Citation Nr: 21025093 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-15 300 DATE: April 27, 2021 ORDER Entitlement to a rating higher than 20 percent for a cervical spine disability is denied. Entitlement to a rating higher than 20 percent for right upper extremity radiculopathy prior to May 8, 2017, is denied. Entitlement to a 30 percent rating, but no higher, from May 8, 2017, is granted. Entitlement to a rating higher than 10 percent for left lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent thereafter is denied. Entitlement to a rating higher than 10 percent for right lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent thereafter is denied. Entitlement to a rating higher than 10 percent for scar, residual of cervical fusion, prior to January 8, 2021, and a rating higher than 30 percent thereafter is denied. Entitlement to a rating higher than 10 percent for painful scars, residuals of cervical fusion, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to April 3, 2017, is denied. FINDINGS OF FACT 1. At no point during the appeal period, even when considering flare-ups, has the Veteran’s cervical spine disability manifested by forward flexion limited to 15 degrees or less. No level of ankylosis has been demonstrated at any point during the appeal period. 2. Prior to May 8, 2017, the Veteran’s right upper extremity radiculopathy manifested by mild incomplete paralysis. As of May 8, 2017, it is factually ascertainable that the Veteran’s right upper extremity radiculopathy manifested by moderate incomplete paralysis. 3. Prior to January 8, 2021, the Veteran’s left lower extremity radiculopathy manifested by mild incomplete paralysis. Since January 8, 201, her disability picture has more nearly approximated moderate incomplete paralysis. 4. Prior to January 8, 2021, the Veteran’s right lower extremity radiculopathy manifested by mild incomplete paralysis. Since January 8, 201, her disability picture has more nearly approximated moderate incomplete paralysis. 5. Prior to January 8, 2021, the evidence of record shows that the Veteran had two scars of the neck. Since January 8, 2021, the evidence of record does not show that the Veteran’s scars caused four or five characteristics of disfigurement. 6. The January 8, 2021 VA examination report confirmed the Veteran has two painful scars which are not unable. She does not have more than two painful scars on her neck. 7. Prior to April 3, 2017, the Veteran’s service-connected disabilities did not render her unable to secure and follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating higher than 20 percent for a cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242. 2. Prior to May 8, 2017, the criteria for a rating higher than 20 percent for right upper extremity radiculopathy have not been met. As of May 8, 2017, the criteria for a 30 percent rating, but no higher, have been met. 38 U.S.C. §§ 1155, 5107, 38 C.F.R. §§ 4.1 4.7, 4.123, 4.124, 4.124a, DCs 8510, 8513. 3. The criteria for entitlement to a rating higher than 10 percent for left lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent, thereafter, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, DC 8520. 4. The criteria for entitlement to a rating higher than 10 percent for right lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent, thereafter, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, DC 8520. 5. The criteria for entitlement to a rating higher than 10 percent for scars, residuals of cervical fusion, prior to January 8, 2021, and a rating higher than 30 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DCs 7801 to 7805. 6. The criteria for entitlement to a rating higher than 10 percent for painful scars, residuals of cervical fusion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DCs 7801 to 7805. 7. The criteria for entitlement to a TDIU prior to April 3, 2017, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from February 1979 to February 1999. The procedural history in this case is quite complicated and worth noting. These matters come before the Board of Veterans’ Appeals (Board) on appeal from January 2014, April 2015, and August 2016 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office). These matters were previously before the Board in December 2019 and again in October 2020. In December 2019, the Board remanded the claims for the RO to issue a supplemental statement of the case (SSOC). Such was rendered in April 2020. In October 2020, the Board again remanded the claims above but addressed the Veteran’s claims for restoration. Specifically, the Board granted the Veteran’s appeal to restore the 10 percent rating for each bilateral lower extremity, the 20 percent rating for her cervical spine disability, and the 20 percent rating for her right upper extremity radiculopathy. The remainder of the claims were remanded for additional development, to include affording the Veteran contemporaneous VA examinations. An October 2020 rating decision effectuated the restorations granted by the Board in its October 2020 decision. In December 2020, the Veteran’s attorney filed a Notice of Disagreement as to this rating decision requesting Direct Review. However, a rating decision that effectuates a grant, which was finally decided by the Board, is not an initial rating decision eligible to opt-in to the Appeals Modernization Act (AMA). 38 C.F.R. § 3.2400. Because these matters were finally addressed by the Board, they are also no longer before it and therefore will not be discussed further. Also, as previously noted by the Board, the Veteran’s current appeal originally contained a service connection claim for posttraumatic stress disorder (PTSD). However, subsequent to a February 2020 Statement of the Case, the Veteran’s attorney elected to opt-in to modernized review system. Since that time, by an October 2020 rating decision, the RO granted the Veteran’s claim for PTSD. In November 2020, the Veteran’s attorney filed a Notice of Disagreement as to that issue again requesting Direct Review. Because this issue has been withdrawn from the legacy appeal stream, that issue is not currently before the Board and cannot be merged into the Veteran’s current appeal and docket number. After scheduling the Veteran for contemporaneous VA examinations and completing the requested development, the RO issued a rating decision as well as a SSOC. The February 2021 rating decision increased the Veteran’s ratings for her cervical spine, bilateral lower extremity radiculopathy, and right upper extremity radiculopathy. TDIU, a separate rating for scars on the Veteran’s neck, and Dependents’ Educational Assistance was also granted. The February 2021 SSOC addressed the Veteran’s increased ratings claims. In March 2021, the Veteran’s attorney filed a request for higher level review as to the Veteran’s increased ratings claims. However, this request is not permissible as the Veteran’s appeal remains in legacy. A rating decision that partially grants an increased ratings claim is not an initial rating decision eligible to opt-in to the Appeals Modernization Act (AMA). 38 C.F.R. § 3.2400. All of the issues listed on the February 2021 Higher Level Review Request were either borne out of the Veteran’s increased ratings claim or are part-and-parcel of the claim. The only issue not currently before the Board that may be separately appealed under the AMA review system is “Basic eligibility to Dependents’ Educational Assistance from April 3, 2017.” The remainder of the issues, however, will be decided herein as they remain part-and-parcel of the Veteran’s claims and the Veteran’s attorney has not properly withdrawn these issues from the legacy appeal system and opted-in to the modernized review system. Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled date, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Facts Private treatment records note that the Veteran experiences limited range of motion in the cervical spine as well as pain in the cervical spine. The Veteran’s VA treatment records also document she experiences pain in her cervical spine. VA treatment records from September 2011 document that the Veteran had cervical spine surgery in May 2011. VA treatment records from September 2016 state that the Veteran did not experience pain in her neck and that she had no limitation of motion. However, VA treatment records from October 2016 note neck pain seven out of 10 in severity. VA treatment records from July 2017 state “she is having a lot of pain that is causing radiculopathy/pain in her hands. She will be having an artificial vertebra put in her cervical spine.” VA treatment records from August 2017 note the Veteran experienced chronic neck pain and was considering another cervical surgery through her private orthopedist. Later August 2017 VA treatment records document complaints of chronic and/or severe neck pain, rated as seven to eight out of 10 in severity. The Veteran has been afforded several VA examinations in connection with her claims. On VA examination in October 2012, the examiner noted a diagnosis of degenerative osteoarthritis of the cervical spine with scar residual from cervical fusion surgery. The examiner noted that the Veteran had “surgical scars on anterior and posterior neck from cervical disc surgeries from 2006, 2008, and 2011.” The scars were not found to be painful or unstable. Scar one was noted to be 2 x 0.3 cm; scar two was noted to be 4.25 x 0.3 cm; and scar three was noted to be 7 x 0.4 cm. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue. Nor was there any abnormal pigmentation or texture. The examiner concluded “the [Veteran] has scars on the body and/or disfigurement of the head, face, and/or neck. For the VA established diagnosis of scar, residual of cervical fusion, there is no change in the scar diagnosis. At this time the claimant’s scar condition is asymptomatic.” Regarding the Veteran’s cervical spine, she reported that her neck condition had worsened through the years with aging and repetitive micro-strains. Her neck pain radiated down both arms into her hands. The examiner noted the Veteran’s history of three surgeries in 2005, 2008, and 2011. “The condition has worsened since her cervical spine surgeries. She has less pain than she did prior to her surgeries, but now has weakness and numbness in both arms and hands.” Regarding flare-ups, the Veteran did not endorse additional loss of motion of her cervical spine and instead stated “the impact as an inability to sometimes hold on to something due to weakness in her hands and fingers.” On range of motion testing, she had flexion to 20 degrees with painful motion beginning at 20 degrees; extension to zero with no objective evidence of painful motion; bilateral lateral flexion to 20 degrees with painful motion beginning at 20 degrees; right lateral rotation to 35 degrees with painful motion beginning at 25 degrees; and left lateral rotation to 45 degrees with painful motion beginning at 45 degrees. The Veteran was able to perform repetitive use testing with no additional loss of motion. Contributing factors of disability included less movement than normal and pain on movement. She did not have any localized tenderness or pain to palpation. However, she had guarding or muscle spasm of the cervical spine severe enough to result in abnormal spinal contour. Muscle strength testing was normal on elbow flexion, elbow extension, and finger abduction; and 4/5 (active movement against some resistance) on wrist flexion, wrist extension, and finger flexion. No muscle atrophy was found. Reflex examination was normal. Sensory examination was normal for the shoulder area and hand/fingers and was decreased in the inner/outer forearm. The examiner noted that the Veteran experienced radiculopathy that was mild in severity and involved the C5/C6 (upper radicular group) and C7 nerve roots (middle radicular group). She did not experience constant or intermittent pain and instead experienced moderate paresthesias and/or dysesthesias and mild numbness. Weakened hand grip/grasping was also noted bilaterally. IVDS was noted with no incapacitating episodes occurring in the prior 12 months. In the remarks portion of the examination report, the examiner noted: The claimant’s posture is stiff and antalgic. This is due to three previous neck and low back surgeries to stabilize her spine. Gait is within normal limits . . . At this time the claimant’s condition is active. Regarding the Veteran’s lower extremity radiculopathy, the examiner noted that Veteran had full muscle strength. The Veteran did not experience chronic or intermittent pain but endorsed moderate paresthesias and numbness in the right lower extremity with none in the left. The examiner stated, “no lumbar radicular nerve involvement or deficits noted on physical exam.” When asked to comment on the severity of the Veteran’s radiculopathy, the examiner stated neither side was affected by radiculopathy. Private treatment records dated in May 2014 (Dr. A.G.) note neck pain as well as tingling and numbness in the bilateral upper extremities. They state: “Neck supple. Spine tender to palpation, muscle spasm in the cervical paraspinals. Range of motion normal in all directions.” Regarding the lumbar spine, they state “spine nontender. Paraspinal muscles normal in tone. Straight leg raise test negative bilaterally. Range of motion normal in all directions. Paraspinal muscles nontender to palpation. Femoral stretch test negative.” The Veteran was afforded another VA examination for her cervical spine and radiculopathy in June 2014. Diagnoses of cervical spine degenerative joint disease with IVDS with right upper extremity radiculopathy was again noted. On examination, she endorsed flare-ups in the form of “increased pain.” She did not endorse additional loss of motion. On range of motion testing, she had flexion to 35 degrees with objective evidence of painful motion beginning at 35 degrees; extension to 35 degrees with objective evidence of painful motion beginning at 35 degrees; bilateral lateral flexion to 35 degrees with objective evidence of painful motion beginning at 35 degrees; and bilateral lateral rotation to 65 degrees with objective evidence of painful motion beginning at 65 degrees. The Veteran was able to perform repetitive use testing without any additional loss of motion. She did not have localized tenderness to palpation nor was guarding or muscle spasms noted. Strength testing was all normal and she did not have any muscle atrophy. Reflex and sensory examinations were all normal. The examiner found that the Veteran did not experience any radicular pain or any other signs or symptoms due to radiculopathy. No other neurological abnormalities were noted. The Veteran had not experienced any incapacitating episodes in the 12 months prior and did not use any assistive devices. The examiner stated “there are no current clinical neurological deficits; however, the use of Gabapentin and Elavil is an objective factor for diagnosis. Mostly likely affected nerve is right median, right ulnar, and right radial nerves. In the remarks portion of the report, the examiner stated: The claimant’s posture is within normal limits. Gait is within normal limits. There are contributing factors of pain, weakness, fatigability and/or incoordination but no additional limitation of functional ability of the cervical spine during flare-ups or repeated us over time. For the VA established diagnosis of cervical spine degenerative joint disease with IVDS, there is no change in the diagnosis. At this time the claimant’s condition is active. For the VA established diagnosis of right upper extremity radiculopathy, there is no change in the diagnosis. At this time the claimant’s condition is active. Regarding the Veteran’s bilateral lower extremity radiculopathy, the examiner noted that straight leg raising test was normal and the Veteran did not have any radicular pain or any other signs or symptoms due to radiculopathy. In the remarks portion of the report, the examiner stated “for the VA established diagnosis of middle radicular group radiculopathy, there is no change in the diagnosis. At this time the claimant’s condition is quiescent. The Veteran was afforded a VA examination for her scars in May 2017. The examiner noted two scars. The first scar was found on the anterior neck and was 4.5 x 0.1 cm. The second scar was posterior and measured 9 x 0.1 cm. The scars were not painful or due to burns. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue. There was also no abnormal pigmentation. She was also afforded a peripheral nerves VA examination in May 2017. At that time, a diagnosis of bilateral radiculopathy C5/C6 nerve roots (upper radicular group) was noted. The Veteran experienced severe constant pain in her bilateral upper extremities with no intermittent pain. She also endorsed severe paresthesias and severe numbness in her upper extremities. She did not experience constant pain, intermittent pain, paresthesias, or numbness in her bilateral lower extremities. Muscle strength testing, reflex examination, and sensory examination was normal for both the upper and lower extremities. No muscle atrophy was found. There were no trophic changes and the Veteran’s gait was normal. The examiner opined that the Veteran experienced mild incomplete paralysis of the upper radicular group. She did not use any assistive devices. The examiner made note that the Veteran’s diagnosis of right upper extremity radiculopathy was changed to bilateral upper extremity radiculopathy. On VA examination for her cervical spine in May 2017, the examiner again noted the change in diagnosis. She stated: For the VA established diagnosis of degenerative arthritis of the cervical spine and right upper extremity nerve impairment of the middle radicular group, the diagnosis is changed and it is a progression of the previous diagnosis. Scar and x-ray findings. Surgery and left upper radiculopathy are a progression of the established degenerative arthritis of the cervical spine and right upper extremity nerve impairment of the middle radicular group. Upper radicular is a progression of the established middle radicular group. At the time of examination, the Veteran endorsed that she would be undergoing her fourth cervical spine surgery in July 2017. Regarding flare-ups, the Veteran endorsed symptoms occurring in both arms and hands (weakness and cramps in the hands). She did not describe loss of motion in the neck. On range of motion testing, she had flexion to 25 degrees; extension to 25 degrees; bilateral lateral flexion to 25 degrees; and bilateral lateral rotation to 35 degrees. Pain was noted on examination in all ranges of motion. There was no objective evidence of localized tenderness or pain on palpation of the joint. The Veteran was able to perform repetitive use testing without any additional loss of motion. Regarding the additional functional loss during flares, the examiner stated, “unable to say without mere speculation, the additional limitation varies and attempting to estimate the degree of additional range of motion loss would require resorting to speculation.” No localized tenderness, guarding, or muscle spasm was noted on examination. Muscle strength testing was normal, and no muscle atrophy was found. Reflex and sensory examination were also normal. The Veteran denied experience constant pain, intermittent pain, or numbness in her upper extremities and instead endorsed only mild paresthesias. The examiner noted bilateral C5/C6 (upper radicular group) nerve root involvement. The examiner opined that the Veteran’s upper extremity radiculopathy was mild in nature. No IVDS was found and the Veteran did not experience any incapacitating episodes. No assistive devices were used for locomotion. The examiner again noted the Veteran’s two neck scars – 4.5 cm x 0.1 cm (anterior neck); 9 cm x 0.1 cm (posterior). The examiner noted that the Veteran had “significant diagnostic test findings” and stated that the Veteran had “anterior and posterior fixation [of the] cervical spine.” The examiner noted that there was objective evidence of pain on passive motion as well as on non-weight bearing testing of the neck. As noted by the Board in its October 2020 remand, given the Veteran’s complaints regarding an increase in severity of her disabilities, as well as the passage of time between her last VA examination, additional VA examination was necessary. The Veteran was afforded another VA examination for her cervical spine disability in January 2021. The examiner noted that the Veteran’s cervical spine has been treated with or by five neck surgeries. The examiner stated “the current symptoms are pain in arms and hands across shoulder blades. The current treatment is Gabapentin. The impact of the condition is damage to nerves and weakness in hands.” Regarding flare-ups, the examiner stated: The neck flare-ups are severe. The neck flare-ups last about 15 minutes. The neck flare-ups are precipitated by when I’m trying to do any[thing] or I could just be sitting . . . my hands have cramps. Muscle spasms were noted. On range of motion testing, the Veteran had forward flexion to 40 degrees; extension to 25 degrees; bilateral lateral flexion to 20 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 20 degrees. Pain was noted on examination and caused functional loss in all ranges of motion tested. There was evidence of pain with weight-bearing as well as localized tenderness or pain on palpation of the joint. The examiner noted “location is diffuse, severity is moderate, relationship to conditions is direct.” The Veteran performed repetitive use testing without any additional loss of motion. Pain, weakness, fatigability, or incoordination significantly limits functional ability with repeated use over time. In terms of range of motion, over time as well as during flare-ups, the Veteran’s flexion would be limited to 20 degrees; extension would be limited to 10 degrees; bilateral lateral flexion would be limited to 20 degrees; and bilateral lateral rotation would be limited to 30 degrees. Regarding loss of motion during flare-ups, the examiner opined that the Veteran’s flexion would be limited the same as after repeated use over time. The examiner noted the Veteran had guarding not resulting in abnormal gait or abnormal spinal contour. No additional contributing factors to disability were noted. Muscle strength testing was normal with no muscle atrophy found. Deep tendon flex examination indicated a normal bicep bilaterally; reflexes were absent in the triceps bilaterally; and were hypoactive in the brachioradialis bilaterally. Sensory examination was normal. The Veteran denied having constant pain but endorsed severe intermittent pain, numbness, and paresthesias in the bilateral upper extremities. The examiner noted involvement of the C5/C6, C7, as well as C8/T1 nerve roots. The examiner opined that the Veteran’s cervical radiculopathy was moderate in severity. There was no ankylosis of the spine. Nor were any neurological abnormalities claimed or demonstrated. IVDS was noted but the Veteran has not experienced any incapacitating episodes. She does not use an assistive device for locomotion. There was objective evidence of pain on passive range of motion testing as well as non-weight bearing testing. She was also afforded a VA examination for her peripheral nerves in January 2021. Diagnoses of upper extremity radiculopathy, upper and middle and lower radicular groups; as well as intervertebral disc syndrome; and bilateral lower extremity (sciatic nerve involvement) were noted. The Veteran’s current symptoms include “neck pain going down my back into shoulder blades down both arms into hands causing muscle spasms, unable to walk for a long period of time.” The impact of these impairments was described by the Veteran as “it is hard for me to walk, stand, and sit for a long period of time. I have problems using my hands I had to change my lifestyle.” The Veteran denied experiencing constant pain in either her upper or lower extremities and instead stated she experienced severe intermittent pain, severe paresthesias, and severe numbness in her upper extremities. She experiences moderate intermittent pain in her bilateral lower extremities. She denied experiencing any paresthesias or numbness in her bilateral lower extremities. Muscle strength testing was all normal on examination and there was no muscle atrophy. Reflexes were absent in the bilateral triceps and ankles, normal in the biceps and knees, and hypoactive in the