Citation Nr: 21024442 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-18 595 DATE: April 22, 2021 ORDER Prior to June 2, 2014, a rating in excess of 10 percent for lumbar spine degenerative disc disease with compression fracture at L2 is denied. Beginning June 2, 2014, a rating of 40 percent for lumbar spine degenerative disc disease with compression fracture at L2 is granted. Beginning July 7, 2016, a separate rating of 60 percent for neurogenic bladder is granted. Beginning December 7, 2016, a separate rating of 30 percent for fecal incontinence is granted. Prior to April 2, 2015, a rating in excess of 10 percent for right lower extremity radiculopathy is denied. From April 2, 2015 through June 6, 2018, a rating of 20 percent for right lower extremity radiculopathy is granted. Beginning June 7, 2018, a rating of 40 percent for right lower extremity radiculopathy is granted. FINDINGS OF FACT 1. Prior to June 2, 2014, the Veteran’s service-connected lumbar spine degenerative disc disease with compression fracture at L2 has been manifested by forward flexion to 90 degrees; a combined range of motion of 240 degrees; no evidence of muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour; no objective evidence of incapacitating episodes requiring prescribed bed rest and treatment by a physician having a total duration of at least four weeks, but less than six weeks, during the past 12 months; and no neurologic abnormalities other than the separately evaluated right lower extremity radiculopathy. 2. Beginning June 2, 2014, the Veteran’s service-connected lumbar spine degenerative disc disease with compression fracture at L2 has been manifested by forward flexion to 30 degrees or less; no evidence of ankylosis; no objective evidence of incapacitating episodes requiring prescribed bed rest and treatment by a physician for at least six weeks during the past 12 months; and no neurologic abnormalities other than the separately evaluated right lower extremity radiculopathy, neurogenic bladder, and bowel incontinence. 3. Beginning July 7, 2016, the Veteran’s service-connected low back disability resulted in neurogenic bladder requiring the use of an appliance. 4. Beginning December 7, 2016, the Veteran’s service-connected low back disability resulted in occasional involuntary bowel movements necessitating the wearing of pads. 5. Prior to April 2, 2015, the Veteran’s right lower extremity radiculopathy was manifested by no more than mild incomplete paralysis of the femoral nerve. 6. From April 2, 2015 through June 6, 2018, the Veteran’s right lower extremity radiculopathy has more nearly approximated moderate incomplete paralysis of the femoral nerve. 7. Beginning June 7, 2018, the Veteran’s right lower extremity radiculopathy has more nearly approximated moderately severe incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. Prior to June 2, 2014, the criteria for an initial rating in excess of 10 percent for lumbar spine degenerative disc disease with compression fracture at L2 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5237 (2020). 2. Beginning June 2, 2014, the criteria for a rating of 40 percent, but not higher, for lumbar spine degenerative disc disease with compression fracture at L2 have been more nearly approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5237 (2020). 3. Beginning July 7, 2016, the criteria for a separate rating of 60 percent for neurogenic bladder have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.71a, Diagnostic Code 5237, 4.115b, Diagnostic Code 7542 (2020). 4. Beginning December 7, 2016, the criteria for a separate rating of 30 percent for fecal incontinence have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.71a, Diagnostic Code 5237, 4.114, Diagnostic Code 7332 (2020). 5. Prior to April 2, 2015, the criteria for a rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.124a, Diagnostic Code 8626 (2020). 6. From April 2, 2015, through June 6, 2018, the criteria for a rating of 20 percent, but not higher, for right lower extremity radiculopathy have been more nearly approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8626 (2020).   7. Beginning June 7, 2018, the criteria for a rating of 40 percent, but not higher, for right lower extremity radiculopathy have been more nearly approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8520 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1986 to December 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This matter was previously before the Board in August 2018 and March 2019 and was remanded for further development. The requested development was completed, and the case has been returned to the Board for further appellate action. Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). 