Citation Nr: 21012808 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 16-35 578A DATE: March 5, 2021 ORDER Prior to February 8, 2017, entitlement to a rating in excess of 10 percent for left wrist (non-dominant) fracture with degenerative joint disease is denied. From February 8, 2017, entitlement to a 40 percent rating for left wrist (non-dominant) fracture with degenerative joint disease is granted. Entitlement to a rating in excess of 20 percent prior to November 4, 2015, and in excess of 40 percent thereafter, for arthritis of the lumbosacral spine is denied. From February 26, 2020, entitlement to a rating in excess of 10 percent for cicatrix lumbar area, residuals of lumbar decompression surgery (painful) (painful scar) is denied. From February 26, 2020, entitlement to a compensable rating for cicatrix lumbar area, residuals of lumbar decompression surgery (length of scar) is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity lumbar radiculopathy, sciatic nerve, prior to August 22, 2017 and in excess of 20 percent thereafter is denied. Effective September 16, 2011, entitlement to an initial rating of 20 percent, but no higher, for right lower extremity lumbar radiculopathy, sciatic nerve, is granted. From August 22, 2017 entitlement to a rating in excess of 20 percent for right lower extremity lumbar radiculopathy, sciatic nerve is denied. From November 4, 2015, entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. Prior to February 8, 2017, the Veteran’s left wrist disability is manifested by, at worst, limited motion. 2. Resolving reasonable doubt in the Veteran’s favor, from February 8, 2017, his left wrist disability is manifested by unfavorable ankylosis. 3. From November 4, 2015, the Veteran’s arthritis of the lumbosacral spine is manifested by, at worst, forward flexion of the thoracolumbar spine 30 degrees or less; it is not manifested by ankylosis of the entire thoracolumbar spine nor the entire spine. 4. From February 26, 2020, the Veteran’s cicatrix lumbar area, residuals of lumbar decompression surgery (painful) is manifested by, at worst, pain. 5. From February 26, 2020, the Veteran’s cicatrix lumbar area, residuals of lumbar decompression surgery (length of scar), at worst, covers an area with length of 11 cm and a width of 0.4 cm for a total area of 4.4 sq. cm. 6. Prior to August 22, 2017, the Veteran’s left lower extremity lumbar radiculopathy, sciatic nerve, is manifested by, at worst, mild symptoms; from August 22, 2017, the Veteran’s left lower extremity lumbar radiculopathy, sciatic nerve, is manifested by, at worst, moderate symptoms. 7. Prior to August 22, 2017, the Veteran’s right lower extremity lumbar radiculopathy, sciatic nerve, is manifested by, at worst, moderate intermittent pain. 8. From August 22, 2017, the Veteran’s right lower extremity lumbar radiculopathy, sciatic nerve, is manifested by, at worst, moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness. 9. From November 4, 2015, the Veteran’s service-connected disabilities prevent him from securing and maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to February 8, 2017, the criteria for a rating in excess of 10 percent for left wrist disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.71, 4.118 Diagnostic Codes 5214, 5215. 2. From February 8, 2017, the criteria for a 40 percent rating for left wrist disability have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.71, 4.118 Diagnostic Codes 5214, 5215. 3. The criteria for a rating in excess of 20 percent prior to November 4, 2015, and in excess of 40 percent thereafter, for arthritis of lumbosacral spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5239. 4. From February 26, 2020, the criteria for a rating in excess of 10 percent for cicatrix lumbar area, residuals of lumbar decompression surgery (painful) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7804. 5. Throughout the appeal period, the criteria for a compensable rating for cicatrix lumbar area, residuals of lumbar decompression surgery (length of scar) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7802. 6. The criteria for an initial rating higher than 10 percent prior to August 22, 2017 and higher than 20 percent thereafter for left lower extremity lumbar radiculopathy, sciatic nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124, Diagnostic Code 8520. 7. Prior to August 22, 2017, the criteria for an initial rating of 20 percent, but no higher for right lower extremity lumbar radiculopathy, sciatic nerve, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124, Diagnostic Code 8520. 8. From August 22, 2017, the criteria for a rating in excess of 20 percent for right lower extremity lumbar radiculopathy, sciatic nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124, Diagnostic Code 8520. 9. From November 4, 2015, the criteria for a total disability rating based on individual unemployability (TDIU) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1969 to January 1972 and from December 1976 to October 1983. These matters come before the Board of Veterans’ Appeals (Board) on appeal from August 2013, July 2014, and June 2016 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In November 2018, the Board remanded the claim to obtain VA examinations with medical opinion as to the current severity of the Veteran’s disabilities. The Board is cognizant that VA examinations were provided subsequent to the most recent SSOC. In a January 2021 rating decision, the AOJ considered this evidence and on this basis the Board finds that it may proceed without prejudice to the Veteran. Increased Rating 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. The Board will consider whether separate ratings may be assigned for separate periods of time based on the facts found, a practice known as ‘staged ratings.’ Fenderson v. West, 12 Vet. App. 119, 12627 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) did not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. However, pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011) (holding that pain alone does not constitute function loss but is just one fact to be considered when evaluating functional impairment). 1. Entitlement to a rating in excess of 10 percent for left wrist disability. The Veteran contends that his left wrist fracture with degenerative disease warrants a rating in excess of 10 percent. The Veteran is in receipt of a 10 percent rating for his left wrist disability, effective September 13, 2006. He filed a claim for increased evaluation that was received on September 16, 2011. In November 2013, the Veteran submitted a notice of disagreement (NOD) with the August 2013 rating decision that denied a higher rating for his left wrist disability. The rating criteria for disabilities of the hand distinguish between the major (dominant) extremity and the minor (non-dominant) extremity. See 38 C.F.R. § 4.69. As cited below, the preponderance of medical evidence of record indicates that the Veteran is right-hand dominant. Thus, the criteria for rating disabilities of the minor extremity are applicable. The Veteran’s left wrist disability is currently rated as ten percent disabling under Diagnostic Code (DC) 5215, for which dorsiflexion less than 15 degrees or palmar flexion limited in line with forearm is rated as ten percent disabling. A 10 percent rating is the highest schedular rating available for limitation of motion of the wrist under Diagnostic Code 5215. For a minor extremity, Diagnostic Code 5214 provides a basis to assign a higher 20 percent rating for favorable ankylosis in 20 to 30 degrees of dorsiflexion; a 30 percent rating for any other position, except favorable; and a 40 percent rating for unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation. 38 C.F.R. § 4.71A, Diagnostic Code 5214. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Shipwash v. Brown, 8 Vet. App. 218, 221 (1995); Lewis v. Derwinski, 3 Vet. App. 259 (1992). Based on the evidence of record and as discussed below, the Board concludes that prior to February 8, 2017, a rating in excess of 10 percent is not warranted. However, the Board further concludes that from February 8, 2017, the maximum rating of 40 percent for left wrist disability, based on unfavorable ankylosis, is warranted. Prior to February 8, 2017 January 2008 private treatment record showed a stable left wrist. His left wrist had 25 degrees of extension and 30 degrees of flexion. He had 20 pounds of grip and 8 pounds of pinch on the left side. He had intermittent pain but full range of motion. He had significant arthritis. April 2012 private treatment record showed dorsiflexion was about 10 degrees and palmar flexion was about 0 degrees. He complained of pain and limited motion. May 2013 VA examination showed left wrist palmar flexion ended at 30 degrees and dorsiflexion ended at 15 degrees. There was no objective evidence of painful motion. No ankylosis was shown. August 2014 private treatment showed gradually increasing pain of the left wrist, with 10 degrees of extension and 10 degrees of flexion. November 2015 VA examination showed palmar flexion ended at 40 degrees and dorsiflexion ended at 10 degrees. Both exhibited pain. There was no ankylosis. The Board concludes that prior to February 8, 2017, the Veteran is entitled to the highest schedular rating available for limitation of motion of the left wrist under Diagnostic Code 5215. The Board fully acknowledges he experiences painful motion, but the very fact that he retains motion in the left wrist during this period demonstrates a higher rating is not warranted under Diagnostic Code 5214. Prior to February 8, 2017, the Veteran has been awarded the highest schedular rating available based on limitation of motion throughout the appeal period. If a musculoskeletal disability is evaluated at the highest schedular evaluation available upon limitation of motion, then a higher rating under 38 C.F.R. §§ 4.40, 4.45, and 4.59 is not warranted. See Johnston v. Brown, 10 Vet. App. 80 (1997). Prior to February 8, 2017, the record does not otherwise show any findings that indicate ankylosis. In the absence of any ankylosis, a higher rating is not warranted under DC 5214 prior to such date. From February 8, 2017 A February 2017 disability benefits questionnaire (DBQ) noted that the Veteran is ambidextrous. He had reduced range of motion in the wrist, with 10 degrees of palmar flexion and 10 degrees of dorsiflexion. ROM was entirely limited for ulnar and radial deviation. The DBQ also shows that he has unfavorable ankylosis. Upon remand, the Veteran underwent a VA examination in December 2019, which noted that he was right hand dominant. The Veteran reports increased pain in the left wrist. He states he has no grip in