Citation Nr: 21030463 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-08 954 DATE: May 19, 2021 ORDER Entitlement to an initial 40 percent rating, from October 30, 2012, for right lower extremity radiculopathy of the sciatic nerve, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to an initial rating higher than 40 percent for right lower extremity radiculopathy of the sciatic nerve is denied. Entitlement to an initial compensable rating, prior to September 24, 2020, and a rating higher than 30 percent, from September 24, 2020, for right lower extremity radiculopathy of the femoral nerve, is denied. Entitlement to an initial 10 percent rating, from January 22, 2020, but no earlier, for left lower extremity radiculopathy of the sciatic nerve is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to an initial rating higher than 10 percent for left lower extremity radiculopathy of the sciatic nerve is denied. Entitlement to an initial compensable rating, prior to September 24, 2020, and a rating higher than 10 percent, since September 24, 2020, for left lower extremity radiculopathy of the femoral nerve, is denied. Entitlement to an initial compensable rating for urinary incontinence is denied. Entitlement to a 20 percent rating (but no higher), from October 30, 2012 through March 10, 2016, and a 50 percent rating (but no higher), from March 11, 2016, for low back strain with lumbosacral spondylosis and intervertebral disc syndrome (IVDS), is granted, subject to the law and regulations governing the award of monetary benefits. FINDINGS OF FACT 1. Since October 30, 2012, the Veteran's right lower extremity radiculopathy of the sciatic nerve has been manifested by at most moderately severe incomplete paralysis; there is no muscular atrophy or complete paralysis. 2. Since September 24, 2020, but no earlier, the Veteran's right lower extremity radiculopathy of the femoral nerve has been manifested by at most severe incomplete paralysis. 3. Since January 22, 2020, but no earlier, the Veteran's left lower extremity radiculopathy of the sciatic nerve has been manifested by at most mild incomplete paralysis. 4. Since September 24, 2020, but no earlier, the Veteran's left lower extremity radiculopathy of the femoral nerve has been manifested by at most mild incomplete paralysis. 5. The Veteran has not required the use of absorbent materials or an appliance for urinary incontinence and has not experienced urinary frequency or obstructed voiding. 6. From October 30, 2012 through March 10, 2016, the Veteran's low back strain with lumbosacral spondylosis and IVDS was manifested by limitation of motion of the thoracolumbar spine to at most 50 degrees of flexion, 25 degrees of extension, 15 degrees of right lateral flexion, 25 degrees of left lateral flexion, and 0 degrees of left and right lateral rotation; there is competent and credible evidence of thoracolumbar spine pain and flare ups, but there was no significant or sustained additional loss of motion due to such factors as pain, weakness, lack of endurance, fatigability, incoordination, or flare ups; there was no actual or functional equivalent of spinal ankylosis or incapacitating episodes due to IVDS. 7. Since March 11, 2016, the Veteran's low back strain with lumbosacral spondylosis and IVDS has been manifested by limitation of extension of the thoracolumbar spine to 0 degrees, the functional equivalent of ankylosis, and associated neurologic symptoms; there is no ankylosis of the entire spine or incapacitating episodes due to IVDS. CONCLUSIONS OF LAW 1. The criteria for an initial 40 percent rating, but no higher, from October 30, 2012, for right lower extremity radiculopathy of the sciatic nerve are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124A, Diagnostic Code (DC) 8520. 2. The criteria for an initial compensable rating, prior to September 24, 2020, and a rating higher than 30 percent, from September 24, 2020, for right lower extremity radiculopathy of the femoral nerve are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124A, Diagnostic Code (DC) 8526. 3. The criteria for an initial 10 percent rating, but no higher, from January 22, 2020, but no earlier, for left lower extremity radiculopathy of the sciatic nerve are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124A, Diagnostic Code (DC) 8520. 4. The criteria for an initial compensable rating, prior to September 24 ,2020, and a rating higher that 10 percent, from September 24, 2020, for left lower extremity radiculopathy of the femoral nerve are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.123, 4.124, 4.124A, Diagnostic Code (DC) 8526. 5. The criteria for an initial compensable rating for urinary incontinence are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.155A, 4.155B, Diagnostic Code (DC) 7517. 