Citation Nr: 21032043 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-38 625 DATE: May 25, 2021 ORDER The request to reopen the prior finally disallowed claim of entitlement to service connection for gingivitis for compensation purposes is denied. Entitlement to a 40 percent rating, but no higher, for lumbar spine degenerative disc disease is granted. Entitlement to a 10 percent rating, but no higher, for radiculopathy of the left lower extremity femoral nerve is granted. Entitlement to a 10 percent rating, but no higher, for radiculopathy of the left lower extremity sciatic nerve is granted REMANDED Issue of entitlement to service connection for a heart disorder is remanded. REFERRED The issue of entitlement to service connection for gingivitis for treatment purposes is referred to the Regional Office (RO) for development, including referral to the Veterans Health Administration (VHA) for adjudication. A claim of entitlement to service connection for a dental condition is considered both a claim for compensation and a claim for treatment. See Mays v. Brown, 5 Vet. App. 302, 306 (1993). The Board recognizes that A June 2016 correspondence indicates that the RO referred the claim to VHA, but it has been several years and it is unclear from the claims file if the Veteran's claim of entitlement to service connection for gingivitis for treatment purposes had been receive and adjudicated. FINDINGS OF FACT 1. The Veteran's claim of entitlement to service connection for gingivitis for compensation purposes was denied in an October 2011 rating decision that was not appealed and then became final. 2. The evidence received since the October 2011 rating decision does not raise a reasonable possibility of substantiating the Veteran's claim of entitlement to service connection for gingivitis for compensation purposes. 3. The evidence is in at least relative equipoise as to whether the Veteran's lumbar spine degenerative disc disease has manifested with a forward flexion limitation to 30 degrees during the entire period on appeal. 4. The evidence is in at least relative equipoise as to whether the Veteran's radiculopathy of the left lower extremity femoral nerve has manifested with mild incomplete paralysis during the entire period on appeal. 5. The evidence is in at least relative equipoise as to whether the Veteran's radiculopathy of the left lower extremity sciatic nerve has manifested with mild incomplete paralysis during the entire period on appeal. CONCLUSIONS OF LAW 1. The October 2011 rating decision that denied entitlement to service connection for gingivitis for compensation purposes is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. As new and material evidence has not been received for the issue of entitlement to service connection for gingivitis for compensation purposes, the criteria for reopening the claim have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for entitlement to a 40 percent rating for lumbar spine degenerative disc disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 4. The criteria for entitlement to a 10 percent rating for radiculopathy of the left lower extremity femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8526. 5. The criteria for entitlement to a 10 percent rating for radiculopathy of the left lower extremity sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1984 to July 1992. This appeal to the Board of Veterans' Appeals (Board) arose from a November 2013 rating decision issued by the Department of Veterans Affairs (VA). See November 2014 Notice of Disagreement (NOD); August 2016 Statement of the Case (SOC); August 2016 Substantive Appeal (VA Form 9). In December 2018, the Board found that new and material evidence warrants reopening the Veteran's claim of entitlement to service connection for a heart disorder. December 2018 Board decision. The Board remanded the underlying claim of entitlement to service connection for a heart disorder as well as the Veteran's claim of entitlement to an increased rating for lumbar spine degenerative disc disease and the request to reopen his claim of entitlement to service connection for gingivitis. Id. The Board also granted entitlement to a total disability rating based on individual unemployability (TDIU). Id. On remand, the agency of original jurisdiction (AOJ) granted an increased rating of 40 percent, effective January 8, 2020, for lumbar spine degenerative disc disease, but continued the denial of the Veteran's other claims. See February 2020 Rating Decision; February 2020 Supplemental Statement of the Case (SSOC). The Veteran was also granted entitlement to separate compensable ratings for radiculopathy of the left lower extremity femoral and sciatic nerves as associated with lumbar spine degenerative disc disease, effective January 8, 2020. February 2020 Rating Decision. In August 2020, the Board remanded the claims again for further development of the evidence. August 2020 Board decision. The AOJ developed the evidence and continued the denial of the Veteran's claims. See October 2020 SSOC. The claims are now back before the Board. 