brachioradiales. Sensation to light touch was all normal. The examiner noted that the Veteran experiences moderate incomplete paralysis of the bilateral upper radicular group, middle radicular group, and lower radicular group. She also experiences moderate incomplete paralysis of the sciatic nerve, bilateral lower extremities. The examiner stated, “both arms now involve with radiation of pain into the hands from the lower cervical radicular group.” The Veteran was additionally afforded a VA examination for her scars in January 2021. The examiner noted that the Veteran had “postoperative scars of the neck and back.” None of the scars on the Veteran’s low back are painful, unstable, or due to burns. A midline lumbar spine scar measuring 9 cm x 0.1 cm was noted. There were no scars with underlying tissue damage. Regarding the Veteran’s neck scars, the examiner noted that the Veteran experiences two scars that are painful. They are not unstable nor are they due to burns. The left anterior neck scar was noted to be 5.5 cm x 1 cm; and the posterior neck scar was noted to be 8.5 cm x 0.4 cm. There is no depression, adherence to underlying tissue, or missing underlying soft tissue. Nor is there any abnormal pigmentation or texture of the head, face, or neck. 1. Entitlement to a rating higher than 20 percent for a cervical spine disability. Throughout the period on appeal, the Veteran’s degenerative arthritis of the lumbar spine has been rated under 38 C.F.R. § 4.71a, DC 5242. As a result of the Board’s October 2020 decision restoring her previously assigned rating, the Veteran’s cervical spine has been rated as 20 percent disabling for the entire appeal period. She contends a higher rating is warranted. Cervical spine disabilities are rated generally under DCs 5235 through 5242. Regardless of which of those DCs VA selects, disabilities rated under those criteria are rated pursuant to the General Rating Formula for Diseases and Injuries of the Spine (Spine Formula). Under the Spine Formula, a 10 percent disability rating is assigned where forward flexion of the cervical spine is greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine is greater than 170 degrees but not greater than 335 degrees; or, muscle spasms, guarding, or localized tenderness not resulting in abnormal gait or abnormal spine contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating is warranted for disabilities marked by 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 30 percent disability rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent disability rating is in order for unfavorable ankylosis of the entire cervical spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is warranted for unfavorable ankylosis of the entire spine. The “combined range of motion” refers to the sum 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. Ankylosis is defined as, “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” See Lewis v. Derwinski, 3 Vet. App. 259 (1992). It is worth noting that effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021). The new regulations do not, however, amend DC 5242. Instead, the regulations amend DC 5243 and state: “intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses.” A review of the Veteran’s most recent VA examination report dated in January 2021 indicates that she has IVDS. However, there is no indication of disc herniation with compression and/or irritation of the adjacent nerve root. She also has not had any incapacitating episodes. As such, the new regulations are not applicable to the current appeal. 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). Pain may cause a functional loss but itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell, 25 Vet. App. at 33, 43. 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). 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). After having considered all of the evidence of record, the Board finds that a rating higher than 20 percent is not warranted for the Veteran’s cervical spine disability at any point during the appeal period. At worst, the Veteran has demonstrated flexion to 20 degrees with painful motion beginning at 20 degrees and extension to zero degrees. On VA examination in October 2012, the Veteran did not endorse additional loss of motion of her cervical spine during flare-ups and instead stated “the impact as an inability to sometimes hold on to some things due to weakness in her hands and fingers.” In order to warrant a higher, 30 percent rating, the evidence of record would have to demonstrate forward flexion of the cervical spine limited to 15 degrees or less. More recently, on initial range of motion testing, the Veteran has demonstrated range of motion in her cervical spine consistent with a 10 percent rating. Specifically, on VA examination in January 2021, she had forward flexion to 40 degrees and extension to 25 degrees. However, the examiner noted that over time as well as during flare-ups, the Veteran’s flexion would be limited to 20 degrees and extension would be limited to 10 degrees, which is consistent with the currently assigned 20 percent rating. The voluminous amount of VA treatment records, private treatment records, and Social Security records do not establish symptomatology worse than that contemplated by the VA examination reports. They also do not contain range of motion measurements indicating forward flexion limited to 15 degrees. Further, at no point during the appeal period has the Veteran demonstrated any level of ankylosis of her neck or cervical spine or evidence demonstrating functional loss consistent with that contemplated by ankylosis. The Board acknowledges the Veteran’s complaints regarding her inability to sometimes hold on to some things due to weakness in her hands and fingers. The Board does not dispute the Veteran experiences such symptoms. Indeed, she is separately service-connected for upper extremity radiculopathy, of which those symptoms have been attributed to. To the extent, however, she contends that a higher rating is warranted for loss of motion of her cervical spine, the Board finds overall evidence of record, including on review of the VA examination reports and private medical evidence, do not show any findings of range of motion or other findings that would warrant a rating higher than 20 percent. 38 C.F.R. § 4.71a, DCs 5242, 5243. The overall probative evidence does not show forward flexion of the cervical spine limited to 15 degrees or less, or favorable ankylosis of the entire cervical spine, even with consideration of pain on motion, stiffness, tightness and other DeLuca factors, including fatigue, weakness, endurance, incoordination. Moreover, as noted above, there is no contention or indication that she is entitled to a higher rating under the Formula for Rating Intervertebral Disc Syndrome, even under the new rating criteria. The VA examiners have indicated that the Veteran has not had any incapacitating episodes requiring prescribed bedrest. The other medical evidence of record also does not demonstrate any episodes. The Board observes that the Veteran has complained of neck pain and stiffness to VA examiners. The descriptions of her symptomatology are both competent and credible. However, even when considering these symptoms, the weight of the medical evidence does not show that these symptoms cause the Veteran’s flexion to be limited to 15 degrees or less. The medical findings are more probative since they are made by clinicians with expertise in assessing the severity of spinal disabilities, based upon physical evaluation and diagnostic testing. 