Citation Nr: 21029623 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 14-25 284A DATE: May 14, 2021 ORDER Entitlement to an initial disability rating of 100 percent for bipolar disorder, with symptoms of depression and anxiety (formerly evaluated as acute psychotic disorder) effective August 29, 2011, is granted. An effective date of March 30, 2012, but no earlier, for service-connected sciatic nerve radiculopathy right lower extremity rated as 10 percent disabling is granted. A 20 percent rating, but no more, for sciatic nerve radiculopathy right lower extremity from October 25, 2019, is granted. REMANDED Entitlement to an initial disability rating in excess of 10 percent for moderate chronic lumbosacral strain effective August 29, 2011, is remanded. FINDINGS OF FACT 1. Throughout the entire period on appeal, the Veterans service-connected bipolar disorder manifested by total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 2. From March 30, 2012, to October 24, 2019, the Veteran's service-connected sciatic nerve radiculopathy right lower extremity manifested by mild incomplete paralysis based on pain but did not include impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, muscle atrophy, or complete paralysis. 3. From October 25, 2019, the Veteran's service-connected sciatic nerve radiculopathy right lower extremity manifested by moderate incomplete paralysis based on pain and sensory disturbances of paresthesias and/or dysesthesias but did not include impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating of 100 percent for bipolar disorder, with symptoms of depression and anxiety (formerly evaluated as acute psychotic disorder) effective August 29, 2011, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9432. 2. The criteria for an effective date of March 30, 2012, but no earlier, for service-connected sciatic nerve radiculopathy right lower extremity rated as 10 percent disabling have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 3. The criteria for a 20 percent rating, but no more, for sciatic nerve radiculopathy right lower extremity from October 25, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1998 to April 2007. These matters come to the Board of Veterans' Appeals (Board) on appeal from December 2012 and June 2013 rating decisions issued by the Department of Veterans' Affairs (VA) Regional Office (RO). Preliminary matters The Veteran's claims have been the subject of multiple rating decisions during the pendency of his appeals. In December 2012, the RO granted service connection for chronic lumbosacral strain at 10 percent disabling effective August 29, 2011, from which the Veteran timely appealed. In a June 2013 rating decision, the RO granted service connection for bipolar disorder with a 30 percent disability rating effective August 29, 2011, from which the Veteran timely appealed. During the pendency of the Veteran's appeals, in a February 2015 rating decision, the RO granted an increased rating for bipolar disorder to 70 percent disabling effective June 9, 2014, and denied entitlement to a total disability rating due to individual unemployability as a result of service-connected conditions (TDIU). In a July 2017 rating decision, the RO granted TDIU effective June 9, 2014. The matters were brought before the Board prompting a June 2019 decision wherein, of relevance, the Board remanded for additional development the issues of entitlement to a disability rating in excess of 10 percent for chronic lumbosacral strain; entitlement to a disability rating in excess of 70 percent from June 9, 2014, and in excess of 30 percent prior to that date for bipolar disorder; and entitlement to TDIU prior to June 9, 2014. Unfortunately, as will be discussed in more detail below, remand is again necessary regarding only the Veteran's chronic lumbar strain claim to ensure substantial compliance with the June 2019 remand directives and an adequate examination. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Thereafter, the RO issued another rating decision in November 2019 increasing the Veteran's disability rating for bipolar disorder to 100 percent, effective October 24, 2019, and granting service connection for sciatic nerve radiculopathy right lower extremity at 10 percent disabling effective October 25, 2019. The United States Court of Appeals for Veterans Claims (CAVC or "the Court") has recently held in Chavis v. McDonough that the Board has jurisdiction to address ratings for associated radiculopathy without requiring a separate notice of disagreement (NOD) as to the radiculopathy ratings when those issues were part of the Veteran's claim for an increased rating. Here, the Veteran filed an increase rating claim for his moderate chronic lumbosacral strain for which radiculopathy ratings had not been assigned at the time of his appeal. Thus, the Board finds, like in Chavis, the Board has jurisdiction to address the newly awarded rating for sciatic nerve radiculopathy right lower extremity as well as any other neurological impairments. Chavis v. McDonough, U.S. Court of Appeals for Vet. Claims No. 18-2928 (decided April 16, 2021). In September 2020, the RO granted TDIU effective August 29, 2011. The RO's award of TDIU based on the date of the Veteran's claim is considered a full grant of the benefit sought; thus, this issue is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997); see also 38 C.F.R. § 3.400. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. 38 C.F.R. § 4.1. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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. 38 C.F.R. § 4.7. The basis of disability evaluations is 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. 38 C.F.R. § 4.10. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). The Veteran's entire history is reviewed when making disability evaluations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1995). After careful consideration of the evidence, any reasonable doubt remaining is resolved in the Veteran's favor. 38 C.F.R. § 4.3. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007); Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 1. Entitlement to an initial disability rating of 100 percent for bipolar disorder, with symptoms of depression and anxiety (formerly evaluated as acute psychotic disorder) effective August 29, 2011, is granted. The Veteran contends his bipolar disorder symptoms entitle him to a higher disability rating prior to October 24, 2019. The Board finds a total disability rating of 100 percent is warranted effective August 29, 2011. Mental health disorders are evaluated under the General Rating Formula for Mental Disorders, a specific rating formula presented under 38 C.F.R. § 4.130. In addition, the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) provides guidance for the nomenclature employed within 38 C.F.R. § 4.130. Under the General Formula for Mental Disorders, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a Veteran's symptoms, but the Board must also make findings as to how those symptoms impact occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the phrase "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear the Veteran's impairment must be "due to" those symptoms, a Veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. In this case, the Veteran's service-connected bipolar disorder is rated under DC 9432 as 70 percent disabling effective August 29, 2011, and 100 percent disabling effective October 24, 2019. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 38 C.F.R. § 4.130, DC 9432. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130, DC 9432. As previously mentioned, the Veteran was assigned a total disability rating of 100 percent effective October 24, 2019. Thus, the Board will consider the remaining period on appeal beginning August 29, 2011, the date of the Veteran's claim for benefits, to October 23, 2019. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400; see also June 2019 Board decision. Turning to the relevant evidence of record, in August 2011, the Veteran reported feeling more depressed, experiencing low energy, and difficulty concentrating. See August 2011 VA treatment records. In 2012, he reported increased anxiety and flashbacks. See February 2012 VA treatment records. He reported two prior hospitalizations including one precipitated by "acting bizarre" including yelling at his roommate to leave the room so that he could use the roommate's bed without wearing clothing. Id.; see also February 2011 VA treatment records. Records reflect the Veteran's mother describing his apartment as being in "disarray" without clean clothes. Id. Another occurred shortly thereafter when the Veteran heard planes flying very low on the way to school and was "triggered by things on the radio." Id. He consulted law school personnel who called an ambulance due to concerns that the Veteran was not making sense. Id. The Veteran was admitted for care. Id. The Veteran's diagnosis remained unclear in early 2012 with various treatment attempts in light of the "risk of another episode." See April and July 2012 VA treatment records. The Veteran reported studying for the bar examination but asking for accommodations because of anxiety. See June 2012 VA treatment records. He also complained of insomnia. Id. In 2013, the Veteran reported depressive mood and frequent anxiety. See February 2013 VA treatment records. He stated that he experiences distractibility during episodes of mania. Id. During episodes of depression, the Veteran reported a diminished ability to think and/or concentrate. Id. He endorsed episodes of mania/hypomania. Id. While his recent and remote memory were intact, he did not have an accurate recall of current events. Id. He reported little interest or pleasure in doing things and feeling down, depressed, or hopeless. Id. He reported being mildly hypervigilant, having difficulty sleeping, and trouble concentrating. Id. The Veteran stated that he had low mood, low energy, and low motivation. Id. A provider cautioned the Veteran and his family to be watchful of worsening mania/hypomania symptoms. Id. In 2014, the Veteran was taken to the hospital due to "bizarre behavior" including digging holes in the yard and making obsessive statements regarding starting a technology company. See March 2014 VA treatment records. He was admitted on March 31, 2014, and discharged April 8, 2014. Id. During his admission, the Veteran was noted be isolating and paranoid of the staff. See April 2014 VA treatment records. He remained manic throughout his admission with multiple incidents. Id. He was found