Citation Nr: 21032483 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-35 690A DATE: May 27, 2021 ORDER Entitlement to an initial 50 percent rating, but not higher, for spondylosis L-5 with intervertebral disc syndrome (low back disability) is granted, subject to the laws and regulations controlling the award of monetary benefits. Entitlement to an initial 40 percent rating, but not higher, for left lower extremity radiculopathy is granted, subject to the laws and regulations controlling the award of monetary benefits. Entitlement to an initial 20 percent rating, but not higher, for right lower extremity radiculopathy is granted, subject to the laws and regulations controlling the award of monetary benefits. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran's low back disability symptomatology more nearly approximates unfavorable ankylosis of the thoracolumbar spine, but it does not more nearly approximate ankylosis of the entire spine, or incapacitating episodes. 2. The evidence is at least evenly balanced as to whether the Veteran's left lower extremity radiculopathy symptomatology more nearly approximates moderately severe incomplete paralysis of the sciatic nerve, but it does not more nearly approximate severe incomplete paralysis, with marked muscular atrophy. 3. The Veteran's right lower extremity radiculopathy symptomatology more nearly approximates moderate incomplete paralysis, but it does not more nearly approximate moderately severe incomplete paralysis. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to an initial rating of 50 percent, but not higher, for low back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.71, Diagnostic Code (DC) 5243. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for an initial 40 percent rating, but not higher, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.123, 4.124, 4.124a, DC 8520. 3. The criteria for an initial 20 percent rating, but not higher, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.123, 4.124, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2003 to February 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma which granted service connection for left lower extremity radiculopathy, evaluating it as 10 percent disabling, and granted service connection for low back disability, evaluating it as 20 percent disabling, each effective May 30, 2015. In May 2016, the Veteran filed his notice of disagreement with the ratings assigned, and in July 2016, was issue a statement of the case and perfected his appeal to the Board. In a July 2016 decision review officer (DRO) decision, the DRO granted a rating increase for the Veteran's low back disability, evaluating it as 40 percent disabling effective June 27, 2016, creating a staged rating. As this constitutes a partial grant of the benefits sought on appeal, this issue remains on appeal before the Board. See AB v. Brown, 6 Vet. App. 35 (1993). In April 2021, the Veteran appeared at a virtual Board hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. The Board notes that the Veteran submitted additional medical evidence in April 2021 after the appeal was certified and transferred to the Board, and the Veteran, through his attorney, explicitly waived RO consideration in the first instance of that evidence during his virtual Board hearing. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. 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 nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination, or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). When evaluating a disability under VA's General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis, i.e., functional loss consistent with that contemplated by ankylosis. See Chavis v. McDonough, No. 18-2928 (Vet. App. Apr. 16, 2021). 1. Low back disability The Veteran testified that his back pain has been pretty bad the entire period, and reported flare-ups wherein at least 3 to 5 times a week, his wife kicks him out of bed because he cannot move. He stated that during flare-ups he is unable to move his back much at all, and it usually takes about half a day before he can start standing straight again. The Veteran indicated that his low back disability symptomatology warranted a 40 percent rating for the entire period on appeal. The Veteran's low back disability is currently rated 20 percent disabling from May 30, 2015, and 40 percent disabling from June 27, 2016 under DC 5243. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Disabilities of the spine are rated under the General Rating Formula for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (IVDS Rating Formula). Under the General Rating Formula for Diseases and Injuries of the Spine applied by DC 5242, the disability is evaluated with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. A 20 percent rating requires thoracolumbar spine forward flexion greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less, or for favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the thoracolumbar spine warrants a 50 percent evaluation, and unfavorable ankylosis of the entire spine is rated 100 percent disabling. 38 C.F.R. § 4.71a. The IVDS Rating Formula provides a 20 percent rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 disability rating for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, normal extension is zero to 30 degrees, normal left and right lateral flexion is zero to 30 degrees, and normal left and right lateral rotation is zero to 30 degrees. 38 C.F.R. § 4.71a, DC 5237, Note 2. Further, all measured ranges of motion should be rounded to the nearest five degrees. 38 C.F.R. § 4.71a, general rating formula, Note 4. Ankylosis is a condition in which an entire spinal segment is immobile and fixed in position. Unfavorable ankylosis exists where the fixation is in flexion or extension, and the ankylosis results in 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; and/or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) is considered favorable ankylosis. 