Citation Nr: 21022902 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-08 607 DATE: April 19, 2021 ORDER Entitlement to a disability rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the cervical spine with cervical strain is denied. Entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the lumbar spine with lumbar strain is denied. FINDINGS OF FACT 1. The medical evidence of record demonstrates that the Veteran’s service-connected PTSD manifests in occupational and social impairment with reduced reliability and productivity, but not in occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood. 2. The evidence of record does not more nearly approximate the criteria for a disability rating in excess of 20 percent for service-connected degenerative arthritis of the cervical spine with cervical strain. 3. The evidence of record does not more nearly approximate the criteria for a disability rating in excess of 20 percent for service-connected degenerative arthritis of the lumbar spine with lumbar strain. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 50 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the cervical spine with cervical strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 5242. 3. The criteria for entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the lumbar spine with lumbar strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1968 to June 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The claims were previously before the Board in January 2019, at which time the Board remanded the claims to the agency of original jurisdiction (AOJ) in order to afford the Veteran new VA examinations to determine the current severity of the disabilities on appeal. The matters have now been returned to the Board for further appellate consideration. The Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that it has reviewed all the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence in the record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss every piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, with respect to the Veteran’s claims. Increased Disability Ratings Disability evaluations are 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 in or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. The Court of Appeals for Veterans Claims (Court) has held that “staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999). In cases wherein reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the veteran. 38 C.F.R. § 4.3. Therefore, where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. 1. Entitlement to a disability rating in excess of 50 percent for service-connected PTSD Psychiatric disorders are rated under the General Rating Formula for Mental Disorders, which provides that mental disorders are to be rated under 38 C.F.R. § 4.130, in pertinent part, as follows: A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting oneself or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or name. Evaluation of a mental disorder requires consideration of the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. Evaluations will be assigned based on all evidence of record that impacts occupational and social impairment, rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126. When determining the appropriate disability evaluation to assign, the Board’s primary considerations are a veteran’s symptoms and how those symptoms impact the veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran’s impairment must be “due to” those symptoms and that a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Historically, the Veteran was awarded service connection for PTSD in a March 2013 rating decision, which assigned the disorder a disability evaluation of 50 percent and an effective date of May 18, 2011. See rating decision dated March 25, 2013. He submitted a Notice of Disagreement in June 2013, asserting that the severity of his PTSD had worsened since his initial PTSD examination in June 2011. See Notice of Disagreement dated June 3, 2013. Notably, the June 2011 initial PTSD examination indicated that the Veteran’s psychiatric symptoms satisfied the criteria for a diagnosis of PTSD. The examination further demonstrated, in pertinent part, that the Veteran’s PTSD manifested in occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks but did not prevent generally satisfactory function such as routine behavior, self-care, and maintaining normal conversation. However, the examiner who evaluated the Veteran noted that the Veteran reported experiencing recurrent and intrusive thoughts of the in-service stressor events as well as intense psychological distress upon exposure to internal or external cues reminiscent of such events. The Veteran also relayed that he exerted efforts to avoid the topics of war or Vietnam and that he experienced markedly diminished interest or participation in activities, feelings of detachment from others, restricted range of affect, difficulty falling or staying asleep, irritability or outbursts of anger, hypervigilance, and an exaggerated startle response. He additionally stated that his symptoms range from mild to severe, depending on his level of stress and the triggers to which he may have been exposed. The Veteran’s