1. Entitlement to a higher initial rating for lumbar spine degenerative disc disease with compression fracture at L2 With the exception of a temporary 100 percent rating assigned for convalescence from July 7, 2016 through August 31, 2016, the Veteran’s service-connected low back disability has been assigned an initial 10 percent rating throughout the period on appeal. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), a 10 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 60 degrees, but not greater than 85 degrees; or where the combined range of motion of the thoracolumbar spine is greater than 120 degrees, but not greater than 235 degrees; or where there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or where there is vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a, General Rating Formula. A 20 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; or where the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or where muscle spasm or guarding is 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 warranted where forward flexion of the thoracolumbar spine is limited to 30 degrees or less, or where there is favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. Full range of motion of the thoracolumbar spine is to 90 degrees of flexion, 30 degrees of extension, 30 degrees of lateral flexion, and 30 degrees of rotation. 38 C.F.R. § 4.71a, Plate V. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastro-intestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula, Note (5). The General Rating Formula provides further guidance in rating diseases or injuries of the spine. In pertinent part, Note (1) provides that any associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id. at Note (1). Alternatively, intervertebral disc syndrome (IVDS) can be rated based on incapacitating episodes under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula) or the General Rating Formula, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Id. at Note (6). Pursuant to the IVDS Formula, 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 past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. A 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks, but less than four weeks, during the past 12 months. Id. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks, but less than six weeks, during the past 12 months. Id. A maximum 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. Id. An “incapacitating episode” is defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, IVDS Formula, Note (1). Prior to June 2, 2014 Upon review of the record, the Board finds that a rating in excess of 10 percent is not warranted at any time prior to June 2, 2014. The Board has reviewed and considered the Veteran’s assertions in support of her claim, including her reports of lower back pain, which causes difficulty bending, lifting, twisting, and prolonged walking, standing, and sitting upright. However, even considering her subjective complaints of pain and other symptoms described in DeLuca, forward flexion of the thoracolumbar spine to 60 degrees or less, or a combined range of motion of 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour has not been shown such that a higher rating would be warranted. See Thompson v. McDonald, 815 F.3d 781, 786 (Fed. Cir. 2016) (holding that provision describing functional loss due to disability of the musculoskeletal system does not supersede requirements for a higher rating specified in the Rating Schedule). The Veteran underwent a VA examination in August 2013, at which time range of motion testing of the thoracolumbar spine revealed full range of flexion to 90 degrees or more, full range of extension to 30 degrees or more, and full range of left and right lateral flexion and rotation to 30 degrees or more. There was no additional limitation after repetition. There was evidence of pain beginning at the endpoints of left and right lateral flexion and rotation, but no evidence of pain with flexion or extension. Additionally, there was no evidence of ankylosis or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Moreover, treatment records during this period do not reflect symptoms more severe than those noted during the VA examinations. Accordingly, a rating in excess of 10 percent is not warranted at any time prior to June 2, 2014. The Board has also considered whether a separate rating is warranted for any associated neurological disorder. However, and the record does not show any neurological abnormalities associated with the Veteran’s thoracolumbar spine disability other than her separately evaluated right lower extremity radiculopathy. Therefore, a separate rating for an associated neurological disability is not warranted at any time prior June 2, 2014. The Board also finds that a higher rating is not warranted under the IVDS formula. An evaluation assigned under the IVDS Formula contemplates both orthopedic and neurological manifestations of disc disease. Prior to June 2, 2014, the Veteran was in receipt of a 10 percent rating for right lower extremity radiculopathy. The combined