Citation Nr: 21040651 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-42 915 DATE: July 6, 2021 ORDER Entitlement to a 10 percent initial disability rating for right hip chronic capsulitis and sacroiliitis (loss of flexion) is granted. Entitlement to an initial disability rating higher than 10 percent for right hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) is denied. Entitlement to a 10 percent initial disability rating for left hip chronic capsulitis and sacroiliitis (loss of flexion) is granted. Entitlement to an initial disability rating higher than 10 percent for left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) is denied. Entitlement to a separate 10 percent disability rating for right hip chronic capsulitis and sacroiliitis (loss of extension) is granted, effective April 26, 2014. Entitlement to a separate 10 percent disability rating for left hip chronic capsulitis and sacroiliitis (loss of extension) is granted, effective April 26, 2014. Entitlement to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease prior to December 1, 2018 is denied. The rating reduction from 60 percent to 40 percent for lumbosacral strain with degenerative disc disease from 60 percent to 40 percent, effective December 1, 2018, was improper and the 60 percent disability rating previously assigned from December 1, 2018 is restored. Entitlement to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease from December 1, 2018 is denied. Entitlement to a separate 20 percent disability rating for right lower extremity radiculopathy, sciatic nerve is granted. Entitlement to a separate 20 percent disability rating for left lower extremity radiculopathy, sciatic nerve is granted. FINDINGS OF FACT 1. The Veteran's right hip chronic capsulitis and sacroiliitis (loss of flexion) has been manifested primarily by decreased painless right hip and thigh flexion to no less than 85 degrees, pain, and flare-ups that have impaired the Veteran's ability to stand and walk for long periods of time. 2. The Veteran's right hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) has been manifested primarily by pain and flare-ups that have impaired the Veteran's ability to stand and walk for long periods of time but retained ability to abduct his right hip and thigh beyond 10 degrees. 3. The Veteran's left hip chronic capsulitis and sacroiliitis (loss of flexion) has been manifested primarily by decreased painless right hip and thigh flexion to no less than 85 degrees, pain, and flare-ups that have impaired the Veteran's ability to stand and walk for long periods of time. 4. The Veteran's left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) has been manifested primarily by pain and flare-ups that have impaired the Veteran's ability to stand and walk for long periods of time but retained ability to abduct his left hip and thigh beyond 10 degrees. 5. Since April 26, 2014, the Veteran's right hip chronic capsulitis and sacroiliitis (loss of extension) has been productive of reduced painless right hip and thigh extension to 5 degrees. 6. Since April 26, 2014, the Veteran's left hip chronic capsulitis and sacroiliitis (loss of extension) has been productive of reduced painless right hip and thigh extension to 5 degrees. 7. Prior to December 1, 2018, the Veteran's lumbosacral strain with degenerative disc disease was manifested primarily by pain, flare-ups, neurological manifestations consistent with IVDS that were productive of incapacitating episodes totaling more than six weeks a year, and reduced thoracolumbar spine motion; however, was not productive of ankylosis. 8. Reduction of the disability rating assigned for lumbosacral strain with degenerative disc disease from 60 percent to 10 percent, effective December 1, 2018, was effectuated in an August 2018 rating decision. 9. The disability rating assigned for lumbosacral strain with degenerative disc disease was increased from 10 percent to 40 percent, effective December 1, 2018, in an April 2020 rating decision; the Veteran maintains on appeal that the reduction of the assigned disability rating, effectively from 60 percent to 40 percent, was improper. 10. The spine examinations conducted in April 2015 and June 2018 are insufficient to support a reduction of the disability rating assigned for the Veteran's lumbosacral strain with degenerative disc disease; moreover, the evidence shows that the Veteran has not experienced actual improvement of his lumbosacral strain with degenerative disc disease. 11. From December 1, 2018, the Veteran's lumbosacral strain with degenerative disc disease has been manifested primarily by pain, flare-ups, neurological manifestations consistent with IVDS, and reduced thoracolumbar spine motion; however, has not been productive of ankylosis. 12. The Veteran's lumbosacral strain with degenerative disc disease has resulted in a right lower extremity radiculopathy involving moderate incomplete paralysis of the sciatic nerve. 13. The Veteran's lumbosacral strain with degenerative disc disease has resulted in a left lower extremity radiculopathy involving moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for a 10 percent initial disability rating for right hip chronic capsulitis and sacroiliitis (loss of flexion) are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5252 (2020). 2. The criteria for an initial disability rating higher than 10 percent for right hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5253 (2020). 