Citation Nr: 21011705 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 18-38 317 DATE: March 2, 2021 ORDER Entitlement to a rating in excess of 20 percent disabling for service-connected low back disability is denied. Entitlement to a rating in excess of 10 percent disabling for service-connected left lower extremity radiculopathy is denied. Entitlement to a rating in excess of 10 percent disabling for service-connected right lower extremity radiculopathy is denied. FINDINGS OF FACT 1. The Veteran’s low back disability has manifested with painful motion and corresponding functional impairment, and more nearly approximates limitation of forward flexion of the thoracolumbar spine of greater than 30 degrees but not greater than 60 degrees; or a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; without more severe manifestations; there is no evidence of ankylosis or incapacitating episodes having a total duration of 4 weeks or more during the past 12 months. 2. The Veteran’s left lower extremity radiculopathy has manifested with no more than mild incomplete paralysis. 3. The Veteran’s right lower extremity radiculopathy has manifested with no more than mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent disabling for service-connected low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5242-5243. 2. The criteria for a rating in excess of 10 percent disabling for service-connected lower left extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8620. 3. The criteria for a rating in excess of 10 percent disabling for service-connected lower right extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8620. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 2002 to March 2003, July 2003 to June 2004 and in January 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, VA. The Veteran testified at a Board videoconference hearing before the undersigned in February 2020. The Veteran’s claims were previously remanded by the Board in a February 2020 decision. The Board finds that the RO has substantially complied with the February 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and an increase in the disability rating is at issue, it is a present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The Court has held that, in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the Veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, are expected in all instances. 38 C.F.R. § 4.21. 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. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). 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. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 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. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. When 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Entitlement to a rating in excess of 20 percent disabling for service-connected low back disability is denied. The Veteran contends that he is entitled to a higher rating because of his functional difficulties with prolonged sitting, standing, and walking. The Veteran’s lumbar spondylolisthesis L5-S1 (due to bilateral pars defects) with laminectomy and fusion, intervertebral disc syndrome and chronic low back pain (lower back disability) is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5242 and 5243. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic codes indicate that the Veteran’s low back disability is rated, by analogy, under the criteria for degenerative arthritis of the spine, which is evaluated under either the General Rating Formula for Rating Diseases and Injuries of the Spine (5235-5243) or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (5243). Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca, 8 Vet. App. at 202; see also Mitchell, 25 Vet. App. at 44. Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton, 25 Vet. App. at 1. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for lumbar spondylolisthesis L-5-S1 (due to bilateral pars defects) with laminectomy and fusion, intervertebral disc syndrome and chronic low back pain under the General Rating Formula. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to difficulty walking, inability to bend, intermittent flare-ups, and constant back pain. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that 2 flare ups a week would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Turning to the evidence of record, the Veteran’s VA and private medical records reveal ongoing treatment for lower back pain, hip pain, and radiculopathy throughout the appeal period. The Veteran was afforded a VA examination in May 2017. The examiner noted diagnoses of lumbar spondylolisthesis L5 - S1 with laminectomy and fusion and chronic low back pain. The Veteran reported difficulty with mobility, incapacitation to bed, and inability to walk or bend, and flare-ups causing him to “feel like I have a balloon in my back with constant spasms.” On initial range of motion testing, the Veteran had forward flexion of 0 to 75 degrees, extension of 0 to 30 degrees, bilateral lateral flexion of 0 to 30 degrees, and bilateral lateral rotation of 0 to 30 degrees. The examiner indicated that the range of motion itself does constitute a functional loss because of limited forward flexion. The examiner also noted pain on exam that causes functional loss with forward flexion. There was not localized tenderness or pain with palpation. 