Citation Nr: 21015119 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 17-59 781 DATE: March 16, 2021 ORDER A disability rating in excess of 40 percent, irrespective of a temporary 100 percent disability rating from March 26, 2019 to May 1, 2019, for intervertebral disc syndrome (IVDS), lumbosacral spine at L3-4 and L4-5, status post microdiscectomy is denied. A compensable disability rating prior to March 23, 2019 and in excess of 10 percent thereafter for scar associated with IVDS of the lumbar spine is denied. An initial 20 percent disability rating, but no higher, for the Veteran’s right lower extremity radiculopathy associated with IVDS of the lumbar spine, is granted. Throughout the pendency of the appeal beginning June 24, 2013, a 20 percent disability rating, but no higher, for the Veteran’s left lower extremity radiculopathy associated with IVDS of the lumbar spine, is granted. REMANDED The claim of entitlement to a disability rating in excess of 10 percent for pseudofolliculitis barbae is remanded. FINDINGS OF FACT 1. The Veteran’s IVDS of the lumbar spine has not been manifested by unfavorable ankylosis or incapacitating episodes at any point during the appeal period. 2. Prior to March 26, 2019, the Veteran’s scar associated with his IVDS of the lumbar spine was asymptomatic. 3. Beginning March 26, 2019, the Veteran has had no more than one unstable scar associated with his IVDS of the lumbar spine. 4. Throughout the pendency of the appeal beginning June 24, 2013, the Veteran’s bilateral lower extremity radiculopathy associated with his IVDS of the lumbar spine has more nearly approximated moderate incomplete paralysis of the sciatic nerve, but no worse. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 40 percent for the Veteran’s IVDS of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 2. The criteria for a disability rating in excess of 10 percent from March 26, 2019 for the Veteran’s scar associated with IVDS of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.118, Diagnostic Code 7804. 3. The criteria for an initial disability rating of 20 percent, but no higher, for radiculopathy of the right lower extremity associated with IVDS of the lumbar spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8620. 4. The criteria for a disability rating of 20 percent, but no higher, for radiculopathy of the left lower extremity associated with IVDS of the lumbar spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1983 to October 2003. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in May 2019 when the issue regarding IVDS of the lumbar spine was remanded and an increased rating for pseudofolliculitis barbae was denied. The Veteran appealed the Board’s May 2019 decision with respect to his pseudofolliculitis barbae rating to the United States Court of Appeals for Veterans Claims (Court). In May 2020, the Court granted the parties’ Joint Motion for Partial Remand (JMPR), which vacated the Board’s May 2019 decision with regard to the pseudofolliculitis barbae claim and remanded that portion of the appeal. The case has now been returned to the Board for further appellate action. Procedural History By way of history, the Veteran’s service treatment records show that he developed a disc herniation in approximately April 2000. The Veteran submitted an initial claim for service connection for a lumbar spine disability in November 2003 and, by rating decision dated in July 2004, the RO granted service connection for IVDS, lumbosacral spine at L3-4 and L4-5, as well as radiculopathy, L5 nerve root, of the left lower extremity, assigning separate 10 percent disability ratings effective November 1, 2003. Subsequently, in March 2009, the Veteran underwent lumbar spine surgery and, by rating decision dated in March 2009, the RO granted a temporary total rating effective March 9, 2009 and recharacterized the lumbar spine disability to include a scar, continuing a 10 percent disability for IVDS of the lumbar spine with surgical scar effective May 1, 2009. The 10 percent disability rating for IVDS was continued by rating decision dated in October 2010 and the 10 percent rating for left lower radiculopathy was continued by rating decision dated in August 2012. The Veteran submitted the current claim for an increased rating for his IVDS and associated radiculopathy in June 2013 and, by rating decision dated in December 2014, the RO continued a 10 percent disability rating for IVDS of the lumbar spine and granted service connection for right lower extremity neuropathy, assigning a 10 percent disability rating effective June 24, 2013. The Veteran disagreed with this decision and perfected this appeal. Thereafter, the Veteran underwent lumbar spine surgery again in March 2019 and, by rating decision dated in May 2019, the RO granted a temporary total rating for the Veteran’s lumbar spine as well as a separate 10 percent disability rating for painful scar, each effective March 26, 2019, and continued a 10 percent disability rating for IVDS of the lumbar spine effective May 1, 2019. More recently, by rating decision dated in March 2020, the RO increased the Veteran’s disability rating for the lumbar spine from 10 to 40 percent disabling effective June 24, 2013, the date of his claim for an increased rating. The RO also increased the Veteran’s disability rating for left lower radiculopathy from 10 to 20 percent disabling effective November 14, 2018, the date of a private treatment record showing complaints of worsened back pain with left leg radiculopathy. Analysis A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. A