Citation Nr: 21015819 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-23 407 DATE: March 18, 2021 ORDER Entitlement to a rating in excess of 20 percent for cervical spine degenerative disc disease, status post fusion of C5-7, is denied. Prior to April 25, 2017, entitlement to a rating in excess of 10 percent for lumbosacral strain with degenerative disc disease is denied. From April 25, 2017, entitlement to an increased 20 percent rating, but no higher, for lumbosacral strain with degenerative disc disease, status post microdiskectomy and hemi-laminectomy, is granted. FINDINGS OF FACT 1. The Veteran’s cervical spine disability has not been shown to result in limitation of forward flexion of the cervical spine to 15 degrees or less, even considering functional limitation factors; nor has favorable ankylosis of the cervical spine been demonstrated. 2. Prior to April 25, 2017, the Veteran’s lumbosacral spine disability was not shown to result in functional limitation of forward flexion of the thoracolumbar spine to 60 degrees or less or combined range of motion of the thoracolumbar spine to 120 degrees or less, even considering functional limitation factors; nor did his disability cause muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. 3. From April 25, 2017, the Veteran’s lumbosacral spine disability was shown to result in abnormal spinal contour. However, the Veteran’s lumbosacral spine disability has not been shown to result in limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, even considering functional limitation factors; nor has ankylosis of the thoracolumbar spine been demonstrated. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for a cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71(a), Diagnostic Code (DC) 5242. 2. Prior to April 25, 2017, the criteria for a rating in excess of 10 percent for a lumbosacral spine disability were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71(a), DC 5242. 3. From April 25, 2017, the criteria for an increased 20 percent rating, but no higher, for a lumbosacral spine disability were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71(a), DC 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1971 to February 1993. These matters come before the Board of Veterans’ Appeals (Board) from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in April 2017. A transcript of that hearing is of record. Following the hearing, the Board remanded these issues in June 2018 for further evidentiary development. In an October 2019 rating decision, the RO granted an increased 20 percent rating for the Veteran’s lumbosacral spine disability, effective July 18, 2019. Because higher schedular ratings are available and the Veteran is presumed to seek the maximum available benefit, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In September 2020, the Board again remanded the claims for evidentiary development. Increased Rating Claims 1. Cervical spine disability The Veteran contends his cervical spine disability is more severe than his current 20 percent rating reflects. For the following reasons, the Board finds an increased rating is not warranted. Disabilities of the spine are evaluated under either the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or under the formula for rating intervertebral disc syndrome (IVDS) based on incapacitating episodes (DC 5243), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. As with his lumbosacral spine disability, the Veteran’s cervical spine symptomatology is currently rated under the General Rating Formula. See 38 C.F.R. § 4.71(a), DC 5242. Under the General Rating Formula, a 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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. Id. A 30 percent rating is assigned for forward flexion of the cervical spine to 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine. Finally, a 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. Note (2) provides that, for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, normal extension is zero to 45 degrees, normal left and right lateral flexion are zero to 45 degrees, and normal left and right lateral rotation are zero to 80 degrees. Thus, the normal combined range of motion of the cervical spine is 340 degrees. Id. The Board notes that, when assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must, in addition to applying schedular criteria, also consider evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-207 (1995). The instant claim dates from a March 2013 letter in which the Veteran stated he experienced daily problems with his neck and back which he believed warranted an increased rating. The Board has reviewed the year prior to VA’s receipt of that claim; records show the Veteran underwent cervical spine surgery on May 29, 2012 and was awarded a temporary 100 percent rating based on convalescence from that procedure. Although the records from the year prior to the March 2013 claim indicate the Veteran was followed for cervical spine disability, there is no definitive evidence he met the criteria for a rating in excess of 20 percent during this period. The Veteran was afforded a VA Compensation and Pension (C&P) examination in December 2013. The report reflects the Veteran denied flare-ups of neck pain. Range of motion testing revealed forward flexion to 45 degrees or greater with no objective evidence of pain; extension