Citation Nr: 21040880 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-15 666A DATE: July 7, 2021 ORDER Prior to August 1, 2016, a rating in excess of 10 percent for a lower back disability is denied. Since August 1, 2016, an increased evaluation of 40 percent, but no higher, for a lower back disability is granted. Entitlement to a rating of 20 percent, but no higher, for right lower extremity radiculopathy is granted. Prior to April 1, 2021, entitlement to a rating in excess of 10 percent, but no higher, for left lower extremity radiculopathy is granted. Since August 1, 2016, an increased evaluation of 20 percent, but no higher, for left lower extremity radiculopathy is granted. FINDINGS OF FACT 1. Prior to August 1, 2016, the Veteran's lower back disability was manifested by symptoms most closely approximating forward flexion of the spine greater that 60 degrees but not greater than 85 degrees. 2. Since August 1, 2016, the Veteran's lower back disability has manifested with symptoms most closely approximating forward flexion of the spine of 30 degrees or less. 3. Radiculopathy of the right lower extremity has manifested as no more than moderate incomplete paralysis of the sciatic nerve. 4. Prior to April 1, 2021, radiculopathy of the left lower extremity manifested as no more than mild incomplete paralysis of the sciatic nerve. 5. Since April 1, 2021, radiculopathy of the left lower extremity has manifested as no more than moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. Prior to August 1, 2016, the criteria for a rating in excess of 10 percent were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. Since August 1, 2016, the criteria for a 40 percent rating and no higher, for a lower back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 3. The criteria for a disability rating of 20 percent and no higher, for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 4. Prior to April 1, 2021, the criteria for a disability rating of 10 percent and no higher for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 5. Since April 1, 2021, the criteria for a disability rating of 20 percent and no higher, for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran was a member of the United States Army National Guard. She had a period of initial active duty training from May 1979 to October 1979 and was called to active Federal service from January 2004 to February 2005. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at a hearing before the undersigned in February 2019; a transcript has been associated with the file. This matter has been remanded twice previously, most recently in January 2021, for additional development including a VA back examination. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions and imposes upon the VA a duty to ensure compliance with the terms of the remand. Stegall v. West, 1 Vet. App. 268, 271 (1998). Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. The Board finds that there has been substantial compliance with the remand directives, and evidence sufficient for rating has been developed. The Veteran filed an application for TDIU in July 2020, during the pendency of her claim for an increased rating for her back. A November 2020 rating decision granted her application, finding TDIU since August 1, 2015. That is less than the entire period on appeal, as the claim for increase in this case was filed February 2015. At that time, the Veteran had a temporary total disability rating for her right knee replacement surgery, which continued until August 1, 2015, at which time, she was granted TDIU. The Court has recognized that a 100 percent schedular disability rating means that a Veteran is totally disabled. See Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a Veteran to be totally disabled due to a particular service-connected disability or combination of disabilities pursuant to the Rating Schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for a TDIU moot where 100 percent schedular rating was awarded for the same period). However, there are occasions when a Veteran having a 100 percent schedular rating does not moot a TDIU claim because the Veteran has not had the 100 percent schedular rating for the entire period under review or, as another example, she might qualify for a certain type of special monthly compensation (SMC). See Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Here, the Veteran was receiving SMC for the period of time between February 2015 and August 2015 based on her temporary total disability rating for her knee replacement surgery, so the award of TDIU for this time period would not entitle her to greater benefits. Accordingly, the Board will not further address TDIU in this decision. Increased Rating The Veteran submitted a claim for increased rating of her back disability in February 2015. As an increased rating claim, the Board looks at the evidence in the year prior to this date to see the earliest date that it is factually ascertainable that an increase occurred. 38 C.F.R. § 3.400. Here, however, in a June 2015 rating decision, the RO reduced the Veteran's rating for her lower back disability to 10 percent, effective April 29, 2015. In a September 2019 decision, the Board approved the reduction of her lower back rating from 20 percent to 10 percent as of April 2015. That same Board decision remanded the Veteran's claim for an increased rating for additional development relating to the period since April 2015 based on the Veteran's February 2019 testimony about worsening back pain. With respect to the Veteran's rating for her back disability under Diagnostic Code 5242-5237, this decision will only consider the period from April 29, 2015 to the present. The VA's Schedule for Rating Disabilities is used to determine disability ratings once a disability is service connected. