Citation Nr: 21012642 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 17-43 540 DATE: March 4, 2021 ORDER A rating in excess of 10 percent for bilateral plantar fasciitis prior to August 18, 2020 is denied. A rating in excess of 30 percent for bilateral plantar fasciitis prior from August 18, 2020 is denied. A rating in excess of 40 percent for a low back condition is denied. REMANDED Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Prior to August 18, 2020, the Veteran’s bilateral plantar fasciitis manifested by moderate symptoms, to include pain, spasms, and swelling. 2. From August 18, 2020, the Veteran’s bilateral plantar fasciitis did not manifest with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement with severe spasm of the tendon Achilles on manipulation not improved by orthopedic shoes or appliances. 3. The Veteran’s low back disability has not manifested by unfavorable ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. Prior to August 18, 2020, the criteria for a disability rating in excess of 10 percent for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276 (2020). 2. From August 18, 2020, the criteria for a disability rating in excess of 30 percent for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276 (2020 & 85 Fed. Reg. 76,453, 76,463 (Nov. 30, 2020)). 3. The criteria for a disability rating in excess of 40 percent for a low back disability are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, DC 5242 (2020 & 85 Fed. Reg. 76,453, 76,463 (Nov. 30, 2020)). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1996 to October 1998. This matter is on appeal from a March 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, a hearing was held before the undersigned. A transcript of the hearing is in the record. In March 2020, the Board remanded the appeal for further development. During the pendency of this appeal, the RO granted the appellant’s claim for entitlement to service connection for a bilateral knee disability in a September 2020 rating decision. As such, the issue has been resolved and is no longer in appellate status before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). Increased Rating In general, disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity caused by a given disability, and separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 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 there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. For example, lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing observable symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In both initial and increased rating claims, the Board must consider staged ratings for the entire period on appeal. A staged rating is appropriate when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings under the applicable diagnostic code. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). The potential for staged ratings accounts for the possible dynamic nature of a disability while the claim works its way through the adjudication process. Id. The Board has therefore considered the claim on appeal with the potential for a staged rating in mind. Bilateral Plantar Fasciitis The Veteran contends that she is entitled to an increased rating for her service-connected bilateral plantar fasciitis. The disability is evaluated under Diagnostic Code (DC) 5276 as 10 percent disabling prior to August 18, 2020 and 30 percent thereafter. The most common symptom of plantar fasciitis is heel pain, which is rated by analogy to pes planus under Diagnostic Code 5276. See Fenderson v. West, 12 Vet. App. 119, 122 (1999) (defining plantar fasciitis as inflammation of the sole of the foot, associated with eosinophilia, edema, and swelling) (citing DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 609-10, 1300 (28th ed. 1994). Under Diagnostic Code 5276 for flatfoot, a 10 percent rating is assigned for moderate flatfoot, characterized by weight-bearing line over or medial to the great toe, inward bowing of the tendon achilles, pain on manipulation and use of the feet, either bilateral or unilateral. A 30 percent schedular rating is assigned for bilateral severe flatfoot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A maximum 50 percent schedular rating is assigned for pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendon Achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. Although the 50 percent rating for pronounced flat feet also references “marked pronation,” the criteria go on to include extreme tenderness of the plantar surfaces, “marked inward displacement and severe spasm” of the Achilles tendon on manipulation, not improved by orthopedic shoes or appliances. Id. In other words, although the rating criteria are not clearly successive in nature, marked pronation alone is not sufficient to rise to the level of a 50 percent rating because it is also contemplated by the 30 percent rating. Cf. Tatum v. Shinseki, 23 Vet. App. 152, 155-56 (2009). Further, some of the criteria for a rating of 50 percent under Diagnostic Code 5276 are in the conjunctive, using the word “and”; therefore, all such criteria must be present and 38 C.F.R. § 4.7 cannot circumvent the need to show all required criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). When assessing the severity of a musculoskeletal disability that is at least partly rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare ups”) due to the extent of pain (and painful motion), weakness, premature or excess fatigability, and incoordination. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see 38 C.F.R. §§ 4.40, 4.45, 4.59. While Diagnostic Code 5276 is not based on limitation of motion, the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of § 4.59 indicates that the regulation is not limited to the evaluation of musculoskeletal disabilities under diagnostic codes predicated on range of motion measurements. See Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The rating criteria used to evaluate the feet were revised effective February 7, 2021. The revisions added Diagnostic Code 5269 to evaluate plantar fasciitis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5269). From the effective date of the revisions, the Veteran could be entitled to a rating under these criteria. Diagnostic Code 5269 provides for a 30 percent rating where there is bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Note (1) provides that where there is actual loss of use of the foot, a 40 percent evaluation should be assigned. Note (2) states that if a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 or 30 percent criteria, whichever is applicable. “Loss of use of the foot” is defined as no effective function remaining other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination is made on the basis of the actual remaining function of balance, propulsion, etc., which could be accomplished equally well by an amputation stump with prosthesis. 38 C.F.R. § 4.63. In considering the applicability of other Diagnostic Codes, the Board finds that Diagnostic Codes 5277 (weak foot), 5278 (claw foot), 5279 (metatarsalgia), 5280 (hallux valgus), 5281 (hallux rigidus), 5282 (hammer toe), 5283 (malunion or nonunion of the tarsal or metatarsal bones), and 5284 (foot injuries) do not apply, as the evidence does not show that the Veteran was found to have any of these disabilities. Prior to August 18, 2020 July 2014 VA treatment records note feet spasms with pain and swelling in the feet. In July 2017, the Veteran was provided with a VA examination. The clinician noted complaints of tenderness to the touch, swelling, discoloration, soreness on the heels, and roughness with tenderness. She reported sharp pain. She did not report flare-ups. The Veteran had bilateral pain on use of the feet that was not accentuated on use or on manipulation of the feet. There was no indication of swelling on use. There were no characteristic callouses. The Veteran did not have extreme tenderness of plantar surfaces and did not have decreased longitudinal arch height. There was no objective evidence of marked deformity of one or both feet and no marked pronation. The weight-bearing line did not fall over or medial to the great toe. There was no inward bowing of the Achilles tendon and no marked inward displacement and severe spasm of the Achilles tendon. The examiner noted bilateral foot pain that did not contribute to additional functional loss. The examiner noted range of motion and gait as normal. The examiner indicate that pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the foot was used repeatedly over a period of time. The Veteran did not use any assistive devices as a normal mode of locomotion. The examiner stated that the condition did not impact the ability to perform any type of occupational task, such as standing, walking, lifting, or sitting. The examiner stated that there was not functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. In August 2017, VA received a VA Form 9, Appeal to Board of Veterans’ Appeals, in which the Veteran reported “swelling and unbearable pain in … [her] feet.” During the December 2019 hearing, the Veteran reported difficulty standing, including for short periods, such as to rinse off a few dishes or put clothes in the washer or dryer. She stated that she wears orthotic shoes and has treated the feet with hot, cold, and massages. She indicated the orthotic shoes and orthotics that go inside of shoes have provided some relief. She also reported swelling. She reported “extreme tenderness” on the plantar surfaces of her feet and a “marked inward displacement” with spasms on the tendon Achilles. She also reported having Charley horses (painful spasms) in her feet. February 2020 VA treatment records note reports of burning and tingling in the feet. Upon review of the record, the Board finds that the Veteran’s bilateral plantar fasciitis most nearly approximated the criteria for the assigned 10 percent rating, for moderate symptomatology, prior to August 18, 2020. The evidence does not reflect the presence of objective evidence of marked deformity. The Board acknowledges the Veteran’s lay reports of marked inward displacement, and the Veteran, as a lay person, is competent to report readily observable symptoms, such as the shape of the foot. See, e.g., Washington v. Nicholson, 21 Vet. App. 191, 195 (2007). However, marked inward displacement was not observed by the clinicians who examined the Veteran’s feet during the appeal period. Further, as will be explained in greater detail below, the Veteran was also provided with an additional VA examination in September 2020, after the hearing, and the examiner noted that marked inward displacement was not present. Therefore, upon review of the record as a whole, the Board finds that such symptomatology, if present, would likely have been noted by the clinicians who thoroughly examined the Veteran’s feet; thus, the Board cannot assign significant probative value to the Veteran’s lay reports of marked inward displacement. The record also does not reflect the presence of callouses prior to August 18, 2020. Further, the evidence does not reflect accentuated pain on manipulation and use. The Board acknowledges the Veteran’s competent and credible reports of pain, burning, and tingling. See, e.g., Washington v. Nicholson, 21 Vet. App. 191, 195 (2007). However, the rating criteria contemplate accentuation of pain upon manipulation and use of the feet, which was not present upon examination and is not otherwise reflected in the record. The Board also acknowledges the credible and competent reports of swelling. However, this is the only symptom present prior to August 18, 2020 which is contemplated in the criteria for severe flatfoot, and this symptom was not observed by the VA examiner during this period. Thus, without an objective showing of the other criteria, the Board finds that the Veteran’s disability picture more nearly approximately the criteria for moderate severity prior to August 18, 2020. Accordingly, a rating in excess of 10 percent is not warranted prior to August 18, 2020. As the evidence preponderates against the Veteran’s claim, the benefit of the doubt doctrine is not applicable, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.   