Citation Nr: 21026558 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-28 919 DATE: May 3, 2021 ORDER Entitlement to service connection for a right hip disability is denied. Entitlement to service connection for a left hip disability is denied. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that a bilateral hip disability was not present in service or until many years thereafter, is not caused by an injury while serving with a Reserve Component, is not related to service or to an incident of service origin, and is not caused or aggravated by a service-connected disability. 2. The preponderance of the evidence shows that the left lower extremity radiculopathy causes no more than moderate incomplete paralysis of the sciatic nerve at any time during the appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hip disabilities have not been met. 38 U.S.C. §§ 101, 106, 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria for a rating in excess of 20 percent for left upper extremity radiculopathy have not been met at any time during the pendency of the appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.123, 4.124, 4.124a, Diagnostic Code 8599-8521. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1997 to July 1997. The Veteran also had additional service with a Reserve Component. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating from the Department of Veterans Affairs (VA) Regional Office (RO). In August 2018 the Board, among other things, remanded the above claims for further development. Post-Remand Compliance In this regard, the Board finds that the post-Remand development complied with the Remands because the August 2020 and March 2021 VA examinations/opinions, when taken together, provides VA with medical evidence adequate to adjudicate the Veteran's service connection and rating claims under all theories of entitlement. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board also finds that the post-Remand development complied with the Remands because while the appeal was in Remand status all identified and available VA and private treatment records were obtained and associated with the record. Id. Lastly, the Board notes that not all of the Veteran's active duty and Reserve Component records are available including an induction medical examination. However, the Board finds that all procedures to obtain the Veteran's service treatment records were correctly followed, and further attempts to obtain any missing records would be futile. See 38 C.F.R. § 3.159(c)(2), (3). As such, the Board recognizes it has a heightened duty to consider the application benefit-of-the-doubt rule when service records are unavailable. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, this heightened duty does not change the legal standard for establishing a service connection claim. See Russo v. Brown, 9 Vet. App. 46, 51 (1996). Therefore, the Board finds that further delay by remanding the appeal to provide the Veteran with a new VA examination or obtain additional service and post-service treatment records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). There is no basis to remand this appeal. The Service Connection Claims The Veteran contends he developed a bilateral hip disability due to military service and/or secondary to his service-connected disabilities, including, his service-connected lumbar spine disability and left lower extremity radiculopathy. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Additionally, service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA) or from injury incurred or aggravated while performing inactive duty training (INACDUTRA). 38 U.S.C. §§ 101(24), 106, 1110. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders, including arthritis and a psychosis, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. However, presumptive periods do not apply to ACDUTRA or INACDUTRA. See Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C. §§ 101(21) and (24); 38 C.F.R. §§ 3.6(a) and (d). ACDUTRA is, inter alia, full-time duty performed by member of the National Guard of any State. 38 C.F.R. § 3.6(c)(3). In this regard, in order to establish service connection for the claimed disorders, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Ward v. Wilkie, 31 Vet. App. 233 (2019). The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for bilateral hip disabilities Initially, the Board finds the Veteran was diagnosed with trochanteric pain syndrome at the February 2021 VA examination. Therefore, the first requirement for service connection, a current disability, has been met. The Boards also finds that the Veteran is competent to report on the events he experienced while on active duty like manifestations of his disabilities, such as (for example) pain and lost motion. See Davidson, supra. However, active duty and Reserve Component treatment records are negative for injuries, complaints, treatment for symptoms, and/or a diagnosis of hip disabilities to include the October 2000 examination medical report for transfer into the Air Force National Guard, the Officer Candidate School commissioning physical examination in April 2006, and the March 2013 final report of the Air Force Physical Evaluation Board even though they documented his complaints, diagnoses, or treatment for other problems and injuries including chronic low back and neck pain. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Accordingly, the Board finds that the most probative evidence of record shows that the Veteran did not develop hip disabilities due to a disease or injury while on active duty or hip disabilities due to an injury while serving with a Reserve Component. 38 U.S.C. §§ 101, 106, 1110; 38 C.F.R. § 3.303(a); Colvin, supra. As to service connection for bilateral hip disabilities based on the presumptions found at 38 C.F.R. § 3.309(a), the record does not show that arthritis in either hip in the first year following his separation from a period of active duty service. Therefore, the Board finds that these presumptions do not help the Veteran establish service connection for bilateral hip disabilities. