Citation Nr: 21031880 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-35 880 DATE: May 24, 2021 ORDER An initial evaluation of 20 percent, but not higher, for lumbosacral strain with intervertebral disc syndrome (IVDS), for the period of appeal from December 17, 2014, to December 2, 2019, is granted. An evaluation in excess of 20 percent for lumbosacral strain with IVDS is denied. REMANDED Entitlement to a separate evaluation(s) for radiculopathy of the bilateral lower extremities associated with the lumbar spine disability is remanded. FINDINGS OF FACT 1. During the entire period on appeal, the Veteran's lumbar spine disability has been manifested by flexion limited to 45 degrees. 2. The Veteran's lumbar spine disability has not been manifested by forward flexion 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine; nor has it been manifested by incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation of 20 percent, but not higher, for lumbosacral strain with IVDS, from December 17, 2014, to December 2, 2019, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237, 5243. 2. The criteria for an evaluation in excess of 20 percent for lumbosacral strain with IVDS are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237, 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 2011 to December 2014. The Veteran's military decorations include the Combat Action Ribbon and the Afghanistan Campaign Medal with One Star. This case comes before the Board of Veterans' Appeals (Board) on appeal from April 2015 and August 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). This case was previously before the Board in November 2018 when it was remanded for additional development. At that time, the issues on appeal included entitlement to service connection for a left hip condition, a left knee condition, and a right knee condition. Service connection for these disabilities was granted by the AOJ in a July 2020 rating decision. The award of service connection represents a full grant of the benefits sought on appeal, and the claims for service connection for a left hip condition, a left knee condition, and a right knee condition are no longer before the Board. In the July 2020 rating decision, an increased 20 percent disability evaluation was granted for the service-connected lumbosacral strain with IVDS currently on appeal effective from December 3, 2019. This did not satisfy the Veteran's appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The case has now returned to the Board for further appellate action. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that, on remand, in August 2019 and in October 2019, the AOJ attempted to assist the Veteran in retrieving the Veteran's private treatment records. However, the Veteran did not return the enclosed VA Form 21-4142, Release of Information Form or the VA Form 21-4142a, General Release for Medical Provider Information. Since the Veteran did not respond to these requests and has not identified any additional medical evidence in support of his claims, no further assistance on the part of VA is necessary. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1993). 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, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Revised Criteria for Evaluating Musculoskeletal Disorders Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In this regard, the Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the agency of original jurisdiction. In Disabled American Veterans v. Sec of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) specifically upheld the validity of 38 C.F.R. § 19.9 (b) (2) (now as noted renumbered as 38 C.F.R. § 20.904 (d) (2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claim. Entitlement to an Initial Evaluation of 20 Percent, but not higher, for Lumbosacral Strain with IVDS, from December 17, 2014 Service connection for lumbosacral strain was awarded in an April 2015 rating decision. An initial 10 percent evaluation was assigned effective December 17, 2014, under Diagnostic Code 5237. In July 2020, the Veteran's lumbar spine disability was assigned an increased 20 percent evaluation effective December 3, 2019, under Diagnostic Code 5243. The Veteran maintains that his lumbar spine disability is more severe than what is contemplated by the currently assigned evaluations. See August 2015 and August 2017 VA Form 21-0958. The Veteran's lumbosacral strain with IVDS is currently rated under Diagnostic Code 5243 and the general rating formula for diseases and injuries of the spine. The General Rating Formula for Diseases and Injuries of the Spine evaluates disabilities for Diagnostic Codes 5235 to 5243. The rating criteria for Diagnostic Codes 5235 to 5243 and the General Rating Formula for Diseases and Injuries of the Spine were not revised. However, effective February 7, 2021, the application of Diagnostic Codes 5242 and 5243 were revised as follows: Diagnostic Code 5242, which contemplates degenerative arthritis, now includes degenerative disc disease (DDD), and Diagnostic Code 5243, which contemplates IVDS, is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Under the general rating formula, with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply. A 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine and a maximum 100 percent evaluation is warranted if there is unfavorable ankylosis of the entire spine. Id. