Citation Nr: 21031165 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-41 288 DATE: May 20, 2021 ORDER Entitlement to service connection for a left knee disorder, to include as secondary to a lumbar spine disability is denied. Entitlement to service connection for a right knee disorder, to include as secondary to a lumbar spine disability is denied. Entitlement to a rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine is denied. Entitlement to a rating in excess of 20 percent for radiculopathy of the left lower extremity is denied. FINDINGS OF FACT 1. The Veteran's left knee disability is not secondary to his service-connected lumbar spine disability, and is not otherwise related to an in-service injury, event, or disease. 2. The Veteran's right knee disability is not secondary to his service-connected lumbar spine disability, and is not otherwise related to an in-service injury, event, or disease. 3. The Veteran's thoracolumbar degenerative disc disease is manifested by limitation of motion with significant pain and functional loss. However, at no time during this period did he exhibit forward flexion of the thoracolumbar spine to 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or incapacitating episodes of IVDS, totaling at least 4 weeks, but no more than 6 weeks, during the past 12 months. 4. The Veteran's radiculopathy of the left lower extremity is not manifested by moderately severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for service connection for a left knee disability due to service or service-connected disease or injury 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 for a right knee disability due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for a rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 4. The criteria for a rating in excess of 20 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1978 to February 1981. In December 2019, the Board remanded the claims for further development. With regard to the VA examinations obtained in connection with the Veteran's service connection claims for a bilateral knee disorder, as well as the increased rating claims for degenerative disc disease of the thoracolumbar spine and radiculopathy of the left lower extremity, the Board finds that there has been substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). Also, the Board notes that during the pendency of the appeal, service connection for a right leg disability, as well as a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) were granted. As these decisions represent a full grant of benefits sought with respect to these claims, these issues are no longer on appeal. SERVICE CONNECTION Generally, to establish direct service connection a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Certain chronic diseases, which are listed in 38 C.F.R. § 3.309(a), including organic diseases of the nervous system (to include arthritis) may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for a left knee disorder, to include as secondary to a lumbar spine disability 2. Entitlement to service connection for a right knee disorder, to include as secondary to a lumbar spine disability The Veteran contends that service connection is warranted for a bilateral knee disorder. The Veteran contends that his knee disabilities are related to his service or are alternatively secondary to his service-connected back disability. See January 2017 NOD, March 2017 VA examination report. The Board notes that the Veteran's DD-214 shows that the Veteran's military occupational specialty (MOS) was that of an infantry weapons repairman. The Veteran's service treatment records (STRs) are negative for any complaint, treatment, or diagnosis of a left or right knee disorder. Specifically, February 1978 and January 1981 Reports of Medical Examination reveal a normal clinical evaluation of the lower extremities. In a February 1978 Report of Medical History, the Veteran denied having a bone, joint, or other deformity and a "trick" or locked knee. The Board notes, however, that the Veteran complained of a litany of other ailments in service, to include swollen, discolored hands; a sore throat; peeling hands; sinus congestion; muscle spasms and pain in the back; neck pain; ankle pain; and foot problems but did not report any problems with his knees during service. Post-service treatment records show that the Veteran underwent a surgical procedure of the bilateral knees in October 1998. See November 2012 VA treatment record. Additionally, the Veteran's post-service treatment records show that he complained of knee pain, to include concerns that his pain kept him awake at night. See March 2017, June 2017, September 2017, December 2017, January 2018, June 2018 VA treatment records. These records, however, do not reflect that any currently diagnosed left or right knee disorder had its onset during, was caused by, or is related to the Veteran's military service; or, was diagnosed to a compensable degree within one year of military discharge; or, was caused or aggravated by a service-connected disability. In a March 2017 statement, the Veteran reported that all of his issues still bother him and are hard to cope with. See March 2017 NOD. The Veteran was afforded a VA examination in