Citation Nr: 21040759 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 17-13 178 DATE: July 6, 2021 ORDER Entitlement to an initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD), but no higher, is granted, subject to the regulations governing the payment of monetary awards. An initial rating of 40 percent, but no higher, for lumbar spondylosis is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an initial rating of 10 percent, but no higher, for left ankle tendonitis (claimed as left ankle pain/instability) is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an initial rating of 20 percent, but no higher, for right lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an initial rating of 20 percent, but no higher, for left lower extremity radiculopathy is granted, subject to the regulations governing the payment of monetary awards. FINDINGS OF FACT 1. For the appeal period, the Veteran's PTSD is characterized by anxiety, chronic sleep impairment, disturbances of motivation and mood, and suicidal ideation, but symptoms and impairment did not more nearly approximate total occupational and social impairment. 2. The functional impairment from the Veteran's lumbar spondylosis, including during flare ups, most nearly approximated forward flexion limited to 30 degrees or less but did not more nearly approximate ankylosis. 3. The functional impairment of the Veteran's left ankle tendonitis has most nearly approximated moderate limitation of motion of the ankle, but did not more nearly approximate marked impairment. 4. The Veteran's radiculopathy of the right and left lower extremities have each manifested as moderate incomplete paralysis of the external popliteal nerves, but did not more nearly approximate severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent, but no higher, for other posttraumatic stress disorder (PTSD) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (2020). 2. The criteria for a 40 percent rating, but no higher, for lumbar spondylosis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5239 (2020). 3. The criteria for a rating of 10 percent, but no higher, for tenosynovitis of the left ankle have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5024, 5271 (2020). 4. The criteria for a rating of 20 percent, but no higher, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8521 (2020). 5. The criteria for a rating of 20 percent, but no higher, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8521 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1992 to September 2014. These matters are before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The February 2017 rating decision granted entitlement to service connection for hemorrhoids, which had been denied in the October 2014 rating decision. As this constitutes a full grant of the benefit sought on appeal in regard to the hemorrhoid disability, there remains no issue of controversy for adjudication by the Board on that claim. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). In February 2021, the Veteran testified at a videoconference hearing before the undersigned; a transcript of that hearing is of record. The Board notes that service connection was established for right lower extremity radiculopathy and left lower extremity radiculopathy in February 2017. The Veteran did not submit a notice of disagreement as to any assigned ratings or effective dates as to these matters and they have not been developed for appellate review. However, given the recent decision of the United States Court of Appeals for Veterans Claims in Chavis v. McDonough, __ Vet. App. __, 2021 U.S. App. Vet. Claims LEXIS 660 (Apr. 16, 2021), the Board will discuss the radiculopathy ratings despite the lack of a notice of disagreement. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2008). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. 1. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD), also claimed as insomnia, depression, anxiety, and stress The Veteran contends that his service-connected PTSD warrants an initial disability rating in excess of the 30 percent currently assigned. PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, and the General Rating Formula for Mental Disorders, which provides the following criteria: A 30 percent rating is to be assigned in cases of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and/or difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and/or inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and/or memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. The list of symptoms in the General Rating Formula for Mental Disorders is not intended to constitute an exhaustive list, but rather provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Furthermore, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. Turning to the evidence, a general medical health assessment taken in December 2013 during service stated that in the previous month the Veteran had nightmares, tried hard not to think about it, was constantly on guard, watchful, and/or easily startled. In December 2013, the Veteran underwent a Disability Benefits Questionnaire (DBQ) for Mental Health Disorders and a separate DBQ for PTSD in particular. The examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran had reported