Citation Nr: 21030777 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 14-19 847A DATE: May 19, 2021 ORDER Entitlement to service connection for a left arm disorder, to include as secondary to service-connected residuals of cervical spine injury with degenerative changes is denied. Entitlement to service connection for left leg disorder to include as secondary to service-connected residuals of injury of the lumbar spine is denied. Entitlement to a rating in excess of 20 percent for residuals of injury of the lumbar spine is denied. Entitlement to a rating in excess of 20 percent for residuals of cervical spine injury with degenerative changes is denied. Entitlement to an initial rating of 30 percent for right upper extremity radiculopathy prior to February 27, 2020 is granted. Entitlement to an initial rating in excess of 30 percent for right upper extremity radiculopathy is denied. Entitlement to an initial rating in excess of 20 percent for right lower extremity radiculopathy is denied. REMANDED Entitlement to an earlier effective date for the 20 percent increase for residuals of injury lumbar spine (also claimed as dorsal somatic dysfunction) is remanded. Entitlement to an earlier effective date for the 20 percent increase for residuals of cervical spine injury with degenerative changes is remanded. FINDINGS OF FACT 1. To the extent the Veteran has a compensable disability in his left arm, the relevant inservice medical records are dated during a period of service that is considered dishonorable for VA purposes and which serves as a bar to the receipt of benefits from the U.S. Department of Veterans Affairs (VA). 2. The preponderance of the evidence of record is against finding that the Veteran has had a left leg disorder at any time during or approximate to the pendency of the claim. 3. During the period on appeal, the Veteran's service-connected lumbar disability did not result in limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 4. During the period on appeal, the Veteran's service-connected cervical disability did not result in limitation of forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. 5. From September 22, 2014 to February 27, 2020, reading the evidence in a light most favorable to the Veteran, the Veteran's right upper extremity peripheral neuropathy was manifested by moderate incomplete paralysis of the major extremity. 6. From February 27, 2020, the Veteran's right upper peripheral neuropathy was not manifested by either severe incomplete paralysis or complete paralysis of the median nerve of the major extremity. 7. To the extent the Veteran experienced radiculopathy in his right lower extremity during the period on appeal, the symptoms were mostly mild in nature, and moderate, at their worse. CONCLUSIONS OF LAW 1. The criteria for service connection for a left arm disorder, to include as secondary to service-connected residuals of cervical spine injury with degenerative changes are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection left leg disorder to include as secondary to service-connected residuals of injury of the lumbar spine are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for an initial rating in excess of 20 percent for residuals of injury of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a. 4. The criteria for an initial rating in excess of 20 percent for residuals of cervical spine injury with degenerative changes have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a. 5. The criteria for an initial rating of 30 percent prior to February 27, 2020 for right upper extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a. 6. The criteria for an initial rating in excess of 30 percent from February 27, 2020 for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a. 7. The criteria for an initial rating higher than 20 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1980 to August 1985. He had an additional period of active duty, from September 1985 to July 2001, from which he was dishonorably discharged. As discussed in an April 2018 decision by the Board of Veterans' Appeals (Board), VA determined that the character of service for the period from November 1989 to July 2001 is a bar to VA benefits. This matter comes to the Board on appeal of a rating decision by a VA Regional Office (RO). In April 2018, the Board remanded the claims on appeal for additional development. The case is again before the Board for appellate review. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for a left arm disorder, to include as secondary to service-connected residuals of cervical spine injury with degenerative changes is denied. 2. Entitlement to service connection for left leg disorder to include as secondary to service-connected residuals of injury of the lumbar spine is denied. In September 2014, the Veteran filed for service connection for "nerve damage," "bilateral arm condition", and "bilateral leg condition." Specifics were not given as to what arm or leg condition the Veteran was claiming entitlement to. Nevertheless, the March 2015 decision on appeal interpreted this to be a claim for bilateral arm and bilateral leg nerve damage. While service connection was granted for neuropathy of the right upper and right lower extremities, the claims regarding the left upper and lower extremities were denied as there was no current disability. Neither the Veteran or his representative have submitted argument or contentions beyond general disagreement with the rating decision on appeal as to how service connection is warranted. The Veteran has not identified any outstanding clinical records pertinent to the claims. Prior to the claims on appeal, at a November 2009 VA examination for the cervical and lumbar spine, the Veteran reported tingling in his left hand from the elbow to his fingers. While numbness from his right buttock to his middle toes and right leg weakness was reported, similar symptomatology for his left lower extremity was not. Later, at