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In the Rating Schedule, Diagnostic Codes are assigned to specific disabilities. These Diagnostic Codes designate percentage ratings based on the average functional impairment of the Veteran due to a service-connected disability. 38 C.F.R. §§ 3.321, 4.10. 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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). A layperson is generally not capable of opining on matters requiring medical knowledge. Lower Back The Veteran's lower back disability, described as degenerative disc disease (DDD), has been evaluated under Diagnostic Code 5242-5237. Hyphenated Diagnostic Codes denote that a condition is diagnosed and service-connected primarily under the first Code, but the criteria of the second are used to assign evaluations based on residuals or predominant manifestations. 38 C.F.R. § 4.27. VA amended the criteria for rating back disabilities effective from February 7, 2021. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after February 7, 2021. With regard to the Veteran's low back disability, the substance of the criteria is unchanged; the amendments addressed changes in terminology and diagnosis which have no impact in this case. Under the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain, whether or not it radiates, stiffness, or aching in the area of the spine affected by the residuals of injury or disease, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm or 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 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 disability of the thoracolumbar spine when there is forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine is evaluated as 50 percent disabling, and unfavorable ankylosis of the entire spine is evaluated as 100 percent disabling. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. In addition, the General Rating Formula for Diseases and Injuries of the Spine provides, in pertinent part, the following: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. In evaluating any disability on the basis of limitation of motion, VA must consider the actual degree of functional impairment imposed by pain, incoordination, weakness, fatigue, and lack of endurance with repetitive motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). In DeLuca, it was held that when the pertinent diagnostic criteria provide for a rating on the basis of loss of range of motion, determinations regarding functional losses are to be "'portray[ed]' (38 C.F.R. § 4.40 ) in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups." 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." 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 Board notes that the Veteran was provided with VA examinations in April 2015, October 2019, and April 2021. All of these examinations concerning range of motion findings are not adequate because they do not comply with Sharp, 29 Vet. App. 26. Therefore, the Board may not rely on the range of motion findings to deny the Veteran's claim. Even so, the Board will discuss the findings of the examinations, other than range of motion, relevant to the Veteran's claim. The Veteran contends that she is entitled to a higher rating for her lower back disability. The Veteran's lower back disability is currently rated as 10 percent disabling since April 29, 2015, under Diagnostic Code 5237. Since October 29, 2019, the Veteran's back has been rated as 20 percent disabling under Diagnostic Code 5237. Prior to August 1, 2016 At the April 2015 VA examination, the Veteran reported that her back made it difficult for her to stand and that she needed a cane for support. She described pain radiating down both legs when she bent over, and that her pain increased when she reached up high, did housework, drove, or sat for a long time. She used muscle relaxers, pain medication and a TENS unit to help relieve her back pain, bringing her TENS unit with her when she left the house for long periods of time. Physical examination measured 80 degrees of forward flexion, with a total of 190 degrees combined range of motion. Pain on extension was observed on testing but the examiner did not specify a degree of onset, and concluded that it did not cause additional loss of use. Although the Veteran described how particular activities worsened her back pain, the examiner concluded that there were no flare ups, and did not attempt to ascertain the Veteran's functioning during these periods of worsening. Repetitive use testing did not reduce motion. The examiner indicated that the Veteran was being examined immediately after repetitive use over time, and concluded that pain, weakness, fatigability, or incoordination did not significantly limit her functional ability. The Veteran had full muscle strength, intact sensation and normal reflexes in her lower extremities, and straight leg raise tests were negative bilaterally. The Veteran reported regular use of a cane and occasional use of a brace to help her walk, explaining that when her back pain worsened, she wore the back brace more often. The Veteran testified that since the April 2015 VA examination, her back condition has worsened. Subsequent VA treatment records show that in June 2015, the Veteran sought treatment for intermittent low back pain that she described as radiating to her right hip. A triage note indicates that the Veteran was able to ambulate without assistance, and the orthopedic surgeon prescribed a "lumbosacral arthrosis" to be worn as needed. He also advised the Veteran to avoid bending, twisting, heavy lifting, prolonged sitting and standing, as well as to sleep in the semi-Fowler's position. In addition to muscle relaxers, he gave her an injection of pain medication for her back, instructing her to return for follow up as needed. In July 2015, the Veteran was