nightmares and intrusive thoughts about an incident when he found a fellow servicemember who was dead. The Veteran had been treated with therapy but no medications during his service. There was no suicidal behavior or psychosis and it was unclear whether the Veteran's therapy was helpful. The Veteran denied any significant behavior problems but reported that he had anger issues at home and was facing a criminal charge for carrying a concealed weapon. The Veteran denied any alcohol or drug problems before or during service. The examiner noted symptoms of anxiety, chronic sleep impairment, disturbances of motivation and mood and dysphoric mood. In his October 2015 Notice of Disagreement, the Veteran said that his PTSD limits his ability to function socially and to function in crowded and noisy places. In September 2016, the Veteran contacted VA to contend that the 2013 examinations were not accurate because they reflected his disabilities during active duty, not the increased severity he contended that they had since leaving active duty. The Veteran testified before the Board in February 2021. He said that his PTSD made him disconnected and emotionless at times, but very emotional at other times. He said that it was difficult to communicate with people, including co-workers but particularly his wife, and he felt that he was very impatient toward her. The Veteran also reported that he had thoughts of hurting himself or others. Considering the evidence, the December 2013 examiner stated that the condition resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, a definition fitting squarely within the criteria for a 30 percent disability rating. The evidence indicates that the Veteran has experienced symptomatology from rating criteria for 30 percent, 50 percent, and 70 percent ratings. These symptoms include anxiety, and chronic sleep impairment (30 percent criteria); disturbances of motivation and mood (50 percent rating criteria); and suicidal ideation (70 percent rating criteria) for the entire appellate period. The record shows that the frequency, severity, and duration of these symptoms have caused the Veteran occupational and social impairment with deficiencies in most areas, as he has reported impatience toward his wife, difficulty relating to co-workers, and, significantly, thoughts of hurting himself or others. The frequency, duration, and severity of these symptoms are consistent with the functioning contemplated by a 70 percent rating. The evidence, however, does not show that the Veteran's occupational and social impairment more nearly approximates total occupational and social impairment as contemplated by a 100 percent rating. There has been no evidence of symptoms that more nearly approximate the frequency, severity, and duration of total occupational and social impairment, including no evidence of symptoms such as gross impairment of thought process or communication, persistent delusions or hallucinations; grossly inappropriate behavior, disorientation to time or place, memory loss for names of close relatives, own occupation, or own name, or any other symptoms of similar frequency, severity, or duration. Regarding social impairment, the evidence indicates that the Veteran is currently married, although the relationship has difficulties. Although the Veteran has reported unspecified thoughts of hurting himself or others the evidence does not reflect that his symptoms are of such frequency, duration, and severity to be a persistent danger to himself or others. The frequency, duration, and severity of his symptoms do not more nearly approximate total social impairment. The frequency, severity, and duration of the Veteran's symptoms also do not more nearly approximate total occupational impairment. Although the Veteran reported difficulties relating to his co-workers, he was employed and there is no indication that the Veteran has been disciplined or terminated from employment. Therefore, the evidence does not indicate that the Veteran's PTSD causes symptoms and impairment that more nearly approximate total occupational impairment. Thus, when considering the frequency, severity, and duration of all of the Veteran's symptoms as to occupational and social impairment, the symptoms of his psychiatric disorder cause him to have occupational and social impairment with deficiencies in most areas but not total occupational and social impairment; hence, they are not characteristic of the next higher, 100 percent rating. The Board has also considered whether staged ratings are appropriate in this case. However, the above evidence reflects that the Veteran's symptomatology and overall impairment have been stable throughout the appeal period and was consistent with no more than a 70 percent rating since service connection was granted, effective September 30, 2014. Therefore, a staged rating is not warranted in this case. 2. Entitlement to an initial rating in excess of 20 percent for lumbar spondylosis, referred as lower back pain The Veteran contends that his lumbar spondylosis warrants a rating higher than the 20 percent currently assigned, effective September 30, 2014. His lumbar spondylosis has been rated using Diagnostic Code 5239. Lumbar spine disabilities are rated using the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), unless the disability is rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS Rating Formula). 