disability rating in excess of 40 percent, irrespective of a temporary 100 percent disability rating from March 26, 2019 to May 1, 2019, for IVDS, lumbosacral spine at L3-4 and L4-5, status post microdiscectomy is denied. The Veteran’s IVDS of the lumbar spine is currently rated 40 percent disabling from June 24, 2013, 100 percent disabling from March 26, 2019, and 40 percent disabling from May 1, 2019. The 100 percent disability rating was temporary related to a period of post-surgical convalescence. The Veteran asserts that he is entitled to a disability rating in excess of 40 percent for the entire appeal period, other than his temporary 100 percent disability rating. The Veteran’s IVDS of the lumbar spine is rated pursuant to Diagnostic Code 5243. This diagnostic code indicates that intervertebral disc syndrome (preoperative or postoperative) should be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (Formula for Rating IVDS), whichever method results in the higher evaluation. Under the General Rating Formula, a 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Under the Formula for Rating IVDS, ratings are assigned based on the quantity and duration of incapacitating episodes over a prior 12-month period. For purposes of evaluation under this formula, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician. Under this Formula, a 40 percent rating is warranted if the total duration is at least four weeks but less than six weeks, and a 60 percent rating is warranted if the total duration is at least six weeks. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, and normal extension, bilateral lateral flexion, and bilateral lateral rotation is zero to 30 degrees. These rating criteria are applied with and 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. Ankylosis is the complete immobility and consolidation of a joint due to disease, injury or surgical procedure. See, e.g., Dinsay v. Brown, 9 Vet. App. 79, 81 (1996), citing Dorland’s Illustrated Medical Dictionary at 86 (27th ed. 1988). Note (5) further explains that, 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. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are separately rated under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code, 5242, 5243, at Note (1). 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; 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) (holding that it 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 criteria.). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Notably, during the course of the appeal, on November 30, 2020, VA issued a final rule revising 38 C.F.R. § 4.71a, the portion of the VA Schedule for Rating Disabilities that addresses the musculoskeletal system, effective February 7, 2021. The rule clarified that Diagnostic Code 5243 should only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root. Diagnostic Code 5242 is to be used for all other disc diagnoses. Here, although the Veteran is diagnosed with IVDS, a higher disability rating is assigned pursuant to the diagnostic criteria enumerated in the General Rating Formula, as will be further explained below. Accordingly, the revised rating criteria do not impact the instant appeal, either before or after the effective date. Turning to the evidence of record, on the Veteran’s June 2013 claim, he stated that his back pain increased 5 years prior to the point of being unbearable. At that point, he decided to get spinal surgery. However, the pain continued. He noted extreme chronic continuous burning pain and numbness in his back and legs. He also indicated that he gets swelling that has resulted in loss of mobility. The Veteran submitted a Back Conditions Disability Benefits Questionnaire in November 2013. The DBQ noted that the Veteran reported flare-ups that impact the function of the thoracolumbar spine. Range of motion testing revealed forward flexion to 90 degrees or greater with pain at 45 degrees, extension to 15 degrees with pain at 15 degrees, right lateral flexion to 25 degrees with pain at 25 degrees, left lateral flexion to 25 degrees with pain at 25 degrees, right lateral rotation to 25 degrees with pain at 25 degrees, and left lateral rotation to 25 degrees with pain at 25 degrees. On repetitive use testing, the Veteran’s flexion was to 75 degrees, extension to 15 degrees, right lateral flexion to 25 degrees, left lateral flexion to 25 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 25 degrees. The physician indicated that there was pain on movement and interference with sitting, standing, and/or weight-bearing. The physician further noted paralumbar tenderness and guarding or muscle spasm of the thoracolumbar spine that did not result in abnormal gait or spinal contour. Muscle strength testing was normal but muscle atrophy was noted in the right thigh and left lower leg. Reflex and sensory examinations were normal. The Veteran was noted to have radicular signs in the bilateral lower extremities involving the femoral and sciatic nerves. The physician found the radiculopathy was severe in the right lower extremity and moderate in the left lower extremity. No other neurologic abnormalities were indicated. While the Veteran was noted to have IVDS causing incapacitating episodes, the physician failed to note the duration of any incapacitating episodes. The physician found that the functioning of the Veteran’s right leg was so diminished that amputation with prosthesis would equally serve the Veteran. The physician noted that the Veteran had unstable scars related to treatment