Citation Nr: 21040117 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 15-40 993 DATE: July 2, 2021 ORDER Entitlement to service connection for an abnormal EKG is denied. Entitlement to service connection for hemorrhoids is denied. Entitlement to service connection for renal insufficiency is denied. Entitlement to service connection for cellulitis is denied. Entitlement to service connection for a skin condition is denied. Entitlement to service connection for hyperlipidemia is denied. Entitlement to service connection for gastroenteritis is denied. Entitlement to service connection for left ear hearing loss is denied. Entitlement to service connection for presbyopia is denied. Entitlement to a disability rating in excess of 10 percent prior to February 12, 2020, and to a disability rating in excess of 20 percent from that date for degenerative disc disease (DDD) of the lumbar spine is denied. Entitlement to a disability rating in excess of 20 percent for radiculopathy of the right lower extremity is denied. REMANDED Entitlement to service connection for a left-hand disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a disability manifested by an abnormal EGK at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a chronic hemorrhoid disability at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence of record is against finding that the Veteran has had a disability manifested by renal insufficiency at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence of record is against finding that the Veteran has had cellulitis at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence of record is against finding that the Veteran has had skin condition at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence of record is against finding that the Veteran has had a disability manifested by hyperlipidemia at any time during or approximate to the pendency of the claim. 7. The preponderance of the evidence of record is against finding that Veteran has had a chronic gastroenteritis condition at any time during or approximate to the pendency of the claim. 8. The preponderance of the evidence of record is against finding that the Veteran has had a left ear hearing loss disability at any time during or approximate to the pendency of the claim. 9. The preponderance of the evidence is against finding that the Veteran has any eye condition other than a refractive error, that began during active service, or is otherwise related to an in-service injury or disease. 10. Prior to February 12, 2020, the Veteran's DDD of the lumbar spine is manifested by a range of motion greater than 60 degrees of forward flexion and greater than 120 degrees of total range of motion without muscle spasm or guarding resulting in abnormal gait or spinal contour. 11. From February 12, 2020 the Veteran's DDD of the lumbar spine is manifested by muscle spasm resulting in reverse lordosis, but with a range of motion greater than 30 degrees of forward flexion and without ankylosis. 12. The Veteran's right lower extremity radiculopathy is manifested by no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for service connection for a disability manifested by an abnormal EKG are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hemorrhoids are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for renal insufficiency are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for cellulitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a skin condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a disability manifested by hyperlipidemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for gastroenteritis a disability manifested by are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a left ear hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 9. The criteria for entitlement to service connection for presbyopia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. Prior to February 12, 2020, the criteria for a rating in excess of 10 percent for DDD of the lumbar spine have not been met; and the criteria for a disability rating in excess of 20 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 11. The criteria for a disability rating in excess of 20 percent for radiculopathy of the right lower extremity have not 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 had active service from May 1983 to May 2009. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision. These matters were previously before the Board in October 2018. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for an abnormal EKG The Veteran seeks service connection for an abnormal EKG. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a heart disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that, while he had an abnormality on an EKG during his service and explained that this was a nonspecific finding and that further workup during service revealed no ischemia. The VA examination conducted in February 2020 revealed that the Veteran continued to have the same abnormality without specific cardiac symptoms. On examination, the Veteran reported no symptoms of chest pain, irregular heartbeats, or syncope. Given the VA examiner's conclusion that the Veteran does not have specific cardiac symptoms and that the Veteran does not report them, the Board concludes that though the Veteran has an abnormality in his EKG, it has not resulted in a disability. Therefore, service connection for a disability manifested by an abnormality in the EKG is denied. 