3. The criteria for a 10 percent initial disability rating for left hip chronic capsulitis and sacroiliitis (loss of flexion) are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5252 (2020). 4. The criteria for an initial disability rating higher than 10 percent for left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5253 (2020). 5. The criteria for a separate 10 percent disability rating for right hip chronic capsulitis and sacroiliitis (loss of extension) from April 26, 2014 are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5251 (2020). 6. The criteria for a separate 10 percent disability rating for left hip chronic capsulitis and sacroiliitis (loss of extension) from April 26, 2014 are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5251 (2020). 7. The criteria for a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease prior to December 1, 2018 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5243 (2020). 8. The reduction of the disability rating assigned for lumbosacral strain with degenerative disc disease from 60 percent to 40 percent, effective December 1, 2018, was improper and the 60 percent disability rating previously assigned is restored. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 3.105 (2020). 9. The criteria for a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease from December 1, 2018 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5235-5243 (2020). 10. The criteria for a separate 20 percent disability rating for right lower extremity radiculopathy, sciatic nerve are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2020). 11. The criteria for a separate 20 percent disability rating for left lower extremity radiculopathy, sciatic nerve are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8520 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from April 1975 through April 2000. The issues on appeal arise from the Veteran's December 2013 claim and rating decisions issued by the agency of original jurisdiction's (AOJ) in September 2014 and August 2018. The issues concerning the Veteran's entitlement to higher initial disability ratings for his right and left hip disabilities were remanded previously by the Board in December 2018. The development ordered by the Board in that remand has been completed and the issues now return to the Board for review. Relative to the issues concerning the Veteran's lumbosacral spine disability, the Board observes that additional evidence was received and added to the record after the April 2020 Statement of the Case (SOC) that addressed those issues. Upon careful review, the Board notes that the evidence received after the April 2020 SOC contains no new or non-duplicative information or evidence that pertains to the Veteran's lumbosacral spine disability. In that regard, a June 2020 letter from the Veteran's treating medical staff at Eisenhower Desert Orthopedic Center merely realleges the same facts and information as that stated previously in September 2015 and September 2018 by the same medical provider. Similarly, Naval Hospital treatment records also received after the April 2020 SOC are duplicative to previously assembled evidence and contain no new information or evidence pertaining to the Veteran's back disability. Given the facts, the Veteran is not prejudiced by the Board accepting jurisdiction over the issues concerning his lumbosacral spine disability and adjudicating those issues at this time. Increased Rating 1. Entitlement to compensable initial disability ratings for right and left hip chronic capsulitis and sacroiliitis (loss of flexion). Service connection for right and left hip chronic capsulitis and sacroiliitis (loss of flexion) was granted to the Veteran, both effective from December 27, 2013. Non-compensable disability ratings were assigned for each hip pursuant to the criteria under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5252. The Veteran contends on appeal that he is entitled to compensable initial disability rating for each hip. Under DC 5252, a 10 percent disability rating is assigned where thigh flexion is limited to 45 degrees. A 20 percent disability rating is assigned where thigh flexion is limited to 30 degrees. A 30 percent disability rating is warranted where thigh flexion is limited to 20 degrees. A 40 percent maximum schedular rating is assigned where thigh flexion is limited to 10 degrees or less. Turning to the evidence, Naval Hospital and private treatment records relevant to the appeal period document ongoing and regular treatment for sacroiliac joint pain. Such treatment included periodic sacroiliac joint injections and radiofrequency ablations to manage the Veteran's pain symptoms. The records show also that the Veteran wore a sacroiliac belt. Nonetheless, those records express no specific findings concerning the range of motion in the Veteran's hips and thighs. Examinations conducted in April 2014, April 2015, and October 2020 all document complaints by the Veteran of progressive pain in his buttocks. During the April 2014 and April 2015 examinations, the Veteran described flare-ups that occurred two or three times a week and that were caused by sitting or walking for long periods of time. Notably, he denied having any flare-ups during the October 2020 examination. Subject to the same, physical examinations of the Veteran's hips and thighs confirmed the presence of localized pain and tenderness during palpation over the right hip joint. Still, range of motion tests