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar or entire spine is fixed in flexion or extension and the ankylosis results in certain enumerated impairments. 38 C.F.R. § 4.71a, General Formula for Rating Diseases and Injuries of the Spine, Note (5). IVDS can be evaluated under the general rating formula or the specific formula for rating IVDS based on incapacitating episodes in Diagnostic Code 5243, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. As indicated above, effective February 7, 2021, Diagnostic Code 5243 is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The provisions of 38 C.F.R. § 4.40 and §4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups have been considered and applied under 38 C.F.R. § 4.59. DeLuca v. Brown, 6 Vet. App. 321 (1993); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board finds that an increased 20 percent evaluation is warranted for the orthopedic impairment associated with the Veteran's service-connected lumbosacral strain with IVDS. The Veteran's limitation of spinal motion and functional impairment most nearly approximates the criteria associated with an initial 20 percent evaluation throughout the claims period. Moreover, the Veteran's flare-ups have been considered in light of Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Veteran's functional loss is contemplated by the evaluation assigned. The evidence includes a November 2014 Separation Health Assessment which indicated an abnormal spine examination with pain on range of motion (ROM) of the spine. The upper and lower extremities were noted to be normal and there were no neurologic symptoms. A November 2014 VA spine examination noted a diagnosis of lumbosacral strain. At that time, the Veteran reported intense and more frequent sharp pains when bending over and getting up. He indicated the pain did not radiate, and there was no numbness or tingling. The Veteran did not report flare-ups of the thoracolumbar spine. The Veteran demonstrated flexion limited, with pain, to 80 degrees. Combined ROM of the thoracolumbar spine was to 230 degrees. There was no additional limitation in ROM after three repetitions. The examiner noted there was pain on movement. There was no localized tenderness or pain on palpation. There was no guarding or muscle spasm. There were no signs or symptoms of radiculopathy, no neurological abnormalities, and the Veteran did not have IVDS. The Veteran ambulated without an assistive device, and there was no evidence of arthritis. Xray of the Veteran's spine showed slight narrowing at L4-5 disc space, but was otherwise negative. The Veteran's posture and gait were within normal limits. There were contributing factors of pain, weakness, fatigability, and/or incoordination, but there was no additional limitation of the functional ability of the thoracolumbar spine during flare-ups or after repeated use over time. A February 2015 VA treatment record noted the Veteran's report of lower back pain when bending. During a February 2015 VA spine examination, the Veteran reported his condition had worsened and that he had constant pressure to the lower back. He reported sharp pain with bending, twisting, and lifting lasting ten to fifteen seconds, and that sometimes he is unable to move for a few seconds. The Veteran reported the pain did not radiate and that he does not use supportive devices. The Veteran reported flare-ups such that he could not bend or twist. He reported pain that felt like a tightness, squeezing, stabbing pain with twisting or bending. The Veteran demonstrated flexion, with pain, limited to 70 degrees. Combined ROM of the thoracolumbar spine was to 220 degrees. The Veteran was able to perform repetitive-use testing with three repetitions with no additional limitation in ROM of the thoracolumbar spine. The examiner noted the Veteran had functional loss/impairment of the thoracolumbar spine due to pain on movement. He had no localized tenderness or pain to palpation, no guarding or muscle spasm, and he did not have muscle atrophy. The examiner noted that the Veteran did not have signs or symptoms due to radiculopathy. He had no neurologic abnormalities and he did not have IVDS. The examiner noted the Veteran did not have arthritis. The examiner remarked that x-ray findings were not significant to warrant a diagnosis. The Veteran's posture and gait were noted to be within normal limits. The