2. Entitlement to service connection for hemorrhoids The Veteran seeks service connection for hemorrhoids because he experienced hemorrhoids during his service and a recurrent bleeding and pain in his rectum during 2009. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of hemorrhoids and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that, while he experienced hemorrhoids during service and a recurrence of rectal bleeding in 2009, the Veteran did not have an ongoing hemorrhoid diagnosis during or proximate to the claim. At the examination, the Veteran did not report any ongoing treatment or symptoms of this condition. The Veteran even declined an examination due to the lack of symptoms. Consequently, the Board finds that service connection must be denied for the claimed hemorrhoid condition due to the lack of a current disability during or proximate to the appeal period. 3. Entitlement to service connection for renal insufficiency The Veteran seeks service connection for renal insufficiency because he was diagnosed with this condition in July 2008 during his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of renal insufficiency and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that, while the Veteran had been diagnosed with renal insufficiency during his service, this had been based on a mildly elevated level of creatine detected at that time. The Veteran's creatine levels have subsequently been variable without causing symptoms, and no kidney condition is diagnosable during the appeal period. 4. Entitlement to service connection for cellulitis The Veteran seeks service connection for cellulitis because he was diagnosed with this condition in November 2006, during his service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of cellulitis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that the Veteran does not have a current diagnosis of cellulitis. The Veteran's service treatment records document a historical diagnosis of this condition in November 2006 near the time that he was diagnosed with hemorrhoids during service. However, the Veteran's post-service treatment records demonstrate that he has not had an ongoing diagnosis or treatment for cellulitis. The 2020 VA examination similarly does not document any such diagnosis. Consequently, the Board finds that service connection must be denied. 5. Entitlement to service connection for a skin condition The Veteran seeks service connection for a skin disability because of his in-service removal of an abcess on his face and the excision of the mole on his nose. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a skin condition and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that he did not have a diagnosed skin condition or observable skin symptoms. The Veteran's service treatment records confirm the Veteran's reports about his in-service removal of a skin abcess and the excision of a mole on his nose. However, the Veteran's post-service treatment records and the Veteran's February 2020 VA examination did not result in any findings of a current skin condition. Consequently, the Board finds that service connection for a skin condition must be denied. 6. Entitlement to service connection for hyperlipidemia The Veteran seeks service connection for hyperlipidemia. The Veteran was diagnosed with hyperlipidemia during his service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that while the Veteran does have hyperlipidemia and has had hyperlipidemia since his service. However, the Veteran does not have any symptoms related to his hyperlipidemia and is not on any special diet for his hyperlipidemia. Hyperlipidemia, high cholesterol is also referred to as hypercholesterolemia or hyperlipidemia. Hypercholesterolemia is an "excess of cholesterol in the blood." See Dorland's Illustrated Medical Dictionary 792 (28th ed. 1994). Hyperlipidemia is "a general term for elevated concentration of any or all of the lipids in the plasma, including hypertriglyceridemia, hypercholesterolemia, etc." Id. at 795. Hyperlipidemia and elevated cholesterol are laboratory findings and are not disabilities in and of themselves for VA purposes. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). The evidence does not show nor has the Veteran contended that his claimed hyperlipidemia, a laboratory finding, is a manifestation of an underlying disease. Thus, the evidence demonstrates that the Veteran does not have a current disability manifested by hyperlipidemia and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and concluded that the Veteran's hyperlipidemia began during service. This conclusion appears to be well attested by the Veteran's service treatment records. Nevertheless, the Veteran's post-service treatment records and the VA examination conducted in February 2020 indicate that there is no disease or disability as a result of this laboratory finding. Consequently, the Board finds that service connection for hyperlipidemia is denied. 