March 2017, at which time the examiner noted diagnoses of a bilateral knee meniscal tear and degenerative arthritis of the bilateral lower extremities. At the time of the examination, the Veteran reported that his condition began from repetitive military activity and an altered gait from lumbar disability. The examiner opined that it was less likely than not that the condition was related to service. The examiner reasoned that there was no abnormal gait related to a back condition noted on prior exams that would cause current left knee pathology. As noted in the December 2019 Remand, this examination is deemed inadequate. A March 2017 medical imaging report reveals a diagnosis of degenerative changes of the bilateral knees without fracture and intravascular stenting of the left lower extremity. In conjunction with a January 2020 VA examination, a VA examiner provided a negative nexus opinion regarding the Veteran's service connection claims for a left and right knee disorder. At the time of the examination, the Veteran stated that his condition onset in approximately 1987. The Veteran also reported that he did not sustain a specific injury to the bilateral knees but that he had wear and tear throughout the years and that his bilateral knee pain had gotten progressively worse. The Veteran also reported that he cannot walk long distances and cannot run. Upon examination, the examiner noted that the Veteran did not have a diagnosis of either knee. The examiner opined that it was less likely than not that the Veteran's knee conditions were related to service. The examiner reasoned that there was no evidence of a bilateral knee issue during service and that there was no chronicity of care within a year of separation. The examiner also opined that it was less likely than not that the Veteran's knee condition was proximately due to or aggravated by a service-connected condition. The examiner reasoned that he was unable to confirm a current chronic diagnosis with current available records and the examination. The examiner also reported that the Veteran did not have an abnormal gait due to the service-connected back condition that would cause stress to the knees. A baseline of severity could not be determined, with the examiner noting that medical evidence was not sufficient to support such a determination. The examiner also noted that there was no evidence to support that the Veteran's lumbar spine disability has caused an aggravation to the knees. In October 2020, the examiner opined that it was less likely than not that the Veteran's bilateral knee disorder was related to service. The examiner reasoned that there was no objective evidence for an etiology of a bilateral knee condition incurred in or onset within one year of service. The examiner noted that the Veteran was diagnosed with mild osteoarthritis of the bilateral knees in 2017, approximately 36 years post service. The examiner also stated that there was no record of treatment for a left or right knee disorder during service or at separation. The examiner additionally stated that the Veteran's medical records were silent for any documented chronicity of treatment of the bilateral knees from 1981 to 2017. The examiner further opined that it was less likely than not that the Veteran's left knee condition was aggravated beyond its normal progression due to his service-connected back disability. The examiner noted that medical literature supports that there must be significant changes in gait to impact the course or progression of degenerative arthritis, but that there was no such documented antalgic gait in the medical record. The examiner also stated that the Veteran was diagnosed with other co-morbid medical conditions, including right lower extremity radiculopathy, as well as severe atherosclerotic changes of the distal right arterial system and that both of these conditions can contribute to right lower extremity/right knee pain. The examiner also reported that the Veteran's lay testimony regarding bilateral knee pain was considered. The examiner acknowledged that while the Veteran is deemed competent to report a chronology of symptoms, he is not capable of diagnosing those symptoms. The examiner determined that it was at least as likely as not that the bilateral knee condition is due to or the result of aging and normal wear and tear. The Board finds that the VA examiners' January 2020 and October 2020 opinions are the most probative evidence of record as to the etiology of the bilateral knee disorder. Here, the examiners' opinions are plainly supported by the evidence of record. Indeed, the examiner indicates the bilateral knee disability is not shown in any treatment record to be due to service or due to the Veteran's service-connected back disability. Instead, the examiner has indicated that the Veteran's knee disability is due to aging and wear and tear. Notably, the Veteran even endorsed, during the January 2020 VA examination, that that he had wear and tear of the knees throughout the years. Specific to secondary service connection, the examiner determined that medical evidence does not support the claim and that the Veteran does not have an altered gait, which is also shown by each VA back examination conducted during the appellate