Citation Nr: 21041693 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 14-10 395 DATE: July 9, 2021 ORDER Entitlement to a disability rating in excess of 20 percent from March 22, 2018 to October 30, 2019 and in excess of 10 percent thereafter for a service-connected lumbar spine disability is denied. Entitlement to an initial disability rating of 20 percent, but no higher, for a service-connected cervical spine disability is granted. FINDINGS OF FACT 1. Between March 22, 2018 and October 30, 2019, the Veteran's lumbar spine disability was manifested by forward flexion of no less than 40 degrees and a combined range of motion of 180 degrees with pain; ankylosis and incapacitating episodes for VA rating purposes were not shown. 2. From October 30, 2019, the Veteran's lumbar spine disability is manifested by forward flexion limited to 85 degrees and a combined range of motion limited to 185 degrees with pain; muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, ankylosis, and incapacitating episodes for VA rating purposes were not shown. 3. Throughout the period on appeal, the Veteran's cervical spine disability is manifested by no more than pain and decreased range of motion with flexion of the cervical spine limited to no less than 30 degrees and a total combined range of motion of the cervical spine no less than 235 degrees; there is no objective evidence of ankylosis or associated neurological disabilities. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent for the period between March 22, 2018 and October 30, 2019, and in excess of 10 percent thereafter, for the Veteran's lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5010-5243. 2. The criteria for an initial disability rating of 20 percent, but no higher, for a cervical spine disability have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1990 to October 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in September 2012 and March 2014 of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded in August 2016, January 2018, and June 2018. In a June 2020 decision, the Board denied the issues currently on appeal. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a March 2021 Order, the Court remanded the claim to the Board for actions consistent with an March 2021 Joint Motion for Partial Remand filed by the parties. Increased Ratings A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (holding that it is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis. 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. 1. Entitlement to a disability rating in excess of 20 percent from March 22, 2018 to October 30, 2019 and in excess of 10 percent thereafter for a service-connected lumbar spine disability The Veteran asserts that increased ratings are warranted for his service-connected lumbar spine disability based on worsening symptomatology during flares. His back disability is currently rated as 20 percent prior to October 30, 2019, and as 10 percent thereafter, pursuant to Diagnostic Code 5010-5243. 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 indicates that traumatic arthritis (Diagnostic Code 5010) is rated pursuant to the criteria for intervertebral disc syndrome (IVDS) (Diagnostic Code 5243). Diagnostic Code 5243 states that IVDS should be rated under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The Notes following the General Rating Formula provide further guidance in rating diseases or injuries of the spine. Note (1) states that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Formula for Rating IVDS), provides a 10 percent rating for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS 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 rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A maximum a 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) to Diagnostic Code 5243 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. Note (2) provides that, if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a. Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76,453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a). When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran's claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the updated regulations from February 7, 2021 forward, applying the most favorable criteria for the Veteran. The changes effective February 7, 2021 under 38 C.F.R. § 4.71a, Diagnostic Code 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under Diagnostic Code 5243 and all other intervertebral disc disabilities under 5242. As such, Diagnostic Code 5242 now reflects "Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either diagnostic code 5003 or 5010)". Diagnostic Code 5243 now reflects "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses." As such, the changes do not impact the general rating formula and evaluation of the disability under the pre-and post-February 7, 2021 regulations is not required. Turning to the evidence of record, the Veteran was afforded a VA examination in March 2018. The examiner diagnosed the Veteran with degenerative arthritis of the spine, IVDS, and mechanical back strain/spondylolysis. The Veteran reported daily back pain and stiffness with flare-ups that occur with sitting, standing, bending, lifting, immobility, and driving. He noted that he forces himself to stretch more during flares and to stand more or to sit less. Range of motion testing revealed forward flexion