Citation Nr: 21024993 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-59 278 DATE: April 27, 2021 ORDER The petition to reopen the claim for service connection for the residuals of corneal ulcer with infiltrate, left eye is granted. Entitlement to a higher rating in excess of 20 percent for lumbosacral pain with degenerative changes and bulging discs (lumbar spine disability) is denied. Entitlement to a higher rating in excess of 20 percent for degenerative disc disease cervical spine (cervical spine disability) is denied. Entitlement to a higher rating in excess of 20 percent for left upper extremity radiculopathy is denied. REMANDED Entitlement to service connection for the residuals of corneal ulcer with infiltrate, left eye is remanded. Entitlement to an initial compensable rating for hypertension is remanded. Entitlement to a compensable rating for residual scarring of the wrists, knees and left shoulder is remanded. Entitlement to a higher rating in excess of 10 percent for right knee patellofemoral arthritis is remanded. Entitlement to a higher rating in excess of 10 percent for left knee osteoarthritis, status post arthroscopy is remanded. Entitlement to a higher rating in excess of 10 percent for right wrist status post surgical repair scaphoid fracture with traumatic arthritis is remanded. Entitlement to a higher rating in excess of 10 percent for left wrist status post surgical repair scaphoid fracture with traumatic arthritis is remanded. Entitlement to a higher rating in excess of 20 percent for degenerative arthritis of the right shoulder acromioclavicular (AC) joint is remanded. Entitlement to a higher rating in excess of 20 percent for left shoulder status post decompressive surgery/left AC joint with residual impingement is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDING OF FACT 1. In an unappealed April 2002 rating decision, the RO denied the Veteran’s claim for service connection for a left eye disability. Additional evidence has been received since the April 2002 rating decision that relates to an unestablished fact necessary to substantiate the claim for service connection for a left eye disability. 3. Throughout the appeal period, the Veteran’s service-connected lumbar spine disability is manifested by complaints of pain as well as decreased range of motion, but without any resulting additional functional loss (to include when considering pain and flare-ups) not contemplated by the assigned ratings of 20 percent. 4. Throughout the appeal period, the Veteran’s service-connected cervical spine disability is manifested by complaints of pain as well as decreased range of motion, but without any resulting additional functional loss (to include when considering pain and flare-ups) not contemplated by the assigned ratings of 20 percent. 5. The Veteran’s cervical radiculopathy of the left upper extremity has been manifested by mild incomplete paralysis of the upper and middle radicular groups, which is wholly sensory. CONCLUSIONS OF LAW 1. The April 2002 rating decision that denied service connection for a left eye disability, is a final and binding determination on the evidence then of record. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.160 (d), 20.302. 2. The criteria for an evaluation in excess of 20 percent, for the lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5243. 3. The criteria for a rating higher than 20 percent for cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71, Diagnostic Code 5243. 4. The criteria for a rating higher than 20 percent for radiculopathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8511. REASONS AND BASES FOR FINDING AND CONCLUSIONS 1. Petition to reopen the claim for service connection for the residuals of corneal ulcer with infiltrate, left eye The RO first considered and denied the Veteran’s claim for service connection for a left eye disability in April 2002. The Veteran was notified of the decision and of his appellate rights. He did not appeal the determination. Therefore, the April 2002 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. VA may reopen a previously and finally disallowed claim when ‘new and material’ evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108; 38.U. S.C. § 3.156(a). This requires a review of all evidence submitted by or on behalf of a claimant since the last final denial, regardless of whether the denial was on the merits or on procedural grounds, to determine whether a claim may be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). In regard to the April 2002 rating action that denied the claim for service connection for a left eye disability; the Board finds that the new evidence-in particular new diagnoses are so significant that this evidence must be considered in order to fairly decide the merits of the claim. Therefore, the Board finds that this evidence is both new and material, and serves to reopen the claim. 38 C.F.R. § 3.156 (a); see Shade v. Shinseki, 24 Vet. App. 110 (2010). As such, the Veteran’s claim for service connection for a left eye disability is reopened. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or his ability to function under the ordinary conditions of daily life, including employment, by comparing his or his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, as is the case here, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the e-file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The record contains service treatment records (STRs); private medical records; Social Security Administration (SSA) records; VA outpatient and examination reports; as well as statements of the Veteran. Rating criteria for lumbosacral degenerative disc disease and radiculopathy During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a 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. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran’s claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Under both the former and amended criteria for DCs 5235-42, the General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, unfavorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. A note (2) to this code indicates that for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, and left and right lateral rotations are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Another note (6) indicated that disability of the thoracolumbar and cervical spine segments will be separately evaluated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.”  Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Unfavorable ankylosis is defined as “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; gastrointestinal 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.” Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is “always” considered favorable ankylosis. Id. Normal thoracolumbar spine motion includes forward flexion from 0 to 90 degrees and normal combined range of motion of the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, Plate V. The former criteria, DCs 5235-42 also instructs to evaluate degenerative arthritis of the spine under Diagnostic Code 5003 if limitation of motion is noncompensable. Under the amended criteria, DCs 5235-42, also instructs to evaluate degenerative arthritis, DDD other than intervertebral disc syndrome (IVDS) under either Diagnostic Code 5003 (Degenerative arthritis, other than post-traumatic) if limitation of motion is noncompensable, or under Diagnostic Code 5010 (Post-traumatic arthritis), which instructs to rate as limitation of motion, dislocation, or other specified instability under the affected joint, and where two or more joints are affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. A rating under Diagnostic Code 5003 cannot be combined with a rating based on limitation of motion of the same joint. Here, the Veteran is currently in receipt of a compensable rating under Diagnostic Code 5243 for limitation of motion for his lumbar spine. The revised Diagnostic Code 5010 distinguishes between joint conditions arising from traumatic causes and joint disease resulting from systemic processes. Traumatic arthritis will be rated as limitation of motion for the affected joint, dislocation or other specified instability under the affected joint. Under the old DC 5243, intervertebral disc syndrome (IVDS) is rated either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations, whichever method results in the higher rating. See Bierman v. Brown, 6 Vet. App. 125 (1994). However, assigning separate ratings for combination may not be permitted to result in pyramiding under 38 C.F.R. § 4.14 - which prohibits “[t]he evaluation of the same disability under various diagnoses”. See Brady v. Brown, 4 Vet. App. 203, 206 (1993). See, too, Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (the critical element is if symptoms of one condition are duplicative of or overlapping of another). Thus, a rating for IVDS may not be assigned while at the same time assigning separate ratings for the orthopedic and the neurologic components of IVDS. As to incapacitating episodes, if there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent rating is warranted. If there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted. If there are incapacitating episodes having a total duration of at least six weeks during the past 12 months, a maximum 60 percent rating is warranted. The IVDS rating criteria do not provide for an evaluation in excess of 60 percent on the basis of the total duration of incapacitating episodes. The Board notes that revised criteria defines the clinical manifestations that are required for a diagnosis IVDS, but does not alter the rating of this disability. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing.  38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011).  Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate.  See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”).  Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis.  See Burton v. Shinseki, 25 Vet. App. 1 (2011).  In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.”  The spine has no opposite joint.  In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. 