a March 2015 VA examination of the cervical spine, radiculopathy symptoms were denied for the left upper extremity. At a May 2015 lumbar spine examination, radiculopathy symptoms were also denied for the left lower extremity. At a May 2015 peripheral nerves VA examination, the examiner checked "none" as to the Veteran having any symptoms attributable to any peripheral nerve conditions for his left upper and left lower extremities. Additionally, the examiner reported after a review of the Veteran's medical records and examination that the Veteran did not have a current diagnosis of a left upper or a left lower extremity nerve condition. The examination of the left upper and lower extremities was within normal limits. A May 2015 VA medical record reports that the Veteran experienced increased numbness in his bilateral upper extremities. He reported experiencing more symptoms in his left side then in his right. He reported bilateral spasms and ulnar distribution. The assessment was cervical radiculopathy. In August 2015, a VA medical record documented the results of a June 2015 EMG/nerve conduction test. The test indicated the presence of left ulnar neuropathy at the elbow that was estimated to be moderate in degree. But the report indicates an absence of cervical radiculopathy. Another August 2015 VA medical record reports the Veteran had moderate cubital tunnel symptoms in the left side. A September 2015 VA medical record reports the results of an EMG of the Veteran's lower extremity. He reported chronic lower back pain and numbness radiating down the right leg to the foot. The report indicated no medical evidence of lumbosacral radiculopathy. In September 2016, the Veteran reported some involuntary spasms in his forearm, and that he noticed numbness in his thumb, index, and long fingers, especially in his right side. Results of an MRI indicated cervical spondylosis. The Veteran denied any significant clumsiness in his hands or unexpectedly dropping objects. He didn't notice a diminished sensation in his thumb, index, and long fingers when he picked things ups. Based on this the clinician found it was problematic to determine whether the symptoms were due to carpal tunnel syndrome or a radiculopathy. Yet, the examiner reported that per his previous 2015 EMG, there was no evidence of cervical radiculopathy As the history regarding the radiculopathy on the left side was unclear, the Board remanded the claims in April 2018 for an opinion as to whether the Veteran had a diagnosis of neuropathy in his left upper extremity and left lower extremity. At his January 2020 VA examination for both his cervical and lumbar condition, cervical and lumbar radiculopathy were denied. Also, at his February 2020 VA examination for peripheral neuropathy, his left upper extremity and left lower extremity were not reported to have any associated peripheral neuropathy symptoms. As to the post-remand opinion, a February 2020 VA examiner reported that the Veteran denied any symptoms pertaining to his left arm and left leg and that there were no abnormal findings on physical examination that indicated a disorder of the left arm or left leg. The service medical records from August 1996 report the Veteran complained of left shoulder pain with an intermittent tingling sensation to the left arm. This was associated with an injury from which a mower rolled onto the Veteran. In a November 1999 report the Veteran complained of having electrical shocks, mostly in his arms, throughout his body. Also, at separation, in August 2000, the Veteran reported "yes" as to ever having a nerve injury. Significantly, these reported symptoms occurred during the period of service from November 1989 to July 2001. This period of service has been found to be dishonorable for VA purposes. VA benefits are not payable unless the period of service upon which the claim is based was terminated by discharge or release under conditions other than dishonorable. 38 U.S.C. § 101(18); 38 C.F.R. § 3.12(a). To that extent, these medical records do not weigh in favor of the Veteran's claims. The Board finds the preponderance of the probative evidence weighs against a finding that there is a current disability or an inservice incident affecting the left upper or lower extremity with regard to the radiculopathy claims. In spite of the June 2015 finding of left ulnar neuropathy in his VA medical records, both the March 2015 and February 2020 VA examinations along with the examiners' opinions, weigh against the evidence that the Veteran has a diagnosed condition in his left arm or left leg. Notably, the February 2020 VA examination discusses the results of the June 2015 EMG in the medical history portion of the examination and still finds that there is no pathology. Consideration has been given as to whether the Veteran's reported symptoms in his left upper extremity amount to a compensable disability under Saunders v. Wilkie, 886 F. 3d (Fed. Cir. 2018). Notably, there is evidence of a left cubital tunnel/ carpal tunnel disorder in the Veteran's left upper extremity. Yet the record shows that symptoms of pain, numbness, and paresethesias/dysesthesias were not present in his left upper extremity at his March 2015 and February 2020 peripheral nerve VA examinations. Also, the Veteran denied symptoms at his February 2020 VA examination and the February 2020 VA examiner reported there was no evidence of a disorder, including neuropathy, in his left arm. The medical record, the Veteran's reports, and the February 2020 VA examiner's medical opinion weigh against finding that the Veteran has a disability under Saunders. Accordingly, neither a direct nor a secondary service connection finding is warranted for these claims. The record lacks evidence of a current disability in either the left upper or left lower extremity. While the Veteran has reported in the alternative that he has neuropathy as secondary to his cervical and lumbar conditions, service connection on a secondary basis is not warranted either. As noted, symptoms were denied in his left upper and left lower extremities at his lumbar, cervical, and peripheral neuropathy VA examinations during the period on appeal. "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.... In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, the claims of entitlement to service connection for left upper and lower extremity disorders must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating Disability ratings assigned in accordance with VA's Schedule for Rating Disabilities are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When a condition is specifically listed in the Rating Schedule, it may not be rated by analogy under a different diagnostic code. See Copeland v. McDonald, 27 Vet. App. 333, 337. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). A "staged" rating will be assigned for diverse symptoms meeting the criteria for different ratings in distinct time periods. See Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not explicit in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995). Pain may be a cause or manifestation of functional loss and may factor into a determination regarding limitation of motion. Pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45 (2019). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). 3. Entitlement to a rating in excess of 20 percent for residuals of injury of the lumbar spine is denied. The Veteran has been service connected for lumbar spine disability since October 2003. The disability has been rated as 20 percent disabling since March 2009. In September 2014, the Veteran claimed entitlement to a higher rating. In March 2015, the RO denied the claim. This appeal arises from disagreement with this decision. The Veteran's service-connected lumbar disability is currently rated under Diagnostic Code 5237. The General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent disability rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted where there is forward flexion of the thoracolumbar spine of 30 degrees or less. A 50 percent evaluation is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. In addition, any associated objective neurologic abnormalities are evaluated separately under the appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note 1. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, General Rating Formula, Note (2), Plate V. Ankylosis is defined as the "immobility and consolidation of a joint due to disease, injury, or surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). Alternatively, VA may evaluate intervertebral disc syndrome (IVDS) under the Formula for Rating IVDS Based on Incapacitating Episodes. Under that Formula, a 20 percent rating is warranted where incapacitating episodes have a total duration of at least two weeks but less than 4 weeks during the past 12 months. A rating of 40 percent is warranted where there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A maximum rating of 60 percent is warranted where the evidence reveals incapacitating episodes having a total duration of at least six weeks during the past 12 months. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. VA amended the criteria pertaining to IVDS effective February 7, 2021. Under the amendment, the criteria for IVDS will be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. As discussed below, IVDS for the Veteran's lumbar spine was not reported during the period on appeal. Thus, further discussion under these criteria is not warranted. Facts Turning to the evidence, the Veteran underwent a March 2015 VA examination for his lumbar spine disability. The Veteran's diagnosis of dorsal somatic dysfunction was confirmed. The Veteran's reported increased pain with pain spikes. He stated that the pain made it hard for him to breathe at times. His back pain was explained to be as numbness that was positional in nature and affected by weather. He reported that sitting more than 15-20 minutes, standing more than 15-20 minutes, and weather changes exacerbated his back pain. He also stated he had problems with toileting himself and bending over due to his back pain. The Veteran rated his back pain as 6 to 7 out of 10. His pain was being treated with over the counter medicine like aspirin, a TENS unit, and tiger balm. The Veteran was able to complete his ADLS (activities of daily living). This included showering with a shower chair, putting his socks on with a reacher, driving, grocery shopping with a scooter, and loading/ unloading his own groceries. He was able to complete simple meal preparation using the microwave. He also could exercise around his home a couple of times a day for 15-20 minutes. He reported flare-ups, as shooting pain across his back, right in the middle, then with spasms. When they occurred, he reportedly could not walk. His initial range of motion was reported with forward flexion of 0 to 60 degrees. Extension of 0 to 20 degrees. Right and left lateral flexion of 0 to 15 degrees. Right and left lateral rotation of 0 to 15 degrees. Decreased range of motion and functional loss were reported due to pain. Pain was exhibited on forward flexion, extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. Also pain with percussion to his lumbar spine and with palpation to his right paraspinous musculature, right thoracic and right lumbar regions was reported Additional loss of function or range of motion was reported with repetitive use. Factors contributing to this loss included pain, fatigue, weakness, lack of endurance, and incoordination. After repetitive testing, range of motion testing was the same. The examiner reported that it was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner also reported it is neither medically consistent nor inconsistent with the Veteran's statements describing functional lost during flare-ups. The examiner was unable to say without mere speculation whether pain, fatigability, or incoordination significantly