to 20 degrees; right and left lateral flexion to 25 degrees; right lateral rotation to 25 degrees; and left lateral rotation to 45 degrees. Following repetitive movements, the Veteran still had flexion to 45 degrees, extension to 20 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation to 45 degrees; no additional functional loss was noted apart from restricted motion as indicated. There was no evidence of localized tenderness or pain to palpation for joints/soft tissue of the cervical spine. No guarding or muscle spasm was noted. Muscle strength, reflexes, and sensation were all normal. There was no evidence of radiculopathy or other neurologic abnormalities. The examiner noted the Veteran did not have IVDS, nor did he use assistive devices. Functional impact was “mild to moderate impairment of moving about.” In her remarks, the examiner explained the Veteran’s posture and gait were normal; there was no contributing factors of weakness, fatigability, incoordination, or pain during flare-ups or repeated use over time that could additionally limit the functional ability of the Veteran’s cervical spine. In the Veteran’s May 2014 notice of disagreement, he asserted (without providing any specific supporting argument) he was entitled to a 60 percent rating for his cervical spine disability. A July 2014 VA primary care note indicates the Veteran had “moderate” restriction in flexion and extension in his neck area. At his Board hearing, he testified experiencing “excruciating” neck pain and bulging discs in his cervical spine. He also reported secondary symptoms, including tingling and muscle atrophy in his upper extremities. (The RO has granted service connection for neurological impairment of both upper extremities.) The Veteran denied experiencing ankylosis. The Veteran was afforded another C&P examination in July 2019. He reported worsening neck pain with decreased range of motion; he described constant pain usually at a 6 or 7 out of 10 in intensity. He reported having improvement initially after his surgery but stated his pain was now worsening due to another disc “acting up.” He also reported neurological symptoms in his upper extremities; he denied bowel or urinary dysfunction. The Veteran reported flare-ups, stating, “If I have to turn my neck, the pain is bad.” He further stated, “I just don’t have the range of motion anymore.” Range of motion testing revealed forward flexion limited to 30 degrees, extension limited to 18 degrees, lateral flexion limited to 20 degrees on both sides, right lateral rotation limited to 25 degrees, and left lateral rotation limited to 20 degrees. “Significant pain” was noted to cause additional functional loss. There was objective evidence of localized tenderness or pain on palpation. During repetitive motion testing, forward flexion was limited to 30 degrees, extension to 10 degrees; right lateral flexion to 20 degrees; left lateral flexion to 15 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 15 degrees. The examiner noted that pain, fatigue, and weakness all contributed to functional loss. The same impairment was noted during flare-ups (i.e., range of motion during flare-ups was estimated to be the same as after repetitive-use testing). No guarding or muscle spasm was noted. Muscle strength was normal, reflexes were hypoactive, and sensation was normal. No ankylosis of the cervical spine was noted. The examiner indicated that the Veteran had IVDS of the cervical spine, but had not had any episodes of acute signs or symptoms requiring bedrest prescribed by a physician in the past 12 months. With respect to Correia v. McDonald, 28 Vet. App. 158 (2017), the examiner noted there was objective evidence of pain with passive range of motion and on non-weight bearing. X-rays revealed significant foraminal and spinal canal stenosis, as well as suspected cord compression. In terms of functional impact, the examiner noted the Veteran’s neck condition limited his participation in physical/heavy labor, including lifting greater than 20 pounds, twisting, use of vibratory equipment, pushing, pulling, lifting overhead, repetitive neck movement, or holding head in same position for prolonged periods of time. The Veteran underwent another C&P examination in October 2020. Diagnoses of spinal fusion, spinal stenosis, and degenerative disc disease were noted. He reported symptoms of dull pain over the posterior neck; he stated he took Neurontin, Robaxin, and Motrin for his symptoms. The Veteran reported flare-ups, stating his symptoms were “worse with movement and exertion.” He explained he had difficulty turning his head to the sides due to pain. Range of motion testing revealed forward flexion limited to 25 degrees, extension limited to 25 degrees, lateral flexion limited to 20 degrees on both sides, and lateral rotation limited to 45 degrees on both sides. Pain was noted in forward flexion, extension, and lateral flexion. The Veteran was able to perform repetitive-use testing without additional functional loss. The examiner noted that pain and flare-ups contributed to functional loss, further restricting his range of motion as follows: forward flexion limited to 20 degrees, extension limited to 20 degrees, lateral flexion limited to 10 degrees on both sides, and lateral rotation limited to 35 degrees on both sides. No guarding or muscle spasm was noted. Muscle strength, reflexes, and sensation were normal. No