Citation Nr: 21011923 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 15-27 126 DATE: March 3, 2021 ORDER Entitlement to a rating higher than 10 percent from January 28, 2011 to November 26, 2013 and higher than 20 percent from January 14, 2019 onward for osteoarthritis of the lumbar spine is denied. Entitlement to a 40 percent rating (but not higher) for osteoarthritis of the lumbar spine is granted from November 27, 2013 to January 13, 2019, subject to the regulations governing the payment of monetary benefits. Entitlement to an initial compensable rating from January 28, 2011 to November 26, 2013, an initial rating higher than 10 percent from November 27, 2013 to November 17, 2020, and higher than 20 percent from November 18, 2020 onward for right lower extremity radiculopathy affecting the sciatic nerve is denied. Entitlement to an initial compensable rating from January 28, 2011 to November 19, 2012, an initial rating higher than 10 percent from November 20, 2012 to November 26, 2013 and higher than 20 percent from November 18, 2020 onward for left lower extremity radiculopathy affecting the sciatic nerve is denied. Entitlement to an initial 20 percent rating (but not higher) from November 27, 2013 to November 17, 2020 for left lower extremity radiculopathy affecting the sciatic nerve is granted, subject to the regulations governing the payment of monetary benefits. Entitlement to a separate initial rating from January 28, 2011 to November 17, 2020 and 20 percent from November 18, 2020 onward for right lower extremity radiculopathy affecting the femoral nerve is denied. Entitlement to a separate initial rating from January 28, 2011 to November 17, 2020 and 20 percent from November 18, 2020 onward for left lower extremity radiculopathy affecting the femoral nerve is denied. Entitlement to service connection for left heel/foot disability, to include as secondary to a service-connected disability is denied. FINDINGS OF FACT 1. For the period from January 28, 2011 to November 26, 2013 osteoarthritis of the lumbar spine at most was limited to 25 degrees of extension with pain; for the period from January 14, 2019 onward osteoarthritis of the lumbar spine at most was limited to 40 degrees of flexion. 2. From November 27, 2013 to January 13, 2019 flexion at most was limited to 20 degrees with pain. 3. From January 28, 2011 to November 26, 2013 right lower radiculopathy affecting the sciatic nerve has not been demonstrated, from November 27, 2013 to November 17, 2020 radiculopathy of the right lower extremity at most was manifested by mild incomplete paralysis of the sciatic nerve and from November 18, 2020 by moderate incomplete paralysis of the sciatic nerve. 4. From January 28, 2011 to November 19, 2012 left lower extremity radiculopathy affecting the sciatic nerve has not been demonstrated, from November 20, 2012 to November 26, 2013 radiculopathy of the left lower extremity at most was manifested by mild incomplete paralysis of the sciatic nerve and from November 18, 2020 onward left lower extremity radiculopathy affecting the sciatic nerve at most was manifested by moderate incomplete paralysis. 5. From November 27, 2013 to November 17, 2020 left lower extremity radiculopathy affecting the sciatic nerve at most was manifested by moderate incomplete paralysis. 6. From January 28, 2011 to November 17, 2020 right lower extremity radiculopathy affecting the femoral nerve was not shown, from November 18, 2020 right lower extremity radiculopathy affecting the femoral nerve at most was manifested by moderate incomplete paralysis. 7. From January 28, 2011 to November 17, 2020 left lower extremity radiculopathy affecting the femoral nerve was not shown, from November 18, 2020 left lower extremity radiculopathy affecting the femoral nerve at most was manifested by moderate incomplete paralysis. 8. A left heel/foot disability is not etiologically related to service, and is not secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 10 percent from January 28, 2011 to November 26, 2013 and higher than 20 percent from January 14, 2019 onward for osteoarthritis of the lumbar spine are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. The criteria for a 40 percent rating (but not higher) from November 27, 2013 to January 13, 2019 for osteoarthritis of the lumbar spine are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 3. The criteria for an initial compensable rating from January 28, 2011 to November 26, 2013, an initial rating higher than 10 percent from November 27, 2013 to November 17, 2020, and an initial rating higher 20 percent from November 18, 2020 for right lower extremity radiculopathy affecting the sciatic nerve are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Code 8520. 4. The criteria for an initial compensable rating from January 28, 2011 to November 19, 2012, an initial compensable rating higher than 10 percent from November 20, 2012 to November 26, 2013, and an initial compensable rating higher than 20 percent from November 18, 2020 for left lower extremity radiculopathy affecting the sciatic nerve are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Code 8520. 