Citation Nr: 21022537 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 16-19 782A DATE: April 16, 2021 ORDER Entitlement to an evaluation higher than 20 percent for degenerative arthritis of the spine with intervertebral disc syndrome (lumbar spine disorder) is denied. Entitlement to an evaluation higher than 20 percent prior to November 6, 2020 for sciatic radiculopathy of the left lower extremity is denied. Entitlement to an evaluation higher than 10 percent on and after November 6, 2020 for sciatic radiculopathy of the left lower extremity is denied Entitlement to an evaluation higher than 10 percent for femoral radiculopathy of the left lower extremity is denied. Entitlement to an evaluation higher than 10 percent for sciatic radiculopathy of the right lower extremity is denied. Entitlement to an evaluation higher than 10 percent for femoral radiculopathy of the right lower extremity is denied. Entitlement to a 20 percent evaluation for left hip gunshot wound residuals with osteoarthritis and residual scar (left hip disorder) is granted. FINDINGS OF FACT 1. The Veteran was not prescribed bed rest by a physician during the appeal period, and at worst forward flexion of the lumbar spine is limited to 40 degrees with repetitive use over time and during flares. There is no evidence of ankylosis or symptoms consistent with ankylosis. 2. Prior to November 6, 2020, the sciatic radiculopathy of the left lower extremity more nearly approximated moderate incomplete paralysis of the sciatic nerve. 3. On and after November 6, 2020, the sciatic radiculopathy of the left lower extremity more nearly approximates mild incomplete paralysis of the sciatic nerve. 4. Femoral radiculopathy of the left lower extremity was first identified on VA examination in November 6, 2020 and more nearly approximates mild incomplete paralysis of the femoral nerve. 5. Throughout the appeal, sciatic radiculopathy of the right lower extremity has more nearly approximated mild incomplete paralysis of the sciatic nerve. 6. Femoral radiculopathy of the right lower extremity was first identified on VA examination in November 6, 2020 and more nearly approximates mild incomplete paralysis of the femoral nerve. 7. The left hip disorder more nearly approximates a moderate injury of Muscle Group XVII. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation higher than 20 percent for the service-connected lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5243. 2. Prior to November 6, 2020, the criteria for entitlement to an evaluation higher than 20 percent for sciatic radiculopathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 3. On and after November 6, 2020, the criteria for entitlement to an evaluation higher than 10 percent for sciatic radiculopathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 4. The criteria for an evaluation higher than 10 percent for femoral radiculopathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526. 5. The criteria for an evaluation higher than 10 percent for sciatic radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 6. The criteria for an evaluation higher than 10 percent for femoral radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8526. 7. The criteria for a 20 percent evaluation for the left hip disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.73, DC 5317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the U.S. Army from May 1977 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2015 and June 2015 rating decisions of a Department of Veteran Affairs (VA) Regional Office (RO). In March 2019 the Veteran testified at a Board hearing before the undersigned Veterans Law Judge and a transcript of the proceeding is of record. All requirements for hearing officers have been met. 38 C.F.R. § 3.103 (c)(2); Bryant v. Shinseki, 23 Vet. App. 488 (2010). The matter was remanded in August 2019 and has been returned for further appellate review. There has been compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Neither the Veteran nor the record has raised any issue with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating 1. Entitlement to an evaluation higher than 20 percent for degenerative arthritis of the spine with intervertebral disc syndrome is denied. The Veteran contends that his service-connected lumbar spine disorder warrants an evaluation higher than 20 percent. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 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 evaluation 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. The Veteran’s lumbar spine disorder is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5243, for intervertebral disc syndrome (IVDS). DC 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 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. at Note 1. [Include any other relevant Note(s) to DC 5243. DC 5243 was amended effective February 7, 2021 to require evidence of disc herniation with compression and/or irritation of the adjacent nerve root. All other disc diagnoses are assigned DC 5242 for all other disc diagnoses. DC 5252 was amended to include degenerative arthritis and degenerative disc disease other than IVDS. The Veteran’s claim was pending prior to February 7, 2021; therefore, the Board will apply the version most favorable to the Veteran. Under the General Rating Formula for Diseases and Injuries of the Spine (General Formula), 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. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent 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 Formula. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. In this case, there is evidence of sciatic and femoral radiculopathy addressed separately herein. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. 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) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). 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.” The spine has no opposite 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. The relevant evidence includes VA treatment records, examination reports, lay testimony, and surgical records from the Brooke Army Medical Center (BAMC). The Veteran underwent a VA examination in March 2015 but the findings in that report are not adequate for rating purposes. The Veteran asserts that the 2015 VA examiner forced his range of motion past the point he would have otherwise been limited by pain, and that the examination was less than thorough. Specifically, he asserted a goniometer was not used and the examiner did not interview him regarding the severity of the condition. The Board finds the Veteran credible. The 2015 examiner also did not comment on pain in passive motion. Thus, the findings of the 2015 examination pertaining to the lumbar spine are not considered probative. The BAMC records show the Veteran underwent surgery for a spinal arachnoid cyst in January 2017 and was instructed to limit his exercise to walking for the first 6 weeks after the surgery. Those records do not show any prescribed bed rest. At the March 2019 hearing, the Veteran described difficulty walking and that he used a cane all the time and had to use a wheelchair at the airport. Otherwise, the Veteran largely discussed the deficiencies in the 2015 VA examination. The Veteran underwent another VA examination in November 2020. That examiner documented degenerative arthritis of the spine and IVDS. At that examination the Veteran reported the condition had progressively worsened over time. He described low back pain with radiation to the extremities, and numbness and tingling. The Veteran was prescribed opiod pain medication and had underwent spinal surgery in 2017. The Veteran reported the pain was constant, and that he had significant impairment in his ability to lift. Initial range of motion showed forward flexion to 45 degrees; and extension, bilateral flexion, and bilateral rotation were all to 15 degrees. There was pain noted on exam in all ranges of motion, and mild tenderness or pain to palpation to the lumbosacral mid-line. There was evidence of pain with weight bearing, but not in non-weight bearing. Passive range of motion of the spine could not be performed without significant burden to the Veteran so it was deemed medically inappropriate. The Veteran was able to perform 3 repetitions without additional loss of range of motion. The examiner found that pain would additionally limit functional ability with repetitive use over time and during flares and estimated the Veteran would have an additional loss of 5 degrees of range of motion in all planes. Thus, at worst flexion was limited to 40 degrees. The examiner identified additional factors contributing to disability, such as instability on standing due to pain. Regarding IVDS, the Veteran has not had any episodes of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran required constant use of a cane for his back and lower extremity conditions. Functionally, the Veteran would have difficulty with activities like carrying, lifting, pushing, pulling, bending, and stooping. The available VA treatment records generally show ongoing complaints of lumbar tenderness, pain, stiffness, and loss of motion. See e.g. October 2015, April 2016, August 2017, August 2018, February 2019, and January 2020 VA treatment notes. Those records do not discuss any incapacitating periods and they do not include any range of motion findings. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for the lumbar spine disorder based on the Formula for Rating IVDS because the lay and medical evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. As such, there is no basis to award a higher evaluation under DC 5243. The preponderance of the evidence is also against a rating in excess of 20 percent for the lumbar spine disorder under the General Rating Criteria. The evidence shows that at worst forward flexion of the lumbar spine is limited to 40 degrees with repetitive use over time and during flares. See November 2020 VA examination report. The evidence does not show that forward flexion of the spine was limited to 30 degrees or less during the appeal period, and there is no evidence of ankylosis or symptoms consistent with ankylosis. The Board acknowledges the reports of flares of severe pain, instability in standing up, and that there was functional loss in his ability to walk, carry, lift, push, pull, bend, and stoop. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that do not more nearly approximate forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Rather, the Veteran is able to accomplish some range of motion albeit limited and with pain and the 2020 examiner adequately estimated the additional degree of loss of range of motion during flares and with repeated use over time. Based on the foregoing, the preponderance of the evidence is against of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for the lumbar spine disorder. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to increased evaluations of left lower extremity sciatic radiculopathy, evaluated at 20 percent from August 14, 2014 and at 10 percent from November 6, 2020 is denied. 3. Entitlement to an evaluation higher than 10 percent for femoral radiculopathy of the left lower extremity is denied. The Veteran seeks entitlement to higher evaluations for sciatic and femoral radiculopathy of the left lower extremity. Paralysis of the sciatic nerve is evaluated according to 38 C.F.R. § 4.124a, DC 8520. Under that criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. Paralysis of the femoral nerve is evaluated at 38 C.F.R. § 4.124a, DC 8526. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis, identified as paralysis of the quadriceps extensor muscles, is rated as 40 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in DCs 8520 and 8526 are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. As noted, the Veteran has challenged the accuracy of the March 2015 VA examination report for the spine, which also contained findings relevant for the left lower extremity radiculopathy. The findings related to radiculopathy are not predicated on range of motion testing, and some of the objective findings are of worse severity than those discussed in the latter November 2020 examination report. Specifically, the 2015 VA examination report documented moderate constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness of the left lower extremity. There was decreased strength in the left hip flexion and ankle dorsiflexion, but no atrophy. Sensory examination showed decreased sensation to light touch from the thigh through the toes. Overall, the examiner assessed moderate sciatic nerve radiculopathy of the left lower extremity. Available VA treatment records document complaints of numbness and tingling in the legs in October 2015, complaints of numbness from the knees down in August 2017, worsening numbness in February 2019, and ongoing pain and numbness in September 2019. At an August 2017 VA psychiatric appointment, the Veteran reported he had “dropped foot,” but VA treatment records do not otherwise discuss or include a diagnosis of dropped foot. At the March 2019 hearing, the Veteran described symptoms of loss of feeling, weakness, and pain in the left lower extremity that was worse compared to the right lower extremity. He reported instances where he will get up and fall because he had no feeling or strength in the leg. The November 2020 VA examination report documents that the Veteran’s reflexes were hypoactive in the left knee and ankle. Sensation to light touch was decreased throughout the left leg from the upper anterior thigh through the toes. Straight leg testing was also positive on the left. For the left lower extremity, the examiner identified symptoms of mild constant pain, paresthesias and/or dysesthesias, and numbness. Muscle strength was normal throughout the left lower extremity and there was no muscle atrophy. There were no other signs or symptoms of radiculopathy. Overall, the examiner concluded there was mild femoral and sciatic radiculopathy of the left lower extremity. a) Entitlement to an evaluation higher than 20 percent for sciatic radiculopathy of the left lower extremity prior to November 6, 2020. Prior to November 6, 2020, the evidence demonstrates impairment in the Veteran’s ability to ambulate that requires use of a cane or wheelchair on occasion. There was also moderate constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness of the left lower extremity. Muscle strength was reduced to 4/5, meaning the Veteran could accomplish active movement against some resistance. Prior to November 6, 2020, the evidence did not show hypoactive reflexes, trophic changes, or muscle atrophy. The preponderance of the evidence also does not show dropped foot consistent with complete paralysis during the appeal. Foot drop in the context of complete paralysis is when the foot dangles and drops and there is no active movement possible of the muscles below the knee. Here, there is no objective evidence that there was no active movement possible below the knee in the VA treatment records or examination reports. Although the Veteran may experience impaired function, that does not equate to foot drop and as a lay person he is not competent to assess foot drop. The Board also acknowledges