38 C.F.R. § 4.71a, general rating formula, Note 5. A United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. An October 2015 disability benefits questionnaire (DBQ) indicated that the Veteran suffered from flare-ups of his low back disability, and reported that his low back disability caused functional impairment including when driving, sitting, and lifting. His range of motion was as follows: forward flexion from 10 to 45 degrees, extension from 10 to 0 degrees, and right and left lateral flexion and rotation each to 15 degrees, with pain noted with each range of motion. The examiner noted objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine, with the Veteran reporting limited prolonged sitting, and bending. There was no additional loss of function, or range of motion after 3 repetitions. The examiner noted that the examination was not conducted during a flare-up, but reported that pain, lack of endurance, and fatigue significantly limit functional ability with flare-ups. However, the examiner was unable to describe the functional loss during a flare-up in terms of range of motion. The examiner noted localized tenderness of the thoracolumbar spine not resulting in abnormal gait, or abnormal spinal contour, and less movement than normal with limited prolonged sitting, lifting, and bending. There was no muscle atrophy, or ankylosis, and while IVDS was noted, the Veteran had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. A June 2016 VA examination report reflected that the Veteran indicated that his back pain had worsened, and was a 6 to 9 out of 10. He reported a constant sharp, or dull pain in the back, more on the left side. The Veteran reported flare-ups with prolonged sitting, standing, or lying down on his back. He reported very limited range of motion, stated he was unable to put on socks, or pick things up off of the floor, and that it was very difficult to put on slip-on boots. Forward flexion was to 5 degrees, extension to 30 degrees, and right and left lateral flexion and rotation each to 10 degrees. Pain was noted with weight bearing, and there was evidence of localized tenderness or pain on palpation of the joints or associated soft tissue in the left paralumbar muscles and lumbar spine. The Veteran was unable to perform repetitive use testing with at least 3 repetitions as there was increased back pain on the second attempt, and he would not attempt anymore. The examination was not administered during a flare-up, so the examiner was unable to determine without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups. The Veteran reported muscle spasms and localized tenderness which did not result in abnormal gait or spinal contour. There was reduced muscle strength as active movement against some resistance was noted, but there was no muscle atrophy, and no ankylosis of the spine. The examiner did note IVDS, but the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran did not report use of any assistive device as a normal mode of locomotion. In an April 2021 letter, the Veteran's private physician reported that the Veteran's back pain had worsened, describing daily pain as a 6 to 9 out of 10. He reported constant sharp or dull pain in the back, more on the left side with radiation down to the left buttock, lateral of the left thigh and leg, to the anterior of the left foot and 1st and 2nd left toes. The physician reported that digital palpation revealed edema in the lumbar region and left shoulder, and palpation of the muscles revealed spasm in the lumbar region and left shoulder. The physician opined that the Veteran's low back disability has progressed immensely, and that his claim for an increased rating is warranted. The Board finds that the evidence is at least evenly balanced as to whether the Veteran's low back disability symptomatology more nearly approximates unfavorable ankylosis of the thoracolumbar spine as contemplated by a 50 percent rating under the general rating formula. While the October 2015 DBQ and June 2016 VA examination report reflect that the Veteran's low back disability limited him to between 5 and 45 degrees forward flexion, and 0 to 30 degrees extension, the examinations were not administered during a flare-up which the Veteran reported occurred with prolonged sitting, standing, or lying down and significantly limited functional ability. Additionally, the Veteran has reported that his low back pain has been "pretty bad" during the entire period on appeal, stating that a few days a week he is unable to move his back much at all during flare-ups. He even testified that 3 to 5 times a week, he suffers from flare-ups to the point that he cannot move. Therefore, it is reasonable to conclude based on the Veteran's competent lay statements regarding back pain during a flare-up that his back range of motion is more severely limited during a flare-up, and that his back pain has caused such functional limitation for the entire period on appeal. The June 2016 examiner also noted that the Veteran's low back disability impacted his ability to put on socks, pick things up off the floor, and caused very limited range of motion. Considering these contentions in light of the evidence of record and the applicable law, the orthopedic manifestations of the Veteran's low back disability are best evaluated as 50 percent disabling. However, a higher 100 percent disability rating is not warranted. The Veteran does not contend, and the evidence does not demonstrate that the Veteran's low back disability has resulted in symptomatology that more nearly approximates ankylosis of the entire spine, to include the Veteran's reports of functional limitation during a flare-up. The Veteran's private physician noted that the Veteran's pain, spasm, and edema were located in the lumbar region rather than in the entire spine, and the Veteran reported flare-ups which caused functional limitation of the low back, not the entire spine. Additionally, while the Veteran has a been diagnosed with IVDS, the evidence from the October 2015 DBQ and June 2016 VA examination report reflects that the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician, and treatment by a physician in the past 12 months. Therefore, the Veteran's low back disability symptomatology, while significant, does not more nearly approximate symptomatology contemplated by a higher than 50 percent rating under either the rating schedule for IVDS or the general rating formula schedule. As the reasonable doubt created by this approximate balance in the evidence must be resolved in favor of the Veteran, entitlement to a rating of 50 percent, but not higher, is warranted for the Veteran's low back disability for the entire appeal period. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 2. Right and left lower extremity radiculopathy The Veteran's attorney testified that the Veteran's VA examination report indicated that the Veteran's strength in both lower extremities is reduced to four-fifths in flexion of the knee, and that plantar flexion and dorsiflexion are both below normal strength in every motion. He also discussed radiating pain, numbness, and tingling in both extremities. The Veteran testified that his pain begins from the moment he wakes up in the morning, radiates down his left quadricep and into his shin, and that his foot is numb pretty consistently. He described pain at the balls of his feet, and numbness throughout the day. The Veteran reported a pain level of between 7 to 9 out of 10 on a daily basis, and cramping in his legs. He stated that he has been dealing with this pain since he was 18, but was taught to deal with it and has not missed work due to the pain. The Veteran stated that his left lower extremity pain has been worse than the right, but that since he first felt the symptoms, they have worsened every year. He and his attorney stated that from the time they filed the claim, his lower extremity radiculopathy was already pretty severe. The Veteran indicated that his left lower extremity radiculopathy warrants a 40 percent rating, and his right lower extremity radiculopathy warrants a 20 percent rating. The Veteran's left lower extremity radiculopathy is currently rated 10 percent disabling under DC 8520. Under DC 8520, a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis; a 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy; and an 80 percent rating is assigned for complete paralysis of the sciatic nerve, where the foot dangles and drops, and there is no active movement possible of muscles below the knee, flexion of knee weakened, or (very rarely), lost. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." The term "incomplete paralysis," with this and other peripheral nerve injuries, 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 ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. See 38 C.F.R. § 4.124a, note at "Diseases of the Peripheral Nerves." VA has generally considered that the mild level of evaluation would be more reasonably assigned when sensory symptoms are recurrent but not continuous assigned a lower medical grade reflecting less impairment and/or affecting a smaller area in the nerve distribution. The moderate level of evaluation would be reserved for the most significant and disabling cases of sensory-only involvement. These are cases where the sensory symptoms are continuously assigned a higher medical grade reflecting greater impairment and/or affecting a larger area in the nerve distribution. This provision does not mean that if there is any impairment that is non-sensory (or involves a non-sensory component) such as a reflex abnormality, weakness or muscle atrophy, the disability must be evaluated as greater than moderate. Significant and widespread sensory impairment may potentially indicate the same or even more disability than a case involving a minimally reduced or increased reflex or minimally reduced strength. An October 2015 DBQ reflected that the Veteran suffered from moderate intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. The examiner noted involvement of the left sciatic nerve, and mild radiculopathy of the left side. In a June 2016 VA examination report, the Veteran's examiner noted moderate constant pain, mild paresthesias and/or dysesthesias, and mild numbness in the left lower extremity, but no constant pain, paresthesias and/or dysesthesias, or numbness in the right lower extremity. A separate June 2016 VA examination report indicated that the Veteran had symptoms attributable to a peripheral nerve condition which included mild intermittent pain in the right and left lower extremities, moderate paresthesias and/or dysesthesias, numbness in the left lower extremity, and mild numbness in the right lower extremity. The examiner noted decreased sensation for light touch in the left thigh/knee, left lower leg/ankle, and left foot/toes. The examination report reflected that the Veteran did not have trophic changes attributable to peripheral neuropathy, his gait was normal, and the examiner reported normal right lower radicular group, and incomplete paralysis of the left lower radicular group, with mild incomplete paralysis of the left sciatic nerve. The examination report also reflected incomplete paralysis of the right and left internal saphenous nerves, and mild incomplete paralysis of the left external cutaneous nerve of the thigh. In an April 2021 letter, the Veteran's private physician reported that the Veteran stated that his left 1st and 2nd toes, dorsum of the left foot, and plantar aspect are numb and tingly. The physician noted incomplete paralysis of the left sciatic nerve, of the internal saphenous nerve bilaterally, and of the left external cutaneous nerve of the thigh. The physician noted that the Veteran's level of discomfort was 9 out of ten 100 percent of the time, and has been present for the past several years. He stated that the symptoms become aggravated by sitting, standing, and lying down. The physician opined that the Veteran's left lower extremity radiculopathy symptomatology warranted a 40 percent disability rating. Based on the foregoing, the Board finds that a higher 40 percent rating for the Veteran's left lower extremity radiculopathy, and a 20 percent rating for right lower extremity radiculopathy is warranted. While the October 2015 and June 2016 examiners both noted that the Veteran's left lower extremity radiculopathy symptomatology included moderate pain, mild paresthesias and/or dysesthesias and numbness, and reported mild incomplete paralysis of the left sciatic nerve and left external cutaneous nerve of the thigh, the Veteran's private physician reported a discomfort level of 9 out of 10 100 percent of the time due to his left lower extremity radiculopathy, indicating an extremely high level of pain and discomfort. Additionally, the