Citation Nr: 21024476 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 17-24 942 DATE: April 22, 2021 ORDER Entitlement to a rating in excess of 20 percent for degenerative disc disease with intervertebral disc syndrome, thoracolumbar spine is denied. Effective December 17, 2012, a separate 10 percent rating for left lower extremity radiculopathy is granted. Entitlement to a rating in excess of 10 percent for painful scars, post-operative open reduction and internal fixation, left distal tibia fracture and left ankle fracture is denied. REMANDED Entitlement to a rating in excess of 20 percent for status post left total ankle replacement status post complete revision for the period prior to August 19, 2016 and from October 1, 2017 to December 14, 2017 and from February 1, 2019 is remanded. Entitlement to a separate rating for right lower extremity radiculopathy is remanded. FINDINGS OF FACT 1. The Veteran’s service-connected degenerative disc disease with intervertebral disc syndrome, thoracolumbar spine has resulted in forward flexion greater than 30 degrees but not greater than 60 degrees; but has not result in limitation of forward flexion of the thoracolumbar spine of 30 degrees or less or ankylosis of the entire thoracolumbar spine or of the entire spine. 2. Effective December 17, 2012, the Veteran had mild radiculopathy in the left lower extremity. 3. The Veteran’s has two scars associated with his status post-operative open reduction and internal fixation, left distal tibia fracture and left ankle fracture which are painful, but do not result in any disabling effects. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for degenerative disc disease with intervertebral disc syndrome, thoracolumbar spine have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.13, 4.40, 4.45, 4.71a, DC 5242. 2. The criteria for a separate 10 percent schedular rating, and no higher, for left lower extremity radiculopathy of the sciatic nerve have been met effective December 17, 2012. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.124a, DC 8521. 3. The criteria for entitlement to a rating in excess of 10 percent for painful scars, post-operative open reduction and internal fixation, left distal tibia fracture and left ankle fracture have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7801-02, 7804-05 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1983 to March 2003. The Veteran testified at a Board hearing held via videoconference before the undersigned Veterans Law Judge (VLJ) in October 2019. The claims were previously remanded by the Board for additional development in December 2019 and now return for further appellate review. The Board finds that there was substantial compliance with the remand directives. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating 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. 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 (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.”). 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. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided. 38 C.F.R. § 4.14. The Veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a “staged rating” (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As a preliminary matter, the Board points out that, while it was the August 2014 rating decision with which the Veteran submitted a notice of disagreement (NOD), additional relevant evidence was received within months of issuance of the August 2013 rating decision. Thus, the Board finds that, at the time of issuance of August 2014 rating decision, the August 2013 rating decision remained pending and the claim period on appeal extends back to March 2012, when the claim underlying the August 2013 rating decision was received. 1. Entitlement to a rating in excess of 20 percent for degenerative disc disease with intervertebral disc syndrome, thoracolumbar spine 2. Entitlement to a separate 10 percent rating for left sciatic radiculopathy The Veteran’s service-connected lumbar spine disability is evaluated under Diagnostic Code 5242 (degenerative arthritis of the spine), which assigns ratings based upon the General Rating Formula for Rating Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a. Diagnostic Code 5242 refers the rater to Diagnostic Code 5003, which provides that degenerative arthritis, established by x-ray findings, is to be rated based on limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or 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 vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or where there is 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 where forward flexion of the thoracolumbar spine is 30 degrees or less; or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for ankylosis of the entire spine. 38 C.F.R. § 4.71a. Normal ranges of motion of the thoracolumbar spine are flexion from 0 to 90 degrees; extension from 0 to 30 degrees; lateral flexion bilaterally from 0 to 30 degrees; and rotation bilaterally from 0 to 30 degrees. 