limited to 60 degrees, extension limited to 30 degrees, and a combined range of motion of 200 degrees. The examiner indicated that while the Veteran's range of motion was abnormal, the range itself did not contribute to a functional loss. Pain was noted on examination during flexion and extension and was noted to cause a functional loss. There was pain with weight bearing but no objective evidence of localized tenderness or pain on palpation of the joints and no loss of function or range of motion on repetition. The examiner stated that pain and weakness could significantly limit functional ability during flareups or when the spine is used repeatedly over time and additional limitation was likely to occur. Although the examiner stated it would be speculation to estimate the loss without observing a flare, the Veteran showed the examiner that his range of motion decreases to about 40 degrees of forward flexion during flares. There was no evidence of guarding or muscle spasms, and muscle strength testing was normal with no indication of muscle atrophy or ankylosis. Reflex and sensory examinations were also normal. The examiner noted radicular pain and symptoms in the right lower extremity. Although the examiner found IVDS, the Veteran was not prescribed bed rest by a physician in the preceding 12 months. VA treatment records from July 2018 indicate that the Veteran reported chronic, dull low back pain that was worse with activity but "fairly well controlled" on his ibuprofen and Gabapentin. He stated that his pain level is typically a 4 out of 10 but is aggravated by holding objects. He further noted that he does not let his back pain hold him back in day-to-day activities. A chiropractic note from October 2018 states that the Veteran reported his back was feeling "quite well" despite a flare of pain "slightly" when the temperature dopped. He indicated the pain leveled off and he continued to exercise more regularly. In November 2018, the Veteran reported that his back was very tight but he attributed such to working on his house and doing yardwork. He indicated he was still exercising regularly. In August 2019, the Veteran reported mild pain with flexion of the back and lateral bending but there was no pain to palpation. His gait was described as normal and there were no obvious focal neurologic findings. The Veteran indicated that chiropractic treatment helped his back pain "quite a bit" the previous year and that his pain appeared to be stable on his medication regimen. The Veteran was afforded an additional VA back examination in October 2019. The examiner diagnosed the Veteran with degenerative arthritis of the spine, IVDS, and bilateral L5 spondylolysis with grade I L5- S1 spondylolisthesis. The Veteran reported that his back pain at rest was a 3 or 4 out of 10 and made him uncomfortable, feeling like he needs to stretch out his back. On a bad day, the Veteran reported pain increases to 7 out of 10 and he does not feel like doing anything. He noted that this occurs a few days per week by the end of the day, depending on what he has done, to include lifting or standing and sitting more than normal. The Veteran stated that the pain during these times is sharp and uncomfortable, radiating up the back and causing tight muscles. He was treated with ibuprofen, Gabapentin, and heat as needed. However, the Veteran denied flare-ups of thoracolumbar spine pain. He described functional loss as a loss of endurance causing him to switch to a desk job because he cannot bend like he used to. He stopped running and working out at the gym because he is afraid of injuring his back. Range of motion testing revealed forward flexion to 80 degrees, extension to 15 degrees, and a combined range of motion of 190 degrees. The examiner indicated that there was pain noted during all ranges of motion but that such did not result in functional loss. There was no evidence of pain with weight bearing or objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the lumbar spine. The Veteran was able to perform repetitive use testing, but such resulted in a loss of function or range of motion. On repetition, range of motion revealed flexion to 80 degrees, extension to 15 degrees, and combined range of motion of 185 degrees. There was no evidence of guarding or muscle spasm. Muscle strength testing and sensory examinations were normal. There was no evidence of muscle atrophy or ankylosis. Deep tendon reflexes were normal in the left lower extremity, but they were hypoactive in the right lower extremity. Radiculopathy was indicated in the right lower extremity, but no other neurologic abnormalities or findings were recorded. The examiner stated that the Veteran had IVDS, but he had not required bed rest prescribed by a physician in the past 12 months. Diagnostic testing revealed arthritis. The examiner explained that the Veteran's functional loss was manifested by the loss of endurance for activity. After consideration of the above, between March 22, 2018 and October 30, 2019, the Veteran's service-connected lumbar spine disability symptomatology is more nearly approximated by 20 percent rating criteria under the Diagnostic Code 5010-5243 because his forward flexion decreased to 60 degrees. Even considering his estimated decrease to 40 degrees of flexion during flare, such does not warrant a higher evaluation, as forward flexion must be limited to 30 degrees or less for a 40 percent disability