7. Entitlement to service connection for gastroenteritis The Veteran seeks service connection for gastroenteritis, relating his experience of having gastroenteritis in January 2009 during his period of service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of gastroenteritis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that the Veteran did not have a current diagnosis of gastroenteritis and explained that gastroenteritis is a self-limiting diagnosis. The Veteran's service treatment records indicate that he suffered from gastroenteritis in January 2009, apparently recovered, and did not mention this condition during the remainder of his service. The Veteran's post-service treatment records do not reveal that the Veteran is being treated for this condition and the Veteran has not described chronically suffering from this condition during the appeal period. The Veteran's description of this condition to the examiner consists of gastrointestinal symptoms that were contemporaneous with his service and not after. Consequently, the Board finds that entitlement to service connection for gastroenteritis must be denied. 8. Entitlement to service connection for left ear hearing loss The Veteran seeks entitlement to service connection for hearing loss in his left ear. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran has hearing loss in his right ear as a result of his military service. Thus, the conditions to cause hearing loss were part of the Veteran's service. Therefore, the resolution of this claim turns on whether the Veteran has a hearing loss disability in his left ear. A hearing loss disability, for VA purposes, is hearing loss causing auditory thresholds in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when the speech recognition scores on the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 501; 38 C.F.R. § 3.385. The Veteran's hearing loss was evaluated in a February 2020 VA examination. None of the Veteran's relevant frequencies in the left ear had an auditory threshold of 40 decibels or greater. Only one of the relevant frequencies in the left ear, 4000 Hertz, had an auditory threshold greater than 26 decibels, and his speech recognition score in the left ear was 100 percent. There are no other records adequate for evaluating the Veteran's left ear hearing loss during the appeal period. Consequently, the Board finds that the Veteran does not have a hearing loss disability in the left ear and has not had one at any time during or proximate to the appeal period. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 501; 38 C.F.R. § 3.385. 9. Entitlement to service connection for presbyopia The Veteran seeks service connection for presbyopia. Importantly, refractive errors of the eye are not diseases or injuries in the meaning of the applicable legislation for disability compensation purposes. 38 U.S.C. § 1155; 38 C.F.R. § 4.9. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of hyperopia and presbyopia, which are refractive errors of the eye, and evidence shows that the Veteran began wearing reading glasses and experienced eye strain in 2008, during his service, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of hyperopia and presbyopia are service connected. The Veteran's service treatment records, post-service treatment records, and the January 2020 compensation and pension examination all confirm that the Veteran has hyperopia and presbyopia. However, as the compensation and pension examination explain, the Veteran does not have any conditions that are not refractive errors of the eye. Refractive errors of the eye, such as hyperopia and presbyopia, are categorically not injuries or diseases. 38 U.S.C. § 1155; 38 C.F.R. § 4.9. Moreover, the January 2020 VA compensation and pension examiner explained that these conditions are longstanding, due to age, and a natural part of the aging process that occurs in people after their mid-forties and not caused by any condition or circumstances other than age and were not subjected to any superimposed disease or condition during service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, because the evidence shows that the Veteran does not have an eye condition for which compensation is available and that the condition was not the result of an in-service event, the Board finds that service connection for the Veteran's claimed presbyopia and the diagnosed hyperopia must be denied. Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings may be assigned for separate periods of time based on the facts found, however. This practice is known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 - 127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). 10. Entitlement to a disability rating in excess of 10 percent prior to February 12, 2020, for DDD of the lumbar spine, and to a disability rating in excess of 20 percent from that date The Veteran contends that he is entitled to a higher rating for his lumbar spine condition. The Veteran's DDD of the lumbar spine is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5242. The Board notes that the rating criteria for musculoskeletal disorders were revised on February 7, 2021. The amended regulations became effective on February 7, 2021 and claims that were pending on this date must be considered under the former and revised criteria with the most favorable version applied to the claim. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, 5242, 5243). However, the general rating criteria for diseases and injuries of the spine and the formula for rating intervertebral disc syndrome based on incapacitating episodes remains unchanged under the new rating criteria. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not 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. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). 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). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Veteran underwent a VA back examination in May 2013. The VA examiner noted the Veteran's diagnosis of DDD lumbosacral spine, mild-moderate degree. Subjective complaints included low back pain with radiation to right hip and right lower extremity. Flare-ups did not impact function of the thoracolumbar spine. Forward flexion of the spine was to 80 degrees, with no objective evidence of pain; extension was to 25 degrees, with no objective evidence of pain; bilateral lateral flexion was to 25 degrees, with no objective evidence of pain; bilateral lateral rotation was to 25 degrees, with not objective evidence of pain. Repetitive use testing did not result in additional limitation of range of motion. No functional loss or functional impairment was noted. The Veteran did not have any localized tenderness or pain on palpation of joints and/or soft tissue of the thoracolumbar spine. No guarding or muscle spasm of the thoracolumbar spine was noted. Muscle strength test results were normal at 5 out of 5. No muscle atrophy was present. Reflex exam results were normal. Sensory exam results were normal with the exception of the right lower leg/ankle and right foot and toes, which had decreased sensation to light touch. The examiner noted radiculopathy of the right lower extremity; symptoms included moderate intermittent pain, mild paresthesias and/or dysesthesias and mild numbness. Involvement of the sciatic nerve was noted. Radiculopathy of the right lower extremity was documented as moderate. The Veteran did not have intervertebral disc syndrome (IVDS) of the thoracolumbar spine. The Veteran underwent a VA back examination in July 2014. The examiner noted the Veteran's diagnosis of DDD of the lumbar spine with myelopathy of the right lower extremity. The Veteran reported that he has participated in physical therapy, received epidural injections, and most recently is seeing a chiropractor. Radicular pain improved with chiropractic treatments, but he experienced more pain radiating up the spine. He takes Naprosyn, Motrin, and Gabapentin. Flare-ups were described as occurring on "prolonged standing, prolonged walking and prolonged sitting on a hard surface, heavy lifting. Lying on back makes it worse." Forward flexion of the spine was to 80 degrees, with no objective evidence of pain; extension was to 25 degrees, with objective evidence of pain at 25 degrees; bilateral lateral flexion was to 25 degrees, with no objective evidence of pain; bilateral lateral rotation was to 25 degrees, with objective evidence of pain at 25 degrees, bilaterally. Repetitive use testing did not result in additional limitation of range of motion. Functional loss and/or functional impairment was described, after repetitive use testing, as less movement than normal, pain on movement, and interference with sitting and standing. Localized tenderness was noted as diffuse lumbar para spinous muscle tenderness. Muscle spasms that did not result in abnormal gait or abnormal contour were reported. No guarding of the thoracolumbar spine was noted. Muscle strength test results were normal at 5 out of 5. No muscle atrophy was present. Reflex exam results were normal. Sensory exam results were normal. The examiner noted radiculopathy of the right lower extremity; symptoms included moderate intermittent pain, moderate paresthesias and/or dysesthesias and moderate numbness. Involvement of the sciatic nerve was noted. Radiculopathy of the right lower extremity was documented as moderate. No ankylosis of the lumbar spine was present. The examiner noted that the Veteran had IVDS but that he had not had any incapacitating episodes over the past 12 months. VA treatment records reflect treatment for complaints of low back pain through June 2020. The Veteran underwent a VA back examination in February 2020. The VA examiner noted the Veteran's diagnosis of DDD of the lumbar spine. The Veteran reported that he tried physical therapy and did not get prolonged results. He has tried using a TENS unit which is somewhat helpful in reducing his pain during a flare. He had epidurals with minimal results. Subjective complaints include constant pain, which is worse when he is active with lifting or carrying objects for more than 15 minutes. He stated that flares will last 2 to 3 days and require bedrest. He reports a stiffness for approximately 15 to 20 minutes. He reported bilateral hip and leg pain when he sits upright with his weight distributed over both hips, and right leg pain when he sits or stands for more than 15 minutes. Flares were described as pain in lower back and lower extremity. Functional loss or functional impairment of the back was described as increased low back pain with lifting or carrying and sitting or standing for prolonged periods increases his hip and leg pain. Forward flexion of the spine was to 90 degrees, extension was to 30 degrees, right lateral flexion was to 25 degrees, left lateral flexion was to 20 degrees, and bilateral lateral rotation was to 20 degrees. Range of motion itself contributed to a functional loss as range of motion was limited. Pain was noted on examination in lateral flexion and lateral rotation and caused functional loss. Localized tenderness was noted as tenderness to palpation over lower lumbar spine; tenderness to palpation over bilateral paraspinal muscles in the lumbar region. The Veteran was not able to perform repetitive use testing due to pain. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. Muscle spasms and guarding resulting in an abnormal gait or abnormal spinal contour were noted. Muscle strength test results were normal at 5 out of 5. No muscle atrophy was present. Deep tendon reflexes of the bilateral knees and ankles were absent. Sensory exam results were decreased in the bilateral upper anterior thigs, bilateral thighs/knees, and right lower ankle. Sensation to light touch was absent in right foot and toes. Straight leg raising test was positive for right leg and negative for left leg. The examiner noted radiculopathy of the right lower extremity; symptoms included moderate intermittent pain, moderate paresthesias and/or dysesthesias and no numbness. Involvement of the sciatic nerve was noted. Radiculopathy of the right lower extremity was documented as moderate. No ankylosis of the lumbar spine was present. The examiner noted that the Veteran had IVDS but that he had not had any incapacitating episodes over the past 12 months. Prior to February 12, 2020 The Board has carefully considered all the evidence and potentially applicable diagnostic codes, including the DeLuca factors, and finds that the disability picture of the Veteran's DDD of the lumbar spine disability does not more nearly approximate the rating criteria of a higher disability level. Motion was, at worst, limited to forward flexion to 80 degrees, warranting the currently assigned 10 percent rating, even upon consideration of the functional impact of pain with use and on flare-ups. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain and other symptoms, however the medical evidence of record does not establish that the degree of additional limitation reflected by the Veteran's statements would result in limitation of motion more nearly approximating 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. Flexion is not reduced to less than 60 degrees, nor did the Veteran experience muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Nor did the Veteran experience any incapacitating episodes which would warrant assignment of a higher rating. The Board finds that the overall disability picture prior to February 12, 2020 is not severe enough to warrant assignment of an evaluation in excess of 10 percent. Therefore, the Board finds that a rating in excess of 10 percent for the Veteran's DDD of the lumbar spine degenerative disc disease, prior to February 12, 2020, is not warranted. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim for a higher rating. 38 C.F.R. §§ 4.7, 4.21. Since February 12, 2020 The Board has carefully considered all the evidence and potentially applicable diagnostic codes, including the DeLuca factors, and finds that the disability picture of the Veteran's lumbar spine disability does not more nearly approximate the rating criteria of a higher disability level. Muscle spasm or guarding resulting in reverse lordosis, a straightening of the back in his paraspinal region, is present warranting no more than the currently assigned 20 percent rating, even upon consideration of the functional impact of pain with use and on flare-ups. Flexion is not reduced to less than 30 degrees, nor has the Veteran experience incapacitating episodes to warrant assignment of a higher rating. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain and other symptoms. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine the criteria for a 30 percent disability evaluation. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain and other symptoms. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the evidence of record does not establish that the degree of additional limitation reflected by the statements would result in limitation of motion more nearly approximating 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. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Therefore, the Board finds that a rating in excess of 20 percent for the Veteran's DDD of the lumbar spine, since February 12, 2020, is not warranted. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim for a higher rating. 38 C.F.R. §§ 4.7, 4.21. The Veteran has been separately rated for the neurological conditions of his bilateral lower extremities and has appealed the award assigned to his right lower extremity. That issue is discussed further in the next section. The award of service connection for radiculopathy of the left lower extremity is the subject of a recent rating decision from October 2020 that the Veteran has not yet appealed and for which the appeal period has not yet closed. 11. Entitlement to a disability rating in excess of 20 percent for radiculopathy of the right lower extremity The Veteran contends that he is entitled to a higher rating for his radiculopathy of the right lower extremity. The Veteran's radiculopathy of the right lower extremity is rated under 38 C.F.R. § 4.71a, Diagnostic Code 8520. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. The Veteran's radiculopathy of the right lower extremity is addressed in the VA back examinations detailed above. Regarding impairment of motor functions, there is no evidence that the Veteran has impaired motor function of his right lower extremity. Regarding trophic changes, there is no evidence of trophic change the Veteran's right lower extremity. Regarding sensory disturbance, the May 2013 VA back examination documents mild paresthesias and/or dysesthesias in the right lower extremity, as well as decreased sensation in the leg, ankle, foot, and toes and mild numbness in the right lower extremity. The July 2014 VA back examination documented moderate paresthesias and/or dysesthesias, and moderate numbness but found normal sensation throughout the right lower extremity. The February 2020 VA examination documented decreased sensation in the bilateral upper thighs, and decreased sensation in the rest of the lower extremity on the right, with absent sensation in the right foot and toes. The May 2013 and July 2014 VA examinations report document normal reflexes. Reflexes were absent at the February 2020 VA examination. Regarding pain, the May 2013 VA examination documented mild intermittent pain. The July 2014 and February 2020 VA examinations found moderate intermittent pain. Muscle atrophy was not found during the Veteran's examinations, and even as late as the February 2020 examination, the Veteran maintained normal strength throughout his lower extremities. The Veteran has not experienced complete paralysis of his right lower extremity or the relevant nerves at any time during the appeal period. Based on the above, the Board finds that the disability is primarily manifest by sensory symptoms such as paresthesia, dysesthesia, numbness, decreased or lost sensation, and pain. Outside of these symptoms, the only recurrent symptoms are decreased or absent reflexes in the lower extremities. Given this constellation of symptoms, and the probative evidence of record showing no impairment of motor functions, complete paralysis, loss of strength, or atrophy, the Board finds that the level of impairment is best characterized as moderate incomplete paralysis. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable rating/rating in excess of 20 percent for radiculopathy of the right lower extremity. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to service connection for a left-hand condition is remanded. The Board finds that an addendum opinion is required in order to adequately address the claim on appeal. The Veteran's service treatment records (STRs) show the Veteran was treated for a wound on his left due to a dog bite in August 1968. The February 2020 VA examiner opined that the Veteran did not have a functional disability of the left hand. However, the VA examination documents arthritis of the left hand. Consequently, the Board finds that a remand is required for an opinion as to whether the Veteran's arthritis in the left hand was caused or aggravated by his in-service dog bite or had its onset during service or within one year of his separation from service. 2. Entitlement to service connection for a right hip disability is remanded. The Board finds that an addendum opinion is required in order to adequately address the claim on appeal. The February 2020 examination and subsequent November 2020 opinion address the Veteran's right hip diagnosis, trochanteric bursitis, and whether such is related to the Veteran's in-service hip strain and reported hip pain. However, the opinion does not address whether or not this condition is caused by or related to the Veteran's service-connected back condition. Consequently, this matter must be remanded for an opinion that addresses this secondary theory of entitlement. 3. Entitlement to service connection for a left hip disability is remanded. The November 2020 VA opinion indicates that the Veteran does not have a diagnosed left hip disability. However, the February 2020 VA examination contains evidence of both pain and limitation of motion of the left hip. Consequently, the Board finds that an opinion as to whether this pain and limited motion, even if not linked to a specifically diagnosed disability, was at least as likely as not caused by the Veteran's service or caused or aggravated by the Veteran's service-connected lower back condition. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's left hand arthritis is at least as likely as not related to the Veteran's in-service dog bite or at least as likely as not had its onset during service or within one year of the end of his service. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right hip trochanteric bursitis is at least as likely as not proximately due to or aggravated beyond its natural progression by his service-connected lumbar spine condition. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's left hip pain and limited motion, regardless of whether there is a discrete diagnosis, is at least as likely as not proximately due to or aggravated beyond its natural progression by his service-connected lumbar spine condition. 4. If any of the opinions requested above cannot be provided without an additional examination, the Veteran should be scheduled for an additional examination. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MARGARET M. LUNGER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Steven H. Johnston, 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.