Citation Nr: 21024529 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 17-20 097 DATE: April 23, 2021 ORDER For the appeal period prior to September 4, 2019, entitlement to an initial rating in excess of 10 percent for service-connected cervical spine disorder is denied. For the appeal period from September 4, 2019 to February 25, 2021, a rating of 20 percent, but no higher, for service-connected cervical spine disorder is granted. For the appeal period from February 25, 2021 to present, a rating of 30 percent, but no higher, for service-connected cervical spine disorder is granted. Entitlement to an initial rating of 30 percent, but no higher, for service-connected left (minor) upper extremity radiculopathy is granted. REMANDED Entitlement to service connection for chronic inflammatory demyelinating polyneuropathy (CIDP) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. For the appeal period prior to September 4, 2019, the Veteran’s service-connected cervical spine disorder was manifested by pain, numbness, and forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; ankylosis, intervertebral disc syndrome with incapacitating episodes, and muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour were not shown. 2. For the appeal period from September 4, 2019 to February 25, 2021, the Veteran’s service-connected cervical spine disorder was manifested by pain, numbness, and forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; ankylosis and intervertebral disc syndrome with incapacitating episodes were not shown. 3. For the appeal period from February 25, 2021, the Veteran’s service-connected cervical spine disorder is manifested by pain, numbness, and forward flexion of the cervical spine to 15 degrees or less; ankylosis and intervertebral disc syndrome with incapacitating episodes are not shown. 4. The Veteran’s service-connected left (minor) upper extremity radiculopathy has been manifested by moderate incomplete paralysis. CONCLUSIONS OF LAW 1. For the appeal period prior to September 4, 2019, entitlement to an initial rating in excess of 10 percent for service-connected cervical spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Codes 5010-5243. 2. For the appeal period from September 4, 2019 to February 25, 2021, entitlement to a rating of 20 percent, but no higher, for service-connected cervical spine disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Codes 5010-5243. 3. For the appeal period from February 25, 2021, entitlement to a rating of 30 percent, but no higher, for service-connected cervical spine disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.71(a), Diagnostic Codes 5010-5243. 4. The criteria for entitlement to an initial rating of 30 percent for service-connected left (minor) upper extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.124(a), Diagnostic Code 8513. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran honorably served on active duty in the United States Coast Guard from July 1983 to August 1991, to include additional service afterwards in the reserves. This case comes before the Board of Veteran’s Appeals (Board) on appeal from an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing held before the undersigned Veterans Law Judge in February 2021. A transcript of the hearing is of record. Importantly, at his hearing, the Veteran (through his attorney) waived the right to have the RO review evidence submitted or obtained since the last adjudicative actions in the issues before the Board. In this decision, the Board has considered evidence generated after the most recent SSOC. Given the Veteran’s blanket waiver, however, the Board finds no remand is required for the RO to review this evidence in the first instance. The Board notes that the issue of entitlement to a TDIU has been raised on the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the Board has recharacterized the issues on appeal accordingly. Increased Rating 1. Entitlement to an initial rating in excess of 10 percent for service-connected cervical spine disorder. 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. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or maligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Consideration must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran is seeking an increased rating for his service-connected cervical spine degenerative arthritis and degenerative disc disease status post spinal fusion. Currently, the Veteran’s service-connected neck disorder is rated at 10 percent from March 7, 2014 under 38 C.F.R. § 4.71(a), Diagnostic Codes 5010-5243. The General Rating Formula for Disease and Injuries of the Spine is laid out in 38 C.F.R. § 4.71 (a), Diagnostic Codes 5235 to 5243. The Spine is evaluated under these rating criteria with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. A 40 percent disability rating is assigned for ankylosis of the entire cervical spine. A 30 percent disability rating is assigned for forward flexion of the cervical spine 15 degrees or less. A 20 percent disability rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 10 percent disability rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, a combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71(a). Under 38 C.F.R. § 4.71(a), Diagnostic Code 5010, arthritis due to trauma and substantiated by X-ray findings is rated as degenerative arthritis under Diagnostic Code 5003. Under 38 C.F.R. § 4.71(a), Diagnostic Code 5003, arthritis shown by X-ray studies is rated based on limitation of motion of the affected joint. When limitation of motion would be noncompensable under the appropriate diagnostic codes, a 10 percent rating may be assigned for