Citation Nr: 21014225 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 09-03 336A DATE: March 11, 2021 ORDER For the initial rating period on appeal from July 1, 2006 to February 22, 2013, a 20 percent rating, but not higher, for a lumbar spine disability, is granted. For the initial rating period on appeal, a rating higher than 20 percent for a lumbar spine disability is denied. For the initial rating period on appeal from July 1, 2006 to February 10, 2009, a separate 10 percent rating for right lumbar radiculopathy, is granted. For the rating period on appeal from February 10, 2009 to September 21, 2020, a separate 20 percent rating for right lumbar radiculopathy, is granted. For the initial rating period on appeal from June 22, 2013 to February 12, 2018, a separate 10 percent rating for left lumbar radiculopathy, is granted. FINDINGS OF FACT 1. For the entire initial rating period on appeal, the lumbar spine disability more nearly approximates forward flexion of the thoracolumbar spine to 55 degrees at worse without any incapacitating episodes of IVDS that resulted in prescribed bed rest by a physician. 2. For the initial rating period on appeal from July 1, 2006 to February 10, 2009, the lumbar spine disability resulted in neurological impairment of the right lower extremity that was analogous to mild incomplete paralysis of the sciatic nerve. 3. For the initial rating period on appeal from February 10, 2009 to September 21, 2020, the lumbar spine disability resulted in neurological impairment of the right lower extremity that was analogous to moderate incomplete paralysis of the sciatic nerve. 4. For the initial rating period on appeal from June 22, 2013 to February 12, 2018, the lumbar spine disability resulted in neurological impairment of the left lower extremity that was analogous to mild incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. For the initial rating period on appeal from July 1, 2006 to February 22, 2013, the criteria for a 20 percent rating for a lumbar spine disability are approximated. 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 (DC) 5243-5242. 2. For the initial rating period on appeal, the criteria for a rating higher than 20 percent for a lumbar spine disability are not met or approximated. 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 (DC) 5243-5242. 3. For the initial rating period on appeal from July 1, 2006 to February 10, 2009, the criteria for a 10 percent for right lumbar radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.123, 4.124, 4.124a; DC 8520. 4. For the rating period on appeal from February 10, 2009 to September 21, 2020, the criteria for a 20 percent for right lumbar radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.123, 4.124, 4.124a; DC 8520. 5. For the initial rating period on appeal from June 22, 2013 to February 12, 2018, the criteria for a 10 percent for left lumbar radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.123, 4.124, 4.124a; DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1984 to June 2006. Procedural History VA received the Veteran’s original claim for compensation in January 2006. Thereafter, in a July 2006 rating decision, the RO granted service connection for a lumbar spine disability and assigned an initial 10 percent rating. In April 2007, the Veteran submitted a timely notice of disagreement with the assigned initial rating. The RO did not issue a statement of the case but issued a supplemental statement of the case in January and April 2009. The Veteran timely perfected his appeal later in April 2009. In March 2012, the Board remanded the claim to provide the Veteran with a new VA examination. In a July 2013 rating decision, the RO increased the lumbar spine disability to 20 percent effective February 22, 2013 (finding that this was the date of the claim for increase despite the claim being pending as an initial rating claim prior to this date). In a September 2015 rating decision, the RO granted a separate 10 percent rating for right lumbar radiculopathy effective February 10, 2009. A supplemental statement of the case was issued on the same day adjudicating the issues of increased rating for a lumbar spine disability higher than 10 and 20 percent as well as right lumbar radiculopathy. In December 2016, the Board remanded the claim for an additional time to provide the Veteran with a VA examination that complies with the holding in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). A supplemental statement of the case was issued in August 2017. In December 2017, the Board remanded the claim for an additional time to provide the Veteran with a VA examination that complies with the holding in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). A supplemental statement of the case was issued in November 2019. A day later, the RO issues a rating decision granting a separate 10 percent rating for left lumbar radiculopathy effective February 12, 2018. In April 2020, the Board remanded the case for an additional time, finding no compliance with the Board’s prior remand directives. A supplemental statement of the case was issued in September 2020, and on the same day, a rating decision increased the right lumbar radiculopathy to 20 percent, effective September 21, 2020. The appeal has since returned to the Board for further appellate consideration. Initial Rating – Applicable Laws and Regulations Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Lumbar Spine – Rating Criteria When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). Where arthritis results in painful motion of the joint, the rating criteria allow for at least the minimum compensable evaluation for the joint. 