Citation Nr: 21025702 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-08 815 DATE: April 28, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for right knee disability is denied. Entitlement to an initial rating in excess of 10 percent for left knee disability is denied. Entitlement to a rating of 20 percent, but no higher, for left ankle disability is granted; effective July 28, 2011. Entitlement to a rating of 20 percent, but no higher, for back disability is granted; effective July 28, 2011. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy is denied. REMANDED Entitlement to service connection for a disability manifested by dizziness is remanded. Entitlement to a rating in excess of 50 percent from May 20, 2011 to July 8, 2014, a rating in excess of 30 percent from July 9, 2014 to April 7, 2018, and a rating in excess of 50 percent from April 6, 2018 forward for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. During the appeal period, the Veteran’s right knee disability has been manifested by painful motion in flexion; his right knee flexion has not been limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 2. During the appeal period, the Veteran’s left knee disability has been manifested by painful motion in flexion; his left knee flexion has not been limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 3. During the appeal period, the Veteran’s left ankle disability has been manifested by marked limitation of motion. 4. During the appeal period, the Veteran’s back disability has been manifested by forward flexion greater than 30 degrees but not greater than 60 degrees; his back disability has not resulted in ankylosis of the entire thoracolumbar spine or forward flexion of 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. 5. Since March 12, 2019, the Veteran’s bilateral lower extremity radiculopathy has resulted in no more than mild incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for right knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.410, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for an initial rating in excess of 10 percent for left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.410, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. The criteria for a rating of 20 percent, but no higher, for left ankle disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 4. The criteria for a rating of 20 percent, but no higher, for back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 5. The criteria for an initial rating in excess of 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for an initial rating in excess of 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2002 to August 2006 and from January 2009 to April 2009. The matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. Subsequently, the Board remanded the case for further development in June 2018. The issues before the Board in June 2018 included entitlement to service connection for a right ankle disability. However, the agency of original jurisdiction (AOJ) granted service connection for a right ankle disability in an August 2020 rating decision. Thus, as this represents a full grant of the benefits sought on appeal with respect to this issue, the matter is no longer in appellate status, and will not be further addressed herein. Moreover, the August 2020 rating decision assigned a 50 percent rating for the Veteran’s PTSD, effective April 6, 2018, and a 20 percent rating for the Veteran’s back disability, effective March 12, 2019. As these increases do not represent a total grant of benefits sought on appeal, the claims for increased rating remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Lastly, the Board notes that the Veteran has not filed an appeal with respect the propriety of the assigned ratings for his bilateral lower extremity radiculopathy; however, such matters are part and parcel of his claim for an increased rating for his back disability. Specifically, the rating criteria governing the evaluation of such disability states that any associated objective neurological abnormalities be separately evaluated under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Therefore, such issues will be addressed herein. Increased Rating A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) did not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. However, pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011) (holding that pain alone does not constitute function loss but is just one fact to be considered when evaluating functional impairment). Bilateral Knee Disabilities The Veteran’s bilateral knee disabilities are in receipt of initial 10 percent ratings pursuant to Diagnostic Code 5260. Limitation of flexion of the leg is rated under Diagnostic Code 5260. A noncompensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees. 38 C.F.R. § 4.71a. Normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. Id., Plate II. The Board notes that while portions of the Rating Schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Code 5260 was not changed. The Veteran underwent a VA examination in April 2014, in which he reported flare-ups of the knees that cause increased pain, decreased range of motion, and difficulty with prolonged weight bearing. Upon examination, the Veteran’s right knee revealed flexion to 130 degrees, with objective evidence of painful motion at 120 degrees, and extension to 0 degrees; and left knee flexion to 135 degrees, with objective evidence of painful motion at 125 degrees, and extension to 0 degrees. Repetitive-use testing of the right knee revealed flexion to 125 degrees, and