Citation Nr: 21031531 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-08 074 DATE: May 24, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and as secondary to service-connected disability, is denied. Entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy is denied. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy is denied. FINDINGS OF FACT 1. An acquired psychiatric disorder, to include PTSD, was not manifest during active service, a psychosis was not manifest within one year of service; and, the preponderance of the evidence fails to establish that an acquired psychiatric disorder is etiologically related to service or to a service-connected disability. 2. The Veteran's service-connected right lower extremity radiculopathy involving the sciatic nerve is manifested by no more than moderately severe incomplete paralysis. 3. The Veteran's service-connected left lower extremity radiculopathy involving the sciatic nerve is manifested by no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and as secondary to service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from April 1991 to April 1995. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions in November 2012 and May 2018 by the Milwaukee, Wisconsin, Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded the service connection issue on appeal for additional development in January 2018 and June 2018, including obtaining VA treatment records and obtaining a VA medical opinion. VA treatment records have since been associated with the claims file and VA medical opinions were obtained in March 2018 and July 2019. The Board therefore finds there has been substantial compliance with the remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). In the case of a veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war VA shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term "disability" for VA compensation purposes refers to the functional impairment of earning capacity rather than the underlying cause of the impairment and it is noted that pain alone may be a functional impairment. See Saunders v. Wilkie, 887 F.3d 1356, 1364-68 (Fed. Cir. 2018). VA regulations provide that service connection for PTSD requires medical evidence diagnosing the condition; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, "fear of hostile military or terrorist activity"' means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3). VA regulations state that mental disorder diagnoses are based upon the criteria provided in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association. 38 C.F.R. § 4.125(a). Certain chronic diseases, including psychoses, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Psychoses are qualifying chronic diseases. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). In determining whether evidence submitted by a claimant is credible, VA may consider internal consistency, facial plausibility, and consistency with other evidence. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). A medical opinion based upon an inaccurate factual premise may be discounted entirely. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and as secondary to service-connected disability. The Veteran contends that he has an acquired psychiatric disorder, to include PTSD, as a result of active service. In a November 2008 statement he asserted he had depression due to service and in a May 2012 statement he asserted he had PTSD due to military trauma without additional information. In a July 2012 statement he reported stressors including being exposed to the noise of his ship's bow anchor swinging into the side of the ship near his berth during strong swells, being aboard the USS GUADACANAL when it ran aground and was stranded, and being exposed to rounds and bombs going off during missions in Somalian and Bosnia. Medical literature addressing depression and anxiety associated with pain conditions was provided in September 2016. Service treatment records include an October 1991 report noting a diagnosis of anxiety with mild gastrointestinal upset. It was further noted that the Veteran reported feeling lots of stress about going overseas and that he was mildly anxious about travel. Other records are negative for complaints, treatment, or diagnosis of an acquired psychiatric disorder. The Veteran's February 1995 separation examination revealed a normal clinical psychiatric evaluation. In his February 1995 report of medical history, he denied having or having ever had frequent trouble sleeping, depression or excessive worry, or nervous trouble of any sort. Service records show he served aboard ship during operations in the Adriatic Sea and the Indian Ocean during the period from September 1993 to January 1994. His primary duties were as a bulk fuel specialist. Records show the Veteran was awarded no medals indicative of combat. VA treatment records include an August 2012 report noting diagnoses of anxiety disorder, PTSD, and cocaine abuse in remission. It was noted the Veteran reported difficulty sleeping due to very frequent vivid dreams of dead service mates. A November 2012 report noted treatment for PTSD and provided a diagnosis of PTSD/anxiety. VA PTSD examination in November 2012 included diagnoses of cocaine dependence, alcohol abuse, and anxiety disorder. The examiner stated the Veteran's symptoms did not meet the diagnostic criteria for PTSD as he was not exposed to a stressor in which he experienced or was exposed to an event that involved actual or threatened death or serious injury. It was further noted that his self-report of traumatic events had not been consistent. A summary of the pertinent evidence and reported history was provided. It was also noted that the results of psychological testing were considered to be invalid due to likely over-reporting of symptoms. The examiner found the Veteran's cocaine dependence and alcohol abuse were less likely related to his in-service complaints of stress associated with going overseas and mild anxiousness about travel. A diagnosis of anxiety disorder, not otherwise specified, was rejected because the Veteran did not