5. The criteria for an initial 20 percent rating is met from November 27, 2013 to November 17, 2020 for left lower extremity radiculopathy affecting the sciatic nerve. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for an initial compensable rating from January 28, 2011 to November 17, 2020 and an initial rating higher than 20 percent from November 18, 2020 for right lower extremity radiculopathy affecting the femoral nerve are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Code 8526. 7. The criteria for an initial compensable rating from January 28, 2011 to November 17, 2020 and an initial rating higher than 20 percent from November 18, 2020 for left lower extremity radiculopathy affecting the femoral nerve are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.7, 4.124a, Diagnostic Code 8526. 8. A left heel/foot disability is unrelated to service and was not caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service to include the period from October 1974 to June 1992. The issues on appeal arise from an October 2012 rating decision. In July 2017 the Veteran cancelled his request for a Board hearing. In a rating decision in January 2014 the Regional Office (RO) granted service connection for right lower extremity radiculopathy rated 10 percent disabling effective November 27, 2013 and left lower extremity radiculopathy rated 10 percent disabling effective November 20, 2012. In a rating decision in December 2020 the RO granted a 20 percent rating for osteoarthritis of the lumbar spine effective January 14, 2019, granted a 20 percent rating effective November 18, 2020 for left lower extremity radiculopathy affecting the sciatic nerve, granted a 20 percent rating effective November 18, 2020 for right lower extremity radiculopathy affecting the sciatic nerve, granted a separate 20 percent rating effective November 18, 2020 for left lower extremity radiculopathy affecting the femoral nerve, and granted a separate 20 percent rating effective November 18, 2020 for right lower extremity radiculopathy affecting the femoral nerve. Thus, the issues are characterized as reflected herein. Service connection for a left foot disorder was denied in an October 1992 rating decision and the Board in August 2018 implicitly reopened the claim. Higher Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. 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. In addition, the Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Rating factors for a disability of the musculoskeletal system include functional loss due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion, weakness, excess fatigability, incoordination, pain on movement, swelling, or atrophy. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). In evaluating musculoskeletal disabilities, the VA must determine whether pain could significantly limit functional ability during flare-ups, or when the joints are used repeatedly over a period of time. See DeLuca 8 Vet. App. at 206. Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Court has held that a higher rating can be based on “greater limitation of motion due to pain on use.” See DeLuca 8 Vet. App. at 206. Any such functional loss must be “supported by adequate pathology and evidenced by the visible behavior of the claimant.” 38 C.F.R. § 4.40. The Court also has held, that “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). 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. Issues 1-2: Entitlement to ratings higher than 10 percent prior to January 14, 2019 and higher than 20 percent from January 14, 2019 for osteoarthritis of the lumbar spine. The Veteran’s service-connected osteoarthritis of the lumbar spine is rated under Diagnostic Code 5242, which is part of the General Rating Formula for Diseases or Injuries of the Spine, Diagnostic Codes 5235 to 5243. The code for intervertebral disc syndrome (Diagnostic Code 5243), permits rating under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher rating when all disabilities are combined. 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases or Injuries of the Spine (General Formula), a 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is 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 evaluation is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating, and unfavorable ankylosis of the entire spine warrants a 100 percent rating. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When rated based on incapacitating episodes, a 20 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent rating is warranted 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 60 percent rating is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An “incapacitating episode” is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243. 38 C.F.R. § 4.71a, Diagnostic Code 5235-5243. The normal findings for range of motion of the lumbar spine are from 0 to 90 degrees for forward flexion; 0 to 30 degrees for extension, lateral flexion, and rotation. 