period. Service connection on a presumptive basis is also not warranted. Here, the earliest notation in available medical records shows a diagnosis of a chronic knee disability in 2017. As a chronic bilateral knee disability was not seen until decades following the Veteran's separation from service, service connection on a presumptive basis is not warranted. Although the Veteran believes that his bilateral knee disability is related to his military service or service-connected back disability, the Board reiterates that the preponderance of the evidence weighs against findings that an in-service injury, event, or disease occurred led to his bilateral knee arthritis; or that the current bilateral knee disability is secondary to his service-connected back disability. Further, the Veteran is not competent to opine that his current bilateral knee disability was directly due to service or secondary to a service-connected disability. This is so because the Veteran has not been shown to have the requisite expertise to opine on a complex medical matter. As such, his statements to that effect are afforded little probative value. The Board finds that the most probative evidence preponderates against a finding that the Veteran's current bilateral knee disabilities are related to his active service. The examiner's opinion as to nexus is the most probative evidence on this question. Thus, service connection for a bilateral knee disability must be denied. INCREASED RATING Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity in civilian occupations resulting from such diseases and injuries, and their residual conditions. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate Diagnostic Codes identify various disabilities and the criteria for separate ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Pain which does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 may still result in functional loss if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination, or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Pursuant to 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Under Diagnostic Code 5003, arthritis established by x-ray findings is rated based on limitation of motion of the affected joints. When, however, the limited motion of the specific joint or joints involved would be non-compensable under the appropriate diagnostic codes, a 10 percent rating is assigned for each involved major joint or group or minor joints affected by limitation of motion, to be combined, not added, under Diagnostic Code 5003. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 1. Entitlement to a rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine The Veteran's back disorder has been rated as 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5243, which addresses IVDS. The Veteran contends that her service-connected degenerative disc disease of the thoracolumbar spine is more disabling than the rating currently assigned. The General Rating Formula for Diseases and Injuries of the Spine provides that a 20 percent disability rating is assigned 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 is 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 disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Under Diagnostic Code 5243, IVDS is to be evaluated either under the General Rating Formula or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. See 38 C.F.R. § 4.71a, Note (6). Under the Formula for Rating IVDS set forth in Diagnostic Code 5243, a 20 percent evaluation is warranted if incapacitating episodes have a total duration of at least two weeks but less than four weeks; a 40 percent rating is warranted if the total duration is at least four weeks but less than six weeks; and a 60 percent rating is warranted if the total duration is at least six weeks. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as 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. 2. As a preliminary matter, the Board acknowledges that effective February 7, 2021, regulation changes have been made to Diagnostic Codes 5243 and 5003, among other codes recognized in the regulations. Under the new regulations, Diagnostic Code 5243 is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root and Diagnostic Code 5003 qualifies as a code for degenerative arthritis other than post-traumatic arthritis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76462 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5242, 5243, 5244); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76460 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5003). In order to receive a higher rating, the Veteran's back disability must produce either: forward flexion of the thoracolumbar spine 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or incapacitating episodes of IVDS having a total duration of at least four weeks but less than six weeks during the past 12 months. As discussed below, the Board finds that the Veteran's symptoms do not meet these criteria and a higher rating is not warranted. The Veteran presented for a VA examination in March 2017, at which time the examiner noted a diagnosis, in relevant part, of degenerative disc disease with intervertebral disc syndrome of the thoracolumbar spine. At the time of the