Citation Nr: 21040092 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 17-53 577 DATE: July 2, 2021 ORDER A rating in excess of 10 percent for residuals of a left ankle sprain is denied. A rating in excess of 10 percent for lumbar strain is denied. The assignment of a separate rating for radiculopathy of the right lower extremity (RLE), evaluated as 20 percent disabling as of October 2, 2018, is proper; the appeal is denied. The assignment of a separate rating for radiculopathy of the left lower extremity (LLE), evaluated as 20 percent disabling as of October 2, 2018, is proper; the appeal is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran's residuals of a left ankle sprain is manifested by, at most, moderate limitation of motion, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy. 2. For the entire appeal period, the Veteran's lumbar strain is manifested by forward flexion greater than 60 degrees and a combined range of motion of the entire thoracolumbar spine greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, intervertebral disc syndrome (IVDS), or associated objective neurological abnormalities other than radiculopathy of the bilateral lower extremity (BLE) as of October 2, 2018. 3. As of October 2, 2018, the Veteran's radiculopathy of the RLE resulted in no more than moderate incomplete paralysis of the sciatic nerve. 4. As of October 2, 2018, the Veteran's radiculopathy of the LLE resulted in no more than moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for residuals of a left ankle sprain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5271. 2. The criteria for a rating in excess of 10 percent for lumbar strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5237. 3. The assignment of a separate rating for radiculopathy of the RLE, evaluated as 20 percent disabling as of October 2, 2018, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124, 4.124a, DC 8520. 4. The assignment of a separate rating for radiculopathy of the LLE, evaluated as 20 percent disabling as of October 2, 2018, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1997 to September 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2014 by a Department of Veterans Affairs (VA) Regional Office. In October 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In February 2020, the Board remanded the appeal for additional development and it now returns for further appellate review. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation 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. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." 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. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be 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." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The appeal period before the Board stems from the Veteran's April 9, 2013, claim for increased ratings for his left ankle and back disabilities, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). 1. Entitlement to a rating in excess of 10 percent for residuals of a left ankle sprain. For the entire appeal period, the Veteran's left ankle disability is rated as 10 percent disabling pursuant to DC 5271, which, prior to February 7, 2021, provides for a 10 percent rating where there is moderate limitation of ankle motion and a 20 percent rating where there is marked limitation of ankle motion. 38 C.F.R. § 4.71. As of February 7, 2021, VA amended the rule pertaining to the evaluation of musculoskeletal disabilities, to include DC 5271. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 25,450 (November 27, 2020). Specifically, as of such date, DC 5271 provides for a 10 percent rating for moderate limited motion of the ankle, defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, and a 20 percent rating for marked limited motion of the ankle, defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. The normal range of motion in the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. Plate II. Also included within 38 C.F.R. § 4.71a are multiple DCs that evaluate ankle disability based on other manifestations, including DC 5270 (ankylosis of the ankle), DC 5272 (ankylosis of the subastragalar or tarsal joint), DC 5273 (malunion of the os calcis or astragalus), and DC 5274 (astragalectomy). Turning to the evidence of record, during the Veteran's July 2013 VA examination, he reported that he did not have flare-ups that impacted the function of his left ankle. Upon range of motion (ROM) testing, he had full left ankle dorsiflexion to 20 degrees and full plantar flexion to 45 degrees. There was no objective evidence of painful motion and the Veteran was able to perform repetitive-use testing with 3 repetitions with no additional limitation in ROM or functional loss and/or impairment. Muscle strength testing was normal, and there was no ankylosis, instability or dislocation, or malunion of os calcis or astragalus. He had not had an astragalectomy and did not use an assistive device. The examiner also noted that his left ankle did not impact the Veteran's ability to work. In November 2013, the Veteran had no joint pain and his ROM was pain-free and intact throughout. The Veteran underwent another VA examination in July 2017, at which time he reported that he had consistent pain, his left ankle swelled often, and had difficulty standing for prolonged periods. He also reported that he had flare-ups anytime the weather changed and after prolonged standing. He further indicated experiencing functional loss or impairment, which he described as having less ROM that caused him to limp when he was in pain. Upon ROM testing, his left ankle dorsiflexion was to 15 degrees and plantar flexion was to 30 degrees with pain exhibited on both, but without resulting in or causing functional loss. With regard to Correia, there was no objective evidence of pain on weight-bearing or non-weight bearing, and passive ROM was the same as active ROM. The Veteran was able to perform repetitive-use testing with 3 