Citation Nr: 21009888 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-12 712 DATE: February 23, 2021 ORDER For the entire period on appeal, entitlement to an initial disability rating of 40 percent, but no higher, for a lumbar spine strain with degenerative disc disease, is granted. For the entire period on appeal, entitlement to a separate disability rating of 20 percent for radiculopathy of the right lower extremity, associated with service-connected lumbar spine strain with degenerative disc disease, is granted. REMANDED Entitlement to a separate compensable rating for erectile dysfunction, associated with service-connected lumbar spine strain with degenerative disc disease, is remanded. Entitlement to a separate compensable rating for bladder incontinence, associated with service-connected lumbar spine strain with degenerative disc disease, is remanded. Entitlement to a separate compensable rating for fecal urgency, associated with service-connected lumbar spine strain with degenerative disc disease, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in his favor, for the entire period on appeal, the Veteran’s lumbar strain has been manifested by forward flexion of the thoracolumbar spine 30 degrees or less; his lumbar strain has not been manifested by unfavorable ankylosis of the entire thoracolumbar spine or entire spine, or incapacitating episodes due to intervertebral disc syndrome having a total duration of at least 6 weeks during the past twelve months. 2. The Veteran’s lumbar spine strain is manifested by radiculopathy of the right leg that is moderate in severity. CONCLUSIONS OF LAW 1. For the entire period on appeal, the criteria for entitlement to an initial rating of 40 percent, but no higher, for a lumbar strain with degenerative disc disease, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237, 5243. 2. For the entire period on appeal, the criteria for a separate 20 percent rating for radiculopathy of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2002 to July 2005. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue was previously remanded by the Board in December 2018 and has since been returned for further adjudication. Increased Rating 1. Entitlement to an initial rating higher than 20 percent for a lumbar strain. Service connection for a lumbar strain was granted in a February 2013 rating decision, at which time a 20 percent rating was assigned, effective November 2012. A notice of disagreement with the rating assigned was received in February 2013. The Veteran asserts his lumbar strain is more severe than what is represented by a 20 percent rating. Disability evaluations are determined by application of criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when the question for consideration is entitlement to a higher initial rating assigned following the grant of service connection, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of “staged rating” (assignment of different ratings for distinct periods of time, based on the facts found), is required. See Fenderson, 12 Vet. App. at 126. The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4. 40. Consideration is to be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse, instability of station, or interference with standing, sitting, or weight bearing. VA must consider “functional loss” of a musculoskeletal disability separately from consideration under the Diagnostic Codes; “functional loss” may occur as a result of weakness, fatigability, incoordination or pain on motion. 38 C.F.R. §§ 4. 40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). VA must consider any part of the musculoskeletal system that becomes painful on use to be “seriously disabled.” Under 38 C.F.R. §§ 4.40 and 4.45, a Veteran’s pain, swelling, weakness, and excess fatigability must be considered when determining the appropriate evaluation for a disability using the limitation of motion Diagnostic Codes. See Johnson v. Brown, 9 Vet. App. 7, 10 (1996). The Court held in DeLuca that all complaints of pain, fatigability, etc., shall be considered when put forth by a Veteran. Therefore, consistent with DeLuca and 38 C.F.R. § 4.59, the Veteran’s complaints of pain have been considered in the Board’s review of the Diagnostic Codes for limitation of motion. The Board has considered the entire record, including the Veteran’s VA clinical records and private treatment records. These show complaints and treatment but will not be referenced in detail. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will discuss the evidence pertinent to the rating criteria and the current disability. The Veteran’s lumbosacral spine disability is currently rated 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5237, General Rating Formula for Diseases and Injuries of the Spine. A higher rating of 40 percent is warranted when there is forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A rating of 50 percent is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a rating of 100 percent is warranted for unfavorable ankylosis of the entire spine. For VA compensation purposes, 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 the thoracolumbar spine is 240 degrees. Any associated objective neurologic abnormalities should be evaluated separately, under an appropriate diagnostic code. Alternatively, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes allows a rating of 40 percent rating when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months, and a rating of 60 percent is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. A note following Diagnostic Code 5243 defines an incapacitating episode as 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. 