fitted for a semi-rigid back orthotic by the VA prosthetic shop. The record documents little additional treatment for the Veteran's back between July 2015 and August 2016. As noted above, the Board previously found that the Veteran's back disability had shown sustained improvement and was most consistent with a 10 percent rating as of April 2015. The record shows minimal treatment for back pain between April 2015 and August 2016 with no objective findings of worsening on examination. Prior to August 1, 2016, the Veteran's symptoms did not approximate a limitation of flexion to less than 60 degrees but more than 30 degrees to warrant a rating in excess of 10 percent. Although the Veteran was experiencing some limitations due to her back disability, she did not report an inability to perform the normal activities of living such as housework or walking. Further, measured range of motion was 80 degrees in April 2015, and no marked increase in functional impairment was noted from that point; the orthopedist recommended that the Veteran avoid heavy lifting, prolonged sitting or standing, but there is no indication of a limitation to 60 degrees flexion or less. Even resolving all doubt in favor of the Veteran, the evidence does not support assignment of a rating in excess of 10 percent prior to August 1, 2016. Since August 1, 2016 Since August 1, 2016, the Board finds that a 40 percent rating is warranted for the Veteran's lumbar spine disability, as her symptoms have most closely approximated a limitation of forward flexion to less than 30 degrees. On August 1, 2016, the Veteran sought treatment at a private urgent care clinic for uncontrolled low back pain radiating down her left leg. After physical examination showed normal range of motion without pain and tenderness to palpation across her lower back, she was diagnosed with muscle spasms and low back pain. That same month, an orthopedic surgeon at the VA observed negative straight leg raise tests, no muscle spasms, tenderness to palpation in the Veteran's back, and full lumbar range of motion with pain at the extremes, although he did not record the degree of onset of pain. A September 2016 VA physical therapy evaluation documented a positive straight leg raise test, tenderness to palpation in the Veteran's lumbar paravertebral muscles and a significantly limited lumbar range of motion. The evaluator did not provide range of motion measurements in degrees. At that evaluation, the Veteran reported that her back pain was aggravated by bending and lifting. She also described back pain radiating down both of her legs to her knees. Private treatment records show that in October 2016, the Veteran denied symptoms of radiculopathy, and physical examination showed a normal gait, minimal tenderness in the lumbosacral region, full muscle strength and discomfort on the straight leg raise test. The Veteran was in a September 2016 car accident and complained of increased back pain. October 2016 medical imaging showed significant scoliosis and degenerative changes at L4-L5, but no acute changes. Those same records show a negative straight leg raise test and no sciatic stretch signs in December 2016. At a January 2017 follow-up appointment, the Veteran reported intermittent left lumbar and left leg pain. Physical examination showed tenderness in the left lumbosacral region with mild discomfort on straight leg raise testing. At a June 2018 annual assessment for Blue Advantage, the Veteran denied active musculoskeletal disorders or pain and had a normal range of motion. In February 2019, the Veteran testified that her back disability had worsened. She described that repeated bending over aggravated her back pain and at times, her back pain would go down one or both of her legs. At the October 2019 VA examination, the Veteran reported that her back pain had worsened, requiring her to have assistance with activities such as cleaning and prevented her from standing, walking, or sitting for prolonged periods of time. She described intermittent sharp pain in her lower back and down her right leg that was aggravated by activity. The Veteran said these flare-ups lasts a couple of days. Physical examination showed 60 degrees of forward flexion, with pain noted on forward flexion, extension, lateral flexion and on weightbearing. The examiner did not record the degree of onset of pain. While the examiner concluded that the Veteran's pain caused functional loss, the examiner did not quantify the functional loss or express it in terms of degrees of range of motion. The examiner recorded that there was no change in the Veteran's range of motion after repetitive use testing. While the Veteran was not being examined immediately after repetitive use over time or during a flare up, the examiner concluded pain, weakness and fatigability significantly limited the Veteran's functional ability. However, the examiner was not able to describe this limitation in terms of degrees of range of motion, and indicated that the examination was neither consistent nor inconsistent with the Veteran's description of functional loss within repeated use over time or during flare-ups. The examination showed muscle spasms as well as guarding resulting in an abnormal gait or spine contour. The Veteran had diminished strength in her right hip and knee, with full muscle strength in her left leg. She had normal reflexes in both legs, although decreased sensation in her right thigh was documented. Straight leg raise tests were negative on the left side and positive on the right side. Due to her back disability, the Veteran reported regularly using a cane and occasionally using a back brace to walk. The examiner concluded that the Veteran's right leg radiculopathy was a progression on her service-connected back disability. VA treatment records show that the Veteran continued to