6. The criteria for a 20 percent rating, but no higher, from October 30, 2012 through March 10, 2016, and a 50 percent rating, but no higher, from March 11, 2016, for low back strain with lumbosacral spondylosis and IVDS are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71A, Diagnostic Codes (DC) 5237, 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1993 to May 2000. These matters come before the Board of Veterans' Appeals (Board) from a September 2014 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a January 2020 hearing and a transcript of the hearing has been associated with his claims file. In March 2020, the Board granted an effective date of October 30, 2012 for the award of an increased (compensable) rating for service-connected back disability and awarded service connection for lumbosacral spondylosis and right lower extremity radiculopathy. The Board also remanded the issue of entitlement to a rating in excess of 10 percent for service-connected back disability for further development. In March 2020, the agency of original jurisdiction (AOJ) implemented the Board's March 2020 decision and assigned an effective date of October 30, 2012 for the award of a 10 percent rating for service-connected back disability (re-characterized as low back strain with lumbosacral spondylosis). The AOJ also awarded service connection for right lower extremity radiculopathy of the sciatic nerve and assigned an initial 20 percent disability rating, from October 30, 2012. In October 2020, the AOJ made the following determinations: awarded service connection for left lower extremity radiculopathy of the sciatic nerve and assigned an initial 10 percent disability rating, from September 24, 2020; awarded service connection for left lower extremity radiculopathy of the femoral nerve and assigned an initial 10 percent disability rating, from September 24, 2020; awarded service connection for right lower extremity radiculopathy of the femoral nerve and assigned an initial 30 percent disability rating, from September 24, 2020; awarded service connection for urinary incontinence associated with service-connected back disability and assigned an initial noncompensable disability rating, from September 24, 2020; and awarded an increased (40 percent) disability rating for service-connected back disability (re-characterized as low back strain with lumbosacral spondylosis and IVDS), from September 24, 2020. As for characterization of the issues on appeal, the Board has included the separate issues of entitlement to higher initial ratings for left and right lower extremity radiculopathy of the sciatic and femoral nerves and urinary incontinence because these issues are being considered as part of the claim for an increased rating for the service-connected back disability. See 38 C.F.R. § 4.71A, General Rating Formula for Diseases and Injuries of the Spine, Note (1) (providing that associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code). Since the claim period for the back issue dates back to October 30, 2012, the Board has characterized the radiculopathy issues as listed above. As a final preliminary matter, in the March 2020 remand, the Board instructed the AOJ to, among other things, ask the Veteran to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records, obtain the Veteran's outstanding VA treatment records, and afford the Veteran an examination to assess the severity of his service-connected back disability and associated lower extremity neurological disability. Pursuant to the Board's remand, the Veteran was asked to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records by way of a March 2020 letter. Copies of the authorization forms (VA Forms 21-4142a and 21-4142) were included with the letter. Moreover, all available outstanding VA treatment records were obtained and associated with the claims file and the Veteran was afforded a VA examination in September 2020 to assess the severity of his service-connected back disability and associated lower extremity neurological disability. Therefore, the AOJ substantially complied with the Board's remand instructions. See Dyment v. West, 13 Vet. App. 141, 146- 47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). Higher Initial Ratings/Increased Rating Disability ratings are determined by the application of rating criteria set forth in the VA Schedule for Rating Disabilities (38 C.F.R. Part 4) based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. Where service connection has been granted and the assignment of an initial rating is disputed, separate ratings may be assigned for separate periods of time based on the facts found. In other words, the ratings may be "staged." Fenderson v. West, 12 Vet. App. 119, 125-126 (1999). If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports considering the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. § 4.40, 4.45, pertaining to functional impairment. The United States Court of Appeals for Veterans Claims (Court) has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point, if