Citation Nr: 21013001 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-12 198 DATE: March 8, 2021 ORDER Entitlement to service connection for depression, secondary to a service-connected back disability, is granted. Entitlement to service connection for right lower extremity radiculopathy is denied. Entitlement to a rating of 50 percent, but not higher, for the entire period on appeal, for tension headaches with migraine features is granted. Entitlement to a rating higher than 40 percent for a low back disability is denied. Entitlement to a rating higher than 10 percent for left lower extremity radiculopathy is denied. Entitlement to a rating higher than 0 percent for Wolff-Parkinson-White syndrome (WPW syndrome) is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to November 7, 2019, is remanded. FINDINGS OF FACT 1. The evidence is at least in equipoise regarding whether the Veteran has depression related to a service-connected low back disability. 2. The preponderance of the evidence is against a finding that the Veteran has a current diagnosis of radiculopathy of the right lower extremity. 3. Throughout the period of appeal, the Veteran’s headaches were manifest by very frequent completely prostrating attacks productive of severe economic inadaptability. 4. Throughout the period of appeal, the Veteran’s lumbar spine disability was manifested by pain and limitation of motion of forward flexion of the spine; unfavorable ankylosis of the entire thoracolumbar spine or incapacitating episodes having a total duration of at least six weeks during a 12-month period requiring bed rest prescribed by a physician were not shown. 5. Throughout the period of appeal, the Veteran has experienced no more than mild incomplete paralysis of the sciatic nerve of the left lower extremity. 6. Throughout the period of appeal, the Veteran’s service connected WPW syndrome was not manifested by a need for continuous medication or symptoms of dyspnea, fatigue, angina, dizziness, or syncope on a workload of less than 10 METs. CONCLUSIONS OF LAW 1. The criteria for service connection for depression have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for service connection for radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303. 3. Throughout the period of appeal, the criteria for a rating of 50 percent, but not higher, for tension headaches with migraine features have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.124a, Diagnostic Code 8100. 4. The criteria for entitlement to a rating higher than 40 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Codes 5237-5243. 5. The criteria for entitlement to a rating higher than 10 percent for radiculopathy of the left lower extremity, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for entitlement to a rating higher than 0 percent for Wolff-Parkinson-White Syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7011. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2003 to December 2005. These matters are before the Board of Veterans’ Appeals (Board) on appeal of an August 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. In November 2015, the Veteran and his spouse testified during a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. An October 2020 rating decision assigned a higher 50 percent rating for headaches, effective November 7, 2019. This rating also granted entitlement to a TDIU, effective November 7, 2019. However, as the Veteran is presumed to seek the maximum available benefit for a disability, the claims for a higher rating for headaches and for entitlement to a TDIU prior to November 7, 2019, remain on appeal. AB v. Brown, 6 Vet. App. 35 (1993). In light of the treatment records that have been obtained and associated with the record, the obtaining of the requested medical opinions, and the further adjudicatory actions taken by the Agency of Original Jurisdiction (AOJ), the Board finds that there has been substantial compliance with the prior remand requests. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Furthermore, service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within the year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. A disability that is proximately due to or the result of a service connected disability shall be service connected. When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a non-service connected disability, which is aggravated by a service-connected disability. In such an instance, the Veteran is compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for a psychiatric disability On VA examination in August 2006, the examiner diagnosed adjustment disorder with depressive features. No etiology opinion was provided. In a March 2011 letter, N.A.O., M.D., opined that the Veteran’s back problem had more probably than not aggravated the Veteran’s nervous problems. On VA examination in July 2011, the examiner diagnosed adjustment disorder with depressive features, resolved without sequelae. The examiner opined that the Veteran’s adjustment disorder was not caused by or a result of the low back disability. The examiner explained that adjustment disorder does not last more than six months. At a November 2015 Board hearing, the Veteran stated that his treatment provider had told him that his depressive condition had to do with his back injury. He stated that when his