Citation Nr: 21014758 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 13-18 629 DATE: March 15, 2021 ORDER 1. Entitlement to a disability rating in excess of 40 percent for lumbosacral strain with degenerative joint disease and intervertebral disc syndrome (IVDS) from April 4, 2011 is denied for the entire period on appeal. 2. Entitlement to an initial rating of 20 percent, but no higher, for left lower extremity radiculopathy is granted for the entire period on appeal. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s lumbosacral strain with degenerative joint disease and IVDS has not been characterized by ankylosis of the entire thoracolumbar spine or by incapacitating episodes of intervertebral disc syndrome (IVDS) having a total duration of at least six weeks during the past 12 months. 2. For the entire period on appeal, the Veteran’s left lower extremity radiculopathy has been primarily manifested by neurologic impairment analogous to moderate incomplete paralysis of the femoral nerve, without severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 40 percent for lumbosacral strain with degenerative joint disease and IVDS, have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Codes (DCs) 5237, 5243. 2. The criteria for an initial rating of 20 percent, but no higher, for left lower extremity radiculopathy have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.124a, DC 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from October 1987 to May 1993. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in April 2015 to obtain a current VA examination. As there has been substantial compliance with prior remand directives, the matters are properly returned to the Board for adjudication. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Evaluations are based upon lack of usefulness of the part or system affected, especially in self-support. 38 C.F.R. § 4.10. In evaluating musculoskeletal disabilities, consideration is given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. 38 C.F.R. §§ 4.40 and 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59 (2016). Johnson v. Brown, 9 Vet. App. 7 (1996). However, in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court clarified that there is a difference between joint motion pain as opposed to pain that places further limitation of the particular range of motion. Disability of the musculoskeletal system is 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. The examination upon which ratings are based must adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant on motion. Disability of the musculoskeletal system is the inability to perform normal working movement with normal excursion, strength, speed, coordination, and endurance, and that weakness is as important as limitation of motion, and that a part that becomes disabled on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, through atrophy, for example. 38 C.F.R. § 4.40. The provisions of 38 C.F.R. §§ 4.45 and 4.59 also contemplate inquiry into whether there is limitation of motion, weakness, excess fatigability, incoordination, and impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity, or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing are also related considerations. The Court has held that diagnostic codes predicated on limitation of motion require consideration of a higher rating based on functional loss due to pain on use or due to flare-ups. 38 C.F.R. §§ 4.40, 4.45, 4.59; Johnson v. Brown, 9 Vet. App. 7 (1997); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower for segments of time during the period under review in accordance with such variations, to the extent they are sufficient to warrant changes in the evaluations assignable under the applicable rating criteria. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 126. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). 1. Entitlement to a disability rating in excess of 40 percent for lumbosacral strain with degenerative joint disease and intervertebral disc syndrome (IVDS) from April 4, 2011. The Veteran contends that he is entitled to an increased disability rating for his service-connected back disability. See Appellate Brief Received by the Board November 2020. The Veteran noted that he experienced difficulty sitting for an extended period of time and difficulty getting comfortable and sleeping for a reasonable amount of time. See Form 9 Received June 2013.The Veteran stated that he has occasional spasming in his lower back which causes pain in his left leg. Id. The Veteran’s friend and co-worker TT provided a statement indicating that the Veteran had undergone back related issues which have frustrated his ability to accomplish the things he loves most including being active in sports and performing at maximum capability at his job. See VA form 21-4138 Received June 21, 2013. The Veteran’s sister, JL stated that she noticed that the Veteran had suffered increasingly more incidents related to his back and that she noticed the time of recovery from his back incidents increasing and also stated that it greatly impacted his mobility. See VA form 21-4138 Received June 21, 2013. The Veteran’s service-connected lumbosacral strain with degenerative joint disability has been rated as 40 percent disabling throughout the relevant period under 38 C.F.R. § 4.71a, DC 5237, which pertains to lumbosacral or cervical strain. DC 5237 directs that lumbosacral strain be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Under the General Rating Formula, a 40 percent rating is assigned for limitation of forward flexion of the thoracolumbar spine to 30 degrees or less. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Thus, for the Veteran to be entitled to a rating in excess of 40 percent under DC 5237, the record must show that he has unfavorable ankylosis of at least the entire thoracolumbar spine. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, DCs 5235 to 5243, Note (5). The Board has carefully reviewed the record, and finds that it does not reflect that the Veteran had favorable or unfavorable ankylosis of the entire thoracolumbar spine at any point during the relevant rating period. The medical treatment records do not show a finding or diagnosis of ankylosis of the thoracolumbar spine at any time during the period on appeal. The Veteran was initially afforded an examination evaluating his back in May 2011. The examiner explicitly stated that the Veteran did not have ankylosis of the thoracolumbar spine. In July 2015, the Veteran was afforded another examination to evaluate his back condition. The examiner described additional contributing factors of the Veteran’s disability to include less movement due to adhesions and “NOT ankylosis”. The examiner noted that the Veteran did not have ankylosis of the spine. The Veteran was afforded an examination evaluating his back disability in April 2019, and the examiner indicated that the Veteran does not have ankylosis of the thoracolumbar spine. Most recently, the Veteran was afforded another VA examination in August 2019, and the examiner noted that the Veteran does not have ankylosis of the spine. Moreover, the Veteran’s treatment records do not indicate that he has had ankylosis of the thoracolumbar spine at any point during the period on appeal. As the record fails to demonstrate a showing of ankylosis of the thoracolumbar spine at any point during the appeal period, the evidence does not support entitlement to a rating in excess of 40 percent under DC 5237. The Board notes that a rating in excess of 40 percent is available for disabilities of the spine when rated under 38 C.F.R. § 4.71a, DC 5243, relating to intervertebral disc syndrome. Under that diagnostic code, a 60 percent rating is assigned for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. For purposes of ratings under DC 5243, 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. Id. Note (1). The May 2011 examiner noted that the Veteran had IVDS of the lumbar spine with left femoral nerve involvement secondary to sequestrated L4/5 disc herniation into the left L4 lateral recess and flattened lumbar lordosis; however, there was no indication that the Veteran experienced any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The July 2015 examiner noted that the Veteran does have IVDS of the thoracolumbar spine, however, it was noted that he did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The April 2019 examiner stated that the Veteran does have IVDS, but has not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Finally, the August 2019 examiner stated that the Veteran does have IVDS of the thoracolumbar spine. The examiner described the total duration of IVDS over the past 12 months by stating that episodes of bed rest had a total duration of at least one week but less than two weeks during the past 12 months. The examiner further noted the medical history of the back disability as described by the Veteran and without documentation; the Veteran reported that it was recommended that he be on bed rest for three to four days due to acute back pain a few months ago. The Board acknowledges that each of the examinations of record regarding the Veteran’s lumbar strain disability indicate that he does indeed have IVDS, however, his May 2011, July 2015, and April 2019 examinations all clearly and unequivocally indicate that he did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Notwithstanding this, the Board does recognize the notations in the August 2019 VA examination regarding the Veteran’s reports of recommended bed rest. The examiner noted that the Veteran himself reported episodes of bed rest without documentation and the examiner also noted that the Veteran himself reported that he was recommended three to four days of bed rest for acute back pain a few months ago. The August 2019 examiner checked a box on the examination report that stated that the Veteran has had episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The examiner explained and clarified this notation in detail however, by specifying that the episodes of bed rest had a total duration of at least one week, but less than two weeks during the past 12 months. In order for the Veteran to be entitled to a disability rating for IVDS, the diagnostic criteria require incapacitating episodes having a total duration of at least 6 weeks during the past 12 months that requires bed rest prescribed by a physician and treatment by a physician. Even when taking into consideration the information that the Veteran reported to the August 2019 examiner, there is still no showing through the Veteran’s own reports or the evidence