the Veteran’s hearing testimony of instances of no feeling or strength in the leg that cases him to fall upon getting up. Here, the objective evidence does not show total loss of sensation or strength but does show moderate symptoms of paresthesias and numbness with motor impairment that is contemplated by the 20 percent rating criteria. Overall, the preponderance of the evidence demonstrates the left lower extremity sciatic radiculopathy is consistent with moderate incomplete paralysis and no higher. Prior to November 6, 2020, there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves. Therefore, a separate or higher rating under a different DC is not warranted. b) Entitlement to an evaluation higher than 10 percent for sciatic and femoral radiculopathy of the left lower extremity on and after November 6, 2020. On and after November 2020, the evidence continued to show motor impairment and use of assistive devices such as a cane or wheelchair on occasion. At this time, loss of sensation had increased to include the entire left lower extremity, and there were hypoactive reflexes of the left lower extremity. The examiner also identified left lower extremity mild constant pain, paresthesias and/or dysesthesias, and numbness, and characterized the severity overall as mild sciatic radiculopathy and mild femoral radiculopathy. Although there was evidence of worsening sensation throughout the leg and hypoactive reflexes at the 2020 examination compared to the 2015 examination, the evidence also shows the Veteran had developed femoral radiculopathy. The findings included in the 2020 examination report are most consistent with mild incomplete paralysis of the sciatic and femoral nerves. Thus, entitlement to an evaluation higher than 10 percent for sciatic or femoral radiculopathy of the left lower extremity on and after November 6, 2020 is denied. 4. Entitlement to an evaluation higher than 10 percent for sciatic radiculopathy of the right lower extremity is denied. 5. Entitlement to an evaluation higher than 10 percent for femoral radiculopathy of the right lower extremity is denied. The Veteran also seeks higher evaluations for the sciatic and femoral radiculopathy of the right lower extremity. The March 2015 VA examiner documented decreased strength in right hip flexion and ankle dorsiflexion that was 4/5 without muscle atrophy. Reflexes were normal. Sensory examination was decreased from the thigh through the toes. Straight leg test was negative on the right, but the examiner did identify symptoms of mild constant pain, mild intermittent pain, mild paresthesias and/or dysesthesias, and numbness. There were no other signs or symptoms radiculopathy. The examiner only identified involvement of the sciatic nerve and assessed the severity of that radiculopathy as mild. The available VA treatment records generally show numbness, tingling, and pain of the right lower extremity and the August 2017 lay report of dropped foot. At the March 2019 hearing, the Veteran reported constant pain and weakness of the right lower extremity that was not as severe as the left lower extremity. The November 2020 VA examiner documented normal strength of the right lower extremity and hypoactive reflexes. Sensation was decreased throughout the right lower extremity and there was a positive straight leg test. The examiner identified mild symptoms of constant pain, paresthesias and/or dysesthesias, and numbness. There were no other signs or symptoms of radiculopathy. Overall, the examiner assessed the severity of the right lower extremity radiculopathy was mild, but now affected both the sciatic and femoral nerves. Prior to the November 2020 examination report, there was no evidence of femoral radiculopathy in the record. Here, the evidence demonstrates that sciatic and femoral radiculopathy of the right lower extremity more nearly approximates the criteria for mild incomplete paralysis. The VA examination reports document impairment in the Veteran’s ability to ambulate, and some reduced muscle strength although the Veteran was able to perform active movement against some resistance and there was no atrophy. The sensory defects were assessed as mild and the both examiners assessed the overall severity as mild. Femoral radiculopathy was not identified until the November 2020 examination report. The findings of the VA examination reports are consistent with the VA treatment records and March 2019 hearing testimony. Again, regarding the Veteran’s August 2017 report of dropped foot, the Board has found the objective evidence more probative. Overall, the criteria for an evaluation higher than 10 percent for sciatic and femoral radiculopathy are not met. 6. Entitlement to an evaluation higher than 10 percent from October 28, 2014 for left hip osteoarthritis with residual scar. The Veteran contends that he is entitled to a higher evaluation for his left hip disorder. The Veteran’s left hip osteoarthritis is rated under 38 C.F.R. § 4.71a, DC 5252, for limitation of flexion of the thigh. Under DC 5252, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252. The left hip disorder