From August 18, 2020 On August 18, 2020, the Veteran was provided with an additional VA examination. The examiner noted tenderness to palpation, and the Veteran reported difficulty walking and standing. The Veteran stated that flare-ups did not impact the function of the foot. The Veteran had pain on use of the feet accentuated on use and pain on manipulation with pain accentuated on manipulation. There was an indication of swelling on use and characteristic calluses. The Veteran reported that she had tried arch supports but remained symptomatic. The Veteran did not have extreme tenderness of plantar surfaces on one or both feet. The Veteran did not have decreased longitudinal arch height, objective evidence of marked deformity, or marked pronation. The weight-bearing line did not fall over or medial to the great toe. There was no lower extremity deformity, other than pes planus, causing alteration of the weight bearing line. There was no inward bowing of the Achilles tendon. The Veteran did not have marked inward displacement and severe spasm of the Achilles tendon. The Veteran had not had foot surgery. Pain on movement, pain on weight-bearing, swelling, interference with sitting and standing were contributing factors of disability and contributed to functional loss. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability during flare-ups or when the foot was used repeatedly over a period of time. The examiner indicated that the functional impact of the condition was that the Veteran would be unable to walk, stand, stoop, or sit for periods of time. The examiner stated that there was not functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Thus, the record reflects that, from August 18, 2020, the Veteran’s bilateral plantar fasciitis did not manifest with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement with severe spasm of the tendon Achillis on manipulation not improved by orthopedic shoes or appliances. As such, a preponderance of the evidence is against a finding that the Veteran is entitled to a rating in excess of 30 percent under Diagnostic Code 5276. From February 7, 2021, the Board has also considered whether rating under new Diagnostic Code 5269 for plantar fasciitis would be more favorable. However, a higher 40 percent rating is only available under that Diagnostic Code if there is actual loss of use of the feet. During the July 2017 and August 2020 VA examinations, the examiners noted that functioning in the Veteran’s feet was not so diminished that amputation with prosthesis would equally serve the Veteran. Consequently, a 40 percent rating under Diagnostic Code 5269 is not warranted, and the Board concludes that it is more favorable to continue the Veteran’s rating under Diagnostic Code 5276. Accordingly, a rating in excess of 30 percent from August 18, 2020 is not warranted. As the evidence preponderates against the Veteran’s claim, the benefit of the doubt doctrine is not applicable, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Low Back Disability The Veteran contends that she is entitled to a rating in excess of 40 percent for her service-connected low back disability. The Veteran’s low back disability has been evaluated under Diagnostic Code 5242. 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases and Injuries of the Spine, a 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine (for DCs 5235 to 5243). When evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excess fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). It is the intent of the Rating Schedule 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; Burton, 25 Vet. App. at 4-5. For VA compensation purposes, unfavorable ankylosis is 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 neutral position (zero degrees) always represents favorable ankylosis. Id., Note (5). Note (1) to the General Rating Formula provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be evaluated separately, under an appropriate diagnostic code. Id., Note (1). If applicable, spinal disabilities manifesting in intervertebral disc syndrome (IVDS) based on incapacitating episodes (preoperatively or postoperatively) may be rated under either the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25. Under the Formula for Rating IVDS, a 40 percent rating is warranted with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted with incapacitating episodes having a total duration of at least 6 months. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. The criteria used to evaluate the spine were revised, effective February 7, 2021. The revisions defined Diagnostic Code 5243 for IVDS as disc herniation with compression and/or irritation of the adjacent nerve root. The revisions indicated that Diagnostic Code 5242 should be assigned for all other disc diagnoses. The revisions also indicated that evaluation under the Formula for Rating IVDS was only available for disabilities evaluated under Diagnostic Code 5243. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5243). In this case, February 2015 VA treatment records note constant, sharp back pain. October 2015 VA treatment records note an antalgic, guarded gait, forward flexion decreased due to pain, no deformity, no spinous process tenderness, and a tender, palpable lumbar paraspinous muscle spasm. A November 2015 correspondence from the Veteran stated that she had to miss an appointment that day due to severe back pain. In July 2017, the Veteran was provided with a VA examination. The examiner noted a diagnosis of lumbar strain and mild degenerative disc disease (DDD). The Veteran reported that she continued to have pain and limited motion in her back and that back pain limits some physical activities. She did not report flare-ups of the thoracolumbar spine. She reported functional loss or functional impairment of limited motion. Initial range of motion testing showed forward flexion to 30 degrees with pain. The clinician noted pain on examination caused functional loss. There was no evidence of pain with weight bearing. There was objective evidence of mild localized tenderness or pain on palpation in the mid-low back with tenderness. The Veteran was able to perform repetitive use testing with at least three repetitions and no additional loss of function or range of motion. The Veteran was