1. The request to reopen the prior finally disallowed claim of entitlement to service connection for gingivitis. As an initial matter, the Board finds that there has been substantial compliance with his prior remand directives as to this claim. The December 2018 Board decision directed that, on remand, the RO should attempt to obtain dental records referenced by the Veteran in his October 2013 VA Form 21-4142. The RO requested and received evidence from the identified dental care provider, who indicated that the only record available is ledger detailing the type and cost of the Veteran's care at the facility. See January 2019 Private treatment evidence. The August 2020 Board decision directed the RO, again, attempt to obtain any records from the identified facility. The RO requested the Veteran provide another signed VA Form 21-4142 in order to obtain the private treatment records (as the prior July 2019 VA Form 21 4142 had expired), but the Veteran did not return a signed authorization form. See August 2020 Subsequent development letter. As the RO had requested and received the only available treatment records from the identified dental treatment provider and then attempted to obtain any records again, the Board finds that there has been substantial compliance with its prior remand directives. The Veteran asserts entitlement to service connection for gingivitis. February 2013 Correspondence; November 2014 NOD. As the claim of entitlement to service connection for gingivitis for compensation purpose was finally disallowed in an October 2011 rating decision, the Board has broadly construed the Veteran's claim as a request to reopen his prior claim. The Secretary must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to the claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decision-makers. 38 C.F.R. § 3.156 (a). Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. The Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). For the limited purpose of evaluating whether evidence is new and material, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 511 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The Board notes that claims for service connection for dental conditions are treated differently than claims for service connection for other medical conditions. Compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include various problems of the maxilla, mandible, or temporomandibular articulation, loss of whole or part of the ramus, loss of the condyloid process or coronoid process, loss of the hard palate, or loss of teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease. Id. In the absence of a claim for any of these disabilities, or evidence that the Veteran has such disabilities, service connection for compensation purposes for a dental disability or condition is not warranted. See id. The October 2011 rating decision denied entitlement to service connection for gingivitis because it found the Veteran's asserted loss of teeth due to gingivitis is not a disability recognized by VA for consideration of entitlement to service connection for compensation purposes. New evidence has been received since the October 2011 rating decision, but the evidence does not raise a reasonable possibility of substantiating the Veteran's claim. The January 2019 ledger provided by the Veteran's private dental provider lists the date, cost, and description of the Veteran's treatments visits from 2003 to 2006. However, even with presuming the evidence as credible and resolving any reasonable doubt in favor of the Veteran, the evidence does not support that the Veteran's loss of teeth, still asserted by the Veteran as due to gingivitis, is due to a condition listed at 38 C.F.R. § 4.150. This evidence is not material as it does not raise a reasonable possibility of substantiating the claims. As new and material evidence has not been received for the issue of entitlement to service connection for gingivitis for compensation purposes, the request to reopen the claim is denied. As discussed above, the Board has referred the claim of entitlement to gingivitis for treatment purposes for development and referral to VHA. Increased Rating Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. See 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Board has considered the entire record, but only the evidence pertinent to the rating criteria and current disability will be discussed. See Gonzales v. West, 218 F. 3d 1378 (Fed. Cir. 2000). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to a 40 percent rating, but no higher, for lumbar spine degenerative disc disease. The Veteran asserts entitlement to an increase rating for his lumbar spine degenerative disc disease. February 2013 Correspondence; November 2014 NOD. The Veteran's lumbar spine degenerative disc disease is currently evaluated under Diagnostic Code 5242 and currently rated as 20 percent disabling prior to January 8, 2020, and 40 percent thereafter. See February 2020 Rating Decision. Rating factors for a disability of the musculoskeletal system include functional loss due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion, weakness, excess fatigability, incoordination, pain on movement, swelling, or atrophy. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). In evaluating musculoskeletal disabilities, VA must determine whether pain could significantly limit functional ability during flare-ups, or when the joints are used repeatedly over a period of time. See DeLuca, 8 Vet. App. at 206. Under 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). Pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system. Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Rather, pain, may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination [, or] endurance." Id., quoting 38 C.F.R. § 4.40. Under Diagnostic Code 5242 and the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating 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 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. 38 C.F.R. § 4.71a. The next higher rating of 40 percent is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Id. The next higher rating of 50 percent is warranted for Unfavorable ankylosis of the entire thoracolumbar spine. Id. The next higher, and highest, rating of 100 percent is warranted for unfavorable ankylosis of the entire spine. Id. Unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. After careful and thorough consideration of the evidence, the Board finds the Veteran's lumbar spine degenerative disc disease has manifested with symptoms that more closely approximates a 40 percent rating. As an initial matter, the Board finds that there has been substantial compliance with the Board's prior remand directives on the issue of entitlement to an increased rating for lumbar degenerative disc disease. The Board remanded the claim for an adequate examination of the Veteran's lumbar spine. See December 2018 Board decision; August 2020 Board decision. The October 2020 VA examination for back conditions evaluates the Veteran's lumbar spine symptoms, including any increased functional loss during a flare-up, with passive range-of-motion, and while nonweight-bearing. The Board finds the October 2020 VA examination to be adequate and probative. The Veteran was afforded several VA examinations for his back during the period on appeal. The November 2013 VA examiner found the Veteran had forward flexion of the thoracolumbar spine up to 50 degrees, but the examiner did not consider the impact of the Veteran's report of worsening symptoms after prolonged sitting, standing, or walking. See November 2013 VA examination for back conditions. Likewise, the July 2016 VA examiner found the Veteran's forward flexion limited to 60 degrees, but found it was "not feasible" to determine functional loss during a flare-up because the Veteran was not having a flare-up at the time of the examination. July 2016 VA examination for back conditions. The January 2020 VA examiner found the Veteran's lumbar spine flexion limited to 30 degrees after repetitive use over time, but did not explain why the Veteran's statements about his functional loss during a flare-up was neither medical consistent or inconsistent with the examination findings. January 2020 VA examination for back conditions. Finally, the October 2020 VA examiner found the Veteran's forward flexion limited to 40 degrees after repetitive use over time or during a flare-up. As discussed above, the Board finds the October 2020 VA examination findings and opinions to be probative as they adequately consider the Veteran's report symptoms after repetitive use over time and during flare-up. The Board finds the November 2013 and July 2016 VA examination findings not probative because they inadequately consider any additional functional limitations during a flare-up of the Veteran's symptoms. As for the January 2020 VA examination findings, the Board notes that the VA examiner's finding of thoracolumbar spine forward flexion up to 30 degrees supports a higher disability rating than the October 2020 VA examiner's finding of 40 degrees forward flexion. While the January 2020 VA examiner did not explain why there are no additional restrictions during a flare-up, the examiner considered the Veteran's statements about his symptoms with repetitive use over time in finding a 30 degree forward flexion limitation. See January 2020 VA examination for back conditions. The January 2020 VA examiner's finding of 30 degrees forward flexion is also close to the October 2020 VA examiner's finding of 40 degrees, and more favorable to the Veteran's claim. The Board finds the January 2020 VA examiner's findings to have some probative value for this reason. The Board also considered the Veteran's statements to his treatment providers and to the VA examiners about his back pain, difficulty with postural movements, and being unable to sit, stand, or walk for prolonged. While the Veteran is competent to report his lumbar spine symptoms, he is not competent to state whether his symptoms warrant a specific rating under the schedule for rating disabilities. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed Cir. 2006); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In this case, the Board finds the January 2020 and October 2020 VA examiners' findings to be more probative as they are medical professionals qualified to evaluate the Veteran's lumbar spine condition and provided findings relevant to the rating criteria. The Board also considered the Veteran's statements that he believes his doctors have not tried to help him and may have falsified records. October 2013 Correspondence. The Board notes that the evaluation of the Veteran's lumbar spine degenerative disc disease have been largely based on the VA examination evidence and not his medical treatment evidence. Based on the more probative evidence of record, and in resolving any reasonable doubt in favor of the Veteran, the Board finds the Veteran's lumbar spine degenerative disc disease