rating for the low back disability and right lower extremity radiculopathy was 20 percent. See 38 C.F.R. § 4.25. Thus, in order for a higher rating to be warranted under the IVDS formula, the record must show incapacitating episodes having a total duration of at least four weeks, but less than six weeks, during the past 12 months. See 38 C.F.R. § 4.71a, IVDS Formula. Although the Veteran testified that she has incapacitating episodes every day, the evidence of record does not show incapacitating episodes requiring prescribed bedrest and treatment by a physician at any time prior to June 2, 2014. Accordingly, a higher rating is not warranted under the IVDS formula. Beginning June 2, 2014 Upon review of the record, the Board finds that a rating of 40 percent, but not higher, is warranted as of June 2, 2014. A VA treatment record dated June 2, 2014, shows that the Veteran reported increased sharp, burning lower back pain, and range of motion testing revealed 20 degrees of flexion. Likewise, range of motion testing performed in January 2015 revealed 20 degrees of flexion. Although the thoracolumbar spine exhibited full range of flexion during an April 2015 VA examination, subsequent VA treatment records show that the Veteran continued to report worsening lower back pain, for which she underwent lumbar fusion surgery in July 2016. VA treatment records dated October 2016 through December 2016 note that the Veteran did not make any progress in physical therapy, and she was restricted in both flexion and extension. In April 2017 and May 2017, the Veteran presented to the emergency room with complaints of unbearable low back pain radiating into the hips after having a nerve stimulator implanted. A June 2017 VA physical therapy treatment record indicates that the Veteran’s back problems were worse than they were prior to the surgery. The treatment provider indicated that he maximized all he could do for the Veteran from a physical therapy standpoint in December 2016, and he did not feel additional physical therapy would be beneficial. The Veteran underwent another VA examination in July 2018, at which time it was noted that she was unable to perform range of motion testing. The examiner indicated that the Veteran stood with a stooped posture flexed forward at 20 degrees and was able to move into 10 degrees of extension, never reaching neutral position (zero degrees). A June 2019 VA treatment record shows that the Veteran’s lumbar spine exhibited 10 percent of normal range of flexion, or 9 degrees, with increased pain and numbness radiating into her right leg with movement. The Veteran underwent another VA examination in January 2020, at which time she was again unable to perform range of motion testing. The examiner explained that the Veteran stood with the assistance of a wheeled walker with a stooped posture forward flexed at 20 degrees, and she was unable to extend to 15 degrees of flexion. It was further noted that she was unable to reach neutral position of 0 degrees; she was constantly flexed to the right at 10 degrees; she unable to come to 0 degrees of lateral flexion; and she could not do twisting motions due to marked increase in her back pain. Based on the foregoing, the Board finds that as of June 2, 2014, the Veteran’s low back disability more nearly approximated forward flexion of the thoracolumbar spine to 30 degrees or less. Accordingly, a rating of 40 percent is granted from that date. The Board finds that a rating in excess of 40 percent is not warranted at any time on or after June 2, 2014. The Board has reviewed and considered the Veteran’s assertions in support of her claim, including her reports of severe low back pain, which causes difficulty sitting upright, standing, and walking. However, unfavorable ankylosis of the entire thoraco-lumbar spine has not been shown such that a higher rating would be warranted. Moreover, although the Veteran was unable to perform range of motion testing during the most recent VA examinations, both the July 2018 and January 2020 VA examiners indicated that there was no evidence of ankylosis. Treatment records likewise do not show evidence of ankylosis at any time during the period under review. Accordingly, a rating in excess of 40 percent is not warranted at any time on or after June 2, 2014. See 38 C.F.R. § 4.71a, Diagnostic Code 5237. With respect to separate ratings for any associated neurological disorders, the Veteran’s neurogenic bladder, fecal incontinence, and right lower extremity radiculopathy are addressed separately below. The record does not show any other neurological abnormalities associated with the Veteran’s thoracolumbar spine disability on or after June 2, 2014. The Board also finds that a higher rating is not warranted under the IVDS formula. An evaluation assigned under the IVDS Formula contemplates both orthopedic and neurological manifestations of disc disease. As will be discussed below, the Veteran