to be "too psychotic" to attend group meetings until stabilization. Id. His behavior was described as strange and bizarre. Id. He was noted to be "very internally preoccupied," disorganized, and going "from crying to laughing very quickly." Id. A provider opined that the Veteran appeared to be responding to internal stimuli, but he denied when asked. Id. Following discharge, the Veteran stated that his manic episodes "come on very quickly," often with less than 24 hours warning. See May 2014 VA treatment records. He acknowledged that it probably starts with a decreased need for sleep and increased focus on a project. Id. Then his mind will not "rest" and he begins to have bizarre delusions and strange behaviors. Id. Records from his admission note that the Veteran was talking about "shooting you in the eye." Id. Later in 2014 he reported that he is not working in law because it is too stressful but is starting his own technology company and designing websites. See June 2014 VA treatment records. In July, he was noted to be "more dysphoric lately" but it could be related to his business start-up. See July 2014 VA treatment records. The Veteran stated that he has been struggling and having more anxiety. See August 2014 VA treatment records. He described having trouble staying organized enough to do what he needs to do. Id. He reported spending more time isolating and arguing with his wife. Id. The provider noted that he was unsure whether the Veteran could actually manage fulltime employment or organize his own business, despite his obvious intelligence. Id. In November, the Veteran reported battling more anxiety and responding with pulling out his hair. See November 2014 VA treatment records. He stated he was having trouble maintaining a schedule, finding himself aimless during the day. Id. He said he has trouble organizing himself with a schedule and finishing tasks and reported worrying "all the time." Id. In 2015, a provider indicated the Veteran "has not really come back to his previous baseline" after his most recent hospitalization. See March 2015 VA treatment records. The provider stated that the Veteran was studying for the bar again but finding it difficult to remain productive. Id. The provider further opined that the Veteran may be so impaired by his bipolar disorder that he might now be unemployable. Id. Later the Veteran said that he was finding it difficult to absorb information. See May 2015 VA treatment records. The Veteran continued to complain of difficulty sleeping, feeling anxious, worrying, and being stressed. See July 2015 VA treatment records. In September 2015, the Veteran was admitted for ten days for "mood stabilization." See September 2015 treatment records. The Veteran reported that his wife had brought him to the hospital because he was having odd behaviors including running outside without clothing. Id. He described feeling "confused" and was "unsure how to communicate." Id. The Veteran was unable to give a clear history of recent events. Id. He denied suicidal or homicidal ideation. Id. He had a slight withdrawn "odd" effect but was aware of time and place. Id. Upon examination, the provider reported that the Veteran was in acute psychosis with disorganized behavior, mimicking, paranoia, and delusions. Id. Throughout his admission, the Veteran continued to display bizarre behavior including hallucinations and delusions. Id. His symptoms improved but the provider continued to note distraction and preoccupation. Id. He was found to be cooperative but had delayed speech that was slow and decreased in volume. Id. In 2016 through 2019, the Veteran continued management and treatment for his bipolar disorder. In July 2017, the Veteran reported feeling very irritable and said that he cannot leave the house. See July 2017 VA treatment records. He complained of feeling excessively moody. Id. Throughout this time period, he continually declined experiencing suicidal or homicidal ideation, hallucinations, or delusions. The Veteran stated that he had a job offer for after law school but due to a breakdown before his summer internship, he could not hold the job. See March 2013 Correspondence. Since then, the Veteran states that he has too much anxiety to complete the bar exam or accomplish anything. Id. He stated that his anxiety is preventing him from accomplishing many day-to-day tasks. Id. He described being paranoid in public and being afraid of having a breakdown. Id. The Veteran stated that he is "fighting to function on the most basic level." Id. The Veteran's wife submitted a buddy statement describing the Veteran experiences symptoms of anxiety, depression, isolation, an inability to socialize outside of the home, grogginess, loss of interest in physical intimacy, and a loss of interest in hobbies such as dumbs, biking, and hiking. See July 2014 Buddy Statement. She described the Veteran as mostly staying inside unless she encourages him to go outside. Id. She stated that the Veteran has had a few "short-term" jobs since they were married but had problems with organization, sleep, and mood which led to job losses. Id. She described the Veteran's actions prior to his 2014 admission including "grandiose" thoughts, placings dozens of notes everywhere with unintelligible to-do lists, and digging in the neighbor's yard