back condition worsened, his depression also worsened. On VA examination in November 2019, the examiner diagnosed major depressive disorder. The examiner noted that the Veteran’s first mental complaints, evaluation, and treatment was in December 2011. At that time, the examiner stated that the Veteran’s initial complaints were related to financial problems, marital problems, and the Veteran’s physical limitations due to chronic back pain. After examining the Veteran and reviewing the record, the examiner opined that the Veteran’s major depressive disorder was more likely than not secondary to service-connected back pain. Based on all the evidence of record, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran has diagnosed depression secondary to a service-connected low back disability. The Board acknowledges the opinion of the July 2011 VA examiner who opined that the Veteran’s adjustment disorder was less likely as not caused by or a result of a service-connected psychiatric disability. However, the July 2011 VA examiner offered no opinion regarding a diagnosis of depression. Contrastingly, the November 2019 VA gave more details regarding the history of the Veteran’s mental health treatment and offered a specific opinion relating a diagnosis of depression to the Veteran’s service-connected low back disability. That examiner also cited to the Veteran’s medical evidence and lay statements to support the opinion. Taken as a whole, the evidence is at least in equipoise regarding whether currently diagnosed depression was caused by a service-connected low back disability. Accordingly, the Board will resolve reasonable doubt in favor of the Veteran, and find that entitlement to service connection for depression, secondary to a service-connected back disability, is warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107. 2. Entitlement to service connection for radiculopathy, right lower extremity On VA examination in July 2011, the VA examiner stated that there were no affected nerves related to the Veteran’s right lower extremity. Vibration, position sense, pinprick, and light touch testing all yielded normal results. On VA examination in September 2012, the examiner found that the Veteran’s right knee and ankle reflexes were normal. Light touch (dermatome) testing was normal for the right lower extremity. The examiner found that the Veteran’s right lower extremity was not affected by radiculopathy. At the November 2015 Board hearing, the Veteran stated that he experienced pain in the right leg. On VA examination in November 2019, the Veteran stated that he occasionally experienced numbness and tingling of the right lower extremity. The examiner found that the Veteran’s right knee and ankle reflexes were normal. Light touch (dermatome) testing was normal for the right lower extremity. The examiner found that the Veteran’s right lower extremity was not affected by radiculopathy. After reviewing the record and examining the Veteran, the examiner specified that the Veteran did not have radiculopathy of the right lower extremity. The Board concludes that the Veteran does not have a current diagnosis of a disability manifested by numbness, tingling, and pain of the right lower extremity and has not had one at any time during the pendency of the claim or contemporary to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board has considered that pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability if it reaches the level of a functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, while the Veteran has stated that he presently experiences right leg pain, he has not claimed that pain has reached the level of a functional impairment of earning capacity, nor has any medical professional found a functional impairment of the right lower extremity due to pain. Additionally, the available treatment records do not indicate that the Veteran’s right lower extremity pain has reached the level of a functional impairment of earning capacity. While the Veteran may believe that he has a current diagnosis of radiculopathy of the right lower extremity, the Board notes that the Veteran has sought consistent medical treatment. However, despite that consistent treatment, the VA treatment records do not contain a diagnosis of a disability manifested by numbness, tingling, and pain of the right lower extremity at any time during the pendency of the claim or contemporary to the filing of the claim. The Board gives more probative weight to the competent medical evidence, as the medical records were created by objective professionals who have the education, training, and expertise to be able to determine diagnoses. Absent competent and credible evidence of diagnoses of a disability manifested by numbness, tingling, and pain of the right lower extremity, the Board concludes that the claim of entitlement to service connection for radiculopathy of the right lower extremity, must be denied because the preponderance of the evidence is against the claim. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). 