his left wrist. He states he is unable to type with left hand and too much motion with left wrist/hand causes it to “throb”. Both palmar flexion and dorsiflexion ended at 50 degrees. After repeated use, both palmar flexion and dorsiflexion ended at 40 degrees. During flare-ups, palmar flexion and dorsiflexion ended at 35 degrees. The wrist exhibited objective evidence of localized tenderness and pain contributed to reduced range of motion. However, there was no ankylosis shown. In a February 2020 letter from a private medical provider, the Veteran’s physician stated that the radiograph of the wrist and hand revealed ankylosis of the midcarpal joint and severe degenerative changes in the radiocarpal joint. VA examination in January 2021 noted that he was right hand dominant. The examiner noted that since the Veteran’s last exam, his left wrist has gotten worse with increased pain and limited ROM. Current symptoms included constant left wrist pain that varies from sharp with activity and dull at rest; pain was rated 8/10 on avg. He had swelling daily. Reported functional loss included difficulty with gripping and the left hand, inability to type, pain upon motion, and throbbing which results in inability to use hand. Left wrist ROM was abnormal or outside of range. Palmar flexion ended at 20 degrees; dorsiflexion ended at 30 degrees; ulnar deviation ended at 20 degrees; radial deviation ended at 5 degrees. All ROMs exhibited pain. The examination report did not find ankylosis. Resolving reasonable doubt in favor of the Veteran, the Board further concludes that from February 8, 2017, the Veteran is entitled to the maximum rating of 40 percent based on unfavorable ankylosis in palmar flexion and, alternatively, with ulnar or radial deviation. The February 2020 letter supported the February 2017 DBQ showing that the Veteran has unfavorable ankylosis in his left wrist along with both ulnar and radial deviation. Additionally, later medical evidence, to include the January 2021 VA examination, is supportive of the Veteran’s inability to use his left wrist. As the DBQ is the first date that it is reasonably ascertainable that the Veteran had such increased level of impairment, the Board finds that from February 8, 2017, the maximum rating of 40 for left wrist, based on the above symptoms, is warranted. Associated Scar December 2019 VA examination found that the Veteran has a scar on his left upper wrist dorsal aspect. The examination further found this scar to be related to the Veteran’s left wrist disability. A separate 10 percent rating may be assigned for an associated scar, if the scar covers an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). 38 C.F.R. § 4.118, Diagnostic Code 7801. Additionally, a separate 10 percent rating may be assigned if the scar is unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7805. After review of the record, there is no evidence that his scar covers an area or areas of at least 6 square inches nor that is it unstable or painful. The December 2019 and January 2021 VA examinations indicated that the Veteran’s scar measures 4.2 cm in length and .2 cm in width. The preponderance of the evidence shows that the Veteran’s associated scar has not more nearly approximated the criteria for a separate compensable rating during the pendency of this claim. Therefore, such compensable rating under Diagnostic Codes 7801 or 7805 is not warranted. 2. Entitlement to a rating in excess of 20 percent prior to November 4, 2015, and in excess of 40 percent thereafter, for arthritis of lumbosacral spine. The Veteran contends that his arthritis of lumbosacral spine status post lumbar decompression and fusion L5-6 (back disability) is more severe than currently rated. He contends that a rating in excess of 20 percent is warranted prior to November 4, 2015 and in excess of 40 percent thereafter, due to worsening symptoms. The Veteran’s back disability is rated 20 percent disabling from January 2001 to December 12, 2013, 100 percent disabling from December 13, 2013 to December 31, 2014, 20 percent disabling from January 1, 2015 to November 3, 2015, and 40 percent disabling from November 4, 2015. The evaluation of 100 percent is based on surgical or other treatment necessitating convalescence, was extended through the end of 2014. He filed a claim for increased evaluation of service-connected disabilities that was received on September 16, 2011. He submitted an informal supplemental claim for increase, shown as evidence asserting a change in the level of impairment of his arthritis of the lumbar spine, that was received on May 20, 2012. The Veteran has further reported that since his November 2015 VA examination, his back disability has increased in severity. He asserts that he has lumbar fusion, which he argues is analogous to ankylosis. The Veteran’s back disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5239. Diagnostic Code 5239 is part of the General Rating Formula for Disease and Injuries of the Spine (General Rating Formula). Under this Diagnostic Code, 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, Diagnostic Codes 5235 through 5243. For VA purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar spine or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (0 degrees) always represents favorable ankylosis. See General Rating Formula for Diseases and Injuries of the Spine, Note 