38 C.F.R. § 4.71a, Diagnostic Code 5239. The General Rating Formula provides that 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 an 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 in cases of 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 disability rating is provided for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (5) states that 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. Under the IVDS Rating Formula, a 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent disability rating is assigned with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Turning to the evidence, a December 2013 DBQ for back conditions found that on initial range of motion testing, the Veteran had forward flexion until pain at 40 degrees, extension until pain at 10 degrees, lateral flexion on both sides to pain at 20 degrees, and lateral rotation on both sides to pain at 20 degrees. There was no change after three repetitions. The examiner noted reduced movement and pain on movement. There was no localized tenderness or muscle spasm, but the Veteran had guarding which did not result in abnormal gait or abnormal spinal contour. His bilateral hips, knees, and ankles showed normal strength and there was no muscle atrophy. The bilateral knee and ankle reflexes were normal. The Veteran's sensation to light touch of thighs, knees, ankles and feet were all normal on the right but all were decreased on the left. There was no radicular pain and the examiner said that there were no signs of radiculopathy. The examiner found that the Veteran did not have IVDS. The examiner remarked that the Veteran had spondylosis and early arthritis of the lumbar spine, seen on X-ray and MRI imaging, but said that the MRI did not show a nerve root impingement or a reason for his radicular symptoms. The examiner said that the Veteran's numbness and exam findings over the left leg are non-radicular and diffuse and not anatomically correct for a nerve root impingement or radicular nerve root compression and concluded that "as far as today's exam, there is no anatomic findings to support a specific nerve root compression." The Physical Evaluation Board in January 2014 found that the Veteran had low back pain and was unfit for service. The Veteran reported that with any sitting, he would have pain in one or both legs. On examination there was pain on palpation of the thoracolumbar spine. Range of motion testing showed forward flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 35 degrees. All of the movements were limited by pain. Concerning radiculopathy, there was no decrease in sensation to light touch and the Veteran's motor strength and reflexes were normal in the bilateral hips, knees and ankles. Imaging showed mild multilevel degenerative changes and the diagnosis was lower back pain, intervertebral disc degeneration, and lumbar radiculopathy. In an October 2015 Notice of Disagreement, the Veteran said that his lumbar spondylosis prevents him from sitting or walking more than 10 minutes without great pain in his lower back and both legs and he cannot rise to his feet in a normal manner when he has been sitting, even for a short time. In September 2016, the Veteran contacted VA to state that the 2013 examinations did not reflect the current severity of his disabilities. In a January 2017 private treatment record, the Veteran reported back pain radiating into his buttocks and legs and said that the severity and frequency of the pain and paresthesias also were increasing due to his sciatic nerves. The Veteran commenced physical therapy. A DBQ for back conditions was prepared in May 2017. The examiner diagnosed lumbar spondylosis. The Veteran said that the condition onset in 2010 and has worsened, and he now has limited motion in the lower back and hip with pain and numbness down both legs. The Veteran said that his flare ups are a general worsening of symptoms which occurs after sitting or standing for five to ten minutes. He said that he cannot carry any weight. In terms of functional loss, the Veteran reported a reduced range of motion and increased pain in the back, hips, and legs. Initial range of motion testing showed forward flexion 0 to 80 degrees, extension 0 to 20 degrees, and all other movements 0 to 30 degrees, with pain noted on forward flexion and extension only, the pain not resulting in functional loss. There was also pain on weight-bearing and mild pain and tenderness of the lumbosacral area associated with movement. There was no change after three repetitions or with repeated use over time. The examiner opined that the functional loss is caused by pain, fatigue, weakness, and lack of endurance. The Veteran had a muscle spasm not resulting in abnormal gait or abnormal spinal contour, localized tenderness not resulting in abnormal gait or abnormal spinal contour, and guarding not resulting in an abnormal gait or abnormal spinal contour. The examiner found no additional factors of disability such as weakened movement or swelling, but the condition interfered with standing or sitting for long period of time. Muscle strength of the bilateral hips and knees and ankles was normal strength with no atrophy. Reflexes in the bilateral knees and ankles