repetitions with no additional loss of function or ROM. The examiner noted the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time and during a flare-up, and indicated that he was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time or during a flare-up as the examination was not being conducted immediately after repetitive use over time or during a flare-up. Muscle strength testing was normal and there was also no ankylosis, instability or dislocation, or malunion of os calcis or astragalus. The examiner also noted that the Veteran's left ankle did not impact his ability to work. In October 2017, VA treatment records reflect that the Veteran reported ankle pain, but no ROM was performed. In October 2018, the Veteran was afforded another VA examination, at which time he reported flare-ups of the left ankle that could be described as daily pain throughout the day with very limited motion. The Veteran also reported he had functional impairment, described as limited continuous walking, no prolonged standing, and constant pain. The examiner was unable to test the Veteran's ROM as it was too painful to examine. With regard to Correia, there was objective evidence of pain on passive ROM testing and no evidence of pain on weight-bearing or non-weight bearing. Nonetheless, the examiner noted that the Veteran was able to perform repetitive-use testing with 3 repetitions with no additional loss of function or ROM. He also indicated that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time and during a flare-up, but found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or during a flare-up. Muscle strength testing revealed active movement against some resistance and there was also no ankylosis, instability or dislocation, or malunion of os calcis or astragalus. The examiner also noted that the Veteran's left ankle did not impact his ability to work. Pursuant to the February 2020 remand, the Veteran was afforded another VA examination that same month. At such time, the examiner noted diagnoses of residuals of left ankle sprain and degenerative arthritis of the left ankle that was a progression of the Veteran's left ankle strain. The Veteran reported that, in the last 18 months, his left ankle disability had not changed and he had intermittent throbbing pain, stiffness, soreness, limited ROM, and aggravated prolonged standing or walking. He did not report flare-ups, but indicated that he had functional loss or impairment described as an inability to stand or walk for long periods. Upon ROM testing, the Veteran's left ankle dorsiflexion was to 15 degrees and plantar flexion was to 45 degrees, with pain exhibited on dorsiflexion without resulting in or causing functional loss. With regard to Correia, there was no objective evidence of pain on weight-bearing or non-weight bearing, and passive ROM was the same as active ROM. The Veteran was able to perform repetitive-use testing with 3 repetitions with no additional loss of function or ROM. The examiner noted the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, and pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner also noted that he had no basis to offer additional losses of function or motion with repeated use over times in describing in terms of ROM. Muscle strength testing was normal and there was also no ankylosis, instability or dislocation, or malunion of os calcis or astragalus. The examiner also noted that the Veteran's left ankle did not impact his ability to work. In this regard, the Veteran reported that he worked as a machinist and was able to perform active work that required repetitive bending, prolonged standing, or walking. Based on the foregoing, the Board finds that a rating in excess of 10 percent for the Veteran's left ankle disability is not warranted as there is no evidence of marked limitation of motion, or functional loss or impairment that more nearly approximates marked limitation of motion. Specifically, while the Veteran has reported pain, swelling, and limitation in physical activities, his ROM has been minimally affected. In this regard, the Veteran's dorsiflexion was limited to, at most 15 degrees, and his plantar flexion was limited, at most, to 30 degrees, to include as a result of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. In this regard, while "marked" and "moderate" are not described in the rating criteria as in effect prior to February 7, 2021, guidance can be found in the VA Adjudication Procedures Manual, M21-1 (Manual). The Manual states that moderate limitation of ankle motion is present when there is less than 15 degrees dorsiflexion or less than 30 degrees of plantar flexion, while marked limitation of motion is demonstrated when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. See M21-1, III.iv.4.A.3.k. The Manual is not binding on the Board; however, the Board must address relevant provisions of the Manual and conduct an independent analysis before determining whether the provisions may be relied upon as a factor to supports is decision. Overton v. Wilkie, 30 Vet. App. 257 (2018). In finding that the Veteran's limitation of left ankle motion does not more nearly approximate "marked" limitation of motion, the Board considers VA's proposed changed to DC 5271, which was published in February 2003. See 68 Fed. Reg. 6998. In the proposed regulation, VA noted that it hired an outside consultant to recommend changes "to ensure that the schedule uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review. The consultant convened a panel of non-VA specialists to review the portion of the rating schedule dealing with the musculoskeletal system in order to formulate recommendations." Id. Regarding DC 5271, VA noted that the terms "marked" and "moderate" are subjective and proposed to substitute more objective criteria that was recommended by the consultants. Specifically, it was proposed to assign a 20 percent rating if there was less than 5 degrees passive dorsiflexion or less than 10 degrees passive plantar flexion, and a 10 percent