ankylosis of the cervical spine was noted. The examiner indicated the Veteran did not have IVDS. With respect to Correia, supra, the examiner noted that range of motion testing was the same in non-weight bearing and passive motion as in active range of motion. In addition to the VA treatment notes and examination reports of record, the Veteran has submitted private treatment notes from providers who have followed him for cervical spine pain. These records broadly document ongoing treatment for neck pain with restricted motion. Based on the above, the Board finds the weight of the evidence is against entitlement to a rating in excess of 20 percent, under the General Rating Formula, at any point during the pendency of the appeal. After careful review, the evidence of record, including all three C&P reports of record, shows that the Veteran was able to obtain forward flexion of the cervical spine to greater than 15 degrees at all times, even when factoring in functional impairment in the form of painful motion, weakness, fatigue, and the impact of flare-ups. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 204-207. There is, furthermore, no evidence that the Veteran’s cervical spine has ever been ankylosed, favorably or otherwise. Under the criteria listed in the General Ratings Formula, such limitation warrants no higher than a 20 percent rating. The Board acknowledges the Veteran’s general allegations that the findings of VA examiners do not reflect his actual level of impairment. However, the Veteran has not put forth specific reasons to question the expertise or test results of any of the C&P examiners of record. Moreover, the Veteran has put forth no evidence, lay or medical, to indicate that his functional limitation was equivalent to forward flexion limited to 15 degrees as is required for an increased rating under the rating criteria. His current 20 percent rating contemplates a significant degree of functional impairment, including painful motion; thus, his lay statements alone, while credible, do not justify an increased rating, as none of the lay or medical evidence of record otherwise suggests restricted range of motion of the cervical spine to an extent that would warrant a rating in excess of 20 percent. The weight of the evidence is also against a finding that the Veteran has suffered incapacitating episodes of IVDS warranting an increased rating under DC 5243 at any time during the appeal period. The Board acknowledges the Veteran has reported constant neck pain with accompanying functional limitation. He is of course competent to report these symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Notwithstanding, none of the Veteran’s medical records or C&P reports reflect incapacitating episodes of such a severity (i.e., requiring bedrest by a physician) or frequency as would warrant an increased rating under DC 5243. For these reasons, the weight of the evidence is against a finding of physician-prescribed bedrest specifically on account of IVDS for at least four weeks over a 12-month period. The Board is aware of the United States Court of Appeals for Veterans Claims (Court) decision in Sharp v. Shulkin, 29 Vet. App. 26 (2017), holding that when flare-ups are an indicated part of a claimant’s service-connected disability, VA examiners are obligated to elicit information concerning the “severity, frequency, duration, or functional loss manifestations” of flare-ups. As discussed above, the Veteran has reported flare-ups throughout the pendency of the appeal. However, the most recent C&P report reflects the examiner’s attempts to estimate the Veterans’ range of motion during flare-ups; the Board has accepted those findings as the relevant measure of his functional limitation. These findings do not demonstrate limitation of motion or incapacitating episodes of IVDS to such a degree that would justify a higher rating. The Board finds that VA has complied with Sharp with respect to the Veteran’s cervical spine disability. The Board acknowledges that Note (1) to the General Rating Formula for Diseases and Injuries of the Spine directs VA to evaluate any associated objective neurologic abnormalities separately, under an appropriate DC. 38 C.F.R. § 4.71(a). In this case, the Veteran has been service connected for neurological impairment of both upper extremities. He has not appealed those ratings, and they are therefore not before the Board at this time. There is no evidence of further neurological impairment due to the Veteran’s cervical spine disability. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the record). In sum, for the reasons discussed above, the Board finds that the evidence of record does not warrant a rating in excess of 20 percent for the Veteran’s cervical spine disability at any point during the appeal period. Unfortunately, the Veteran’s claim must be denied. 