38 C.F.R. § 4.71a, Plate V. Note (5) of the General Formula defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in the neutral position (zero degrees) always represents favorable ankylosis. Pursuant to Note (1) of the General Formula, associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are separately evaluated under an appropriate diagnostic code. Effective February 7, 2021 VA’s schedule for rating disabilities of the musculoskeletal system and muscle injuries was amended. See 85 FR 76453, 76463, Nov. 30, 2020. Changes were made to Diagnostic Code 5242 noting that the code pertains to degenerative arthritis and degenerative disc disease other than intervertebral syndrome. As for Diagnostic Code 5243 for intervertebral disc syndrome, this diagnostic code now applies when there is disc herniation with compression and/or irritation adjacent to the nerve root, otherwise a rating is to be assigned for Diagnostic Code 5242 for all other disc diagnoses. The Board is required to consider the claim in light of both the old and new criteria to determine whether an increase is warranted. If the amended rating criteria are favorable to the claim, the amended criteria can be applied only from and after the effective date of the regulatory change. The Veteran does get the benefit of having both the old and new criteria considered for the period after the change was made. VAOPGCPREC 3-2000. The Board has considered the criteria both prior to February 7, 2021 and thereafter in evaluating the Veteran’s service-connected osteoarthritis of the lumbar spine. By way of history, the Veteran’s claim for a higher rating for a back disability was received on January 28, 2011. As will be discussed further below, the evidence does not more nearly approximate a rating higher than 10 percent from January 28, 2011 to November 26, 2013 and higher than 20 percent from January 14, 2019 onward for osteoarthritis of the lumbar spine. Prior to November 26, 2013 the Veteran’s range of motion at most was limited to 25 degrees of extension with pain and from January 14, 2019 onward at most was limited to 40 degrees of flexion. The Board acknowledges that a VA medical record in January 2011 shows that the Veteran met the criteria for a 20 percent rating including due to forward flexion of the thoracolumbar spine being greater than 30 degrees but not greater than 60 degrees. However, on VA back examination in June 2010, the findings do not support a higher rating. The examiner noted that the Veteran reported stiffness, fatigue, spasms, decreased motion and paresthesia. The Veteran denied having bladder or bowel problems. He reported moderate radiating pain to the left hip. During flare-ups he experienced neither functional impairment nor any limitation of motion. He denied incapacitation in the last 12 months. Physical evaluation shows there was no radiating pain on movement. Muscle spasm was absent and there was no guarding and weakness. There was no ankylosis. Flexion was zero to 90 degrees, extension, right and left lateral flexion, right and left rotation were zero to 30 degrees. The examiner determined that joint function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. Inspection of the spine shows normal head position with symmetry. There was symmetry of spinal motion with normal curves of the spine. On VA back examination in June 2012, the examiner noted that the Veteran reported flare-ups impacting his ability to stand for long periods of time, bend, or walk. Flexion was 90 degrees without pain. Extension was 30 degrees with pain at 25 degrees; right and left lateral flexion and right and left lateral rotation were 30 degrees with no pain. The Veteran was able to perform repetitive-use testing with range of motion almost remaining unchanged or better. The examiner determined that the Veteran did not have additional limitation of range of motion following repetitive use. He did have functional loss due to pain on movement. He did not have guarding on muscle spasm of the thoracolumbar spine. The examiner determined that the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine. As for the period from January 14, 2019 onward, on VA back examination in January 14, 2019, the examiner noted that the Veteran did not report flare-ups. The Veteran reported difficulty sitting and standing for long periods of time. Range of motion findings show that forward flexion was zero to 45 degrees and extension was zero to 10 degrees. The examiner noted there was pain that did not result in functional loss. There was no pain with weight bearing. Upon repetitive use range of motion findings were almost unchanged. The examiner found that there was no ankylosis nor any other neurologic abnormalities or findings related to the thoracolumbar spine. The examiner determined that the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine. The examiner noted that passive range of motion of the lumbar spine could not be performed and there was evidence of pain in non-weight bearing. An addendum in April 2019 shows the Veteran was able to perform repetitive use testing with at least three repetitions and there was additional loss of function or range of motion after three repetitions affected by pain. Range of motion after three repetitions was zero to 45 degrees flexion, extension was zero to 10 degrees, right and left lateral flexion and rotation were zero to 20 degrees. The examiner indicated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner commented that range of motion after three repetitions was significantly reduced. On VA back examination in November 2020, the Veteran complained of flare-ups with activity. Flexion was zero to 40 degrees extension was zero to 5 degrees with pain. There was pain with weight bearing. The examiner found that there was no objective evidence of pain on non-weight bearing and passive range of motion could not performed or was not medically appropriate. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion. Pain and lack of endurance significantly limited functional ability with repeated use over a period of time causing flexion to be 40 degrees and extension 5 degrees. The examiner found that lack of endurance significantly limited functional ability with flare-ups causing flexion to be 40 degrees, extension to be 5 degrees. The Veteran had guarding or muscle spasm which did not result in abnormal gait or abnormal spinal contour. There was no guarding. The examiner determined that there was no ankylosis and that the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine. As for the period from November 27, 2013 to January 13, 2019 for osteoarthritis of the lumbar spine entitlement to a 40 percent (but not higher) for osteoarthritis of the lumbar spine is more nearly approximated as the evidence shows that at most the Veteran had flexion limited to 20 degrees with pain. Notably, the evidence does not show ankylosis and findings show that the Veteran retained motion on every plane. On VA back examination on November 27, 2013, the Veteran did not report flare-ups. Flexion was 90 degrees with pain at 20 degrees. Extension was 30 degrees with no pain. Right lateral flexion was 30 degrees with pain at 20 degrees. Left lateral flexion was 30 degrees with pain at 10 degrees. Right and left lateral flexion was 30 degrees with no pain. The examiner determined that the Veteran did not have additional limitation of range of motion of the thoracolumbar spine following repetitive use. The Veteran had functional impairment due to pain on movement. He did not have guarding or muscle spasm of the thoracolumbar spine. The examiner determined that the Veteran did not have intervertebral disc syndrome of the lumbar spine. The examiner commented that the Veteran’s gait and posture were within normal limits. There were contributing factors of pain, weakness, fatigability and/or incoordination but no additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. The above findings are consistent with the other competent evidence of record. To the extent that the Veteran may believe that he is entitled to higher ratings, the Board finds the objective medical findings by skilled professionals are more persuasive which, as discussed above, do not support a rating higher than the rating being granted herein. Thus, the preponderance of the evidence is against the claim for a rating higher than 10 percent from January 28, 2011 to November 26, 2013 and higher than 20 percent from January 14, 2019 onward for osteoarthritis of the lumbar spine, and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 40 percent rating for osteoarthritis of the lumbar spine from November 27, 2013 to January 13, 2019 are more nearly approximated. 38 U.S.C.§ 5107(b). The Board notes that in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. In Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016) the Court held that for musculoskeletal disabilities, the examination report must indicate if range of motion testing was done in both active and passive motion, and in weight-bearing and non-weight-bearing positions. To the extent that there are any deficiencies in examinations prior to the most recent VA examination in November 2020, the Board finds that a remand for further development would serve no useful purpose as it is not feasible to expect an examiner to be able to provide retrospective opinions to address the concerns raised in Sharp and Correia. Issues 3-7: Entitlement to initial rating higher than 10 percent prior to November 18, 2020 and 20 percent thereafter for right lower extremity radiculopathy affecting the sciatic nerve; entitlement to an initial rating higher than 10 percent prior to November 18, 2020 and 20 percent from November 18, 2020 onward for left lower extremity radiculopathy affecting the sciatic nerve; and entitlement to a separate initial rating prior to November 18, 2020 and 20 percent thereafter for right and left lower extremity radiculopathy affecting the femoral nerve. The Veteran’s radiculopathy in the lower extremities affecting the sciatic nerve is rated under Diagnostic Code 8520. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; moderately severe incomplete paralysis is rated 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. With complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of the knee weakened or (very rarely) lost, is rated 80 percent disabling. 