showed that the Veteran was able to produce painless hip and thigh flexion bilaterally to no less than 85 degrees (shown during the October 2020 examination). The October 2020 examiner opined that the findings from that examination were consistent with the Veteran's description of the functional impairment that he experienced during flare-ups and after repetitive use over time. The extent of painless bilateral hip and thigh motion shown by the Veteran throughout the appeal period well exceeds that contemplated for a compensable disability rating under DC 5252. Subject to the same, the evidence shows that the Veteran's right and left hip disabilities have been manifested by pain symptoms and flare-ups that have prevented the Veteran from being able to stand and walk for long periods. The regulations note that it is the intent of the ratings schedule to recognize painful motion and painful, unstable, or malaligned joints, due to healed injury, as entitled to at least a minimum compensable rating for that joint. 38 C.F.R. § 4.59. Based on the facts, the Veteran is therefore entitled to 10 percent initial disability rating for right and left hip chronic capsulitis and sacroiliitis based on noted chronic pain symptoms. The Veteran is entitled to a 10 percent initial disability rating for right hip chronic capsulitis (loss of flexion) and a 10 percent initial disability rating for left hip chronic capsulitis (loss of flexion). To that extent, this appeal is granted. 2. Entitlement to an initial disability rating higher than 10 percent for right and left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) Service connection for right and left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) was also granted to the Veteran, effective December 27, 2013. The AOJ assigned 10 percent initial disability ratings for each hip based on demonstrated hip and thigh motion pursuant to the criteria under DC 5253. Under DC 5253, a 10 percent disability rating is assigned where there is limitation of rotation of the thigh such that the Veteran cannot toe-out more than 15 degrees, or, when there is limitation of adduction such that the Veteran cannot cross his legs. A 20 percent disability rating is warranted where there is limitation of hip and thigh abduction such that motion is lost beyond 10 degrees. As mentioned above, the private treatment records and Naval Hospital records relevant to the appeal period show that the Veteran has sought regular and ongoing treatment for pain in his sacroiliac joint and back pain. The records, however, reflect no specific range of motion findings for either of the Veteran's hips. As mentioned, the April 2014, April 2015, and October 2020 examinations each note observed pain and tenderness over both of the Veteran's hip joints. Repeated range of motion tests showed that the Veteran had retained the ability to abduct both hips painlessly beyond 10 degrees. The extent of retained painless bilateral hip and thigh abduction shown by the Veteran throughout the appeal period exceeds that contemplated for a disability rating higher than 10 percent under DC 5253. Moreover, the Veteran's symptoms of pain, flare-ups, and associated functional impairment are contemplated fully by the 10 percent initial disability rating that has already been assigned for each hip. Given the facts, the criteria for an initial disability rating higher than 10 percent for right and left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation) are not met. The Veteran is not entitled to initial disability ratings higher than 10 percent for right and left hip chronic capsulitis and sacroiliitis (loss of abduction, adduction, and rotation). To that extent, this appeal is denied. 3. Entitlement to separate disability ratings for right and left hip chronic capsulitis and sacroiliitis (loss of extension) prior to October 21, 2020. During the pendency of this appeal, the AOJ issued a November 2020 rating decision in which it awarded separate non-compensable disability ratings for right and left chronic capsulitis and sacroiliitis, based on demonstrated loss of right and left hip and thigh extension, pursuant to the criteria under DC 5251. The Board accepts jurisdiction as to the issues concerning the Veteran's entitlement to separate disability ratings based on loss of right and left hip and thigh extension prior to October 21, 2020. Under DC 5251, a 10 percent disability rating is assigned where the evidence shows thigh extension that is limited to 5 degrees. Once again, the Board notes for purposes of the analysis that records for private and Naval Hospital treatment received by the Veteran during the appeal period document ongoing complaints of chronic pain in the Veteran's sacroiliac joints and buttocks. As mentioned, those records reflect no specific findings relating to the ranges of motion in either of the Veteran's hips. Subject to the same, the April 2014 examination revealed that, although the Veteran was able to extend his hips and thighs beyond 5 degrees, he was able to do so painlessly only up to 5 degrees. Although subsequent examinations conducted in April 2015 and October 2020 both note that the Veteran was able to extend his hips and thighs to well beyond 5 degrees during those examinations, there is no indication that the findings during the April 2014 examination are unreliable or invalid. Therefore, accepting the April 2014 range of motion findings as being valid and entitled to the same probative weight as the findings from the later examinations, the Board must conclude that the evidence shows that, at worst, the Veteran's right and left hip disabilities have been manifested by decreased painless hip and thigh extension to 5 degrees. Given the facts, the criteria for separate 10 percent disability ratings for right and left chronic capsulitis and sacroiliitis (loss of extension) are met, effective from April 26, 2014, the date of the April 2014 examination. The Veteran is entitled to separate 10 percent disability ratings for right hip chronic capsulitis (loss of extension) and for left hip chronic capsulitis (loss of extension), both effective from April 26, 2014. To that extent, this appeal is granted. 