2. Lumbosacral spine disability The Veteran contends his lumbosacral spine disability is more severe than his current rating reflects. At present, he is in receipt of a 10 percent rating prior to July 18, 2019, and a 20 percent rating thereafter. As noted above, disabilities of the spine are evaluated under either the General Rating Formula, or under the formula for rating IVDS based on incapacitating episodes (DC 5243), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. The General Rating Formula provides that a 10 percent rating is warranted 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. § 4.71(a). A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. Alternatively, DC 5243 provides that a 10 percent rating is warranted for incapacitating episodes of IVDS having a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating is assigned for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months; a 40 percent rating is assigned for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months; and a 60 percent rating is assigned in the event of incapacitating episodes having a total duration of at least six weeks during the past 12 months. Id. The Board reiterates that, when assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must, in addition to applying schedular criteria, also consider evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 204-207. The instant claim dates from a March 2013 letter in which the Veteran stated he experienced daily problems with his back which he believed warranted a rating in excess of 10 percent. The Board has reviewed the year prior to VA’s receipt of that claim; records show that while the Veteran was followed for lower back pain, there is no definitive evidence he met the criteria for a rating in excess of 10 percent during this period. The Veteran was afforded a VA C&P examination in December 2013. A diagnosis of lumbar degenerative disc disease status post discectomy and minimal anterior wedging at the L1 vertebra was noted. The Veteran reported his condition worsened upon standing, doing yardwork, or prolonged standing at work. He denied flare-ups of back pain. Range of motion testing revealed forward flexion to 90 degrees or greater with no objective evidence of pain; extension to 30 degrees; right and left lateral flexion to 30 degrees; and right and left lateral rotation to 30 degrees. Following repetitive movements, the Veteran had no additional functional loss. There was no evidence of localized tenderness or pain to palpation for joints/soft tissue of the cervical spine. No guarding or muscle spasm was noted. Muscle strength, reflexes, and sensation were all normal. There was no evidence of radiculopathy or other neurologic abnormalities. The examiner noted the Veteran did not have IVDS, nor did he use assistive devices. Functional impact was “mild impairment of moving about and mild impairment of lifting.” In her remarks, the examiner explained the Veteran’s posture and gait were normal; there was no contributing factors of weakness, fatigability, incoordination, or pain during flare-ups or repeated use over time that could additionally limit the functional ability of the Veteran’s thoracolumbar spine. In the Veteran’s May 2014 notice of disagreement, he asserted (without providing any specific supporting argument) he was entitled to a 60 percent rating for his lumbosacral spine disability. In March 2015, the Veteran sought treatment after aggravating his back. A VA treatment notes shows he was observed to ambulate with erect posture and steady gait. His active range of motion was normal, albeit with pain in extension. At his April 2017 Board hearing, he testified that he felt the December 2013 C&P report was inaccurate—specifically, that it underrated his functional limitation. The Veteran stated he could not stand up for any length of time without pain; could not bend over; and could not walk, sit, or bend for long periods. He reported having difficulties performing household chores such as washing dishes or vacuuming. He also reported experiencing neurological impairment in his lower extremities. (The RO has granted service connection for radiculopathy of both lower extremities, as well as erectile dysfunction.) On April 25, 2017, the Veteran attended a VA rehabilitation consult due to back pain; a treatment note reflects the Veteran had increased pain on movement and standing and a “10 percent decrease” in flexion and extension. In addition, it was noted the Veteran exhibited rounded shoulders and kyphosis. An April 2018 VA treatment note indicates the Veteran had poor posture in both sitting and standing; the examiner remarked the Veteran stood in eight degrees forward flexion. It was noted that standing increased thoracic kyphosis with flattened lumbar spine. On testing, unspecified “impairments” were found in range of motion, strength, flexibility, motor control, power, gait, and posture. The Veteran underwent another C&P examination in July 2019. He reported flare-ups of back pain, depending on his activity. He explained, “Working in my yard, any bending, stooping, and squatting, standing up to do dishes, any heavy lifting” could result in flare-ups. Range of motion testing revealed forward flexion limited to 60 degrees, extension limited to 10 degrees, lateral flexion limited to 20 degrees on both sides, and lateral rotation limited to 20 degrees on both sides. Pain was noted to cause additional functional loss. There was pain with weight-bearing but no objective evidence of localized tenderness or pain on palpation. During repetitive-use testing, forward flexion was limited to 50 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 15 degrees. The examiner noted that pain contributed to functional loss. The same impairment was noted during flare-ups (i.e., range of motion during flare-ups was estimated to be the same as after repetitive-use testing). No guarding or muscle spasm was noted; the Veteran reported pain