3. Entitlement to a rating higher than 30 percent prior to November 7, 2019, and higher than 50 percent as of November 7, 2019, for tension headaches with migraine features Diagnostic Code 8100 provides ratings for migraine headaches. That diagnostic code provides a 0 percent rating for less frequent attacks. A 10 percent rating is assigned for characteristic prostrating attacks occurring an average of once every two months over the several months. A 30 percent rating is assigned for characteristic prostrating attacks occurring on an average of once a month over the last several months. A maximum 50 percent rating is assigned for very frequent completely prostrating attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The rating criteria do not define “prostrating,” nor has the Court. Fenderson v. West, 12 Vet. App. 119 (1999). According to WEBSTER’S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION (1986), p. 1080, “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th Ed. 1994), in which “prostration” is defined as “extreme exhaustion or powerlessness.” “Productive of economic inadaptability” can be read as having either the meaning of “producing” or “capable of producing,” and nowhere in Diagnostic Code 8100 is “inadaptability” defined, nor can a definition be found elsewhere in Title 38 of the Code of Federal Regulations. But, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440 (2004). On VA examination in July 2011, the Veteran reported experiencing headaches about four times per week that would last from a few hours to two days. During the attacks, he experienced nausea, vomiting, and photophobia. He required total rest in a dark room, and he took Naproxen. At the November 2015 Board hearing, the Veteran stated that he experienced 10 to 12 incapacitating episodes of headaches a month. He stated that took medication each time he experienced a headache. On VA examination in November 2019, the examiner diagnosed tension headaches with migraine features. The Veteran reported experiencing frequent headaches that could last from several hours up to three days. The Veteran stated that he experienced nausea and vomiting. The throbbing headaches started on the back of the head and spread to the rest of the head. The Veteran took Fioricet and Flexeril when needed. The examiner stated that the Veteran had very prostrating and prolonged attacks of migraine and non-migraine pain productive of severe economic inadaptability. The Board notes that the Veteran has previously been assigned a rating of 30 percent prior to November 7, 2019, and a rating of 50 percent after November 7, 2019, for tension headaches with migraine features. After reviewing the evidence, the Board finds that a 50 percent rating, but not higher, is warranted throughout the period of appeal. The VA examinations found objective evidence of consistent symptoms of frequent, severe headaches. Additionally, the Board observes that pain, nausea, vomiting, and photophobia are symptoms capable of lay observation, and the Board has considered the Veteran’s statements in this regard. Layno v. Brown, 6 Vet. App. 465 (1994). Extending every reasonable doubt to the Veteran, the Board finds that a single rating of 50 percent is warranted throughout the period of appeal based on evidence of very frequent completely prostrating attacks productive of severe economic inadaptability. According to 38 C.F.R. § 4.124a, Diagnostic Code 8100, the maximum schedular rating available for migraine headaches is 50 percent. Therefore, a schedular rating higher than 50 percent is not available under 38 C.F.R. § 4.124a, Diagnostic Code 8100. As no schedular rating higher than 50 percent is available, and no other Diagnostic Code is more appropriate for rating, a rating higher than 50 percent is not warranted. AB v. Brown, 6 Vet. App. 35 (1993); Sabonis v. Brown, 6 Vet. App. 426 (1994). Consequently, extending every reasonable doubt to the Veteran, a single rating of 50 percent is granted for tension headaches with migraine features throughout the period of appeal. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to a rating higher than 40 percent for a low back disability Rating a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain and functional loss due to weakness, fatigability, incoordination, or pain on movement of a joint. 38 C.F.R. §§ 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. When rating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention 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. Disabilities of the spine are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Intervertebral disc syndrome is rated under the General Formula for Rating Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is assigned 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. 38 C.F.R. § 4.71a. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, unfavorable 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 entire spine. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2). The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (4). In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion. Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3). 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 (0 degrees) always represents favorable ankylosis. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). Diagnostic Code 5243 provides that intervertebral disc syndrome is to be rated either under 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 method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that a 10 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent rating is warranted with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted with incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. 