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. § 3.307. Next, the Board will consider whether the Veteran is entitled to service connection for bilateral hip disabilities due to continuity of symptomatology under 38 U.S.C. § 1110; 38 C.F.R. § 3.303(b). In this regard, and as noted above, the service and Reserve Component medical records, including the October 2000, April 2006, and March 2013 examinations, are negative for complaints, diagnoses, or treatment for hip disabilities. See Colvin, supra. Likewise, and more important than the above, the post-service record is negative for complaints or treatment for bilateral hip disabilities until 2016 with the first diagnosis of a hip problem appearing in the record in 2021. At this point, the Board finds that the service medical records, Reserve Component examinations, and the post-active duty medical records provide the most probative evidence of record and it is against finding continuity of symptomatology. See Owens, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with hip disabilities in and since service. See 38 U.S.C. § 101, 106, 1110; 38 C.F.R. § 3.303(b). Furthermore, the Board finds that the record does not show that the Veteran's post-service bilateral hip disabilities are due to his military service. See 38 U.S.C. §§ 101, 106, 1110; 38 C.F.R. § 3.303(d); also see Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred therein). In this regard, given the above record which is negative for an injury and/or treatment for hip disabilities while on active duty or serving with a Reserve Component, the Board finds that VA had no obligation to obtain a medical opinion as to this question. See Paralyzed Veterans of America, et. al., v. Secretary of Veterans Affairs, 345 F.3d 1334 (Fed. Cir. 2003) (holding that the criteria for obtaining an etiology opinion have not been met when the evidence of record does not establish that the veteran suffered an event, injury, or disease in service because no reasonable possibility exists that providing a medical examination or obtaining a medical opinion would substantiate the claim); Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (VA is not obligated to provide an examination for a medical nexus opinion where, as here, the supporting evidence of record consists only of a lay statement). It is important for the Veteran to understand that at this point both the factual evidence and the medical evidence (treatment records and the best medical opinions) provides highly probative evidence against the claims that the Board cannot ignore. In addition, the Board finds that the Veteran is not competent to provide the missing nexus opinions because she does not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused his current bilateral hip disabilities). See Davidson, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's post-service bilateral hip disabilities are not due to his military service. See 38 U.S.C. §§ 101, 106, 1110; 38 C.F.R. § 3.303(d); also see Rabideau, supra. Lastly, the Board finds that the most probative evidence of record shows that the Veteran's bilateral hip disabilities are not caused or aggravated by his service-connected lumbar spine disability and left lower extremity radiculopathy. See 38 U.S.C. §§ 101, 106, 1110; 38 C.F.R. § 3.310; also see Allen, supra; Wallin, supra; Ward, supra. In this regard, the Board notes that in August 2020 VA requested the examiner who conducted the November 2016 VA examination to render an opinion on the etiology of the Veteran's claimed hip condition and to state if it was proximately due to or aggravated by any of his service-connected disabilities. Ultimately, in August 2020 the VA examiner opined the Veteran's claimed hip condition is at least as likely as not proximately due to or the result of the Veteran's service-connected lumbar spine disability. In support, examiner cited to a radiographic study of the Veteran's bilateral hip, ordered in November 2016, showing there is no bony, articular, or soft tissue abnormalities identified, specifically, the hip joints are well preserved. The examiner pointed to the fact that radiculopathy, which results from nerve compression in the lower back, can lead to a variety of uncomfortable symptoms, including pain, weakness and numbness in the low back, legs and hip region. The Board notes that it is not entirely clear from the record what hip disability is referred to by the August 2020 VA opinion, because the examiner refers to his November 2016 examination, where there is no hip disability diagnosed. Thus, the Board will take the August 2020 VA opinion to refer to the Veteran's symptoms of pain while walking during flare-ups and abnormal range of hip motion, which, are documented symptoms of the Veteran's hip disability that presumably went undiagnosed. Nonetheless, the Board finds the August 2020 VA addendum opinion provides very little probative value and affords it little weight in the analysis of the Veteran's claim because it first reports negative radiographic results that show no abnormalities in the Veteran's hip and then opined generally that nerve compression can lead to comfortability issues in several areas of the body, not specific to the Veteran. See Nieves-Rodriguez, 22 Vet. App. at 301 ("[An adequate] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." (citing Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007)). The Veteran next underwent a VES contract examination for the VA in February 2021 for his bilateral hip condition. The examiner diagnosed the Veteran with trochanteric pain syndrome (includes trochanteric bursitis). On examination, the Veteran reported constant pain, numbness and tingling down the left lower extremity and left hip. He continued to have limitation in range of motion in all planes with global hypertonicity. In describing the symptoms, the Veteran reported his pain runs along the outer aspect of his