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. The examiner indicated pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner indicated that he could not determine whether the Veteran’s pain, weakness, fatigability, and incoordination would limit his functional ability during a flare-up because the Veteran was not experiencing a flare-up. The Veteran did not have guarding or muscle spasm. There were no additional factors contributing to disability. Muscle strength testing was normal, no muscle atrophy noted, reflexes were normal 2+ in the bilateral knees and absent in the ankles. A sensory examination was normal except for decreased sensation to light touch in the feet/toes (L5) bilaterally. Straight leg test was negative bilaterally. There was no ankylosis of the spine. The Veteran has been diagnosed with IVDS but had not had any episodes requiring bed rest prescribed by a physician in the past 12 months. The Veteran did not report the use of an assistive device. The examiner indicated there would be functional impacts with bending and intermittent difficulties with walking. The examiner noted evidence of pain on passive range of motion testing, and no evidence of pain when the joint is used in non-weightbearing. The Veteran was afforded another VA examination in March 2018. The examiner noted diagnoses of residuals of L5-S1 laminectomy, lumbar spondylolisthesis, IVDS, and chronic low back pain. The Veteran reported constant back pain of 6/10 increasing in intensity with movement and activity. The Veteran reported that repeated use over the course of a usual day does not cause increased pain, but a vigorous day does cause pain to increase to 8/10. On initial range of motion testing, the Veteran had forward flexion of 0 to 40 degrees, extension of 0 to 20 degrees, bilateral lateral flexion of 0 to 15 degrees, and right lateral rotation of 0 to 20 degrees, and left lateral rotation of 0 to 15 degrees. The examiner indicated that the range of motion itself does constitute a functional loss because the Veteran is unable to make normal movements such as fully bending over. The examiner also noted pain on exam that causes functional loss in all planes. There was localized tenderness or pain with palpation. The Veteran was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or range of motion. The examiner indicated pain would significantly limit functional ability with repeated use over a period of time. The examiner indicated that the Veteran’s pain would limit his functional ability during a flare-up. Specifically, the examiner indicated the Veteran reported he would continue to experience pain persistently for two or three days after a flare up which occur approximately twice a week. The Veteran did not have guarding or muscle spasm. There were no additional factors contributing to disability. Muscle strength testing was normal, no muscle atrophy noted, reflexes were normal 2+. A sensory examination was normal. Straight leg test was negative bilaterally. The Veteran was positive for radicular symptoms resulting in mild constant pain, mild paresthesias, and/or dysesthesias, and mild numbness bilaterally. The Veteran’s radiculopathy was rated as mild bilaterally. There was no ankylosis of the spine. The Veteran has IVDS with episodes of bed rest having a total duration of at least two weeks but less than four weeks during the last twelve months requiring bed rest prescribed by a physician. The Veteran did not report the use of an assistive device. The examiner indicated there would be functional impacts including occupational tasks that require the use of the back or physical effort including prolonged standing, walking, climbing or lifting. The examiner also noted that pain would impact the Veteran’s ability to be successful in any position that requires focus, concentration, or interacting with others. The examiner indicated he believed Correia issues were inapplicable to spinal conditions as there was no way to safely do the required testing. The examiner noted the Veteran is in constant pain in both weight-bearing and non-weight-bearing situations. The Veteran again underwent a VA examination in May 2018. The examiner noted diagnoses of residuals of L5-S1 laminectomy (fusion procedure), lumbar spondylolisthesis, IVDS, and degenerative joint disease of the spine, sacroiliac joint dysfunction, and radiculopathy. The Veteran reported that repeated use over time in some situations causes flare ups from baseline symptoms. He reported constant back pain that occasionally will interrupt his sleep. On initial range of motion testing, the Veteran had forward flexion of 0 to 40 degrees, extension of 0 to 20 degrees, bilateral lateral flexion of 0 to 15 degrees, and right lateral rotation of 0 to 20 degrees, and left lateral rotation of 0 to 15 degrees. The examiner indicated that the Veteran is unable to bend over. The examiner also noted pain on exam that causes functional loss in all planes. There was evidence of pain with weight bearing. There was localized tenderness or pain with palpation. 