a higher rating due to constant itching that affects his ability to sleep, the Board notes that such symptoms are contemplated under the current rating. The Board has also considered whether a staged rating under Hart, supra, is appropriate for the Veteran’s service-connected neurodermatitis; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning a staged rating for such disability is not warranted. Further, the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Additionally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran is currently in receipt of a TDIU as of October 9, 2015, based on the combined effects of all of his service connected disabilities. The Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment prior to October 9, 2015 due solely to his service connected neurodermatitis. As such, a Rice claim is not raised. Accordingly, the Board finds that a preponderance of the evidence is against an initial compensable rating for neurodermatitis, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Lumbar Spine and Cervical Disorders The Veteran asserts that his lumbar spine and cervical spine disorders are more severe than currently contemplated by the current rating assigned. In that regard, the Veteran reports that his back and neck pain radiate into his extremities, resulting in limited range of motion in his upper extremities, numbness and cramps in his hands, and lower extremities and with a diagnosis of carpal tunnel syndrome. See VA Form 21-4138 Statement in Support of Claim, November 21, 2006 The Veteran’s lumbar spine and cervical spine disorders are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: a 10 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted when forward flexion of the cervical spine is 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or, 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 schedular maximum 100 percent rating is warranted for unfavorable ankylosis of the entire spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are 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 cervical spine is 340 degrees and 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. See Note (2); see also Plate V. A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Although pain may cause functional loss, pain itself does not constitute functional loss. 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. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). Turning to the evidence of record, at a December 2008 VA examination, the Veteran reported low back and neck pain that was treated with oral pain medication. Side effects from his pain medication included decreased sleep and poor memory. Other symptoms included fatigue, decreased motion, stiffness, weakness, spasm and pain in the neck and low back that described as severe, sharp, burning, constant, and occurring daily. Symptoms were further reported to include radiation of pain to arms and shoulder blades, and pain and numbness in the arms and legs. The Veteran denied flare-ups of the spinal conditions. There were no incapacitating episodes of his spine. He denied the use of devices or aids. The Veteran was unable to walk more than a few yards. His posture was normal, his head position was normal, his gait was normal, and he had symmetry in appearance. He did not have cervical nor thoracolumbar spine ankylosis. Range of motion of the cervical spine was as follows: flexion was to 35 degrees; extension was to 25 degrees; left lateral flexion was to 35 degrees; left lateral rotation was to 45 degrees; right lateral flexion was to 25 degrees; and right lateral rotation was to 45 degrees. Range of motion of the thoracolumbar spine was as follows: forward flexion was to 70 degrees; extension was to 12 degrees; bilateral lateral flexion and bilateral lateral rotation were to 30 degrees each. There was objective evidence of pain on active range of motion. There was objective evidence of pain following repetitive motion; and there was no additional limitations after three repetitions of range of motion. During the December 2008 VA examination, the Veteran reported he had difficulty walking and climbing stairs due to his low back. He was employed full time; and reported he had lost six weeks of work during the last twelve month period due to his neck and low back pain. The examiner noted the Veteran’s neck and low back impacted his ability to work due to being assigned different duties, increased absenteeism, memory loss, decreased concentration, poor social interactions, decreased mobility, problems with lifting and carrying, difficulty reaching, lack of stamina, weakness or fatigue, decreased strength in the upper and lower extremities, and pain. Additionally, effects on usually daily activities were as follows: prevents chores, sports and traveling, severe shopping, moderate exercise, recreation, bathing, and toileting, and mild dressing. A November 2010 VA treatment record indicates the Veteran reported back pain that was described as a six out of ten pain intensity, radiated and had tenderness. He had an unassisted adequate gait, without spasms, and was unable to sit for prolonged periods. At a March 1, 2011 VA examination, the Veteran reported his symptoms had progressively worsened, treated with medicine, occupational and physical therapy, and a TENS unit and did not have side effects of his treatment. The Veteran reported flare-ups of his cervical pain that was described as moderate, occurring every two to three weeks and lasting hours in duration. He also reported that it was exacerbated by overhead activities and alleviated with medication. There was a history of decreased motion, stiffness, spasm, pain that radiated into the upper extremities, and stabbing and moderate pain lasting