rating if there was less than 15 degrees of passive dorsiflexion or less than 30 degrees passive plantar flexion. Id. at 7018. It was noted that this change would promote consistent evaluations. Id. The Board finds the explanation of the proposed regulation to be persuasive. Significantly, VA consulted with specialist medical professionals who recommended objective criteria based upon current medical knowledge with the specific intent of ensuring more consistent outcomes for veterans. Thereafter, in August 2017, VA again proposed to change DC 5271. See 82 Fed. Reg. 35719. VA noted that the criteria set forth in DC 5271 are "subjective and the terminology is vague, resulting in inconsistent evaluations." VA proposed to define "marked" as less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion, and "moderate" as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion. Id. at 35723. VA noted that, "[a]s VA currently uses these standards to define marked and moderate, this change is intended as clarification of current policy and would ensure consistent application of these criteria among rating personnel." Id. The Board, again, finds the explanation of the proposed regulation to be persuasive as VA is expressing its intent to codify a policy that was employed to ensure more uniformity among its rating personnel. Additionally, the proposed criteria were similar to those proposed in 2003, with the exception that the word "passive" was not included. Furthermore, in Dorland's Illustrated Medical Dictionary, 1592 (32nd ed. 2012), range of motion redirects the reader to "exercise." Passive exercise is "motion imparted to a segment of the body by another individual, machine, or other outside force, or produced by voluntary effort of another segment of the patient's own body." Id. at 658. Active exercise of "motion imparted to a part by voluntary contraction and relaxation of muscles controlling the part." Id. It is reasonable from these definitions to conclude that active motion is the more difficult of the two types of motion to perform because it is done without assistance from external forces, which would be capable of pushing the veteran's joint farther than he would be able to move it on his own. Therefore, the omission of the word "passive" from the 2017 proposed regulation is likely more favorable to veterans, which causes the Board to be further inclined to employ its use. The Board does not consider the Manual's provision to be binding, but finds the reasoning employed in the 2003 and 2017 proposed rules to be highly persuasive in support of a finding that the ranges of motion listed in the Manual are appropriate, given that they are nearly identical to the 2003 proposal that was made in consultation with specialist medical professionals. Moreover, in the most recent revision to DC 5271, effective February 7, 2021, VA codified the foregoing definitions of marked and moderate, defining the former as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion, and the latter as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion. Consequently, as the Veteran's dorsiflexion and plantar flexion were limited to, at most, 15 and 30 degrees, even in consideration of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, throughout the appeal period, such does not more nearly approximate marked limitation of ankle motion. Therefore, a higher rating under DC 5271 is not warranted. Moreover, as there is no evidence of ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy at any point during the appeal period, higher or separate ratings under DCs 5270, 5272, 5273, and 5274 are not warranted. 2. Entitlement to a rating in excess of 10 percent for lumbar strain. For the entire appeal period, the Veteran's back disability has been rated as 10 percent disabling pursuant to DC 5237, which provides that lumbosacral strain is evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, such DC was not changed. Ratings under the General Rating Formula are made 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. Such provides for a 10 percent rating where forward flexion of the thoracolumbar spine is greater than 60 degrees but no greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine 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 to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, 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. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. IVDS may be evaluated under either the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.25 (combined ratings table). The IVDS Rating Formula provides that a 10 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. As an initial matter, the Board notes that, while the Veteran testified that he had symptoms of IVDS, the record does not show that his back disability resulted in IVDS with incapacitating episodes as defined by VA regulations. Therefore, the IVDS Rating Formula is inapplicable and a higher rating for his back disability is not warranted under such criteria. As pertinent to the General Rating Formula, in July 2013, the Veteran underwent a VA examination, at which time he reported that he did not have flare-ups. ROM testing revealed forward flexion to 90 degrees without pain and extension to 30 degrees with no objective evidence of pain. Right and left lateral rotation was to 30 degrees without pain, and right and left lateral flexion was to 30 degrees with no pain. The Veteran was able to perform repetitive-use testing with 3 repetitions with no additional limitation in ROM. The Veteran also did not have any functional loss and/or functional impairment. There was no muscle spasm and he had full strength and sensation, and normal reflexes, in the BLE. The examiner noted that the Veteran did not have radiculopathy of the BLE or any other neurologic abnormalities. There was also no ankylosis of the spine. In November 2013, the Veteran had no back pain and his ROM was pain-free and intact throughout. The Veteran was afforded another VA examination in July 