of his back disability, but failed to provide any further information regarding the scars. The physician stated that imaging studies revealed arthritis in the Veteran’s spine and that his thoracolumbar spine would impact his ability to work a job that required prolonged standing or sitting. The Veteran was afforded a VA examination in September 2014. At that time, the Veteran reported flare-ups that impact the function of the thoracolumbar spine in that it affects his ability to bend, stoop, or stand for extended periods. Range of motion testing revealed forward flexion to 70 degrees with pain at 65 degrees, extension to 25 degrees with pain, bilateral lateral flexion to 25 degrees with pain, and bilateral lateral rotation to 25 degrees with pain. The Veteran was unable to perform repetitive use testing due to pain. There was localized tenderness and pain to palpation for the joints and soft tissue of the thoracolumbar spine but did not have guarding or muscle spasm. Muscle strength and reflex testing were normal. The Veteran’s sensory testing was normal other than decreased sensation in the bilateral feet. The Veteran was noted to have IVDS but had no incapacitating episodes over the previous 12 months. The examiner indicated that the Veteran’s thoracolumbar spine condition would impact his ability to work because it limits bending, stooping, and prolonged standing. The Veteran was afforded an additional VA examination in April 2019. At that time, the Veteran reported surgery in March 2019 to stabilize his back but that he continued to have radiculopathy down his left leg. His range of motion was severely limited by pain associated with surgery. The Veteran was afforded a final VA back examination in January 2020. At that time, the Veteran reported flare-ups of thoracolumbar spine pain precipitated by prolonged standing, sitting, bending, and lifting. Range of motion testing revealed forward flexion to 50 degrees, extension to 15 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees. There was pain noted on examination at rest/non-movement, evidence of pain with weight-bearing, and objective evidence of tenderness or pain on palpation of the spine. The Veteran was able to perform repetitive use testing without additional loss of function or range of motion. The examiner found that pain would significantly limit functional ability with repeated use over a period of time, reducing forward flexion to 40 degrees, extension to 10 degrees, bilateral lateral flexion to 15 degrees and bilateral lateral rotation to 15 degrees. During flare ups, range of motion would be limited to 30 degrees of forward flexion, 5 degrees of extension, 10 degrees of bilateral lateral flexion, and 10 degrees of bilateral lateral rotation. The examiner noted that the Veteran had muscle spasm that resulted in an abnormal gait or spinal contour. Muscle strength testing was normal with no evidence of muscle atrophy. Reflex testing was also normal. The Veteran’s sensory testing was decreased in the left lower extremity. There was no ankylosis of the spine. The Veteran was noted to have IVDS but had no incapacitating episodes over the previous 12 months. The examiner indicated that the Veteran’s thoracolumbar spine condition would impact his ability to work because it limits sitting, standing, lifting, and bending. There was objective evidence of pain on passive range of motion of the back but no evidence of pain on non-weight bearing. The Veteran’s treatment records during the appeal period document his complaints of back pain. After review of the above, the Board finds that a rating in excess of 40 percent is not warranted at any time during the appeal period, other than the temporary 100 percent disability rating assigned between March 26, 2019 and May 1, 2019. Notably, there is no evidence of ankylosis in the Veteran’s thoracolumbar spine at any time during the appeal period. Accordingly, the evidence does not support the assignment of a rating in excess of 40 percent due to limited motion of the spine. The Board also finds insufficient evidence to support a finding that the Veteran’s back pain was so disabling as to actually or effectively limit lumbar spine motion to such an extent as to warrant the assignment of a higher disability rating. Even considering pain on repetition or with flare-ups, flexion and extension were limited, at worst, to 40 degrees and 5 degrees, respectively. This does not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine. Thus, while the Veteran clearly experienced pain and functional loss, the Board cannot find that it approximated the level of severity as described by a 50 percent rating. The Board has considered the Veteran’s statements indicating that his intervertebral disc syndrome warrants and increased disability rating. Further, the Veteran is found both competent and credible to report symptoms of his service-connected back disability. See Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Indeed, the Veteran’s reports are consistent with the findings in the VA examination reports. Further, the Board finds that the Veteran’s complaints of pain and functional loss have already been considered in assigning the current rating. As for consideration of a higher rating on the basis of incapacitating episodes, the VA examiners found the Veteran has IVDS of the spine, but there were no incapacitating episodes. The Veteran’s treatment records also do not indicate that he was prescribed bed rest by a physician due to the service-connected thoracolumbar spine disability. As such, the criteria for a higher evaluation under Diagnostic Code 5243 have not been met. For all the foregoing reasons, the Board finds the preponderance of the evidence is against a rating in excess of 40 percent, other than the temporary 100 percent disability rating, for the intervertebral disc syndrome at any time during the appeal period.  