each major joint or group of minor joints so affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objective confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of arthritis involving two or more major or minor joint groups will warrant a 10 percent rating, and two or more major or minor joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The 10 percent and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. The 10 percent and 20 percent ratings based on X-ray findings will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024. Under 38 C.F.R. § 4.71(a), Diagnostic Code 5243, intervertebral disc syndrome is rated under the General Rating Formula for Disease and Injuries of the Spine or under the Formula for rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, which method resulted in the higher evaluation rating when all disabilities are combined under § 4.25. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71(a) were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. Under the amended Diagnostic Code 5010, post-traumatic arthritis is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. Under the amended Diagnostic Code 5243, intervertebral disc syndrome is only assigned this diagnostic code when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other diagnoses. Here, the amended codes will not have any effect on the rating for the Veteran’s neck disorder, so they will not be discussed. In June 2015, the Veteran was afforded a VA examination for his neck disorder. The Veteran was diagnosed with left upper extremity radiculopathy and degenerative disc disease of the cervical spine. The Veteran complained of constant pain aggravated by putting pressure on his left elbow or raising his left arm. His neck was also aggravated by looking up. His current treatment consisted of muscle relaxants and hydrocodone. The medications were helpful. He complained of pain and numbness radiating into the left arm to the hand, which he stated was different from his CIDP symptoms. The Veteran was right hand dominant. When the Veteran had flare-ups, he remained sedentary and iced his neck. Initial range of motion testing revealed forward flexion to 35 degrees, extension to 25 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 65 degrees, and left lateral rotation to 65 degrees. Pain was noted on examination; it caused functional loss. The Veteran had difficulty looking up and lifting his left arm. The Veteran was able to perform repetitive use testing with at least three repetitions, but there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time or during a flare-up. However, pain significantly limited functional ability after repeated use over time and during flare-ups. Also, the Veteran had muscle spasms and localized tenderness that did not result in abnormal gait or abnormal spinal contour. The Veteran did not have guarding. The Veteran did not have muscle atrophy. The examiner diagnosed the Veteran with radiculopathy. The Veteran had mild intermittent pain, paresthesias and/or dysesthesias, and numbness in his left upper extremity. The Veteran’s radiculopathy affected the C7 nerve rights (middle radicular group) of the left upper extremity to a mild degree. The Veteran did not have ankylosis. Although the Veteran had intervertebral disc syndrome of the cervical spine, he was not prescribed bed rest by a physician and treatment by a physician in the past 12 months. He did not use any assistive devices as a normal mode of locomotion. The Veteran’s neck pain interfered with his ability to work, but the main reason he was currently on disability was for his CIDP. The Veteran stated that he was a plumber; he reported that it was painful to lift his left arm. In June 2015, the Veteran also had a peripheral nerves VA examination. He was diagnosed with CIDP. The Veteran complained of progressive weakness and numbness in all four extremities, mostly the leg and left arm. The Veteran complained of tingling/numbness in the legs and left arm mostly, but some symptoms in the right upper extremity as well. The Veteran complained of fatigue/feeling tired. The Veteran had moderate paresthesias and/or dysesthesias and moderate numbness in the left upper extremity. In September 2019, the Veteran was afforded a VA examination for his neck condition. The Veteran was diagnosed with left upper extremity radiculopathy and cervical spine degenerative arthritis and degenerative disc disease status post spinal fusion. The Veteran reported daily aching cervical spine pain. His pain became sharp with neck movement; he had a recent onset of left arm numbness and tingling. Those symptoms were reported as lasting several minutes to an hour. The Veteran reported sharp cervical pain and left arm numbness/tingling occurring daily with neck rotations. He reported pain with rotation, flexion, and extension of neck. Initial range of motion testing revealed forward flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Pain and noted cervical fusion limited range of motion in all planes to a marked degree. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue to the cervical spine. The Veteran was able to perform repetitive use testing with at least three repetitions, but there was no additional loss of function or range of motion after three repetitions. The Veteran was examined immediately after repetitive us over time. Pain significantly limited functional ability with repeated use over a period of time. Range of motion was described as: forward flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The Veteran was not being examined during a flare-up. The VA examiner noted that pain significantly limited the Veteran’s functional ability during flare-ups. The VA examiner described the range of motion during flare-ups as: forward flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The Veteran did not have guarding or muscle spasms of the cervical spine. The VA examiner noted that the Veteran had radiculopathy. The Veteran had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left upper extremity. The Veteran’s radiculopathy affected his C7 nerve root (middle radicular group) and C8/T1 nerve roots (lower radicular group) on the left side to a mild degree. The Veteran did not have ankylosis of his cervical spine or any other neurologic abnormalities. He did not have intervertebral disc syndrome or ankylosis. His cervical spine condition impacted his ability to work. The VA examiner concluded that the Veteran was poorly suited to work in a vocation which required frequent neck movements as a result of worsening neck pain. He was better suited for as a sedentary vocation, which required fixed forward gaze. In October 2019, the Veteran was afforded another VA examination for his neck condition. The Veteran was diagnosed with cervical strain, degenerative arthritis of the spine, intervertebral disc syndrome, spinal fusion, and bilateral upper extremity radiculopathy. The Veteran’s symptoms included pain, stiffness, numbness to the left side, balance issues, and difficulty walking. His current treatment included Hydrocodone and ice. The Veteran had flare-ups of the cervical spine. He had spasms, increased pain, and more numbness. Initial range of motion testing revealed forward flexion to 20 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 25 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 40 degrees. Range of motion contributed to functional loss. Pain was noted in all ranges of motion; it caused functional loss. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine throughout his cervical spine of moderate severity. It was directly related to strain and degenerative arthritis. Also, there was evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, but there was no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive use over time. Pain, weakness, and fatigue significantly limited his functional ability with repeated use over a period of time. The Veteran’s examination was not conducted during a flare-up. Pain, weakness, fatigue, and lack of endurance significantly limited functional ability with flare-ups. The Veteran had muscle spasms and guarding not resulting in abnormal gait or abnormal spinal contour. He had difficulty looking up and turning his head side to side, especially during driving to make sure oncoming traffic was cleared. His neck condition also caused disturbance of locomotion, weakened movement, and less movement than normal. The VA examiner reported that the Veteran had radiculopathy. The Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the left upper extremity. The C5/C6 nerve roots were affected to a mild degree. The Veteran did not have ankylosis or any other neurologic abnormalities. Although the Veteran had intervertebral disc syndrome of the cervical spine, it did not require bed rest prescribed by a physician and treatment by a physician within the past 12 months. The Veteran’s cervical spine condition impacted his ability to work. The Veteran had difficulty looking up and turning his head from side to side, especially during driving to make sure oncoming traffic was cleared. In February 2021, the Veteran was afforded a VA examination for his cervical spine disorder. The Veteran was diagnosed with cervical spine degenerative arthritis and degenerative disc disease status post spinal fusion and bilateral upper extremity radiculopathy. The Veteran’s current symptoms included right and left arm pain with weakness and numbness along with loss of fine motor skills. The Veteran’s conditions made him unable to button clothes and pick up things; he had pain and discomfort. The Veteran stated that it was hard to have much quality of life without his medications. Flare-ups of the neck occurred when he did strenuous work or pulling. When the Veteran lifted objects over his head, his arms would go numb and pain increased. The neck flare-ups were severe and usually lasted 3 to 4 weeks. The neck flare-ups were precipitated by repetitive motions, lifting anything over his head, and looking up or down to read (computer or books). His neck flare-ups were alleviated by pain medications; ice helped the most, but most of the time the pain never went away. Pain and stiffness caused decreased range of motion. Initial range of motion testing revealed forward flexion to 15 degrees, extension to 10 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 15 degrees. Pain was exhibited in all ranges of motion. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions. However, there was no additional loss of function or range of motion after three repetitions. The Veteran was not being examined after repeated use over time. The VA examiner noted that pain significantly limited the Veteran’s functional ability with repeated use over time. The estimated range of motion in degrees after repeated use over time was described as: forward flexion to 10 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 5 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 10 degrees. The Veteran was not being examined during flare-ups, but the VA examiner noted that pain significantly limited functional ability with flare-ups. Estimated range of motion during flare-ups was: forward flexion to 5 degrees, extension to 0 degrees, right lateral flexion to 5 degrees, left lateral flexion to 0 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 5 degrees. The