Citation Nr: 21026027 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-45 764 DATE: April 29, 2021 ORDER For the entire period on appeal, an increased evaluation in excess of 10 percent for the Veteran’s service-connected low back disability, to include a lumbar strain and degenerative disc disease, is denied. FINDING OF FACT For the entire period on appeal, the Veteran’s service-connected low back disability, to include degenerative disc disease (DDD), manifested the following: pain; forward flexion of the thoracolumbar spine of 85 degrees; a combined range of motion of the thoracolumbar spine of 180 degrees, without evidence of the following: unfavorable ankylosis of the entire lumbar spine; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or IVDS with incapacitating episodes of acute signs and symptoms requiring bed rest and treatment prescribed by a physician in the past 12 months. CONCLUSION OF LAW For the entire period on appeal, the criteria for the assignment of an increased evaluation in excess of 10 percent for the Veteran’s service-connected low back disability have not been met. 38 U.S.C. § 1155, 5107, 5110; 38 C.F.R. §§ 3.400, 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Codes 5237, 5242. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the U.S. Marine Corps from August 2002 to April 2003, from June 2004 to April 2005, and from May 2007 to April 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned at a hearing held in March 2019; a transcript of that hearing is of record. In September 2020, the Board remanded this appeal for further development, including scheduling the Veteran for a VA examination to evaluate his low back condition. To the extent that the directed VA examination report was procured in January 2021, the Board finds that substantial compliance with its remand directives pertaining to the Veteran’s low back claim has been accomplished. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). For the entire period on appeal, an increased evaluation in excess of 10 percent for the Veteran’s service-connected low back disability, to include a lumbar strain and degenerative disc disease, is denied. For the entire period on appeal, the Veteran has been awarded a 10 percent evaluation for his service-connected low back disability, effective June 17, 2013. The Veteran contends that the severity of his service-connected low back disability warrants an increased evaluation in excess of 10 percent; however, for the reasons set forth below, the Board disagrees and finds that an increased evaluation in excess of 10 percent for the Veteran’s service-connected low back disability is not warranted in this case. Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Disability evaluations are based upon the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. See 38 C.F.R. § 4.10. In evaluating the severity of a particular disability, it is essential to consider its history. See 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Separate diagnostic codes identify the various disabilities. See 38 C.F.R. § 4.27. VA has a duty to acknowledge and to consider all regulations that are potentially applicable to issues raised in the record and to explain the reasons and bases for its conclusions. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. See 38 C.F.R. §§ 3.321(a), 4.1, 4.21. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. See 38 C.F.R. § 4.3. The assignment of a particular diagnostic code depends upon the facts of each particular case, and the Board is authorized to choose an appropriate diagnostic code that is supported by both the evidence of record and a sufficiently articulated rationale. See Butts v. Brown, 5 Vet. App. 532, 538-39 (1993). Moreover, service connection for a disability is not severed when the diagnostic code assigned to that disability is revised in order to more accurately reflect the veteran’s relevant medical history, diagnoses, and demonstrated symptomatology. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether they were raised by the Veteran, as well as the entire history of the Veteran’s disability. See 38 C.F.R. § 4.1, 4.2; Schafrath,1 Vet. App. at 595. Separate evaluations may be assigned for separate periods of time, or staged, where factual findings show distinct time periods during which the Veteran’s disability exhibits symptoms that warrant the application of different ratings. See Fenderson v. West, 12 Vet. App. 119, 126-28 (1999); see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Additionally, the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. See 38 C.F.R. § 4.14. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Effective dates for disability ratings may be established up to one year prior to the date of claim if, based upon all the evidence of record, it can be factually ascertained that an increase in the Veteran’s service-connected disability occurred during that year preceding the claim. See 38 U.S.C. § 5110(b)(3); C.F.R. § 3.400(o)(2). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. See 38 C.F.R. § 4.40. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. See id. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. See id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. See id. The factors involved in evaluating and rating disabilities of the joints include the following: less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); weakened movement (due to muscle injury, disease, or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; incoordination and impaired ability to execute skilled movements smoothly; or pain on movement, swelling, deformity, or atrophy of disuse. See 38 C.F.R. § 4.45. Functional loss caused by pain must be rated at the same level as if that functional loss were caused by some other factor that actually limited motion, such as deformity, atrophy, adhesions, or any of the other factors cited above. See Schafrath, 1 Vet. App. at 592. Consequently, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See id. Where the veteran is diagnosed with any form of arthritis, painful motion is an important factor of disability, and facial expressions such as wincing exhibited in the presence of pressure on or manipulation of the affected joints, should be carefully noted and related to the affected joints. See 38 C.F.R. § 4.59. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. See id. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See id. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. See id. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weightbearing and, if possible, with the range of the opposite undamaged joint. See id. When adjudicating disabilities evaluated based upon limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40 and 4.45 pertaining to functional impairment. See DeLuca v. Brown, 8 Vet. App. 202, 205-07 (1995). In applying these regulations, VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, or incoordination. See id. Such inquiry should not be limited to muscles or nerves, and, if feasible, these determinations should be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, or incoordination. See id. Consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis; thus, a rating based on painful motion of a joint may be appropriate regardless of whether the painful motion stemmed from joint or periarticular pathology. See Burton v. Shinseki, 25 Vet. App. 1, 4-5 (2011). However, pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Although pain may cause functional loss, pain itself does not constitute functional loss and is merely one factor to be considered when evaluating functional impairment; see id.; however, 38 C.F.R. § 4.40 does not require a separate rating for pain, but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194, 196 (1997). Once the evidence has been assembled in the record, it is the Board’s responsibility to consider all lay and medical evidence of record, analyze the credibility and probative value of the evidence, and provide reasons for rejecting any material evidence favorable to the claimant. See 38 U.S.C. § 7104(a); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In addressing lay evidence and determining its probative value, the Board must assess both its competency, a legal concept determining whether testimony may be heard and considered, and credibility, a factual determination regarding the probative value of the evidence. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall afford the claimant the benefit of the doubt. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Where the evidence is in relative equipoise, the claimant shall prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). The preponderance of the evidence must weigh against the Veteran’s claim in order for it to be denied. See Alemany v. Brown, 9 Vet. App. 518, 519-20 (1996). Disabilities of the spine, to include the low back (lumbar spine) are evaluated under the criteria set forth in Diagnostic Codes 5235 through 5243. See 38 C.F.R. § 4.71a (2020). Diagnostic Code 5242 provides that evaluations of degenerative arthritis of the lumbar spine shall be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). See id. The General Rating Formula provides that with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, evaluations of the spine apply as follows: (1) a 100 percent evaluation is warranted where there is evidence of unfavorable ankylosis of the entire spine; (2) a 50 percent evaluation is warranted where there is evidence of unfavorable ankylosis of the entire thoracolumbar spine; (3) a 40 percent evaluation is warranted where there is evidence of unfavorable ankylosis of the entire cervical spine; forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine; (4) a 30 percent evaluation is warranted where there is evidence of forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine; (5) a 20 percent evaluation is warranted where there is evidence of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the thoracolumbar spine not greater than 120 degrees; 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; and (6) a 10 percent evaluation is warranted where there is evidence of forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; 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. See id. Note 1 requires the evaluation of any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. See id. Note 2 provides that for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See id. Note 3 provides that in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). See id. Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note 4 requires that each range of motion measurement be rounded to the nearest five degrees. See id. Note 5 provides that for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. See id. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note 6 provides that disabilities of the thoracolumbar and cervical spine segments, must be evaluated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. See id. If applicable, spinal disabilities manifesting IVDS based on incapacitating episodes (preoperatively or postoperatively) may be rated under either the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25. The IVDS Rating Formula provides as follows: (1) a 60 percent evaluation is warranted where there is evidence of incapacitating episodes having a total duration of at least 6 weeks during the past 12 months; (2) a 40 percent evaluation is warranted where there is evidence of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; (3) a 20 percent evaluation is warranted where there is evidence of incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; and (4) a 10 percent evaluation is warranted where there is evidence of incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. See 38 C.F.R. § 4.71a For purposes of evaluations under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires treatment by a physician and bed rest prescribed by a physician. See 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note 1. If IVDS is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula, whichever method results in a higher evaluation for that segment. See id., Note 2. Degenerative arthritis established by x-ray findings must be evaluated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. However, when the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. See id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. See id. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations, will warrant a 20 percent rating. See id. X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups will warrant a 10 percent rating. See id. The 10 percent and 20 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. In addition, VA regulations require that any evaluation of a disability of the lumbar spine must also include a separate evaluation of any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note 1. The Board notes that the criteria for the evaluation of musculoskeletal disabilities in the VA Rating Schedule have been amended effective February 7, 2021 (the 2021 Regulations); therefore, claims filed on or after February 7, 2021, must be evaluated under the 2021 Regulations. See 85 Fed. Reg. 76453-76469 (November 30, 2020); 85 Fed. Reg. 85523-85524 (December 29, 2020). In this case, although the Veteran’s low back claim was filed prior to February 7, 2021, to the extent that the period on appeal relating to such claim extends beyond February 7, 2021, such claims must be evaluated under both the prior regulations and the 2021 Regulations, and the set of criteria most favorable to the Veteran must be applied. See Kuzma v. Principi, 341 F.3d 1327, 1328-29 (Fed. Cir. 2003). However, because the 2021 Regulations made no changes to Diagnostic Codes 5237 or 5242 that substantively impact the Veteran’s claim, the Board’s analysis of the Veteran’s claim is not modified by the application of either set of criteria in any appreciable manner. As stated above, the Veteran has been awarded a 10 percent evaluation for his service-connected low back disability, effective June 17, 2013, and the Veteran contends that the severity of his service-connected low back disability warrants an increased evaluation in excess of 10 percent. However, after careful consideration of the evidence of record, the Board finds that an increased evaluation in excess of 10 percent for the Veteran’s service-connected low back disability is not warranted in this case, as a preponderance of the evidence of record demonstrates that for the entire period on appeal, the Veteran’s service-connected low back disability has manifested pain, forward flexion of the lumbar spine limited at most to 80 degrees, and a combined range of motion of the lumbar spine limited at most to 180 degrees, without evidence of the following: unfavorable ankylosis of the entire lumbar spine; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or IVDS with incapacitating episodes of acute signs and symptoms requiring bed rest and treatment prescribed by a physician in the past 12 months. In August 2014, the Veteran was afforded a VA examination to evaluate his service-connected low back disability, which culminated in a report diagnosing degenerative arthritis of the spine and thoracic degenerative disc disease (DDD), and indicating the following symptoms: thoracic back pain without radiation, numbness, tingling or weakness starting in 2003; forward flexion limited to 90 degrees, unchanged after three repetitions; a combined range of motion of the lumbar spine of 240 degrees, unchanged after three repetitions; no objective evidence of painful motion; flare-ups described as the Veteran “constantly trying to crack” his back; localized tenderness or pain to palpation for joints and/or soft tissue, including mild thoracic paraspinal tenderness to palpation; and x-rays dated August 2014 indicating mild DDD of the midthoracic spine. The August 2014 VA examination report further indicates as follows: no observed guarding or muscle spasm of the thoracolumbar spine; no loss of muscle strength; no muscle atrophy; no decreased sensation; no radiculopathy symptoms; no ankylosis; no neurological abnormalities; no bowel or bladder symptoms; no use of assistive devices; no IVDS; no impact on the Veteran’s ability to work; no additional loss of range of motion due to pain on use or during flare-ups; and neither pain, weakness, fatigability, or incoordination significantly limiting the Veteran’s functional ability during flare-ups or when the joint is used repeatedly over a long period of time. In November 2015, the Veteran was afforded a second VA examination which culminated in a report confirming his diagnosis of degenerative arthritis of the spine and mild DDD of the mid-thoracic spine, and indicating the following symptoms: gradual onset of thoracic back pain without radiation, numbness, tingling or weakness, including pain with sitting for long periods; treatment by a chiropractor; forward flexion limited to 90 degrees, unchanged after three repetitions; a combined range of motion of the lumbar spine of 235 degrees, unchanged after three repetitions; and pain noted upon exam with extension but does not result in or cause functional loss. The November 2015 VA examination report further indicates as follows: no flare-ups reported; no observed guarding or muscle spasm of the thoracolumbar spine; no evidence of pain with weight bearing; no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine; no