examination, the Veteran stated that his pain worsened and that he underwent surgery in 1985. The Veteran noted that flare-ups of the back can be described as "lots of pain" which limit his duties. The Veteran's forward flexion measured to 80 degrees with a combined range of motion of 210 degrees. The examiner noted pain on forward flexion, right lateral flexion, right lateral rotation, and left lateral rotation, which cause functional loss. There was no objective evidence of tenderness or pain on palpation. After repetitive use testing, the Veteran's range of motion did not change. Over time, pain and weakness significantly limited functional ability with repeated use over a period of time. Range of motion included 70 degrees of forward flexion. No guarding or muscle spasm of the thoracolumbar spine was noted on examination; however, the examiner found that the Veteran's back disability caused less movement than normal; weakened movement; deformity; disturbance of locomotion; and, interference with sitting. No ankylosis of the thoracolumbar spine was observed. Furthermore, although the Veteran was noted to have IVDS, he did not experience any incapacitating episodes as defined by VA regulations during the previous 12 months. He did not report the use of any assistive devices for his back condition. Imaging studies had not been performed. The examiner concluded that the Veteran's disability impacts his ability to work. Specifically, the Veteran's disorder limits prolonged walking, standing, sitting, and pushing/pulling objects. The examiner conducted tests on both active and passive motion and both with weight-bearing and non-weight-bearing. Accordingly, this examination is compliant with Correia and Sharp. The Veteran presented for another VA examination in January 2020, at which time the examiner again noted a diagnosis of degenerative disc disease with intervertebral disc syndrome of the thoracolumbar spine. At the time of the examination, the Veteran stated that his low back pain had gotten progressively worse over time. The Veteran noted that flare-ups of the back can be described as "lots of pain" which limit his duties. The Veteran's forward flexion measured to 65 degrees with a combined range of motion of 210 degrees. No pain was noted on examination. There was no evidence of pain with weight bearing. There was no objective evidence of tenderness or pain on palpation. After repetitive use testing, the Veteran's range of motion did not change. Over time, pain and weakness significantly limited functional ability with repeated use over a period of time, to include 60 degrees of forward flexion. No guarding or muscle spasm of the thoracolumbar spine was noted on examination. No ankylosis of the thoracolumbar spine was observed. Furthermore, although the Veteran was noted to have IVDS, he did not experience any incapacitating episodes as defined by VA regulations during the previous 12 months. He did not report the use of any assistive devices for his back condition. Imaging studies had not been performed. The examiner concluded that the Veteran's back disability did not impact his ability to work. Here, the Veteran's IVDS has not been noted to cause any incapacitating episodes under the regulatory definition, thus a rating under Diagnostic Code 5243 is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under the General Rating Formula for the spine, governing the evaluation of back disabilities other than IVDS, the Board finds that the Veteran's back disability is properly evaluated as 20 percent disabling. Under the General Rating Formula, an evaluation higher than 20 percent is warranted only when there is forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the thoracolumbar spine. The Veteran's most limited forward flexion, upon repetitive use, was 60 degrees at the January 2020 examination, and there was no ankylosis of the thoracolumbar spine. Favorable ankylosis is defined as fixation of a spinal segment in neutral position (zero degrees). See 38 C.F.R. § 4.71a, Note (5). The Veteran was not found to exhibit fixation of a spinal segment to zero degrees. Therefore, a disability evaluation in excess of 20 percent for the Veteran's condition is not warranted. The Board notes that pain significantly limited functional ability with repeated use over a period of time. However, the examination report reflects this. Accordingly, the criteria in DeLuca and Mitchell regarding painful motion are encompassed in the Veteran's current 20 percent evaluation. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 207-08; Mitchell, 25 Vet. App. at 43. Throughout the period on appeal, there is no indication that the Veteran's painful motion results in functional limitation of an ankylosed spine or bed rest prescribed by a physician. Also, the Veteran's arthritis manifested by painful motion is also incorporated in his currently compensable 20 percent evaluation. Therefore, entitlement to a higher and/or separate rating under Diagnostic Code 5003 for arthritis is not warranted. The Board acknowledges the Veteran's belief that his lumbar spine symptomatology is more severe than as reflected by the currently assigned rating and notes that he is competent to describe his symptoms and their effects on his daily life. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the Veteran is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board finds the medical evidence in which professionals with medical expertise examined the Veteran, completed necessary testing, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such conditions. In sum, the Board finds that a preponderance of the medical evidence establishes that the Veteran has not experienced incapacitating episodes of IVDS, forward flexion limited to 30 degrees or less, or ankylosis of the thoracolumbar spine. Therefore, entitlement to a disability evaluation in excess of 20 percent for the Veteran's service-connected degenerative disc disease with IVDS of the thoracolumbar spine is denied. 2. Entitlement to a rating in excess of 20 percent for radiculopathy of the left lower extremity The Veteran's radiculopathy of the left lower extremity has been rated as 20 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8520, which addresses diseases of the peripheral nerves. The Veteran contends that his service-connected radiculopathy of the left lower extremity is more disabling than the rating currently assigned. Diagnostic Code 8520 provides ratings for paralysis of the sciatic nerve. Diagnostic Code 8520 provides that mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; moderately severe incomplete paralysis is rated 40 percent disabling; and severe incomplete paralysis, with marked muscular atrophy, is rated 60 percent disabling. Complete paralysis of the sciatic nerve, the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent disabling. The words "mild," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "mild" and "moderate" by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. The term "incomplete paralysis" of peripheral nerve injuries 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. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. In a July 2015 Back DBQ, an examiner indicated that the Veteran had radicular pain or any other signs or symptoms due to radiculopathy. As to the left lower extremity, the examiner specified that the Veteran had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness, which involved the L4-L5-S1-S2-S3 sciatic nerve roots. Muscle strength was normal. The reflect exam revealed a normal left knee and absent left ankle reflexes. Sensation to light touch was decreased in the left thigh/knee and left foot/toes. The examiner opined that the overall severity of radiculopathy was moderate on the left side. In a March 2017 Back DBQ, an examiner indicated that the Veteran had radicular pain or any other signs or symptoms due to radiculopathy. As to the left lower extremity, the examiner specified that the Veteran had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness, which involved the L4-L5-S1-S2-S3 sciatic nerve roots. Muscle strength and reflexes were normal. Sensation to light touch was decreased in the left thigh/knee, left lower legs/ankles, and left foot/toes. The Veteran did not have trophic changes attributable to peripheral neuropathy. The examiner opined that the overall severity of radiculopathy was moderate on the left side. In a January 2020 Back DBQ, an examiner indicated that the Veteran had radicular pain or any other signs or symptoms due to radiculopathy. As to the left lower extremity, the examiner specified that the Veteran had mild paresthesias and/or dysesthesias, which involved the L4-L5-S1-S2-S3 sciatic nerve roots. Muscle strength and reflexes were normal. Sensation to light touch was normal. The examiner opined that the overall severity of radiculopathy was mild, bilaterally. In a January 2020 Peripheral Nerves DBQ, an examiner indicated that the Veteran had radicular pain or any other signs or symptoms due to radiculopathy. As to the left lower extremity, the examiner specified that the Veteran had mild paresthesias and/or dysesthesias. Muscle strength and reflexes were normal. Sensation to light touch was normal. The Veteran did not have trophic changes attributable to peripheral neuropathy. The examiner opined that the Veteran had mild incomplete paralysis of the sciatic nerve, bilaterally. The Board acknowledges the Veteran's belief that symptomatology relating to his left lower extremity radiculopathy is more severe than reflected by the currently assigned rating and notes he is competent to describe his symptoms and their effects on his daily life. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the Veteran is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Here, the evidence does not demonstrate that the Veteran's left lower extremity radiculopathy involving the sciatic nerve manifested in moderately severe incomplete paralysis to warrant a rating in excess of 20 percent. Rather, the evidence reflects that the Veteran's left lower extremity radiculopathy manifested, at worst, symptoms of moderate incomplete paralysis of the sciatic nerve. Thus, the assigned 20 percent ratings for his left lower extremity radiculopathy involving the sciatic nerve adequately contemplates his symptoms, and a rating in excess of 20 percent is not warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Hanson, 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.