any, at which such factors cause functional impairment. Moreover, the joints involved should be tested for pain on both active and passive motion, in weight bearing and non weight-bearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016); Mitchell v. Shinseki, 25 Vet. App. 32, 43-4 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. The Board notes that during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71A were amended effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claim under the former criteria prior to February 7, 2021 and both the former and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Entitlement to higher initial ratings for right lower extremity radiculopathy of the sciatic nerve, right lower extremity radiculopathy of the femoral nerve, left lower extremity radiculopathy of the sciatic nerve, left lower extremity radiculopathy of the femoral nerve, and urinary incontinence, and entitlement to an increased rating for low back strain with lumbosacral spondylosis and IVDS. I. Background The Veteran's claim for an increased rating for his service-connected back disability was received on October 30, 2013. The Veteran reported during an August 2014 VA back examination that he began to experience low back pain in service, reinjured his back in 2003 and experienced low back pain that radiated into the right leg, and again injured his back in 2008 which resulted in "complete right foot drop with atrophy" due to a large disk fragment impinging a nerve root. He underwent surgery with good outcome and "recovery of foot drop." However, he continued to experience chronic aching pain in the right lower extremity, fatigue, a sense of weakness in the right ankle, mild sensory loss with dysesthesias in the right lower extremity, and loss of right knee muscle stretch reflex. He also experienced chronic, but variable and activity-related low back pain with flare ups of increased back pain three or four days per week, usually without provocation other than normal activities. Examination revealed that the ranges of motion of the thoracolumbar spine were flexion to 50 degrees with pain beginning at 30 degrees, extension to 25 degrees with pain beginning at that point, right lateral flexion to 15 degrees with pain beginning at that point, left lateral flexion to 25 degrees with pain beginning at 15 degrees, and right and left lateral rotation both to 0 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive use testing with 3 repetitions and the ranges of spinal motion remained the same following repetitive use. There was functional loss/impairment of the thoracolumbar spine in terms of less movement than normal, pain on movement, and interference with sitting, standing, and/or weight-bearing. There was no localized tenderness or pain on palpation for joints or soft tissue of the thoracolumbar spine, muscle spasms, or guarding. Moreover, lower extremity muscle strength was all normal (5/5) bilaterally and there was no muscle atrophy. Right knee reflex was absent (0), but lower extremity reflexes were otherwise normal (2+). Sensation was decreased at the right thigh/knee, lower leg/ankle, and foot/toes, but lower extremity sensation was otherwise normal. Straight leg raise testing was positive on the right and negative on the left. There was moderate intermittent pain and mild paresthesias/dysesthesias in the right lower extremity, but no constant pain or numbness in either lower extremity or intermittent pain or paresthesias/dysesthesias in the left lower extremity. There were no other signs or symptoms of radiculopathy. Overall, there was moderate radiculopathy of the right sciatic nerve. There was no radiculopathy of the left lower extremity. There was no ankylosis of the spine, the Veteran did not have any other neurologic abnormalities or findings related to the thoracolumbar spine, and he did not have IVDS of the thoracolumbar spine. He occasionally used a cane for back and bilateral knee disabilities, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There was scarring related to the Veteran's back disability, but the scarring was not painful or unstable and the total area of all related scars was not greater than 39 square centimeters (6 square inches). The Veteran was diagnosed as having lumbosacral strain, lumbosacral spondylosis, and right L5 radiculopathy. These disabilities impacted his ability to work in that he was unable to perform any repetitive lifting, bending, or climbing. The examiner who conducted the August 2014 examination noted that there were no additional functional limitations of the lumbar spine, including no additional loss of range of motion during flare ups or secondary to repetitive use of the low back, painful motion, weakness, fatigability, or incoordination. A VA primary care physician note dated on March 11, 2016, the Veteran's February 2017 substantive appeal (VA Form 9), an April 2019 VA