with prolonged standing and walking. Muscle strength was normal, reflexes were hypoactive, and sensation was normal. There was evidence of radiculopathy of both lower extremities (as noted, service connection has been separately awarded for these symptoms.) No ankylosis of the spine was noted. The examiner indicated the Veteran had IVDS of the spine but had not had any episodes of acute signs or symptoms requiring bedrest prescribed by a physician in the past 12 months. With respect to Correia, supra, the examiner noted there was no objective evidence of pain with passive range of motion or on non-weight bearing. In terms of functional impact, the examiner noted the Veteran’s lumbosacral spine disability limited his participation in physical/heavy labor, including lifting and carrying greater than 20 pounds, bending, twisting, stooping, kneeling, squatting, walking on uneven surfaces, and prolonged walking or standing. The Veteran was afforded another C&P examination in October 2020. Diagnoses of lumbosacral strain, spinal stenosis, and degenerative disc disease were noted. He reported symptoms of dull pain across the lower back, with numbness and tingling in both legs; he stated he took Neurontin, Robaxin, and Motrin for his symptoms. The Veteran reported flare-ups, which he said were worse with movement and exertion; he stated he had difficulty lifting heavy objects or sitting for prolonged periods of time due to back pain. Range of motion testing revealed forward flexion limited to 60 degrees, extension limited to 20 degrees, lateral flexion limited to 20 degrees on both sides, and lateral rotation limited to 30 degrees on both sides. Pain was noted in forward flexion and extension, and there was objective evidence of localized tenderness or pain on palpation that was “moderate” in severity. There was also evidence of pain with weight-bearing. The Veteran was able to perform repetitive-use testing without additional functional loss. The examiner noted that pain and flare-ups contributed to functional loss, further restricting his range of motion as follows: forward flexion limited to 45 degrees, extension limited to 10 degrees, lateral flexion limited to 10 degrees on both sides, and lateral rotation limited to 25 degrees on both sides. No guarding or muscle spasm was noted. Muscle strength was slightly reduced in the lower extremities; there was no muscle atrophy. Reflexes were hypoactive, and sensation was decreased in the lower leg/ankles. There was evidence of radiculopathy in both lower extremities. No ankylosis was noted. The examiner indicated the Veteran did not have IVDS. He did not require assistive devices. With respect to Correia, supra, the examiner noted there was no objective evidence of pain in non-weight bearing, and that passive range of motion testing could not be performed. In terms of functional impact, the examiner noted the Veteran had difficulty lifting heavy objects due to pain. In addition to the VA treatment notes and examination reports of record, the Veteran has submitted private treatment notes from providers who have followed him for his lumbosacral spine disability. These records broadly document ongoing treatment for back pain with restricted motion. The Board first finds the most probative evidence establishes that the criteria for an increased 20 percent rating were met as of April 25, 2017. On that date, as discussed above, the Veteran reported for treatment for increased back pain and was noted to have kyphosis of the spine. Later, in April 2018, a medical examiner observed the Veteran had poor posture in both sitting and standing positions, and confirmed “increased” thoracic kyphosis with “flattened lumbar spine,” noting the Veteran stood at eight degrees of forward flexion. Under the General Rating Formula, a 20 percent rating is warranted when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour; one of the examples of abnormal spinal contour given is abnormal kyphosis. Here, while there was no explicit finding of guarding or spasm, the Veteran was clearly experiencing significant back pain in conjunction with flare-ups. Moreover, the indication of kyphosis coupled with “increased” pain convinces the Board the criteria for a 20 percent rating were met on the date kyphosis was first observed. The Board acknowledges none of the C&P reports of record show abnormal spinal contour; nonetheless, the Board will resolve doubt in the Veteran’s favor given his complaints of severe pain and the multiple instances of specific findings of spinal kyphosis of record. To that extent, the Veteran’s claim will be granted. Prior to April 25, 2017, however, the evidence of record does not establish entitlement to a rating in excess of 10 percent. As illustrated above, the December 2013 VA examination report shows the Veteran’s forward flexion was limited to 90 degrees, and the examiner made clear that while the Veteran experienced functional impairment, his impairment was not measurably equivalent to the criteria for a 20 percent rating. The examiner further noted the Veteran’s gait and posture were normal, indicating no abnormal spinal curvature. The Veteran’s subsequent lay statements and treatment records likewise do not establish that his range of motion was limited to such a degree that the 20 percent criteria were met. The Veteran has credibly reported chronic pain and functional impairment. Furthermore, the