2. A separate compensable disability rating prior to March 23, 2019 and in excess of 10 percent thereafter for scar associated with IVDS of the lumbar spine is denied. As above, the Veteran’s lumbar spine disability was originally characterized as “IVDS, lumbosacral spine at L3-4 and L4-5” but, after undergoing back surgery on March 9, 2009, the RO recharacterized the Veteran’s lumbar spine disability to include a surgical scar and continued a 10 percent disability rating for the combined disability by rating decision dated in March 2009. The Veteran underwent surgery on his lumbar spine again in March 2019 and, by rating decision dated in May 2019, the RO, in part, granted a separate 10 percent disability rating for painful scar effective March 26, 2019. The Veteran’s scar is rated pursuant to Diagnostic Code 7804, which assigns a 10 percent disability rating for one or two scars that are unstable or painful, a 20 percent disability rating for three or four scars that are unstable or painful, and a 30 percent disability rating for five or more scars that are unstable or painful. An unstable scar is one where, for any reason, there is frequent loss of covering of the skin over the scar. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1). The Board notes that during the September 2014 VA examination, the Veteran reportedly had a scar from back surgery. However, it was not painful or unstable and the total area was less than 39 square centimeters. During a February 2019 VA examination, the Veteran’s scar was noted to be on his central low back and measured 3 centimeters in length and 0.2 centimeters in width. It was not described as painful or unstable. During the April 2019 VA examination, though, the Veteran was noted to have a new, painful scar related to his March 2019 surgery. During a January 2020 VA examination, the Veteran was noted to have a scar related to his back surgery that measured 2.5 centimeters in length and 0.3 centimeters in width and it was not painful or unstable. Accordingly, the Board finds that a preponderance of the evidence is against awarding a separate compensable disability rating prior to March 26, 2019, the date of the surgery that resulted in his painful scar. The Board has considered the private Disability Benefit Questionnaire that noted the Veteran had an unstable or painful scar or a scar area greater than 39 square centimeters in November 2013. However, the physician failed to provide any additional information regarding the scar that is pertinent to assigning a disability rating. Additionally, this finding contrasts with the remaining medical evidence from the appeal period. Further, there is no evidence that the Veteran has more than 2 scars that are unstable or painful to warrant an increased rating under Diagnostic Code 7804 from March 26, 2019. As such, the Board finds that the preponderance of the evidence is against a rating in excess of that already assigned. 3. An initial 20 percent disability rating, but no higher, for the Veteran’s right lower extremity radiculopathy associated with IVDS of the lumbar spine, is granted. 4. A 20 percent disability rating, but no higher, for the Veteran’s left lower extremity radiculopathy associated with IVDS of the lumbar spine, is granted. As noted above, any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are separately rated under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code, 5242, 5243, at Note (1). As above, the Veteran’s left lower extremity radiculopathy was assigned an initial 10 percent disability rating prior to November 14, 2018 and 20 percent disability rating thereafter. The right lower extremity radiculopathy was assigned an initial 10 percent disability rating from June 24, 2013. The Veteran’s radiculopathy of the left lower extremity has been rated under Diagnostic Code 8520 and the right lower extremity is rated under Diagnostic Code 8620, pertaining to impairments of the sciatic nerve. Under these diagnostic codes, mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating, moderate incomplete paralysis warrants a 20 percent rating, moderately severe incomplete paralysis warrants a 40 percent rating, and severe incomplete paralysis with marked muscular atrophy warrants a 60 percent rating. An 80 percent rating is warranted for complete paralysis, where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. The term “incomplete paralysis” with peripheral nerve injuries 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. See Note at Diseases of the Peripheral Nerves in 38 C.F.R. § 4.124(a). The words mild, moderate, and severe are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. “Mild” is generally defined as “not being or involving what is extreme” or “not severe.” Merriam-Webster’s Collegiate Dictionary, 787 (11th ed. 2003). “Moderate” is generally defined as “tending toward the mean or average amount.” Id. at 798. “Severe” is generally defined as “of a great degree” or “serious.” Id. at 1140. The November 2013 private Disability Benefits Questionnaire noted that the Veteran had radicular signs in the bilateral lower extremities involving the femoral and sciatic nerves. The physician found the radiculopathy was severe in the right lower extremity and moderate in the