4. Entitlement to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease prior to December 1, 2018. The Veteran asserted in his December 2013 claim that he was entitled to a disability rating higher than 10 percent for service-connected lumbosacral strain with degenerative disc disease. In the September 2014 rating decision, the AOJ granted a higher 60 percent disability rating based apparently on the criteria under DC 5243 and the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS Formula). In an August 2015 rating decision, however, the AOJ proposed that the disability rating assigned for the Veteran's back disability be reduced from 60 percent to a non-compensable disability rating. An August 2018 rating decision effectuated the proposed reduction, but from 60 percent to 10 percent, effective from December 1, 2018. The Veteran has perfected an appeal in which he challenges the reduction, and, alleges entitlement to higher disability ratings over the applicable appeal period. Criteria for rating disabilities caused by IVDS are provided by the regulations under 38 C.F.R. § 4.71a, DC 5243 and the IVDS Formula. Under those criteria, a 40 percent disability rating is assigned for IVDS resulting in incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months is assigned a 40 percent disability rating. A 60 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least six weeks during the past twelve months is assigned a maximum schedular 60 percent disability rating. An "incapacitating episode" is defined as a period of acute signs and symptoms due to IVDS that requires bedrest prescribed by a physician and treatment by a physician. Other applicable rating criteria are available under DCs 5235 through 5242 and the General Rating Formula for Diseases and Injuries of the Spine (Spine Formula). Under the Spine Formula, a 40 percent disability rating is appropriate where there is evidence of forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is warranted where the disability has resulted in unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating contemplates unfavorable ankylosis of the entire spine. For VA compensation purposes, the "combined range of motion" refers to the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. 38 C.F.R. § 4.71a (Plate V) defines that normal range of thoracolumbar spine motion as consisting of flexion to 90 degrees and extension, bilateral lateral flexion, and bilateral rotation to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. Ankylosis is defined as, "immobility and consolidation of a joint due to disease, injury, or surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992). The evidence relevant to the appeal period at issue shows that the Veteran sought regular private treatment at Eisenhower Medical Center for ongoing low back pain that radiated into his buttocks and lower extremities. Those records document noted local tenderness during palpation over the spine and an antalgic gait that was attributed to pain in the Veteran's back, hips, and lower extremities. They show that the Veteran's back was treated with periodic radiofrequency ablations and physical therapy. In January 2014, the Veteran was prescribed a lumbar corset. A February 2014 physical therapy note from Hi-Desert Physical Rehabilitation Group notes ongoing "significant pain" that was causing the Veteran to have a "fairly sedentary lifestyle." An August 2015 lumbar spine MRI showed findings that were consistent with disc degeneration and mild central canal stenosis. A September 2015 letter from attending medical staff at Eisenhower Medical Center summarizes that the Veteran was being seen approximately every six weeks for ongoing low back pain that was radiating into his lower extremities. The letter adds that the Veteran had experienced severe spasms and pain that required emergency admission and treatment and that the Veteran was considered a potential candidate for spine surgery or a spinal stimulator implant. A September 2018 letter reports the same ongoing complaints and findings but adds that the Veteran was requiring assistance from his family to perform certain household chores and self-care activities. The attending medical staff added that the Veteran was experiencing episodes once every three or four months in which he was bedridden for weeks at a time. Overall, the letter summarizes that the Veteran was incapacitated and required bed rest over approximately eight weeks a year. The records for treatment received by the Veteran at Eisenhower Medical Center note that repeated thoracolumbar spine range of motion tests conducted throughout the appeal period at issue showed decreased spine motion. The records do not, however, report any specific range of motion findings. Contemporaneous