38 C.F.R. § 4.71a, Diagnostic Code 5243, note 1. The Veteran was afforded a VA examination in January 2013. The Veteran reported episodic severe low back pain, which extended into the right thigh. He indicated experiencing an onset of pain with bending and twisting movements, lasting for days to weeks, including spasms. He reported flare-ups involving severe low back pain, spasms, difficulty standing erect, which lasted several days and was relieved with rest, ice and medication. On examination, flexion was to 60 degrees, with pain beginning at 50 degrees, extension to 15 degrees with pain beginning at 10 degrees, right and left lateral flexion to 30 degrees with no objective evidence of pain, and right and left lateral rotation to 30 degrees with no objective evidence of pain. The Veteran was able to complete repetitive-use testing with no additional loss of range of motion; however, the Veteran was noted to have functional loss in the form of less movement than normal and pain on movement. The examiner indicated the Veteran had right lower paraspinal tenderness. Muscle strength and reflexes were normal. Sensory examination was normal. There was no noted radiculopathy and the examiner indicated the Veteran did not have IVDS. The examiner indicated the Veteran’s lumbar disability impacted his ability to work in that it caused frequent severe low back pain, difficulty bending, lifting and carrying. A January 2013 private treatment record indicates the Veteran had a forward flexion of 30 degrees, with pain. The private physician noted that the Veteran’s forward flexion and extension were limited, and he was unable to forward flex without pain. An addendum VA opinion was obtained in March 2015, wherein the examiner stated that they were unable to specify the additional degree of decreased range of motion without resorting to mere speculation because this would have to be obtained during a flare-up or after using the joint repeatedly over a period of time. The Veteran was afforded a VA examination in February 2017. He reported he did not take any pain medication since the day prior. The Veteran was diagnosed with a lumbar strain and degenerative disc disease with right lower extremity radiculopathy. The Veteran noted erectile dysfunction, bowel and bladder incontinence, constant pain to numbness, inability to bend over or move, inability to sleep, and reported that he switched careers from border patrol to being a barber due to his back disability. He reported flare-ups, during which he cannot move. He indicated he was in constant pain, cannot bend over and cannot step up. Examination revealed forward flexion to 15 degrees, no extension, and 15 degrees of right and left lateral flexion, and right and left lateral rotation. Pain was noted on all ranges of motion and on weight bearing. It was noted the Veteran had guarding or muscle spasms that resulted in an abnormal gait or spinal contour. The examiner indicated that prolonged standing, walking, sitting and bending were all compromised due to his back disability. Muscle strength was reduced in hip flexion, knee extension, ankle planar flexion, ankle dorsiflexion, and great toe extension. Reflexes were normal. Sensory examination was normal; however, the Veteran was unable to perform the straight leg raising test. The examiner explained that the Veteran unable to perform the straight leg raising test even in a modified seated position due to pain and an anticipated increase in immobility if he tried today; however, a February 2017 emergency room visit for acute chronic lumbar pain noted a positive straight leg raising test of the right lower extremity. The Veteran was noted to have right lower extremity radiculopathy. The examiner reported that the Veteran had IVDS but did not have any prescribed periods of bedrest in the prior 12 months. The examiner noted that the Veteran’s disability may negatively impact the Veteran's ability to perform heavy lifting, repetitive bending and prolonged walking and standing. It was noted that the Veteran works as a barber because he was not able to fulfill requirements of his prior job with border patrol and having to chase suspects. The examiner stated the Veteran’s current job requires prolonged standing and getting up from a seated position when the next customer arrives, and that both of these activities can be challenging enough to the point that the Veteran has given his customers to other employees due to pain. The examiner also opined that the Veteran’s lumbar disability may negatively affect the Veteran's ability to sit for prolonged periods of time without getting up to move around periodically. Passive range of motion could not be performed because it was not medically appropriate. The examiner noted that the Veteran was service connected for a lumbar strain; however, a magnetic resonance image (MRI) now ascertains a diagnosis of degenerative disc disease with right lower extremity radiculopathy. The examiner explained that the Veteran’s service treatment records document lumbar pain with radiating pain down the right leg and given the Veteran’s history, it is more likely than not that the Veteran’s degenerative disc disease with right lower extremity radiculopathy is a progression of his initial back condition while on active duty. The Board remanded this appeal in December 2018 to obtain a VA examination that complied with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The Veteran was afforded a VA examination in October 2019. The Veteran reported that for the last 5 years he has experienced flares of back pain lasting up to 8 weeks that occur four to six times per year. He indicated he was unable to perform activities of daily living without a flare. The examiner was unable to test range of motion as the Veteran was currently in a flare and could not perform range of motion testing due to pain. There was pain on weight bearing and the examiner indicated the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time as well as during flare ups. Muscle strength was reduced in right knee, right ankle and right great toe. Reflexes were absent in the