Veteran had muscle spasms not resulting in abnormal gait or abnormal spinal contour. The Veteran did not have muscle atrophy. The Veteran had radiculopathy. The Veteran had moderate constant pain, severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left upper extremity. These nerve roots were affected by the Veteran’s radiculopathy: C5/C6 (upper radicular group), C7 (middle radicular group), and C8/T1 (lower radicular group). The Veteran did not have ankylosis or any other neurologic abnormalities. The VA examiner noted that the Veteran did not have intervertebral disc syndrome. The Veteran’s neck disorder impacted his ability to work in that he had difficulty looking up and turning his head side to side, especially during driving to make sure oncoming traffic was cleared. Prior to September 4, 2019 For the appeal period prior to September 4, 2019 (date of VA examination), a rating in excess of 10 percent is not warranted for the Veteran’s service-connected cervical spine degenerative arthritis and degenerative disc disease status post spinal fusion. The Veteran’s neck disorder was characterized by radiating pain and numbness. The Veteran took medication to help with the symptoms. When the Veteran had flare-ups, he remained sedentary and iced his neck. Range of motion testing on the June 2015 VA examination revealed forward flexion to 35 degrees, extension to 25 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 65 degrees, and left lateral rotation to 65 degrees. The Veteran did not have ankylosis. He also did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Although the Veteran had intervertebral disc syndrome, he did not have incapacitating episodes. A higher rating would not be warranted under any applicable diagnostic code. Thus, a rating in excess of 10 percent for the Veteran’s service-connected cervical spine disorder is denied for the appeal period prior to September 4, 2019. The Board has considered the Veteran’s lay statements in support of his claim for an increased rating for his service-connected neck disorder for the appeal period prior to September 4, 2019. However, the Board concludes that the medical findings are of greater probative value than the Veteran’s allegations regarding the severity of his condition. The nature and extent of the Veteran’s disability have been addressed during the appeal period and the medical findings directly address the criteria under which this disability is evaluated. From September 4, 2019 to February 25, 2021 For the appeal period from September 4, 2019 to February 25, 2021 (dates of VA examinations), a rating of 20 percent, but no higher, is warranted for the Veteran’s service-connected cervical spine degenerative arthritis and degenerative disc disease status post spinal fusion. During this appeal period, the Veteran’s symptoms worsened. His symptoms included pain, stiffness, numbness to the left side, balance issues, and difficulty walking. The Veteran reported sharp cervical pain and left arm numbness/tingling that occurred daily with neck rotations. Range of motion testing on the September 4, 2019 VA examination revealed forward flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Range of motion testing on the October 2019 VA examination revealed forward flexion to 20 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 25 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 40 degrees. The Veteran did not have ankylosis or intervertebral disc syndrome with incapacitating episodes during this appeal period. Therefore, a rating of 20 percent, but no higher, is warranted for the Veteran’s service-connected cervical spine disorder from September 4, 2019 to February 25, 2021. February 25, 2021 to present For the appeal period from February 25, 2021 (VA examination), a rating of 30 percent, but no higher is warranted. The Veteran’s symptoms worsened. The Veteran’s current symptoms included right and left arm pain with weakness and numbness along with loss of fine motor skills. The Veteran’s conditions made him unable to button clothes and pick up things; he had pain and discomfort. The neck flare-ups were severe and usually lasted 3 to 4 weeks. The Veteran stated that it was hard to have much quality of life without his medications. Initial range of motion testing on the February 2021 VA examination revealed forward flexion to 15 degrees, extension to 10 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 15 degrees. The estimated range of motion in degrees after repeated use over time was described as: forward flexion to 10 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 5 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 10 degrees. The estimated range of motion during flare-ups was: forward flexion to 5 degrees, extension to 0 degrees, right lateral flexion to 5 degrees, left lateral flexion to 0 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 5 degrees. The Veteran did not have ankylosis or intervertebral disc syndrome with incapacitating episodes. Therefore, a rating of 30 percent, but no higher, is warranted for the Veteran’s service-connected cervical spine disorder from February 25, 2021 to present. 