barefoot partly clothed. Id. She stated that it took five to six weeks after hospitalization for the Veteran to return to himself. Id. In August 2014, a private provider stated that the Veteran's mental health problems have caused "significant difficulties" in his ability to organize and function. See August 2014 treatment records. The provider stated that his condition is disruptive to the Veteran's law school performance and attempts to start a business. Id. Although "intelligent and personable," the provider stated that the Veteran has not been able to make use of his law degree or follow through with his business ideas. Id. The provider explained that the Veteran continues to struggle with mood and is having "great difficulty" organizing and translating his business ideas into a viable entity. Id. From a clinical standpoint, the provider opined that the Veteran should be considered unemployable due to his service-connected bipolar disorder. Id. In July 2019, a private provider recommended to the Veteran that he should not attempt to work, even on a part-time basis, because the provider did not believe the Veteran's bipolar disorder symptoms would allow him to tolerate the stress of even a part-time job. See July 2019 Court Documents. The provider opined that if the Veteran attempted work, even on a part-time basis, it would aggravate his anger-related outbursts, irritability, and other bipolar disorder-related symptoms. Id. The provider described that the Veteran has not had the capacity to attend educational or training classes even ten to fifteen hours per week because of his inability to interact appropriately with, or even tolerate the stress of being in the presence of, other students and instructors. Id. The provider further opined that the Veteran has been able to "keep his mental status stable" and prevent his condition from becoming even more severe only because he has severely restricted his lifestyle and interactions with others. Id. The provider explained that the Veteran's residual disease process has resulted in such marginal adjustment that the stress of even a minimal increase in his mental demands or a change in his environment such as trying to go to school or work for ten to fifteen hours per week would more likely than not, to a reasonable degree of medical certainty, cause him to decompensate. Id. The provider ultimately opined that the Veteran's bipolar disorder causes him total occupational and social impairment. Id. The Veteran was afforded multiple VA examinations to determine the severity of his bipolar disorder. In February 2015, the Veteran was noted to have bipolar I disorder with manic episodes including multiple hospitalizations since 2012. See February 2015 VA examination. The provider opined that the Veteran experienced occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, and thinking and/or mood. Id. The Veteran reported that finding work was too stressful to function well. Id. The examiner noted the Veteran worked briefly as a paralegal for twenty hours a week but had trouble completing tasks because of concentration difficulties and anxiety with an increase in agitation. Id. He reported trying to set-up a web development business but was unable to do the task because of "mood pressures leading to disorganization." Id. The examiner opined that the stress of work, even in a part-time setting, has led to deterioration in functioning for the Veteran. Id. Symptoms were noted to include depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work or a worklike setting. Id. He was noted to have a "pressured affect" but was cooperative. Id. Other symptoms included a history of manic symptoms due to bipolar disorder with a need for hospitalizations. Id. He was noted to have the ability to maintain good hygiene and other basic activities of daily living. Id. He was oriented to time, place, and person. Id. The examiner found no evidence of memory loss or impairment but did note chronic mild concentration difficulty. Id. There was no obsessive or ritualistic behavior noted. Id. Speech was somewhat pressured and fast, but understandable and logical. Id. He had a history of depressed mood and anxiety associated with manic states. Id. There is impairment in impulse control when his mood is in an active state and not regulated. Id. The examiner described the Veteran's bipolar disorder to be in a "very fragile" condition with difficulty maintaining stabilization. Id. The Veteran stated that when he has an active episode, he usually feels mild depressive symptoms first with some psychomotor slowing then will quickly change into an agitated state with racing thoughts and delusional thoughts of time. Id. Following his last hospitalization, he experienced symptoms of his hyper religiosity belief system present during admission for 4 to 6 weeks post discharge. Id. Another VA examination was completed in April 2016 wherein the examiner opined the Veteran experiences occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, and thinking and/or mood. See April 2016 VA examination. The Veteran reported difficulty controlling his thoughts and having delusions, being psychotic and depressed. Id. He described anxiety, difficulty leaving the house, staring, and pacing. Id. He described low energy and anxiety. Id. He declined recent