of record that the Veteran experienced incapacitating episodes of IVDS symptoms for a duration of at least 6 weeks during the past 12 months that required bed rest prescribed by a physician and treatment by a physician at any time during the relevant appeal period. As such, consideration of DC 5243 does not warrant an increased rating in excess of 40 percent for the Veteran’s lumbar spine disability. The Board acknowledges the Veteran’s assertions as well as other assertions made in the record regarding the severity of his lumbosacral strain with degenerative joint disability, however, while the Veteran and others are competent to provide testimony or statements relating to symptoms or facts of events that they have observed and are within the realm of their personal knowledge, they are not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Specifically, neither the Veteran nor other individuals who provided lay statements regarding this claim are competent to provide an opinion as to the rating assignment for the severity level of his back disability, as it is based upon objective range of motion testing and/or prescribed bed rest by a physician. Therefore, the Board places greater reliance on the objective medical evidence. Jandreau v. Nicholson, 492 F 3d 1372, 1377 (Fed Cir 2007). Based on the foregoing, the Board finds that the criteria for entitlement to a rating in excess of 40 percent for the Veteran’s service-connected lumbosacral strain with degenerative joint disability have not been met as the medical evidence of record does not demonstrate that the Veteran had unfavorable ankylosis of the entire thoracolumbar spine at any time during the period on appeal. Accordingly, there is no basis for staged rating of the Veteran’s service-connected lumbar spine disability pursuant to Hart, 21 Vet. App. at 519. As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert, 1 Vet. App. 49. Entitlement to a disability rating in excess of 40 percent for lumbosacral strain with degenerative joint disease and intervertebral disc syndrome (IVDS) from April 4, 2011 is denied. 2. Entitlement to an initial rating in excess of 10 percent prior to July 20, 2015, and in excess of 20 percent thereafter. The Veteran asserts that he is entitled to a higher rating for his left lower extremity radiculopathy disability. In his substantive appeal, the Veteran requested that his left lower extremity radiculopathy disability be rated as 20 percent disabling. See Form 9 Received June 2013. The Veteran stated that he experiences difficulty sitting for an extended period of time and has sharp pains in his left leg. He noted that the left leg pain begins in his upper front thigh and radiates to his foot causing some tingling in his toes. Id. The Veteran noted that the pain is only relieved by standing and massaging his thigh and further noted that he seeks medical attention when the pain in his left leg lingers or is excruciating. Id. The Veteran through his representative references findings from C & P examinations from June 2015, August 2015, May 2011, and March 2015 to support an increase in the disability rating for left lower extremity radiculopathy. See Informal Hearing Presentation Received November 2020. The Veteran through his representative stated that the Board should find that the Veteran’s radiculopathy of the left lower extremity is moderately severe based on the evidence of record and assign a 40 percent rating. See Informal Hearing Presentation Received November 2020. The Veteran’s co-worker and friend TT provided a statement regarding the Veteran’s disabilities. TT stated that due to the Veteran’s disabilities he becomes frustrated because he is unable to accomplish the things that he loves the most including being active in sports and performing his job with maximum capabilities. TT stated that she has observed that as a result of the disabilities the Veteran’s productivity has been significantly impacted and he can’t seem to stand or sit for a long period of time. Sometimes work requires them to do a lot of walking. See VA Form 21-4138 Received April 2011. The Veteran’s sister, JL provided a statement regarding the extent that the Veteran’s back issues have impacted his walking. JL stated that the Veteran had suffered increasingly more incidents related to his back. She stated that the Veteran was unable to do simple task for himself like cook and clean and had to walk with a cane. JL also stated that the Veteran favors his right leg when he walks and his back problems appear to have affected his walking. See VA Form 21-4138 Received May 2013. A statement was provided by AH who stated that she observed the Veteran in severe pain on several occasion. It was noted that he is not comforted while standing, laying down, or sitting down. AH als noted that the only thing that gives him minor relief is deep massage of the affected areas leg, lower back hip and foot. She stated that even then, the relief lasts only few minutes. AH also alleged that the Veteran’s life and work have been adversely impacted as a result of the pain and weakness he experiences daily. See VA Form 21-4138 Received May 2011. Another statement was provided by TE. TE stated that she observed that the pain in the Veteran’s back and leg are sometimes so severe that he is unable to get out of bed and requires help dressing himself. See VA Form 21-4138 Received May 2011. For the relevant period on appeal, the Veteran’s in receipt of a 10 percent rating for his left lower extremity radiculopathy prior to July 21, 2015, and in receipt of a 20 percent rating thereafter pursuant to DC 8526, regarding paralysis of the anterior crural nerve (femoral). Under DC 8526, a 10 percent rating is warranted for mild and incomplete paralysis of the femoral nerve; a 20 percent rating is warranted for moderate incomplete paralysis; a 30 percent rating is warranted for severe incomplete paralysis; and a 40 percent rating (the highest schedular rating available) is warranted for complete paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in DC 8526 are not defined in the Rating Schedule. 