thigh, crosses over the knee, and runs into his big toe. The record contains an addendum VA opinion, initially dated in July 2020, but presumably updated, because it discusses the February 2021 VES contract examination directly, associated with the claims file in March 2021. The March 2021 VA examiner opined the Veteran's subjective bilateral hip pain and limited range of motion (as noted on previous November 2016 VA examination) and bilateral trochanteric pain syndrome (diagnosed in the February 2021 VA examination) are less likely than not proximately due to or the result of Veteran's service connected lumbar spine disability with left lower extremity radiculopathy. In support, the examiner reported, the two diseases are different disease entities with different pathophysiological processes unrelated to each other at different anatomical position with different biomechanical interaction. Each condition is intrinsic of its own anatomical area and there is insufficient medical literature to support a direct nexus between the two diseases. Moreover, the examiner reported that based on Mayo Clinic literature there is no causal relationship between bilateral trochanteric pain syndrome and the service connected back disability with left lower extremity radiculopathy. Furthermore, while the examiner reported the medical evidence is not sufficient to support a determination of a baseline level of severity, it was nonetheless opined that it is less likely than not the Veteran's subjective bilateral hip pain and limited range of motion and recent diagnosis of bilateral trochanteric pain syndrome was aggravated by the service connected lumbar spine disability with left lower extremity radiculopathy. In support, the examiner reported that there is no clinical and objective evidence that can support that the Veteran's current condition was aggravated beyond its natural progression by the Veteran's service-connected disabilities. Moreover, the examiner found the current condition followed its natural progression from onset. The Board finds the March 2021 VA opinion the most probative evidence of record because it is provided after a review of the record on appeal as well as because it is supported by the evidence found in the record including the Veteran's lay statements and controlling medical principles. See Colvin, supra; Owens, supra; Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators..."). Therefore, the Board finds that it is the most probative evidence of record. In addition, the Board finds that the Veteran is not competent to provide the missing nexus opinions because he does not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused his current bilateral hip disabilities). See Davidson, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's bilateral hip disability are not caused or aggravated by a service-connected disability. See 38 U.S.C. §§ 101, 106, 1110; 38 C.F.R. § 3.310; also see Allen, supra; Wallin, supra; Ward, supra. Accordingly, the Board finds that the preponderance of the evidence is against the Veteran's claims of service connection for bilateral hip disabilities. 38 U.S.C. §§ 101, 106, 1101, 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. In reaching the above conclusions, the Board has also considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the probative evidence is against the claims, the Board finds that this doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, 1 Vet. App. at 55-56. The Increased Rating Claim The Veteran also claims, in substance, that he is entitled to a higher rating for his service-connected left lower extremity radiculopathy. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155: 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation 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. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009). Importantly, the evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. 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 of or overlapping with the symptomatology of the other condition. Id. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy The Veteran's left lower extremity radiculopathy is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8599-8521 as 20 percent disabling. Under Diagnostic Code 8521, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis, with foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes is rated as 40 percent disabling. 38 C.F.R. § 4.124a. 38 C.F.R. § 4.123 provides that neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.124 provides that neuralgia, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. Importantly, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124A, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). With the above criteria in mind, the Board notes that at the June 2011 VA examination for spine disabilities, muscle strength in the left lower extremity was normal and there was no muscle atrophy. Detailed reflexes in the left lower extremity as well as the sensory and motor examinations were all normal. Electrodiagnostic study results showed no evidence of left lower extremity radiculopathy. While the Veteran reported pain and pressure from his low back that radiated to his left lower extremity, the examiner opined that there was no evidence of left lower extremity radiculopathy by examination or by electrodiagnostic study. At the December 2012 VA examination, the Veteran reported constant pain manifesting as an electric sensation in his left lower extremity (radiculopathy). The VA examiner opined that his left lower extremity radiculopathy caused severe constant pain, no intermittent pain, no paresthesias/dysesthesias, and moderate numbness. On examination, muscle strength in the left lower extremity was normal at 5/5, except for 4/5 with great toe extension. There was no muscle atrophy. Deep tendon reflexes in the left lower extremity were hypoactive (less active than normal) at 1+. The sensory examination showed decreased sensation in the left lower