with the medical history detailed above, an April 2014 spine examination notes ongoing complaints by the Veteran of back pain and flare-ups that seemed to occur spontaneously and with simple movements such as changing the coffee filter and putting on socks. He stated that he had difficulty attending family outings, shopping, and getting in and out of bed. Overall, he described his movements as being "robotic." Similar symptoms and flare-ups were reported by the Veteran during subsequent spine examinations conducted in April 2015 and June 2018. Thoracolumbar spine examinations revealed no evidence of ankylosis. A neurological examination conducted during the April 2014 examination revealed positive findings that were interpreted as being consistent with IVDS that was causing the Veteran to experience incapacitating episodes totaling more than six weeks over the preceding 12-month period. Interestingly, the subsequent April 2015 and June 2018 examinations note no neurological examinations, and as such, the examiner from those examinations did not diagnose IVDS. Still, neither examiner provides any explanation for why the neurological findings from their examinations differ from those noted in the previous private treatment records and during the April 2014 spine examination. Under the circumstances, the evidence seems to indicate that the Veteran's neurological manifestations and IVDS were intermittent and waxed and waned, but nonetheless, was a consistent manifestation throughout the appeal period at issue. In the absence of evidence showing ankylosis in the Veteran's spine, the criteria for a disability rating higher than 60 percent for the Veteran's back disability are not met under the Spine Formula. The Board notes also that the criteria under the IVDS Formula do not provide criteria for a disability rating higher than 60 percent. Although the Board recognizes that a higher disability rating may be awarded on an extra-schedular basis, the evidence does not show that the constellation of symptoms and impairment associated with the Veteran's back disability has been productive of an exceptional case that is not addressed adequately by the applicable rating criteria. 38 C.F.R. § 3.321(b)(1). In that regard, the Board notes again that the treatment records show that the Veteran generally had a "fairly sedentary lifestyle," as noted in the February 2014 private physical therapy note. Indeed, the Veteran has reported, and the April 2014 examiner noted, that the Veteran has experienced periods of incapacitation and bed rest. Nonetheless, the degree of impairment shown in the evidence appears to be contemplated fully by the assigned 60 percent disability rating over the part of the appeal period prior to December 1, 2018. Also, to the extent that the evidence indicates that the functional impairment associated with the Veteran's back disability has interfered with the Veteran's occupational capacity, such impairment is also compensated by TDIU, which has also been assigned effective throughout the appeal period at issue (see November 2020 rating decision). The criteria for a disability rating higher than 60 percent for the Veteran's lumbosacral strain with degenerative disc disease are not met for the part of the appeal period prior to December 1, 2018. The Veteran is not entitled to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease prior to December 1, 2018. To that extent, this appeal is denied. 5. Whether a reduction of the disability rating assigned for lumbosacral strain with degenerative disc disease from 60 percent to 40 percent, effective December 1, 2018, is proper. As mentioned above, the disability rating assigned for the Veteran's lumbosacral strain with degenerative disc disease was reduced from 60 percent to 10 percent, effective from December 1, 2018, in an August 2018 rating decision. The Veteran perfected an appeal in which he disputed the propriety of the reduction. During the pendency of the appeal, the AOJ issued an April 2020 rating decision in which it increased the disability rating assigned for the Veteran's back disability from 10 percent to 40 percent, also effective from December 1, 2018. In effect, the AOJ's decisions reduced the disability rating assigned for the Veteran's back disability from 60 percent to 40 percent over the part of the appeal period since December 1, 2018. The question on appeal is therefore whether reduction of the disability rating for the Veteran's lumbosacral strain with degenerative disc disease from 60 percent to 40 percent, effective December 1, 2018, was proper. Where the reduction in the rating assigned for a service-connected disability or employability status is considered warranted, and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance and setting forth all material facts and reasons must be prepared. The veteran must be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefore, and, will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. The veteran must also be informed that he or she may request a predetermination hearing, provided that the request is received by the VA within 30 days from the date of the notice. If additional evidence is not received within the 60 day period and no hearing is requested, final rating action will be taken and the award will be reduced or discontinued effective from the last day of the month in which a 60-day period from the date of notice to the veteran expires. 