also includes a muscle injury to muscle group XVII. DC 5317 is for muscle group XVII, which is for pelvic girdle group 2: gluteus maximus, gluteus medius and gluteus minimus. The functions for this group are “[e]xtension of hip; abduction of thigh; elevation of opposite side of pelvis; tension of fascia lata and iliotibial (Maissiat’s) band, acting with XIV in postural support of body steadying pelvis upon head of femur and condyles of femur on tibia.” Under DC 5317, disability of Muscle Group XVII, warrants a 20 percent rating when moderate, a 40 percent rating when moderately severe and a 50 percent rating when severe. Evaluation of muscle injuries is subject to 30 C.F.R. § 4.56, which provides that a through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement. Section 4.56 provides guidance on meaning of slight, moderate, moderately severe, and severe. The type of disability associated with a slight muscle disability is a simple wound of muscle without debridement or infection. A history with regard to this type of injury should include service department record of superficial wound with brief treatment and return to duty, healing with good functional results, and no cardinal signs or symptoms of muscle disability. Objective findings should include minimal scar, no evidence of fascial defect, atrophy, or impaired tonus, no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56 (d)(1). The type of injury associated with a moderate muscle disability is a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history with regard to this type of injury should include service department record or other evidence of in-service treatment for the wound and record of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56 (d)(2). The type of injury associated with a moderately severe muscle disability is a through-and-through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history with regard to this type of injury should include service medical record or other evidence showing prolonged hospitalization for treatment of wound, record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56 (d)(3). The type of injury associated with a severe disability of muscles is a through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. A history consistent with this type of injury would include service department record or other evidence showing hospitalization for a prolonged period for treatment of wound, record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings of a severe disability would include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, a severe injury would also show x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56 (d)(4). A muscle injury rating will not be combined with any peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. 38 C.F.R. § 4.55 (a). Here, the Veteran is in receipt of separate evaluations for sciatic and femoral radiculopathy of the bilateral lower extremities secondary to his lumbar spine disorder. Paralysis of the sciatic nerve involves function of the knee and below. See 38 C.F.R. § 4.124, DC 8520. Paralysis of the femoral nerve involves the function of the quadriceps extensor muscles. See 38 C.F.R. § 4.124, DC 8526. Group XVII affects the function of the gluteus maximus, gluteus maximus, gluteus medias, gluteus minimus and extension of hip, abduction of thigh, elevation of the opposite side of the pelvis, and postural support in steadying the body. As DC 5317 involves separate body parts and functioning than sciatic and femoral paralysis, there is no impermissible pyramiding with the separate evaluations for sciatic and femoral neuropathy and the Board may consider assignment of an evaluation under DC 5317. For this issue, the relevant evidence includes VA treatment records, VA examination reports, and lay testimony. The Veteran first underwent a VA examination in 2015. As discussed previously, the Veteran asserted the 2015 examiner failed to conduct a thorough examination and forced his range of motion past the point of pain. The Board finds the 2015 examination report is not adequate for rating purposes. The Veteran was reexamined in November 2020. At that time, he reported gradually worsening pain on use of the left hip. He endorsed flares of symptoms he described as an inability to stand more than several minutes, and that he was unable to do long distance walking. Initial range of motion testing showed left hip flexion to 50 degrees, extension to 20 degrees, abduction and adduction to 20 degrees, external rotation to 30 degrees and internal rotation to 20 degrees. Adduction was not limited such that the Veteran would not cross his legs. Pain was noted on exam in all ranges of motion but did not result in functional loss. There was pain to palpation and pain with weight bearing, but no objective evidence of pain in non-weight bearing. Passive range of motion testing was not indicated as it was not medically appropriate. The Veteran was able to accomplish 3 repetitions without additional loss of range of motion. With repetitive use over time and during flares the examiner estimated the Veteran