examined immediately after repetitive use over time, and pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use. The Veteran did not have guarding or muscle spasm. The examiner noted that the Veteran does not have intervertebral disc syndrome (IVDS) of the thoracolumbar spine. There was no ankylosis of the spine. The Veteran did not use any assistive device as a normal mode of locomotion. The Veteran did not have neurologic abnormalities of bowel or bladder impairment. December 2018 private treatment records note acute complaints in the lumbar spine with constant discomfort described as throbbing and stiffness that has improved since the onset, with pain present rated as 8 out of 10. April 2019 VA treatment records note lumbar spondylosis with chronic low back pain. The clinician noted that epidural steroid injections had been performed attempting to improve the low back pain with only transient relief. During the December 2019 hearing, the Veteran reported chronic pain and difficulty sitting for long periods of time. She reported having gone to physical therapy and having injections with minimal relief. She reported that she cannot climb stairs due to her back and that she has two stairs in front of her house that she needs to take her time using. She reported having a walker, cane, back brace, TENS unit, and heating pads. In August 2020, the Veteran was provided with an additional VA examination. The examiner noted lumbosacral strain and degenerative arthritis of the spine. The Veteran did not report having flare-ups. She reported having difficulty walking, standing, and stooping. Initial range of motion testing showed forward flexion to 30 degrees with pain that caused functional loss. The clinician noted evidence of pain with weight bearing. There was objective evidence of mild localized tenderness or pain on palpation in the mid low back. The Veteran was able to perform repetitive-use testing with at least three repetitions and no additional loss of function or range of motion. The examiner noted that pain, fatigue, weakness, and lack of endurance significantly limit functional ability with repeated use over time. The clinician estimated forward flexion to 20 degrees. The examiner noted guarding or muscle spasm resulting in an abnormal gait or abnormal spine contour. The examiner noted less movement than normal, weakened movement, disturbance of locomotion, and interference with sitting and standing as factors contributing to disability. There was no ankylosis of the spine. The Veteran did not have IVDS of the thoracolumbar spine. The clinician noted regular use of a brace. The Veteran did not have neurologic abnormalities of bowel or bladder impairment. The clinician stated that the functional impact of the back disability was that the Veteran would be unable to walk, stand, stoop, or sit for periods of time. The Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for the Veteran’s low back disability. The Board acknowledges the Veteran’s lay reports of symptoms and evidence of functional loss due to pain, weakened movement, disturbance of locomotion, and interference with sitting and standing; however, even considering this evidence, the degree of additional limitation reflected by the evidence showing an inability to walk, stand, stoop, or sit for periods of time would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. Even when considering the functional limitation during a flare-up, the Veteran’s symptoms do not more nearly approximate the entire spine fixed in flexion or extension and one of the additional symptoms set forth in Note 5. Regarding neurological impairment, a September 2020 rating decision awarded separate ratings for left and right lower extremity radiculopathy, sciatic nerve paralysis, with each being assigned 10 percent ratings, effective February 5, 2020, and 20 percent ratings, effective August 18, 2020. This rating decision also awarded separate ratings for left and right lower extremity radiculopathy, femoral nerve paralysis, with each being assigned 20 percent ratings, effective August 18, 2020. As of the date of this decision, the Veteran has not appealed the ratings or effective dates assigned to these awards; therefore, they are not before the Board on appeal. The lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with her spine disability. Further, the evidence does not reflect that the Veteran has IVDS requiring bed rest prescribed by a physician and treatment by a physician. Therefore, the rating criteria based on IVDS are inapplicable both prior to and from February 7, 2021. Accordingly, the Board finds that the evidence preponderates against the Veteran’s claim. As such, the benefit of the doubt doctrine is not applicable, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.   REASONS FOR REMAND Entitlement to TDIU is remanded. Upon review of the record, the Board finds that the issue of entitlement to a TDIU has been raised by the record as part and parcel of the claims for increased ratings. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). Specifically, April 2019 VA treatment records reflect that the clinician noted that the Veteran’s employment had “exacerbated the knee and back pains” and that “I am surprised [she] continues to engage in her duties as I believe the patient is disabled and will not be able to continue to work much longer.” Additionally, a July 2020 VA treatment record reflecting a message from the Veteran to her treating provider indicates that she is now medically retired. As the issue of entitlement to a TDIU has been raised by the record but not developed by the agency of original jurisdiction (AOJ), remand is necessary for the RO to adjudicate the issue of entitlement to a TDIU in the first instance. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 2020 to the present. 2. Provide the Veteran with appropriate notice regarding the TDIU claim and request a completed VA Form 21-8940, Veteran’s Application for Increased Compensation   Based on Unemployability. Complete any other development needed before adjudicating the claim of TDIU. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, 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.