2017, at which time he reported that he had constant pain and flare-ups described as severe pain after prolonged standing and walking. He also stated that he had functional loss/impairment described as less range of motion. ROM testing revealed forward flexion to 80 degrees and extension to 25 degrees. Right lateral flexion was to 25 degrees and left lateral flexion was to 20 degrees. Right lateral rotation was to 20 degrees and left lateral rotation was to 25 degrees. ROM itself did not contribute to functional loss and pain was exhibited on all ROM, but did not result in/cause functional loss. The Veteran was able to perform repetitive-use testing with at least 3 repetitions and there was no additional loss of function or ROM. With regard to Correia, there was no objective evidence of pain on weight-bearing or non-weight-bearing and passive ROM was the same as active ROM. The examiner also noted the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time and during a flare-up, and indicated that he was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time or during a flare-up as the examination was not being conducted immediately after repetitive use over time or during a flare-up. The examiner further stated that he could not described such in terms of ROM for the same reason. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine and there was no ankylosis of the spine. He also had full strength and sensation, and normal reflexes, in the BLE. The examiner noted that the Veteran did not have radiculopathy of the BLE or any other neurologic abnormalities. In October 2017, VA treatment records reflect that the Veteran reported low back pain, but no ROM was performed. In October 2018, the Veteran underwent another VA examination. At such time, he reported that his condition had gotten worse as he had increased medical visits, lost days of work, an increase in pain medications, change in lifestyle, and work restrictions. He also reported flare-ups described as no prolonged standing, loss of motion, and pain all day, every day. The examiner was unable to test the Veteran's ROM as the Veteran was uncooperative. Nonetheless, he noted that pain was exhibited on all ROM and there was evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. The examiner also noted that the Veteran was able to perform repetitive-use testing with 3 repetitions with no additional loss of function or ROM. With regard to Correia, there was no objective evidence of pain on weight-bearing, non-weight-bearing, or passive ROM. The examiner also noted the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time and during a flare-up, but found that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or during a flare-up. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine and there was no ankylosis of the spine. Neurological findings pertinent to the BLE will be discussed further in the next section; however, other than radiculopathy of the BLE, no neurologic abnormalities or findings related to the Veteran's back disability, to include bladder or bowel problems, were noted on examination. Pursuant to the February 2020 remand, the Veteran was afforded another VA examination later that same month. At such time, the examiner noted diagnoses of lumbosacral strain and degenerative arthritis of the spine that was a progression of the Veteran's lumbosacral strain. The Veteran reported that, in the last 18 months, his back disability had worsened, and reported intermittent sharp pain to throbbing in the lower back with burning, tingling, radiating to the buttocks and legs, and limited ROM aggravated by bending, prolonged standing or walking. He did not report flare-ups and he indicated that he had functional loss or impairment described as an inability to stand or walk too long. ROM testing revealed forward flexion to 80 degrees and extension to 25 degrees. Right lateral flexion was to 25 degrees and left lateral flexion was to 30 degrees. Right and left lateral rotation was to 30 degrees. Pain was exhibited on forward flexion and extension. The Veteran was able to perform repetitive-use testing with at least 3 repetitions and there was no additional loss of function or ROM. With regard to Correia, there was no pain on weight-bearing, passive ROM was not performed as it was not feasible to do in a safe and reasonable manner, and non-weight bearing assessment was not applicable. The examiner also noted the examination was medically consistent with the Veteran's statement describing functional loss with repetitive use over time. Pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran did not have guarding or muscle spasm and there was no ankylosis. Neurological findings pertinent to the BLE will be discussed further in the next section; however, other than radiculopathy of the BLE, no neurologic abnormalities or findings related to the Veteran's back disability, to include bladder or bowel problems, were noted on examination. The examiner also noted that the Veteran's back disability impacted his ability to work as he had 0 to 1 week of work time lost in the last 12 months and that he was unable to lift more than 25 pounds, or stand or walk for more than 20 minutes. Based on the foregoing, the Board finds that a rating in excess of 10 percent for the Veteran's back disability is not warranted. Specifically, the evidence of record does not reveal that forward flexion of the thoracolumbar spine was limited to 60 degrees or less or the combined range of motion was limited to 120 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. In this regard, the Veteran's forward flexion was limited to, at most, 80 degrees, and his combined ROM of the thoracolumbar spine was limited to, at most, 195 degrees, even in contemplation of functional loss due to such symptoms or circumstances. Furthermore, while the Veteran reported experiencing muscle spasms at his October 2019, there was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, on examination. Furthermore, there is no evidence of ankylosis, or functional impairment more nearly approximating ankylosis. The Board has also considered whether separate ratings for associated objective neurologic abnormalities other than the Veteran's already separately rated radiculopathy of the BLE are warranted pursuant to Note (1) of the General Rating Formula. However, as there is no evidence that his service-connected back disability results in such manifestations, such additional separate ratings are not warranted. 