examiner noted contributing factors of pain, weakness, fatigability, and/or incoordination, but there was no additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. During a July 2017 VA spine examination, the Veteran reported flare-ups when "turning wrong" or bending/twisting which caused a sudden, sharp pain in the lower back. The Veteran reported no radiation of symptoms. The Veteran demonstrated flexion to 90 degrees. Combined ROM of the thoracolumbar spine was to 240 degrees. Pain was noted on examination, but did not result in/cause functional loss. The examiner noted there was pain with weightbearing and objective evidence of localized tenderness or pain on palpation over the bilateral SI joints, right more than left. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or ROM. The examiner stated the Veteran was not examined after repetitive use over time nor was he examined during a flare-up. The examiner opined that he was unable to state without mere speculation if pain, weakness, fatigability, or incoordination significantly limits functional ability with repeated use over a period of time or during a flare-up, because the Veteran was "not examined with repeated use over a period of time," and the Veteran was "not flared." The examiner noted the Veteran had guarding or muscle spasm, but that it did not result in abnormal gait or abnormal spinal contour. Such was described as pain in the SI joint, right more than left. The examiner noted normal muscle strength, no muscle atrophy, normal reflexes, and a normal sensory exam. There was no radicular pain or other signs or symptoms of radiculopathy, no ankylosis, and no neurologic abnormalities. The Veteran did not have IVDS. The examiner noted the Veteran did not have arthritis and did not use assistive devices. The examiner noted evidence of pain on passive ROM testing, and evidence of pain when the joint is used in non-weightbearing. During the November 2018 VA spine examination, the Veteran reported chronic lower back pain since service that had worsened over the years with increased pain more to the right side than left, described as "sharp, shooting, comes and goes," "dependent on activity," and positioning such as "bending down or over the side." The Veteran reported radiation to the buttocks/hip, but denied numbness or tingling to the lower extremities. The Veteran reported flare-ups that occur five to ten times per month, with a severity of pain rated as "8/10," for a duration of 24-hours. The Veteran reported functional loss or functional impairment of the thoracolumbar spine described as decreased ROM with "bending down/over," "weakness" of the right leg, and "pain with walking." The Veteran demonstrated flexion to 90 degrees. Combined ROM of the thoracolumbar spine was to 220 degrees. The Veteran reported decreased ROM due to right sided lower back pain described as "mild to moderate," "depending on activity at the time." The examiner noted pain on examination that did not result in/cause functional loss. There was no pain with weightbearing. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or ROM. The examiner noted the Veteran was not examined immediately after repeated use over time or during a flare-up. The examiner, therefore, stated that she unable to state without speculation if pain, weakness, fatigability, or incoordination significantly limits functional ability after repeated use over a period of time or during a flare-up because "there is no conceptual or empirical basis for making such a determination without directly observing function under the repeated use over time, or flare-up condition." She stated that it is not possible to determine, without resorting to mere speculation, or estimate loss of ROM after repeated use over time or during flare-ups because there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions. The examiner noted that there was no guarding or muscle spasm. The Veteran had normal muscle strength, reflex, and sensory exams. The examiner indicated the Veteran has constant mild pain in the right lower extremity, described as an intermittent mild pain in the sciatic nerve. The examiner indicated the severity of the Veteran's right lower extremity radiculopathy to be mild. There was no ankylosis of spine and no neurologic abnormalities. The Veteran did not have IVDS, did not use assistive devices, and did not have arthritis. The examiner remarked that if clinical concerns persisted and there was a concern for DDD, then further evaluation with MRI lumbar spine without contrast was recommended. The examiner noted that passive ROM was not performed because it was not feasible to do in a safe and reasonable manner, that non-weightbearing was not applicable, and there was no objective evidence of pain when the spine is in a non-weightbearing position at rest. During the December 2019 VA spine examination, the examiner noted diagnoses