were normal. The Veteran had normal sensation to light touch in the bilateral thighs, knees, ankles and feet. Straight leg raising tests were positive bilaterally. The examiner found no radiculopathy symptoms and said that the Veteran does not have IVDS. The Veteran reported using a back brace. Concerning functional impact, the Veteran was unable to perform any job requiring him to stand or sit in certain positions too long due to pain and spasms. Finally, the examiner noted that there was objective evidence of pain on passive range-of-motion testing and on non-weight-bearing movements. The Veteran testified during his February 2021 hearing that his lower back pain is like a toothache, radiating down the lower back into the buttocks and both legs. He said that it varies, goes from left to right, and sometimes is a sensation of needles poking his calves and the bottoms of his feet. The Veteran reported that it changes as he changes position, and that if he sits on a regular-height toilet his legs will go completely numb. He said that his lower back becomes painful after standing for five or ten minutes and that if he sits for ten or fifteen minutes his lower back and legs become numb. The Veteran reported that his employment requires him to lift, bend and carry things, so he must take breaks and sit on a stool at times. He also said that he has missed work due to back pain and other disabilities. The Veteran said that he must move and shift his position in order to prevent numbness. He said that his pain varies from day to day, sometimes 3 on a scale of 10, and sometimes 8 or 9, at which times he is forced to lie down. He said that reducing his movements prevents the painful flare ups. Applying the rating criteria, in response to Note (1) to the General Rating Formula, the Veteran has already been granted service connection separately for neurological abnormalities including radiculopathy of the right and left lower extremities, and the evidence does not indicate any other associated objective neurological abnormalities requiring separate evaluation under an appropriate diagnostic code. The Veteran is entitled to an increased 40 percent rating throughout the appeal period. Although the Veteran's forward flexion was to 40 degrees on examination, the record indicates that he has experienced severe flare ups during which his movement is very severely limited. The Veteran reported that these flare ups are frequent and that he is forced to lie down when the occur. Although the evidence does not adequately show the reduced range of motion during flare ups, the evidence at least in equipoise that the Veteran's forward flexion is limited to 30 degrees or less during flare ups that occur on a frequent basis. Therefore, the evidence more nearly approximates the criteria for a 40 percent rating for the period on appeal. The weight of the evidence is against a finding that the Veteran is entitled to a higher 50 percent rating as the evidence does not reflect findings that more nearly approximate unfavorable ankylosis. Although the Veteran indicated that his movement is severely limited during flare ups, the evidence does not more nearly approximate the definition of unfavorable ankylosis in Note 5 of the General Rating Formula, that is, that the thoracolumbar spine is fixed in flexion and includes one or more of the following symptoms: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a. There is no evidence of incapacitating episodes due to intervertebral disc syndrome; therefore, a rating in excess of 40 percent based on incapacitating episodes is not warranted. The Board has also considered whether staged ratings are appropriate in this case. However, the above evidence reflects that the Veteran's symptomatology has been stable throughout the appeal period and was consistent with no more than a 40 percent rating since service connection was granted, effective September 30, 2014. Therefore, a staged rating is not warranted. 3. Entitlement to an initial compensable rating for left ankle tendonitis (claimed as left ankle pain/instability) The Veteran is also appealing the denial of a higher initial rating for his left ankle tendonitis. It is currently rated at 0 percent, effective September 30, 2014. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic code 5271-5024 indicates that the Veteran's tenosynovitis (DC 5024) has been rated by analogy under the criteria for limitation of motion of the ankle under Diagnostic Code 5271. Diagnostic Code 5271 provides a 10 percent rating for moderate limitation of motion, and a 20 percent rating for marked limitation of motion. 38 C.F.R. § 4.71a. While the earlier versions of the Rating Schedule did not provide any information as to what manifestations constituted "moderate" or "marked" limitation of ankle motion, an amended version of 38 C.F.R. § 4.71a which became effective February 7, 2021, states that moderate limitation of ankle motion is present when there is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, while marked limitation of motion is demonstrated when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. Normal range of motion of the ankle, for VA compensation purposes, is from zero to 20 degrees of ankle dorsiflexion and from zero to 45 degrees of ankle plantar flexion. 