rating. From October 30, 2019, the date of the VA examination, the available evidence of record indicates that the Veteran was limited to forward flexion of no less than 80 degrees or a combined thoracolumbar range of motion of 190 degrees. Even considering his loss of endurance on repetition, the Veteran's thoracolumbar spine was limited to 80 degrees of forward flexion and a combined range of motion of 185 degrees. Therefore, for the period from October 30, 2019, the Veteran's symptomatology for a lumbar spine disability more nearly approximates the criteria for a 10 percent disability rating under Diagnostic Code 5010-5243. The Board has considered whether the Veteran's back disability resulted in a level of functional loss greater than that already contemplated by the assigned ratings throughout the period on appeal. DeLuca, 8 Vet. App. at 206; 38 C.F.R. §§ 4.40, 4.45. Specifically, the Board has considered the Veteran's reports of flares, to include after periods of prolonged use and during changes in the weather. However, the Board does not find evidence of limited functionality warranting an increased rating at any time during the appeal period. Notably, while the Veteran reported flares of back pain, he also stated that he did not allow his pain to limit him and that he was able to continue exercising. He noted a flare of pain attributed to doing work around the house and yardwork but stated that his prescribed medication provided relief. The Veteran has not provided any specific narrative describing how his back disability reduced his range of motion to a point that a higher disability rating is warranted during either appeal period. At most, there appears to be pain on motion that did not limit functionality of the thoracolumbar spine. See Mitchell, 25 Vet. App. at 32 (pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system.). There is no evidence of ankylosis (functional or diagnosed) in any of the available evidence. Further, the evidence does not reflect that the Veteran experienced any incapacitating episodes requiring bed rest and treatment by a physician for the requisite duration at any time during the appeal period. To receive a higher rating for incapacitating episodes, the Veteran must have a total duration of at least two weeks or more, that requires bed rest prescribed by a physician and treatment by a physician. Although the Veteran was found to have IVDS, no muscle spasms were reported to any degree during any of the VA examinations. Furthermore, the Veteran did not report, and the evidence does not otherwise show, prescribed bed rest during any period for the requisite duration. Therefore, the criteria for a higher rating under the Formula for Rating IVDS have not been met. 38 C.F.R. § 4.71a, Diagnostic Code 5010-5243. The Board acknowledges the Veteran's contentions that his service-connected lumbar spine disability warrants an increased evaluation. Lay people are competent to report on matters observed or within their personal knowledge, such as back pain. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Furthermore, there is no reason to doubt his credibility. However, the Board must emphasize that the Veteran is not competent to accurately interpret clinical findings pertaining to musculoskeletal disorders, to include a lumbar spine disability, as this requires specialized knowledge and training. 38 C.F.R. § 3.159(a)(1); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The VA examination reports are completed by medical professionals and are specifically responsive to the diagnostic criteria in VA's schedule of ratings and include consideration of the Veteran's lay reports. Consequently, the Board finds the VA examination reports and medical evidence of record more probative in determining the severity of the Veteran's service-connected lumbar spine disability. The Board has also considered whether a separate evaluation for any neurological disability is warranted. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). However, the Veteran is currently compensated for right lower extremity radiculopathy, and no other neurological impairments are shown in the lay or medical evidence of record warranting a separate evaluation. In light of the above, the Board finds that the Veteran is not entitled to a disability evaluation in excess of 20 percent between March 22, 2018 and October 30, 2019 or in excess of 10 percent thereafter for his service-connected lumbar spine disability. A preponderance of the evidence weighs against the assignment of an increased evaluation, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). The claim is denied. 2. Entitlement to an initial disability rating in excess of 10 percent for a service-connected cervical spine disability The Veteran asserts that a higher initial rating is warranted for his service-connected neck disability. The Veteran's cervical spine disability is rated under Diagnostic Code 5237, for cervical strains, which also applies the General Rating Formula. Under the applicable diagnostic criteria, a 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5237. A 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees. Id. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Id. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine. Id. Finally, a 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. As above, Note (1) indicates that any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code. Note (2) states that for VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Turning to the evidence of record, private chiropractic treatment records from July 2013 reveal range of motion testing for the cervical spine with forward flexion limited to 35 degrees with stiffness and extension limited to 20 degrees without pain. Combined range of motion was 235 degrees. The Veteran was afforded a VA examination in January 2014. He reported that his neck always feels like it needs to be stretched out and that flare ups occur during prolonged sitting. Range of motion testing revealed forward flexion limited to 45 degrees with pain at 30 degrees and extension to 45 degrees with pain at 30 degrees. The Veteran's combined range of motion was limited to 310 degrees when considering pain. The Veteran was able to perform repetitive use testing without additional loss in range of motion but with pain on movement. There was no objective evidence of pain to palpation or muscle spasms, but there was guarding not resulting in an abnormal gait or spinal contour. Muscle strength, sensory, and reflex examinations were normal. There was no evidence of radicular pain or other neurologic abnormalities, and no evidence of ankylosis of the cervical spine. The examiner found that the functional ability of the Veteran's cervical spine would not likely be limited during flare ups or when the neck was used repeatedly over a period of time, as the cervical spine disability was mild. The Veteran was afforded an additional VA neck examination in August 2016. The examiner confirmed the Veteran's diagnosis of cervical strain. The Veteran reported experiencing flare ups after staring at his computer causing loss of motion in his cervical spine. Range of motion testing revealed forward flexion limited to 40 degrees, extension limited to 40 degrees, and a combined range of motion of 310 degrees. Pain was noted on examination during forward flexion, and there was evidence of mild paracervical tenderness on examination. The Veteran was able to perform repetitive use testing without additional loss of range of motion and the examiner did not find that pain, weakness, fatigability, or incoordination would significantly limit the Veteran's functional ability with flare-ups. There was no evidence of muscle spasms, guarding, atrophy, or ankylosis. Muscle strength and sensory examinations were normal while reflexes were hypoactive. Further, there was no evidence of cervical radicular pain or other neurologic abnormalities, and diagnostic testing did not reveal arthritis or any other significant findings. The Veteran was afforded another a VA neck examination in March 2018. At that time, the examiner diagnosed the Veteran with a cervical spine strain. The Veteran reported daily neck pain with flares that occur with moving his head and neck, extended sitting or standing, lifting, and overhead use that cause immobility and require the Veteran to move around and stretch more. Range of motion testing was noted to be abnormal with forward flexion to 45 degrees, extension to 45 degrees, and a combined range of motion of 310 degrees. The examiner noted that the range of motion did not contribute to a functional loss but that the Veteran exhibited pain on forward flexion. There was no evidence of pain with weight bearing or localized tenderness or pain on palpation of the joint. The Veteran was able to complete repetitive use testing without additional loss of function or range of motion. The examiner was unable to state whether pain, weakness, fatigability, or incoordination would significantly limit the Veteran's functional ability with repeated use over a period of time without observing such but noted that the Veteran did not exhibit it at the examination. There was no guarding or muscle spasm of the cervical spine. Muscle strength testing was normal without evidence of muscle atrophy or ankylosis. Reflex and sensory examinations were normal. No neurologic abnormalities were indicated. The examiner noted that there was mild pain on active range of motion and weight bearing but passive range of motion and non-weight bearing testing was not performed. The examiner further stated that based on the Veteran's reporting, there did not appear to be a true lack of endurance or functional loss due to pain and pain on use, as he stated he will stretch more and move around. In an April 2018 addendum opinion, the examiner explained that manipulating the head and neck/cervical spine can be potentially injurious, even in cases where minimal or mild physical symptoms may be present. Hence, in many cases, it may be unwise to purposefully manipulate the cervical spine for fear of injury. However, the examiner reported that passive range of motion testing revealed flexion to 40 degrees, extension to 35 degrees, and a combined range of motion of 275 degrees. A final VA neck examination was conducted in October 2019. The Veteran reported a constant dull ache with a pain level of 2 out of 10 that increases to 6 or 7 out of 10 on a "bad day", with throbbing pain that can give him a migraine. He noted stiffness and loss of range of motion at times and stated he takes ibuprofen and Gabapentin daily for the pain. The Veteran did not report any functional loss due to his cervical spine disability. Range of motion testing revealed forward flexion to 45 degrees, extension to 45 degrees, and a combined range