5. From September 16, 2011 to December 12, 2013 June 2013 VA examination showed flexion ending at 60 degrees, extension ending at 15 degrees, right lateral flexion ending at 20 degrees, left lateral flexion ending at 15 degrees, right and left lateral rotation ending at 30 degrees. He did not have guarding and muscle spasm. No ankylosis was noted. September 2013 private treatment records showed that the Veteran’s physician recommended he avoid bending, heavy lifting, or twisting; these were pre-and postoperative restrictions. At no point from September 16, 2011 to December 12, 2013, does the record show flexion of 30 degrees or less, or; ankylosis of the entire thoracolumbar spine, as required for the higher 40 percent rating. Rather, the record shows that symptoms during this period are consistent with the 20 percent rating assigned. From December 13, 2013 to December 31, 2014 The Veteran’s back disability is rated 100 percent disabling from December 13, 2013 to December 31, 2014, for convalescence related to his arthritis of the lumbosacral spine. From January 1, 2015 to November 3, 2015 The Veteran’s back disability is rated 20 percent disabling from January 1, 2015 to November 3, 2015. From November 4, 2015 The Veteran’s back disability is rated 40 percent disabling, effective November 4, 2015. November 2015 private treatment record instructed the Veteran that he may lift up to 10 lbs. and occasionally lift articles or small tools. The physician noted that tasks are limited to sedentary and occasional walking and standing, if required. The Veteran was instructed to not bend or twist at the waist under any circumstances and to avoid all types of reaching as may cause further injury. The Veteran underwent a VA examination in December 2019. Initial range of motion (ROM) was abnormal or outside of normal range. ROM for forward flexion was limited to 20 degrees, extension was entirely limited, right lateral flexion ranged from 0 to 30 degrees, left lateral flexion was limited to 25 degrees, right and left lateral rotation ranged from 0 to 30 degrees. ROM after three repetitions was from 0 to 15 degrees, extension limited to 0 degrees, right and left lateral flexion from 0 to 25 degrees, right and left lateral rotation from 0 to 30 degrees. He had muscle spasm and guarding that resulted in abnormal gait or abnormal spinal contour. The examiner indicated that there was no ankylosis. The examiner noted that the Veteran reports difficulty with sitting, standing, going up and down stairs, and walking long periods of time, and he is unable to reach or bend down due to his arthritis of the lumbosacral spine condition. The examiner noted that the Veteran had a decompression of L4-5 in December 2013 and reports the surgery helped with his pain. The Veteran states that over the last 12 to 18 months his back pain is getting more painful and incapacitating and he needs to get stair chairs to be able to assist with him going up and down the stairs. The Veteran also underwent VA examination in July 2020. The examiner stated that the Veteran’s lumbosacral strain has progressed. The examination report indicated that prolonged sitting, standing, walking, bending, twisting, and lifting activities cause pain in the lower back. The Veteran reported functional loss during acute pain flares of the lower back. He has difficulty with activities that involve prolonged sitting, standing, walking, bending, twisting, and lifting with the lower back. His initial range of motion was abnormal. Forward flexion ranged from 0 to 60 degrees. Extension ranged from 0 to 5 degrees. Right and left lateral flexion ranged from 0 to 10 degrees. Right and left lateral rotation ranged from 0 to 10 degrees. Range of motion itself did not contribute to functional loss. Pain on all range of motion was noted to cause functional loss. There was objective evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing without additional functional loss. After repetitive use testing and during flare ups, forward flexion ranged from 0 to 60 degrees; extension ranged from 0 to 5 degrees; right and left lateral flexion ranged from 0 to 10 degrees; right and left lateral rotation ranged from 0 to 10 degrees. Pain significantly limited functional ability with flare ups. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing was normal. There was no muscle atrophy. Reflex testing was normal. Sensory testing was normal. There was no ankylosis of the spine. He underwent a VA examination in January 2021. ROM for forward flexion was from 0 to 25 degrees, extension is from 0 to 5 degrees, right and left lateral flexion from 0 to 15 degrees, and right and left lateral rotation from 0 to 5 degrees. Muscle spasm resulted in abnormal gait or spinal contour. There was no ankylosis of the spine. The Board has considered the lay statements in the record regarding the Veteran’s spine disability; however, they do not support a basis for assignment of a higher rating. The Veteran is competent to report his observations, including reports of pain and decreased mobility. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, his statements are consistent with the rating assigned. The Veteran is already in receipt of a compensable rating for limitation of motion, and his lay reports in that regard are fully contemplated by the current rating assigned. See 38 C.F.R. § 4.59. The occurrence of pain and increased difficulty while performing physical activities are not additional symptoms, but rather the practical effect of the symptoms of pain and limited range of motion that have been clinically observed and measured in the evidence of record. The Veteran has contended that his spine disability is manifested by ankylosis. However, the medical evidence revealed no ankylosis throughout this period. Although the Veteran reported increased pain, pain alone is not sufficient to warrant a higher rating; as pain, in itself, does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 40-41 (2011). Pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. The Board considered the DeLuca factors, and the Veteran’s contentions of immobility of his back. However, July 2020 VA examination found no further limitation of motion on repetitive use testing and, thus, there is no suggestion that pain is akin to ankylosis. See 38 C.F.R. §§ 4.40, 4.45, 4.59; Deluca v. Brown, 8 Vet. App. 202 (1995). To the extent that the Veteran and his representative have indicated symptomatology greater than that found on examination, the clinical findings of a trained medical professional are found to be of greater probative weight than their general lay assertions. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In sum, the preponderance of evidence is against a rating in excess of 40 percent for the Veteran’s spine disability. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Associated Scars Disability ratings for scarring is evaluated pursuant to Diagnostic Codes 7800-7803 & 7804-7805. The Board notes that VA amended the criteria for rating skin disabilities during the period on appeal. Nevertheless, the changes to the rating criteria do not substantively impact the outcome of this case. To simplify matters, the Board will use the more recent versions of the rating criteria. Diagnostic Code 7800 (scars of the head, face, or neck) is not raised by the record, because the Veteran has not been granted service connection for any scars of the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Codes 7800-7803, 7804-7805. Under Diagnostic Code 7801, a disability rating of 10 percent is assigned when the Veteran manifests scaring associated with soft underlying tissue damage with an area of at least 6 sq. in. (39 sq. cm) but less than 12 sq. in. (77 sq. cm), and a disability rating of 20 percent is assigned when the Veteran manifests scaring associated with soft underlying tissue damage with an area of at least 12 sq. in. (77 sq. cm) but less than 72 sq. in. (465 sq. cm). A disability rating of 30 percent is assigned when the Veteran manifests scaring associated with soft underlying tissue damage with an area of at least 72 sq. in. (465 sq. cm) but less than 144 sq. in. (929 sq. cm), and a disability rating of 40 percent when the Veteran manifests scaring associated with soft underlying tissue damage with an area of at least 144 sq. in. (929 sq. cm). 38 C.F.R. § 4.118, Diagnostic Code 7801. Under Diagnostic Code 7802, a disability rating of 10 percent is assigned for scarring not associated with underlying soft tissue damage with an area of at least 144 sq. in. (929 sq. cm). 38 C.F.R. § 4.118, Diagnostic Code 7802. Under Diagnostic Code 7804, a disability rating of 10 percent is assigned when the Veteran manifests one to two painful or unstable scars, and a disability rating of 20 percent is assigned when the Veteran manifests three to four painful or unstable scars; and a disability rating of 30 percent is assigned when the Veteran manifests five or more painful or unstable scars. 38 C.F.R. § 4.118, Diagnostic Code 7804 Under Diagnostic Code 7805, scars are evaluated by analogy to other disabilities based on the presence of additional disabling effects. 38 C.F.R. § 4.118, Diagnostic Code 7805. Entitlement to a compensable rating for cicatrix lumbar area, residuals of lumbar decompression surgery (painful) prior to February 26, 2020 and in excess of 10 percent thereafter. During the pendency of the appeal, the Veteran was granted separate ratings for his scars associated with his lumbar decompression surgery. The Veteran is in receipt of a noncompensable rating for cicatrix lumbar area, residual of lumbar decompression surgery associated with arthritis of lumbosacral spine status post lumbar decompression and fusion L5-6 prior to February 26, 2020. He is in receipt of a 10 percent rating, effective from February 26, 2020, the date a new claim for increased evaluation of lumbar disability was received. See 38 C.F.R. § 3.400. Since the maximum benefit has not been achieved, the above is considered a partial grant. For the reasons above, the Board will consider whether he is entitled to a higher disability rating for the associated scar from February 26, 2020. The Veteran’s scar has been evaluated under DC 7804. Under Diagnostic Code 7804, a disability rating of 10 percent is assigned when the Veteran manifests one to two painful or unstable scars, and a disability rating of 20 percent is assigned when the Veteran manifests three to four painful or unstable scars; and a disability rating of 30 percent is assigned when the Veteran manifests five or more painful or unstable scars. 