38 C.F.R. § 4.71a, Plate II. Turning to the evidence, the Veteran underwent a DBQ for ankle conditions during active duty service in December 2013. The left ankle showed full range of motion with plantar flexion to 45 degrees and dorsiflexion to 20 degrees, with no pain on movement. Repetitive use testing showed no change in the range of motion and no pain on movement. There was localized tenderness. The ankle had normal muscle strength on plantar flexion and dorsiflexion and stability testing was normal. Other pertinent physical findings included "TTP point specific of Extensor Digitorum Longus Tendons over the instep of the left ankle." There was no effusion of the ankle. In his October 2015 Notice of Disagreement, the Veteran said that his left ankle tendonitis is painful and results in instability which makes it difficult to go up and down stairs and affecting his balance so that he has fallen down stairs. As noted above, the Veteran told VA personnel in September 2016 that he did not believe that the December 2013 examinations reflected the severity of his conditions since he separated from service. Private treatment records in January 2017 note that the Veteran reported left ankle pain and said that the ankle goes out when he is climbing stairs. Examination showed mild swelling in the lateral left ankle, pain to the lateral ankle on palpation, pain to lateral ankle, mild anterior drawer, pain over the left ATFL, and increased inversion of the left ankle. The doctor assessed a sprain of the left ankle with chronic ankle pain and instability. A DBQ for ankle conditions was completed in May 2017. The Veteran stated that his symptoms began in 1998 and they have worsened over time. He reported increased pain, weakness, and pain on movement. The Veteran said that flare-ups lead to increased pain when walking and an inability to climb stairs or even put weight on the ankle. Initial range of motion testing was normal (0 45 degrees plantar flexion, 0 20 degrees dorsiflexion) with no pain noted and no localized tenderness. There was no change after three repetitions. The examiner was unable to test range of motion on repeated use over time but said that pain, weakness, fatigability and incoordination do not limit the Veteran's functional ability with repeated use over time or during flare ups. The examiner also stated that no additional factors such as weakened movement, swelling, or deformity. Muscle strength was normal on plantar flexion and dorsiflexion and there was no atrophy. The examiner did not find instability of the ankle. The examiner concluded that the Veteran had Achilles tendonitis of the left ankle during service and that it has resolved without residuals. The examiner noted that there was no evidence of pain on passive range-of-motion testing or when not bearing weight. In his February 2021 hearing before the Board, the Veteran testified that he gets cortisone injections for the ankle every six months and that a planned surgery had to be canceled due to the COVID-19 pandemic. He said that the ankle becomes painful when he is required to get on his knees in the course of his work. He said that when the ankle becomes stiff he cannot walk normally because he cannot bend the ankle as he walks forward; he must keep the ankle in a fixed position. Applying the rating criteria, the Veteran's left ankle did not show even moderate limitation of ankle motion as defined by DC 5271 (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). However, a rating decision for a musculoskeletal disability must consider the factors listed in 38 C.F.R. §§ 4.40 and 4.45. The May 2017 DBQ holds little probative value because it disregarded the Veteran's reports of his symptoms. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the Veteran's reports of stiffness, painful motion, and weakness during flare ups, and the January 2017 private treatment records showing pain on palpation, instability, and mild swelling, the Veteran's symptoms more nearly approximate the impairment of moderate limitation of motion of the ankle. DeLuca v. Brown, 8 Vet. App. 202 (1995). However, the Veteran's reports of stiffness, painful motion, and weakness during flare ups and the evidence of the January 2017 private evaluation do not more nearly approximate marked limitation of motion of the ankle. 38 C.F.R. § 4.71a. There is no evidence of limitation of motion except during flare ups, and that limitation is shown by the above evidence not to be so limited as to more nearly approximated marked limitation of motion. Moreover, there is no evidence of deformity or atrophy. As such, the symptoms do not have the severity analogous to a marked limitation of motion of the ankle and thus a higher rating of 20 percent is not warranted. Id., DC 5271. The Board has also considered whether staged ratings are appropriate in this case. However, the above evidence reflects that the Veteran's symptomatology has been stable throughout the appeal period and was consistent with no more than a 10 percent rating since service connection was granted, effective September 30, 2014. Therefore, a staged rating is not warranted in this case. 4. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy and in excess of 10 percent for left lower extremity radiculopathy In February 2017, the RO granted service connection for radiculopathy of the right and left lower extremities. The RO granted a 10 percent disability rating for each one, with service connection for the right lower extremity to be effective May 12, 2015, and for the left lower extremity to be effective September 30, 2014. The Veteran has not appealed these ratings but, as noted above, the Board will discuss the radiculopathy ratings nonetheless because of the recent decision of the United States Court of Appeals for Veterans Claims in Chavis v. McDonough, __ Vet. App. __, 2021 U.S. App. Vet. Claims LEXIS 660 (Apr. 16, 2021). The Veteran's radiculopathy of the right and left lower extremities has been rated according to the criteria for Diagnostic Code 8521, Paralysis of the External Popliteal Nerve. 38 C.F.R. § 4.124a. Under these criteria, complete paralysis (manifesting as "foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes") is to be assigned a 40 percent rating. Severe incomplete paralysis warrants a 30 percent rating; moderate incomplete paralysis calls for a 20 percent rating, and mild incomplete paralysis is to be assigned 10 percent. Id. While complete paralysis of the external popliteal nerve is given a thorough description, the varying degrees of incomplete paralysis, to include terms such as "moderate," and "severe" are not defined by the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning to the evidence, a December 2013 DBQ for back conditions found that the Veteran's sensation to light touch of thighs, knees, ankles and feet were all normal on the right but all were decreased on the left. There was no radicular pain and the examiner said that there were no signs of radiculopathy. The examiner found that the Veteran did not have IVDS. The examiner remarked that the Veteran had spondylosis and early arthritis of the lumbar spine, seen on X-ray and MRI imaging, but said that the MRI did not show a nerve root impingement or a reason for his radicular symptoms. The examiner said that the Veteran's numbness and exam findings over the left leg are non-radicular and diffuse and not anatomically correct for a nerve root impingement or radicular nerve root compression and concluded that "as far as today's exam, there is no anatomic findings to support a specific nerve root compression." The Physical Evaluation Board in January 2014 found that there was no decrease in sensation to light touch and the Veteran's motor strength and reflexes were normal in the bilateral hips, knees and ankles. Imaging showed mild multilevel degenerative changes and the diagnosis was lower back pain, intervertebral disc degeneration, and lumbar radiculopathy. In an October 2015 Notice of Disagreement, the Veteran said that sitting or walking more than 10 minutes without great pain in his lower back and both legs. In a January 2017 private treatment record, the Veteran reported back pain radiating into his buttocks and legs and said that the severity and frequency of the pain and paresthesias also were increasing due to his sciatic nerves. The May 2017 DBQ for back conditions stated that the Veteran reported pain and numbness down both legs. Muscle strength of the bilateral hips and knees and ankles was normal strength with no atrophy. Reflexes in the bilateral knees and ankles were normal. The Veteran had normal sensation to light touch in the bilateral thighs, knees, ankles and feet. Straight leg raising tests were positive bilaterally. The examiner found no radiculopathy symptoms and said that the Veteran does not have IVDS. In the February 2021 testimony before the Board, the Veteran stated that the pain from his back radiates into his buttocks and down his legs and that he sometimes has sensations of pins and needles on his calves and feet. Notably, he said that when he sits on a regular-height toilet his legs will go completely numb and that if he sits under any circumstances for ten or fifteen minutes he will have numbness in his legs. He reported that he must shift his weight and fidget in order to prevent his legs from becoming numb. In light of the above, the Veteran's bilateral lower extremity radiculopathy has resulted in moderate incomplete paralysis of the external popliteal nerve, manifested by numbness, paresthesias, and pain. However, the evidence does not show severe incomplete paralysis; the Veteran is able to ambulate and has generally good range of motion in those extremities with normal muscle strength, no atrophy, and a normal sensation to touch according to the evidence during the appeal period. Further, there is no evidence of symptoms indicating or more nearly approximating complete paralysis of the external popliteal nerve. As such, the Board finds that ratings of 20 percent, but no higher, for radiculopathy of both the right and left lower extremities is warranted. Finally, the Board has also considered whether staged ratings are appropriate in this case. The evidence reflects that the Veteran's symptomatology has been stable throughout the appeal period and was consistent with no more than a 20 percent rating since service connection was granted, effective May 12, 2015, for the right lower extremity and September 30, 2014, for the left lower extremity. Therefore, a staged rating is not warranted in this case. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.