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, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). In a March 2011 letter, N.A.O., M.D., stated that the Veteran was unable to tolerate prolonged sitting, standing, walking, or stair climbing. That doctor stated that the Veteran experienced continuous muscle spasm. The Veteran needed to use a back brace. On VA examination in July 2011, the Veteran stated that he experienced constant low back pain that was aggravated by lifting, bending, sustained standing, sitting, or walking more than one kilometer. There was no history of flare-ups, urinary incontinence, erectile dysfunction, falls, or unsteadiness. The veteran reported experiencing stiffness and spasms. There were no incapacitating episodes of spine disease. The Veteran had an antalgic gait. There was no ankylosis. Forward flexion of the thoracolumbar spine was to 75 degrees. Extension was to 25 degrees. Left lateral flexion was to 20 degrees. Left lateral rotation was to 25 degrees. Right lateral flexion was to 20 degrees. Right lateral rotation was to 20 degrees. There was objective evidence of pain on all ranges of motion. On VA examination in September 2012, the Veteran reported experiencing pain but no flare-ups. The examiner measured forward flexion of the thoracolumbar spine to 45 degrees with pain beginning at 15 degrees. Extension was to 20 degrees with pain beginning at 15 degrees. Right and left lateral flexion were each to 20 degrees with pain beginning at 15 degrees. Right and left lateral rotation were each to 20 degrees with pain beginning at 15 degrees. There was no additional loss of range of motion after repetitive use testing. There was no guarding or muscle spasm of the thoracolumbar spine. The examiner stated that the Veteran did not have any other neurologic abnormalities or findings related to his thoracolumbar spine condition. The examiner specified that the Veteran did not have intervertebral disc syndrome. The Veteran regularly used a crutch. At the November 2015 Board hearing, the Veteran stated that he had been issued a brace for the lower back. The Veteran stated that most of the time, the pain rated a 10 on a 1 (low) to 10 (high) pain scale. The Veteran had received cortisone shots and physical therapy. The Veteran took pain medicine on a daily basis. The Veteran used a cane and a TENS unit. On VA examination in November 2019, the examiner diagnosed L5/S1 disc herniation with L4/L5 bulging disc and lumbosacral spine degenerative joint disease. The Veteran stated that he experienced daily morning pain that rated a 10 on a 1 (low) to 10 (high) pain scale. During the day, he stated that his pain rated a 7 or 8 on the same scale. The Veteran stated that two weeks prior to the examination, he had an episode that required bed rest for three days. The Veteran stated that he did not go to the Emergency Room. He stayed at home and took oral medication during the episode. The Veteran reported that prolonged walking or sitting exacerbated his condition. On objective observation, the examiner measured forward flexion of the thoracolumbar spine to 40 degrees. Extension was to 20 degrees. Right and left lateral flexion were each to 25 degrees. Right and left lateral rotation were each to 20 degrees. Pain was noted on all ranges of motion, but the pain did not result in or cause functional loss. There was no evidence of pain with weight bearing. There was no additional loss of range of motion after repetitive use testing. The examiner estimated that pain, weakness, fatigability, incoordination, and flare-ups would limit forward flexion to 10 degrees, extension to 5 degrees, right and left lateral rotation each to 5 degrees, and right and left lateral rotation each to 5 degrees over time. There was no muscle spasm. There was guarding which did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal. There was no muscle atrophy. There was no ankylosis. Other than radiculopathy of the left lower extremity, the examiner stated that the Veteran did not have any other neurologic abnormalities related to the back condition. The examiner stated that the Veteran had intervertebral disc syndrome of the thoracolumbar spine and had episodes of bed rest having a total duration of at least one week but less than two weeks during the past 12 months. The Veteran used a cane. The examiner stated that there was no pain with nonweight-bearing. There was pain with passive ranges of motion that did not result in or cause functional loss. Based on the evidence of record the Board finds that the Veteran’s lumbar spine disability does not warrant a rating in excess of 40 percent. In order for the Veteran’s symptomatology to warrant a higher rating than 40 percent, unfavorable ankylosis would have to be shown affecting the entire thoracolumbar spine. Here, objective medical examination by the VA examiners shows no ankylosis of the entire lumbosacral spine. While the medical evidence shows pain and limited range of motion due to pain, the Veteran’s entire thoracolumbar spine is not shown to be ankylosed as required for a higher rating. Joint pain alone, including pain throughout the entire range of motion, but without evidence of decreased functioning ability, does not warrant a higher rating. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Finally, the Board notes that the Veteran did not have incapacitating episodes of at least six weeks during any 12-month period which is required for a rating in excess of 40 percent as reported in the VA examination reports. Therefore, the Board finds that the Veteran’s claim for a rating higher than 40 percent for his lumbar spine disability must be denied. The Board has also considered the statements submitted by the Veteran in support of the claim. The Board finds that the Veteran is a lay person and is competent to report observable symptoms he experiences through his senses such pain and stiffness. Layno v. Brown, 6 Vet. App. 465 (1994). However, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. The identification of a spinal disability and the determination of the range of motion of the spine and the prescription for bed rest require medical expertise that the Veteran has not shown he possesses. Determining whether the Veteran meets some of the criteria for a higher rating requires medical diagnostic testing. Competent evidence concerning the nature and extent of the Veteran’s lumbar spine disability has been provided by the medical personnel who have examined him during the current appeal and who have made pertinent clinical findings in conjunction with the examination. The medical findings, as provided in the examination reports, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs the Veteran’s statements in support of his claim. As a final matter, the Board notes that service connection was previously established for radiculopathy of the left lower extremity as part of the service-connected lumbar spine disability, and the Board is discussing the rating for left lower extremity radiculopathy below. There are no other neurological disabilities which have been attributed to the Veteran’s lumbar spine disability by a medical professional. The competent evidence does not show any other objective neurologic abnormalities associated with the low back disability so as to warrant any separate rating. Accordingly, the Board finds that a rating higher than 40 percent for the Veteran’s low back disability is not warranted. The Board finds that the preponderance of the evidence is against the claim for increase and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to a rating higher than 10 percent for radiculopathy of the left lower extremity Under Diagnostic Code 8520, complete paralysis of the sciatic nerve warrants an 80 percent rating. A 60 percent rating is warranted for severe incomplete paralysis with marked muscular muscle atrophy. A 40 percent rating is warranted for moderately severe incomplete paralysis. A 20 percent rating is warranted for moderate incomplete paralysis warrants. A 10 percent rating is warranted for mild incomplete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term incomplete paralysis indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note. The Board notes that the terms slight, moderate, and severe are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. On VA examination in July 2011, the Veteran reported experiencing pain that radiated down the left leg to below the knee. The examiner indicated that the Veteran had decreased sensation to vibration, pinprick, and light touch to the left lower extremity. On VA examination in September 2012, the examiner the examiner found that the Veteran’s left knee and ankle reflexes were normal. Light touch (dermatome) testing was normal for the left lower extremity. At the November 2015 Board hearing, the Veteran stated that he could not feel the heel of the left foot. He stated that he walked less and could not do household chores. On VA examination in November 2019, the examiner diagnosed left leg radiculopathy. The Veteran reported that he experienced pain, tingling, and numbness. Motor strength testing was 5/5 for the left lower extremity. The examiner indicated that the Veteran experienced numbness and paresthesias and/or dysesthesias of the left lower extremity. The examiner indicated that there was involvement of the left sciatic nerve root, and the examiner indicated that the severity of the left radiculopathy was mild. During the course of the claim, the Board finds that the objective evidence shows no more than mild impairment resulting from the radiculopathy of the left lower extremity, associated with the service-connected low back disability. Motor strength has been no worse than 5/5, which was noted on the November 2019 VA examination of record. The objective evidence strongly suggests that the neurological symptoms are best objectively described as mild. They do not demonstrate any greater motor weakness that would warrant any higher rating. Significantly, the November 2019 VA examiner stated that the severity of the left radiculopathy was mild. Mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating. That is the rating currently assigned, and the Board finds that the preponderance of the evidence is against the assignment of any higher rating. The Board finds that moderate incomplete paralysis is not shown. In so finding, the Board in no way discounts the pain, numbness, and tingling that the Veteran reported experiencing in his left lower extremity. However, as the objective evidence shows mild symptoms, the Board finds that no higher rating is warranted for sciatic nerve symptoms. Accordingly, the Board finds that rating higher than 10 percent for the left lower extremity radiculopathy associated with the service-connected lumbar spine disability is not warranted. The preponderance of the evidence is against the assignment of any rating higher than 10 percent. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 6. Entitlement to a rating higher than 0 percent for Wolff-Parkinson-White Syndrome (WPW syndrome) WPW syndrome is rated under Diagnostic Code 7011, for sustained ventricular arrhythmias. Under Diagnostic Code 7011, a 10 percent rating is warranted where a workload of greater than 7 METs, but not greater than 10 METs, results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. A 30 percent rating is warranted where a workload of greater than 5 METs, but not greater than 7 METs, results in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram (EKG), echocardiogram (ECG), or X-ray. A 60 percent rating is warranted where there has been more than one episode of acute congestive heart failure in the past year; or a workload of greater than 3 METs, but not greater than 5 METs, results in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for (1) indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia; or for indefinite period from date of hospital admission for ventricular aneurysmectomy; or with an automatic implantable Cardioverter-Defibrillator (AICD) in place; or (2) chronic congestive heart failure; or a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7011. The rating schedule notes that 1 MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level at which dyspnea, fatigue, angina, dizziness or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner on the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness or syncope may be used. 38 C.F.R. § 4.104, Note (2). On VA examination in July 2011, the examiner noted that the Veteran’s condition was stable, and he was not taking any medication for his Wolff-Parkinson-White Syndrome. The examiner stated there was no history of dizziness, syncope, fatigue, or dyspnea. At the November 2015 Board hearing, the Veteran stated that he experienced heart palpitations. He was not taking any type of medication for the heart. On VA examination in November 2019, the examiner diagnosed Wolff-Parkinson-White Syndrome, status post radiofrequency ablation. The Veteran reported that since the last examination, he had several tests which were normal. The Veteran denied experiencing chest pain, fatigue, dizziness, or shortness of breath. Continuous medication was not required for control of the Veteran’s heart condition. The Veteran had not had a myocardial infarction or congestive heart failure. The Veteran’s heart rhythm was regular. Peripheral pulses were normal, and there was no peripheral edema. There was no evidence of cardiac hypertrophy. The Veteran said that he was unable to perform an exercise stress test due to his lumbar condition with radiculopathy. The examiner conducted an interview-based METs test, and the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. The examiner noted that a recent pharmacological stress test was reported as normal, and it did not show any hypertrophy or wall motion abnormality. The Board finds that the reported symptomatology discussed above, to include heart racing, is contemplated in the currently assigned 0 percent disability rating for WPW syndrome. Clinical findings from both VA examinations do not show symptoms impacting any level of physical activity. To meet the criteria for a 10 percent rating, a workload of at least 7 METs but not greater than 10 METs must result in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. 38 C.F.R. § 4.104, Diagnostic Code 7011. As the need for continuous medication or symptoms of dyspnea, fatigue, angina, dizziness, or syncope on a workload of less than 10 METs have not been shown, a compensable rating for WPW syndrome is not warranted. 38 C.F.R. §§ 4.3, 4.7. The preponderance of the evidence is against the assignment of any rating higher than 0 percent. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to November 7, 2019, is remanded. Within this decision, service connection has been established for a psychiatric disability. The Agency of Original Jurisdiction has not yet had the opportunity to establish the initial rating and effective date for the psychiatric disability. The Veteran’s claim for TDIU is inextricably intertwined with the issue of the initial rating assigned for the newly service-connected depression disability. Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, further consideration of the claim for TDIU must be deferred pending the establishment of the disability rating and effective date for the service-connected depression disability. (Continued on the next page)   The matters are REMANDED for the following action: Establish the initial disability rating and effective date for service-connected depression. Then, readjudicate the claim for entitlement to a TDIU prior to November 7, 2019. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow the applicable time for response. Then, return the case to the Board. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Layton, 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.