would experience an additional 5-degree loss of range of motion in all planes. There were no additional contributing factors of disability. Muscle strength was normal and there was no atrophy. There was no malunion or nonunion of femur, flail hip joint or leg length discrepancy. Functionally, the Veteran was impaired in his ability to perform weight bearing activities, such as lifting, running, long distance walking, prolonged standing, squatting, or repetitive stair climbing. A November 2020 VA scars examination report documents a scar of the left lateral thigh that was painful but not unstable, tender to palpation, and that measured 3 cm x 0.7 cm, for a combined total area of 2.1 cm. The scar did not result in any functional impairment. The Veteran also underwent a VA muscle injury examination the same month. The examiner noted a history of muscle injury that occurred in 1972 when the Veteran was shot in the hip. The condition had worsened over time. The injury involved muscle group XVII affecting the pelvic girdle muscles, the function of which involved extension of hip, abduction of thigh, and postural support of the body. The examiner found the damage was not severe enough to prevent the Veteran from rising from a seated and stooped position and maintain postural stability without assistance of any type. The Veteran had scars associated with the muscle injury, including entrance and exit scars that were small or linear, indicating short track. There were no known fascial defects, but there was some impairment of muscle tonus. The muscle injury caused symptoms of fatigue and/or pain. Muscle strength testing was normal and there was no atrophy. Due to the muscle injury, the Veteran had impairment in activities that required weight-bearing, such as such as lifting, running, long distance walking, prolonged standing, squatting, or repetitive stair climbing. The available VA treatment notes generally document pain, stiffness, and loss of motion of the left hip and thigh. Those records do not contain specific range of motion findings, or findings more severe than documented by the 2020 examiner. Here, the criteria for a 20 percent evaluation for a muscle injury of Group XVII is warranted. The STRs document the Veteran suffered a gunshot wound to the left hip area in early 1972 and was hospitalized for several days in February 1972 and treated with local irrigation and debridement. See March 1972 STR; see January 1990 Medical Evaluation Board proceedings. The bullet was not removed until 1975, and the Veteran continued to have atrophy and weakness of the area. The history of the injury shows a through and through or deep penetrating wound of a single bullet that did require debridement and caused residuals of atrophy and weakness. The 2020 VA examiner documented there were entrance and exit scars that were small or linear, and indicated a short track of the missile through muscle tissue, but not scars indicating the track went through one or more muscle groups. The 2020 examiner also noted the Veteran did not have any known fascial defects or evidence of fascial defects, but there was some impairment of muscle tonus with symptoms of fatigue and pain. Overall, these findings are more consistent with the 20 percent evaluation criteria for moderate muscle injury. Although the evidence does show the Veteran’s wound was debrided at the time and the Veteran spend some time in the hospital—factors considered in the history of the 30 percent criteria—the remaining objective signs and symptoms of the muscle injury are contemplated by the 20 percent criteria. Overall, the Board concludes the overall disability picture more nearly approximates the 20 percent evaluation criteria for moderate muscle injury, but no higher. The 20 percent rating criteria under DC 5317 replaces the previous evaluation under DC 5252 as these ratings may not be combined without impermissible pyramiding of symptoms. DC 5317 and 5252 contemplate pain and functional impairment of the hip, and the Veteran may not receive compensation for the same symptoms twice. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). For the same reason, the Veteran is not entitled to a separate compensable evaluation for the painful scar of the left thigh as the pain is contemplated by the rating criteria for the muscle injury. The evidence does not show that an evaluation higher than 20 percent is warranted under DC 5252. Even considering the additional degree of impairment experienced by the Veteran after repetitive use over time of during flares, the evidence does not show flexion of the thigh limited to 20 degrees or less. There is no other potentially applicable DC for the thigh that would yield a higher evaluation. In sum, the criteria for a 20 percent evaluation, but no higher, for gunshot wound residuals of the left hip with osteoarthritis are met and the claim is granted to this degree. Neither the Veteran nor his/her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2018) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). K. MILLIKAN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.