Citation Nr: 21041785 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 14-05 761 DATE: July 10, 2021 ORDER For the period prior to January 5, 2016, an initial evaluation higher than 10 percent for back strain with degenerative disc disease of the thoracolumbar spine is denied. For the period from January 5, 2016 to April 20, 2021, an initial evaluation of 40 percent, but no higher, for back strain with degenerative disc disease of the thoracolumbar spine is granted. For the period from April 21, 2021, an initial evaluation higher than 40 percent for back strain with degenerative disc disease of the thoracolumbar spine is denied. For the period prior to February 28, 2018, an initial 10 percent evaluation, but no higher, for gastroesophageal reflux disease (GERD) is granted. REMANDED The appeal regarding the evaluation of right lower extremity radiculopathy is remanded. FINDINGS OF FACT 1. Prior to January 5, 2016, back strain with degenerative disc disease of the thoracolumbar spine was manifested by forward flexion limited to 65 degrees by pain, and combined range of motion of the thoracolumbar spine of 195 degrees, with no evidence of muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour. 2. From January 5, 2016, back strain with degenerative disc disease of the thoracolumbar spine is manifested by forward flexion limited to 30 degrees, with no evidence of ankylosis. 3. Prior to February 28, 2018, GERD was manifested by persistent heartburn and reflux, with no considerable overall health impairment. CONCLUSIONS OF LAW 1. For the period prior to January 5, 2016, the criteria for an initial evaluation higher than 10 percent for back strain with degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5237, 5242, 5243. 2. For the period from January 5, 2016 to April 20, 2021, the criteria for an initial evaluation of 40 percent, but no higher, for back strain with degenerative disc disease of the thoracolumbar spine have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5237, 5242, 5243. 3. For the period from April 21, 2016, the criteria for an initial evaluation higher than 40 percent for back strain with degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5237, 5242, 5243. 4. For the period prior to February 28, 2018, the criteria for an initial 10 percent evaluation for GERD have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.6, 4.20, 4.114, Diagnostic Code 2399-7346. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty for training (ACDUTRA) from August 1978 to December 1978, and active duty from April 1979 to April 1983, and from July 1989 to December 1995. This matter comes before the Board of Veterans' Appeals (Board) from rating decisions by the Agency of Original Jurisdiction (AOJ). In November 2019, the Board denied higher initial evaluations for the Veteran's low back disability, right lower extremity radiculopathy, and gastroesophageal reflux disease (GERD) prior to February 28, 2018. An evaluation of 30 percent was assigned for GERD from February 28, 2018. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In August 2020, the Court granted the parties' joint motion for partial remand (JMR), vacating the Board's November 2019 decision to the extent that it denied higher initial evaluations for the Veteran's low back disability, right lower extremity radiculopathy, and GERD prior to February 2018. The parties specified that the Veteran did not appeal the Board's denial of an evaluation higher than 30 percent for GERD from February 28, 2018. The Board remanded those matters for additional development of the record in February 2021. In May 2021, the AOJ increased the evaluation of the Veteran's low back disability to 40 percent, effective April 21, 2021; assigned separate evaluations for bilateral femoral nerve radiculopathy, each evaluated as 20 percent disabling; and established basic eligibility to Dependents' Educational Assistance effective April 21, 2021. Following issuance of a supplemental statement of the case in May 2021, the appeal was returned to the Board's docket. Evaluation of Low Back Disability The Veteran's low back disability is evaluated as 10 percent disabling prior to November 15, 2016, as 20 percent disabling from November 15, 2016 to April 20, 2021, and as 40 percent disabling from April 21, 2021. Disability evaluations are determined by the application of a schedule of ratings based on average impairment in earning capacity. 38 U.S.C. § 1155 (2012). Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the 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 practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. In cases where the original rating assigned is appealed, consideration must be given to whether a higher rating is warranted at any point during the appeal period. Fenderson v. West, 12 Vet. App. 119 (1999). If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation 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 general rating formula for disease and injuries of the spine, specifically, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, provides a 10 percent evaluation 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 applies where there is 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 evaluation is warranted where there is forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation 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. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992) (memorandum decision); Nix v. Brown, 4 Vet. App. 462, 465 (1993); and Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Ankylosis has also been defined as stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. See 38 U.S.C. § 5110. The criteria that is more favorable to the Veteran will be applied from the effective date of the change. Relevantly, Diagnostic Code 5243 for intervertebral disc syndrome (IVDS) was revised. However, the Formula for Rating IVDS Based on Incapacitating Episodes did not change. Prior to February 7, 2021, Diagnostic Code 5243 required evaluations of IVDS (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method resulted in the higher evaluation when all disabilities are combined under §4.25. As of February 7, 2021, DC 5243 specifies that the diagnostic code may be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise Diagnostic Code 5242 is to be assigned for all other diagnoses. Under the formula for evaluation of intervertebral disc syndrome (IVDS), ratings are assigned based on duration incapacitating episodes during the past 12 months. 38 C.F.R. § 4.71a, IVDS Formula. For these purposes, an incapacitating episode is defined as 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. Id. at Note (1). Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees and left and right lateral rotation are 0 to 30 degrees. The normal combined range of motion for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, DCs 5235-5243. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40 and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. On VA examination in January 2012, the diagnoses were back strain and degenerative disc disease of the thoracolumbar spine. The Veteran described pain on and off two to three times per week. He noted that he took Motrin. He stated that his occupation required a lot of activity. He indicated that his pain sometimes went down his right leg. He endorsed flare-ups, indicating that they occurred with walking and chores. Range of motion testing revealed forward flexion to 80 degrees with pain at 65 degrees, extension to 25 degrees with pain at 25 degrees, lateral flexion to 25 degrees bilaterally with pain at 25 degrees, right rotation to 30 degrees or greater with pain at 25 degrees, and left rotation to 25 degrees with pain at 25 degrees. There was no change in range of motion following repetitive use testing. The examiner indicated that there was functional loss due to excess fatigability and pain on movement. There was no muscle spasm. The examiner indicated that the Veteran had IVDS of the thoracolumbar spine, but that there had been no incapacitating episodes during the previous 12 months. He noted that imaging revealed degenerative disc disease as well as an S-shaped curvature of the thoracic spine, and mild degenerative disc disease and degenerative joint disease of the lumbar spine. A December 2012 record from Womack Army Medical Center (AMC) indicates the Veteran's complaint of back pain. He denied incontinence and radicular pain. The thoracic spine was normal in appearance and not tender to palpation. Range of motion was full and pain free. The lumbosacral spine was tender to palpation. The provider noted that there were muscle spasms. Range of motion was full and pain free. Straight leg raising was negative. A femoral nerve traction test was negative. No sensory abnormalities were noted. There was no motor dysfunction. Balance and gait were normal. No peripheral neuropathy was noted. A January 2013 report from Womack AMC indicates that MRI was consistent with minimal degenerative disc disease and facet arthropathy at L2-3 and L3-4. At that time, the Veteran denied neurologic deficits and bowel and bladder dysfunction. Examination revealed sciatic notch tenderness, and pain on motion. There were no muscle spasms. A September 2013 VA record indicates that the Veteran requested an evaluation for a back brace. A consultation was placed. There is no indication in the subsequent records that the Veteran was measured for or issued a brace. Records from Orthopaedic Solutions & Sports Medicine Center dated in October 2013 reflect diagnoses of lumbosacral disc degeneration, lumbosacral spondylosis, lumbago, and lumbar disc displacement. The provider noted that previous treatment had included epidural steroid injections, and that they lasted only one week. The Veteran endorsed pain as severe at 10/10, with radiation. He also endorsed