Board acknowledges the Veteran’s testimony that his functional impairment at his December 2013 examination was perhaps underestimated. However, even assuming that the December 2013 C&P results reflected greater range of motion than the Veteran actually had, there remains no probative evidence that his symptoms resulted in motion loss to a degree that warrants a rating in excess of 10 percent. To reiterate, a 20 percent rating under the General Ratings Formula requires limitation of 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. See 38 C.F.R. § 4.71(a). The Veteran has not alleged his forward flexion or combined range of motion was functionally limited to such a degree. Moreover, there is no lay or medical evidence to suggest that the Veteran displayed guarding, muscle spasm, or abnormal spinal contour as a result of his lumbosacral spine disability prior to April 25, 2017. The Board emphasizes VA is obligated to consider evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 204-07. The Veteran has demonstrated many of these factors in the context of his lumbosacral spine disability; however, even when considering these factors, there is no evidentiary basis to support a finding that the criteria for a 20 percent rating were met prior to April 25, 2017. From April 25, 2017 to the present, the Board further finds that the Veteran’s lumbosacral spine disability symptoms do not warrant a rating in excess of 20 percent under the General Rating Formula. In short, the Board can find no probative evidence establishing the Veteran’s symptoms more nearly approximated forward flexion of the thoracolumbar spine to 30 degrees or less, even when considering the types of functional impairment noted in 38 C.F.R. §§ 4.40 and 4.45 and DeLuca, nor is there any evidence of spinal ankylosis. The July 2019 and October 2020 VA examination reports clearly demonstrate range of motion of the thoracolumbar spine exceeding the criteria for a higher rating, including estimates of range of motion lost following repetitive-use testing and during flare-ups of back pain. The Veteran has not called those results into question, and there is no evidence that they are inaccurate or that the Veteran’s symptoms have worsened since the October 2020 examination. The Veteran’s private and VA outpatient notes likewise do not reflect that the criteria for a rating in excess of 20 percent have been met at any point during the appeal period. The weight of the evidence is also against a finding that the Veteran has suffered incapacitating episodes of IVDS warranting an increased rating under DC 5243. The Board acknowledges the Veteran reported constant back pain with flare-ups and associated functional limitation. He is of course competent to report these symptoms. See Layno, 6 Vet. App. 465; Jandreau, 492 F.3d at 1376-77. Notwithstanding, none of the Veteran’s treatment records or C&P reports reflect incapacitating episodes of such a severity (i.e., requiring bedrest) or frequency as would warrant an increased rating under DC 5243. Thus, the weight of the evidence is against a finding of physician-prescribed bedrest specifically on account of IVDS for at least two weeks over a 12-month period (prior to April 25, 2017) or for at least four weeks over a 12-month period (from April 25, 2017). The Board again notes the Court decision in Sharp, 29 Vet. App. 26, holding that when flare-ups are an indicated part of a claimant’s service-connected disability, VA examiners are obligated to elicit information concerning the “severity, frequency, duration, or functional loss manifestations” of flare-ups. As discussed above, while the Veteran reported flare-ups during his VA examinations, examiners attempted to estimate the functional impact, including in degrees of range of motion lost, in the examination reports. The Board has factored those estimates in to its evaluation of the Veteran’s impairment. The Board finds VA has complied with Sharp with respect to the Veteran’s lumbosacral spine disability. Moreover, the Board has considered the Veteran’s lay reports regarding his back pain, as well as symptoms such as fatigue, difficulty sitting and standing for long periods, and difficulty lifting and carrying heavy objects. These symptoms are consistent with the Veteran’s current evaluations. Finally, the Board acknowledges that Note (1) to the General Rating Formula for Diseases and Injuries of the Spine directs VA to evaluate any associated objective neurologic abnormalities separately, under an appropriate DC. 38 C.F.R. § 4.71(a). In this case, the Veteran has been service connection for radiculopathy of both lower extremities, as well as erectile dysfunction. He has not appealed those ratings, and they are therefore not before the Board at this time. There is no evidence of further neurological impairment. (Continued on the next page)   Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369-70. In sum, for the reasons discussed above, the Board finds that the Veteran is entitled to an increased 20 percent rating for his lumbosacral spine disability, effective April 25, 2017. Prior to that date, a rating in excess of 10 percent is not warranted by the evidence of record. There is no evidentiary basis for a rating in excess of 20 percent at any time during the appeal period. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ryan, 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.