38 C.F.R. § 4.59. The intent of the rating schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or misaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Id. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made 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. The General Rating Formula for Diseases and Injuries of the Spine provides a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is provided 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 disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. Intervertebral disc syndrome can alternatively be rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS Formula). Under the IVDS Formula, a 10 percent rating requires incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A rating of 20 percent is warranted for incapacitating episodes with a total duration of at least two weeks but less than four weeks during the past 12 months. A rating of 40 percent is warranted for incapacitating episodes with a total duration of at least four weeks but less than six weeks during the past 12 months. A maximum rating of 60 percent is warranted for incapacitating episodes with a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, IVDS Formula. For these purposes, an incapacitating episode is defined as 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. Id. at Note (1). On February 7, 2021, amendments to the schedule for rating disabilities of the musculoskeletal system, including DC 5242 for degenerative arthritis and DC 5243 for IVDS, went into effect. See 85 Fed. Reg. 76460 (November 30, 2020). The amendment to DC 5242 clarifies that the rating criteria is to be applied for other than IVDS. The amendment to DC 5243 for IVDS specifies that it is to be applied only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Id. Lumbar Spine – Rating Analysis The Veteran’s lumbar spine disability is rated as 10 percent disabling from July 1, 2006 to February 22, 2013, and as 20 percent disabling thereafter. For the reason expressed below, the Board finds that a 20 percent rating, but not higher, is warranted for the entire initial rating period on appeal. In January 2006, the Veteran underwent a VA examination, at which time the examiner noted that the Veteran had a history of back pain with not enough clinical evidence to render a diagnosis. The examiner further rendered some rather confusing measurements. Specifically, the examiner noted forward flexion of the lumbar spine to 112 degrees and to 112 degrees after repetitive use testing; extension to 17 degrees and to 12 degrees after repetitive use testing; right external flexion to 30 degrees and to 20 degrees after repetitive use testing; left lateral flexion to 17 degrees and to 20 degrees after repetitive use testing; right lateral rotation to 50 degrees and to 52 degrees after repetitive use testing; and, left lateral rotation 67 degrees and to 72 degrees after repeated use testing. Notably, these measurements deviate from normal lumbar spine measurements. The Veteran’s gait was normal. There was no evidence of spasm, tenderness, fatigue, weakness, lack of endurance, or incoordination. In the April 2007 notice of disagreement, the Veteran indicated that the examination failed to consider the extreme pain she lived with on a daily basis and how the pain impacted her life. In a February 2009 letter, a clinician noted that the Veteran had recurrent sciatica since 1993, and added that while x-rays at the time were normal, MRI showed L5-S1 disc dislocation, which was deemed to be the cause of the right-side sciatica. At the present, the Veteran continued to have right side sciatica that was controlled by anti-inflammatory medication, muscle relaxants, and Tylenol/Codeine. She had intermittent physiotherapy for exacerbations of the sciatica, which she described as pain that was 8 out of 10 in severity. She also had intermittent numbness and weakness. According to August 2011 VA treatment records, range of motion of the lumbar spine revealed forward flexion to 60 degrees; extension to 15 degrees; lateral flexion to 20 degrees, bilaterally; and, lateral rotation to 30 degrees, bilaterally. According to January 2013 private treatment records, the Veteran complained of back pain. The symptoms were reported as moderate and occurring constantly. The physician noted that the Veteran had moderate to severe back pain since 1993. She could not tolerate medications. The pain wrapped up around her back. She denied pain shooting down her legs consistently, but felt more of a cramping tightness in both legs and hips without current tingling. She indicated that she had a normal EMG. On physical examination, the Veteran’s gait was compensated. There was mild spasm and tenderness. There was evidence of moderate to severe pain from L2-3 through L5-S1. Range of motion revealed flexion to 70 degrees; extension to 10 degrees; and, lateral flexion to 25 degrees, bilaterally. The physician noted that pain on motion was severe. Lower extremities strength was normal, bilaterally. Reflex and sensory examinations were normal. The physician stated that since conservative measures failed it was recommended