38 C.F.R. § 4.120 states that “[i]n rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.” In a March 2011 private treatment record, it is noted that the Veteran has severe back pain that then progressed into the left upper thigh and occasionally down to the bottom of the left foot. It was noted that the Veteran’s pain is quite severe at this particular visit. The record states that the Veteran rates his leg pain as 10/10 and it is noted that he was not using any pain medication. See Non-Governmental Treatment Record Received June 1, 2011. In a March 2015 treatment note it was stated that the Veteran experienced low back pain that radiated to the left thigh and down to the outer left foot that he rated as 4/10 with 10 being the worst on the scale. The Veteran noted that the pain is made better by a hot back, being still, and applying a heating pad. It was noted that his symptoms are made worse when he sits or stands for too long. See CAPRI Treatment Records Received July 6, 2015. The Veteran was afforded an examination to evaluate his left lower extremity disability in May 2011. The examiner noted that the Veteran did not experience neuritis, neuralgia, paralysis, IVDS, or peripheral neuropathy with respect to the left lower extremity. The Veteran’s left lower extremity muscle strength was abnormal and described as difficulty with left leg knee bending. Fine motor control and muscle note was normal for left lower extremity. Test were performed for nociception and for proprioception. The pinprick test, which was used for nociception revealed normal results, the position sense test which was used for proprioception revealed normal results. Vibratory sense of the left lower extremity was normal. The examiner noted that the Veteran’s IVDS most likely effected the femoral nerve causing the Veteran to experience mild weakness of the left quadriceps on left leg knee bending. The Veteran’s July 2015 back examination provided information regarding the Veteran’s left lower extremity. The examiner noted that the Veteran experienced mild radicular pain or other symptoms due to radiculopathy in the left lower extremity and mild numbness. It was noted that the Veteran experienced moderate intermittent pain and moderate paresthesias. The severity of radiculopathy of the left side was noted to be moderate. A clarifying VA opinion was provided in August 2015 regarding the Veteran’s left lower extremity disability. The examiner advised referring to the July 2015 examination outlines regarding the current level of disability caused by the Veteran’s service-connected left radiculopathy and noted that it was a moderate left L4 and L5 radiculopathy in the left lower extremity. When asked to describe the paralysis of the involved radicular nerves, the examiner said that this is addressed in the July 2015 examination and again noted that the Veteran has a moderate left L4 and L5 radiculopathy. The examiner further stated that paralysis of the noted radicular nerves is not complete since only sensation is affected and no muscular paralysis was noted. The Veteran’s April 2019 VA examination back examination also offered an evaluation of his left lower extremity radiculopathy disability. The examiner noted that the Veteran reported that he is service connected for left lower extremity radiculopathy and stated that the condition is progressively getting worse. The examiner noted that the Veteran experienced no symptoms of constant pain in the left lower extremity. The examiner noted that intermittent pain was moderate for the left lower extremity, and moderate symptoms of paresthesias and/or dysesthesias. Additionally, it was noted that numbness was moderate in the left lower extremity. The examiner further noted that the overall severity of radiculopathy of the left side was moderate. The Veteran’s August 2019 VA back examination offers another evaluation of this left lower extremity radiculopathy disability. The examiner noted that the Veteran did not have constant or intermittent pain in the left lower extremity. The examiner noted that moderate paresthesias and/or dysesthesias in the left lower extremity. Further, the examiner noted that the Veteran experienced moderate numbness in the left lower extremity. The examiner noted that the overall severity of radiculopathy of the left side is mild. After careful review of the evidence, the Board determines the Veteran’s left lower extremity radiculopathy most nearly approximates moderate incomplete paralysis for the entire period on appeal, which is consistent with a 20 