has manifested with symptoms that limit the forward flexion of the thoracolumbar spine to 30 degrees or less for the entire period on appeal. Accordingly, a 40 percent rating is warranted for the Veteran's lumbar spine degenerative disc disease prior to January 8, 2020. The Board considered whether a rating higher than 40 percent is warranted. There is no evidence that the Veteran has ankylosis of the entire thoracolumbar spine to warrant a higher rating under the General Rating Formula for Diseases and Injuries of the Spine. The January 2020 and October 2020 VA examiners affirmatively found no evidence of ankylosis. The January 2020 and October 2020 VA examiners also found that the Veteran does not have intervertebral disc syndrome (IVDS), nor is there evidence in the claims file of incapacitating episodes having a total duration of at least 6 weeks during a 12-month period due to IVDS, to warranted a higher rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. See 38 C.F.R. § 4.71a. The Board, thus, finds that a 40 percent rating, but no higher, is warranted for the Veteran's lumbar spine degenerative disc disease. 3. Entitlement to a 10 percent rating, but no higher, for radiculopathy of the left lower extremity femoral nerve. The Board finds that the issue to a separate compensable rating for the Veteran's left lower extremity is raised by the record as part of the Veteran's claim for an increased rating for his lumbar spine degenerative disc disease. Note 1 to the General Rating Formula for Diseases and Injuries of the Spine provides that any associated objective neurological abnormalities are to be rated separately under the appropriate diagnostic code. See 38 C.F.R. § 4.71a. In this case, the January 2020 and October 2020 VA examinations for back conditions found evidence of mild left lower extremity radiculopathy. The October 2020 VA examiner opined that the Veteran's radiculopathy is due to his service connected lumbar spine disability. The Board, thus, finds that a separate compensable rating for radiculopathy of the left lower extremity is on appeal before the Board. The Board recognizes that the issue of entitlement to a compensable rating for the Veteran's radiculopathy of the left lower extremity femoral nerve was adjudicated by the February 2020 rating decision and rated as 10 percent disabling, effective January 8, 2020. As the issue of entitlement to a higher rating for radiculopathy of the left lower extremity is considered associated with the Veteran's claim for an increased rating for his lumbar spine disability, the question of entitlement to separate compensable rating for radiculopathy of the left lower extremity during the entire period on appeal is before the Board. Under Diagnostic Code 8526, a 10 percent rating is warranted for mild incomplete paralysis of the femoral nerve; a 20 percent rating is warranted for moderate incomplete paralysis, a 30 percent rating is warranted for severe incomplete paralysis, and a 40 percent rating is warrant for complete paralysis. See 38 C.F.R. § 4.124a. Complete paralysis of the femoral nerve is characterized by paralysis of the quadriceps extensor muscles. See 38 C.F.R. § 4.124a. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" at 38 C.F.R. § 4.124a. Words such as "severe" and "moderate" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, the use of such terminology is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. After careful and thorough consideration of the evidence, the Board finds that the Veteran's radiculopathy of the left lower extremity femoral nerve has manifested with symptoms that more closely approximates the criteria for a 10 percent rating. The Board considered the Veteran's contention that his treating doctors did not help him and falsified records. October 2013 Correspondence. While the Board did consider some of the Veteran's treatment records, they were used to show that his left lower extremity radiculopathy symptoms existed prior to January 8, 2020. The severity of his symptoms are largely evaluated on the more probative January 2020 and October 2020 VA examination findings and opinions as discussed below. During the November 2013 and July 2016 VA examinations for back conditions, the examiners found normal muscle strength, reflexes, sensation, and no evidence of radiculopathy. As discussed above, the Board finds the November 2013 and July 2016 VA examiners' findings and opinions to be less probative as it is unclear if the Veteran's reported symptoms after repetitive use over time and during a flare up of symptoms were considered. The January 2020 VA examiner found the Veteran to have radiculopathy in the lower left extremity involving the sciatic and femoral nerves. January 2020 VA examination for back conditions. The examiner found symptoms of 4/5 strength and decreased sensation to light touch in his left upper anterior thigh to his toes. Id. The examiner also found mild intermittent pain and numbness in the Veteran's left lower extremity. Id. The January 2020 VA examiner opined that the evidence supported mild left lower extremity radiculopathy. Id. The October 2020 VA examiner opined that the Veteran had mild left lower extremity radiculopathy, but involving only the sciatic nerve and not the femoral nerve. October 2020 VA examination for back conditions. The examiner also found evidence of mild intermittent