of lumbosacral strain and IVDS. The examiner opined that IVDS was likely caused by service due to the history of combat and explosion. The examiner stated that the Veteran's back symptoms started shortly after the explosion and has progressed from the strain. The examiner noted the Veteran's report of constant low back pain that limits him on bending over and picking-up things. He reported flare-ups when awakening, or with long periods of sitting, or when getting out of the car which causes extreme tightness and tenseness. He reported that he "can't bend well" and that he has "a lot of trouble with side movements." The Veteran reported that when his back flares, he "can't bend over well," and he "can't pick-up light things." The examiner noted objective evidence of localized tenderness or pain on palpation at L5-SI of mild severity that corresponds to the history of lumbosacral strain. Combined ROM of the thoracolumbar spine was to 233 degrees. There was no evidence of pain with weightbearing. The Veteran reported no change in ROM with repeated use over time. However, the examiner noted that pain, weakness, fatigability, or incoordination significantly limits functional ability with flare-ups due to pain. The Veteran reported the pain on flare-ups gets so bad that he drops things. The examiner described ROM during flare-ups as flexion limited to 45 degrees; extension limited to 20 degrees; right and left lateral flexion limited to 8 degrees; right lateral rotation limited to 25 degrees; and left lateral rotation to 30 degrees. Combined ROM of the thoracolumbar spine, during flare-ups, was described as 136 degrees. The examiner noted that the Veteran does not have guarding or muscle spasms, but that he does have weakened movement due to muscle, or of the peripheral nerve. The examiner explained that during flare-ups, the pain gets so bad the Veteran drops things. The examiner noted normal muscle strength, normal reflex, and normal sensory exam. The examiner indicated the Veteran does not have radicular pain or signs or symptoms of radiculopathy, no ankylosis, and no neurologic abnormalities. The examiner opined the Veteran does have IVDS, but that he has not had any episodes of acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past twelve months. The examiner noted the Veteran does not use assistive devices, but that his gait is wide-based and that he only squats half-way down. The examiner indicated that arthritis is not documented. The examiner stated that IVDS has been diagnosed based on x-ray of the Veteran's lumbar spine which showed minimal disk space narrowing at L3-SI. The examiner opined there was no objective evidence of pain on non-weightbearing, and that passive ROM cannot be performed or is not medically appropriate. Based on the above, the Board finds that an initial evaluation of 20 percent is warranted throughout the entire period on appeal. As an initial matter, the Board assigns probative value to the December 2019 VA spine examination report that documents the Veteran's complaints and symptoms, and the Veteran's lay statements. The examiner conducted necessary testing for rating purposes and recorded the Veteran's limitations. The examiner also documented the Veteran's lay statements regarding his functional impairment. Accordingly, this contemplates a 20 percent evaluation under the general rating formula. Moreover, while the July 2017 and November 2018 VA spine examinations indicated that it would be mere speculation to state at what point painful motion began during a flare-up, on examination in February 2015, the Veteran reported sharp pain with bending, twisting, and lifting which lasts ten to fifteen seconds, and that sometimes he is unable to move for a few seconds during flare-ups. The Board finds that an evaluation in excess of 20 percent for the Veteran's lumbar spine disability is not warranted. In that regard, the Veteran's lumbar spine disability has been manifested by symptoms of forward flexion to 45 degrees, at worst. In order to warrant a higher 40 percent evaluation, there must be forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. That is not the case here, as the most probative evidence does not show such severe impairment. The Board notes that the Veteran has a diagnosis of IVDS based on the December 2019 VA spine examination. Turning to whether an increased rating is warranted under the criteria pertaining to IVDS, under the old and revised versions of 38 C.F.R. § 4.71a, Diagnostic Code 5243, a 40 percent rating contemplates incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months. A 60 percent rating contemplates incapacitating episodes having a total duration of at least six weeks during the past twelve months. An "incapacitating episode" is a period of acute signs and symptoms due to IVDS that requires bedrest prescribed by a physician and treatment by a physician. Associated