38 C.F.R. § 4.118, Diagnostic Code 7804. January 2021 VA examination showed the associated scar, which was described as painful. The record does not show that the scar is unstable. The Board concludes that a rating in excess of 10 percent is not warranted under any Diagnostic Code pertaining to scars. First, there is no evidence that the Veteran manifests three to four painful or unstable scars, as required for a 20 percent rating under Diagnostic Code 7804. Second, there is no evidence that it is associated with soft underlying tissue damage or covers an area of at least 144 sq. in. (929 sq. cm). The scar is located on the right lumbar region and measures 7.0 cm in length and 0.2 cm in width for a total of 1.4 sq. cm. Therefore, the Veteran is not entitled to separate higher ratings under Diagnostic Codes 7801 or 7802. For the reasons discussed above, a rating in excess of 10 percent from February 26, 2020 for associated scar is not warranted. Entitlement to a compensable rating for cicatrix lumbar area, residuals of lumbar decompression surgery (length of scar). During the pendency of the appeal, the Veteran was granted a separate noncompensable rating for a scar associated with lumbar decompression surgery. See January 2021 rating decision. From February 26, 2020, the Veteran is in receipt of a noncompensable rating for cicatrix lumbar area, residual of lumbar decompression surgery associated with arthritis of lumbosacral spine status post lumbar decompression and fusion L5-6. Since the maximum benefit has not been achieved, the above is considered a partial grant. Thus, the Board will consider whether he is entitled to s higher disability rating for the associated scar. The Veteran’s scar has been envaulted under DC 7802. Under Diagnostic Code 7802, a disability rating of 10 percent is assigned for scarring not associated with underlying soft tissue damage with an area of at least 144 sq. in. (929 sq. cm). 38 C.F.R. § 4.118, Diagnostic Code 7802. January 2021 VA examination showed the Veteran has a scar located on the posterior trunk. It has a length of 11 cm and a width of 0.4 cm for a total area of 4.4 sq. cm. The covered area is less than 144 square inches (929 sq. cm.) and is not associated with underlying soft tissue damage. The Board concludes that a compensable rating is not warranted under any Diagnostic Code pertaining to scars. First, there is no evidence that his scar covered an area of 144 square inches (929 sq. cm.) or greater, as required for a higher rating under Diagnostic Code 7802. Second, there is no evidence that it is otherwise associated with soft underlying tissue damage or is unstable or painful; therefore, the Veteran is not entitled to separate higher ratings under Diagnostic Codes 7801 or 7804 for this scar. Thus, a compensable rating for his residual scar is not warranted. 3. Entitlement to an initial rating higher than 10 percent prior to August 22, 2017 and higher than 20 percent thereafter for left lower extremity lumbar radiculopathy, sciatic nerve. The Veteran contends that radiculopathy of his left sciatic nerve warrants a rating in excess of 10 percent. Under Diagnostic Code 8520, mild incomplete paralysis warrants a 10 percent disability rating. Moderate incomplete paralysis warrants a 20 percent disability rating. Moderately severe incomplete paralysis warrants a 40 percent disability rating. Severe incomplete paralysis with marked muscular atrophy, warrants a 60 percent rating. Complete paralysis of the sciatic nerve is evidenced by the foot dangled and dropped, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost and warrants an 80 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8520. For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for mild, or at the most, the moderate degree. Id. The Board observes that the words “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. 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. The Veteran’s left sciatic nerve is rated 10 percent disabling, effective June 23, 2014, and 20 percent disabling, effective August 22, 2017, under Diagnostic Code 8520. In July 2014, the Veteran submitted a notice of disagreement (NOD) with the July 2014 rating decision that granted service connection and issued the initial rating for this disability. He also reported an increase in the severity of his radiculopathy symptoms since the last VA examination in November 2015. Based on the complete evidence of record, the Board finds that prior to August 22, 2017, the criteria for a higher disability rating for radiculopathy of the left lower extremity are not met. The Board concludes that from June 23, 2014 to August 21, 2017, radiculopathy of the left sciatic nerve does not warrant a rating in excess of 10 percent because symptoms are shown to be mild, at most. June 2014 VA examination showed mild paresthesias and/or dysesthesias and numbness in the left lower extremity. November 2015 VA examination noted no radicular symptoms. The Board further concludes that from August 22, 2017, radiculopathy of the left sciatic nerve does not warrant a rating in excess of 20 percent. December 2019 VA examination showed radicular pain due to radiculopathy affecting the sciatic nerve. The left lower extremity exhibited moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The severity of the radiculopathy was described as moderate. An updated VA examination was performed in July 2020. The Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the sciatic nerve. For an involvement that is wholly sensory, the