percent rating under DC 8526. The Board notes that the Veteran’s most recent August 2019 examination notes a mild severity level, however, the Board finds that the Veteran’s overall disability picture reveals that the 20 percent rating is applicable for the entire appeal period. The Board finds ratings in excess of 20 percent are not warranted throughout the appeal period for the left lower extremity disability. In this regard, the April 2019 VA examination report noted that the Veteran’s overall severity of left lower extremity radiculopathy was moderate. Further, the examination showed moderate levels of intermittent pain, paresthesias and/or dysesthesias, as well as moderate levels of numbness. While the August 2019 examiner indicated the overall severity of the Veteran’s left lower extremity radiculopathy was mild, the evidence tends to support that the disorder remained moderate in severity. Notably, the August 2019 examiner found moderate paresthesias and/or dysesthesias as well as moderate levels of numbness in the Veteran’s left lower extremity, suggestive of a 20 percent rating. 38 C.F.R. § 4.124a, DC 8526. The Board acknowledges the Veteran and his representative’s assertions regarding a 40 percent rating for his left lower extremity radiculopathy disability. The Board also acknowledges the assertions made by TT, JL, AH, and TE who provided statements regarding their observations of the Veteran’s back and left leg disabilities, however, an opinion concerning the relationship between the Veteran’s back and symptoms of radiculopathy and the extent and severity of the left lower extremity radiculopathy disability is of a medically complex nature. That diagnosis and analysis requires medical training and experience, which the Veteran, his representative, or other individuals who provided statements have not demonstrated they possess. Therefore, the Board finds that they are not competent to provide an opinion as to the rating assignment for the severity level of his left lower extremity radiculopathy disability. The Board finds the objective evidence provided by the VA examiners to be more persuasive than the contentions of the Veteran, his representative, TT, JL, AH, and TE. See Jandreau, 492 F.3d at 1377. (Continued on the next page)   In sum, the Board finds that throughout the period on appeal, the Veteran’s left lower extremity radiculopathy produced neurologic impairment analogous to moderate incomplete paralysis. The VA examiners all stated that the Veteran’s left lower extremity disability was moderate. Specifically, the July 2015, August 2015, April 2019, and August 2019 examiners each noted in their medical report that the severity of the Veteran’s left lower extremity disability was moderate. Even in providing the clarifying August 2015 opinion, the examiner reiterated the current level of disability caused by the Veteran’s service-connected left radiculopathy and noted that it was a moderate. The Board notes that the Veteran’s May 2011 examination suggests that the Veteran’s left lower extremity radiculopathy was manifested by the femoral nerve causing the Veteran to experience mild weakness of the left quadriceps on left leg knee bending, however the Board extends the Veteran the benefit of the doubt and finds that considering the evidence in the treatment records prior to the July 2015 examination the Veteran’s left lower extremity radiculopathy disability resulted in moderate symptoms. Although the Veteran through his representative contends that the Veteran’s left lower extremity radiculopathy was moderately severe, this is not supported with the overall medical evidence of record, especially considering that the July 2015, August 2015, April 2019, and August 2019 examiners explicitly stated that the Veteran’s disability was moderate. The Board notes that the Veteran has reported that his pain in the left leg is severe at times, however, this has been occasional and the record does not demonstrate that the pain the Veteran experienced resulted in severe paralysis. The record overall, supports that the Veteran’s left lower extremity radiculopathy disability has not caused severe incomplete paralysis nor complete paralysis of the quadriceps extensor muscles at any time during the appeal period. As such, an initial rating of 20 percent for left lower extremity radiculopathy is warranted for the entire period on appeal, and to that extent only, the claim is granted; however, entitlement to a disability rating in excess of 20 percent for left lower extremity radiculopathy is denied for the entire period on appeal. An increased rating in excess of 20 percent for left lower extremity radiculopathy is not warranted at any time during the period on appeal because as stated, the evidence of record does not show that the Veteran’s left lower extremity radiculopathy manifest as severe incomplete paralysis of the nerve nor did it manifest in complete paralysis of the quadriceps extensor muscles during the appeal period. The benefit-of-the-doubt doctrine is therefore not for application and a rating in excess of 20 percent for left lower extremity radiculopathy is denied. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b). D. C. JOHNSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dorsey-Kwansa, 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.