that the lumbar spondylosis will be treated with “diagnostic block.” In June 2013, the Veteran underwent a VA back examination, at which time the examiner confirmed a diagnosis of lumbar disc degeneration. The Veteran reported back pain that radiated down the posterior aspect of the legs, bilaterally. This pain was constant on the right and intermittent on the left. She reported having flare-ups that were described as occurring once to twice a month and lasting ten to twelve hours. During these times she had to use a TENS unit. The examiner indicated that range of motion and functional disability during flare-ups could not be measured. Upon physical examination, range of motion of the lumbar spine revealed forward flexion to 60 degrees; extension to 25 degrees; lateral flexion to 25 degrees, bilaterally; and, lateral rotation to 30 degrees, bilaterally. There was no objective evidence of pain. The examiner noted that the Veteran had additional imitation in range of motion after repetitive use testing; however, the examiner recorded the same measurements as the initial range of motion testing. The examiner further noted that there was no functional loss/impairment of the lumbar spine, but indicated that less movement than normal resulted in functional impairment and/or additional limitation of range of motion. There was bilateral paraspinal tenderness, but no muscle spasm or guarding. Muscle strength testing was normal throughout with no evidence of muscle atrophy. Reflex and sensory examinations were normal. Straight leg raising test was negative, bilaterally. The examiner noted that the Veteran had signs and symptoms of radiculopathy, to include severe right constant pain, paresthesias, and numbness, and severe left intermittent pain, paresthesias, and numbness. The examiner did not answer any additional questions regarding nerve involvement or severity of the radiculopathy. There was IVDS with no incapacitating episodes over the previous 12 months. She used no assistive devices. The Veteran worked as an intelligence liaison officer and indicated that she had to change positions frequently. According to VA treatment records dated from 2014 to 2015, the Veteran continuously complained of severe back pain. She had trouble putting on shoes/socks and the back felt much stiffer than it used to be. In September 2015, the Veteran underwent an additional VA back examination. The Veteran reported having pain that was 5 to 6 out of 10 in severity, which radiated to her right lower extremity. She had a hard time putting shoes on due to lack of flexibility. She recently had flare-ups that were so severe that she could not walk without taking painkillers. The examination was eight weeks after this flare-up, and she was still not back to the “baseline” of pain that was 3 to 4 in severity at best. The pain during the examination was 5 to 6 in severity and at worse was 10 out of 10. Normally, the worst pain was 8 to 9 out of 10 in severity three to four times a year. She did not know what triggered those flare-ups, but she developed increased pain a day earlier and could not walk after sitting on her couch during that time. Back pain was worse with sitting, and with walking the right leg pain worsened. She could walk at best a mile and that triggered pain. She could sit for an hour in a really good chair and only 15 to 20 minutes in a “bad” chair. She could no longer put her hands flat on the floor. Prior to her last flare-up she was able to hike with her 11-year-old son, but could no longer do this. During storms her pain worsened. She was unable to have sexual relations with her husband. On really bad days, she was able to do a little pool walking and on good days tried to swim as well. The examiner noted that the Veteran stood and stretched multiple times during the history portion of the examination. Her gait was slightly wide based, but she could do normal heel walking, toe walking, and squatting. There was tenderness to palpation of the lower lumbar paraspinals and even more so over the bilateral SI joints. The examiner noted that range of motion was quite good for most individuals, but for this Veteran it was not normal because she usually could touch the floor with flat hands and now could only reach down the mid-tibia. She used her hands to climb up and down her thighs to stabilize her spine. The examination seemed genuine and consistent. Range of motion of the lumbar spine revealed forward flexion to 90 degrees; extension to 20 degrees; lateral flexion to 25 degrees, bilaterally; right lateral rotation to 30 degrees; and, left lateral rotation to 25 degrees. Range of motion contributed to a functional loss due to difficulty putting on shoes and socks or picking things off the floor. There was evidence of localized tenderness and pain on palpation. The Veteran was able to perform repetitive use testing that did not result in additional loss of function or range of motion. The examiner indicated that the Veteran was not examined immediately after repetitive use over time, but the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain significantly limited functional ability with repeated use over a period of time. The examiner estimated that after repeated use over time forward flexion will be to 55 degrees; extension to 15 degrees; lateral flexion to 15 degrees, bilaterally; right lateral rotation to 20 degrees; and, left lateral rotation