38 C.F.R. § 4.124a. The Veteran’s radiculopathy in the lower extremities affecting the femoral nerve is rated under Diagnostic Code 8526. Under Diagnostic Code 8526, a 10 percent rating is warranting for mild incomplete paralysis, a 20 percent rating is warranted for moderate incomplete paralysis; a 30 percent rating is warranted for severe incomplete paralysis; and a 40 percent rating is warranted for complete paralysis of quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8526. It is noted that the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement, when bilateral combine with application of the bilateral factor. 38 C.F.R. § 4.124a. These descriptive words “mild,” “moderate,” “moderately severe” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Use of terminology such as “severe” by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. As discussed above, Pursuant to Note (1) of the General Formula for rating disabilities of the spine, associated objective neurologic abnormalities are separately evaluated under an appropriate diagnostic code. In the instant case ratings radiculopathy of the lower extremities affecting the sciatic nerve and femoral nerve are associated with osteoarthritis of the lumbar spine. Given that the Veteran’s claim for a higher rating for osteoarthritis of the lumbar spine was received on January 28, 2011, evidence of neurological impairment of the lower extremities for consideration is from January 28, 2011 to the present. Based on the evidence of record, and for the reasons discussed further below, the evidence does not more nearly approximate an initial compensable rating from January 28, 2011 to November 26, 2013, an initial rating higher than 10 percent from November 27, 2013 to November 17, 2020 and higher than 20 percent from November 18, 2020 onward for right lower extremity radiculopathy affecting the sciatic nerve as prior to November 27, 2013 radiculopathy was not shown, from November 27, 2013 it was evaluated at most as mildly impaired and from November 18, 2020 it was evaluated as moderately impaired. The evidence does not more nearly approximate an initial compensable rating from January 28, 2011 to November 19, 2012, an initial rating higher than 10 percent from November 20, 2012 to November 26, 2013 and higher than 20 percent from November 18, 2020 onward for left lower extremity radiculopathy affecting the sciatic nerve. Prior to November 20, 2012 radiculopathy was not shown and from November 20, 2012 to November 26, 2013 was not shown to cause moderate incomplete paralysis. An initial 20 percent rating (but not higher) from November 27, 2013 to November 17, 2020 for left lower extremity radiculopathy affecting the sciatic nerve is more nearly approximated. While a January 2019 VA examination evaluated radiculopathy of the left lower extremity affecting the sciatic nerve as mildly impaired, on VA examination on November 27, 2013 the Veteran complained of left leg sciatica with pain, which was being treated with steroid injections, and the examiner opined that it was moderately impaired. The evidence during the appeal period does not show that radiculopathy of the left lower extremity affecting the sciatic nerve has been more than moderately impaired. As for the femoral nerve, the criteria for a separate initial rating from January 28, 2011 to November 17, 2020 and higher than 20 percent from November 18, 2020 onward for right and left lower extremity radiculopathy affecting the femoral nerve are not approximated as the evidence does not show impairment of the femoral nerve in the lower extremities prior to November 18, 2020 and from November 18, 2020 at most shows that there has been moderate impairment. On VA back examination in June 2010, neurological evaluation of the lumbar spine shows no sensory deficits. The evaluation of the sacral spine show no sensory deficits. There was no lumbosacral motor weakness. The bilateral lower extremity reflexes reveal knee jerk 2+ and ankle jerk 2+. The examiner determined that there were normal cutaneous reflexes. On VA back examination in June 2012, muscle strength testing, reflex exam, and sensory exam were normal in the lower extremities. Straight leg testing was normal in the lower extremities and the examiner determined that there was no radiculopathy. On VA back examination on November 27, 2013, the Veteran complained of left leg sciatica with pain, which was being treated with steroid injections. Muscle strength testing and reflex exam in the lower extremities was normal. Sensory exam was decreased in the lower extremities, including in the upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. There was bilateral decrease in pin prick. Straight leg raising test was negative in the right extremity and positive in the left extremity. The Veteran had bilateral radiculopathy. Although there was no constant pain nor intermittent pain, he had moderate paresthesias and/or dysesthesias in the right lower extremity and mild in the left lower extremity. He had mild numbness in the right lower extremity and