numbness and tingling. On flexion, the Veteran could reach to his mid-tibia. Extension, rotation, and lateral flexion were normal, with pain on range of motion. On VA examination in January 2016, the diagnoses were degenerative arthritis of the spine and IVDS. The Veteran reported moderate to severe sharp pain in his back, with spasms. He indicated that he had pain radiating down both legs as well as daily numbness and tingling. He endorsed flare-ups, noting severe stabbing pain twice a week with spasms. He noted that he had difficulty picking up heavy items, with repetitious activity, walking or standing for long periods, and climbing ladders or stairs. Range of motion testing revealed flexion to 85 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 25 degrees, and rotation to 30 degrees bilaterally. The examiner noted that pain was noted with flexion, and that it caused functional loss. Pain was also noted on weightbearing. Following repetitive use, flexion was to 80 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 30 degrees, and lateral rotation was to 30 degrees bilaterally. The examiner declined to estimate additional limitation caused after repeated use over time or with flare-ups. There was no ankylosis. On VA examination in November 2016, the diagnoses were lumbosacral strain, degenerative arthritis of the spine, and radiculopathy. The Veteran reported flare-ups occurring two to three times per day, with pain and numbness across his low back. He described pain in his buttocks that ran down to his feet. He indicated that he experienced numbness in his groin two to three times per week. He also indicated that he experienced a sensation of having fallen one to two times per day. Regarding functional loss, the Veteran reported difficulty walking and having to take extra breaks at work. Range of motion testing revealed forward flexion to 40 degrees, extension to 10 degrees, lateral flexion to 20 degrees bilaterally, and rotation to 20 degrees bilaterally. Following repetitive use testing, forward flexion was to 35 degrees, extension to 10 degrees, right lateral flexion was to 10 degrees, left lateral flexion was to 20 degrees, and rotation was to 20 degrees bilaterally. The examiner noted that functional loss was due to pain. The examiner estimated that during flare-ups, forward flexion would be reduced to 30 degrees. There was no ankylosis. The examiner concluded that the Veteran did not have IVDS. On VA examination in February 2018, the diagnoses were back strain, degenerative disc disease of the thoracolumbar spine, and radiculopathy of the lower extremities. The Veteran endorsed back pain that was worsened by long periods of sitting. He also noted pain with transferring from sitting to standing and intermittent radiation of pain down the bilateral lower extremities. He indicated that he experienced a needle like sensation above his left hip and back spasms. He endorsed flare-ups, noting a burning sensation in his low back and difficulty moving his legs. He indicated that flare-ups affected his ability to sleep. He stated that flares occurred two to three times per week and were of 10/10 severity. He also endorsed functional loss, describing difficulty walking. He noted that he used a scooter while shopping, and indicated that he had difficulty getting in and out of the forklift at work, as well as climbing ladders. Range of motion testing revealed forward flexion to 50 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 15 degrees, and rotation to 15 degrees bilaterally. The examiner indicated that there was pain with forward flexion and extension that caused functional loss. Repetitive use testing did not result in further reduction of motion. The examiner declined to state whether pain, weakness, fatigability, or incoordination significantly limited functional ability following repetitive use over time or with flare-ups. There was no ankylosis. In April 2018, the Veteran complained of worsening back pain and radiation into his legs. On VA physical therapy consultation in March 2019, the provider noted that the Veteran had undergone right hip replacement in 2015. Examination revealed right paraspinal tenderness. Active range of motion was grossly limited to 50 percent throughout the cardinal planes. The Veteran's gait was antalgic and his sitting posture was left leaning due to pain with sitting. The provider noted that MRI revealed spondylitic and degenerative changes with multilevel disc bulging, causing varying degrees of central canal and neural foraminal stenosis. Records from National Spine and Pain Centers indicate that the Veteran underwent epidural injections and radiofrequency ablation in 2019 and 2020. On VA examination in April 2021, the diagnoses were back strain and degenerative disc disease with IVDS. Lower extremity radiculopathy was also identified. The Veteran reported that since his last examination, his back disability had worsened. He indicated that he