38 C.F.R. § 3.159(a)(2); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); and Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Importantly, it is clear she experiences some functional loss, such as some loss of motion due to her neck pain, but such loss does not approximate the criteria contemplated by the assignment of a higher rating under §§ 4.40, 4.45 and 4.49. As such, the appeal for a rating higher than 20 percent for a cervical spine disability must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Entitlement to a rating higher than 20 percent for right upper extremity radiculopathy prior to January 8, 2021, and higher than 30 percent thereafter. The Veteran’s right upper extremity radiculopathy is currently rated as 20 percent disabling prior to January 8, 2021, and 30 percent disabling thereafter, under DC 8510. According to the January 2021 VA examination report as well as the Veteran’s service treatment records, she is left hand dominant. See e.g. March 1984 Report of Medical History. Although the May 2017 VA examination report states the Veteran is right hand dominant, the Board finds that examination report, as it relates to hand dominance, is outweighed by the other probative evidence of record. See also March 2005 VA Treatment Records. Thus, the Veteran’s right upper extremity is her minor limb. The Veteran’s peripheral neuropathy of the right upper extremity is evaluated under the rating criteria for paralysis of the upper radicular group. Complete paralysis is shown when all shoulder and elbow movements are lost or severely affected, and wrist movements are not affected. Complete paralysis is evaluated as 70 percent disabling for the major limb and 60 percent disabling for the minor limb. Severe incomplete paralysis is rated 50 percent disabling for the major limb and 40 percent for the minor limb; moderate incomplete paralysis is 40 percent disabling for the major limb and 30 percent for the minor limb; and mild incomplete paralysis is 20 percent for either limb. 38 C.F.R. § 4.124a, Code 8510. On VA examination in October 2012, the examiner stated that the Veteran’s right upper extremity radiculopathy involved the C5/C6 (upper radicular group) as well as the C7 nerve roots (middle radicular group). DC 8511 (middle radicular group) provides the same ratings for mild, moderate, and severe incomplete paralysis and complete paralysis as DC 8510 (upper radicular grou). Therefore, prior to January 8, 2021, rating the Veteran’s impairments under DC 8510 is appropriate. It is not more favorable to the Veteran to evaluate her right upper extremity radiculopathy under such DC 8511. On most recent VA examination, it was noted that the nerves impacted included the Veteran’s upper radicular group (5th and 6th cervical), middle radicular group, and lower radicular group. DC 8513 contemplates “all radicular groups” and therefore the Veteran’s impairments are better contemplated under DC 8513 as of January 8, 2021. See also May 2017 VA Examination Report (noting only upper radicular group involvement). DC 8513 provides the rating criteria for paralysis of the radicular nerve, and therefore neuritis and neuralgia of that nerve. Disability ratings of 20 percent, 40 percent and 70 percent are assignable for incomplete paralysis of all radicular groups of the major extremity, which is mild, moderate, or severe in degree, respectively. Disability ratings of 20 percent, 30 percent, and 60 percent are assignable for incomplete paralysis of the minor extremity, which is mild, moderate, or severe in degree, respectively. Disability ratings of 90 percent and 80 percent are assignable for complete paralysis of the radicular nerve of the major and minor extremity respectively. 38 C.F.R. § 4.124a, DC 8513. The term “incomplete paralysis” with 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 involvement is wholly sensory, the rating should be for mild, or at most, moderate degree. 38 C.F.R. § 4.124a. The words “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. According to MERRIAM WEBSTER, “Mild” means “gentle in nature or behavior.” See www.merriam-webster.com/dictionary/mild. “Moderate” means “tending toward the mean or average amount or dimension.” “Severe” means “very painful or harmful.” “Incomplete” means “lacking a usually necessary part, element of step.” In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. The February 7, 2021 regulation changes did not provide any amendments to the language of DC 8510 or 8513. It is worth noting that pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes. However, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). After having considered all of the evidence of record, the Board finds that prior to May 8, 2017, the Veteran’s right upper extremity radiculopathy manifested by mild incomplete paralysis. However, as of the May 8, 2017 VA examination, it is factually ascertainable that the Veteran’s right upper extremity radiculopathy more closely approximated moderate incomplete paralysis, such that a 30 percent rating is warranted as of that date. Prior to May 8, 2017, the evidence of record shows that the Veteran had normal muscle strength and reflex examinations were also normal. Sensation to light touch was normal in the shoulder area and hands/fingers on VA examination in October 2012. It was decreased in the inner/outer forearm. The Veteran denied experiencing constant pain or intermittent pain and endorsed moderate paresthesias and mild numbness. The Veteran also experienced weakened hand grip/grasping bilaterally. The examiner determined there was involvement of the C5/C6 and middle radicular groups C7 (without involvement of the C8/T1 (lower radicular group). He opined that the Veteran’s radiculopathy was mild in severity. The evidence of record prior to May 8, 2017, shows that the Veteran’s right upper extremity radiculopathy manifested by symptoms that were wholly sensory. She experienced moderate paresthesias and mild numbness with no constant or intermittent pain. As such, the Board finds that her disability picture more nearly approximated mild incomplete paralysis. In so finding, the Board affords much probative weight to the October 2012 VA examiner’s opinion that the Veteran’s right upper extremity radiculopathy was mild in severity. The examiner had the opportunity to consider the Veteran’s lay statements and based his opinion on the Veteran’s lay statements coupled with objective testing. For the period from May 8, 2017, the Board finds that the Veteran’s right upper extremity radiculopathy has manifested by, at worst, moderate incomplete paralysis. In order to warrant a rating higher than 30 percent, the evidence must show that she experiences severe incomplete paralysis. Although on VA examination in May 2017 it was noted that the Veteran experiences severe constant pain, severe paresthesias, and severe numbness, the Board finds it highly probative that the VA May 2017 and January 2021 examiners have found the Veteran’s right upper extremity to most nearly approximate, at worst, moderate incomplete paralysis. Indeed, the May 2017 VA examiner found that despite the Veteran’s reports of experiencing severe constant pain, severe paresthesias, and severe numbness in her upper extremities, her disability picture more nearly approximated mild incomplete paralysis. On VA examination in May 2017, the Veteran had full muscle strength, sensory examination was normal, she had normal sensation to light touch, and her deep tendon reflexes were all normal. The Veteran’s VA treatment records do not reflect symptoms or manifestations worse than demonstrated on VA examination. On VA examination in January 8, 2021, the VA examiner noted additional root involvement. Specifically, the examiner found upper, middle, and lower nerve involvement in the right upper extremity. In addition to experiencing severe constant pain, severe paresthesias and/or dysesthesias, and severe numbness in the right upper extremity, the VA examination report indicates the Veteran’s triceps tendon reflex is absent and her brachioradialis (elbow) reflex is hypoactive. She has normal reflexes in the biceps. As noted above, DC 8513 contemplates impairment caused by “all radicular groups.” Although deep tendons reflexes were impaired on VA examination in January 2021, but not on VA examination in May 2017, the Board finds that the impairment caused by the Veteran’s right upper extremity radiculopathy has been consistent during that time period. Put differently, although there were additional impairments shown on most recent examination in the form of decreased deep tendon reflexes, when considering the overall impairment caused by the Veteran’s right upper extremity radiculopathy, the Board does not find that it more closely approximates