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. The examiner indicated pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner indicated that the Veteran’s pain, weakness, fatigability, and incoordination would limit his functional ability during a flare-up. The Veteran did not have guarding or muscle spasm. There were no additional factors contributing to disability. Muscle strength testing was normal, no muscle atrophy noted, reflexes were normal 2+. A sensory examination was normal. Straight leg test was negative bilaterally. The Veteran had symptoms of radiculopathy including mild constant pain bilaterally, mild paresthesias and/or dysesthesias bilaterally, and mild numbness bilaterally with involvement of the sciatic nerve. The examiner indicated the Veteran’s radiculopathy was mild bilaterally. There was no ankylosis of the spine. The Veteran has IVDS episodes of bed rest prescribed by a physician having a total duration of at least 2 weeks but less than 4 weeks in the past 12 months. The Veteran did not report the use of an assistive device. The examiner indicated there would be functional impacts on occupational tasks requiring the use of the back. Due to reported worsening, the Veteran was afforded an updated VA examination in July 2020. The examiner noted diagnoses of left lower extremity radiculopathy; lumbar spondylolisthesis l-5-s1 (due to bilateral pars defects) with laminectomy and fusion, intervertebral disc syndrome and chronic low back pain; right lower extremity radiculopathy and SI joint dysfunction. The Veteran reported persistent back pain in his lower back radiating into his bilateral lower extremities at 5/10 worsening with prolonged sitting, standing, walking, standing, or climbing stairs. The Veteran reported random acute exacerbations every 2-3 months requiring 2-3 weeks to recover. On initial range of motion testing, the Veteran had forward flexion of 0 to 65 degrees, extension of 0 to 25 degrees, bilateral lateral flexion of 0 to 30 degrees, and bilateral lateral rotation of 0 to 30 degrees. The examiner indicated that the range of motion itself does not constitute a functional loss. The examiner also noted pain on exam that does not cause functional loss with forward flexion and extension. There was moderate localized tenderness or pain with palpation along the muscles of the lumbosacral spine. 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. The examiner indicated pain would significantly limit functional ability with repeated use over a period of time. The examiner indicated that the Veteran’s pain would limit his functional ability during a flare-up. The examiner further indicated that the Veteran would have reduced range of motion after repetitive use over time or during a flare-up including 0 to 55 degrees of forward flexion and 0 to 20 degrees of extension. The Veteran did not have guarding or muscle spasm. There were no additional factors contributing to disability. Muscle strength testing was normal, no muscle atrophy noted, reflexes were normal 2+. A sensory examination was normal except for decreased sensation to light touch in the bilateral thighs/knees (L3/4). The Veteran had signs or symptoms of radiculopathy including moderate constant pain bilaterally, mild paresthesias and/or dysesthesias, and mild numbness bilaterally. The examiner noted involvement of the sciatic nerve bilaterally. The examiner indicated the Veteran’s radiculopathy was mild bilaterally. Straight leg test was negative bilaterally. There was no ankylosis of the spine. The Veteran has IVDS but has not had any episodes requiring bed rest prescribed by a physician in the past 12 months. The Veteran reported regular use of a back brace for his lower back pain. The examiner indicated there would be functional impacts with employment that required physical activity to include walking, standing, climbing stairs, or sitting for an extended period. The examiner noted no evidence of pain on passive range of motion testing, passive range of motion the same as active, and no evidence of pain when the joint is used in non-weightbearing. The Board finds that, when applying the General Rating Formula to the Veteran’s service-connected low back disability, the evidence does not warrant a rating in excess of 20 percent disabling. There have been no findings of forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine to warrant a 40 percent rating. The most restrictive range of motion found during the March 2018 and July 2020 VA examinations, which showed forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. The Veteran has reported chronic low back pain, and, thus, the Board recognizes the application of 38 C.F.R. §§ 4.40, 4.45, and Deluca. However, a higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant a rating in excess of 20 percent. In the range of motion testing of record, pain was elicited at the limits of forward flexion, however it was noted that the pain itself did not result in or cause functional loss. The examiners further noted that the Veteran could do repetitive motion testing and there was either mild or no additional loss of function or range of motion after repetition. In sum, there is no objective evidence that flare-ups result in loss of range of motion meeting the criteria