38 C.F.R. § 3.105(e). Notwithstanding the above, the United States Court of Appeals for Veterans Claims has indicated that there are several other general VA regulations that apply to all rating reductions, regardless of how long the disability rating at issue has been in effect. Brown v. Brown, 5 Vet. App. 413, 420-21 (1993). Specifically, 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history. It also requires that for application of the rating schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Id. As to interpretation of examination reports, 38 C.F.R. § 4.2 requires that if the examination report does not contain sufficient detail, it is incumbent on the rating board to return the report as inadequate for evaluation purposes. The Court has also stated that examination reports on which the reduction are based must be adequate. Tucker v. Derwinski, 2 Vet. App. 201 (1992). Also, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, in order for a rating reduction to be proper, the evidence must not only show that an improvement in a disability has actually occurred, but also, that such improvement reflects improvement in the ability to function under ordinary conditions of life and work. Id.; see also 38 C.F.R. §§ 4.2, 4.10. As discussed in detail above, the evidence leading to the effectuated rating reduction shows that the Veteran was under regular and ongoing private orthopedic treatment, to include frequent injections and radiofrequency ablations, for continuing low back pain that was radiating into his lower extremities. A September 2015 letter from Eisenhower Medical Center reported that the Veteran's back problems had required him to seek emergency admission and treatment and that he was considered a candidate for back surgery. A September 2018 letter reported the same symptoms and listed diagnoses for lumbar facet arthropathy, lumbar facet syndrome, lumbar degenerative disc disease, lumbar disc tears, acute and chronic sacroiliitis, chronic pain syndrome, and lumbar radiculopathy. The attending medical staff mentioned also that the Veteran was experiencing episodes in which he was incapacitated and bedridden for weeks at a time and that he had experienced more than eight weeks of incapacitation over the preceding year. Indeed, the letter mentioned also that the Veteran needed assistance from his family for performing household chores and self-care activities. Although spine examinations conducted in April 2015 and June 2018 apparently revealed no neurological findings or IVDS, as noted above, the examiners gave no explanation as to why their neurological findings differed from the well-documented positive neurological examinations noted in the previous private treatment records and the earlier April 2014 spine examination. Indeed, as discussed more fully below, the evidence since the effectuated reduction continues to document complaints of radiating back pain and positive neurological findings indicating IVDS and associated radiculopathies. As the Board alluded to above, the evidence suggests that the Veteran's neurological manifestations and IVDS (which served as the bases for the previously assigned 60 percent disability rating) were intermittent and waxed and waned, but nonetheless, remained a consistent manifestation throughout the appeal period. Under the circumstances, the Board concludes that the evidence does not show that there has been sustained improvement of the Veteran's back disability such as to warrant a reduction of the disability rating that was assigned. Moreover, where neither the April 2015 nor the June 2018 examiners were able to provide any explanation that reconciled their opinions that the Veteran did not have IVDS with the other neurological findings and diagnoses in the record, those examinations were inadequate for purposes of serving as bases for a reduction of the Veteran's rating. The reduction of the disability rating assigned for lumbosacral strain with degenerative disc disease from 60 percent to 40 percent, effective December 1, 2018, is improper. As such, the disability rating assigned for that disability is restored to 60 percent, effective December 1, 2018. To that extent, this appeal is granted. 6. Entitlement to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease from December 1, 2018. Having determined that the disability rating assigned for the Veteran's lumbosacral strain with degenerative disc disease was improper, and, having restored the assigned disability rating to 60 percent, the Board must consider as part of this appeal the question of whether the Veteran is entitled to a disability rating higher than 60 percent for the part of the appeal period from December 1, 2018. The applicable rating criteria under the IVDS Formula and Spine Formula are discussed above and are incorporated herein by reference. The evidence for the part of the appeal period since December 1, 2018 shows that the Veteran has remained under continuing treatment for low back pain via frequent radiofrequency ablations at Eisenhower Desert Orthopedic Center. Again, those records report no specific range of motion findings, nor do they suggest any findings that are consistent with ankylosis. A February 2020 spine examination noted continuing complaints by the Veteran of low back pain that radiated into his lower extremities. He continued to report difficulty standing and walking for long periods of time and stated that such activities caused him to have flare-ups of pain that could last for periods