symptoms were reported to have resulted in clinically significant distress or impairment in social and/or occupational functioning. The Veteran’s wife furnished a lay statement in January 2012, chronicling the change in the Veteran’s behavior once he returned from Vietnam. See correspondence dated January 21, 2012. She articulated that the Veteran’s behavior post-service was characterized by extreme anger, frequent nightmares, a tendency to control others, common use of expletives, substance abuse, and indifference or contempt for their children. April 2013 correspondence from a psychiatrist noted that the Veteran’s PTSD also manifested in “extreme irritability, difficulty being around other people, avoiding crowds, hypervigilance, paranoia, distrust of others, and variable mood.” See document labelled “Medical Treatment Record – Non-Government Facility,” dated April 22, 2013. In correspondence received by VA in April 2014, the Veteran relayed the extent to which his PTSD interfered with his social life, especially in how the disorder had influenced his behavior towards close family members. See correspondence received by VA on April 1, 2014. The record indicates that the Veteran was next afforded a VA examination for his PTSD in June 2015, at which time a psychologist opined that the Veteran’s PTSD resulted in occupational and social impairment due to mild or transient symptoms that decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress. See VA examination dated June 3, 2015. The Veteran relayed to the psychologist that he felt claustrophobic indoors and in crowds and that he experienced feelings of irritability marked by occasional angry outbursts in public, nightmares, difficulty sleeping, intrusive thoughts occurring at least once per week, and anxiety. The examiner additionally noted that the Veteran’s PTSD caused difficulty in adapting to stressful circumstances, including work or a worklike setting. As the examiner did not provide a rationale for her assertion that the Veteran’s symptoms were mild and transient, despite the extent to which the disorder affected the Veteran in a social and occupational capacity, the Board has deemed the findings of the June 2015 examination inadequate for purposes of evaluating the disability. See Board remand dated January 9, 2019. The Veteran’s 50 percent disability evaluation for PTSD was upheld in a June 2015 rating decision. The Veteran then perfected an appeal of the claim to the Board, asserting that his PTSD had increased in severity, that his lay statements were not taken into consideration in evaluating his PTSD, and that his symptoms were not accurately reported by the June 2015 examination. See VA Form 9, Appeal to Board of Veterans’ Appeals, dated June 11, 2015; VA Form 9 dated August 25, 2015; appellate brief dated November 14, 2018. In January 2019, the Board remanded the appeal to the AOJ in order to afford the Veteran a new VA examination to assess the current severity of his PTSD. Pursuant to the Board’s remand, the Veteran was offered a new psychological examination. In October 2019, a clinician evaluated the Veteran and reported that his PTSD was “in partial remission” and that the disability resulted in occupational and social impairment due to mild or transient symptoms that decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress. See VA examination dated October 3, 2019. In documenting the Veteran’s PTSD symptoms, the clinician reported only that the Veteran experiences anxiety and difficulty in adapting to stressful circumstances, including work or a work-like setting. Given the foregoing, the Board finds that the medical and lay evidence does not support finding that the Veteran’s PTSD warrants a disability rating in excess of 50 percent. Specifically, a 70 percent rating is not warranted, as the record does not demonstrate that the disorder results in occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking and/or mood due to symptoms such as suicidal ideation, obsessional rituals that interfere with routine activities, intermittently illogical or irrelevant speech, near-continuous panic or depression affecting the ability to function independently, spatial disorientation, neglect of personal appearance and hygiene, or the inability to establish and maintain effective relationships. Moreover, the record does not reflect symptomatology of a similar severity, frequency, or degree. Hence, entitlement to a disability rating in excess of 50 percent for service-connected PTSD is not warranted. The Board is grateful for the Veteran’s honorable service. However, given the record before it, the Board finds that evidence in this case does not reach the level of equipoise with respect to this claim. See 38 U.S.C. § 5107(a) (“[A] claimant has the responsibility to present and support a claim for benefits....”); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009) (stating that the claimant has the burden to “present and support a claim for benefits” and noting that the benefit of the doubt standard in section 5107(b) is not applicable based on pure speculation or remote possibility). 2. Entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the cervical spine with cervical strain A disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. When determining the severity of musculoskeletal disabilities, which are at least partly rated on the basis of range of motion, VA must consider the extent of additional functional impairment a Veteran may have above and beyond the limitation of motion objectively demonstrated due to pain, limited or excess movement, weakness, incoordination, and premature or excess fatigability, etc., particularly when symptoms “flare up,” to include periods of prolonged use, and assuming these factors are not already contemplated in the governing rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also Sharp v. Shulkin, 29 Vet. App. 26, 31-35 (2017); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). However, where a musculoskeletal disability is evaluated at the highest rating available based upon limitation of motion, further DeLuca analysis is deemed unnecessary. Johnston v. Brown, 10 Vet. App. 80 (1997). The Veteran’s cervical spine disability is rated under Diagnostic Code 5242, which directs that evaluation of cervical spine disabilities be rated under the General Rating Formula for Diseases and Injuries of the Spine, which provides, in pertinent part, the following: A 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees, but not greater than 40 degrees; or combined range of motion of the cervical spine greater than 170 degrees, but not greater than 335 degrees. A rating of 20 percent 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. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees of less; or favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted for unfavorable ankylosis of the cervical spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire (cervical and thoracolumbar) spine. Ankylosis is defined as the immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). Notably, normal ranges of motion of the thoracolumbar spine are flexion from 0 degrees to 90 degrees, extension from 0 degrees to 30 degrees, lateral flexion from 0 degrees to 30 degrees bilaterally, and lateral rotation from 0 degrees to 30 degrees bilaterally. 38 C.F.R. § 4.71, Plate V; see also 38 C.F.R. § 4.71, General Rating Formula for Diseases and Injuries of the Spine, Note 2. An alternative Formula for Rating is available for intervertebral disc syndrome (IVDS) based upon incapacitating episodes. In relevant part, a 10 percent rating is warranted for incapacitating episodes having a total duration of at least one week but less than two weeks during the last 12 months of the applicable rating period. 38 C.F.R. § 4.71a, Code 5243. The Veteran was awarded service connection for cervical strain in a March 2013 rating decision, which assigned the disability a rating of 10 percent disabling under DC 5242 and an effective date of May 18, 2011. The Veteran filed a timely Notice of Disagreement, asserting that the severity of the condition warrants a rating in excess of 10 percent. See Notice of Disagreement dated June 3, 2013. As an initial matter, the Board observes that the Veteran has been afforded three VA examinations for his service-connected cervical spine disability. The Veteran first underwent a VA examination of his neck disability in March 2012. Upon examination, the Veteran’s cervical spine exhibited a range of motion limited to forward flexion to 35 degrees, with objective evidence of pain beginning at 30 degrees. See VA examination dated March 19, 2012. No ankylosis was observed; and the Veteran’s cervical spine was reported not to have resulted in any episodes of IVDS. In May 2015, the Veteran was offered another VA examination of his cervical spine. At that time, a clinician diagnosed the Veteran with degenerative arthritis of the cervical spine with cervical strain. See VA examination dated May 27, 2015. The clinician documented, in pertinent part, that the disorder resulted in a range of motion limited to forward flexion of 40 degrees. The Veteran’s neck did not experience ankylosis or cause the Veteran episodes of IVDS. Significantly, the Board determined in January 2019 that the findings of the March 2012 and May 2015 examinations were inadequate for rating purposes. See Board remand dated January 9, 2019. Therefore, as the Board has found these examinations to be of no probative value, the Board will focus its analysis on the findings of most recent VA examination, as well as the relevant lay evidence of record. Consistent with the Board’s January 2019 remand directives, the Veteran was afforded a new VA examination to assess the current severity of his neck disability. In October 2019, an examiner noted that the Veteran’s cervical strain and degenerative arthritis of the cervical spine resulted in a limited or abnormal range of motion. See VA examination dated October 7, 2019. Specifically, the cervical spine’s range of motion was limited to forward flexion of 30 degrees, extension to 20 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. Testing of forward flexion, extension, right lateral rotation, and left lateral rotation caused the Veteran pain. The examiner remarked that the disability resulted in functional loss of the cervical spine, due to pain, in that the Veteran cannot turn his head (which was noted to impact his ability to drive), rest in a seated position for too long