evaluation was for the mild degree. From August 22, 2017, the disability is manifested by, at worst, moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness. Such symptoms are consistent with a 20 percent rating. The Veteran’s complaints of pain and numbness are acknowledged. The record, however, does not contain findings or other adequate pathology sufficient to support a higher rating based on symptoms. Therefore, a rating in excess of 20 percent from August 22, 2017 is not warranted. As the preponderance of evidence weighs against finding higher ratings throughout the appeal period, entitlement to an increased rating must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 4. Entitlement to an initial rating higher than 10 percent prior to August 22, 2017 and higher than 20 percent thereafter for right lower extremity lumbar radiculopathy, sciatic nerve. The Veteran contends that radiculopathy of his right sciatic nerve warrants a rating in excess of 10 percent. The Veteran’s right sciatic nerve is rated 10 percent disabling, effective September 16, 2011, and 20 percent disabling, effective August 22, 2017, under Diagnostic Code 8520. In July 2014, the Veteran submitted a NOD with the August 2013 rating decision that granted service connection and issued the initial rating for this disability. He stated that his right lower radiculopathy is far worse than the left but was not considered during the previous examination. He contends that his right lower radiculopathy warrants a higher rating and reported an increase in the severity of symptoms since the last VA examination in November 2015. Resolving reasonable doubt in the Veteran’s favor, the Board concludes that prior to August 22, 2017, a rating of 20 percent, but no higher, is unwarranted. During this period, the Veteran’s symptoms are shown to be both mild and moderate, at worst. Moderate symptoms, at worst, are shown since the beginning of the appeal period. April 2013 VA treatment noted showed the Veteran reported pain that occasionally radiates down to his legs. May 2013 VA examination showed signs of radiculopathy to include moderate intermittent pain in the right lower extremity involving the sciatic nerve. November 2013 private treatment record notes continued bilateral leg pain that worsens with walking that is consistent with neurogenic claudication. June 2014 VA examination showed mild paresthesias and/or dysesthesias and numbness. July 2014 VA treatment noted the Veteran reported severe leg pain. November 2015 VA examination showed moderate intermittent pain. As the objective medical evidence shows moderate intermittent pain beginning near the start of the appeal period, the Board resolves reasonable doubt in the Veteran’s favor and finds an initial rating of 20 percent, but no higher, is warranted. The Board further concludes that from August 22, 2017, a rating in excess of 20 percent is unwarranted. During this period, the Veteran’s symptoms continue to show symptoms that are, at worst, moderate in severity. December 2019 VA examination showed radicular pain due to radiculopathy affecting the sciatic nerve. The right lower extremity exhibited moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The severity of the radiculopathy was described as moderate. An updated examination was performed in July 2020. The Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the sciatic nerve. For an involvement that is wholly sensory, the evaluation was for the mild degree. From August 22, 2017, radiculopathy of the right sciatic nerve exhibited, at most, moderate constant pain, paresthesias and/or dysesthesias, and numbness. The Veteran’s complaints of pain and numbness are acknowledged. The record, however, does not contain findings or other adequate pathology sufficient to support a higher rating based on symptoms. As the preponderance of evidence weighs against finding a rating in excess of 20 percent from August 22, 2017, entitlement to an increased rating from that date must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 5. Entitlement to a total disability rating based on individual unemployability (TDIU). The Veteran contends that his service-connected disabilities prevent him from securing and following substantially gainful employment. Specifically, he reports that his left wrist, low back and related radiculopathies preclude him from working. Accordingly, a TDIU has been inferred for consideration as part and parcel of his earlier increased rating claims. Rice v. Shinseki, 22 Vet. App. 447, 553-54 (2009). The VA received the Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940) in October 2020. The Veteran has been awarded TDIU effective February 26, 2020. See January 2021 rating decision. The RO’s grant of TDIU served only as a partial grant of the Veteran’s request for TDIU, which he contends he is entitled to throughout the appeal period pertaining to the underlying claims. The current appeal stems from a claim for increased rating of the underlying claims that was received on September 16, 2011. Total disability is considered to exist when there is any impairment that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The fact that a Veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). A TDIU rating may be assigned where the schedular rating is less than total, when it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more