extension to 0 degrees as well as left knee flexion to 130 degrees, and extension to 0 degrees. The examiner noted bilateral tenderness or pain to palpation for the joint. No evidence of muscle atrophy, reduction in muscle strength, ankylosis, recurrent effusion, lateral instability, or recurrent subluxation/dislocation was noted during the examination. Joint stability testing revealed normal results. During the March 2018 Board hearing, the Veteran asserted that the April 2014 VA examination did not provide an accurate depiction of the severity of this bilateral knee disabilities as the examiner pushed him past the point of pain when measuring range of motion. The Veteran was afforded another VA examination in March 2019, in which he reported knee pain and giving way. He also reported that his knees become painful and stiff from sitting and that he cannot sit for more than an hour without moving his knees. He indicated that he did not experience flare-ups. Upon examination, the Veteran’s right knee revealed flexion to 120 degrees and extension to 0 degrees; and left knee flexion to 120 degrees and extension to 0 degrees. The examiner noted that while the Veteran exhibited pain on flexion and extension, pain did not result in/cause functional loss. The examiner also noted bilateral moderate localized tenderness or pain on palpation. There was no evidence of pain on weight bearing. Repetitive-use testing revealed no additional loss of function for the right or left knee. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time or flare-ups; the examiner indicated that it was not possible to determine, without resorting to mere speculation, to estimate loss of range of motion because there was no conceptual or empirical basis for making such a determination without directly observing function under these conditions. Additionally, the examiner stated that for this Veteran, there was no persistent evidence of record, considered to be valid or reproducible for ratings purposes, that indicates a loss of function during these conditions. No evidence of muscle atrophy, reduction in muscle strength, ankylosis, recurrent effusion, lateral instability, or recurrent subluxation was noted. Joint stability testing revealed normal results. The examiner indicated that Veteran did not require the use of any assistive device as a normal mode of locomotion. The examiner indicated that there was no objective evidence of pain on passive range of motion testing or non-weight bearing of the bilateral knees. The Board notes the Veteran’s VA treatment records note several complaints of bilateral knee pain during the pendency of the appeal. A March 2014 VA treatment record reveals that the Veteran’s right and left knee range of motion were within functional limits. Additionally, a July 2017 VA orthopedic surgery note indicates that the Veteran reported having on and off pain of the left knee. The examiner noted left knee flexion to 130 degrees and no instability. Initially, the Board acknowledges that the March 2019 VA examiner indicated that it was not possible to provide loss of range of motion measurements with repeated use over time or during flare-ups without resorting to mere speculation. The Board is cognizant of Sharp v. Shulkin, 29 Vet. App. 26 (2017), however, notes that the examination indicated that the Veteran did not have flare-ups and he described his functional impairment as increased pain and stiffness with sitting. The Board finds that this sufficiently addresses the functional loss experienced by the Veteran with repeated use over time. Nevertheless, the examiner considered the Veteran’s particular bilateral knee disabilities and the available evidence of record, explaining that there was no persistent evidence of record, considered to be valid or reproducible for ratings purposes, that indicated additional loss of function during these conditions. Therefore, the Board finds that the March 2019 VA examination is adequate for purposes of deciding the Veteran’s claims on appeal. After a review of the evidence, the Board finds that evaluations in excess of 10 percent for right and left knee limitation of flexion is not warranted. The Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent under Diagnostic Codes 5260 for either knee as the Veteran’s flexion has not been limited to 30 degrees or less at any time during the appeal, even when taking into account his functional loss to include flare-ups, pain, and repeated use over a period of time. Thus, considering the lay and medical evidence of record, the Board finds that the assigned 10 percent ratings adequately compensates him for the extent of his functional impairment due to pain, flare-ups, and repeated use over a period of time. The Board has also considered whether higher ratings or additional separate ratings are warranted under other diagnostic codes at any time during the appellate period for the Veteran’s bilateral knees. A rating under Diagnostic Code 5256 is not warranted as there is no evidence of ankylosis. A rating under Diagnostic Codes 5258 or 5259 is not warranted because there is no evidence of any meniscal condition. There is no evidence that the Veteran’s range of motion in extension was limited to 10 degrees or more to warrant a compensable rating under Diagnostic Code 5261. There is no evidence of tibia and fibula impairment to warrant a rating under Diagnostic 5262. Additionally, there is no evidence of genu recurvatum to warrant a rating under Diagnostic 5263. Lastly, the Board notes that although the Veteran credibly reported that his knees give way, the weight of the probative evidence demonstrates