severe incomplete paralysis. Indeed, the January 2021 VA examiner noted that notwithstanding these findings, the Veteran’s right upper extremity radiculopathy manifested by, at worst, moderate incomplete paralysis. The Board has considered the Veteran’s lay reports regarding right upper extremity weakness and numbness. Indeed, the VA examination reports of record are based on the Veteran’s report of her symptoms. As a result, the Board finds these reports to be highly probative. Finally, the Board notes that although the Veteran is separately service-connected for left upper extremity radiculopathy, the propriety of that rating is not currently before the Board. In sum, the Board finds that the evidence of record shows that the Veteran’s right upper extremity radiculopathy, which impacts her minor extremity, most closely approximated mild incomplete paralysis prior to May 8, 2017, such that a rating higher than 20 percent is not warranted. As of May 8, 2017, however, it is factually ascertainable that the Veteran’s right upper extremity radiculopathy has manifested by moderate incomplete paralysis, but no higher. Therefore, a 30 percent rating, but no higher, is warranted as of that date. 3. Entitlement to a rating higher than 10 percent for left lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent thereafter is denied. 4. Entitlement to a rating higher than 10 percent for right lower extremity radiculopathy prior to January 8, 2021, and higher than 20 percent thereafter is denied. The Veteran’s bilateral lower extremity radiculopathy is currently rated as 10 percent disabling prior to January 8, 2021, and 20 percent disabling thereafter under DC 8520. By advancing her appeal, she contends higher ratings are warranted. It is worth noting, however, that since issuance of the February 2021 SSOC, the Veteran’s attorney has not advanced specific argument as to why a higher rating is warranted. In addition, on the March 2017 VA Form 9, it was merely contended “the Veteran is entitled to a higher rating for right lower extremity radiculopathy and left lower extremity radiculopathy.” No specific argument was advanced. DCs 8520-8730 address ratings for paralysis of the peripheral nerves affecting the lower extremities, neuritis, and neuralgia. 38 C.F.R. § 4.124a, DCs 8520-8730. The February 2021 regulation amendments did not impact these DCs. Under DC 8520, ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. Id. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. After having considered all of the evidence of record, the Board finds that ratings higher than 10 percent are not warranted for the Veteran’s bilateral lower extremity radiculopathy prior to January 8, 2021, and ratings higher than 20 percent are not warranted thereafter. Private treatment records from June 2010 from R. Orthopedics, prior to the appeal period, note a diagnosis of bilateral SI radiculopathy, right side worse than the left, due to compression and mild displacement. It was noted that she was having pain more in the right buttocks than the left side, but both sides were bothering her with radiation down the back. She had 5/5 motor strength in her bilateral lower extremities with pain elicited in the buttocks on bilateral slump test. See also Social Security Records; December 2010 Wellstar Private Treatment Records; October 2010 C.R. Orthopedics. The October 2012 VA examination report indicates that the Veteran denied experiencing constant or intermittent pain in her bilateral lower extremities. She endorsed moderate paresthesias and moderate numbness in the right lower extremity with none in the left. Straight leg raising test was negative bilaterally. Sensory examination, muscle strength testing, and reflex examinations were all normal. The examiner noted “no lumbar radicular nerve involvement or deficits noted on physical examination.” On VA examination in June 2014, a diagnosis of bilateral lower extremity radiculopathy was noted, however, the Veteran denied experiencing any symptoms. Straight leg raising test was normal. Sensory examination, reflex examination, and muscle strength testing was all normal. The examiner stated that the Veteran’s condition was quiescent. Essentially, the evidence of record establishes that at worst, the Veteran experienced pain as a result of her bilateral lower extremity radiculopathy prior to January 8, 2021 with some numbness and paresthesias in her right lower extremity only. Her symptoms were wholly sensory. The Board finds this is consistent with mild incomplete paralysis. In so finding, the Board affords much probative weight to the VA examiner’s findings that the Veteran experienced, at worst, mild incomplete paralysis. As of January 8, 2021, the evidence establishes that the Veteran’s bilateral lower extremity radiculopathy manifested by moderate incomplete paralysis, and no more. The evidence continues to show that the Veteran does not experience constant pain, paresthesias, or numbness in the bilateral lower extremities. Her only symptom is moderate intermittent pain with loss of deep tendon reflexes in the ankle. Muscle strength testing on the bilateral lower extremities has been normal. Her radiculopathy involves the sciatic nerve only and the January 2021 VA examiner opined that it was moderate in severity. The Board finds this examination report highly probative as it was based on the Veteran’s lay statements as well as objective testing. The Veteran’s VA and private treatment records do not indicate symptoms more severe than moderate since January 8, 2021. Although he disagreed with the assigned ratings, the Veteran’s attorney has not advanced any specific argument as to why a higher rating is warranted at any time during the appeal period. Thus, the Board finds that ratings higher than 10 percent for bilateral lower extremity radiculopathy prior to January 8, 2021, and a rating higher than 20 percent thereafter is not warranted. Thus, the claim must be denied. 4. Entitlement to a rating higher than 10 percent for scar, residual of cervical fusion, prior to January 8, 2021, and a rating higher than 30 percent thereafter. 5. Entitlement to a rating higher than 10 percent for painful scars, residuals of cervical fusion. The Veteran is service-connected for two types of scars. She is service-connected for scars of the neck (not painful or unstable), under DC 7800, rated as 10 percent disabling prior to January 8, 2021, and 30 percent disabling thereafter. And as of January 8, 2021, she is also separately service-connected for two painful neck scars rated as 10 percent disabling under DC 7804. During the pendency of the appeal, the applicable rating criteria for scars were amended, effective August 13, 2018. VA’s General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. Under the scar regulations in effect from October 23, 2008 to August 13, 2018, DC 7800 provided for burn scars of the head, face or neck, scars of the head, face or neck due to other causes, or other disfigurement of the head, face, or neck. The particular criteria set out under DC 7800 provided for a 10 percent rating with one characteristic of disfigurement. 38 C.F.R. § 4.118, DC 7800. DC 7801 provided ratings for scars, other than the head, face, or neck, that were deep and nonlinear. Scars covering an area or areas exceeding 6 square inches (39 square centimeters) were rated as 10 percent disabling. Higher ratings were warranted for larger areas affected by scarring. Note (1) to DC 7801 provided that a deep scar was one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801 (in effect from October 23, 2008 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 square centimeters) 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, DC 7802 (in effect from October 23, 2008 to August 13, 2018). DC 7804 provided that one or two scars that were unstable or painful were rated as 10 percent disabling. Higher ratings were assigned when more scars were involved. 