objective neurological abnormalities (i.e., bladder and bowel impairment) are to be evaluated separately. As indicated above, effective February 7, 2021, the rating criteria for Diagnostic Code 5243 did not change. However, the application of the Diagnostic Code was revised such that it is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Accordingly, under the old version of Diagnostic Code 5243 and the regulatory change effective February 7, 2021, a rating in excess of 20 percent is unavailable as the rating criteria for IVDS continues to require incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months. Here, while the December 2019 VA examiner stated that the Veteran had IVDS, the Veteran has not experienced any incapacitating episodes of IVDS. Treatment records do not otherwise indicate that clinicians have prescribed bed rest at any time during the period on appeal. Accordingly, a rating in excess of 20 percent is not warranted under the criteria for rating IVDS based on incapacitating episodes. Most significantly, the Board finds the objective medical evidence to be probative and credible in determining that the Veteran does not meet the criteria for an evaluation in excess of that assigned. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In addition to the medical evidence above, the Board has considered the lay evidence in the form of the Veteran's correspondence. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). However, even affording the Veteran full competence and credibility, the statements do not show impairment more closely approximating the criteria for a higher evaluation. This claim has also been reviewed with consideration of whether staged ratings would be warranted. The evidence shows no distinct periods of time when the Veteran's symptoms have varied to such an extent that an evaluation in excess of the currently assigned evaluation would be warranted. 38 U.S.C. § 5110; 38 C.F.R. § 3.344; Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board has considered other potentially applicable Diagnostic Codes. See Schafrath, 1 Vet. App. at 589. Here, the evidence does not reflect that there are any other musculoskeletal disorders of the back or that the Veteran's lumbar spine disability is more properly rated under another Diagnostic Code. See 38 C.F.R. § 4.71a, Diagnostic Code 5010-5237. Accordingly, a higher rating under alternate Diagnostic Codes is not warranted. The Veteran's reported symptomatology did not, when viewed in conjunction with the medical evidence, tend to establish additional limitations of motion to the degree that would warrant an evaluation in excess of 20 percent for the service-connected lumbosacral strain with IVDS at any time during the appeal under 38 C.F.R. §§ 4.40, 4.45, 4.59 and the holdings in DeLuca and Mitchell. In sum, the Veteran's service-connected lumbosacral strain with IVDS is appropriately rated for the period on appeal as 20 percent disabling from December 17, 2014. While a higher rating is not warranted for the orthopedic component of this disability, the general rating formula provides for separate ratings for neurologic manifestations of a back disability. Such is addressed herein below. REASONS FOR REMAND Entitlement to a Separate Evaluation(s) for Radiculopathy of the Lower Extremities Associated with the Lumbar Spine Disability is Remanded. The General Formula for Diseases and Injuries of the Spine also, in pertinent part, provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a. The evidence is unclear as to whether the Veteran has radiculopathy of his lower extremities associated with his lumbar spine disability. Although the November 2014, July 2015, July 2017, and December 2019 VA spine examinations indicated the Veteran did not have radiculopathy, the November 2018 VA spine examination indicated mild right lower extremity radiculopathy. Further, the December 2019 VA examiner noted weakness in the peripheral nerve during flare-ups. As such, the Board finds that the Veteran should be afforded a neurological examination to assist in determining the nature and severity of any diagnosed radiculopathy associated with his lumbar spine disability. The matter is REMANDED for the following action: Afford the Veteran an appropriate VA examination to assist in determining the nature and severity of his lumbar spine radiculopathy. For each neurological manifestation diagnosed, the examiner must specifically identify the nerve that is involved and indicate whether there is complete paralysis. If incomplete paralysis is found, the examiner should indicate the severity of the symptoms. The examiner must address the November 2018 VA spine examination indicating mild right lower extremity radiculopathy, and the December 2019 VA spine examination indicating weakness in the peripheral nerve during flare-ups. N. NELSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.