right ankle. Sensory examination was decreased in right thigh, right lower leg/ankle and right foot/toes. The examiner indicated the Veteran had radiculopathy of the right lower extremity of a moderate severity. There was no ankylosis and no IVDS. The Veteran used a cane constantly. The examiner explained that during a flare up the Veteran is not able to perform his activities of daily living such as standing, walking, dressing or bathing without assistance. There was objective evidence with nonweight-bearing and passive range of motion could not be tested. The Veteran was afforded a VA examination in August 2020. It was noted that the Veteran was in the midst of a flare during the prior VA examination, so he was unable to perform testing. The Veteran reported that the prior flare lasted three months and he could hardly get off the floor. It was noted that the Veteran was again in the middle of a flare. He reported that three to four times a month for three to four days he is “100 percent debilitated” and can only lay in bed. The Veteran indicated he was fully reliant on his wife and she helps him to the bathroom. The Veteran’s range of motion was 70 degrees of forward flexion and -50 degrees of extension. The examiner noted that the Veteran was not able to straighten to the upright and remained hunched over at 50 degrees even when walking and sitting. Pain was noted, causing functional loss in all ranges of motion. There was evidence with weight bearing. He was able to perform repetitive use testing with no additional loss of range of motion. It was noted that the examination was being conducted during a flare up and the Veteran’s function was severely limited. Muscle strength revealed reduced strength on the right. Reflexes were normal except for absent reflex of the right ankle. Sensory examination of the right lower extremity was abnormal. The Veteran was noted to have moderate radiculopathy of the right lower extremity. The examiner indicated the Veteran has IVDS but did not have any prescribed periods of bedrest in the prior year. He was noted to use a brace and a cane. The examiner described the Veteran as “he remains forward flexed with knees also flexed when walking and to walk he uses a cane in both hands positioned at the center of his body. He swings the right leg outward when walking. He also sits forward flexed. He is unable to fully extend either leg at the knee when sitting or standing and cannot tolerate attempts at sitting straight leg raise. He reports inability to discern movement of the right foot prevents him from plantar flexing the foot against resistance and from dorsiflexing the right great toe against resistance. Decreased sensation is at the lateral right thigh, the lateral and posterior right lower leg and the lateral right foot.” The Board notes the August 2020 VA examiner opined that the Veteran’s degenerative disc disease and right lower extremity radiculopathy were not a progression of his service-connected lumbar strain; however, the February 2017 VA examiner opined that they were a progression of the Veteran’s initial back condition. Resolving all reasonable doubt in his favor, the Board finds the evidence is in equipoise, and his degenerative disc disease and right lower extremity radiculopathy are a progression of his service-connected disability. Given the totality of the evidence when considering the Veteran’s competent and credible reports of limited lumbar spine motion, stiffness, and pain, combined with his consistent reports of flare-ups, the Board finds that an initial rating of 40 percent, but no higher, is warranted from November 21, 2012. In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board has also considered the effects of weakened movement, excess fatigability, and incoordination under 38 C.F.R. § 4.45. The Board accepts the Veteran’s competent and credible assertions that his lumbar spine is painful, and as described in VA examinations, he suffers from additional loss of motion and pain during flare-ups. See DeLuca, 8 Vet. App. at 205-206; see also Mitchell, 25 Vet. App. at 38; Sharp, 29 Vet. App. at 33. As such, a rating of 40 percent, but no higher, is warranted. However, the Board finds that the Veteran is not entitled to a rating in excess of 40 percent. A higher 50 percent rating is warranted only when there is unfavorable ankylosis of the thoracolumbar spine, or a 100 percent rating is warranted when there is unfavorable ankylosis of the entire spine. Generally, ankylosis is stiffening or fixation of the joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland’s Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is “immobility and consolidation of a joint due to disease, injury, or surgical procedure.”); see also Coyalong v. West, 12 Vet. App. 524, 528 (1999). Note (5) of the General Rating Formula states that, for VA compensation purposes, unfavorable ankylosis is a condition in which the thoracolumbar spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin of the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in a neutral position (zero degrees) always represents favorable ankylosis. In this case, there have been no findings of ankylosis. Although limited, the Veteran had a range of motion in the January 2013 and February 2017 VA examinations. In the October 2019 VA examination, although the Veteran was experiencing a flare and unable to perform range of motion testing, the examiner specifically checked off that he did not have ankylosis. Similarly, the August 2020 VA examination was also conducted during a flare, and although the Veteran’s range of motion was severely limited so that he was not able to straighten his back and was bent at 50 degrees, he still was able to have a forward flexion to 70 degrees from 50 degrees. The examiner specifically noted that there was no ankylosis. The Veteran has not asserted experiencing any symptoms that describe