to 15 degrees. The examiner indicated that the same measurements would apply during flare-ups. There was guarding that resulted in abnormal gait. Additional factors contributing to the disability included disturbance of locomotion and interference with sitting and standing. Muscle strength testing was normal with no evidence of muscle atrophy. Reflex examination was normal for both knees and left ankle, but hypoactive in the right ankle. Sensory examination was normal throughout except the right lower leg/ankle. Straight leg raising test was negative, bilaterally. Signs and symptoms of radiculopathy included moderate constant and intermittent right lower extremity pain. The examiner noted that only the right lower extremity was affected and was mild in severity. There was no ankylosis or IVDS. The Veteran used no assistive devices. At work, she did not do any heavy lifting and needed an ergonomic workstation and the ability to get up and walk around every hour. According to a November 2016 MRI, there were overall mild degenerative changes with moderate foraminal stenosis at the right L5-S1 and crowding of the left lateral recess at L4-L5. In March 2017, the Veteran underwent an additional back compensation examination, at which time the examiner confirmed a diagnosis of lumbar degenerative disc disease with IVDS. The Veteran reported that her back pain increased in severity and frequency. The pain was daily with stiffness and radiation to both legs. She added that walking was very challenging. Flare-ups were described as severe pain, at which time movement was almost impossible and pain radiating to the right leg. Functional loss/impairment was described as limited range of motion due to pain. Upon physical examination, range of motion of the lumbar spine revealed forward flexion to 70 degrees; extension to 10 degrees; lateral flexion to 20 degrees, bilaterally; and, lateral rotation to 30 degrees, bilaterally. Range of motion itself contributed to functional loss due to pain. Pain was noted on examination and caused functional loss. There was no evidence of pain with weight bearing or localized tenderness/pain on palpation. There was no additional loss of function or range of motion after repetitive use testing with three repetitions. The examiner noted that the examination was neither medically consistent, nor inconsistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner further noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. Although the Veteran did not report flare-ups at the time of the examination, the examiner concluded that the examination was conducted during a flare-up, which did not cause additional loss. Muscle strength testing was normal with no evidence of muscle atrophy. Reflex and sensory examinations were normal and straight leg raising test was negative, bilaterally. Despite the Veteran’s reports of radicular pain, the examiner concluded that she had no signs or symptoms or radiculopathy. There was no ankylosis. IVDS did not result in any episodes of acute signs and symptoms that required bed rest prescribed by a physician. The Veteran used no assistive devices. The impact on the Veteran’s work was noted as inability to lift more than 40 pounds, needing to change positions every 10 to 15 minutes, and using an ergonomic desk and chair at work. In a June 2017 addendum, the examiner indicated “I cannot determine a level of severity due to the fact that it is subjective, and her condition can vary day to day.” In an October 2017 informal hearing presentation, the Veteran’s representative noted that her symptoms were worse than those noted in the 2017 examination report. More specifically, the Veteran reported that she had “severe flare-ups that impact the function, and range of motion of the lumbar spine,” and contended that “during a flare-up, she is unable to forward flex beyond 30 degrees because of the pain, weakness, and fatigability.” In February 2018, the Veteran underwent an additional back compensation examination, at which time the Veteran reported constant sharp/throbbing pain that was 4 to 5 out of 10 in severity with intermittent pain that was 8 to 9 out of 10 in severity and spasms. She also had constant severe paresthesia and numbness that extended to the right leg and toes and intermittent severe paresthesia and numbness that extended to the left leg and toes. Treatment included stretches, Aleve, and magnesium. Flare-ups were described as occurring once every other month/six times a year where pain was 9 to 10 out of 10 in severity. Those could occur while driving and required her to pull over, take magnesium, and resume driving 30 minutes to an hour later. Functional loss/impairment was described as having to change positions regularly and having special sitting to standing desk at work. Upon physical examination, range of motion testing of the lumbar spine revealed forward flexion to 80 degrees; extension to 10 degrees; lateral flexion to 20 degrees, bilaterally; and, lateral rotation to 20 degrees, bilaterally. The examiner noted that range of motion itself contributed to functional loss due to severe pain. There was no evidence of localized tenderness or pain to palpation. Pain was noted on examination and caused functional loss. There was evidence of pain with weight bearing. After repetitive use testing, range of motion revealed forward flexion to 70 degrees; extension to 10 degrees; lateral