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, DC 7804 (in effect from October 23, 2008 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, DC 7805 (in effect from October 23, 2008 to August 13, 2018). Under the scar regulations in effect after August 13, 2018, DC 7800 remained the same. DC 7801 provides ratings for scars other than the head, face, or neck, that are associated with underlying soft tissue damage, which is not present in this case. 38 C.F.R. § 4.188, DC 7801 (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. Scars that are in area or areas of 144 square inches (929 sq. cm.) or greater are rated as 10 percent disabling. 38 C.F.R. § 4.188, DC 7802 (effective August 13, 2018). This DC is also not applicable in this case. DC 7804 provides for a 10 percent disability rating for one or two scars that are unstable or painful. Higher ratings are warranted when more scars are involved. 38 C.F.R. § 4.188, DC 7804 (effective August 13, 2018). DC 7805 provides that scars and other effects of scars evaluated under 7800-04 should evaluate any disabling effect(s) not considered in a rating provided under DCs 7800-04 under an appropriate DC. 38 C.F.R. § 4.188, DC 7805 (effective August 13, 2018). After having considered all of the evidence of record, the Board finds that higher ratings are not warranted for the Veteran’s scars rated under DC 7800. Similarly, a rating higher than 10 percent is not warranted for the Veteran’s painful scars, rated under DC 7804. The evidence of record shows that prior to January 8, 2021, the Veteran had scars of the neck that were not painful, unstable, and were not due to burns. The two scars were 4.5 x 0.1 cm (anterior neck) and 9 x 0.1 cm (posterior neck) in size. There was no elevation, depression, or adherence to underlying tissue. Nor was there any abnormal pigmentation or texture of the head, face, or neck. There were no characteristics of disfigurement. There was no gross distortion or asymmetry of facial features or visible/palpable tissue loss. None of the scars caused limitation of function. As noted above, the new regulations did not change DC 7800. The evidence of record shows that prior to January 8, 2021, the Veteran’s scars caused only one characteristic of disfigurement – her scars, when taken together, were 13 or more cm. in length. This is consistent with the currently assigned 10 percent rating. Since January 8, 2021, the evidence of record shows that the Veteran has additional scars of the neck as she has undergone additional surgery. The January 2021 VA examiner noted a diagnosis of “post-operative scars of the neck and back.” He noted a posterior trunk scar without underlying tissue damage that was approximately 0.9 centimeters squared in size. It was noted that the Veteran had two painful scars of the neck but none that were unstable or due to burns. The posterior neck and left anterior neck scars measuring 8.5 x 0.4 cm and 5.5 x 1 cm in size were again noted. No scars were elevated, depressed, or adhered to underlying tissue. They are also not abnormal in texture or pigmentation. However, they are tender to palpation. By a February 2021 rating decision, the RO increased the Veteran’s scar rating to 30 percent under DC 7800 as a result of the size of the scars. This was a generous grant as the Veteran’s scars are only 5.5 cm with a width of 1 cm and 8.5 cm with a width of 0.8 cm (total area of 5.5 square cm and 3.4 square cm). In order to warrant a 30 percent rating, under the rating criteria, the scars must be five or more inches. The Veteran’s largest scar is approximately 3.35 inches (8.5 cm). At no point during the appeal period does the evidence show that the Veteran meets this criteria, much less the criteria for a higher 50 percent rating under DC 7800. Therefore, the claim for a higher rating under DC 7800 must be denied. As it relates to the Veteran’s painful scars, the evidence of record demonstrates that as of January 8, 2021, she had two painful scars. In order to warrant a higher rating, the evidence must show that there are three or four scars that are unstable of painful. This simply has not been shown. The VA and private treatment records of record do not otherwise document symptoms related to the Veteran’s scars worse than described on VA examination in May 2017 and January 2021. The Veteran’s attorney has also not advanced specific argument as to why a higher rating is warranted. Thus, the Board finds that higher ratings for the Veteran’s scars, both under DC 7800 and 7804 are not warranted at any point during the appeal period. Therefore, the claims must be denied. 6. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to April 3, 2017. The Veteran contends that her service-connected disabilities render her unable to secure and follow substantially gainful employment. By a February 2021 rating decision, she was granted a TDIU effective April 3, 2017. Therefore, the question before the Board is whether a TDIU is warranted prior to that time. Generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Prior to April 3, 2017, the Veteran was service-connected for a lumbar spine disorder, rated as 20 percent disabling; a cervical spine disorder, rated as 20 percent disabling; bilateral lower extremity radiculopathy, each rated as 10 percent disabling; right upper extremity radiculopathy, rated as 20 percent disabling; left upper extremity radiculopathy, rated as 10 percent disabling; and scars, rated as 10 percent disabling. Her combined rating was 70 percent. Total disability ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent disability evaluation, or, with less disability, if certain criteria are met. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, will be considered as one disability. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Similarly, disorders of common etiology or the same system will be considered one disability for purposes of meeting the criteria. In this instance, all of the Veteran’s service-connected disabilities prior to April 3, 2017 involve the musculoskeletal system and as such, she meets the minimum percentage requirements for consideration of a TDIU under 38 C.F.R. § 4.16(a). Therefore, the question before the Board is whether her service-connected disabilities alone were of sufficient severity to produce unemployability prior to April 3, 2017. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may not be given to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In Ray v. Wilkie, the Court held that the phrase “unable to secure and follow a substantially gainful occupation” in section 4.16(b) has two components: one economic and one noneconomic. 31 Vet. App. 58, 72-73 (2019). The economic component “simply means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person.” Id. As for the “noneconomic component,” the Court held that this refers to the individual claimant’s “ability to secure or follow” an occupation earning more than marginal income. Id. In determining whether a Veteran can secure and follow a substantially gainful occupation, the Court stated that attention must be given to several relevant factors: (1) the Veteran’s occupational history, education, skill, and training; (2) whether the Veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g. sedentary, light, medium, heavy, or very heavy) required by the occupation at issue; and (3) whether the Veteran has the mental ability to perform the activities required by the occupation at issue. Id. The Court noted that these potentially relevant factors were not a “checklist that must be completely run through in every case,” and that any factor need only be discussed if the evidence raises it as an issue. Id. Regarding the physical limitations factor, the Court stated that relevant considerations include, but are not limited to, the Veteran’s limitations with respect to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations. Id. Regarding the mental ability factor, the Court stated that relevant considerations include, but are not limited to, the Veteran’s limitations with respect to memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Id. Furthermore, in Withers v. Wilkie, the Court held that the meaning and relevance of the term sedentary work will have to be discerned on a case-by-case basis from the medical and lay evidence presented and considering each Veteran’s education, training, and work history. 