is in receipt of a 10 percent rating for right lower extremity radiculopathy prior to April 2, 2015; a 20 percent rating for right lower extremity radiculopathy from April 2, 2015, through June 6, 2018; a 40 percent rating for right lower extremity radiculopathy beginning June 7, 2018; a 60 percent rating for neurogenic bladder beginning July 7, 2016; and fecal incontinence beginning December 7, 2016. She is also in receipt of a temporary 100 percent rating for convalescence from December 7, 2016, through August 31, 2016. Thus, Veteran’s combined rating for her low back disability and associated neurological disorders exceeds the maximum 60 percent rating available under the IVDS formula as of July 7, 2016. See 38 C.F.R. § 4.25. From June 2, 2014, through July 6, 2016, the combined rating for the Veteran’s low back disability and associated neurological disorders was 50 percent. See 38 C.F.R. § 4.25. In order for a higher rating to be warranted under the IVDS formula during this period, the record must show incapacitating episodes having a total duration of at least six weeks during the past 12 months. See 38 C.F.R. § 4.71a, IVDS Formula. Although the Veteran testified that she has incapacitating episodes every day, the evidence of record does not show incapacitating episodes requiring prescribed bedrest and treatment by a physician at any time from June 2, 2014, through July 6, 2016. Accordingly, a higher rating is not warranted under the IVDS formula. 2. Entitlement to a separate compensable rating for neurogenic bladder prior to January 25, 2017 In a June 2017 rating decision, service connection was granted for neurogenic bladder associated with the Veteran’s service-connected low back disability, and a 60 percent rating was assigned, effective January 25, 2017, the date the Veteran filed a claim for compensation for bladder symptoms. Although the Veteran did not appeal the effective date of that rating, the General Rating Formula provides for the assignment of separate ratings for any neurologic abnormalities associated with a spine disability. See 38 C.F.R. § 4.71a, General Rating Formula, Note (1). As the Veteran’s appeal of the initial rating assigned to her service-connected low back disability was pending at the time of the January 2017 claim for compensation for bladder problems, the Board will address entitlement to separate rating for associated bladder symptoms throughout the period on appeal. Pursuant to Diagnostic Code 7542, neurogenic bladder is evaluated based on voiding dysfunction. 38 C.F.R. § 4.115b, Diagnostic Code 7542. A 20 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed less than two times per day. 38 C.F.R. § 4.115a. A 40 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed two to four times per day. Id. A maximum 60 percent rating is warranted for voiding dysfunction requiring the use of an appliance or wearing of absorbent materials which must be changed more than four times per day. Id. Upon review of the record, the Board finds that a separate 60 percent rating for neurogenic bladder is warranted as of July 7, 2016. VA and private treatment records show that the Veteran reported being unable to feel the need to void ever since her July 2016 back surgery, and she was diagnosed with postoperative neurogenic bladder. The Veteran underwent a VA examination in June 2017, during which she reported developing urinary retention after her July 2016 back surgery. It was noted that she was initially taught self-catheterization, but had a suprapubic catheter placed in March 2017. The examiner indicated that the Veteran’s neurogenic bladder was likely related to her lumbar spine surgery. As the Veteran used a catheter for neurogenic bladder as of her July 2016 surgery, the Board finds that a separate 60 percent rating for neurogenic bladder is warranted as of July 7, 2016. 3. Entitlement to a separate compensable rating for fecal incontinence prior to May 30, 2017 In a June 2017 rating decision, service connection was granted for fecal incontinence associated with the Veteran’s service-connected low back disability, and a 30 percent rating was assigned, effective May 30, 2017, the date the Veteran filed a claim for compensation for bowel symptoms. Although the Veteran did not appeal the effective date of that rating, the General Rating Formula provides for the assignment of separate ratings for any neurologic abnormalities associated with a spine disability. See 38 C.F.R. § 4.71a, General Rating Formula, Note (1). As the Veteran’s appeal of the initial rating assigned to her service-connected low back disability was pending at the time of the May 2017 claim for compensation for associated bowel problems, the Board will address entitlement to a separate rating for associated bowel symptoms throughout the period on appeal. Under Diagnostic Code 7332, relating to impairment of sphincter control, a 10 percent rating is warranted for constant slight or occasional moderate leakage. 