primary care physician note, and the Veteran's testimony during the January 2020 Board hearing indicate that he experienced chronic back pain and lower extremity neurological symptoms. Flare ups of increased symptoms occurred, during which he would experience difficulty sleeping for days due to pain. He reported on his Form 9 that it felt as if he had been kicked between the legs on a good day, and on a bad day there was pain, burning, and aching down his right leg that prohibited almost any activity. He reported during the January 2020 hearing that his back pain was radiating down both legs, but he acknowledged that he had never been prescribed bedrest by a physician. Moreover, the Veteran reported that as a result of his back and lower extremity neurological disabilities, he was limited in his ability to perform various activities of daily living. For example, he was unable to sit for more than 20 to 25 minutes, lift more than 20 to 25 pounds, walk more than 100 yards without experiencing burning pain and taking a knee, stand stationary for more than a few minutes, put on his pants without assistance, drive for more than one hour without experiencing "great pain and burning," perform regular household chores and yardwork, bend, lift, twist, and exercise. He would constantly trip due to foot drop. He was unable to perform spinal ranges of motion due to chronic back pain during the March 2016 VA evaluation and he reported during the April 2019 VA evaluation that his back pain was worsening. The report of a VA back examination dated on September 24, 2020 indicates that the Veteran experienced lumbago and radicular pain. He did not report any flare ups of back symptoms. There was functional loss/impairment of the thoracolumbar spine in that he was unable to bend, lift, twist, get dressed, or wipe himself after a bowel movement. Examination revealed that the ranges of motion of the thoracolumbar spine were flexion to 20 degrees, extension and right lateral flexion both to 0 degrees, left lateral flexion to 15 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 15 degrees. There was pain associated with all ranges of motion and the pain caused functional loss. There was no objective evidence of localized tenderness of pain on palpation of the joint or associated soft tissue of the thoracolumbar spine and there was no evidence of pain with weight-bearing. The Veteran was not able to perform repetitive-use testing with at least three repetitions because he was in extreme pain. He was not being examined immediately after repetitive use over time or during a flare up and the examination was medically consistent with his statements describing functional loss with repetitive use over time and during a flare up. Pain significantly limited functional ability with repeated use over a period of time and the examiner who conducted the September 2020 examination specified that the ranges of spinal motion with repeated use over time would be flexion to 10 degrees, extension and right lateral flexion both to 0 degrees, left lateral flexion to 10 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 10 degrees. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare ups. There was no guarding or muscle spasm of the thoracolumbar spine and there were no additional factors contributing to disability. Moreover, muscle strength associated with right ankle dorsiflexion and great toe extension was 4/5, but lower extremity muscle strength was otherwise normal (5/5) and there was no muscle atrophy. Knee and ankle reflexes were absent (0) on the right and normal (2+) on the left. Right lower extremity sensation was decreased at the upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes and left lower extremity sensation was all normal. Straight leg raise testing was positive bilaterally. Constant pain, paresthesias/dysesthesias, and numbness were severe in the right lower extremity and moderate in the left lower extremity and there was no intermittent pain in either lower extremity. The Veteran also experienced mild urinary incontinence due to nerve impingement. Overall, there was bilateral lower extremity radiculopathy involving the sciatic and femoral nerves which was severe on the right and mild on the left. There was no ankylosis of the spine. The Veteran had IVDS of the thoracolumbar spine, but he had not experienced any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician during the previous 12 months. He occasionally used a walking stick due to lumbar radiculopathy, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There was scarring related to the Veteran's back disability, but none of the scarring was painful or unstable and the total area of the scarring was not equal to or greater than 39 square centimeters (6 square inches). There were no other pertinent physical findings, complications, conditions, signs, or symptoms. Diagnoses of lumbosacral strain, IVDS, lumbar