ankylosis of the spine, as defined by the General Rating Formula. Collectively, these findings demonstrate that the Veteran’s lumbar spine is not fixed, and there is no diagnosis of ankylosis of the thoracolumbar spine or the entire spine. Therefore, a rating higher than 40 percent rating under the General Rating Formula is not warranted. As the evidence does not indicate that the Veteran has unfavorable ankylosis of the entire thoracolumbar spine at any time during the course of this appeal, entitlement to a rating higher than 40 percent is not warranted. The Board has carefully considered the Veteran’s contentions, including regarding flare-ups, and notes that the 40 percent rating is recognition that the Veteran has a severe low back disability as it is the maximum rating for limitation of motion under the schedular criteria. Where the Veteran is already receiving the maximum disability rating for limitation of motion, 38 C.F.R. §§ 4.40 and 4.45 are not applicable. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Also, the Board notes that the criteria for a 40 percent rating includes compensation for favorable ankylosis. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Thus, the 40 percent rating currently assigned presently contemplates episodes in which the Veteran believes his disability is so severe that he cannot move his back and can only lay on the floor or in bed. Unfavorable ankylosis, as contemplated in the 50 percent and 100 percent ratings, however, is a condition in which the entire thoracolumbar spine or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The Board does not find that the medical evidence or the Veteran’s lay description of the functional impairment he experiences during such flare-ups demonstrates the level of disability associated with unfavorable ankylosis of the thoracolumbar spine, which is the criteria associated with the next higher rating of 50 percent. The General Rating Formula also provides that neurologic abnormalities associated with a spine condition are to be rated separately. Here, the Board notes that the Veteran reported fecal urgency, bladder incontinence and erectile dysfunction symptoms. These issues are discussed in the remand below. Regarding radiculopathy, the Board finds the Veteran is entitled to a separate rating for his radiculopathy of the right lower extremity, as discussed below. There is no evidence of left lower extremity radiculopathy or any additional neurological symptoms associated with his spine disability. Finally, the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes allows for a higher 60 percent rating if the Veteran’s lumbar spine condition results in incapacitating episodes having a total duration of 6 weeks during a 12-month period. 38 C.F.R. § 4.71a. Note (1) of this Formula defines an incapacitating episode as 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. Despite evidence of a diagnosis of IVDS, the evidence does not reflect that the Veteran was prescribed bed rest by a physician for his lumbar spine disability. No incapacitating episodes were noted during any of the VA examinations. The Veteran reports flare-ups, during which he cannot do anything other than lay on the floor or in bed. While the Board acknowledges these statements, they do not demonstrate incapacitating episodes as defined in the regulations, as they do not show that the Veteran spent this time in bed on his physician’s orders. In reaching these conclusions, the Board has considered any additional functional limitation due to factors such as pain, weakness, incoordination, or fatigability. See 38 C.F.R. §§ 4.40 and 4.45; Deluca v. Brown. In considering additional limitation of function, the Board acknowledges the Veteran’s complaints of pain and stiffness. These complaints are well documented in the Veteran’s written statements and treatment records. However, the Board has considered the Veteran’s functional limitations based on pain and finds that the 40 percent rating assigned herein appropriately compensates the Veteran for his symptoms. Moreover, whereas here, the Veteran is already receiving the maximum disability rating for limitation of motion, 38 C.F.R. §§ 4.40 and 4.45 are not applicable. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The Board notes that the Veteran is competent to give evidence about what he experiences; for example, he is competent to discuss current pain and other experienced symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). These symptoms have been considered in the Board’s assignment of the 40 percent rating for the entire period on appeal. In conclusion, the Board finds that a 40 percent rating, but no higher, is warranted for the entire period on appeal. In making this determination, the Board has considered the Veteran’s statements and all reasonable doubt has been resolved in favor of the Veteran. See Gilbert, 1 Vet. App. at 55. 2. Entitlement to a separate compensable rating for radiculopathy of the right lower extremity. As noted, the General Rating Formula for Diseases and Injuries of the Spine provides that VA is to evaluate any associated objective neurologic abnormalities associated with a service-connected spinal disability under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Note 1. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot 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. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating that may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. The Veteran underwent a VA examination in May 2017. He reported 4/5 muscle strength for bilateral hip flexion, knee extension, ankle plantar flexion and dorsiflexion, and great toe extension, and severe right lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. The examiner found that the Veteran suffered from moderate incomplete paralysis of the right lower extremity of the sciatic nerve and stated that it is more likely than not that his degenerative disc disease with right lower extremity radiculopathy represents a progression of his initial back condition while on active duty. Next, the Veteran underwent a VA examination in October 2019. He reported 4/5 muscle strength for right knee extension, ankle plantar flexion and dorsiflexion, great toe extension, decreased right thigh/knee, lower leg/ankle, and foot/toes sensation, and moderate right lower extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. The examiner found that the Veteran suffered from moderate incomplete paralysis of the sciatic nerve of the right lower extremity. Finally, the Veteran underwent a VA examination in August 2020. He reported 3/5 muscle testing for hip flexion, ankle plantar flexion, and great toe extension, 4/5 ankle dorsiflexion, decreased thigh/knee, lower leg/ankle, and foot/toes sensation, moderate right lower extremity constant pain and numbness, and mild paresthesias and/or dysesthesias. The examiner found that the Veteran suffered from moderate incomplete paralysis of the sciatic nerve of the right lower extremity. In this case, the Board finds that a separate rating is warranted for the Veteran’s radiculopathy of the right leg for the entire period on appeal, as the medical evidence clearly shows that such disorder is associated with his service-connected lumbar spine disability. Medical evidence indicates the Veteran reported pain radiating into the right leg as early as January 2013. The medical evidence, as well as the Veteran’s lay statements, sufficiently establish that his radiculopathy of the right leg is moderate in nature to warrant a rating of 20 percent. The evidence indicates the Veteran experiences moderate constant pain and moderate numbness as well as mild paresthesias and/or dysesthesias of the right lower extremity. The evidence does not indicate that the Veteran experiences symptoms that more nearly approximate moderate severe or severe impairment to warrant a rating higher than 20 percent. At no time has a VA examiner described the Veteran’s radiculopathy as moderately severe or severe. For example, although the Veteran’s muscle strength for the right lower extremity is decreased, he continues to have at least active movement against gravity and there is no muscle atrophy. While sensory examination revealed decreased sensation, it was not absent. Although the Veteran experiences numbness and pain, they are no more than moderate in severity. As such, based on the evidence of record, the Board finds that the Veteran is entitled to a separate 20 percent rating, but no higher, for radiculopathy of the right leg. In making this determination, the Board has considered the Veteran’s statements and all reasonable doubt has been resolved in favor of the Veteran. See Gilbert, 1 Vet. App. at 55. REASONS FOR REMAND 3. Entitlement to a separate compensable rating for erectile dysfunction associated with service-connected lumbar spine strain with degenerative disc disease. 4. Entitlement to a separate compensable rating for fecal urgency, associated with service-connected lumbar spine strain with degenerative disc disease. 5. Entitlement to a separate compensable rating for bladder incontinence, associated with service-connected lumbar spine strain with degenerative disc disease. In a February 2017 VA treatment note, the Veteran reported experiencing symptoms of fecal urgency when he coughed or sneezed and some issues with not being able to achieve an erection. During the May 2017 VA examination, the Veteran complained of erectile dysfunction and bowel and bladder incontinence. The May 2017 VA examiner stated that a review of the medical evidence does not definitively ascertain these symptoms represent cauda equina and/or are due to his lumbar condition. The Board notes this opinion uses the incorrect standard. The VA examiner is reminded that the evidence need not be definitive, and the correct standard is that the evidence need only be in equipoise (at least as likely as not or 50 percent or greater probability). Accordingly, a remand is necessary to obtain an addendum opinion. 6. Entitlement to a TDIU. The Veteran has asserted on several occasions that his lumbar spine disability affects his ability to work. Evidence indicates that the Veteran was working as a barber for at least part of the appeal period, however, the most recent VA examination indicates the Veteran stated he cannot work as a barber due to his back. Medical examinations have indicated that both physical and sedentary employment would be affected by his lumbar spine disability. On remand, development should be conducted to determine whether the Veteran is entitled to a TDIU. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Obtain an addendum opinion for the Veteran’s claimed fecal urgency, bladder incontinence and erectile dysfunction. The claims folder must be made available to the examiner for review. The examiner is asked to review all pertinent records associated with the claims file. The examiner should offer comments and an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability): a) that the Veteran’s fecal urgency is proximately due to or aggravated (beyond a natural progression) by his service-connected lumbar spine disability; b) that the Veteran’s bladder incontinence is proximately due to or aggravated (beyond a natural progression) by his service-connected lumbar spine disability; c) that the Veteran’s erectile dysfunction is proximately due to or aggravated (beyond a natural progression) by his service-connected lumbar spine disability. All opinions must be supported by a clear rationale, and a discussion of the facts and medical principles involved. 3. Appropriately develop the Veteran’s TDIU claim. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hofmeister, Attorney Advisor 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.