2. Entitlement to an initial rating in excess of 20 percent for service-connected left (minor) upper extremity radiculopathy. The Veteran is seeking an increased rating for his service-connected left (minor) upper extremity radiculopathy. According to the VA examinations, the Veteran is right hand dominant (major joint). Therefore, the Veteran’s left upper extremity is the Veteran’s minor joint. The Veteran is currently rated at 20 percent for his left upper extremity radiculopathy under 38 C.F.R. § 4.124(a), Diagnostic Code 8513. The Board finds that a rating of 30 percent is warranted for the Veteran’s service-connected left upper extremity radiculopathy. Diagnostic Code 8513 pertains to radiculopathy that affects all radicular groups. Complete paralysis of all radicular groups is rated at 80 percent disabling for the minor extremity. Incomplete paralysis of all radicular groups that is severe is rated at 60 percent disabling for the minor extremity. Incomplete paralysis of all radicular groups that is moderate is rated at 30 percent disabling for the minor extremity. Incomplete paralysis of all radicular groups that is mild is rated at 20 percent disabling for the minor extremity. 38 C.F.R. § 4.124(a), Diagnostic Code 8513. The note that pertains to diseases of the peripheral nerves states that 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. 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. The Board finds that the Veteran’s left upper extremity radiculopathy symptoms are better characterized as moderate throughout the entire period on appeal. The Veteran’s VA examinations show that the Veteran complained of pain and numbness radiating from his neck into his left arm and to his hand. On the Veteran’s June 2015 VA examination for peripheral nerves, the VA examiner noted that the Veteran had moderate paresthesias and/or dysesthesias and moderate numbness in the left upper extremity. On the Veteran’s September 2019 VA examination, it was noted that the Veteran had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left upper extremity. However, the September 2019 VA examiner concluded that the Veteran’s radiculopathy affected his C7 nerve root (middle radicular group) and C8/T1 nerve roots (lower radicular group) on the left side to a mild degree. On his February 2021 VA examination, the Veteran’s VA examiner reported that the Veteran had radiculopathy. The Veteran had moderate constant pain, severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in the left upper extremity. Overall, the Board finds that the Veteran’s radiculopathy is more accurately characterized as being moderate in degree of severity throughout the entire period on appeal. Therefore, a rating of 30 percent, but no higher, is warranted for the Veteran’s left (minor) upper extremity radiculopathy. REASONS FOR REMAND 1. Entitlement to service connection for CIDP is remanded. The Veteran is seeking service connection for CIDP. The Veteran claims that his CIDP was due to breathing jet fuels, such as benzene, for which he came into contact with a lot during his time in the military. See March 2015 Correspondence. In June 2015, a VA examination was obtained. The Veteran was diagnosed with CIDP. The VA examiner opined that the Veteran’s CIDP was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran was not diagnosed with CIDP in service and the Veteran’s service treatment records were silent for related symptoms. During his hearing, the Veteran contended that his CIDP was secondary to his currently service-connected back condition and also claimed it as actually radiculopathy with possible symptoms in service. The Veteran’s June 2015 VA examination is inadequate because it does not take into account the Veteran’s claims that his CIDP was caused by exposure to jet fuel. Also, the VA examiner did not consider whether the Veteran’s CIDP was secondary to his service-connected degenerative arthritis of the spine and intervertebral disc syndrome. Moreover, the Veteran seems to claim that his CIDP was actually radiculopathy. The Veteran has already been service-connected for radiculopathy. Therefore, the VA examiner should determine whether the Veteran’s CIDP symptoms are separate and distinct from his radiculopathy. Therefore, a remand is warranted for an adequate medical opinion. 2. Entitlement to a TDIU is remanded. Regarding the Veteran’s claim of entitlement to a TDIU, this matter is inextricably intertwined with the appeal seeking a claim for service connection for CIDP. Hence, as the service connection claim is also being remanded, consideration of whether the Veteran is entitled to TDIU must be deferred pending resolution of that claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (whether a claim is inextricably intertwined with another claim, the claims must be adjudicated together). The matters are REMANDED for the following action: 1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran’s CIDP. If a medical opinion cannot be rendered without an examination, then a VA examination should be scheduled. A copy of this remand and the claims file must be reviewed. The VA examiner should consider the following: (a.) Are the Veteran’s symptoms for his CIDP separate and distinct from the Veteran’s service-connected radiculopathy? The VA examiner should list the Veteran’s CIDP symptoms. (b.) Is it at least as likely as not that the Veteran’s CIDP is related to his military service, to include exposure to jet fuel, such as benzene? (c.) Is it at least as likely as not that the Veteran’s CIDP is caused by, proximately due to, and/or aggravated by his service-connected degenerative arthritis of the spine and interverbal disc syndrome? 2. After the above development has been completed, undertake any additional development indicated by the results of the development requested above, and re-adjudicate the claims, to include the claim for TDIU. If the issues remain denied, issue an appropriate supplemental statement of the case and afford the Veteran and his attorney the opportunity to respond. The case should then be returned to the Board, if in order, for further review. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, 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.