38 C.F.R. § 4.71a, Plate V. The Board finds that the preponderance of the evidence for the period on appeal demonstrates that no more than a 20 percent rating is warranted. A VA examination report dated in December 2012 reflects the Veteran’s diagnosis of degenerative disc disease of the thoracolumbar spine. At that time, he complained that his condition had worsened and reported flare-ups with functional limitation due to chronic pain. Upon range of motion testing, the Veteran had forward flexion to 70 degrees, and a combined range of motion of at least 210 degrees. Pain was noted upon flexion at 60 degrees. The Veteran did not have localized tenderness or pain to palpation of joints or guarding and/or muscle spasm of the lumbar spine. He was not noted to have ankylosis. The Veteran was not able to perform repetitive motion testing because of severe left ankle pain and stiffness, but was noted to have functional impairment including less and more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, disturbance of locomotion, and interference with sitting, standing, and/or weight bearing. Muscle strength testing revealed 4 out of 5 in the left lower extremity but 5 out of 5 in the right. Additional, neurologic abnormalities and radiculopathy were not observed. The Veteran did not have atrophy or IVDS of the lumbar spine or require assistive devices. The Veteran was afforded another VA examination in June 2014. At that time, he was noted to have IVDS in addition to degenerative disc disease of the thoracic spine, however, there were no incapacitating episodes over the prior 12 months due to IVDS. The Veteran reported that his condition had worsened and that his back hurts. He also reported flareups of constant pain rating down the leg and that he required aback brace for support. Upon range of motion testing, the Veteran had forward flexion to 70 degrees, and a combined range of motion of at least 210 degrees. Pain was noted upon flexion at 50 degrees. The Veteran did not have muscle atrophy, localized tenderness or pain to palpation of joints, or guarding and/or muscle spasm of the lumbar spine. He was not noted to have ankylosis. Range of motion was not additionally limited following repetitive motion; however, he was noted to have functional impairment including less movement than normal and pain on movement. The Veteran used a cane for balance due to weakness in his left ankle. Neurological testing revealed decreased sensation in the left lower leg/ankle as well as moderate numbness in the left lower extremity. The examiner indicated that the Veteran had moderate radiculopathy involving the left sciatic nerve. There were no other neurologic abnormalities or radiculopathy noted. The examiner noted that the impact on the thoracolumbar spine condition on the Veteran’s ability to work is pain worse with activity. The examiner also specified that the degree of range of motion loss during pain on use or flare-ups is approximately lumbar flexion 20 degrees and left lateral rotation 15 degrees. Pursuant to the Board’s remand, the Veteran was afforded another VA examination in August 2020. He reported current symptoms of sciatic nerve pain rated as 9 out of 10, but denied flare-ups of back pain. Upon range of motion testing, the Veteran had forward flexion to 50 degrees, and a combined range of motion of at least 150 degrees. Pain was noted upon flexion at 40 degrees. Pain was noted to cause functional loss including difficulty lifting and carrying. The Veteran did not have ankylosis, muscle atrophy, or localized tenderness or pain to palpation of joints. He was observed to have guarding and/or muscle spasm of the lumbar spine resulting in abnormal gait or spine contour. Range of motion was additionally limited in flexion following repetitive motion and with repeated use over time to 40 degrees due ot pain and lack of endurance. The examiner noted that the Veteran used a cane due to back and ankle issues. There were no neurologic abnormalities or radiculopathy noted. The examiner noted that the impact on the thoracolumbar spine condition on the Veteran’s ability to work is difficulty lifting and carrying work objects over ten pounds. Although the examiner noted the diagnosis was unchanged, he stated that the Veteran did not have IVDS of the lumbar spine. Additional private and VA treatment records indicate the Veteran’s complaints of back pain without any specific range of motion findings. Based on a review of the available evidence, we find that the severity of the Veteran’s lumbosacral spine disability warrants a rating no higher than 20 percent for the period on appeal. The medical records show the Veteran had reduced range of motion to no less than 40 degrees of flexion. However, the symptoms associated with the Veteran’s lumbar spine disability did not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine 30 degrees or less or any favorable ankylosis. The Veteran had lumbar spine forward flexion to no less than 40 degrees. The assigned 20 percent evaluation for the Veteran’s lumbar spine disability fully contemplates all muscle spasm and gait symptoms, as well as all motions other than flexion; these need not be further discussed here. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a, including Diagnostic Codes 5242 and 5243, were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 30, 2020). These changes to the rating criteria need not be discussed here because they do not affect or allow for a more favorable outcome in this case. The Board finds that the Veteran’s service-connected lumbosacral spine disability symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings for such is not warranted. The Board has considered the applicability of the benefit of the doubt doctrine. The objective evidence of record does not show that the Veteran’s lumbar spine disability was ever manifested by forward flexion of the thoracolumbar spine to 30 degrees or less or by favorable ankylosis of the entire thoracolumbar spine. Additionally, an alternative rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is not warranted as the Veteran has not exhibited any incapacitating episodes during the relevant period and, therefore, a rating under the General Rating Formula for Diseases and Injuries of the Spine is more favorable. There accordingly exists no basis for a lumbosacral spine disability rating in excess of 20 percent. 38 C.F.R. § 4.71, Diagnostic Codes 5242. Because the preponderance of the evidence is against the Veteran’s claim for any higher ratings, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). The Board has considered whether the Veteran should receive additional ratings for neurologic abnormalities associated with his lumbar spine disability. Turning to a separate rating or ratings for neurological abnormalities associated with lumbosacral spine disability, as stated at Note (1) above, the Board must evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. The Veteran has generally denied having bowel and bladder problems. According to a March 2013 private treatment records review of symptoms indicated loss of bladder and bowel control. This appears to be an isolated event. The evidentiary record does not suggest there was a recurrence of this or that the Veteran experienced any symptoms of bladder or bowel incontinence outside of this isolated event. As such, a separate rating for bowel or bladder impairment is not warranted. The evidence of record, however, reflects evidence of additional neurologic abnormalities associated with the thoracolumbar spine disability. The Veteran’s radiculopathy of the left lower extremity was assigned a 20 percent rating under DC 8521 effective September 11, 2013. However, the Board finds that the Veteran demonstrated weakness in his left leg on December 17, 2012 as documented in the VA Examination report. Because December 17, 2012 is the earliest date the evidence shows symptoms of radiculopathy, the Board finds that a separate rating for this condition is warranted effective that date. Specifically, the Board finds that the most probative evidence of record supports a level of impairment most analogous to mild incomplete paralysis at that time. For disease of the peripheral nerves, the term “incomplete paralysis” when used with peripheral nerve injuries indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation 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 should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral combine with application of the bilateral factor. DC 8521 provides ratings based on paralysis of the external popliteal nerve. The minimum 10 percent rating is warranted for incomplete mild paralysis. A 20 percent rating is warranted for moderate incomplete paralysis. A 30 percent rating is warranted for severe incomplete paralysis. A 40 percent rating is warranted for complete paralysis. 38 C.F.R. § 4.124a, DC 8521. The words “moderate” and “severe” are not defined in 38 C.F.R. §§ 4.120-4.124 a. In applying the schedular criteria for rating peripheral nerve disabilities, the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured 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. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The Board notes that the 2012 VA examination report reflects muscle strength testing was 4 out of 5 in the left lower extremity without any further neurologic abnormalities. The Board further notes that private treatment reports reflect complaints of radiculopathy involving the lower extremities including numbness and tingling. Accordingly, the Board finds that separate 10 percent rating under Diagnostic Code 8521 should be granted for the period prior to September 2013 for the left lower extremity. However, the Board finds a rating in excess of 10 percent of the left external popliteal nerve is not warranted. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. While the Veteran’s December 2012 VA examination indicate some diminished strength in the left lower extremity, he consistently maintained active movement against gravity. At that time, the Veteran was able to perform straight leg raising test and his reflex exam and sensory exam all found normal results. The Board finds that this evidence does not reflect moderate impairment that warrants rating higher than 10 percent. The evidence does not conclusively show neurological manifestations, other than left lower extremity radiculopathy, for which separate ratings should be assigned. Entitlement to right lower extremity radiculopathy is being remand as discussed further below. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). In reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to a rating in excess of 10 percent for painful scar, post-operative open reduction and internal fixation, left distal tibia fracture and left ankle fracture The Veteran has scars associated with his left ankle disability. Scars are rated under the provisions of 38 C.F.R. § 4.118, Diagnostic Code (DC) 7805. Scars are rated under 38 C.F.R. § 4.118, DCs 7800-7805. The scar regulations were revised effective August 13, 2018 and these new regulations apply to claims that were pending on August 13, 2018 (as here), if the new regulations are more favorable to the Veteran’s case. Thus, the Board will discuss both the old and new scar regulations and apply the more favorable criteria to the Veteran’s claims where appropriate. 38 C.F.R. § 4.118, DCs 7800-05. Under the scar regulations in effect prior to August 13, 2018, DC 7801 provided ratings for scars, other than the head, face, or neck, that were deep or that caused limited motion. Scars that were deep or that caused limited motion in an area or areas exceeding 6 square inches (39 sq. cm.) were rated as 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 sq. cm.) were rated as 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) were rated as 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq.cm.) were rated as 40 percent disabling. Note (1) to DC 7801 provided that a deep scar was one associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Under the scar regulations in effect prior to August 13, 2018, DC 7802 provided ratings for scars, other than the head, face, or neck, that were superficial or that did not cause limited motion. Superficial scars that did not cause limited motion, in an area or areas of 144 square inches (929 sq. cm.) or greater, were rated as 10 percent disabling. Note (1) to DC 7802 provided that a superficial scar was one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Under the scar regulations in effect prior to August 13, 2018, DC 7804 provided a 10 percent rating for superficial unstable scars. DC 7804 provided that one or two scars that were unstable or painful were rated as 10 percent disabling. Three or more scars that were unstable or painful were rated as 20 percent disabling. Five or more scars that were unstable or painful were rated as 30 percent disabling. Note (1) to DC 7804 provided that an unstable scar was one where, for any reason, there was frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118. Under the scar regulations in effect prior to August 13, 2018, DC 7805 provided that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. § 4.118. Effective August 13, 2018, DC 7801 provides ratings for scars, other than the head, face, or neck, that are associated with underlying soft tissue damage. Scars that are associated with underlying soft tissue damage in an area or areas exceeding 6 square inches (39 sq. cm.) are rated as 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 sq. cm.) are rated as 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) are rated as 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq.cm.) are rated as 40 percent disabling. 38 C.F.R. § 4.118. Effective August 13, 2018, DC 7802 provides ratings for scars, other than the head, face, or neck, that are not associated with underlying soft tissue damage. A scar that is not associated with underlying soft tissue damage in an area or areas of 144 square inches (929 sq. cm.) or greater is rated as 10 percent disabling. 38 C.F.R. Effective August 13, 2018, DC 7804 provides a 10 percent rating for a scar that is unstable or painful. DC 7804 provided that one or two scars that are unstable or painful are rated as 10 percent disabling. Three or more scars that are unstable or painful are rated as 20 percent disabling. Five or more scars that are unstable or painful are rated as 30 percent disabling. Note (1) to DC 7804 provides that an unstable scar was one where, for any reason, there was frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118. Under the scar regulations in effect since August 13, 2018, DC 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. § 4.118 DC 7805 calls for evaluation of scars under DC 7800, 7801, 7802, or 7804. Under DC 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful; a 20 percent rating is assigned for three or four scars that are unstable or painful; and, a 30 percent rating is assigned for five or more scars that are unstable or painful. If one or more scars are both unstable and painful, an additional 10 percent should be added to the rating. See 38 C.F.R. § 4.118, DC 7804, Note (2). An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, DC 7804, Note (1). The December 2012, June 2014, December 2017, and August 2020 VA examiners indicated that Veteran’s scars were not greater than 39 square centimeters or unstable. According to the December 2012 VA examination report, the Veteran’s left lower extremity scars measured 8 and 9 cm respectively and were both painful. In June 2014, the left lower extremity scars measured 9cm by 0.4cm, 11cm by 0.7cm, 0.6cm by 0.5cm, and 0.5cm by 0.5cm, with two being painful by history. On examination, all scars were well healed and nontender. The December 2017 VA examination report reflects scars on the medial left lower leg, medial lateral ankle, dorsum left ankle, and lateral left ankle measuring less than 39 square centimeters and without objective evidence of pain. In August 2020, the Veteran had two scars which were tender to palpation and involved underlying soft tissue damage and were measure to a total of 36 square centimeters. There are no treatment records or other evidence relating to the Veteran’s left ankle scars. The Veteran’s left ankle scars do not cover an area of at least 77 square centimeters, and therefore a rating in excess of 10 percent is not warranted under Diagnostic Code 7801. The left ankle scars do not result in any limitation of function, and therefore a rating in excess of 10 percent is not warranted under Diagnostic Code 7805. The scars were also not superficial. Finally, the Veteran has a four total left lower extremity scars, only 2 of which are painful and none of which are unstable, and therefore a rating in excess of 10 percent is not warranted under Diagnostic Code 7804. Both the pre-amended and current diagnostic criteria have been considered in arriving at this determination. Accordingly, a rating in excess of 10 percent for scars associated with the left ankle disability is not warranted, and the Veteran’s claim is denied. REASONS FOR REMAND 1. Entitlement to a rating in excess of 20 percent for status post left total ankle replacement status post complete revision for the period prior to August 19, 2016 and from October 1, 2017 to December 14, 2017 and from February 1, 2019 is remanded. In light of the Veteran’s reported ankle replacement surgeries, his left ankle disability could alternatively be rated under Diagnostic Code 5056, which outlines criteria for rating ankle replacements. The Veteran is currently in receipt of a 20 percent rating for marked limitation of motion of his ankle under Diagnostic Code 5271. This is the highest schedular rating under Diagnostic Code 5271. Diagnostic Code 5056, in contrast, provides a higher, 40 percent rating, when there is prosthetic replacement of the ankle joint with chronic residuals consisting of severe painful motion or weakness. Though the Board remanded for additional VA examination and the August 2020 examiner acknowledged the Veteran underwent left total ankle replacement and was status post complete revision, such was not described in the portion of the examination report pertaining to “Surgical Procedures” i.e., Part VIII, on page 10 which includes medical questions specific to the presence of post-surgical pain, weakness and other potential residuals. A remand is required so that a complete assessment can be performed. 2. Entitlement to a separate rating for right lower extremity radiculopathy is remanded. While the Veteran has a diagnosis of left sciatic radiculopathy, findings of the right lower extremity are less clear. An assessment of lumbar radiculopathy-improved was noted in a March 2013 private treatment report. According to a June 2016 private examination report, the Veteran was noted to have numbness and tingling in the lower limbs. The July 2014 and August 2020 VA examination reports do not contain any objective findings or diagnosis of right lower extremity radiculopathy, although the Veteran reported symptoms of sciatic nerve pain in August 2020 without specifying either side. In light of the above, remand is warranted for clarification regarding whether the Veteran has radiculopathy affecting his right lower extremity. The matters are REMANDED for the following actions: 1. Return the claims file to the August 2020 examiner, or a suitable substitute. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner is asked to indicate whether the Veteran suffers from chronic residuals of his total ankle replacement consisting of severe painful motion or weakness, to include during flare-ups or after repetitive use. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. 2. Return the claims file to the August 2020 examiner, or a suitable substitute. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner is asked to opine whether the Veteran has radiculopathy of the right lower extremity associated with his service-connected back disability.   A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements and reports of radiculopathy, numbness, tingling, and nerve pain. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Williams, 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.