of motion of 280 degrees. Pain was noted on examination during all ranges of motion, but the examiner stated that it did not result in or cause functional loss. There was evidence of pain with weight bearing and localized tenderness or pain on palpation of the mid-cervical paravertebral muscles that was mild. The Veteran was able to perform repetitive use testing without loss of range of motion on repetition. The examiner found that weakness, fatigability, or incoordination would not significantly limit functional ability with repeated use over a period of time. The examination was negative for localized tenderness, guarding, or muscle spasms of the cervical spine. Muscle strength, reflex, and sensory examinations were normal and there was no atrophy or ankylosis. No symptoms of radiculopathy or any other neurologic abnormalities were noted. Further, there was no IVDS of the cervical spine and diagnostic testing did not reveal arthritis. The examiner indicated that passive range of motion of the spine was not performed as it was not feasible to do such in a safe and reasonable manner. Further, there was no objective evidence of pain when the spine was in a non-weight bearing position at rest, so non-weight bearing was similarly not performed. After a review of the above and affording the Veteran the benefit of every doubt, the Board finds that the Veteran is entitled to an increased initial evaluation of 20 percent for his cervical spine disability. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Notably, during the January 2014 VA examination, the Veteran's forward flexion was limited to 30 degrees when considering pain. However, there is no evidence that a rating in excess of 20 percent is warranted for the Veteran's service-connected cervical spine disability at any point during the appeal period. Specifically, neither forward flexion of the cervical spine 15 degrees or less nor favorable ankylosis of the entire cervical spine has been shown. The Board has considered the Veteran's own statements regarding the severity of his neck disability during the period on appeal, to include any periods of flares, as well as the private and VA treatment records available. Unfortunately, there is no basis upon which to grant an increased rating. Notably, while the Veteran described his neck pain increasing to 6 or 7 out of 10 during flare-ups, the examiners regularly described his cervical spine disability as mild and there was no indication of decreased functionality after prolonged use. Indeed, the Veteran himself described stiffness and indicated that increased stretching was necessary during flares, leading the March 2018 VA examiner to opine that there did not appear to be a true lack of endurance or functional loss due to pain and pain on use. Further, the available imaging studies did not reveal any significant findings, to include arthritis, and treatment records do no show regular treatment for neck complaints, with the Veteran reporting treatment with ibuprofen and Gabapentin. Finally, the VA examinations do not indicate relevant sensory or other neurological abnormalities, and the one-time finding of hypoactive reflexes in August 2016 did not appear limiting and had resolved by the next examination in March 2018. The Veteran has not provided any specific narrative describing how his neck disability reduced his range of motion to a point that a higher disability rating is warranted at any point during the appeal period. At most, there appears to be pain on motion that did not further limit functionality of the cervical spine. See Mitchell, 25 Vet. App. at 32 (pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system.). There is certainly no evidence of ankylosis (functional or diagnosed) in any of the available evidence. The Board has also considered whether a separate evaluation for any neurological disability is warranted. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). However, there is no competent evidence of record to indicate the Veteran suffers from a neurological impairment, to include upper extremity radiculopathy or bowel or bladder impairment, that would warrant a separate evaluation. Indeed, the VA examinations of record are specifically responsive to such inquiries. The Board also acknowledges the Veteran's contentions regarding an increased evaluation for his service-connected cervical spine disability. The Veteran is competent to report that which comes to him through his senses, like pain and limitation of motion of his cervical spine. However, as to the specific issue in this case, the question of the medical severity of a specific joint falls outside the realm of common knowledge of a lay person. Jandreau, 492 F.3d 1372. Here, the current severity of the Veteran's spine disability is a matter suited to the realm of medical expertise. As such, to the extent the Veteran is addressing questions of the severity of his cervical spine disability, the Board finds that his statements are not competent lay evidence. Notwithstanding, the probative medical evidence of records outweighs the Veteran's lay statements. In light of the above, the Board finds that the Veteran is entitled to a disability evaluation of 20 percent, but no higher, for his service-connected cervical spine disability throughout the period on appeal. 38 U.S.C. § 5107(b). The claim is granted to this extent only. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.