spondylitis, neuroforaminal narrowing L4-5, L5-S1, and bilateral lower extremity radiculopathy were provided. These disabilities impacted the Veteran's ability to work in that he was unable to bend, lift, twist, get dressed, or wipe himself after a bowel movement. The examiner who conducted the September 2020 examination noted that there was objective evidence of pain when the back was used in non weight-bearing, that the passive ranges of spinal motion were the same as the active ranges of motion, and that the pain associated with the passive ranges of motion was the same as that which was associated with the active ranges of motion. A September 2020 VA urinary tract examination report indicates that the Veteran experienced urinary incontinence due to nerve impingement. The voiding dysfunction caused urine leakage, but it did not require the wearing of absorbent material or the use of an appliance. The voiding dysfunction did not cause urinary frequency or any signs or symptoms of obstructed voiding. The Veteran did not have a history of urethral or bladder calculi or recurrent symptomatic bladder or urethral infections, did not have any findings, signs, or symptoms attributable to a bladder or urethral fistula, and did not have a neurogenic or severely dysfunctional bladder, bladder injury, bladder surgery, renal dysfunction, or any benign or malignant neoplasm or metastases. There were no scars related to the Veteran's urinary disability and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran was diagnosed as having loss of urinary continence with onset of back pain. This disability did not impact his ability to work. II. Radiculopathy The Veteran's left and right lower extremity radiculopathy of the sciatic nerve is rated under 38 C.F.R. § 4.124A, DC 8520. Under DC 8520, the following ratings apply: a 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; a 40 percent rating is warranted for moderately severe incomplete paralysis; a 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy; and an 80 percent rating is warranted for complete paralysis resulting in the foot dangling and dropping, no possible active movement of muscles below the knee, and weakened or (very rarely) lost flexion of the knee. 38 C.F.R. § 4.124A , DC 8520. The left and right lower extremity radiculopathy of the femoral nerve is rated under 38 C.F.R. § 4.124A, DC 8526. Under DC 8526, the following ratings apply: a 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; a 30 percent rating is warranted for severe incomplete paralysis; and a 40 percent rating is warranted for complete paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124A, DC 8526. The rating schedule provides guidance for rating neurological disabilities. With regard to rating neurological disabilities, cranial or peripheral 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. 38 C.F.R. § 4.123. The maximum rating that can be assigned for neuritis not characterized by organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Cranial or peripheral neuralgia, usually characterized 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. 38 C.F.R. § 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124A. A. Left Lower Extremity Radiculopathy of the Sciatic and Femoral Nerves The Veteran's left lower extremity radiculopathy of the sciatic and femoral nerves are currently rated noncompensable prior to September 24, 2020 and 10 percent disabling since that date. The above evidence reflects that the Veteran has reported back pain radiating to the left lower extremity with associated numbness. There is no evidence of any such left lower extremity neurological symptoms prior to the January 2020 Board hearing, during which the Veteran reported that his back pain radiated to both lower extremities. Examinations conducted during the claim period have consistently revealed normal muscle strength, sensation, and reflexes in the left lower extremity and there is no evidence of any muscle atrophy. He was first diagnosed as having left lower extremity radiculopathy of the sciatic and femoral nerves during the September 2020 VA back examination and the examiner indicated that the radiculopathy was mild. In light of the Veteran's reported left lower extremity neurological symptoms and resolving reasonable doubt in the Veteran's favor, the Board finds that the symptoms of his service-connected left lower extremity radiculopathy of the sciatic nerve have more closely approximated the criteria for a 10 percent rating (i.e., mild incomplete paralysis) under DC 8520 for paralysis of the sciatic nerve during the period since the January 22, 2020 Board hearing. This is the earliest that is factually ascertainable that he experienced any left lower extremity neurological symptoms associated with his back disability during the claim period. As for left lower extremity radiculopathy of the femoral nerve, there is no evidence of involvement of the femoral nerve until the September 2020 VA back examination. Moreover, the Veteran's reported left lower extremity neurological symptoms prior to September 24, 2020 are all contemplated by the 10 percent rating that is being awarded under DC 8520, and to separately compensate him for the same symptoms under DC 8526 during this period would constitute pyramiding. 