additional loss of function or range of motion after three repetitions; no loss of muscle strength; no muscle atrophy; no decreased sensation; no radiculopathy symptoms; no ankylosis; no neurological abnormalities; no bowel or bladder symptoms; no use of assistive devices; no IVDS; and no impact on the Veteran’s ability to work. In January 2021, the Veteran was afforded a third VA examination which culminated in a report diagnosing a lumbosacral strain and mild DDD of the mid-thoracic spine and indicating the following symptoms: daily back pain, to include his low, mid, and upper spine; tightness causing him to stretch several times per day and to “crack his back” on a daily basis; flareups described as excruciating back pain that occurs daily and radiates to his chest, tightness, and stiffness which causes him to awaken during the night and can last from six to eight hours; functional loss involving the inability to bend or to twist his body and a limited ability to pick up heavy objects from the floor; current treatment involving motrin, a TENS unit, an inversion table, rest, physical therapy, chiropractic treatment, and acupuncture treatment; initial forward flexion limited to 90 degrees; an initial combined range of motion of the lumbar spine of 240 degrees; no additional loss of function or range of motion after three repetitions; pain noted on exam with forward flexion and extension, but does not result in or cause functional loss; no evidence of pain with weight bearing; no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine; objective evidence of pain when the spine is non-weight bearing; pain significantly limiting functional ability with repeated use over a period of time, described in range of motion as forward flexion limited to 80 degrees, and a combined range of motion limited to 200 degrees; pain significantly limiting functional ability with flareups described in range of motion as forward flexion limited to 80 degrees, and a combined range of motion limited to 180 degrees; and a negative impact on the Veteran’s ability to work as a police officer, due to his daily back pain that awakens him and results in his inability to maintain sleep, his inability to fully bend or to flex his back, and his limited ability to engage in physical activities. The January 2021 VA examination report further indicates as follows: no observed guarding or muscle spasm of the thoracolumbar spine; no loss of muscle strength; no muscle atrophy; no decreased sensation; no radiculopathy symptoms; no ankylosis; no neurological abnormalities; no bowel or bladder symptoms; no use of assistive devices; and no IVDS. After careful review and in light of the foregoing, the Board finds that, for the entire period on appeal, the preponderance of the evidence of record weighs against a finding that an increased evaluation in excess of 10 percent is warranted, as the Veteran’s service-connected low back disability manifested forward flexion limited at most to 80 degrees, and a combined range of motion of the lumbar spine limited at most to 180 degrees. Moreover, at no time during the period on appeal did the Veteran’s low back disability manifest the following: forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; 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. The Board has also considered whether the provisions of 38 C.F.R. §§ 4.40, 4.45 pertaining to functional impairment must be applied in order to determine whether the disability at issue manifested weakened movement, excess fatigability, or incoordination. See DeLuca, 8 Vet. App. at 205-07. In this case, the examiner conducted repetitive testing and noted no change in the range of motion. In other words, even factoring the functional impact of pain, the Veteran’s range of motion did not more nearly approximate forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, 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. The evidence of record also does not reflect a separate evaluation is warranted as no neurological symptoms associated with the low back have been indicated. Although the Veteran described symptoms of numbness and tingling and a March 2021 private record noted bilateral radiculopathy, this practitioner did not support the diagnosis with clinical findings. Furthermore, the VA examinations have consistently reflected that all sensory examination has been normal, and no evidence has been presented of radiculopathy or neurological involvement such as bowel or bladder incontinence. The Board has also considered whether the Veteran’s service-connected low back disability warrants the assignment of an additional or a higher rating under other diagnostic codes at any point during the period on appeal; however, because the record contains no evidence of IVDS episodes requiring bed rest prescribed by a physician, or of any neurologic abnormalities, such as radiculopathy, or bowel or bladder impairment, the Board finds that no additional disability ratings are warranted in this case. See Schafrath, 1 Vet. App. at 595. The Veteran has not specifically raised any other issues, nor have any other issues been reasonably raised by the evidence of record. See Doucette v. Shulkin, 28 Vet. App. 366, 370 (2017). (Continued on the next page)   Accordingly, in consideration of the foregoing evidence, the Board finds that, for the entire period on appeal, the preponderance of the evidence of record weighs against an award of an evaluation in excess of 10 percent under Diagnostic Codes 5237 or 5242 for the Veteran’s service-connected low back disability. Accordingly, because the preponderance of the evidence weighs against the award of any additional increased evaluations, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Marsdale 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.