without exacerbating his neck pain, or change positions from lying to sitting without difficulty. Additionally, the examiner noted that prolonged walking bothers the Veteran’s neck and that the neck disability causes the Veteran difficulty in bending and lifting. The Veteran’s cervical spine presented objective evidence of localized tenderness on palpation of the paracervical muscles, reported to be of moderately severity. The neck also exhibited evidence of pain with weight-bearing. The examiner observed that the Veteran was able to perform repetitive-use testing with at least three repetitions and that such testing did not cause additional functional loss. Although the Veteran was not examined immediately after repetitive use of the cervical spine over time, the clinician reported that his findings were medically consistent with the Veteran’s statements regarding functional loss with repetitive use over time. The examiner further noted that pain significantly limits the neck’s functional ability over time, estimating that such pain results in ranges of motion limited to forward flexion to 25 degrees, extension to 15 degrees, right lateral flexion to 35 degrees, left lateral flexion to 35 degrees, right lateral rotation to 5 degrees, and left lateral rotation to 5 degrees. Notably, the Veteran reported experiencing flare-ups of the neck disability, which he relayed as his neck pain increasing from a 0 to a 10, on a ten-point scale, while engaging in everyday activities such as driving, changing positions, or sitting for a prolonged period of time. The Veteran further described the functional loss of his neck in terms of his inability to turn his neck or look down without experiencing severe pain, thus making it especially challenging to drive. Although the examination was not conducted during a flare-up, the examiner reported that his findings were medically consistent with the Veteran’s statements. The examiner estimated that the pain caused by the flare-ups would limit the forward flexion to 25 degrees, the extension to 15 degrees, the right lateral flexion to 30 degrees, the left lateral flexion to 30 degrees, the right lateral rotation to 5 degrees, and the left lateral rotation to 5 degrees. The examiner further reported that the cervical spine disability causes muscle spasms, which require that the Veteran position his head forward, slightly flexed, when painful. The Veteran relayed that his neck could become very rigid with ambulation. Furthermore, the Veteran’s neck disability did not cause ankylosis of the cervical spine or episodes of IVDS. Concerning Correia criteria, the examiner observed objective evidence of pain when the Veteran uses his neck in non-weight bearing. Passive range of motion testing, even with pain present, was noted to be limited to the same extent as indicated in the active range of motion. Finally, the examiner opined that the Veteran’s neck pain would markedly impair his ability to function in an occupational environment, whether sedentary or active, due to his limited ability to rotate his neck. Based on these findings, VA issued a rating decision in August 2020 reclassifying the disability as degenerative arthritis of the cervical spine with cervical strain, increasing the disability evaluation from 10 percent to 20 percent, effective May 18, 2011. In light of the foregoing, the Board finds that a disability rating in excess of 20 percent for the Veteran’s service-connected neck disability is not supported by the evidence of record. Specifically, a disability rating of 30 percent is not warranted under DC 5242, as forward flexion of the cervical spine was not limited to 15 degrees or less and as the cervical spine did not exhibit ankylosis. As the disability does not cause episodes of IVDS, a rating under the criteria for IVDS episodes is not applicable. The Board has considered whether there is any other basis for granting further increased and/or additional ratings but has found none. Thus, entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the cervical spine with cervical strain is not warranted; and the claim must be denied. 3. Entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the lumbar spine with lumbar strain The Veteran was granted service connection for his lumbar strain in a March 2013 rating decision, which assigned the disability a rating of 10 percent disabling under DC 5242 and an effective date of May 18, 2011. The Veteran expressed his disagreement with the assigned evaluation, asserting that the severity of the condition warrants a rating in excess of 10 percent. See Notice of Disagreement dated June 3, 2013. Turning to the relevant medical evidence of record, the Board observes that the Veteran has been afforded three VA examinations for his service-connected lumbar spine disability. The Veteran first underwent a VA examination of his back in March 2012. At that time, the forward flexion of the Veteran’s thoracolumbar spine extended to an endpoint of 90 degrees or greater; and objective evidence of pain was not noted to begin until 90 degrees or greater. See VA examination dated March 19, 2012. The medical report did not indicate whether the Veteran’s lumbar spine exhibited ankylosis; however, the examiner documented that the disability