moderate numbness in the left lower extremity. The examiner opined that the sciatic nerve was impaired resulting in mild radiculopathy on the right side and moderate radiculopathy on the left side. On VA back examination on January 14, 2019, muscle strength testing was normal in the lower extremities. Reflex exam was hypoactive in the lower extremities. Sensory exam was normal in the lower extremities. As for radiculopathy, there was mild intermittent pain and numbness in the left lower extremity. There was no constant pain in the lower extremities nor paresthesias and/or dysesthesias. There was no intermittent pain nor numbness in the right lower extremity. The examiner opined that the sciatic nerve was impaired with mild radiculopathy in the left lower extremity. The examiner determined that the right lower extremity was not affected. On VA back examination in November 2020, muscle strength testing on the right side was 5/5 hip flexion, 5/5 knee extension, 4/5 ankle plantar flexion, 4/5 ankle dorsiflexion, and 5/5 great toe extension. On the left side muscle strength testing was 5/5 for hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. Reflex exam was normal in the knees and ankles. Sensory exam on both the right side and left side was decreased in the upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. As for radiculopathy, the examiner indicated that there was mild constant pain in the left lower extremity, severe intermittent pain in the left lower extremity, moderate paresthesias and/or dysesthesias in both lower extremities, and moderate numbness in both lower extremities. The examiner determined that there was moderate impairment of the femoral nerve and moderate impairment of the sciatic nerve in both lower extremities. The above findings are consistent with the other competent evidence of record. To the extent that the Veteran may believe that he is entitled to higher ratings, the Board finds the objective medical findings by skilled professionals are more persuasive which, as discussed above, do not support a higher rating that is not being granted herein. Thus, the preponderance of the evidence is against the claim for an initial compensable rating from January 28, 2011 to November 26, 2013, an initial rating higher than 10 percent from November 27, 2013 to November 17, 2020, and higher than 20 percent from November 18, 2020 onward for right lower extremity radiculopathy affecting the sciatic nerve; an initial compensable rating from January 28, 2011 to November 19, 2012, an initial rating higher than 10 percent from November 20, 2012 to November 26, 2013, and higher than 20 percent from November 18, 2020 onward for left lower extremity radiculopathy affecting the sciatic nerve; and, separate initial compensable ratings from January 28, 2011 to November 17, 2020 and higher than 20 percent from November 18, 2020 onward for right and left lower extremity radiculopathy affecting the femoral nerve. 38 U.S.C.§ 5107(b). Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for an initial 20 percent rating (but not higher) from November 27, 2013 to November 17, 2020 for left lower extremity radiculopathy affecting the sciatic nerve are more nearly approximated. 38 U.S.C.§ 5107(b). Issue 8: Entitlement to service connection for left heel/foot disability, to include as secondary to a service-connected disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another condition. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). The Veteran contends that he has a left foot disability due to service as he indicated that he was treated for foot problems during service. See, e.g., July 2015 Form 9 Appeal. As will be discussed further below, an opinion was also obtained as to whether his left foot disability is secondary to his service-connected right achilles tendonitis. Service treatment records show that in July 1989 the examiner indicated that the Veteran injured his achilles tendon running a year earlier and had pain with running and walking. In March 1980 he sprained his left foot. In March 1981 he complained of pain in his left foot. A service treatment record dated on July 31, 1981 shows documented left heel pain that hurt on ambulation. The assessment was swelling and tenderness. In November 1982 the Veteran was treated for a bruise on the plantar aspect of the foot. Bilateral tendonitis and chronic left heel pain were documented on October 7, 1987 and September 3, 1987. In September 1988 and onward the Veteran had a diagnosis of bilateral achilles tendonitis. The retirement examination in March 1992 evaluated the Veteran’s feet as normal. On the accompanying Report of Medical History the Veteran reported foot trouble, which the examiner associated with back pain radiating to the lower extremity. After service, VA treatment records including in January 2006 and March 2015 show chronic left achilles tendinitis. On VA examination for the left foot in June 2012, the diagnoses were plantar fascitis and calcaneal spur, left heel. The examiner noted that date of onset of symptoms was in 1984. The Veteran reported that the disorder began while