no lateral instability or subluxation of the knees. The VA examiners did not find instability upon examination, and instability of the knees or the need for an assistive device for the knees is not noted in the Veteran’s medical treatment records. As such, the Board finds that a separate rating under Diagnostic Code 5257 is not warranted. Moreover, the Board notes that the Veteran’s functional loss was considered as the medical evidence shows that the Veteran has consistently complained of pain. 38 C.F.R. §§ 4.40, 4.45. However, the limitation of motion and functional loss documented in the medical records as resulting from pain, including flare-ups or repetitive use over time, is contemplated in the ratings currently assigned. There is otherwise no evidence of additional significant impairment of motor skills, muscle function, or strength attributable to the Veteran’s bilateral knee disabilities beyond what is already being compensated. Consequently, the Board finds that a higher rating based on functional loss is not warranted. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his bilateral knee disabilities are more severe than as reflected by the current assigned ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. Accordingly, the Board affords the March 2019 VA examination report greater probative value. In sum, the Board finds that the Veteran’s bilateral knee disabilities do not warrant initial ratings in excess of 10 percent. Accordingly, as the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b). Left Ankle Disability The Veteran’s left ankle disability is in receipt of a 10 percent rating pursuant to Diagnostic Code 5271. As previously discussed, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, to include Diagnostic Code 5271. Diagnostic Code 5271 provides a 10 percent rating for moderate limited ankle motion and a 20 percent rating for marked limited ankle motion. 38 C.F.R. § 4.71a. Normal ankle motion is dorsiflexion to 20 degrees, and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II. The Board observes that recent revisions to the criteria of Diagnostic Code 5271, effective February 7, 2021, clarify that prior regulatory references to “marked” means less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion and that “moderate” means less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion. 85 Fed. Reg. 76453 (Nov. 30, 2020). The Board provides the highest rating under DC 5271 based on the former criteria; the Board therefore finds that further discussion regarding the impact of the amendment change is unnecessary. The Veteran underwent a VA examination in May 2013, in which he was diagnosed with left ankle ligament strain and lateral instability. The Veteran reported having pain with activity, pain at the end of the day with stiffness, and giving way a few times a month. He further reported that his standing limitation was 45 minutes and his walking limitation was two to three miles. He indicated that he did not experience flare-ups. Range of motion testing revealed left ankle dorsiflexion to 0 degrees and plantar flexion to 45 degrees. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. There was no evidence of reduction in muscle strength, ankylosis, malunion of the calcaneus or talus, or talectomy. No use of an assistive device was noted. During a March 2014 VA examination, the Veteran reported having flare-ups of the left ankle which he described as increased pain and difficulty with prolonged weight bearing and high impact activities. Range of motion testing revealed left ankle dorsiflexion to 20 degrees, with objective evidence of painful motion at 15 degrees, and plantar flexion to 45 degrees, with objective evidence of painful motion at 40 degrees. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. The examiner noted localized tenderness or pain on palpation of the left ankle. There was no evidence of reduction in muscle strength, joint instability, ankylosis, malunion of the calcaneus or talus, or talectomy. No use of an assistive device was noted. During the March 2018 Board hearing, the Veteran testified that his March 2014 VA examination did not provide an accurate description of the severity of his left ankle disability, as the examiner pushed past the point of pain when measuring range of motion. The Veteran was afforded a VA examination in March 2019, in which he reported recurring pain as well as episodes of giving way and rolling. The Veteran did not report flare-ups. Range of motion testing revealed left ankle dorsiflexion to 5 degrees and plantar flexion to 45 degrees. The examiner noted moderate localized tenderness or pain on palpation. There was no objective evidence of pain with weight bearing or non-weight bearing as well as on passive range of motion testing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time or flare-ups; the examiner indicated that it was not possible to determine, without resorting to mere speculation, to estimate loss of range of motion because there was no conceptual or empirical basis for making such a determination without directly observing function under these conditions. Additionally, the examiner stated that for this Veteran, there was no persistent evidence of record, considered to be valid or reproducible for ratings purposes, that indicates a loss of function during these conditions. Upon consideration of the evidence of record, the Board finds that a rating of 20 percent, but no higher, is warranted for the Veteran’s left ankle disability, effective July 28, 2011. During the appeal period, the May 2013 VA examination revealed left ankle dorsiflexion to 