for a rating in excess of 20 percent. Again, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss but does not itself constitute functional loss. See Mitchell, supra. In this case, no additional functional loss has been caused by pain. Therefore, a rating in excess of 20 percent is not warranted based on limitation of motion. The Board has also considered whether it may be appropriate to rate the Veteran’s service-connected low back disability under other diagnostic codes, but finds that no higher ratings are warranted. The evidence of record reflects that the Veteran had one reported incidence of muscle spasm in 2018, but no abnormal gait or abnormal spine contour. With respect to neurological abnormalities pursuant to Note (1) of the General Rating Formula for Disease and Injuries of the Spine, the Veteran has already been granted service connection for bilateral lower extremity radiculopathy, which is discussed separately below. Furthermore, the Board also notes that the Veteran has been separately service connected for issues relating to his SI dysfunction. Finally, the record does not suggest and the Veteran does not contend that he suffers from related bowel or bladder problems. A rating is also not warranted based on incapacitating episodes. See 38 C.F.R. § 4,81a, Diagnostic Code 5243. The March 2018 VA examiner indicated the Veteran had IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months, but a review of the record does not reveal physician prescribed bed rest of greater than 4 weeks. Therefore, the Board finds that a rating in excess of 20 percent disabling is not warranted for the Veteran’s low back disability. Based on the foregoing, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent disabling for service-connected low back disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Entitlement to ratings in excess of 10 percent disabling for service-connected left and right lower extremity radiculopathy is denied. The Veteran contends that he is entitled to ratings higher than those he is currently assigned for his service-connected bilateral lower extremity radiculopathy. The Veteran’s bilateral lower extremity radiculopathy is currently rated as 10 percent disabling under Diagnostic Code 8620. 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. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which 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 Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for bilateral lower extremity radiculopathy. Turning to the evidence of record, the Veteran underwent VA examinations for his bilateral lower extremity radiculopathy in May 2017, March 2018, May 2018, and July 2020 as discussed above. Regarding impairment of motor functions, VA examinations have consistently shown normal (5/5) strength in hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. Regarding trophic changes, the Veteran has not reported any trophic changes. Regarding sensory disturbance, the Veteran had decreased feet/toes (L5) light touch sensation during the May 2017 VA examination and had decreased sensation to light touch in the bilateral thighs/knees (L3/4) during the July 2020 examination. Regarding loss of reflexes, the Veteran had absent ankle reflexes during his May 2017 examination, but normal reflexes in March 2018, May 2018, and July 2020. Regarding pain, throughout the appeal period, the Veteran reported mild to moderate constant pain, no intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness with involvement of the sciatic nerve. The March 2018, May 2018, and July 2020 examiners indicated the Veteran’s radiculopathy was of mild severity. Regarding muscle atrophy, there is no evidence of muscle atrophy in the record. Regarding complete paralysis, there is no evidence of complete paralysis of the lower extremities in the record. Based on the above, the Board finds that the Veteran’s disability is primarily manifest by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis. The Board acknowledges that the Veteran uses an assistive device due to his lower back pain. However, 38 C.F.R. § 4.120 “contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker.” Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). Accordingly, the Board finds that ratings in excess of 10 percent disabling are not warranted for the Veteran’s bilateral lower extremity radiculopathy. Other Considerations The Board has considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable for each disability throughout the appeal. Therefore, assigning staged ratings for such disabilities is not warranted. In assessing the severity of the disabilities under consideration, the Board has considered the Veteran’s assertions regarding his symptoms, which he is certainly competent to provide. See, e.g. Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings require medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher ratings pursuant to any applicable criteria at any point pertinent to this appeal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claims for increased ratings, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Julie C. Unger Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Taylor, 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.