flexion to 15 degrees, bilaterally; and, lateral rotation to 15 degrees, bilaterally. Pain, fatigue, and weakness caused functional loss. The examiner indicated that the Veteran was not examined immediately after repetitive use over time or during a flare-up and that the examination report was neither medically consistent nor inconsistent with the Veteran’s statements describing functional loss under these conditions. The examiner explained that it was not possible to determine, without resorting to mere speculation, to estimate loss of range of motion, because there was no conceptual or empirical basis for making such a determination without directly observing function under these conditions. Muscle spasm did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal throughout with no evidence of muscle atrophy. Reflex examination was normal on the left lower extremity and hypoactive in the right lower extremity. Sensory examination was normal decreased throughout the right lower extremity and decreased in the left foot/toes. Straight leg raising test was positive on the right and negative on the left. Signs and symptoms of radiculopathy included moderate constant pain, intermittent pain, paresthesias, and numbness in the right lower extremity and mild constant pain, intermittent pain, paresthesias, and numbness in the left lower extremity. The examiner concluded that the Veteran’s radiculopathy was mild in severity, bilaterally. There was no ankylosis and the Veteran’s IVDS did not result in any episodes of acute signs and symptoms that required bed rest prescribed by a physician. The Veteran used on assistive devices. According to June and September 2018 VA treatment records, range of motion of the lumbar spine revealed flexion to 85 degrees; extension to 12 degrees; right forward flexion to 18 degrees; left forward flexion to 20 degrees; and, lateral rotation equal in both directions without a degree measurement. In September 2020, the Veteran underwent an additional back compensation examination, at which time the examiner again confirmed diagnoses of IVDS and degenerative disc disease. The Veteran reported back pain that continuously radiated to her right lower extremity. She used Aleve, TENS unit, and supplements for treatment. Flare-ups were described as feeling like being hit with a baseball bat, which prevented her from even laying down during that time. Functional loss/impairment was described as inability to run, do auto mechanics, lift heavy items, and sit for too long. Upon physical examination, range of motion of the lumbar spine revealed forward flexion to 90 degrees; extension to 20 degrees; lateral flexion to 20 degrees, bilaterally; and, lateral rotation to 10 degrees, bilaterally. The examiner indicated that range of motion did not contribute to functional loss. Pain was noted on examination, but did not result in or cause functional loss. There was objective evidence of moderate tenderness over the right lumbar paraspinous muscles. There was no evidence of pain with weight bearing. The examiner noted that the examination report was neither medically consistent nor inconsistent with the Veteran’s statements describing functional loss after repeated use over time/during flare-ups. The examiner estimated that under these conditions forward flexion will be to 80 degrees; extension to 15 degrees; lateral flexion to 15 degrees, bilaterally; and, lateral rotation to 10 degrees, bilaterally. Muscle spasm and guarding resulted in abnormal gait. Factors contributing to the disability included less movement than normal, disturbance of locomotion, interference with sitting and standing, and inability to run, jog, or sit for long periods. Muscle strength testing was normal throughout except active movement against some resistant (4/5) for right hip flexion with no evidence of muscle atrophy. Reflex examination was hypoactive on the right knee and ankle and normal on the left. Sensory examination was decreased in the foot/toes, bilaterally. Straight leg raising test was negative, bilaterally. Symptoms of radiculopathy included right lower extremity mild constant pain, moderate intermittent pain, and mild numbness. No symptoms of left lower extremity radiculopathy were noted, and the examiner indicated that the previous examination showed symptoms of neuropathy and not radiculopathy. The examiner concluded that the left lower extremity was not affected, and the right lower extremity was moderate in severity. There was no ankylosis and IVDS did not result in any episodes of acute signs and symptoms that required bed rest prescribed by a physician. The Veteran used no assistive devices. At work, the Veteran could not turn and twist easily, lift heavy items, run/jog, and sit/stand for long periods. On review, the Board finds extreme inconsistencies regarding the severity of the Veteran’s lumbar spine condition throughout the pendency of the appeal. In 2006, forward flexion was recorded to 112 degrees, outside the normal measurement with full range of motion to 90 degrees. In 2011 and 2013, forward flexion was to 60 degrees, and although the 2013 examiner noted that there was additional loss of motion after repeated use/during flare-ups, such was not recorded in degrees. In 2015, forward flexion was to 90 degrees and the examiner estimated that during flare-ups there would be a 35-degree loss to 55 degrees, and the examiner indicated that