endorse symptoms consistent with panic disorder or other historical anxiety-related diagnoses. It was noted he did not show gross impairment due to reported anxiety symptoms in areas of occupation nor within the social relationships most meaningful to him and, given the variable report of symptoms and etiology related to anxiety, a formal anxiety disorder diagnosis was not warranted. A disability benefits questionnaire (DBQ) signed in April 2013 by a private psychologist, A.H.F., Ph.D., included diagnoses of anxiety disorder due to medical condition with panic attacks, alcohol dependence in early remission, and polysubstance dependence in sustained full remission. In an associated statement the examiner noted the Veteran experienced chronic pain from his service-connected back disability that was a source of continuing stress. His mental condition was found more likely than not to have been permanently aggravated by pain and limitations from the service-connected back condition. Reference to medical literature in support of the opinion was provided. VA treatment records include a July 2013 report noted the Veteran's PTSD symptoms were exacerbated by his chronic pain experience. A September 2013 report noted diagnoses of panic disorder, PTSD, and cocaine abuse in full sustained remission. VA examination in October 2014 included diagnoses of major depressive disorder in partial remission with anxious distress and history of substance use disorder in partial remission. The examiner found the Veteran's symptoms did not meet the diagnostic criteria for PTSD. It was noted he reported military stressors including that his ship ran aground three times and that he was exposed to surface to air missiles from the ship in Bosnia. The examiner noted previous records indicated he was exposed to dead bodies but that he did not discuss it during the examination. Although it was noted he met the PTSD diagnostic criteria of directly experienced traumatic events, he did not demonstrate symptoms such as persistent avoidance of stimuli or negative alterations in cognitions and mood associated with the traumatic events. He was found to meet the diagnostic criteria for major depressive disorder, in partial remission, with anxious distress, moderate, and substance use disorder, in partial remission, which were not related to his military service. As rationale, it was noted that the Veteran reported the onset of symptoms consistent with the major depressive disorder diagnosis beginning in the mid-2000s, years after the claimed trauma, and that his substance use was reportedly concurrent and was considered secondary the major depressive disorder with anxious distress. In an associated medical opinion, the examiner found it was less likely the Veteran's disorder was proximately due to or the result of his service-connected back disability. A summary of the pertinent evidence of record, including the May 2013 private medical opinion, was provided. The examiner stated it was more likely that situational psychosocial stressors contributed to his mental health symptoms which began in 2005. VA treatment records include an October 2015 report providing an assessment of "PTSD (military)." Similar diagnoses were provided including in November 2015, February 2016, March 2016, and June 2016. No additional information as to the specific military stressor was provided. Private treatment records dated in June 2016 noted the Veteran was seen for follow up with chief complaints including low back pain. It was noted he reported pain made him feel depressed, angry, frustrated, and helpless/hopeless. A March 2018 VA medical opinion found it was less likely that the Veteran's psychiatric disorder had its onset in service or is otherwise the result of service, to include anxiety associated with travel in 1991. The examiner, A.J., identified as a psychologist, acknowledged a review of the available record, including recent VA diagnoses of PTSD, panic without agoraphobia, alcohol use disorder, and cocaine use in full remission. It was noted that records showed multiple stressors in 2016, such as the deaths of family members and financial stress, and multiple psychosocial stresses as the focus of therapy, including an eye injury, moving, and estrangement from his daughter. The therapy and medication management did not focus on back pain or military service. The examiner found treatment records showed the onset of mental health concerns began years after military service and clinically significant symptoms emerging around the mid-2000's. It was explained that, while one service treatment report discussed stress and anxiety about going overseas and travel, that the records did not show a full constellation of symptoms needed for a psychiatric diagnosis at that time. In summary, the examiner found medical and mental health records revealed psychiatric concerns arising in the context of psychosocial stressors in the mid-2000's, continuing in the context of ongoing psychosocial stresses, and that was not in parallel with or intertwined with low back concerns. In a July 2019 VA medical opinion A.J. acknowledged a review of the conflicting medical evidence and found it was less likely that the Veteran's current psychiatric disorder was proximately due to or was aggravated (worsened) by his service-connected low back disability and associated radiculopathy. As rationale for the opinions, the examiner stated that psychiatric evaluations in 2016 and 2017 noted stresses including three close family deaths, support for his mother and father, financial distress due to child support indebtedness and potential incarceration, and poor performance in college classes. It was noted that the Veteran did not discuss back pain in this context. An April 2013 private mental health DBQ was noted to have provided a diagnosis of anxiety disorder due to a medical condition with panic attacks, alcohol dependence in early remission, and polysubstance dependence in sustained full remission. That report also lists limited finances, unemployment, and medical conditions as psychosocial problems and noted the interview had