3. Propriety of the assignment of a separate rating for RLE radiculopathy, evaluated as 20 percent disabling as of October 2, 2018. 4. Propriety of the assignment of a separate rating for LLE radiculopathy, evaluated as 20 percent disabling as of October 2, 2018. The Veteran is in receipt of separate ratings for radiculopathy of the RLE and LLE associated with his back disability as of October 2, 2018. Such disabilities are rated pursuant to DC 8520, which pertains to paralysis of the sciatic nerve. Such provides a 20 percent rating for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating for moderately severe incomplete paralysis of the sciatic nerve; and a 60 percent rating for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. Further, an 80 percent rating is warranted where there is complete paralysis of the sciatic nerve where the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. As previously noted, the Veteran's BLE radiculopathy is rated as 20 percent disabling as of October 2, 2018. In this regard, the Board finds that an earlier effective for such separate ratings are not warranted. Specifically, while the Veteran testified he had radiculopathy symptoms prior to his October 2018 VA examination, the evidence of record reveals otherwise. Specifically, his VA treatment records show that the Veteran denied having numbness and tingling in March 2013, January 2015, October 2017, and February 2018. Further, at the latter appointment, his sensation was intact on examination. Additionally, the July 2013 and July 2017 VA examiners also found that the Veteran did not have radiculopathy of the BLE. Thus, as such associated neurologic abnormalities were not objectively shown, as required by Note (1) of the General Rating Formula, prior to October 2, 2018, an earlier effective date for such separate ratings is not warranted. Furthermore, the Board finds that ratings in excess of 20 percent for radiculopathy of the RLE and LLE are not warranted as such disabilities result in no more than moderate incomplete paralysis of the sciatic nerve. In this regard, the October 2018 VA examiner noted that the Veteran had moderate constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness of his BLE. Further, he had reduced strength at 4/5 throughout the BLE, hypoactive reflexes in the bilateral knee and ankles, and decreased sensation throughout the BLE. Thus, based on such subjective symptoms and objective examination findings, the examiner found that the Veteran had moderate radiculopathy of the BLE. Additionally, during his February 2020 VA back examination, the Veteran reported moderate intermittent pain and paresthesias and/or dysesthesias, and mild numbness in the BLE. On examination, he had reduced strength at 4/5 with bilateral hip flexion, but normal strength throughout the remainder of the BLE; normal reflexes; and decreased sensation in the bilateral lower leg/ankle, but normal sensation throughout the remainder of the BLE. Thus, based on such subjective symptoms and objective examination findings, the examiner found that the Veteran had moderate radiculopathy of the BLE. Similarly, at a VA peripheral neuropathy examination conducted the same day, the Veteran stated that, over the last 18 months, his BLE radiculopathy had not changed and he continued to have intermittent sharp to throbbing pain with burning, tingling, or numbness radiating to his buttocks and legs. His subjective reports were the same as those recorded at the VA back examination; however, he had normal strength and reflexes in the BLE on examination. He also again had decreased sensation in the bilateral lower leg/ankle, but normal sensation throughout the remainder of the BLE. Based on the foregoing, the examiner found that the Veteran had moderate incomplete paralysis of the sciatic nerve of the BLE. Therefore, based on the foregoing, the Board finds that a rating in excess of 20 percent is not warranted for radiculopathy of the BLE. Specifically, based on consideration of the Veteran's subjective complaints and objective examination of his strength, reflexes, and sensation, the October 2018 and February 2020 VA examiners found that his radiculopathy of the BLE resulted in no more than moderate incomplete paralysis of the sciatic nerves. Consequently, the assignment of separate ratings for radiculopathy of the RLE and LLE, evaluated as 20 percent disabling as of October 2, 2018, was proper. Other Considerations In reaching the foregoing determinations, the Board acknowledges the Veteran's sincerely held belief that the symptoms of his left ankle and back disability, with associated radiculopathy of the BLE, are more severe than as reflected by the currently assigned rating. While the Board recognizes that he is competent to describe his symptomatology and resulting functional difficulties, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Thus, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's left ankle and back disabilities, with associated radiculopathy of the BLE; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings for such disabilities is not warranted. Moreover, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Based on the foregoing, the Board finds that increased ratings fir the Veteran's left ankle and back disabilities, with associated radiculopathy of the BLE, is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, such doctrine is inapplicable and his increased rating claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark, 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.