2. Entitlement to a higher rating in excess of 20 percent for lumbosacral pain with degenerative changes and bulging discs In April 2002, the RO granted service connection for lumbosacral pain with degenerative changes associated with bulging discs, assigning a 20 percent rating, effective in August 2000. This rating has remained in effect since then. The Veteran filed his current claim in August 2013. The May 2014 Disability Benefits Questionnaire (DBQ) shows that the Veteran reported a history of back pain since 2011/2012. He experienced pain and numbness that radiated down his legs. This limited his ability to stand. On range of motion study, forward flexion was to 90 degrees; extension was to 30 degrees; left and right lateral flexion was 30 degrees; right and left lateral rotation was 30 degrees. There was no pain noted on motion testing. There was no pain or loss of function on repetitive motion testing. There was no loss of muscle strength. Reflex and sensory examinations were normal. Straight leg raising was negative. There was no radicular pain or other neurological symptoms. He did not have IVDS. The examiner diagnosed moderate scoliosis and marked degenerative joint disease of the lumbar spine. There was mild to moderate levoscoliosis and trace degenerative joint disease of the thoracic spine. Records received in August 2014 show that SSA assessed the functional limitations in the workplace. It was noted that he had exertional limitations such as only be able to lift 20 pounds; stand or walk 6 out of 8 hours; and postural limitations. The RO denied a higher rating in November 2014. In July 2017, the Veteran underwent lumbar fusion, T-9 pelvis; L4-5 and L5-S1 interbody fusion and laminectomy. VA outpatient records dated in 2017 show that spinal fusion and laminectomy failed. He continued his complaints of pain. On VA examination in January 2018, the Veteran reported increased soreness and stiffness. He reported He had difficulty with bending, twisting, and on repetitive motion. He was only able to stand 20 minutes. He had flareups 2-3 times a week. This has increased since his surgery in July 2017. On range of motion study, forward flexion was to 70 degrees; extension was to 5 degrees; left and right lateral flexion was 25 degrees; right and left lateral rotation was 25 degrees. After 3 repetitive motions, forward flexion was to 60 degrees; extension was to 5 degrees; left and right lateral flexion was 25 degrees; right lateral rotation was 25 degrees and left lateral rotation was 20 degrees. Pain, fatigue, and lack of endurance significantly limited functional ability with repeated use over time. There was muscle spasm that resulted in abnormal gait or abnormal spinal contour. Hip flexion was 4/5, otherwise muscle strength was normal. There was no muscle atrophy. The deep tendon reflexes of the ankles were 1+, hypoactive. There was decreased sensation to light touch to the ankle/leg and foot/toes. Straight leg testing was positive. There was moderate pain, numbness and paresthesias and/or dysesthesias in the lower extremities. IVDS was diagnosed. The Veteran used a brace occasionally. VA contract outpatient records dated between 2017 and 2020 show that the Veteran continues to undergo rehabilitation and therapy for orthopedic pain. In July 2020 it was noted that his medication was effective. The Board finds that based on the Veteran’s reported pain and functional loss a rating in excess of 20 percent is not warranted for the disability of the lumbar spine for this period. As noted above, VA examinations show that the lumbar spine disability has been manifested by forward flexion greater than 40 degrees, but not greater than 60 degrees within this period. The Veteran’s reports of pain and functional loss are adequately considered by the VA examination reports and findings of motion limitation. During this period, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, or of favorable ankylosis of the entire thoracolumbar spine (or evidence of the functional equivalent of ankylosis), even considering other functionally limiting factors during this time period. Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating under the IVDS formula is not proper. Therefore, a rating in excess of 20 percent is not warranted. 3. Entitlement to a higher rating in excess of 20 percent for degenerative disc disease cervical spine In April 2002, the RO granted service connection for neck pain with degenerative changes and bulging discs, assigning a separate 20 percent rating, effective in August 2000. This rating has remained in effect since then. The Veteran filed his current claim in August 2013. The Veteran’s cervical spine disability is currently rated at 20 percent under the General Rating Formula for Diseases and Injuries of the Spine. A higher 30 percent rating is assigned when forward flexion of the cervical spine is 15 degrees or less, or when there is favorable ankylosis of the cervical spine. The May 2014 DBQ shows that the Veteran reported a history of neck strain that began in 2011/2012. He reported pain and numbness that radiated to the lower extremities. On range of motion study, forward flexion was to 45 degrees; extension was to 45 degrees; left and right lateral flexion was 45 degrees; right and left lateral rotation was 80 degrees. There was no pain on motion. On repetitive motion, the range of motion was the same. There was no pain or loss of function on repetitive motion. There was no loss of muscle strength. Reflex and sensory examinations were normal. There was noted radiculopathy to the upper extremities. The examiner diagnosed moderate DJD cervical spine C5-6, C6 7, with degenerative neuroforaminal stenosis C4/5 and C5-6 on the right and C4-5 on the left; IVDS with narrowing/stenosis of neural foramina. The RO denied a higher rating in November 2014. On VA examination, in January 2018, the Veteran reported increased weakness and stiffness. He had difficulty looking up for an extended period of time which limited him in reading, watching TV, and viewing the computer. He had problems with buttons, zippers, shoes, socks, etc. During flareups he experienced burning pain to both sides