been conducted by telephone. It was the opinion of the examiner, A.J., that the April 2013 DBQ evaluation did not document the full constellation of DSM-IV/DSM-5 symptoms required for the noted diagnoses and did not provide any timeline or rationale for those findings. Similarly, a July 2013 group health records was noted to have stated that the Veteran continued to struggle with PTSD symptoms which were exacerbated by his chronic pain experience, but the record did not discuss the constellation of symptoms, the location or nature of the reported chronic pain, and did not review the timeline of the Veteran's concerns. It was further noted that it would not be unexpected for patients with pain to report some mood concerns; however, for the veteran it appeared that his psychiatric symptoms had occurred in the context of other psychosocial stresses. The examiner explained that while pain is unlikely to improve psychiatric concerns, there were no records in this case demonstrating that the Veteran's low back disability had increased the severity or frequency of his psychiatric symptoms. Based upon the evidence of record, the Board finds that an acquired psychiatric disorder, to include PTSD, was not manifest during active service, that a psychosis was not manifest within one year of service, and that the preponderance of the evidence fails to establish that an acquired psychiatric disorder is etiologically related to service or a service-connected disability. The available service treatment records are found to be persuasive that an acquired psychiatric disorder, such as PTSD or a chronic anxiety disorder, was not manifest during or as a result of active service. The Board finds the Veteran's reported stressors of exposure to ship noises during strong swells, being aboard ship when it ran aground and was stranded, and being exposed to weapons fire from his ship during missions in Somalian and Bosnia are consistent with the circumstance of his service. To some extent, his stressors as to having been aboard ship during missions in Somalian and Bosnia are found to be related to a fear of hostile military or terrorist activity based upon a threat to the physical integrity of the Veteran or others. It is noted, however, that the Veteran does not contend that he had personally engaged in combat with the enemy, that his duties involved his leaving the ship during these missions, nor that his ship received incoming weapons fire. The Board finds that, overall, the November 2012, October 2014, March 2018, and July 2019 VA opinions are persuasive as to these matters and based upon adequate rationale. The examiners are shown to have reviewed of the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Although the medical evidence of record includes VA treatment reports noting diagnoses of PTSD, the October 2014, March 2018, and July 2019 VA opinions are found to be more persuasive as they are shown to have been based upon more comprehensive examinations and review of the evidence. It is significant that the October 2014 examiner found the Veteran met the PTSD diagnostic criteria of directly experienced traumatic events, but that he did not demonstrate the criteria for persistent avoidance of stimuli or negative alterations in cognitions and mood associated with the traumatic events. Similarly, the July 2019 VA examiner indicated that the reports noting diagnoses of PTSD did not discuss the constellation of symptoms necessary to support the diagnosis. The April 2013 private DBQ and treatment records associating psychiatric diagnoses to the Veteran's service-connected low back disorder were, in essence, found to be deficient because they did not document the full constellation of DSM-IV/DSM-5 symptoms and did not provide any timeline or rationale for the findings. The Board finds the November 2012, October 2014, March 2018, and July 2019 VA examinations and medical opinions warrant a greater degree of probative weight. The Board acknowledges that the Veteran is competent to report observable symptoms, but there is no indication that he is competent to etiologically link any such symptoms to a diagnosis of an acquired psychiatric disorder. He is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he received any special training or acquired any medical expertise in evaluating such disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. Consideration has also been given to the Veteran's personal assertions that he has an acquired psychiatric disorder, to include PTSD, as a result of service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a matter that is readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In conclusion, the Board finds that service connection for an acquired psychiatric disorder, to include PTSD, is not warranted. When all the evidence is assembled, VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim in which case the claim is denied. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the claim. Increased Ratings Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. This Rating Schedule is primarily a guide in the rating of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. For the application of this schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Over a period of many years, a veteran's disability claim may require re-ratings in accordance with changes in laws, medical knowledge and his or her physical or mental condition. It is essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. Consideration of factors wholly outside the rating criteria constitutes error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-08 (1994). Unless otherwise specified in the rating schedule, all disabilities are rated separately, including those arising from a single disease entity, with the exception that VA may not rate the same symptoms twice, which would constitute impermissible "pyramiding." 38 C.F.R. § 4.14; Cullen v. Shinseki, 24 Vet. App. 74, 81-82 (2010). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Sciatic nerve disabilities are evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. 