0 degrees and the March 2019 VA examination revealed left ankle dorsiflexion to 5 degrees. Accordingly, the Board finds the limited range of motion shown during the May 2013 and March 2019 VA examinations is marked, and therefore, supports an increase in the Veteran’s evaluation of his left ankle disability. The Board notes that while the March 2014 VA examination revealed normal range of motion for the left ankle, the Board finds the Veteran’s testimony regarding the inadequacy of March 2014 VA examination range of motion testing to be credible and thus affords this examination little probative value. The Board notes that an evaluation of 20 percent is the highest schedular rating for limitation of motion of the ankle under Diagnostic Code 5271. All potentially applicable codes have been considered; however, the Board finds that no higher rating is warranted under any other diagnostic code. Specifically, as there is no competent medical evidence of record, to include VA examinations and medical treatment records, documenting the presence of any ankylosis or malunion in the Veteran’s left ankle. Additionally, there is no indication that the Veteran has undergone a talectomy (an astragalectomy). Accordingly, separate ratings are not warranted under Diagnostic Codes 5270, 5272, 5273 or 5274. In sum, the Board finds that a rating of 20 percent, but no higher, is warranted for the Veteran’s left ankle disability, effective July 28, 2011. To the extent that the Veteran contends entitlement to a higher rating, the preponderance of the evidence is against the claim; there is no reasonable doubt to be resolved; and the appeal is denied. 38 U.S.C. § 5107(b). Back Disability The Veteran’s back disability has been in receipt of a 10 percent rating prior to March 12, 2019, and a 20 percent rating thereafter pursuant to Diagnostic Code 5242. As previously discussed, the schedule for rating disabilities of the spine was revised during the appellate period. The changes effective February 7, 2021 under Diagnostic Code 5242 were not to the rating schedule itself but added instruction to classify disabilities associated with Diagnostic Code 5242. As such, Diagnostic Code 5242 now reflects “Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either Diagnostic Code 5003 or 5010).” As such, the changes do not impact the general rating formula and evaluation of the disability under the pre- and post-February 7, 2021 regulations is not required. Diagnostic Code 5242 is part of the General Rating Formula for Disease and Injuries of the Spine (General Rating Formula). Under the General Rating Formula, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, a combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, a 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. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation requires unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating is assigned due to unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. The Veteran was afforded a VA examination in May 2013, in which the Veteran reported having daily back pain. He also reported having left lower extremity pain, without numbness, tingling, or burning. The Veteran did not report flare-ups of the thoracolumbar spine. Initial range of motion testing revealed forward flexion to 85 degrees, extension to 20 degrees, bilateral lateral flexion to 30 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 10 degrees. No additional loss of function or range of motion was noted after repetitive-use testing. Reflex examination revealed hypoactive reflexes for the bilateral knees and ankles. There was no evidence of reduced muscle strength, localized tenderness or pain to palpation, muscle atrophy, decreased sensation to light touch, radicular pain or any other signs or symptoms due to radiculopathy, ankylosis, IVDS, or other neurologic abnormalities. No use of an assistive device was noted. The Veteran underwent a VA examination in March 2014, in which he reported having low back pain, stiffness, achiness, and tightness. He further reported that prolonged weight bearing, bending, lifting, twisting, or high impact activities aggravate and flare-up his back. The examiner noted that while the Veteran reported some left lower extremity pain, he did not describe or demonstrate any evidence of radiculopathy affecting the lower extremities. Initial range of motion testing revealed forward flexion to 75 degrees, extension to 25 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 30 degrees. Repetitive-use testing revealed forward flexion to 70 degrees, extension to 20 degrees, bilateral lateral flexion to 25 degrees, and bilateral lateral rotation to 25 degrees. The examiner noted that the Veteran had midline lumbar tenderness and some tenderness over the SI joint regions. The examiner indicated that he was unable to opine as to whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time or flare-ups without resorting to mere speculation because an examination would be required to ascertain functional ability with repeated use over time and/or during flare-ups. Sensory and reflex examinations revealed normal results. There was no evidence of muscle spasm, muscle atrophy, reduction in muscle strength, radicular pain or other signs or symptoms due to radiculopathy, IVDS, ankylosis, or other neurologic abnormalities. No use of an assistive device was noted. A March 2015 private medical record noted significant muscle spasms, marked tenderness to light palpation, and decreased range of motion due to pain. During the March 2018 Board hearing, the Veteran testified that his March 2014 VA examination