leg/ankle and foot/toes. Straight leg raising was positive on the left. The VA examiner opined the severity of the condition was normal (i.e., neither complete paralysis nor incomplete paralysis existed) for all lower extremity nerves, including the sciatic, external and internal popliteal, deep peroneal, posterior tibial and anterior crural (femoral) nerve, amongst others as noted in the report. The Veteran's condition was thereafter diagnosed as clinical left lower extremity radiculopathy. At the November 2016 VA examination, the Veteran reported shooting pain in left lower extremity that is intermittent. The VA examiner opined that his left lower extremity radiculopathy caused severe constant pain, no intermittent pain, moderate paresthesias/dysesthesias, and moderate numbness. On examination, muscle strength in the left lower extremity was normal at 5/5. There was no muscle atrophy. Deep tendon reflexes in the left lower extremity were hypoactive (less active than normal) at 1+. The sensory examination showed decreased sensation in the left lower leg/ankle and foot/toes. The VA examiner opined the severity of the condition was normal (i.e., neither complete paralysis nor incomplete paralysis existed) for all lower extremity nerves, including the sciatic, external and internal popliteal, deep peroneal, posterior tibial and anterior crural (femoral) nerve, amongst others as noted in the report. In February 2021 the Veteran underwent a VA examination for hip and thigh conditions in order to determine if his left lower extremity radiculopathy was a distinct and separate medical condition from his claimed hip condition. The Veteran reported his radiculopathy pain runs along the outer aspect of his thigh, crosses over the knee, and runs into his big toe. He said it is near constant and exacerbated by prolonged sitting and standing. He also reported numbness and tingling down the same distribution. On examination, the examiner found the condition progressed/worsened since onset and opined his condition was currently at a moderate severity level. The examiner opined that the most-significant contributor to the Veteran's pain was his lower back, which manifests mainly as numbness and tingling in his left lower extremity. Initially, the Board finds that while treatment records document the Veteran's complaints and treatment for left leg radiculopathy, nothing in these records shows the Veteran's adverse symptomatology to be worse than what was reported by the above VA examiners. See Colvin, supra. The Board also finds the VA examiners opinions as to the severity of the adverse radiculopathy symptomatology more probative than any lay claims from the appellant to the contrary, even though his symptomatology is observable by a lay person, because the examiners have medical training. See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). Additionally, the February 2021 VA examiner characterized the radiculopathy as moderate after reporting the most-significant contributor to the Veteran's pain was his lower back, which manifests mainly as numbness and tingling in his left lower extremity. The December 2012 and November 2016 VA examiners both opined the severity of the Veteran's lower extremity condition was "normal" (i.e., neither complete paralysis nor incomplete paralysis existed) for all lower extremity nerves, despite finding severe constant pain, moderate paresthesias/dysesthesias and moderate numbness. However, as noted above, the examiners characterization as to the severity of a disability is not binding on the Board but instead all evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Importantly, "severe" incomplete paralysis is not defined by regulation, given the above record the Board finds that it must equate to more serve symptomatology than the 4/5 with great toe extension strength as reported by the December 2012 VA examiner and the 1+ deep tendon reflexes in the left lower extremity as well as sensory examination showing decreased sensation in the left lower leg/ankle and foot/toes, and straight leg raising being positive as reported by the December 2012 and the November 2016 VA examiners. See Owens, supra. In this regard, the Board finds it significant that both VA examiners reported strength in the left lower extremity otherwise being normal at 5/5 and there was no muscle atrophy. Id. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's left lower extremity radiculopathy is manifested by no more than moderate symptoms at any time during the appeal. Id. Accordingly, the Board finds that the preponderance of the evidence shows that the Veteran's does not meet the criteria for a rating in excess of 20 percent for his left lower extremity radiculopathy under Diagnostic Code 8521 at all times during the appeal. See 38 C.F.R. § 4.124a; Fenderson, supra; Hart, supra. In reaching the above conclusions, the Board notes that the November 2016 VA examiner noted functional impact of the Veteran's left lower extremity radiculopathy prevented him from standing or sitting for long periods of time. However, the record shows that the Veteran remained working full-time. See June 2011 VA Spine Disabilities Examination (Veteran employed as construction manager for 10-20 years; lost 3 weeks due to back pain). Moreover, the Board finds that the combined 80 percent rating already assigned his service-connected disabilities contemplates the fact that service-connected disabilities would cause claimants to lose time from work. Therefore, the Board finds that the record does not raise a claim for a total rating based on individual unemployability (TDIU) despite the Court's holding in Rice v. Shinseki, 22 Vet. App. 447 (2009). In reaching all the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claim to the extent outline above, the Board finds that the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert, supra. NEIL T. WERNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Davidson 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.