the Veteran’s reports were genuine. In 2018 and 2020, forward flexion was to 80 and 90 degrees, respectively. The 2020 examiner estimated additional loss of motion to 80 degrees. In the interim, in 2017, the Veteran reported that forward flexion was to not more than 30 degrees during flare-ups. Given this evidence, the Board finds that an initial 20 percent rating, but not higher, is warranted. In so finding, the Board resolves all doubt in the Veteran’s favor in finding that despite close to normal range of motion throughout the pendency of the appeal, during flare-ups her limitation of motion was more severe. Accordingly, the Board resolves all doubt in the Veteran’s favor in finding that an initial 20 percent rating, is warranted. However, a rating higher than 20 percent is not warranted. In this regard, the Board notes that contrary to the Veteran’s attorney argument that by her own estimation during flare-ups her forward flexion is limited to no more than 30 degrees, all medical evidence contradicts these assertions. Moreover, per the Veteran’s reports, her flare-ups occurred only between four to six times a year. Specifically, even taking into consideration the Veteran’s competent and credible reports of flare-ups and functional loss after repetitive use over time, limitation of flexion to 30 degrees is still not met or approximated. Throughout the pendency of the appeal, forward flexion was, at worst, to 60 degrees with the 2015 estimation of 55 degrees during flare-ups. The Board concludes that the currently assigned 20 percent rating already contemplates the additional loss due to pain and other DeLuca factors after repetitive use and/or during flareups. See 38 C.F.R. §§ 4.40, 4.45. A higher rating under the General Rating Formula is not warranted. A rating higher than 20 percent is also not warranted under the IVDS Formula. Notably, a diagnosis of IVDS was not shown until 2013. In addition, there is no evidence of her experiencing any incapacitating episodes of IVDS as defined by VA regulation. Indeed, incapacitating episodes are defined by VA as those episodes for which bedrest is prescribed by a physician. Here, there is no evidence of incapacitating episodes, let alone episodes of IVDS of at least four weeks but less than six weeks during the past 12 months to warrant a higher rating. This is true even pursuant to the 2021 amended rating criteria. In sum, there is no basis to support a rating higher than 20 percent for the Veteran’s lumbar spine disability at any point during the pendency of the appeal under either the General Rating Formula or the IVDS formula. Associated Neurological Impairment In addition to consideration of the orthopedic manifestations of the lumbar spine disability, VA regulations require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, DCs 5235 to 5243, Note (1). Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted for complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as “mild,” “moderate,” “moderately severe,” and “severe.” See Spellers v. Wilkie, 30 Vet. App. 157 (2018). Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Here, the Veteran is in receipt of a 10 percent rating from February 10, 2009 to September 21, 2020, and 20 percent rating thereafter, for right lumbar radiculopathy and a 10 percent rating for left lumbar radiculopathy beginning February 12, 2018. On review, the Board finds that the right lumbar radiculopathy was present throughout the initial rating period on appeal. Prior to February 10, 2009, the right lumbar radiculopathy appeared to be only mild in severity. In fact, while present, the Veteran did not seek treatment for it or provide any lay assertions regarding its severity. While subsequent records showed perhaps only mild symptoms, the Veteran continuously complained of severe right lower extremity pain, weakness, and numbness. Accordingly, the Board resolves all doubt in the Veteran’s favor in finding that from July 1, 2006 to February 10, 2009, a separate 10 percent disability rating for right lumbar radiculopathy is warranted. In addition, a 20 percent rating is warranted beginning February 11, 2009, at which time symptoms approximated moderate incomplete paralysis of the sciatic nerve. Regarding the left lumbar radiculopathy, the Board finds that the first time the Veteran complained of left lower extremity symptoms was on June 22, 2013 during the VA examination. Throughout the pendency of the appeal, all medical professionals indicated that the left lumbar radiculopathy was mild in severity. There is no evidence suggesting moderate and/or severe symptoms. Accordingly, the Board finds that a separate 10 percent rating, but not higher, for left lumbar radiculopathy are met. Finally, neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Specifically, while she needed some accommodations, the record suggests that the Veteran continued working throughout the pendency of the appeal. Thus, a TDIU claim is not raised by the record. To the extent ratings in excess of those awarded by the RO or by way of this decision are denied, the Board has duly considered the benefit-of-the-doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim in this regard, so that doctrine is not applicable. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). A. ADAMSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Yaffe, 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.