pain and numbness in the lower left extremity, but normal strength, reflexes, and sensation to light touch. Id. The Board finds the January 2020 and October 2020 VA examiners' findings and opinions to be probative as they are medical professional who considered the Veteran's reported symptoms either after repetitive use over time and/or during a flare-up. Both the January 2020 and October 2020 VA examiners support at least mild intermittent pain and numbness in the Veteran's left lower extremity, considered to be mild radiculopathy. The Board finds the opinions are supported by detailed findings of no more than 4/5 decrease in strength; a decrease, but not absent, sensation to touch; and mild intermittent pain and numbness. The Board finds this evidence more closely approximates mild incomplete paralysis of the left femoral nerve. The Board also considered the medical treatment evidence. During November 2005 visit with a private pain management provider, the Veteran was diagnosed with mild left lower extremity radiculopathy related to back disability. See November 2005 Private treatment evidence. In 2014, the Veteran complained of numbness with a radiating sensation in his left leg and foot. August 2014 VA treatment evidence; September 2014 VA treatment evidence. The Veteran continued to complain of similar symptoms of mild numbness and tingling that intermittently radiates to his lower left extremity. September 2019 VA treatment evidence. The Board finds the medical treatment evidence probative and supports finding that the Veteran's lower left radiculopathy manifested prior to January 8, 2020. The Board recognizes that the October 2020 VA examiner's finding that the Veteran's radiculopathy symptoms only involve the sciatic nerve raises a doubt as to whether the Veteran has a left femoral nerve disability associated with his lumbar spine degenerative disc disease. In resolving any reasonable doubt in favor of the Veteran, the Board finds that the Veteran's radiculopathy of the left lower extremity femoral nerve has manifested with mild incomplete paralysis. Accordingly, entitlement to a 10 percent rating, but no higher, for the Veteran's radiculopathy of the left lower extremity femoral nerve is warranted prior to and since January 8, 2020. 4. Entitlement to a 10 percent rating, but no higher, for radiculopathy of the left lower extremity sciatic nerve. As discussed above, the Board finds that the issue to a separate compensable rating for the Veteran's left lower extremity is raised by the record as associated with the Veteran's claim for an increased rating for his lumbar spine degenerative disc disease. See 38 C.F.R. § 4.71a, Note 1 to the General Rating Formula for Diseases and Injuries of the Spine; January 2020 VA examination for back conditions; October 2020 VA examinations for back conditions. As with the Veteran's radiculopathy of the left lower extremity femoral nerve, the Board recognizes that the issue of entitlement to a compensable rating for the Veteran's radiculopathy of the left lower extremity sciatic nerve was adjudicated by the February 2020 rating decision and rated as 10 percent disabling, effective January 8, 2020; but the question of entitlement to separate compensable rating for radiculopathy of the left lower extremity during the entire period on appeal is still before the Board. Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is warranted for moderate incomplete paralysis, a 40 percent rating is warranted for moderately severe incomplete paralysis, and a 60 percent rating is warrant for severe incomplete paralysis with marked muscular atrophy; and an 80 percent rating is warranted for complete paralysis of the sciatic nerve. See 38 C.F.R. § 4.124a. Complete paralysis of the sciatic nerve is characterized by a foot that dangles and drops, no active movement of the muscles below the knee, and lost or weakened flexion of the knee. See 38 C.F.R. § 4.124a. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" at 38 C.F.R. § 4.124a. Words such as "severe" and "moderate" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, the use of such terminology is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. After careful and thorough consideration of the evidence, the Board finds that the Veteran's radiculopathy of the left lower extremity sciatic nerve has manifested with symptoms that more closely approximates the criteria for a 10 percent rating. During the November 2013 and July 2016 VA examinations for back conditions, the examiners found normal muscle strength, reflexes, sensation, and no evidence of radiculopathy. As discussed, the Board finds the November 2013 and July 2016 VA examiners' findings and opinions to be less probative as it is unclear if the Veteran's reported symptoms after repetitive use over time and during a flare up of symptoms were considered. The January 2020 VA examiner found the Veteran to have radiculopathy in the lower left extremity involving the sciatic and femoral nerves. January 2020 VA examination for back conditions. The examiner found symptoms of 4/5 strength and decreased sensation to light touch in his left upper anterior thigh to his toes. Id. The examiner also found mild intermittent pain and numbness in the Veteran's left lower extremity. Id. The January 2020 VA examiner opined that the evidence supported mild left lower extremity