limited functional ability with flare-ups because the Veteran was not being examined under those conditions. Muscle spasm, localized tenderness, and guarding all resulting in abnormal gait or abnormal spinal contour was also reported. During the examination, the Veteran needed to alternate between sitting and standing and walking around the examination room, due to reported increased back pain. Muscle atrophy, ankylosis, and IVDS were all denied. The Veteran reportedly used a brace and cane constantly for his back condition. The examiner noted the Veteran had poor effort related to pain when completing range of motion testing and repetitive testing. The Veteran became tearful during his examination and became overwhelmed with specific interview questions for the history of his lumbar condition. VA physical therapy records from September 2017 report the Veteran was fitted for a new back brace, but he was experiencing back pain of a 7 out of 10. He was taking gabapentin for his pain. An April 2018 VA medical record reported lower back pain, and again in a May 2019 VA medical record. Most recently, the Veteran underwent an additional VA examination for his lumbar spine disability in January 2020. Diagnoses of lumbosacral strain and degenerative arthritis were confirmed. The Veteran reported constant middle to lower back pain that seemed to radiate down his right leg. He rated his average back pain as 6 out of 10. Walking more than 20-30 minutes, sitting for more than 45 minutes, standing for more than 45 minutes, weather changes, stooping/ lifting, all aggravated his back pain. He treated his back pain with gabapentin three times a day. He also used CBD oil topically and orally, aspirin, hot baths, and a TENS unit all on an "as needed" basis. He continued to be independent with his ADLs and drove himself to his examination. He described his flare-ups as being like a numb ball in the middle of his back. The pain went down into his right legs and toes, and it was hard for him to walk. That pain would last a while, and sometimes, put him down for a day. Initial range of motion testing revealed forward flexion of 0 to 65 degrees. Extension of 0 to 30 degrees. Right lateral flexion of 0 to 20 degrees. Left lateral flexion of 0 to 30 degrees. Right lateral rotation of 0 to 10 degrees; and left lateral rotation of 0 to 20 degrees. While pain was noted on the examination, it did not result in functional loss. Pain was noted during forward flexion, right lateral flexion, and right lateral rotation. Pain was also noted with palpation to the middle to lower right sided thoracic and lumbar paraspinous musculature. Repetitive use testing revealed loss of function or range of motion. Forward flexion was 0 to 50 degrees. Extension was 0 to 30 degrees. Right lateral flexion was 0 to 20 degrees. Left lateral flexion 0 to 30 degrees. Right lateral rotation was 0 to 10 degrees; and left lateral rotation was 0 to 20 degrees. While the examiner reported that the Veteran was not being examined immediately after repetitive use over time, the examination reports that it was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner opined that pain, weakness, and lack of endurance significantly limited the Veteran's functional ability with repeated use over a period of time. In terms of range of motion, forward flexion was 0 to 65 degrees; extension was 0 to 30 degrees; right lateral flexion was 0 to 20 degrees; left lateral flexion was 0 to 30 degrees; right lateral rotation was 0 to 10 degrees; and left lateral rotation was 0 to 20 degrees. The examination was not being conducted during a flare-up but the examiner reported that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. Muscle spasms were reported, but it did not result in abnormal gait or abnormal spinal contour. Muscle atrophy, ankylosis, and IVDS were all denied. Regular use of a cane and brace were reported. The lumbar spine condition reportedly impacted the Veteran's ability to work. He had not worked full-time since May 2019, where he worked full time in IT. He reported increased pain when sitting in his chair for more than 45 minutes. He also reported he could not stand longer than 45 minutes and that climbing stairs increased his pain. Analysis The Board does not find a higher rating warranted at any time during the appeal period. To warrant a higher rating, the evidence must show forward flexion of the lumbar spine limited to 30 degrees or less or show evidence of ankylosis in the spine. During the appeal period, the Veteran's lumbar spine forward flexion was limited to, at worse, 0 to 50 degrees at his January 2020 VA examination, after repetitive testing. Moreover, the record does not indicate symptoms approximating ankylosis of the lumbar spine. The Board does acknowledge the March 2015 VA examiner's note indicating "less movement than normal due to ankylosis, adhesion, etc." Thus, the preponderance of the evidence including the Veteran's statements and the two VA examinations during the appeal period indicates an absence of ankylosis. The Board has considered whether a higher disability rating is warranted based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint. Pursuant to 38 C.F.R. § 4.59, at least the minimum compensable rating for painful motion with joint or a particular pathology is authorized. However, the Veteran is already compensated for his pain with his 20 percent rating. Moreover, even when considering pain, fatigue, weakness, lack of endurance, incoordination or flare-ups, limitation of functional ability approximates the criteria for the 20 percent rating assigned during the appeal period. See 38 C.F.R. §§ 4.45, 4.71a. In sum, despite the Veteran's complaints of painful motion, a preponderance of the evidence shows an ability to forward flex without functional impairment beyond 30 degrees, shows an absence of incapacitating episodes due to IVDS, and shows an absence of ankylosis in the spine. As such, the claim of entitlement to an increased rating for lumbar spine disability must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 4. Entitlement to a rating in excess of 20 percent for residuals of cervical spine injury with degenerative changes is denied. The Veteran has been service connected for cervical spine disability since October 2003. The disability has been rated as 20 percent disabling since March 2009. In September 2014, the Veteran claimed entitlement to a higher rating. In March 2015, the RO denied the claim. This appeal arises from disagreement with this decision. The Veteran's cervical spine disability is rated under 5242-5237. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Diagnostic Code 5242 refers to degenerative arthritis of the spine. Diagnostic Code 5237 refers to cervical strain. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) discussed above apply to the cervical spine as well. Thereunder, the next-highest rating of 30 percent is warranted for forward flexion of the cervical spine of 15 degrees or less, while 40, 50, and 100 percent ratings are warranted for ankylosis in the spine. 38 C.F.R. § 4.71a. For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The normal combined range of motion of the cervical spine is 340 degrees. Facts A VA July 2015 physical therapy record reports the Veteran was given a home unit for cervical traction to treat his neck pain. At the Veteran's March 2015 VA examination for the cervical spine, a diagnosis of degenerative arthritis of the spine was confirmed. The Veteran reported that he had increased neck pain. He was experiencing spasms to his neck and had right arm weakness from his neck to right hand. He reported constant neck pain and needle-like spasms. His pain was on average 6/10. He reported radiation of pain to his right arm with numbness. He reported that he treated his neck pain with over the counter medications such as asprin, tiger balm, and a TENs unit. He reported difficulty with turning his neck, and at times, he was unable to concentrate because of his neck pain. If he got startled or had sudden action to his neck, this would exacerbate his neck pain. Also, standing more than 15-20 minutes, sitting more than 5-10 minutes, along with weather changes would exacerbate his neck pain. The Veteran was independent with ADLs. He reported the same abilities as noted in his lumbar spine examination, discussed above. Flare-ups were reported. The Veteran reported, "it's the arm and neck all tied together." He indicated that laying down with a pillow behind his neck, along with use of a TENs unit, helped with the symptoms. Initial range of motion was forward flexion, extension, right and left lateral flexion, of 0 to 20 degrees. Right and left lateral rotation were 0 to 60 degrees. The limited range of motion and mobility were related to pain. Pain was noted on the examination with forward flexion, extension, right and left lateral flexion and rotation. Pain with palpation to the right cervical spine paraspinous musculature was reported. The Veteran was unable to perform repetitive use testing. Decreased efforts with range of motion testing and repetitive use related to increased pain. The examination report notes that it was neither medically consistent nor medically inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Also, the examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time or during a flare up because the Veteran wasn't examined under those conditions. Muscle spasm, localized tenderness, and guarding resulting in abnormal gait or abnormal spinal contour was reported. The March 2015 report indicated that the Veteran alternated between sitting and standing and walked around the examination room. Muscle atrophy and ankylosis were denied. IVDS of the cervical spine was reported, but the Veteran had not had any episodes of acute signs and symptoms due to IVDS that required best rest prescribed by a physician and treatment by a physician in the prior 12 months. Constant use of his cane was reported for the neck condition. It was also observed, as noted in his lumbar spine March 2015 examination, that the veteran exhibited poor effort related to reported pain when completing range of motion testing and repetitive testing. He was tearful during his examination and became overwhelmed with interview questions regarding his medical history. Imaging studies had been performed that confirmed arthritis. A VA September 2016 orthopedic clinic note reported magnetic resonance imaging (MRI) of the cervical spine revealing multilevel DDD (degenerative disc disease), C5/C6 posterior protruding disc with moderate spinal cord stenosis, C6/C7 posterior protruding disc with spinal cord stenosis. Also, a diagnosis of cervical spondylosis was reported. Most recently, the Veteran underwent a VA examination for his cervical spine in January 2020. A diagnosis of degenerative arthritis of the spine and spinal stenosis were confirmed. The Veteran reported pain that radiated from his cervical spine to his right upper extremity. He rated his neck pain as a 4 out of 10 but it could get up to a 9 out of 10. Sitting more than 30 minutes, standing more than 30 minutes, and excessive lifting and moving of the neck all aggravated his neck pain. He reported that driving to his appointment also aggravated his neck pain and numbness in his right arm. He was limited to doing tasks such as typing or computer work because of the neck pain that also radiated to his right upper extremity. He was treating the pain with gabapentin three times a day, aspirin, taking CBD orally or topically, hot baths, or a TENs unit, as needed. He was able to perform his ADLs and drive. He also reported neck pain that radiated into his head (headaches) and was experiencing dizzy spells. Flare-ups of cervical pain were reported. If he did a lot of lifting or was more mobile, he would get a burning headache that went down into his arm. The pain hurt more through his arm and through his fingers. He would usually lay down