with loss of strength. On range of motion study, forward flexion was to 30 degrees; extension was to 20 degrees; left and right lateral flexion was 25 degrees; right lateral rotation was 30 degrees and left lateral rotation was 50 degrees. Pain was noted on every planes of motion. There was no pain on weight-bearing. After 3 repetitions, forward flexion was to 25 degrees; extension was to 20 degrees; left and right lateral flexion was 20 degrees; right lateral rotation was 20 degrees and left lateral rotation was 30 degrees. After repeated use over time, the range of motion was considered the same. Pain, fatigue, and lack of endurance significantly limited functional ability with repeated use over time. There was muscle spasm that resulted in abnormal gait or abnormal spinal contour. Muscle strength was normal in elbow flexion, wrist flexion, wrist extension, finger flexion, and finger abduction. There was no muscle atrophy. The deep tendon reflexes of the ankles and knees were normal. There was decreased sensation to light touch to the shoulders and left hand/fingers. There was mild pain to the upper extremities. There was mild numbness and paresthesias and/or dysesthesias in the left lower extremity. There was evidence of moderate radiculopathy and mild radiculopathy in the left. There was no ankylosis. IVDS is diagnosed. The Veteran’s cervical spine disability has been manifested by pain, painful motion, limitation of forward flexion to no less than 25 degrees, a combined range of motion of no less than 325 degrees, and subjective complaints of radiation to the upper extremities. When these symptoms are applied to the rating criteria, they are consistent with the current 20 percent rating. 38 C.F.R. § 4.71a, DCs 5235-42. This rating reflects pain and limitation of motion. See Id. A higher rating requires forward flexion of the cervical spine not greater than 15 or ankylosis (or evidence of the functional equivalent of ankylosis) of the cervical spine. Id. This level of impairment is not shown on the record. Thus, a rating higher than the current 20 percent is not warranted. Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating under the IVDS formula is not proper. Therefore, a rating in excess of 20 percent is not warranted. 4. Entitlement to a higher rating in excess of 20 percent for left upper extremity radiculopathy The Veteran filed his current claim in August 2013. In the November 2014 rating action, the RO granted service connection left upper extremity radiculopathy, assigning a separate 20 percent rating, effective in August 2013. In determining the degree of functional impairment caused by an upper extremity disability, an adjudicator must focus on whether the disability at issue involves the major or minor extremity, i.e., the one predominantly used by the individual. Only one extremity is considered to be major. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. 38 C.F.R. § 4.69. The medical evidence in this case indicate that the Veteran is left-handed. Paralysis of the upper radicular group and the middle radicular group are evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Codes 8510 and 8511, respectively. Under the criteria for both, mild incomplete paralysis is rated as 20 percent disabling for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. For the middle radicular group, complete paralysis with adduction, abduction and rotation of the arm, flexion of the elbow and extension of the wrist lost or severely affected is rated as 70 percent for the major extremity and 60 percent for the minor extremity. For the upper radicular group, complete paralysis with all shoulder and elbow movements lost or severely affected, but the hand and wrist movements not affected, are rated 70 percent for the major extremity and 60 percent for the minor extremity. 38 C.F.R. § 4.124a. Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. 38 C.F.R. § 4.124a note following Diagnostic Code 8719. In rating peripheral nerve injuries and their residuals, attention must be given to the site and character of the injury, the relative impairment of motor function, trophic changes, and/or sensory disturbances. 38 C.F.R. § 4.120. 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 partial regeneration. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild degree, or at most, the moderate degree. Id. ; see also 38 C.F.R. § 4.123 (indicating neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated with a maximum equal to severe, incomplete paralysis); 38 C.F.R. § 4.124 (indicating neuralgia characterized by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated with a maximum equal to moderate incomplete paralysis). The terms “mild,” “moderate,” and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. The May 2014 cervical spine DBQ shows that the Veteran reported pain and numbness that radiated to the lower extremities. On examination, there was no loss of muscle strength in the extremities. Reflex and sensory examinations were normal. The Veteran endorsed moderate intermittent pain as well as moderate numbness in the left upper extremity. The examiner indicated that there was involvement of C7 nerve roots (middle radicular group). The examiner determined there was mild radiculopathy of the left upper extremity. In November 2014, the RO granted service connection for radiculopathy of the left lower extremity, assigning a 20 percent rating. Records received in August 