radiculopathy. Id. The October 2020 VA examiner opined that the Veteran had mild left lower extremity radiculopathy involving only the sciatic nerve. October 2020 VA examination for back conditions. The examiner found evidence of mild intermittent pain and numbness in the lower left extremity, but normal strength, reflexes, and sensation to light touch. Id. Here, the Board also finds the January 2020 and October 2020 VA examiners' findings and opinions to be probative as they are medical professional who considered the Veteran's reported symptoms either after repetitive use over time and/or during a flare-up. The January 2020 and October 2020 VA examination findings support at least mild intermittent pain and numbness in the Veteran's left lower extremity; no more than 4/5 decrease in strength; a decrease, but not absent, sensation to touch; and mild intermittent pain and numbness. The Board finds this evidence supports no more than mild incomplete paralysis of the sciatic nerve. The Board also considered the medical treatment evidence showing the Veteran complained of left lower extremity numbness or tingling sensation prior to January 8, 2020. See, e.g., November 2005 Private treatment evidence; August 2014 VA treatment evidence; September 2014 VA treatment evidence; September 2019 VA treatment evidence. The Board finds the medical treatment evidence probative and supports finding mild lower left radiculopathy associated with the Veteran's lumbar spine disability prior to January 8, 2020. The Board considered the Veteran's contention that his treating doctors did not help him and falsified records. October 2013 Correspondence. While the Board did consider some of the Veteran's treatment records, they were used to show that his left lower extremity radiculopathy symptoms existed prior to January 8, 2020, and the severity of his symptoms were largely evaluated on the more probative January 2020 and October 2020 VA examination findings. Based on the more probative evidence of record, the Board finds that the Veteran's radiculopathy of the left lower extremity sciatic nerve has manifested with symptoms the more closely approximates mild incomplete paralysis. Accordingly, entitlement to a 10 percent rating, but no higher, for the Veteran's radiculopathy of the left lower extremity sciatic nerve is warranted prior to and since January 8, 2020. REASONS FOR REMAND 5. Issue of entitlement to service connection for a heart disorder is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of service connection for a heart disorder. The December 2018 Board decision directed that the AOJ obtain an opinion from a VA examiner to specifically discuss the April 1990 and June 1992 service treatment records showing sinus bradycardia and sinus arrhythmia, and whether the evidence supports evidence of a heart disorder. The VA examiner's opinion obtained on remand found no evidence of a current heart disorder and did not consider the service treatment evidence. January 2020 VA examination for heart conditions. The Board remanded the claim again for a VA examiner to consider evidence showing a possible current heart disorder, and to address service treatment evidence of reported chest pain or pressure, abnormal lung and chest findings, and the EKG findings showing sinus bradycardia and sinus arrythmia. See August 2020 Board decision. The October 2020 VA examiner found evidence of a heart disorder during the period on appeal (diagnosed as myocardial infarction, coronary artery disease, and stable angina), but only discussed service treatment evidence of a normal pulse. October 2020 VA examination for heart conditions. The examiner did not specifically consider and discuss the Veteran's reported chest pain or pressure, lung and chest findings, or the EKG findings as directed by the Board. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate medical professional to determine the nature and cause of the Veteran's heart disorder, diagnosed as myocardial infarction, coronary artery disease, and stable angina. If the medical professional determines that it is necessary, schedule the Veteran for a VA examination. The medical professional should respond to the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's heart disorder(s) began in (or is otherwise related to) the Veteran's military service? The examiner should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms. The VA examiner should also specifically consider and discuss the April 1990 and June 1992 EKG findings showing sinus bradycardia and/or sinus arrythmia. The VA examiner should also specifically consider and discuss the Veteran's report of chest pain or pressure during his June 1992 Report of Medical History and the abnormal chest and lung findings on his June 1992 Report of Medical Examination. The examiner should opine on whether the evidence supports a heart disorder incurred during service and if there is a medical link between his current heart disorders and service. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. (b) If the Veteran's current heart disorder (diagnosed as myocardial infarction, coronary artery disease, and stable angina) is deemed to be unrelated to service, the examiner should, if possible, identify the cause considered more likely and explained why that is so. 2. Readjudicate the claim. J. Smith Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.