when he had such pain issues. After taking gabapentin, the pain would usually subside. Yet, he reported that episodes like this no longer occurred since he stopped working. The January 2020 VA report notes initial range of motion of forward flexion of 0 to 35 degrees, extension of 0 to 30 degrees, right lateral flexion of 0 to 30 degree, left lateral flexion of 0 to 40 degrees, right lateral rotation of 0 to 60 degrees and left lateral rotation of 0 to 70 degrees. While pain was noted during forward flexion, it did not result in functional loss. Pain with weight bearing was denied. Pain was also reported with palpation to his right sided cervical paraspinous musculature. The Veteran was able to perform repetitive use testing and it did not result in additional loss of function or range of motion. The examiner reported that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. Pain and weakness were factors that limited his ability with repeated use over time. Yet, when described in terms of range of motion, the findings were the same as those reported on examination for initial range of motion. As the examination was not being conducted during a flare-up, the examiner reported that it was medically consistent with the Veteran's statements describing functional loss during flare-ups. Moreover, pain, weakness, fatigability, or incoordination did not significantly limit his ability with flare-ups. Muscle spasm not resulting in abnormal gait or abnormal spinal contour was reported. The report indicated no muscle atrophy, ankylosis, or IVDS of the cervical spine. Regular use of a cane was reported for his cervical condition. Functional loss was reported. As noted in the lumbar discussion above, the Veteran had not worked since May 2019. He reported that his back impacted his ability to do work due to his increased pain with sitting in a chain for more than 45 minutes. Moreover, he could not stand longer than 45 minutes due to increased neck pain. Additionally, he could no longer sit in front of a computer screen because it put a strain on his neck and caused him pain. He was unable to perform passive range of motion testing, and pain during a non- weight-bearing status was reported. Analysis A rating in excess of 20 percent is not warranted for the cervical spine disability during the period on appeal. To warrant a higher rating, the Veteran's cervical spine would need to be restricted to forward flexion of 15 degrees or less or favorable ankylosis of the cervical spine. At its worse, the Veteran's cervical spine disability exhibited forward flexion to 20 degrees (March 2015 VA examination). Moreover, the record does not indicate symptoms approximating ankylosis of the cervical spine. The Board does acknowledge the examiner's note at the March 2015 examination that reported additional symptoms contributing to the Veteran's cervical condition included "less movement than normal due to ankylosis, adhesion, etc." Yet aIn sum, despite the Veteran's complaints of painful motion, a preponderance of the evidence shows an ability to forward flex without functional impairment beyond 15 degrees, shows an absence of incapacitating episodes due to IVDS, and shows an absence of ankylosis in the spine. As such, the claim of entitlement to an increased rating for cervical spine disability must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 5. Entitlement to an initial rating of 30 percent for right upper extremity radiculopathy prior to February 27, 2020 is granted. 6. Entitlement to an initial rating in excess of 30 percent for right upper extremity radiculopathy is denied. 7. Entitlement to an initial rating in excess of 20 percent for right lower extremity radiculopathy is denied. The Veteran filed a claim for "nerve damage," a bilateral arm condition, and a bilateral leg condition in September 2014. As a result, the Veteran was granted service connection for radiculopathy in the right upper extremity and right lower extremity, with September 22, 2014 effective dates and 20 percent ratings. The appeals arise from disagreement with this decision. While the claims were pending, the Veteran's rating for his right upper extremity was increased to 30 percent, effective February 27, 2020 in an August 2020 rating decision. The Veteran has not indicated he is satisfied with the increased rating, so the issue remains on appeal. Peripheral neuropathy in the right upper extremity is rated under Diagnostic Code 8515 for the median nerve. See 38 C.F.R. § 4.124a. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8615 and 8715. Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated 70 percent disabling for the major extremity and 60 percent for the minor extremity. Complete paralysis is manifested by such symptoms as: the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb at right angles to palm; flexion of wrist weakened; pain with trophic disturbances. 38 C.F.R. § 4.124a. The Veteran's right lower extremity is rated under Diagnostic Code 8520. This DC addresses paralysis of the sciatic nerve. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720. Under these criteria, 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. And complete paralysis, manifested by such evidence as dangling and dropping foot, 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 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). Facts The Veteran underwent a VA examination in March 2015 for peripheral nerves conditions. The diagnosis was sciatica to the right lower extremity. He reported neck pain that radiated to his right arm with intermittent numbness and tingling. He also stated he had back pain that radiated down his right leg with intermittent numbness and tingling. Symptoms included moderate intermittent pain, mild paresthesias/ and or dysesthesias, and mild numbness in the right upper and right lower extremities. Muscle strength testing revealed elbow flexion, elbow extension, wrist flexion, wrist extension, grip, pinch, knee