playing combat football in Panama. In an accompanying opinion the examiner opined that it is less likely than not that the left foot disorder was incurred in or caused by service based on the rationale that the Veteran’s current left calcaneal spurs were not present during active service and x-rays of the left foot were within normal limits. In a January 2018 VA opinion the examiner opined that the Veteran’s left achilles tendonitis is less likely than not proximately due to or the result of the Veteran’s service-connected right achilles tendonitis. The examiner noted that while the Veteran was treated for achilles tendonitis during service and reported foot problems upon retirement from service the examination was negative for a diagnosis of achilles tendonitis. The examiner noted that VA treatment records in February 2015 show the Veteran complained of bilateral achilles tendon pain since the 1970s. However a MRI (dated in December 2014) did not show left achilles tendinitis or tear. The examiner explained that medical literature shows that achilles tendonitis develops from repetitive stress to the tendon from overuse and also can occur as a result of arthritis due to age. The examiner found it significant that the literature search does not show that achilles tendonitis in one foot will lead to or cause tendonitis in the opposite extremity. The examiner opined that the left achilles tendonitis most likely resulted from overuse. The examiner opined that left achilles tendonitis is less likely than not proximately due to or the result of the Veteran’s service-connected right achilles tendonitis. While the examiner did not use the term “aggravation” the overall context of the examiner’s opinion shows that the Veteran’ left achilles tendonitis was less likely than not aggravated by his service-connected right achilles tendonitis as the examiner after reviewing the medical literature concluded that the achilles tendonitis in one foot will not “lead” to tendonitis in the other extremity. Thus the Board finds that the January 2018 VA opinion also shows that left achilles tendonitis was not aggravated by the service-connected right achilles tendonitis. Medical reports must be read as a whole and in the context of the evidence of record. See Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012). On VA ankle examination in November 2020, the diagnosis was left ankle lateral collateral ligament sprain. On VA foot examination in November 2020, the diagnosis was residuals of stone bruise left heel with tendonitis. To the extent the opinion was based on a factually inaccurate rationale and addendum opinion was obtained in December 2020. In an addendum opinion in December 2020, the examiner opined that the left foot disability is not related to service as there were no continued complaints until 2002. The examiner noted that the Veteran was on active duty from November 1971 to June 1992. A January 2018 VA examination reports onset of symptom in the 1970’s. A service treatment record dated on July 31, 1981 shows documented left heel pain that hurt on ambulation. A service treatment record dated on July 20, 1989 shows edema and tenderness to palpitation to achilles. Bilateral tendonitis and chronic left heel pain were documented on October 7, 1987 and September 3, 1987. VA records dated on December 13, 2017 and January 10, 2018 showed documented left achilles pain as early as 2002 and 2003. However, the VA examiner found it significant that the 2014 MRI of the left calcaneus demonstrated no evidence of fracture but there were achilles and plantar calcaneal enthesophytes. The examiner reiterated that the record showed no continued complaints from separation through 2002. Thus, the examiner opined that the Veteran’s left foot disability, to include residuals of stone bruise left heel with tendonitis and left ankle lateral collateral ligament sprain, was less likely than not (less than 50 percent probability) incurred in or caused by the left heel pain and achilles tendonitis during service. The Board finds the June 2012, January 2018, and December 2020 VA opinions regarding direct and secondary service connection to be probative as they were based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The examiners considered the nature of the Veteran’s disability in proffering the opinions. The opinions are uncontroverted by the other competent evidence of record. As a lay person, the Veteran is competent to report symptoms pertaining to his left heel/foot disability and the Board finds his statements to be credible. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of the left heel/foot disability falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran’s disability is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran or his spouse received any special training or acquired any medical expertise in evaluating such disorder. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. Accordingly, because the preponderance of the evidence is against the claim of service connection for a left heel/foot disability, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.