did not provide an accurate description of the severity of his back disability, as the examiner pushed past the point of pain when measuring range of motion. The Veteran was afforded another VA examination in March 2019, in which he reported having throbbing and sharp back pain and spasms. He also reported having occasional shooting pain down his right lower extremity and tingling down the left lower extremity as well as numbness in his bilateral lower extremities with sitting. The Veteran reported flare-ups of the back that require him to get a shot of Toradol yearly. He stated that during flare-ups he has decreased range of motion, loss of endurance, and pain with sharp movement. Initial range of motion testing revealed forward flexion to 70 degrees, extension to 15 degrees, bilateral lateral flexion to 20 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 20 degrees. The examiner indicated that the Veteran exhibited pain on forward flexion, extension, bilateral lateral flexion, and bilateral lateral rotation which causes functional loss. The examiner noted moderate localized tenderness or pain on palpation of the joint. Repetitive-use testing revealed forward flexion to 60 degrees, extension to 10 degrees, bilateral lateral flexion to 20 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 20 degrees. The examiner was unable to say without resorting to mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time or flare-ups; the examiner indicated that it was not possible to determine, without resorting to mere speculation, to estimate loss of range of motion because there was no conceptual or empirical basis for making such a determination without directly observing function under these conditions. Additionally, the examiner stated that for this Veteran, there was no persistent evidence of record, considered to be valid or reproducible for ratings purposes, that indicates a loss of function during these conditions. Muscle spasm and guarding, not resulting in abnormal gait or abnormal contour, were noted. Reflex examination revealed hypoactive reflexes for the bilateral ankles. Sensory examination revealed decreased sensation to touch in the right lower leg/ankle (L4/L5/S1) and left thigh/knee (L3/4). The examiner noted that the Veteran had bilateral lower extremity radiculopathy, indicating moderate right lower extremity intermittent pain, mild left lower extremity paresthesias and/or dysesthesias, and mild bilateral lower extremity numbness. The examiner indicated that the Veteran had mild bilateral radiculopathy of the sciatic nerve roots. No reduction in muscle strength, muscle atrophy, ankylosis, IVDS, or other neurologic abnormalities was noted. No use of an assistive device was noted. The examiner indicated that passive range of motion of the spine was not performed as it was not feasibly to do so in a safe and reasonable manner. She further noted that non-weight bearing assessment was not applicable and that there was no objective evidence of pain of the spine in a non-weight bearing position at rest. After careful review of evidence of record, the Board finds that the Veteran’s back disability warrants a 20 percent rating, but no higher, for the entire appellate period. The Board notes that the May 2013 VA examiner did not address whether the Veteran experienced increased functional loss during repeated use over time or provide an estimate of functional loss during repeated use over time. Therefore, the Board finds that the May 2013 VA examination is inadequate or VA rating purposes in this regard. See Sharp, 29 Vet. App. at 35. Additionally, the Board finds the Veteran’s testimony regarding the inadequacy of March 2014 VA examination range of motion testing to be credible and thus affords this examination little probative value. The March 2019 VA examiner noted that the Veteran’s forward flexion decreased to 60 degrees due to pain and lack of endurance. Unfortunately, the VA examiner was not able to estimate whether pain, fatigue, weakness, lack of endurance, and incoordination caused any additional functional loss during flare-ups or with repeated use over time due to a deficiency in the record. Specifically, the VA examiner noted "there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions” and “there is no persistent evidence of record . . . that indicates a loss of function during these conditions." As the VA examiner provided a well-reasoned analysis, the Bord finds this VA examination does not violate the requirements put forth in Sharp. Further, the Board finds the Veteran's symptoms of decreased range of motion on repetition adequately reflects the Veteran's decreased motion with repetitive use over time. Thus, providing the Veteran the benefit of the doubt, the record reflects the Veteran's back disability more closely approximates the functional loss equivalent to forward flexion greater than 30 degrees but not greater than 60 degrees during flare-ups and with repeated use over time. The Board finds that a rating in excess of 20 percent is not warranted as the record does not reflect ankylosis or forward flexion of the thoracolumbar spine limited to 30 degrees or less, even during the Veteran's reported flare-ups or with repeated use over time. The Board has considered whether the Veteran is entitled to a disability rating under an alternative diagnostic code as back disabilities may also be evaluated under Diagnostic Code 5243 for IVDS. The criteria for IVDS rates the disability according to the number of incapacitating episodes suffered per year. 38 C.F.R. § 4.71a, Diagnostic Code 5243. As indicated above, the evidence does