30 Vet. App. 139, 148 (2018). Merriam-Webster online dictionary defines “sedentary” as (a) “doing or requiring much sitting” or (b) “not physically active.” https://www.merriam-webster.com/dictionary/sedentary. The Board employs this definition in the current analysis. The Board first considers the economic component. As indicated in the Veteran’s VA Form 21-8940, she worked from April 1999 to September 2008 as a probation officer. She was earning $2,800.00 a month. She has a college education as well as a master’s degree in Business. Social Security records indicated that the Veteran worked as a Team Leader of Communications in the United States Marine Corps; she reported this consisted largely of office work on computer “when not deployed.” She further stated it included “supervision of daily operations and activities of 65 marines, planned and executed training exercises for deployments.” She also previously worked as a probation officer from April 1999 to January 2004, where she supervised a caseload of over 300 felony offenders and completed end of month reports. Therefore, the evidence of record shows that the Veteran has experience in both physical employment as well as sedentary work. Regarding the non-economic component of TDIU, the Board finds that in light of the Veteran’s occupational history, education, skill, and training, prior to April 3, 2017, her service-connected disabilities did not sufficiently impair her physical or mental ability to perform sedentary employment such that she was unable to secure or follow a substantially gainful occupation. The Veteran’s attorney has submitted an “Independent Medical Evaluation Report” dated in July 2017. In the report, the examiner listed the Veteran’s medical history as it relates to her cervical spine and low back disabilities. The examiner then went on to state “approximately two or three days per week she has an exacerbation of her symptoms to the point where she cannot walk at all.” Regarding the Veteran’s extremity radiculopathy, the examiner stated “I believe the C&P examiners have consistently underestimated the impact of the Veteran’s condition on her level of function. For instance, the Veteran’s ability to work is impacted by flareups and repeated use of her spine and her limitations go significantly beyond difficulty turning her head and driving as described above.” The examiner ultimately opined that the Veteran was unemployable and stated: She stated in our phone interview that in 2008 her back and neck pain significantly worsened. Her work at the time as a probation officer required her to carry a weapon and work with convicted felons and [she] could not continue to do this work because of her neck, low back, bilateral arm, and right leg back . . . The Veteran has worked her entire career both in the military and as a civilian in strenuous positions that would be considered at least a light level occupation. First, the Board wishes to make clear that the ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013) (“applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner”). The Board does not find the July 2017 opinion probative. As noted above, the Veteran’s occupational experience is not only limited to physical “strenuous” employment. The examiner stated, “she attended college prior to entering the Marine but has no other training or education.” This is also blatantly inaccurate, given that the Veteran herself stated that she had a master’s degree on her TDIU application. The Board does not dispute that the Veteran’s cervical spine and low back disabilities as well as related neurological abnormalities would preclude physical labor. Indeed, the evidence consistently shows that her cervical spine and low back impact her ability to stand, walk, and carry objects. However, this opinion is not probative as to the question of whether the Veteran would be able to perform sedentary work. Instead, the Board finds the Veteran’s contemporaneous VA treatment records, private records, as well as VA examination reports, which were based entirely on the Veteran’s own lay statements at the time, more probative. As to the private examiner’s contention that the Veteran is essentially housebound, the Board finds the other evidence of record shows this to be untrue. VA treatment and private treatment records show that the Veteran consistently presented for treatment as well as to group therapy. Furthermore, despite her physical impairments, VA treatment records from March 2017 show that the Veteran attended the movies by herself, went fishing, went out to eat at a restaurant and went to church. Furthermore, private treatment records from May 2014 from Dr. A.G. indicate that the Veteran’s hobbies included swimming, running, and lifting. The private examiner also seemed to suggest that the Veteran required the care of her husband, however, June 2018 VA treatment records state that it was the Veteran who was taking care of her ill husband. On VA examination in June 2014, the Veteran was able to describe the symptoms her cervical spine disability caused. There is no dispute that her cervical spine caused severe pain. As much is well-documented in the VA and private treatments of record. As it relates to the functional impairment caused by the Veteran’s cervical spine, the VA examiner clearly stated that physical employment would be impacted as it would be difficult to bend, lift, and carry items. The examiner stated, “there is no effect on sedentary employment.” At that time, the Veteran did not have any radicular symptomatology. On VA examination in May 2017, she did endorse more severe symptoms. However, the Board finds that any impact on her employability due to her radiculopathy is accounted for in her currently assigned ratings and do not rise to the level required for a TDIU. Indeed, the May 2017 VA examiner noted that during flare-ups, her peripheral neuropathy would impact her ability to hold and carry objects. However, not all sedentary work would require the Veteran to hold and carry objects. For example, the Veteran’s work history indicates that she worked in corrections. The jobs duties of a jail control room operator do not require her to hold and carry objects. Instead, the jobs duties would require things such as monitoring cameras and radio traffic, operating base radio, monitoring activities of prison via security cameras, operating computerized management information system, making verbal or written reports of significant violations of rules of conduct, and reporting unauthorized movements, emergency situations or unusual activities to designated personnel for response. The Board acknowledges that on her Social Security Application, the Veteran reported being unable to walk and stand for long periods of time. However, because the Veteran is heavily educated, the Board finds that the evidence is against finding that her service-connected disabilities would preclude her from performing clerical positions (sedentary work) in any industry. Such would likely require interacting with others, answering phones, and tracking schedules and invoices. The evidence of record does not show the Veteran’s service-connected disabilities would preclude her from adequately performing such duties. The Board additionally acknowledges that the Veteran has been awarded SSA benefits and was found to be unable to work as a result of her service-connected low back disability as well as nonservice-connected hypertension. However, determinations of the Social Security Administration are not binding on the Board. Further, a high disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). The preponderance of the evidence weighs against a finding that the Veteran did not have the physical or mental ability to secure or follow a substantially gainful occupation due to service-connected disabilities, prior to April 3, 2017. Thus, the preponderance of the evidence is against a finding of unemployability, prior to April 3, 2017. The benefit-of-the-doubt rule does not apply, and the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. SMART Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Martha R. Luboch, 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.