38 C.F.R. § 4.14. Therefore, a compensable rating for left lower extremity radiculopathy of the femoral nerve during the claim period prior to September 24, 2020 is not warranted. Lastly, the Board finds that a rating higher than 10 percent for left lower extremity radiculopathy of the sciatic nerve during the period since January 22, 2020 and a rating higher than 10 percent for left lower extremity radiculopathy of the femoral nerve during the period since September 24, 2020 are not warranted. In particular, the Veteran has only reported pain and numbness in his left lower extremity, all left lower extremity neurological testing has been normal, there has been no muscle atrophy, and the September 2020 examiner only reported at most mild incomplete paralysis of the left sciatic and femoral nerves. While an examiner's characterization of the level of severity of a disability is not binding on the Board, here it is consistent with the evidence, as the symptoms of the Veteran's left sciatic and femoral nerve radiculopathy have been wholly sensory and these disabilities have been manifested by at most mild incomplete paralysis. 38 C.F.R. § 3.100(a) (2017) (delegating the Secretary's authority "to make findings and decisions... as to the entitlement of claimants to benefits" to, inter alia, VA "adjudicative personnel"); 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present"). In sum, an initial 10 percent rating, but no higher, is warranted for left lower extremity radiculopathy of the sciatic nerve, from January 22, 2020, but no earlier. An initial compensable rating, prior to September 24, 2020, and a rating higher than 10 percent, since that date, for left lower extremity radiculopathy of the femoral nerve are not warranted. B. Right Lower Extremity Radiculopathy of the Sciatic and Femoral Nerves The Veteran's right lower extremity radiculopathy of the sciatic nerve is rated 20 percent disabling during the entire claim period prior to September 24, 2020 and 40 percent disabling since that date. His right lower extremity radiculopathy of the femoral nerve is rated noncompensable prior to September 24, 2020 and 30 percent disabling since that date. The above evidence reflects that during the claim period, the Veteran has experienced back pain radiating to the right lower extremity, as well as right leg fatigue, weakness, and decreased sensation. He occasionally experiences right foot drop and is unable to perform any activities during flare ups of his back disability due, at least in part, to his right lower extremity neurological symptoms. Examinations have revealed decreased muscle strength (4/5), absent (0) knee and ankle reflexes, and decreased sensation, but no muscle atrophy. The Veteran was first diagnosed as having right lower extremity radiculopathy of the femoral nerve during the September 2020 VA back examination. In light of these reported symptoms and examination findings, the Board finds that the symptoms of the Veteran's right lower extremity radiculopathy of the sciatic nerve have most closely approximated the criteria for a 40 percent rating under DC 8520 (which contemplates moderately severe incomplete paralysis) during the entire claim period. As explained in the Board's March 2020 decision, an increase in the Veteran's back disability was factually ascertainable one year prior to his October 30, 2013 increased rating claim. Therefore, an initial 40 percent rating for right lower extremity radiculopathy of the sciatic nerve is warranted since October 30, 2012. As for right lower extremity radiculopathy of the femoral nerve, there is no evidence of involvement of the femoral nerve until the September 2020 VA back examination. Moreover, the Veteran's reported right lower extremity neurological symptoms prior to September 24, 2020 are all contemplated by the 40 percent rating that is being awarded under DC 8520, and to separately compensate him for the same symptoms under DC 8526 during this period would constitute pyramiding. 