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. Complete paralysis, when the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based 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 lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." A 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). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant. However, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 4.3. 2. Entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy. 3. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy. The Veteran contends that increased ratings are warranted for his service-connected radiculopathy disabilities. The issue arose from a May 2018 rating decision establishing separate 20 percent ratings for right and left lower extremity radiculopathy. A subsequent June 2020 rating decision assigned earlier effective dates from November 10, 2008, for the award of 20 percent ratings resolving the appeal as to that matter. VA treatment records indicate that in September 2008, the Veteran reported having intermittent tingling in in his feet when he had back spasms. In a September 2012 VA back examination, the Veteran reported symptoms of mild intermittent pain and numbness in the right lower extremity, and moderate intermittent pain and numbness in the left lower extremity. The examiner indicated that the Veteran had bilateral sciatic nerve radiculopathy of a moderate severity. In an October 2014 VA examination, the Veteran was found to have no radicular pain or any other signs or symptoms due to radiculopathy. Private treatment records dated in February 2018 noted the Veteran reported episodes of left lower extremity numbness and loss of balance. Magnetic resonance imaging (MRI) revealed diffuse disc bulging and facet hypertrophy at L5-S1 with a disc fragment compressing the left L-5 nerve root sleeve. A VA back examination in May 2018 noted the Veteran complained of pain, numbness, and tingling from the back to the right anterior thigh and posterior calf and to the left lateral thigh and bottom of the foot. The examiner noted that muscle strength was 4/5 to bilateral and 5/5 to bilateral hip flexion, knee extension, ankle plantar flexion, and great toe extension. Ankle dorsiflexion was 5/5 on the right and 4/5 on the left. There was no muscle atrophy. Deep tendon reflexes were 1+, hypoactive, in the knees and ankles. Sensation to light touch was normal to the bilateral upper anterior thigh and left thigh/ankle and was decreased to the right thigh/knee and bilateral lower leg/ankle and foot/toes. There was radiculopathy with severe intermittent pain, paresthesias and/or dysesthesias, and numbness to the bilateral lower extremities. The examiner noted involvement to the L4/L5/S1/S2/S3 (sciatic) nerve roots. The severity of radiculopathy was found to be mild on the right and moderate on the left. VA examination in July 2019 included a diagnosis of lumbar radiculopathy. It was noted the Veteran reported that he experienced numbness down the bilateral lower extremities. He stated he had fallen in January 2019 when he lost sensation or feeling in the left lower extremity. The examiner found muscle strength was 5/5 to hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension on the right and 4/5 on the left. There was no muscle atrophy. Deep tendon reflexes were normal in the knees and ankles. Sensation to light touch was normal on the right and decreased to the left thigh/knee, lower leg/ankle, and foot/toes. There was radiculopathy with moderate constant pain, paresthesias and/or dysesthesias, and numbness to the bilateral lower extremities. The examiner noted involvement to the L4/L5/S1/S2/S3 (sciatic) nerve roots. The severity of radiculopathy was found to be mild on the right and moderate on the left. The Board finds that ratings in excess of 20 percent for the bilateral lower extremity radiculopathy are not warranted. For a higher 40 percent rating, the evidence must show moderately severe incomplete paralysis. Here, the evidence shows that the bilateral sciatic radiculopathy is, at worst, moderate. The September 2012, May 2018, and July 2019 VA examiners concluded that the radiculopathy was moderate. The Board finds these examinations findings to be persuasive as to the nature and extent of the lower extremity radiculopathy. As such, the preponderance of the evidence indicates that the Veteran's right sciatic radiculopathy is of a severity no worse than moderate. The Board acknowledges that the Veteran is competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he is not competent to identify a specific level of disability. It is also noted that competent evidence concerning the nature and extent of the Veteran's service-connected disabilities have been provided by VA medical professionals who have examined him. These medical findings directly address the criteria under which the disability is evaluated, including whether a specific symptom caused a level of impairment required for a higher disability rating. The Board accords these medical findings greater weight than any subjective complaints of increased symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the peripheral nerves. See 38 C.F.R. § 4.124a, Diagnostic Codes 8510-8540. However, the Board finds no basis upon which to assign higher evaluations at any point during the period of appeal. Diagnostic Codes 8520 through 8540 refer to paralysis of various lower extremity nerves. The Veteran has not been shown to have any paralysis of any other nerves, including her external popliteal, musculocutaneous, anterior tibial, internal popliteal, posterior tibial, anterior crural nerve, internal saphenous, obturator, external cutaneous, and ilio-inguinal nerves. Other diagnostic codes are therefore not applicable. As such, ratings in excess of 20 percent for the bilateral lower extremity radiculopathy are not warranted at any point during the period of the appeal. Because the preponderance of the evidence weighs against the claims, the benefit of the doubt doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). N. NELSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.