hallucinations. Id. Symptoms were noted to include depressed mood, anxiety, mild memory loss, such as forgetting names, directions, or recent events, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Id. Eye contact was noted to frequently be poor. Id. From August 29, 2011, to October 23, 2019 After reviewing the evidence of record, the Board finds that the Veteran's bipolar disorder has been productive of symptoms so disabling as to warrant the assignment of a 100 percent rating for the entirety of the appeal period, or since the filing of the Veteran's August 29, 2011, claim. Since that time, the Veteran's symptoms have included, among others, hallucinations, delusions, threatening behavior, episodes of severe depression and psychosis resulting in hospitalization, an inability to perform the activities of daily living, episodes of inappropriate behavior, and an inability to concentrate. The Veteran has been hospitalized multiple times during the appeal period both precipitated by "bizarre" or odd behaviors. Additionally, the Veteran reported, and treatment records reflect, a hospitalization shortly before filing the claim herein. The Veteran conveyed experiencing episodes of mania with distractibility. He competently and credibly described an inability to concentrate which has been consistently noted throughout the entire period on appeal. While the record lacks an opinion addressing the Veteran's occupational and social impairments until 2014, the Board finds the totality of his symptoms during the entire period on appeal amount to total occupational and social impairment. Indeed, the Veteran's wife reported that he has lost his short-term jobs due to problems with organization, sleep, and mood. Also, the Veteran consistently conveyed difficulty concentrating while studying, being stressed by work, and experiencing anxiety so severe that it prevents him from accomplishing many day-to-day tasks. Of note, the Veteran described himself as "fighting to function on the most basic level" which is corroborated by the evidence of record including his mother's notation that his housing was in a state of disarray with garbage and no clean clothing. The Veteran's bipolar disorder has been referred to as "fragile" and difficult to treat. The Board finds the totality of the Veteran's treatment records during the period on appeal corroborate this notion. Indeed, the period of 2016 to 2019 is the longest period on appeal that the Veteran did not experience or report a hospitalization due to his bipolar disorder. Notably, however, the July 2019 private provider opined that the Veteran has been able to "keep his mental status stable" and prevent his condition from becoming even more severe "only because he has severely restricted his lifestyle and interactions with others." The August 2014 provider stated that the Veteran's bipolar disorder is disruptive to his law school performance and attempts to start a business ultimately concluding the Veteran is considered unemployable. The Board acknowledges the RO granted a 100 percent disability rating based on the July 2019 private providers opinion that the Veteran's bipolar disorder causes total occupational and social impairment. As an aside, the RO stated this opinion was rendered October 24, 2019, but the record reflects the opinion was received July 30, 2019. Regardless, the Board finds no reason to conclude, based on the general disability picture portrayed by the evidence as discussed above, that it marks the exact date on which the Veteran's bipolar disorder became totally disabling. In sum, the Veteran's bipolar disorder has been shown to be productive of total occupational and social impairment throughout the appeal period. Moreover, there is no probative evidence demonstrating that his symptomatology has drastically changed over the course of his appeal. Given the extensive, consistent, and debilitating social and occupational impairment described above, the Board finds that the Veteran's psychiatric symptoms more nearly approximate the criteria for a 100 percent rating since the filing of his August 2011 claim. See 38 C.F.R. §§ 4.7, 4.130. Accordingly, a total rating is assigned for the duration of the period under review. 2. An effective date of March 30, 2012, but no earlier, for service-connected sciatic nerve radiculopathy right lower extremity rated as 10 percent disabling is granted. 3. A 20 percent rating, but no more, for sciatic nerve radiculopathy right lower extremity from October 25, 2019, is granted. The Veteran contends his sciatic nerve radiculopathy right lower extremity should be assigned a higher disability rating. The Board finds an effective date of April 19, 2012, but no earlier, for sciatic nerve radiculopathy right lower extremity rated as 10 percent disabling, but no higher, as secondary to service-connected moderate chronic lumbosacral strain, is warranted. At the outset, the Board notes, the Veteran filed a claim for benefits on August 29, 2011. The Veteran timely appealed the initial December 2012 rating decision stemming from said claim. Thus, the Board will consider the period on appeal beginning August 29, 2011, the date of the Veteran's claim for benefits. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. As previously mentioned, the Veteran's sciatic nerve radiculopathy right lower extremity is rated under DC 8520. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8520. Mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. 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 on 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. The term "incomplete paralysis" indicates a degree of loss 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. 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). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Turning to the relevant evidence of record, in March 2012, the Veteran complained of experiencing acute flares of back pain and spasm with intermittent pain into the buttocks and legs and to rarely to the side of the right foot. See March 2012 treatment records. He denied constant tingling, numbness, or lower limb weakness. Id. The Veteran went to the emergency room in March 2012 for his lower back pain declining weakness or numbness "without significant radiation bilaterally" but "occasionally to right." See March 2012 VA treatment records. In April 2012, the Veteran complained of experiencing back pain with radiating pain down both legs. See April 2012 treatment records. The Veteran declined associated numbness or tingling in the legs. Id. He noted that the pain was worse in the back of the legs rather than the front. Id. The Veteran stated that he feels worse with increased activity noting that he feels that he could not run. Id. In September 2014, the Veteran denied leg weakness or paresthesias. See September 2014 VA treatment records. In August 2015, the Veteran complained of lower back pain radiating down the posterior right leg/lateral foot. See August 2015 VA treatment records. He stated that he has had a three-month history of right leg pain "superimposed on chronic low back pain." Id. He stated that he was unsure of what started his leg pain at the time. Id. He noted that the pain was sharp and shooting. Id. His leg pain was worsened with sitting, standing, or being upright in one position for too long. Id. He described being unable to ride his bike because the pain extended to his foot. Id. In 2017, the Veteran stated that his back pain is "still going down" the right leg. See June 2017 VA treatment records. He described the pain as so severe that he used a cane to walk into the dentist. Id. In July, the Veteran stated that he has chorionic lower back pain and radicular pain in the right lower extremity. See July 2017 VA treatment records. He described the pain in the back as "aching" with a "shooting pain" down the lateral buttock, posterolateral thigh and calf. Id. The Veteran complained of "significant" back pain with worsening radicular symptoms affecting the right lower extremity. See August 2017 VA treatment records. The Veteran was afforded multiple VA examinations to determine the severity of his underlying moderate chronic lumbosacral strain and any radiculopathy associated therewith. In August 2012, the VA examiner found that the Veteran did not have radiculopathy pain or any other signs or symptoms due to radiculopathy. See August 2012 VA examination. Another VA examination occurred in October 2019 during which the examiner determined the Veteran has radiculopathy pain or other signs or symptoms thereof. See October 2019 VA examination. The examiner opined that the Veteran has moderate right lower extremity intermittent pain and moderate right lower extremity paresthesias and/or dysesthesias. Id. From August 29, 2011, to March 29, 2012 Upon review of the totality of the record beginning August 29, 2011, through March 29, 2012, the Board finds a separate rating for sciatic nerve radiculopathy right lower extremity is not warranted. The evidence fails to show the Veteran's service-connected moderate chronic lumbosacral strain caused any right lower extremity radiculopathy symptoms. Indeed, the medical evidence of record lacks any mention of, or complaints related to, the right lower extremity during this period. While the Veteran reported experiencing intermittent pain in the right leg associated with his lower back pain in March 2012, the record lacks any complaints prior to that date. As such, the preponderance of the evidence is against a separate compensable rating for sciatic nerve radiculopathy right lower extremity from August 29, 2011, to March 29, 2012. In denying a separate rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. From March 30, 2012, to October 24, 2019 Upon review of the totality of the record beginning March 30, 2012, but no earlier, the Board finds a 10 percent rating, but no higher, for sciatic nerve radiculopathy right lower extremity is warranted to October 24, 2019. The Veteran first complained of right lower extremity pain associated with his lower back pain on March 30, 2012. While the Veteran's radiculopathy was not recognized by the VA until the October 2019 VA examination, the Board finds the Veteran competently and credibly conveyed his symptoms of right lower extremity pain beginning on March 30, 2012. Said symptoms, however, are appropriately compensated for as mild incomplete paralysis. Indeed, during this period, the Veteran consistently and credibly denied experiencing weakness, tingling, and/or numbness in his right lower extremity. Rather, the Veteran's complaints always remained as pain in the right lower extremity. The record lacks evidence of or complaints related to impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, muscle atrophy, or complete paralysis from March 30, 2012, to October 24, 2019. Based on the above, the Board finds that the disability is primarily manifest as pain from March 30, 2012, to October 24, 2019. In so finding, the Board also concludes that the preponderance of the evidence is against a finding that the disability is manifest by impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, muscle atrophy, or complete paralysis warranting a rating in excess of 10 percent. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis from March 30, 2012, but no earlier, to October 24, 2019. From October 25, 2019 From October 25, 2019, the Board finds a 20 percent disability rating, but no higher, is warranted for sciatic nerve radiculopathy right lower extremity. During the Veteran's October 2019 VA examination, the examiner assessed the Veteran's right lower extremity radiculopathy as moderate intermittent pain and moderate paresthesias and/or dysesthesias, which the Board finds highly probative regarding severity under the ratings when considered with the Veteran's reports of symptoms worsening. The record lacks complaints of impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. As such, the Board finds that the Veterans' right lower extremity radiculopathy is primarily manifest by pain and sensory disturbance of paresthesias and/or dysesthesias. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis from October 24, 2019. In so finding, the Board also concludes the preponderance of the evidence is against determining that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis as the record lacks any complaints of or treatment related thereto to warrant a rating in excess of 20 percent. In conclusion, a 20 percent rating, but no higher, for sciatic nerve radiculopathy right lower extremity from October 24, 2019 is warranted. REASONS FOR REMAND 1. Entitlement to an initial disability rating in excess of 10 percent for moderate chronic lumbosacral strain effective August 29, 2011, is remanded. The Veteran contends his lumbosacral strain symptoms entitle him to a higher disability rating. The Board finds the evidence is insufficient to resolve his claim. The Veteran was most recently afforded a VA examination in October 2019 wherein the examiner found that the Veteran does not have any other neurologic abnormalities or findings related to the thoracolumbar spine condition (such as bowel or bladder problem/pathologic reflexes). Upon review, however, treatment records reflect multiple complaints of urine retention, sensations of frequency with hesitancy, pain with urination, and complaints of urine frequency. While testing was completed in relation to the Veteran's complaints, the record is unclear as to whether the numerous neurological complaints are due to or associated with the Veteran's service-connected thoracolumbar spine condition. Thus, the Board finds the record lacks sufficient competent medical evidence to determine whether the Veteran experiences any neurological complaints of the bladder that are related to his service-connected thoracolumbar spine condition and remand is necessary to obtain an addendum opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The examiner also found that the Veteran experiences moderate intermittent pain and moderate paresthesias and/or dysesthesias in the right lower extremity only. Upon review, however, treatment records reflect multiple complaints of pain radiating to the left lower limb "with sensory change to the lateral calf" in 2012. Thus, remand is necessary for an addendum opinion addressing whether the Veteran had any radiculopathy signs or symptoms in the left lower extremity during the period on appeal. Id. Consequently, remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Return the entire claims file and this remand to an appropriate examiner for review. The necessity of an in-person examination is left to the discretion of the examiner. Upon review, the examiner shall render an addendum opinion, including rationale, addressing the following: (a.) Whether the Veteran has any neurological abnormalities due to or associated with his thoracolumbar spine condition including bladder problems and if so, also complete the appropriate Disability Benefits Questionnaire for each condition identified. In so opining, the examiner is specifically directed to address the Veteran's reports of urine retention, sensations of frequency with hesitancy, pain with urination, and complaints of urine frequency in 2015, 2016, and 2017. (b.) Whether the Veteran experienced any radiculopathy signs or symptoms in the left lower extremity at any point during the period on appeal and if so, determine the severity thereof as requested within a Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire. In so opining, the examiner is directed to address the Veteran's complaints of pain radiating to the left lower limb with sensory changes in 2012. The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (Continued on the next page) 2. After the above development, and any other development deemed necessary, readjudicate the claim. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.