extension, ankle plantar flexion, and ankle dorsiflexion was reduced to 4 out of 5 for the right side. Muscle atrophy was not present. Reflex examinations revealed the right bicep, triceps, brachioradiales, knee, and ankle were hypoactive. Sensory testing was normal except for the right lower leg/ankle and right foot/toes which were "decreased." Trophic changes were not found. An abnormal gait was observed, but the etiology was due to his back condition. The examiner opined that the service-connected disabilities were productive of mild incomplete paralysis in the right median nerve and moderate incomplete paralysis in the sciatic nerve. Constant use of a cane was reported. The examiner opined that the peripheral nerve disability did not impact the Veteran's ability to work. A June 2015 VA medical record reports the results of an EMG. Right median neuropathy at the wrist, to a moderate degree, was reported. A September 2015 VA medical record includes the results of an EMG of the Veteran's lower extremity. He reported chronic lower back pain and numbness radiating down the right leg to the foot. He complained of numbness in the second, third, and fourth toes of the right foot had begun in 1984. His pain was worse with driving, and he denied loss of bowel or bladder control. He ambulated slowly using a back brace and a cane. The impression was that there was electrodiagnostic evidence of right peroneal neuropathy at the ankle. There was no evidence of lumbosacral radiculopathy. A VA orthopedic clinic surgery outpatient note in September 2016 reports the Veteran reported some involuntary spasms in his forearm and that he noticed numbness in his thumb, index, and long fingers, especially in his right side. The Veteran denied any significant clumsiness in his hands or unexpectedly dropping objects. Yet, he did report a diminished sensation in his thumb, index, and long fingers when he picked things ups. The clinician found it problematic to determine whether the Veteran's symptoms were due to carpal tunnel syndrome or a radiculopathy. The examiner reported that per his previous June 2015 EMG, there was no evidence of cervical radiculopathy. In January 2020, at his Cervical Spine VA examination, the Veteran described numbness that extended from his neck all the way down to his right fingers. He reported that his right hand was "weak." Most recently, the Veteran underwent VA examination for his peripheral nerve disabilities in February 2020. He reported his current symptoms included radiating pain from his neck to his fingers in his right hand. He also described pain and spasms starting in his lower back and radiating down his right leg into his right foot. He stated he had constant numbness in his "2 center toes." Also, he reported there was constant pain and numbness in his right arm, and 3rd, 4th, and 5th fingers. He reported weakness of his right hand and arm. His current treatment included a TENS unit, physical therapy, walking, and Gabapentin at bedtime. When the pain is worse, he stated he would take two additional daytime doses of gabapentin. He stated the impact of his condition on his functioning was that he could not sit or stand for longer than 35 to 45 minutes. He also stated that he struggled with using a keyboard or driving for long periods of time. Mild constant pain, mild paresthesias and/or dysesthesias, and mild numbness were attributed to the peripheral nerve conditions in the right upper and right lower extremities. Muscle strength testing revealed elbow flexion, elbow extension, wrist flexion, wrist extension, grip, pinch, knee extension, ankle plantar flexion, and ankle dorsiflexion was reduced at 4/5 for the right side. Deep tendon reflexes were hypoactive for the right biceps, triceps, and brachioradialis but the knee and ankle were normal on testing. Sensation testing was decreased in the right shoulder area, forearm, and right upper anterior thigh, thigh/knee, lower leg/ankle, and the foot and toes. Trophic changes were not observed, and his gait was normal. No muscle atrophy was found. The February 2020 VA examiner opined that the service-connected disability was productive of mild incomplete paralysis of the median nerve. Regarding the right lower extremity, the examiner found that the diagnosis was changed and there was no evidence of a right lower extremity radiculopathy. The examiner found the neurological examination was inconsistent with a radiculopathy of any nerve pathway in the right lower extremity. Analysis Right Upper Extremity a. Before February 27, 2020 The February 27, 2020 date is consistent with the Veteran's February 2020 VA examination. The Veteran is right-hand dominant. To that extent, to warrant a higher rating prior to February 27, 2020, the service-connected disability would need to be productive of moderate incomplete paralysis. The Board finds the Veteran's symptoms warrant a 30 percent rating for moderate incomplete paralysis prior to February 27, 2020. During this period, the Veteran has reported pain that radiated to his arm, intermittent numbness and tingling, muscle spasms, and diminished sensations in his fingers when he picked things up. His observed symptoms included moderate intermittent pain, mild paresthesias/or dysestheias, mild numbness, somewhat reduced muscle strength at 4 out 5; and hypoactive reflexes. Yet his sensory testing was reported to be normal, and both muscle atrophy and trophic changes were denied. As noted at his June 2015 EMG, the Veteran's right median neuropathy to a moderate degree was observed. The Board acknowledges that not all of these symptoms were observed at the time of the March 2015 VA examination. However, the Veteran's lay reports of pain and numbness have been consistent throughout the period on appeal. As recent as January 2020, the Veteran was reporting similar symptomatology. As such, the Board will afford the Veteran the benefit of the doubt and finds that the overall symptomatology prior to February 27, 2020 