of up to three days. A physical examination revealed that the Veteran ambulated with a cane and a walker and wore a back brace. Range of motion tests showed decreased thoracolumbar spine motion that included flexion to 30 degrees and extension, bilateral lateral rotation, and bilateral lateral flexion to 5 degrees during flare-ups and after repetitive use over time. Still, the examiner noted that there was no evidence of ankylosis, and indeed, the extent of recorded thoracolumbar spine motion is not consistent with ankylosis. A neurological examination showed positive findings that were interpreted by the Veteran as being consistent with IVDS and bilateral lower extremity radiculopathies involving mild incomplete paralysis of the sciatic nerve. In terms of function, the examiner concluded that the Veteran's disability prevented the Veteran from sitting, standing, or walking for long periods and from bending over or lifting. In the absence of evidence showing ankylosis in the Veteran's spine, the criteria for a disability rating higher than 60 percent for the Veteran's back disability are also not met under the Spine Formula for the part of the appeal period from December 1, 2018. Under similar analysis as that given above, the Board concludes also that a disability rating higher than 60 percent may not be granted on an extra-schedular basis pursuant to DC 5243 and the IVDS Formula. 38 C.F.R. § 3.321(b)(1). In that regard, the symptoms and impairment shown in the evidence are compensated adequately by the assigned 60 percent disability rating assigned from December 1, 2018. Again, to the extent that the evidence indicates that the functional impairment associated with the Veteran's back disability has interfered with the Veteran's occupational capacity, such impairment is also compensated adequately by the AOJ's TDIU award, made effective from December 27, 2013. The criteria for a disability rating higher than 60 percent for the Veteran's lumbosacral strain with degenerative disc disease are not met for the part of the appeal period from December 1, 2018. The Veteran is not entitled to a disability rating higher than 60 percent for lumbosacral strain with degenerative disc disease from December 1, 2018. To that extent, this appeal is denied. 7. Entitlement to separate disability ratings for right and left lower extremity radiculopathies, sciatic nerve. As discussed, the evidence shows that the Veteran has remained under treatment for radiating low back pain and neurological manifestations in his lower extremities over the course of the appeal period. On review of the record, the Board notes that initial neurological complaints in the Veteran's lower extremities were first noted in early 2012. A March 2012 nerve conduction study showed findings that were consistent with a L5-S1 radiculopathy on the left. Records for treatment received by the Veteran throughout 2013 at Eisenhower Desert Orthopedic Center document ongoing and consistent complaints by the Veteran of low back pain that radiated into his lower extremities and which were managed by repeated epidural steroid injections. Indeed, a March 2013 treatment note reflects the ongoing diagnosis for lumbar radiculitis. The Veteran's April 2014 spine examination revealed decreased sensation in both of the Veteran's ankles and feet and in the toes of both feet. Straight leg raises were also positive. Based on those findings, the examiner opined that the findings indicated bilateral lower extremity radiculopathies that were marked by moderate incomplete paralysis of the sciatic nerve. The Veteran's February 2020 spine examination again revealed positive straight leg raises, although no other neurological findings were observed at that time. The February 2020 examiner opined that the findings indicated ongoing radiculopathies in the Veteran's lower extremities, but which at that time were productive of only mild incomplete paralysis of the sciatic nerve. DC 8520 are the rating criteria used to evaluate neurological disabilities that involve the sciatic nerve. Under those criteria, a 10 percent disability rating is assigned for mild incomplete paralysis of the sciatic nerve. A 20 percent disability rating is assigned for moderate incomplete paralysis of the sciatic nerve. A 40 percent disability rating is warranted for moderately severe incomplete paralysis of the sciatic nerve. A 60 percent disability rating contemplates severe incomplete paralysis with marked muscular atrophy. A maximum schedular 80 percent disability rating is warranted for complete paralysis, i.e., the foot dangles and drops, no active movement of the muscles below the knee is possible, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, DC 8520. Here, the evidence shows that the Veteran's back disability has resulted in radiculopathies involving both of the Veteran's lower extremities, involving at worst moderate incomplete paralysis of the sciatic nerve. The criteria for separate 20 percent disability ratings for the Veteran's right and left lower extremity radiculopathies are therefore met. The Veteran is entitled to a separate 20 percent disability rating for right lower extremity radiculopathy, sciatic nerve, and, a separate 20 percent disability rating for left lower extremity radiculopathy, sciatic nerve, for the entire appeal period. To that extent, this appeal is granted. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.S. Lee 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.