Veteran has testified that he has pain pretty consistently all day which he stated was between a 7 to 9 out of 10, that his left foot is numb pretty consistently, and that his symptoms have been severe since filing of the claim. He also described reduced strength in both lower extremities, indicating that his symptomatology is more than simply sensory, but includes some functional limitations. The Veteran is competent to describe the symptoms associated with his service connected left lower extremity radiculopathy and the Board has no reason to challenge the credibility of his contentions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The evidence is thus at least evenly balanced as to whether the Veteran's left lower extremity radiculopathy symptomatology more nearly approximates moderately severe incomplete paralysis, thus a 40 percent rating for left lower extremity radiculopathy is warranted. However, the October 2015 DBQ and June 2016 examination report do not indicate, and there is no evidence within the claims file which suggests, that the Veteran's left lower extremity radiculopathy symptomatology more nearly approximated at least severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy. In fact, the June 2016 examination report specifically reflects that the Veteran has suffered no muscle atrophy, and there is no evidence of record to the contrary. The examiner also reported mild incomplete paralysis of the left sciatic nerve. The evidence of record thus reflects that the Veteran's left lower extremity radiculopathy does not more nearly approximate severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy, and a higher 60 percent rating is not warranted. As the preponderance of the evidence is against a higher rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. As for the Veteran's right lower extremity radiculopathy, the Board notes that the Veteran does not have a separate claim with regard to right lower extremity radiculopathy. However, in Chavis, supra, the Court held that if the issue of entitlement to an increased rating for radiculopathy is determined to be within the scope of the claim for an increased rating for a spinal disability on appeal, the Board has jurisdiction to address the ratings for associated radiculopathy without requiring a separate notice of disagreement as to the radiculopathy ratings. Here, the Veteran has a claim for a higher rating for a low back disability, and a claim for a higher disability rating for left lower extremity radiculopathy. During his virtual Board hearing, the Veteran stated that he also suffers from right lower extremity radiculopathy symptomatology which it is reasonable to conclude is, like the left lower extremity radiculopathy, associated with the low back disability. Therefore, the Board may adjudicate the Veteran's claim of entitlement to an increased rating for right lower extremity radiculopathy without a notice of disagreement as ruled by the Court in Chavis. The Board finds that an initial 20 percent rating, but not higher, is warranted for the Veteran's right lower extremity radiculopathy. While the June 2016 VA examination report reflects that the examiner noted no constant pain, paresthesias and/or dysesthesias, or numbness in the right lower extremity, the separate June 2016 VA examination report indicated that the Veteran had symptoms of mild intermittent pain and mild numbness in the right lower extremity. The June 2016 examination report and April 2021 private physician's letter also indicated that the Veteran had incomplete paralysis of the right internal saphenous nerves. Additionally, as with his left lower extremity radiculopathy symptomatology, the Veteran reported a pain level of between 7 to 9 out of 10 on a daily basis with cramping, and although the Veteran stated his left leg pain was worse than the pain in his right leg, he reported that it has worsened every year since it first started. The Board finds considering the Veteran's competent description of his right leg pain, coupled with the findings of the 2016 VA examination report and April 2021 private physician's letter, that his right lower extremity radiculopathy symptomatology more nearly approximates moderate incomplete paralysis of the sciatic nerve as contemplated by a 20 percent disability rating under DC 8520. However, a higher 40 percent disability rating is not warranted under DC 8520 for the Veteran's right lower extremity radiculopathy symptomatology. The June 2016 VA examination report does not indicate, and there is no evidence within the claims file which suggests, that the Veteran's right lower extremity radiculopathy symptomatology more nearly approximates at least moderately severe incomplete paralysis of the sciatic nerve to warrant a disability rating higher than 20 percent. Pain, and numbness were each described as intermittent and mild within the right lower extremity, and the examiner noted no constant pain, paresthesias and/or dysesthesias, or numbness in the right lower extremity. The examiner also reported that the Veteran's right lower radicular group was normal. While the Veteran reported reduced strength in flexion of the knee, and below normal strength in every motion of plantar flexion and dorsiflexion, the overall impairment does not more nearly approximate at least moderately severe symptomatology, as the Veteran has primarily described mild symptomatology with moderate reduction in strength, and as previously discussed, any impairment that is non-sensory does not necessarily mean that the disability must be evaluated as greater than moderate. Considering the medical evidence in conjunction with the Veteran's reports of pain that has been worsening in his right leg, the evidence of record reflects that the Veteran's right lower extremity radiculopathy more nearly approximated moderate incomplete paralysis, and a 20 percent rating, but not higher, for the Veteran's right lower extremity radiculopathy is warranted. As the preponderance of the evidence is against any higher ratings, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Conclusion The Board has considered the Veteran's claims and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Maddox, 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.