38 C.F.R. § 4.14. Therefore, a compensable rating for right lower extremity radiculopathy of the femoral nerve during the claim period prior to September 24, 2020 is not warranted. Lastly, the Board finds that a rating higher than 40 percent for right lower extremity radiculopathy of the sciatic nerve during the period since October 30, 2012 and a rating higher than 30 percent for right lower extremity radiculopathy of the femoral nerve during the period since September 24, 2020 are not warranted. In particular, there has been no marked muscle atrophy associated with the Veteran's right lower extremity radiculopathy at any time during the claim period, and there has not been complete loss of right lower extremity motor function. In sum, an initial 40 percent rating, but no higher, is warranted for right lower extremity radiculopathy of the sciatic nerve, from October 30, 2012. An initial compensable rating, prior to September 24, 2020, and a rating higher than 30 percent, since that date, for right lower extremity radiculopathy of the femoral nerve are not warranted. III. Urinary Incontinence The Veteran's urinary incontinence is rated under 38 C.F.R. § 4.115B, DC 7517. A bladder injury under DC 7517 is rated as voiding dysfunction under 38 C.F.R. § 4.115A. A voiding dysfunction may be rated as urine leakage, urinary frequency, or obstructed voiding. Where a diagnostic code refers to the criteria for a voiding dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. 38 C.F.R. § 4.115A. As applicable to this case, urine leakage (including continual urine leakage, post-surgical urinary diversion, urinary incontinence, and stress incontinence) is rated as follows: a 10 percent rating is warranted for urine leakage requiring the wearing of absorbent materials which must be changed less than 2 times per day; a 40 percent rating is warranted for urine leakage requiring the wearing of absorbent materials which must be changed 2 to 4 times per day; and a maximum 60 percent rating is warranted for urine leakage requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. 38 C.F.R. § 4.115A. The above evidence reflects that the Veteran has experienced urinary incontinence due to nerve impingement. However, he has not required the use of any absorbent materials or an appliance and his voiding dysfunction has not caused any urinary frequency or signs or symptoms of obstructed voiding. Therefore, a compensable rating for urinary incontinence is not warranted at any time during the claim period. IV. Low Back Strain with Lumbosacral Spondylosis and IVDS The Veteran's service-connected back disability is rated under 38 C.F.R. § 4.71A, DCs 5237-5243. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Here, the use of DCs 5237-5243 reflects that the Veteran's back disability is partially described as lumbosacral strain under DC 5237 and IVDS under DC 5243. A lumbosacral strain under DC 5237 is rated based on limitation of motion of the thoracolumbar spine under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Under the General Rating Formula both prior to and since the regulatory change, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings apply: A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is warranted for ankylosis of the entire spine. Id. Note (2) provides that normal forward flexion of the thoracolumbar spine is to zero to 90 degrees and extension and left and right lateral flexion and rotation of the thoracolumbar spine are all 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 thoracolumbar spine is 240 degrees. Each range of motion measurement is to be rounded to the nearest five degrees. The rating criteria provide 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. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71A, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The Court has held that a veteran may be entitled to a rating higher than 40 percent under the General Rating Formula if he experiences the functional equivalent of ankylosis when considering the provisions of 38 C.F.R. §§ 4.40 and 4.45. Chavis v. McDonough, No. 18-2928, 2021 U.S. App. Vet. Claims LEXIS 660 (Vet. App. Apr. 16, 2021). Under DC 5243 both prior to and since the regulatory change, IVDS (preoperatively or postoperatively) is rated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71A , DC 5243. Under the criteria for rating IVDS, the following ratings apply: a 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months; and a 60 percent rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71A, DC 5243. For purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, DC 5243, Note (1). Considering the pertinent evidence in light of the applicable rating criteria and considerations delineated above, the Board finds, for the following reasons, that the Veteran has manifested thoracolumbar spine symptoms of the type and extent, frequency, and/or severity, as appropriate, to warrant a 20 percent rating, but no higher, during the entire claim period from October 30, 2012 through March 10, 2016, and a 50 percent rating, but no higher, from March 11, 2016, under the criteria in effect both prior to and since the regulatory change. The evidence reflects that during the claim period prior to March 11, 2016, the Veteran experienced back pain and limited spinal motion. The ranges of spinal motion during the August 2014 VA examination were flexion to 50 degrees, extension to 25 degrees, right lateral flexion to 15 degrees, left