left lower extremity. In his December 2013 statement, the Veteran reported that he had burning pain and numbness that extended down his bilateral legs and into his feet. He also reported that he gets swelling. During the September 2014 VA examination, the Veteran was noted to have radiculopathy in the bilateral lower extremities. It was described as mild in the right lower extremity and moderate in the left lower extremity, affecting the sciatic nerve and causing paresthesias and numbness. On a peripheral nerves examination, the Veteran reported severe constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the bilateral lower extremities. Muscle strength testing was normal, there was no muscle atrophy, and reflexes were normal. A sensory examination noted decreased sensation in the bilateral feet related to the Veteran’s service-connected back condition. No trophic changes were noted and the Veteran’s gait was normal. The examiner noted mild incomplete paralysis of the sciatic nerve affected the left lower extremity and moderate incomplete paralysis of the sciatic nerve affected the right lower extremity. During a February 2019 VA peripheral nerves examination, the Veteran reported the onset of bilateral lower extremity radiculopathy symptoms in 1997. The Veteran stated he had mild constant pain in the right lower extremity and severe constant pain in the left lower extremity. He also had moderate intermittent pain in the right lower extremity. Muscle strength testing was normal bilaterally, there was no evidence of muscle atrophy, and his reflexes were normal. A sensory examination revealed decreased sensation in his lower legs and feet. There were no trophic changes indicated and his gait was normal. The examiner noted that the sciatic nerve was affected bilaterally but indicated it was normal. During a January 2020 VA examination, the Veteran was noted to have radicular pain in the bilateral lower extremities. His symptoms included mild constant pain bilaterally, mild intermittent pain in the right lower extremity, moderate intermittent pain in the left lower extremity, mild paresthesias in the left lower extremity, moderate paresthesias in the right lower extremity, mild numbness in the right lower extremity, and moderate numbness in the left lower extremity. His sciatic nerve was affected bilaterally. The examiner found that the impairment was mild on the right and moderate on the left. After a review of the pertinent evidence, the Board finds that a 20 percent disability rating, each, is warranted for the Veteran’s right and left leg radiculopathy for moderate incomplete paralysis of the sciatic nerve throughout the period on appeal. While the various examiners found different levels of impairment, the Board will afford the Veteran the benefit of the doubt and find moderate impairment for both extremities throughout the period on appeal. However, as the symptoms of the Veteran’s radiculopathy are not more than sensory in nature, the Board finds a rating in excess of 20 percent is not warranted. The examination reports and treatment records do not otherwise reflect moderately severe left leg radiculopathy for this time period. The Board additionally finds that throughout the period on appeal, no other neurological impairments associated with the Veteran’s spine disability have been shown. Each VA examiner specifically determined that other than bilateral radiculopathy, there were no other associated neurological abnormalities or findings. As such, the preponderance of the evidence is against any further separate neurological disability rating. REASONS FOR REMAND 5. The claim of entitlement to a disability rating in excess of 10 percent for service-connected pseudofolliculitis barbae is remanded. In the May 2020 Joint Motion for Partial Remand, the parties agreed that the Board did not properly consider whether the topical corticosteroids like those taken by the Veteran could be systemic therapy which could warrant a higher rating in light of the holdings in Johnson v. Shulkin, 862 F. 3d 1351 (Fir Cir. 2017); Burton v. Wilkie, 30 Vet. App. 286 (2018). Therefore, the Board finds that a VA examination is warranted to address the current severity and manifestations of the Veteran’s pseudofolliculitis barbae. The matter is REMANDED for the following action: Obtain a VA opinion from an examiner with appropriate expertise to determine the current level of severity of all impairments resulting from the Veteran’s pseudofolliculitis barbae in accordance with VA rating criteria. The claims file must be made available to and reviewed by the examiner. The need for further in-person examination is left to the discretion of the examiner. The examiner must identify each topical medication prescribed to treat the pseudofolliculitis barbae during the appeal period. For each such topical medication, the examiner must provide an opinion as to whether such medication constitutes systemic therapy like a corticosteroid or other immunosuppressive drug. For topical treatments, the examiner must state: (a.) Whether the treatment operates by affecting the body as a whole to treat pseudofolliculitis barbae; and, (b.) Whether the treatment is like a corticosteroid or other immunosuppressive drug. If the treatment is clearly systemic, the examiner must only address whether the treatment is like a corticosteroid or other immunosuppressive drug. A complete rationale should be given for each opinion expressed. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Connor, Lindsey 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.