not show, and the Veteran does not allege, that he has had any physician prescribed bed rest at any time during the appeal period. Accordingly, Diagnostic Code 5243 is not applicable. Moreover, the Board has considered whether the Veteran is entitled to additional separate ratings for associated neurologic conditions, other than his bilateral lower extremity radiculopathy discussed in more detail below. However, the record does not reflect that the Veteran has had other neurologic abnormalities associated with his service-connected back disability. Therefore, a separate evaluation for associated additional neurologic conditions is not warranted. In sum, the Board finds that a disability rating of 20 percent, but no higher, is warranted for the Veteran’s back disability, effective July 28, 2011. To the extent that the Veteran contends entitlement to a higher rating, the preponderance of the evidence is against the claim; there is no reasonable doubt to be resolved; and any further increased rating is not warranted. 38 U.S.C. § 5107(b). Bilateral Lower Extremity Radiculopathy The Veteran’s bilateral lower extremity radiculopathy is in receipt of initial 10 percent ratings, pursuant to Diagnostic Code 8520, effective March 12, 2019. Under Diagnostic Code 8520, mild incomplete paralysis warrants a 10 percent disability rating. Moderate incomplete paralysis warrants a 20 percent disability rating. Moderately severe incomplete paralysis warrants a 40 percent disability rating. Severe incomplete paralysis with marked muscular atrophy, warrants a 60 percent rating. Complete paralysis of the sciatic nerve is evidenced by the foot dangled and dropped, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost and warrants an 80 percent rating. 38 C.F.R. § 4.124a. For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for mild, or at the most, the moderate degree. Id. The Board observes that the words “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. Upon review of the record, the Board finds that, as of March 12, 2019, the evidence shows that the Veteran was diagnosed with radicular symptoms related to his back disability, and thus, the assigned effective date for the Veteran’s radiculopathy is proper. The Board notes that while the Veteran’s 2012 VA treatment records note complaints of sciatic shooting pain, his MRI and CT at the time were normal and showed cysts on the sciatic nerve on the left lower extremity. Additionally, the May 2013 and March 2014 VA examiners specifically indicated that the Veteran did not have a peripheral nerve condition or a signs or symptoms due to radiculopathy. Moreover, the Board finds that the Veteran’s bilateral lower extremity radiculopathy does not warrant initial ratings in excess of 10 percent. There is no competent evidence to support a finding that the Veteran has worse than mild, incomplete paralysis of the bilateral lower extremities. The March 2019 VA examination noted normal muscle strength testing. Reflex examination revealed hypoactive reflexes for his bilateral ankles. Additionally, sensory examination revealed decreased sensation to light touch for the right lower leg/ankle and left thigh/knee. The examiner noted moderate intermittent pain of the right lower extremity, mild paresthesias and/or dysesthesias of the left lower extremity, and mild numbness of the bilateral lower extremities. The examiner classified the severity of the Veteran’s radiculopathy as mild. In sum, the Board finds that the Veteran’s bilateral lower extremity radiculopathy does not warrant initial ratings in excess of 10 percent. Accordingly, as the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b). REASONS FOR REMAND Service Connection for a Disability Manifested by Dizziness The Board finds that remand is required in order to obtain a VA examination and medical opinion for dizziness associated with traumatic brain injury (TBI). In this regard, the Veteran’s VA medical treatment records note that the Veteran sustained several in-service concussions without loss of consciousness and has been diagnosed with TBI. Additionally, the record indicates that the Veteran’s dizziness may be associated with his TBI. See March 2014 TBI consult note. To date, no VA examiner has opined whether the Veteran’s disability manifested by dizziness is due to TBI. Increased Rating for PTSD As the above requested examination might produce evidence pertaining to the evaluation of the Veteran’s PTSD, the Board has determined that the claim for an increased rating for PTSD is intertwined with the claim for service connection for a disability manifested by dizziness. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, a decision by the Board on the Veteran’s claim for an increased rating for PTSD would, at this point, be premature. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for a VA examination by an appropriate clinician to determine the nature and etiology of any disability manifested by dizziness. Based on the examination and review of the claims file, the examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sustained a TBI while in service. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran has any current residuals, to include dizziness, resulting from an in-service TBI. In providing the requested opinions, the examiner cannot rely on the absence of documentary evidence as a basis for an opinion. A complete rationale must be provided for all opinions expressed. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, to include the inextricably intertwined claim for an increased rating for PTSD. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.