service-connected disabilities, provided at least one is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In this case, the Veteran was in receipt of a combined disability rating of at least 60 percent from November 4, 2015. The disabilities that compromise the 60 percent are considered one disability when considering 38 C.F.R. §§ 4.16, 4.25. The AOJ has acknowledged that the schedular criteria are met as of this date. See June 29, 2020 SSOC. Thus, from November 4, 2015, his combined rating met the threshold for schedular TDIU. During this period, service-connected disabilities included back disability, left wrist disability, bilateral lower extremity radiculopathy and hearing loss. The Veteran reported that due to his service-connected disabilities, he had to work minimum wage jobs and was limited in lifting abilities. He stated that he worked on a cash register and could not stand in one spot for a continuous time. He stated that when on the registrar for more than one hour at a time, he was in pain and unable to move continuously for the next two days. He submitted employment information showing he worked for 18 years with the postal service, then at an auto store and a speedway; he was last employed from June 2011 to April 2012 at a harbor freight company. See October 2020 Application for Increased Compensation Based on Unemployability. November 2015 private treatment record showed that due to the Veteran’s back disability, he was restricted from lifting up to 10 lbs. and able to occasionally lift articles or small tools. The examiner noted that the Veteran can perform sedentary tasks if walking and standing are required only occasionally and other sedentary criteria are met. The examiner instructed the Veteran that he may not bend or twist at the waist under any circumstances, and he was further restricted from all types of reaching as it may cause further injury. Following a November 2015 VA back examination, the examiner opined that the Veteran has functional limitations when considering his service connected and low back condition that would prevent hard, medium or light manual labor but not sedentary labor. During a November 2015 VA wrist examination, the examiner opined that the Veteran has functional limitations when considering his service-connected left wrist condition that would prevent strenuous, consistent activity. February 2017 disability benefits questionnaire (DBQ) shows his wrist impacts his ability to perform occupation tasks. The examiner noted that the Veteran cannot use his wrist for daily activity due to extreme pain and severe limitations to ROM, to include gripping, pulling, pushing, and lifting with left upper extremity. December 2019 VA back examination showed that the Veteran’s back disability limited his ability to work. The Veteran reported difficulty with sitting, standing, and walking long periods of time. He is unable to reach or bend down due to his arthritis of the lumbosacral spine condition and has difficulty going up and down stairs. During a December 2019 VA wrist examination, the Veteran reported that he has no grip left in his left wrist. He states he is unable to type with left hand and too much motion with left wrist/hand causes it to “throb”. The Veteran states he is unable to type due to his left wrist condition ans states that his wrist is 95 percent nonfunctional due to pain upon use. February 2020 VA peripheral nerves examination noted that due his bilateral lower extremity radiculopathy, the Veteran has functional limitations with prolonged walking or standing due to pain in the legs. He would likely require frequent regular breaks to rest on an as needed basis. In a February 2020 letter, the Veteran’s private physician opined that the severity of and distribution of the pattern of arthritis precludes him from obtaining and holding gainful employment. The Veteran reported that he worked at the Post Office for 12 years. Afterward, he stated, he worked as a customer service manager at a store and remained there for about a year. He states he worked for about a year at a freight company and was the floor manager and has not worked for four to five years. See November 2015 VA examination report. The Board concludes that from November 4, 2015, the date of the private examination and date his combined disability rating met the schedular criteria, the Veteran’s service-connected disabilities preclude him from securing and following substantially gainful employment. The record indicates that he is limited to sedentary work only. However, the record also shows an employment history that is limited to working in jobs that require mobility, such as a freight company, post office, and auto store. The examinations indicate that the Veteran is unable to lift, grip, reach, bend, stand or walk for long periods, due to his service-connected disabilities. As such, his service-connected disabilities preclude him from obtaining and securing employment consistent with his experience and abilities. As noted, the November 2015 date is the date of evidence of increase severity of service-connected disability leading to unemployability. The Board finds that referral for extraschedular consideration of TDIU is not warranted on the evidence of record.   Accordingly, the criteria for TDIU from November 4, 2015 have been met. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.