lateral flexion to 25 degrees, and left and right lateral rotation both to 0 degrees. These ranges of motion by themselves, and without consideration of any additional functional impairment, warrant a 20 percent rating under the General Rating Formula as the combined range of motion during this period was not greater than 120 degrees. As explained in the Board's March 2020 decision, an increase in the Veteran's back disability was factually ascertainable one year prior to his October 30, 2013 increased rating claim. Therefore, a 20 percent rating is warranted for the service-connected back disability during the entire period from October 30, 2012 through March 10, 2016. The Board also finds that a rating higher than 20 percent is not warranted any time during the claim period prior to March 11, 2016. Specifically, the Veteran's ranges of spinal motion during the August 2014 examination remained the same following repetitive use testing. The Veteran reported that he experienced flare ups of increased pain approximately 3 to 4 days per week, but the examiner who conducted the August 2014 examination explained that there were no additional functional limitations or additional loss of motion during flare ups or with repetitive use due to pain, weakness, fatigue, or incoordination. The Veteran is competent to report the symptoms associated with his service-connected back disability and the extent of his impairment during flare ups of symptoms and following repetitive use, and the Board has no reason to challenge the credibility of his contentions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Regardless of the competent and credible reports of flare ups, pain, and other functional impairments, and despite the fact that painful motion was documented, the preponderance of the evidence nonetheless supports the conclusion that the Veteran's back symptoms most closely approximated the criteria for at most a 20 percent rating for limitation of spinal motion under the General Rating Formula during the claim period prior to March 11, 2016. Specifically, the above evidence reflects that the flare ups and other functional impairments were not so severe, frequent and/or prolonged to warrant the next higher percent rating at any time during the claim period. A preponderance of the evidence shows that even considering pain, flare ups, and other functional factors, the Veteran's back symptoms were not shown to have been so disabling to actually or effectively result in limitation of forward flexion of the thoracolumbar spine more nearly approximating 30 degrees or less (which is the requirement for a 40 percent rating based on limitation of spinal motion under the General Rating Formula), much less fixation of the entire thoracolumbar spine in flexion or extension with any of the additional symptoms or limitations listed in Note (5) of the General Rating Formula. Also, the absence of actual ankylosis was specifically noted during the August 2014 examination. As for the period since March 11, 2016, the Veteran has experienced lower extremity neurological impairment associated with his service-connected back disability. Also, as noted above, he was unable to perform spinal ranges of motion due to chronic back pain during the March 2016 VA evaluation, he reported during the April 2019 VA evaluation that his back pain was worsening, extension of the thoracolumbar spine was to 0 degrees during the September 2020 examination, and he was unable to perform repetitive use testing due to extreme pain during that examination. In light of the extreme limitation of spinal motion (to include limitation of extension to 0 degrees) and the fact that the Veteran has experienced neurologic symptoms associated with his back disability, the Board finds that the Veteran has experienced the functional equivalent of ankylosis of the thoracolumbar spine during the period since March 11, 2016. There is no evidence of actual ankylosis of the entire spine. Therefore, a 50 percent rating under the General Rating Formula for the service-connected back disability, from March 11, 2016, is warranted. Moreover, the Board acknowledges that the Veteran has been diagnosed as having IVDS during the claim period. However, he has not experienced incapacitating episodes of IVDS, as that term is defined above, at any time during the claim period. Therefore, a higher rating is not warranted on the basis of IVDS at any time during the claim period. In sum, a 20 percent rating, from October 30, 2012 through March 10, 2016, and a 50 percent rating, from March 11, 2016, for low back strain with lumbosacral spondylosis and IVDS is warranted. V. Additional Considerations As a final matter, the Board finds that, in conjunction with the higher rating matters discussed herein, no other related issues have been raised by the Veteran or his representative, and no other such issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.