hours in duration and occurring daily. He also reported flare-ups of his lumbar pain that was described as stabbing and moderate pain lasting hours in duration and occurring daily, and radiation of shock like pain into the lumbar area. He did not have incapacitating episodes of spinal disease. He used a cane as an assistive device or aid, and was able to walk one quarter of a mile. Upon physical examination, his posture was normal, head position was normal and had symmetry in appearance and had a normal gait. He had lumbar flattening, reverse lordosis, list, and did not have ankylosis of the cervical or thoracolumbar spine. Objective abnormalities of the cervical spine included bilateral spasm, bilateral guarding, pain with motion to both sides and bilateral tenderness. Objective abnormalities of the thoracolumbar spine included bilateral spasm, bilateral guarding, pain with motion to both sides and bilateral tenderness. Range of motion of the cervical spine was as follows: flexion to 35 degrees; extension to 25 degrees; left lateral flexion to 20 degrees; left lateral rotation to 20 degrees; right lateral flexion to 15 degrees; and right lateral rotation to 25 degrees. Range of motion of the thoracolumbar spine was as follows: forward flexion to 40 degrees; extension, bilateral lateral flexion, and bilateral lateral rotation were to 20 degrees each. There was objective evidence of pain on active range of motion. There was objective evidence of pain following repetitive motion; and there was no additional limitations after three repetitions of range of motion. The March 2011 VA examiner diagnosed cervical strain, lumbar spine, degenerative spondylotic changes of the cervical spine, muscle spasm, and lumbar and cervical spondylosis. At a February 2015 VA examination for the thoracolumbar spine, the Veteran reported he had low back pain that radiated to his right leg, and stabbing pain. The examiner diagnosed degenerative arthritis of the lumbar spine with a herniated disc, and clinical right lower extremity radiculopathy. He reported constant pain, regardless of medications, and stated his pain was a nine out of ten pain intensity. He had limited weight-bearing and felt better sitting. He had to sleep on his left side. The Veteran claimed limitation in dressing his lower extremities. He denied flare-ups, and said his pain was always the same. The Veteran did not report having functional loss or functional impairment of the thoracolumbar spine, regardless of repetitive use. Upon physical examination, range of motion was as follows: forward flexion to 30 degrees; extension to 5 degrees; right lateral flexion to 10 degrees; left lateral flexion to 15 degrees; and bilateral lateral rotation to 5 degrees each. Range of motion itself contributed to a functional loss due to pain. There was evidence of pain with weight-bearing. The Veteran had localized tenderness or pain on palpation of the joints and/or soft tissue of the thoracolumbar spine. He was not able to perform repetitive use testing with at least three repetitions due to severe pain. The Veteran was not examined immediately after repetitive use over time or during a flare-up; and the examination neither supported nr contradicted his statements describing a functional loss with repetitive use over time or during a flare-up. The examiner could not state without resorting to mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time or during a flare-up. With regard to flare-ups, the examiner noted that all musculoskeletal disorders present in an individual could potentially cause functional limitations during repetitive-use over a period of time or during flare-ups; and noted that if pain, weakness, fatigability or incoordination were present, it could significantly limit functional ability during a flare-up. An adequate response was not feasible because the evaluation must be done during the present of a flare-up in order to objectively compare baseline to flare-ups limitations, and providing data of a functional loss related to a possible future event such as a flare-up would be mere speculation. The February 2015 VA examiner noted that the Veteran had muscle spasm and guarding that resulted in increased muscle tone of the bilateral lumbar paravertebral muscles and resulted in a stooped posture. Additional factors contributing to the dix included disturbance of locomotion and antalgic slow propulsion. Muscle strength testing showed active movement against some resistance in the right ankle dorsiflexion and right great toe extension. The Veteran did not have muscle atrophy. Reflex examination was normal. Sensory examination showed decreased sensation to light touch in the bilateral lower leg or ankle and bilateral foot or toes. Straight leg raising test was positive on the right side. The Veteran had radicular pain or other signs or symptoms due to radiculopathy; and examiner noted severe constant pain of the right lower extremity and mild constant pain of the left lower extremity, and mild paresthesias and/or dysesthesias and numbness of the right lower extremity. The examiner found the Veteran had moderate radiculopathy of the right lower extremity. He did not have ankylosis. There were no other neurologic abnormalities or findings related to the thoracolumbar spine. The Veteran had IVDS that did not result in medically prescribed bed rest. He endorsed the constant use of crutches as a normal mode of locomotion, due to leg weakness and frequent falls. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging studies documented arthritis without thoracic vertebral fracture with loss of 50 percent or more of height. At a February 2015 VA examination for the cervical spine, the Veteran reported he had severe “sounds” at the neck, frequent headaches, constant pain, rated as a ten out of ten pain intensity, that he used oral pain medication to treat his neck disorder, that he used two pillows to sleep at night and that Canadian crutches worsened his neck pain. He denied numbness or cramps, and claimed finger joints pain. He endorsed flare-ups of the cervical spine that limited his driving. Upon physical examination, range of motion was as follows: forward flexion was to 45 degrees; extension was to 15 degrees; right lateral flexion was to 10 degrees left lateral flexion was to 15 degrees; right lateral rotation was to 20 degrees; and left lateral rotation was to 45 degrees. Range of motion itself contributed to a functional loss because his neck rotation compromised his ability to drive. Pain was noted on examination and caused a functional loss on bilateral lateral rotation. There was no evidence of pain with weight-bearing. There was not objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the neck. The Veteran was able to perform repetitive-use testing with at least three repetitions; and there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive-use over time or during a flare-up; and the examination neither supported nor contradicted the Veteran’s statements describing a functional loss with repetitive use over time or during a flare-up. The examiner could not state, without resorting to mere speculation, whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time or during a flare-up and noted that the examination was not conducted after repetitive movements over a period of time, therefore, a description of range of motion would be speculative. With regard to flare-ups, the examiner noted that all musculoskeletal disorders present in an individual could potentially cause functional limitations during repetitive-use over a period of time or during flare-ups; and noted that if pain, weakness, fatigability or incoordination were present, it could significantly limit functional ability during a flare-up. An adequate response was not feasible because the evaluation must be done during the present of a flare-up in order to objectively compare baseline to flare-ups limitations, and providing data of a functional loss related to a possible future event such as a flare-up would be mere speculation. A February 2015 VA examiner noted that the Veteran had muscle spasm that did not result in abnormal gait or abnormal spinal contour, and had an increased muscle tone at cervical paravertebral muscles. He had localized tenderness that did not result in an abnormal gait or abnormal spinal contour. He did not have guarding. There were no additional factors contributing to the disability. Muscle strength testing was normal and there was no muscle atrophy. Reflex examination was normal. Sensory examination was normal. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. He did not have ankylosis of the spine. There were no other neurologic abnormalities or findings related to the cervical spine. The Veteran had IVDS that did not result in medically prescribed bed rest. He endorsed the constant use of crutches as a normal mode of locomotion, due to leg weakness and frequent falls. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging studies documented arthritis without thoracic vertebral fracture with loss of 50 percent or more of height. The examiner noted the Veteran’s neck impacted his ability to work due to an inability to drive. The examiner remarked the Veteran did not have upper extremity radiculopathy. A December 2015 VA treatment record indicates the Veteran reported his back pain limited his ability to walk but that he was able to walk for approximately 20 minutes without a significant increase in pain and that he walked about 3,000 to 7,000 steps daily. A January 2016 VA treatment record indicates the Veteran was experiencing back spasms and was told to not have any type of physical activities. An April 2018 VA treatment record indicates the Veteran had neck spasm and lower back exacerbation that made him unbale to walk. Cervical spine range of motion was as follows: flexion to 20 degrees; extension to 30 degrees; right lateral flexion not 15 degrees; and left lateral flexion to 10 degrees. The Veteran was noted to have a wide base and weight shifting to the left side, sit to stand was adequate, that he had slow pacing between supine to sit and that he used a cane for ambulation. The Veteran had impaired activity tolerance in standing, sitting, and ambulation and impaired balance with limited participation in activities that challenge balance. He had an abnormal gait, and was dependent on assistive devices for ambulation and mobility. He presented with pain, cooperative, guarded in movements, apprehensive to bend, back weakness, lack of back flexibility, lack of lower extremity flexibility, lower extremity weakness, postural deviation and abdominal weakness. At a December 2018 VA examination for the cervical spine, the Veteran reported his neck had worsened over the years, and currently experienced pain, stiffness, limitation of movement, frequent crepitus, and numbness in his arms. He treated with oral medication, nerve blocks, and physical therapy. He endorsed flare-ups of the neck that were described as increased pain and stiffness. He reported functional loss or functional impairment described as difficulty driving. Upon physical examination, range of motion was as follows: flexion was to 30 degrees; extension was to 15 degrees; right lateral flexion was to 10 degrees; left lateral flexion was to 25 degrees; and bilateral lateral rotation were to 25 degrees each. Range of motion itself did not contribute to a functional loss. Pain was noted on all range of motion movements but did not result in or