seek treatment for her back pain, and doctors renewed her prescriptions for muscle relaxers, topical analgesics, and non-steroidal anti-inflammatory medication. By January 2021, VA treatment records show that the Veteran was referred to physical therapy for her back. At the April 2021 VA examination, the examiner noted that the Veteran had been diagnosed with bilateral lower extremity radiculopathy since 2016. The Veteran described increased pain with bending and pain radiating down both legs, and at times, she cannot sit on the toilet or get out of bed. The examiner concluded that the Veteran did not have flare-ups, and did not elicit additional information from the Veteran regarding her functional loss during these flare-ups. Physical examination showed 50 degrees of forward flexion, with pain on flexion, extension, bilateral flexion, and bilateral rotation. However, the examiner did not document the degree of onset of pain. Passive range of motion testing was not conducted because the Veteran was using a cane and had poor balance, raising concerns for a fall. The examiner observed objective evidence of severe tenderness or pain on palpation at L4-L5. There was no reduction in range of motion after repetitive use testing. Although the examination was not conducted immediately after repeated use over time, the Veteran's statements suggested functional loss due to pain and lack or endurance with repeated use over time. However, examiner estimated there would be no additional range of motion loss with repeated use over time. The examiner documented guarding that resulted in abnormal gait or abnormal spine contour, and identified less movement than normal as an additional factor contributing to disability. She noted that the Veteran's limited range of motion impaired her ability to do most tasks. The Veteran had diminished muscle strength in both legs without atrophy, normal reflexes, and intact sensation. Her straight leg raise tests were negative. The examiner noted the Veteran had moderate intermittent pain in both legs, with mild bilateral numbness and paresthesias. She concluded that the Veteran's sciatic nerve root was involved bilaterally. There was no ankylosis, but the examiner noted that the Veteran had an antalgic gait and used a cane on her right side. The Veteran is competent to report the functional limitations caused by her intermittent back pain. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the measurements taken at the October 2019 and April 2021 VA examinations are in excess of 60 degrees of forward flexion, the examiners did not note where on range of motion the Veteran's pain began, and did not account for the Veteran's descriptions of the limitations caused by her back pain during flare-ups. Although the April 2021 VA examiner estimated that the Veteran's range of motion after repetitive use over time and flareups would be 50 degrees in forward flexion, this is inconsistent with the examiner's own conclusion that pain and lack of endurance would cause additional functional loss after repeated use over time. This estimate is given no probative weight. The Veteran has reported having difficulty sitting on the toilet and getting out of bed due to back pain, and the April 2021 examiner was unable to perform passive range of motion testing due to concerns about severe pain and the Veteran's risk of falling due to her poor balance and use of a cane. These observations are more consistent with a limitation of forward flexion to less than 30 degrees. As found in the January 2021 Board remand, the October 2019 VA examination was inadequate, and the Board instructed the examiner to provide a retrospective assessment, if possible, of the Veteran's functional loss since April 2015. The April 2021 examiner did not explicitly do so, but extending all benefit of the doubt to the Veteran, the Board finds that the Veteran's lower back disability symptoms, including her descriptions of her symptoms and functional losses during flare-ups have most closely approximated a limitation to less than 30 degrees of forward flexion since she sought urgent treatment for uncontrolled back pain on August 1, 2016. The Veteran's symptoms do not more closely approximate unfavorable ankyloses of her entire thoracolumbar spine or unfavorable ankylosis of the entire spine required for the 50 percent and 100 percent ratings, respectively. Although at times, the Veteran is unable to sit on the toilet and has trouble getting out of bed, this is most consistent with a limitation to less than 30 degrees of forward flexion. In sum, the Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for a lower back disability since August 1, 2016. Lower Extremity Radiculopathy Evaluation of the spine also requires assessment of neurological complications, including radiculopathy. Diagnostic Code 8520 provides the rating criteria for paralysis of the sciatic nerve. Mild incomplete paralysis of the sciatic nerve warrants a 10 percent rating. A 20 percent rating requires moderate incomplete paralysis of the sciatic nerve. A 40 percent rating requires moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating requires severe incomplete paralysis with marked muscular atrophy. An 80 percent rating requires complete paralysis. When there is complete paralysis, 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. The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at Diseases of the Peripheral Nerves in 38 C.F.R. § 4.124 (a). The words "mild," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. At the March 2013 VA examination, the Veteran did not report any symptoms of radiculopathy, and physical examination showed that she had full muscle strength, normal reflexes, and intact sensation in her bilateral lower extremities. VA treatment records show that the Veteran complained of intermittent