38 C.F.R. § 4.114, Diagnostic Code 7332. A 30 percent rating is warranted for occasional involuntary bowel movements necessitating wearing of pads. Id. A 60 percent rating is assigned for extensive leakage and fairly frequent involuntary bowel movements. Id. A 100 percent rating is assigned for complete loss of sphincter control. Id. Upon review of the record, the Board finds that a separate 30 percent rating for fecal incontinence is warranted as of December 7, 2016. A VA treatment record dated December 28, 2016, shows that the Veteran reported being unable to feel the urge to defecate and having a couple of stool accidents. She reported the onset of her symptoms as three weeks earlier, i.e., December 7, 2016. The Veteran underwent a VA examination in June 2017, during which she reported occasional involuntarily passing stool, which began around Christmas time following her July 2016 back surgery. It was noted that the Veteran was evaluated by a gastroenterologist and was found to have severe weakness of her internal and external anal sphincters. The examiner opined that the Veteran’s bowel issues were likely related to her lumbar spine surgery. Based on the foregoing, the Board finds that a 30 percent rating is warranted for fecal incontinence as of December 7, 2016, the date the Veteran’s bowel symptoms began. The Board finds that a rating ine excess of 30 percent is not warranted, as the record does not show extensive leakage and fairly frequent involuntary bowel movements or complete loss of sphincter control. See 38 C.F.R. § 4.114, Diagnostic Code 7332. 4. Entitlement to a higher rating for right lower extremity radiculopathy The Veteran’s service-connected right lower extremity radiculopathy has been assigned a 10 percent rating prior to June 7, 2018, and a 20 percent rating thereafter. Prior to June 7, 2018, the Veteran’s right lower extremity radiculopathy was evaluated under Diagnostic Code 8626, relating to the femoral nerve. Beginning June 7, 2018, it was evaluated under Diagnostic Code 8520, relating to the sciatic nerve. The Board will evaluate the Veteran’s symptoms under both diagnostic codes and assign the rating most favorable. However, the Board finds that the Veteran is not entitled to separate ratings under Diagnostic Codes 8520 and 8626, as the femoral nerve and sciatic nerve both affect the L4 nerve root. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY, 1252, 1253, 1256, 1257 (32nd ed. 2012). Therefore, the functions associated these nerves overlap, and, thus are not separate and distinct. See 38 C.F.R. § 4.14 (the evaluation of the same manifestation or disability under different diagnoses is to be avoided); see also Esteban v. Brown, 6 Vet. App. 259, 261 (1994) (separate ratings are permissible where none of the symptomatology for one condition is duplicative of or overlapping with the symptomatology of another condition). Accordingly, separate ratings for impairment of the sciatic and femoral nerves are not warranted. Under Diagnostic Code 8626, a 10 percent rating is warranted for mild incomplete paralysis of the femoral nerve; a 20 percent rating is warranted for moderate incomplete paralysis of the femoral nerve; a 30 percent rating is warranted for severe incomplete paralysis of the femoral nerve; and a 40 percent rating is warranted for complete paralysis of the femoral nerve, manifested by paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8626. Under Diagnostic Code 8520, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis of the sciatic nerve; a 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy; and a maximum 80 percent rating is assigned for complete paralysis of the sciatic nerve, where the foot dangles and drops, and there is no active movement possible of muscles below the knee, flexion of knee weakened, or very rarely, lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Words such as “mild,” “moderate,” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Additionally, the term “incomplete paralysis,” with this and other peripheral nerve injuries, 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. 38 C.F.R. § 4.124a, Note at Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. Id. Prior to April 2, 2015 Upon review of the record, the Board finds that the criteria for a rating in excess of 10 percent for right lower extremity radiculopathy is not warranted at any time prior to April 2, 2015. The Veteran underwent a VA examination in August 2013, during which she reported mild intermittent right lower extremity pain and numbness and denied any paresthesias and/or dysesthesias. Muscle strength and reflexes were normal throughout the right lower extremity, and there was no evidence of muscle atrophy. The examiner indicated that the Veteran’s right lower extremity affected the femoral nerve and characterized it as mild. Treatment periods during the period on appeal prior to