did not cause episodes of IVDS. In May 2015, the Veteran was afforded another VA examination to determine the severity of his low back disability. The physician who conducted the examination provided an additional diagnosis of degenerative arthritis of the lumbar spine. He further reported that the forward flexion of the Veteran’s thoracolumbar spine was limited to 80 degrees. The examiner also noted that the Veteran’s lumbar spine did not exhibit ankylosis or cause episodes of IVS. As was the case with the cervical spine examinations, the Board concluded in its January 2019 remand that the findings of the March 2012 and May 2015 examinations were inadequate for rating purposes. Consequently, as the Board has found these examinations to be of no probative value, the Board will focus its analysis on the findings of most recent VA examination, as well as the relevant lay evidence of record. Pursuant to the Board’s remand directives, the Veteran was afforded a new VA examination in October 2019 to assess the current severity of his lumbar spine disability. At that time, an examiner reported that the Veteran’s back disability, recharacterized as lumbar strain and degenerative arthritis of the lumbar spine, resulted in an abnormal range of motion. See VA examination dated October 7, 2019. The abnormal range of motion was noted to contribute to functional loss in that it causes the Veteran difficulty bending, carrying too much weight, pushing, pulling, lifting, changing positions from supine to sitting, and changing positions from sitting to standing. The examiner documented that the Veteran’s range of motion was limited to a forward flexion to 70 degrees, extension to 20 degrees, right lateral flexion to 25 degrees, left lateral flexion to 25 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Pain observed on examination reportedly causes functional loss in all ranges of motion. The Veteran’s lumbar spine exhibited objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, described as moderate pain and spasms in the muscles of the back. The lumbar spine also presented evidence of pain with weight-bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, and no additional loss of function was noted following three repetitions. Although the Veteran was not examined immediately after repetitive use of the back over time, the examiner documented that her findings were consistent with the Veteran’s statements describing functional loss. To that end, the examiner remarked that pain significantly limited functional ability with repeated use over a period of time, estimating that the range of motion of the Veteran’s lumbar spine would be limited to forward flexion to 60 degrees, extension to 15 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The Veteran reported experiencing flare-ups of the disability, which he described as increasing the pain in his back and decreasing his ability to bend or move. Although the Veteran was not examined during a flare-up, the clinician reported that her findings were medically consistent with the Veteran’s statements regarding functional loss. She further noted that pain during flare-ups significantly limits the functional ability of the Veteran’s back, estimating the ranges of motion to be limited to the same degrees as her estimates of limitation of motion following repetitive use of the back over a period of time. The examiner furthermore documented that the Veteran’s back disability did not manifest in ankylosis of the spine or in episodes of IVDS. Regarding Correia criteria, the examiner documented that the Veteran’s lumbar spine did not demonstrate objective evidence of pain on non-weight bearing. Passive range of motion testing was observed the be the same as indicated during active range of motion testing, despite the presence of pain. Finally, the examiner opined that the effect of the Veteran’s low back disorder on his ability to function would be significant, causing issues with everyday activities such as lifting, bending, reaching, or sitting for a prolonged period of time. Based on the findings of the October 2019 examination, VA issued a rating decision in August 2020 reclassifying the disability as degenerative arthritis of the lumbar spine with lumbar strain and increasing the disability evaluation of the disability from 10 percent to 20 percent, effective as of the original date of service connection, May 18, 2011. In light of the above, the Board finds that the severity of the Veteran’s lumbar disorder does not warrant a disability rating in excess of 20 percent. Specifically, the medical evidence does not demonstrate that the Veteran’s lumbar spine warrants a 40 percent disability rating, as forward flexion was not limited to 30 degrees or less and as ankylosis of the entire thoracolumbar spine was not observed. The Board has considered whether there is any other basis for granting further increased and/or additional ratings but has found none. Accordingly, entitlement to a disability rating in excess of 20 percent for service-connected degenerative arthritis of the lumbar spine with lumbar strain is not warranted; and the claim must be denied. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, 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.