pain radiating down her right leg beginning on May 13, 2014, when she underwent a physical therapy evaluation. The physical examination showed slightly decreased muscle strength in the myotomes of her bilateral lower extremities, although her straight leg raise test was negative and her deep tendon reflexes were normal. At the April 2015 VA examination, the Veteran reported that she experienced pain in both of her legs whenever she bent over. She regularly used a cane to help her walk, and occasionally used a back brace. Despite this report, the examiner concluded that the Veteran did not have any symptoms of radiculopathy. VA treatment records show that the Veteran complained of pain from her back radiating to both legs in September 2016, February 2019, and October 2019. The October 2019 VA examiner diagnosed the Veteran with right leg radiculopathy and noted decreased muscle strength and sensation in the Veteran's right leg as well as mild paresthesias. The Veteran had full muscle strength and intact sensation in her left leg. A straight leg raise test was positive on her right side. Although the Veteran described episodes lasting several days of severe pain radiating down both legs, the October 2019 examiner characterized her symptoms as mild right lower extremity radiculopathy. The April 2021 VA examiner found that the Veteran had been diagnosed with bilateral radiculopathy in 2016. The examiner observed diminished muscle strength, moderate intermittent pain, as well as mild paresthesias and numbness in both legs. At this same examination, the Veteran described her radicular pain as an 8 out of 10. The evidence shows that the Veteran has used a cane on her right side since at least April 2015. The Veteran is competent to describe the nature, frequency, and severity of her radicular pain. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, contemporaneous reports, and statements made to treatment providers for purposes of diagnosis and treatment are generally considered more probative evidence. Rucker v. Brown, 10 Vet. App. 67, 73 (1997). The Veteran has repeatedly described her radicular pain as intermittent, so the instances in the treatment record where she denies radicular symptoms are consistent with her description of her symptoms. The Board finds her statements competent and credible. The Board finds that there was an ascertainable increase in the Veteran's symptoms of radiculopathy within in a year of her claim for increased compensation for her back disability, specifically May 13, 2014. 38 C.F.R. § 3.400(o)(2). The Veteran had not consistently reported neurological symptoms in her legs prior to May 2014. See March 2013 VA examination. Previous physical examinations had likewise not documented objective findings of neurological abnormalities, until the May 13, 2014 physical therapy evaluation examination where bilateral myotome weakness was observed by the clinician. Right Lower Extremity Currently, the Veteran's right lower extremity radiculopathy is rated as 10 percent disabling, effective October 29, 2019. Based on the above, the Board finds that the Veteran's right lower extremity radiculopathy was primarily manifested by diminished muscle strength, sensory disturbance, and pain, most closely approximating moderate symptoms. The Board notes that the April 2015 VA examiner did not account for the Veteran's credible and competent lay reports of neurological symptoms. The October 2019 VA examination documented that the Veteran used a cane to ambulate, had slightly diminished muscle strength, periods of severe pain lasting several days and diminished sensation. The most probative evidence of record is against a finding that her right lower extremity was manifest by muscle atrophy, loss of reflexes or complete paralysis. Such warrants assignment of a 20 percent evaluation for moderate radiculopathy of the right lower extremity. Left Lower Extremity Currently, the Veteran's left lower extremity radiculopathy is rated as 10 percent disabling, effective April 1, 2021. The Board finds that the Veteran's left lower extremity radiculopathy was primarily manifested by pain with some diminished muscle strength prior to April 1, 2021, most closely approximating mild symptoms. The evidence of record shows that the for much of the period on appeal, the Veteran's left leg neurological symptoms were generally less severe than her right leg. Although she consistently reported radiating pain in both legs when bending over, physical examinations consistently documented normal strength and intact sensation in her left leg until April 2021. Treatment records similarly document that her complaints were generally focused on her right leg. At the April 1, 2021 VA examination, physical examination showed diminished muscle strength, paresthesia, and numbness as well as moderate intermittent pain in the Veteran's left leg. The findings on examination for the Veteran's left leg were the same as those for her right leg, and she described her pain as an 8 out of 10. Given the objective evidence of loss of strength and parasthesia on the Veteran's left leg, and the Veteran's credible and competent reports of her pain and functional loss, the Board finds that since April 1, 2021, her left lower extremity radiculopathy has manifested as pain, slightly diminished muscle strength, and sensory disturbances which most closely approximately moderate symptoms. The most probative evidence of record is against a finding that her right lower extremity was manifest by muscle atrophy, loss of reflexes or complete paralysis. As such, the evidence warrants a 20 percent evaluation, and no higher, for moderate radiculopathy of the left lower extremity since April 1, 2021. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Megan-Brady Viccellio 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.