cause a functional loss. There was objective evidence of localized tenderness or pain on the posterior neck and paraspinal muscles, that was mild to moderate, and due to degenerative disc disease and muscle spasm. There was no evidence of pain with weight-bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions; and there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time or during a flare-up and the examination was medically consistent with the Veteran’s statements describing a functional loss with repeated use over a period of time and during flare-ups. Pain was noted to cause this functional loss. The examiner was unable to describe in terms of range of motion because the Veteran reported loss of range of motion was variable, depending on how strenuously the joint was used; and that at its worst, the Veteran could not move at all due to pain and fatigue, but there were other times where range of motion loss was minimal. The Veteran did not have guarding or muscle spasm. There were no additional factors contributing to the disability. The December 2018 VA examination found muscle strength testing, reflex testing and sensory examination to be normal. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. He did not have ankylosis. There were no other neurologic abnormalities or findings related to a cervical spine condition. The Veteran did not have IVDS. The Veteran did not use any assistive device as a normal mode of locomotion. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging documented arthritis without cervical vertebral fracture with loss of 50 percent or more of height. The examiner noted the Veteran’s neck disorder did not impact his ability to work. There was objective evidence of pain when the neck was used in nonweight-bearing. Passive range of motion measurements were as follows: forward flexion to 35 degrees; extension to 20 degrees; bilateral lateral flexion to 35 degrees each; right lateral rotation to 50 degrees; and left lateral rotation to 55 degrees. Pin was present on passive range of motion, and was the same as active range of motion. At a December 2018 VA examination for the thoracolumbar spine, the Veteran reported that the low back disorder had been worsening, and he experienced constant pain with radiation into his lower extremities. He reported he had interference with daily chores that include weight-bearing, bending down, exercising, standing or sitting for long periods of time, walking long distances, climbing stairs, and driving. His current symptoms included pain, limitation of motion, fatigue, inability to walk more than a few meters without requiring rest, paresthesia, and difficulty climbing stairs. He treated with NSAIDs and physical therapy. He endorsed flare-ups that were described as severe pain, interference with sitting, standing, walking, and radiation into the bilateral lower extremities. He reported functional loss or functional impairment that was described as inability to drive, inability to sit or stand in one position for more than a few minutes, inability to lift even light objects, and inability to bend down or pick objects or tie shoes. Upon physical examination, range of motion were as follows: forward flexion to 40 degrees; extension to 10 degree; bilateral lateral flexion to 20 degrees each; and bilateral lateral rotation to 10 degrees each. Range of motion itself contributed to a functional loss such as dressing and putting shoes on, lifting objects, and bending down to pick objects below waist level. Pain was noted on examination on rest and non-movement. There was objective evidence of localized tenderness or pain on palpation on the lumbosacral spine, that was moderate, due to degenerative disc disease and bulging discs. There was evidence of pain with weight-bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions; and there was no additional loss of function or range of motion after three repetitions. Pain, fatigue, and lack of endurance caused a functional loss. The Veteran was not examined immediately after repetitive use over time or during a flare-up and the examination was medically consistent with the Veteran’s statements describing a functional loss with repeated use over a period of time and during flare-ups. Pain, fatigue, and lack of endurance caused a functional loss with repeated use over time; and pain and lack of endurance caused a functional loss during flare-ups. The examiner was unable to describe in terms of range of motion because the Veteran reported loss of range of motion was variable, depending on how strenuously the joint was used; and that at its worst, the Veteran could not move at all due to pain and fatigue, but there were other times where range of motion loss was minimal. The Veteran had muscle spasm that did not result in an abnormal gait or abnormal spinal contour; and he did not have guarding. Additional factors that contributed to his disability included interference with sitting; interference with standing; and the Veteran stated he could not sit or stand in one place for more than a few minutes. The December 2018 VA examination found that muscle strength testing showed active movement against some resistance in the right ankle dorsiflexion and right great toe extension. The Veteran did not have muscle atrophy. Reflex examination was normal. Sensory examination showed decreased sensation in the right lower leg or ankle and right foot or toes. Straight leg raising test was positive on the right side. The Veteran had radicular signs or symptoms that included moderate constant pain of the right lower extremity, severe intermittent pain of the right lower extremity, moderate paresthesias and/or dysesthesias of the right lower extremity and mild numbness of the right lower extremity. The examiner noted the Veteran had moderate right lower extremity radiculopathy. He did not have ankylosis. There were no other neurologic abnormalities or findings related to a thoracolumbar spine condition. The Veteran had IVDS that did not require bed rest prescribed by a physician. The Veteran endorsed the constant use of a cane and bath chair as normal modes of locomotion. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging studies showed arthritis without thoracic vertebral fracture with loss of 50 percent or more of height. The examiner noted that the Veteran’s low back disorder impacted his ability to work because the Veteran could not remain seated for prolonged periods, could not drive, could not lift objects or bend down, and was in constant pain. There was objective evidence of pain when the back was used in nonweight-bearing. Passive range of motion could not be performed or was not medically appropriate. Additionally, the December 2018 VA examiner noted that the Veteran’s neck disorder was mild to moderate in severity and the low back disorder was moderate to severe in severity. The physical examination showed decreased and abnormal range of motion, with evidence of degenerative disc disease in the lower back and neck. The Veteran presented with very limited range of motion of the thoracolumbar spine, and constant pain limited his capacity to work in most environments. The examiner also noted that the previous examinations were accurate representations of his disability level, and were consistent with the examination performed in December 2018. There was no ankylosis of the spine, and there had been no episodes of doctor prescribed bed rest in the past twelve months. The examiner noted that there was no weakened movement, incoordination, or excess fatigability noted on examination. At examination, the Veteran’s right ankle dorsiflexion and right great toe extension were abnormal and showed movement against some resistance; and showed decreased sensation at the L4, L5-S1 nerve roots. Signs and symptoms of radiculopathy were moderate on the right lower extremity, and did not affect the left lower extremity. A December 2019 VA treatment record indicates the Veteran reported his back pain was less severe, localized on the right side with an occasional radiation down to his leg and testicle, pain was exacerbated with ambulation and there was no associated numbness or tingling. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his low back and neck. A review of the treatment notes of record does not show the Veteran to have symptoms of a spine disability worse than those reported at the VA examinations of record and noted above. I. Analysis—Lumbar Spine Disorder Based on the foregoing, the Board finds that a rating in excess of 10 percent prior to March 1, 2011 for a lumbar spine disorder is not warranted. Forward flexion was found to be 70 degrees and combined range of motion was found to be to 202 degrees, both at worst, in a December 2008 VA examination report. There was no clinical evidence showing limitation in forward flexion to 30 degrees, a combined range of motion of 120 degrees or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour of the thoracolumbar spine during any part of the appeal period, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the thoracolumbar spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. However, there is no objective evidence that this painful motion has resulted in measurable functional impairment. In this regard, the Veteran reported pain, difficulty walking and climbing stairs, decreased mobility, problems with certain physical activities, lack of stamina, weakness, fatigue, and decreased strength. However, even in considering the Veteran’s subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 10 percent assigned prior to March 1, 2011. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. For the appeal period from March 1, 2011 to February 5, 2015, the Board finds that a 20 percent rating for a lumbar spine disorder is not warranted. The Veteran’s forward flexion was found to be to 40 degrees, at worst, during the March 2011 VA examination, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the thoracolumbar spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. In this regard, the Veteran reported pain, difficulty walking and climbing stairs, decreased mobility, problems with certain physical activities, lack of stamina, weakness, fatigue, and decreased strength. However, even in considering the Veteran’s subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 20 percent assigned for the appeal period from March 1, 2011 to February 5, 2015. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. For the appeal period beginning on February 5, 2015, the Board finds that a 40 percent rating for a lumbar spine disorder is not warranted. The Veteran’s examinations have been consistently negative for ankylosis and the Veteran has retained range of motion in the lumbar spine. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996); Lewis v. Derwinski, 3 Vet. App. 259 (1992) (indicating that ankylosis is complete immobility of the joint in a fixed position, either favorable or unfavorable); see March 2011, February 2015, and December 2018 VA examination reports (indicating the Veteran did not have ankylosis of the spine at any time). Therefore, the Board finds that, at no time during the appeal period has the Veteran’s service-connected lumbar spine disorder resulted in ankylosis warranting a higher rating. The Board has considered whether a higher evaluation could be assigned for any period on appeal under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran has had incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that the Veteran has a diagnosis of IVDS that resulted in medically prescribed bedrest. Specifically, the Veteran was shown to have IVDS at his February 2015 and December 2018 VA examinations, but did not require medically prescribed bedrest. At all other times, the Veteran did not have a diagnosis of IVDS. Accordingly, a higher or separate rating is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment or bowel impairment as a result of his service-connected lumbar spine disorder. The Veteran is already in receipt of separate ratings for right lower extremity radiculopathy. Therefore, the Board finds that, at no time during the appeal period, has the Veteran’s service-connected lumbar spine disorder resulted in neurological impairment. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court of Appeals for Veterans’ Claims (Court’s) holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the VA examiners did not test the opposite joint; however, the spine does not have an opposite joint. The VA examiners indicated there was interference with weight-bearing. Pain was noted on examination. Regarding repeated use over time, the Board notes that VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the VA examiners were not able to provide an opinion regarding additional functional impairment during flare-ups, however, the Veteran was able to describe his symptoms during a flare-up and the impact of such. Specifically, the examiners elicited information from the Veteran regarding the severity, frequency, duration and functional loss manifestations of flare-ups. Therefore, the Board finds that all information required for rating purposes was provided. In this regard, the Board notes that the examiners clearly noted that the Veteran specifically reported pain, limited prolonged sitting, stiffness, and difficulty with certain daily activities, to include driving and bending over. There is no other indication from the record, to include the Veteran’s own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. Moreover, a rating higher than 40 percent requires ankylosis; hence, the provisions of Correia and Sharp do not apply to the appeal period beginning on February 5, 2015. As the Veteran has not endorsed those symptoms, the Board finds the examinations of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. The Veteran’s belief that he is entitled to higher ratings for his lumbar spine disorder 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 report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to higher ratings. The Board acknowledges the statements of the Veteran that his lumbar spine disorder manifests with pain that radiates into his extremities, limited range of motion, and numbness and cramps. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board finds, however, that neither the Veteran’s statements, nor medical evidence demonstrates that the criteria for higher ratings have been met during any period on appeal. Specifically, as noted above, the Veteran’s range of motion is described, and the Veteran has not been shown to have ankylosis of the spine at any time. In addition, the Veteran was able to describe his symptoms during flare-ups, following repetitive-use, the impact of his symptoms on his daily life, and the severity, frequency, duration and functional loss manifestations of flare-ups. The Board also acknowledges that the Veteran’s VA treatment records note complaints of and treatment for his back. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. This argument is therefore without merit. Consideration has been given to assigning further staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned, and the disability has been stable throughout each appeal period. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran is currently in receipt of a TDIU as of October 9, 2015, based on the combined effects of all of his service connected disabilities. The Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment prior to October 9, 2015 due solely to his service connected lumbar spine disorder. As such, a Rice claim is not raised. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for prior to March 1, 2011, in excess of 20 percent from March 1, 2011 to February 5, 2015, and in excess of 40 percent beginning February 5, 2015 for a lumbar spine disorder, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. II. Analysis – Cervical Spine Disorder Based on the foregoing, the Board finds that a rating in excess of 10 percent prior to March 1, 2011 for a cervical spine disorder is not warranted. As the Veteran was shown on examination, his forward flexion of the cervical spine was to 35 degrees, at worst; with a combined range of motion of 210 degrees. See December 2008 VA examination report. There was no clinical evidence showing limitation in forward flexion to 15 degrees, a combined range of motion limited to 170 degrees or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour of the cervical spine at any part of the appeal period, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the cervical spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. However, there is no objective evidence that this painful motion has resulted in measurable functional impairment. In this regard, the Veteran reported pain that was severe, sharp, burning, constant, and occurring daily; with radiation of pain into his upper extremities and impact on certain daily activities. However, even in considering the Veteran’s subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 10 percent assigned prior to March 1, 2011. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. Based on the foregoing, the Board finds that a rating in excess of 20 percent beginning March 1, 2011 for a cervical disorder is not warranted. As the Veteran was shown on examination, his forward flexion of the cervical spine was to 30 degrees, at worst, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. See March 2011 VA examination report; see February 2015 VA examination report; see December 2018 VA examination report. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the cervical spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. However, there is no objective evidence that this painful motion has resulted in measurable functional impairment Additionally, the Veteran’s examinations have been consistently negative for ankylosis and the Veteran has retained range of motion in the cervical spine. See Dinsay v. Brown, supra; Lewis v. Derwinski, supra; see March 2011, February 2015, and December 2018 VA examination reports (indicating the Veteran did not have ankylosis of the spine at any time). Therefore, the Board finds that, at no time during the appeal period has the Veteran’s service-connected cervical disorder resulted in ankylosis warranting a higher rating. The Board has considered whether a higher evaluation could be assigned for any period on appeal under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran has had incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that the Veteran has a diagnosis of IVDS that resulted in medically prescribed bedrest. Specifically, the Veteran was shown to have IVDS at his February 2015 and December 2018 VA examinations, but did not require medically prescribed bedrest. At all other times, the Veteran did not have a diagnosis of IVDS. Accordingly, a higher or separate rating is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In addition to considering the orthopedic manifestations of a cervical spine disorder, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment or bowel impairment as a result of his service-connected cervical spine disorder, nor has the Veteran been shown to have radiculopathy of the upper extremities. Therefore, the Board finds that, at no time during the appeal period, has the Veteran’s service-connected cervical spine disorder resulted in neurological impairment. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. In this case, the VA examiners did not test the opposite joint; however, the spine does not have an opposite joint. The VA examiners indicated there was interference with weight-bearing. Pain was noted on examination. Regarding repeated use over time, the Board notes that VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the VA examiners were not able to provide an opinion regarding additional functional impairment during flare-ups, however, the Veteran was able to describe his symptoms during a flare-up and the impact of such. Specifically, the examiners elicited information from the Veteran regarding the severity, frequency, duration and functional loss manifestations of flare-ups. Therefore, the Board finds that all information required for rating purposes was provided. In this regard, the Board notes that the examiners clearly noted that the Veteran specifically reported pain, limited prolonged sitting, stiffness, and difficulty with certain daily activities, to include driving and turning his head. There is no other indication from the record, to include the Veteran’s own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. As the Veteran has not endorsed those symptoms, the Board finds the examinations of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. The Veteran’s belief that he is entitled to higher ratings for his cervical spine disorder 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 report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to higher ratings. The Board acknowledges the statements of the Veteran that his neck disorder manifests with pain that radiates into his extremities, limited range of motion, and numbness and cramps, and carpal tunnel syndrome. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, supra. The Board finds, however, that neither the Veteran’s statements, nor medical evidence demonstrates that the criteria for higher ratings have been met during any period on appeal. Specifically, as noted above, the Veteran’s range of motion is described, and the Veteran has not been shown to have ankylosis of the spine at any time. In addition, the Veteran was able to describe his symptoms during flare-ups, following repetitive-use, the impact of his symptoms on his daily life, and the severity, frequency, duration and functional loss manifestations of flare-ups. The Board also acknowledges that the Veteran’s VA treatment records note complaints of and treatment for his neck. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. This argument is therefore without merit. Consideration has been given to assigning further staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned, and the disability has been stable throughout each appeal period. Hart v. Mansfield, supra. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. Additionally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability has been raised pursuant to Rice v. Shinseki, supra. The Veteran is currently in receipt of a TDIU as of October 9, 2015, based on the combined effects of all of his service connected disabilities. The Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment prior to October 9, 2015 due solely to his service connected cervical spine disorder. As such, a Rice claim is not raised. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for prior to March 1, 2011, in excess of 20 percent thereafter for a cervical spine disorder, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, Associate 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.