2014 show that SSA assessed the functional limitations noted that he had unlimited in handling (gross manipulation) and fingering (fine manipulation). On VA compensation and pension neurological examination, in January 2018, the Veteran reported increased weakness and stiffness. He had problems with buttons, zippers, shoes, socks, etc. During flareups he experienced burning pain with loss of strength. On examination, the Veteran endorsed mild constant pain as well as severe intermittent pain in the left upper extremity. There was mild numbness and paresthesias and/or dysesthesias in the left upper extremity. There was decreased sensation to light touch in the left shoulder area. His muscle strength was normal on elbow flexion, wrist flexion, wrist extension, finger flexion, and finger abduction. Deep tendon reflexes were normal in the biceps, triceps and brachioradialis. The Phalen’s and Tinel’s signs were negative. The examiner determined that there was mild incomplete paralysis of the upper and middle radicular groups on the left. Overall, the Board finds that the symptoms of the Veteran’s neuropathy of the left upper extremity is adequately contemplated by the currently assigned 20 percent disability rating. The Veteran’s peripheral neuropathy has been productive of mild incomplete paralysis of the upper radicular group. A higher rating is not warranted because the evidence does not show that the Veteran’s disability is productive of moderate incomplete paralysis. Although the Veteran endorsed symptoms of numbness, constant pain, and hand weakness, the examiners characterized the Veteran’s disability as mild. Neurological testing also showed mild symptomology. Muscle strength testing was 4/5 at the most and there was no muscle atrophy found. Reflex testing also found normal reflexes in the bilateral biceps, triceps, and brachioradialis. Indeed, the examination reflected that the involvement was wholly sensory, with decreased sensation in the upper radicular group. Overall, considering the entirety of the evidence, the Board finds that the level of impairment present for the Veteran’s left extremity radiculopathy is most analogous to mild incomplete paralysis and not moderate incomplete paralysis. REASONS FOR REMAND 1. Entitlement to service connection for the residuals of corneal ulcer with infiltrate, left eye The Veteran maintains that he has a left eye disorder that resulted from an inservice injury. VA examination and opinion are needed. 2. Entitlement to a compensable rating for residual scars involving the wrists, knees and left shoulder Reviewing the May 2014 scar DBQ (of the scars of the wrists, knees); in response to the questionnaire question as to whether any of the scars are painful, the examiner indicated that “the claimant states swelling and stiffness in both knees.” The answer is not responsive to whether there is objective evidence of pain or tenderness. Furthermore, a compensation examination has not been conducted since 2014. 3. Entitlement to an initial compensable rating for hypertension 4. Entitlement to a higher rating in excess of 10 percent for right knee patellofemoral arthritis 5. Entitlement to a higher rating in excess of 10 percent for left knee osteoarthritis, status post arthroscopy 6. Entitlement to a higher rating in excess of 10 percent for right wrist status post surgical repair scaphoid fracture with traumatic arthritis 7. Entitlement to a higher rating in excess of 10 percent for left wrist status post surgical repair scaphoid fracture with traumatic arthritis 8. Entitlement to a higher rating in excess of 20 percent for degenerative arthritis of the right shoulder AC joint 9. Entitlement to a higher rating in excess of 20 percent for left shoulder status post decompressive surgery/left AC joint with residual impingement 10. Entitlement to a TDIU A VA compensation examination that addressed the severity of his hypertension, shoulders, wrists and knees has not been conducted since 2014. The evidence of record provides evidence of increase since these last examinations. As the TDIU claim is inextricably intertwined with the remanded claims for higher rating, it also will be remanded pending adjudication of those claims. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all healthcare providers (both VA and non-VA) for his claimed disabilities. Make arrangements to obtain all records that he adequately identifies. 2. After completing the above development, provide the e file to an appropriate medical professional in order to opine whether it is at least as likely as not that any left eye disability was caused by, or otherwise related to an in-service disease or injury. Although a complete review of the record is imperative, attention is called to the inservice treatment records: * May 1995 ophthalmology treatment for corneal infiltrate and conjunctivitis * April 1992 MEB report including diagnoses of tilted discs, bilaterally; left greater than right eye; high myopia, left eye; and astigmatism, bilaterally. Permanently service aggravated, The examiner should provide a rationale for any opinion expressed.   3. After completing directive #1, schedule the Veteran for appropriate VA examination(s) to determine the severity of his disabilities of the knees, wrists, and shoulders as well as service-connected scars, and hypertension. Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.D. Jackson, 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.