April 2, 2015, do not show symptoms more severe than those noted during the VA examination. As the record shows only mild, intermittent symptoms that were wholly sensory, the Board finds that a rating in excess of 10 percent is not warranted under Diagnostic Code 8520 or 8626 at any time prior to April 2, 2015. See 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520, 8626. April 2, 2015 through June 6, 2018 Upon review of the record, the Board finds that a rating of 20 percent is warranted for right lower extremity radiculopathy from April 2, 2015, through June 6, 2018. The Veteran underwent a VA examination in April 2015, during which she reported constant moderate right lower extremity pain and paresthesias and/or dysesthesias and mild numbness. A sensory examination revealed decreased sensation in the right thigh/knee and lower leg/ankle, but sensation was intact in the right anterior thigh, foot, and toes. The examiner characterized the Veteran’s right lower extremity radiculopathy as moderate incomplete paralysis of the femoral nerve. Accordingly, the Board finds that the criteria for a 20 percent rating have been more nearly approximated as of April 2, 2015. See 38 C.F.R. §§ 4.124a, Diagnostic Codes 8520, 8626. The Board finds that a rating in excess of 20 percent is not warranted at any time from April 2, 2015, through June 6, 2018. VA and private treatment records during this period show subject reports of weakness and decreased muscle strength on at least one occasion. However, more often than not, the right lower extremity exhibited full muscle strength upon testing, and sensation was intact. Furthermore, the Veteran denied any symptoms of extremity pain, numbness, or weakness at times. Moreover, during the April 2015 VA examination, the Veteran described her pain and paresthesias and/or dysesthesias as moderate and her numbness as mild. Accordingly, the Board finds that the evidence of record shows no more than moderate incomplete paralysis of the sciatic and/or femoral nerve from April 2, 2015, through June 6, 2018. Accordingly, a rating in excess of 20 percent is not warranted. See id. June 7, 2018 to the Present Upon review of the record, the Board finds that the criteria for a 40 percent rating under Diagnostic Code 8520 have been more nearly approximated for right lower extremity radiculopathy as of June 7, 2018. The Veteran underwent another VA examination in July 2018, at which time right lower extremity muscle strength was 2/5 for ankle dorsiflexion, 2/5 for great toe extension, 3/5 for hip flexion, and 4/5 for knee extension, and 5/5 for ankle plantar flexion. Sensation was absent in the right leg/ankle and foot/toes. The examiner indicated that the Veteran’s radiculopathy affected the sciatic nerve and characterized it as moderate. The Veteran underwent another VA examination in January 2020, at which time right lower extremity muscle strength was 2/5 for ankle dorsiflexion, 2/5 for great toe extension, 3/5 for hip flexion, 4/5 for knee extension, and 5/5 for ankle plantar flexion. Deep tendon reflexes were hypoactive, and sensation was absent in the right leg/ankle and foot/toes and decreased in the thigh/knee. The examiner indicated that the Veteran’s radiculopathy affected the sciatic nerve and characterized it as moderate. Treatment records during this period show that the Veteran reported being unable to feel her right foot and lower leg, and treatment providers noted objective evidence of decreased muscle strength in the right lower extremity. In September 2019, the Veteran reported that her right leg was so weak that she was unable to lift it to get dressed, and she had to use her hands to lift it. As the medical evidence of record consistently showed involvement that was more than wholly sensory, including objective evidence of muscle weakness upon testing, the Board finds that the Veteran’s overall disability picture more nearly approximated moderately severe incomplete paralysis of the sciatic nerve as of June 7, 2018. Accordingly, a 40 percent rating is granted under Diagnostic Code 8520 as of that date. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. The Board finds that a rating in excess of 40 percent is not warranted under either Diagnostic Code 8520 or 8626 at any time on or after June 7, 2018, as the evidence of record does not show paralysis of the quadriceps extensor muscles; or marked muscle atrophy; or complete paralysis of the sciatic nerve where the foot dangles and drops, and there is no active movement possible of muscles below the knee, flexion of knee weakened, or very rarely, lost. See 38 C.F.R. § 4.124a, Diagnostic Codes 8520, 8626. In reaching the above conclusions, the Board has considered and applied the doctrine of reasonable doubt; however, to the extent that higher ratings have been denied, the preponderance of the evidence is against the claim, and the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.