approximated the above-noted symptoms. Based on his reported symptoms, his observed reduced muscle strength and reflexes, and the June 2015 EMG reporting "moderate" right median neuropathy, the Board finds a 30 percent rating for moderate incomplete paralysis warranted for the period of appeal prior to February 27, 2020. However, a rating in excess of 30 percent is not warranted. None of the Veteran's observed symptoms have been reported as severe. Muscle strength was no less than 4 out of 5. While his reflexes were hypoactive, they were still present. In spite of his report of reduced sensation in his fingers when picking things up, sensation was not absent. Moreover, trophic changes and muscle atrophy were not observed. Accordingly, the Board finds a rating of 30 percent, but no higher, is warranted for this condition prior to February 27, 2020. b. After February 27, 2020 For the same reasons, a rating higher than 30 percent is not warranted after February 27, 2020. In the February 2020 VA examination, the Veteran complained of constant pain and numbness in his right arm, and 3rd, 4th, and 5th fingers; and weakness of his right hand and arm. His observed attributed symptoms of constant pain, paresthesias/dysesthesias, and numbness were all reportedly mild. Muscle strength, at its worse, was reportedly a 4 out of 5, and both atrophy and trophic changes were not observed. While his reflexes were hypoactive, they were not absent. Also, while sensory testing revealed decreased senses, they were not absent either. Moreover, complete paralysis was not shown. Based on the Veteran's reports and the February 2020 VA report, the Board finds the next-highest rating of 50 percent unwarranted. In short, the evidence dated after February 2020 continues to show as it did prior to February 2020, that neurological impairment in the right arm has been moderately rather than severely disabling. As such, the claim for a higher rating from February 27, 2020 is denied. Right Lower Extremity Right lower extremity neurological disability has been rated 20 percent disabling throughout the appeal period. To warrant a higher rating, the evidence must indicate incomplete paralysis of a moderately severe nature or a greater level of impairment. The Board finds a higher rating for this right lower extremity neuropathy is not warranted. During the appeal period, the Veteran reported radiating pain in his right leg with intermittent tingling, numbness, and spasms. Specifically, numbness in the second, third, and fourth toes of the right foot was reported. He experienced pain with driving and walking. Observed symptoms included mild constant pain, moderate intermittent pain, mild paresthesias/ and or dysesthesias, mild numbness, reduced muscle strength (4 out of 5); and decreased sensation. Yet, muscle atrophy or trophic changes were not observed. While an abnormal gait was reported at his March 2015 examination, it was attributed to his lumbar condition. Moreover, the February 2020 VA examiner found that the Veteran did not have symptoms indicating radiculopathy in the right lower extremity. The Board notes that the Veteran's symptoms and incomplete paralysis have been observed to be, at their worse, moderate during the period on appeal. To the extent he reported numbness in his some of his toes and issues with driving and walking, the Board finds this is consistent with his current 20 percent rating for moderate incomplete paralysis. Moreover, it is not distinguished whether his functional limitations are wholly attributed to his right lower extremity radiculopathy, as he is also separately service connected for cervical and lumbar conditions. Further, complete paralysis has not been shown. While his function has been reduced, the Veteran was still able to walk, stand, and drive during the appeal period. This is not consistent with the symptoms associated with a rating for complete paralysis. Accordingly, an initial rating in higher than 20 percent for radiculopathy of his right lower extremity has not been warranted during the appeal period. REASONS FOR REMAND 9. Entitlement to an earlier effective date for the 20 percent increase for residuals of injury lumbar spine (also claimed as dorsal somatic dysfunction) is remanded. 10. Entitlement to an earlier effective date for the 20 percent increase for residuals of cervical spine injury with degenerative changes is remanded. While the March 2015 rating decision did not grant service connection or a higher rating for the Veteran's cervical spine or lumbar condition, the Veteran's April 2015 Notice of Disagreement reports he disagrees with the evaluation of the disability and the effective date of the disability. Yet, a statement of the case (SOC) has not been issued by the RO for the effective date claims, so the claims must be remanded. See Manlincon v. West, 12 Vet. App. 238 (1999). The Board notes that these earlier effective date claims were not addressed in the prior Board remand. The Board could not find any additional statements or arguments regarding the earlier effective date claims. However, the Board also did not find a statement withdrawing these disagreements, so the issues will be remanded for issuance of an SOC. After the RO has issued the SOC, the claim should be returned to the Board only if the Veteran perfects the appeal in a timely manner. See Smallwood v. Brown, 10 Vet. App. 93, 97 (1997). (Continued on the next page) The matters are REMANDED for the following action: Furnish the Veteran an SOC for the earlier effective date claims. The Veteran must be informed that in order to perfect an appeal of the issues, he must timely file a substantive appeal, following the issuance of the SOC. If an appeal is perfected, and after any further action deemed warranted, certify the matter to the Board unless the issue is resolved to the Veteran's satisfaction. C. J. McEntee Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Wade 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.