had pain when reaching for objects, and that he experienced numbness and tingling in his lower extremities with sitting or driving. He related that he had been receiving injections and that he was trying to avoid surgery. Regarding current symptoms, he reported sharp to aching pain in the thoracic spine and pressure like pain with burning, numbness, and tingling in the bilateral lower extremities. He endorsed flare-ups, describing sharp, burning pain with numbness and tingling down his legs, causing an inability to walk during those episodes, and requiring him to stop activity until he felt better. He indicated that flare-ups occurred four to five times per week and lasted three to four minutes. He noted that they were precipitated by sitting and driving for long periods. Regarding functional impairment, the Veteran reported that his back disability caused difficulty with lifting heavy items, riding the forklift at work, and sitting or driving for long periods. Range of motion testing revealed forward flexion to 45 degrees, extension to 15 degrees, lateral flexion to 15 degrees, bilaterally, and rotation to 20 degrees bilaterally. Pain was noted on forward flexion, extension, and lateral flexion. Pain was noted on active and passive motion. Following repetitive use, there was no additional limitation of motion. The examiner estimated that with flare ups, motion would be additionally limited, with forward flexion to 30 degrees, extension to 5 degrees, lateral flexion to 5 degrees bilaterally, and rotation to 10 degrees bilaterally. There was no ankylosis. The examiner indicated that the Veteran had IVDS, but that there had been no incapacitating episodes requiring bed rest in the previous 12 months. Prior to January 5, 2016 The current evaluation for this period is 10 percent. This evaluation contemplates 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. The next higher evaluation requires evidence demonstrating 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. Such is not shown by the record. Rather, motion was limited by pain to 65 degrees in January 2012. At that time, there was no guarding or muscle spasm. The Board accepts that the Veteran experienced functional impairment and pain during the period under consideration. See DeLuca. The Board also finds the lay reports of symptomatology to be credible. However, neither the lay nor medical evidence reflects the functional equivalent of limitation of motion or incapacitating episodes required to warrant the next higher evaluation. The Board therefore finds that the currently assigned evaluation is appropriate for the Veteran's spine disability. Period from January 5, 2016 As noted, the Veteran's spine disability is evaluated as 20 percent disabling from November 15, 2016 to April 20, 2021, and as 40 percent disabling from April 21, 2021. Having carefully reviewed the record, the Board concludes that a 40 percent evaluation is warranted from January 5, 2016. Notably, the January 2016 VA examiner declined to estimate any additional loss of function following repetitive use over time or with flare-ups. However, examination disclosed pain on flexion, and the examiner indicated that it caused functional loss. Pain was also noted on weightbearing. Moreover, during examination in November 2016, the examiner estimated that with flare-ups, flexion would be limited to 30 degrees. Considering that this examination was conducted less than one year following the previous examination, and that the Veteran's complaints and reports were essentially the same during both examinations, the Board finds that it is reasonable to conclude that the Veteran's functional limitation in January 2016 was similar to that noted in November 2016, when the examiner provided an estimate of the Veteran's functional limitation due to flare-ups. The general formula specifies that a 40 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine of 30 degrees or less. Accordingly, the Board finds that a 40 percent evaluation is warranted from January 5, 2016, the date of the earlier 2016 VA examination. The Board also concludes that an evaluation higher than 40 percent is not warranted for the period from January 5, 2016. In that regard, an evaluation higher than 40 percent requires evidence demonstrating for unfavorable ankylosis of the entire thoracolumbar spine. Such is not shown by the evidence of record. Moreover, as incapacitating episodes of IVDS with prescribed bedrest are not shown, evaluation under the IVDS formula is not appropriate. The Board accepts that the Veteran experienced functional impairment and pain during the period under consideration. See DeLuca. The Board also finds the lay reports of symptomatology to be credible. However, neither the lay nor medical evidence reflects the functional equivalent of limitation of motion or incapacitating episodes required to warrant the next higher evaluation. The Board therefore finds that a 40 percent evaluation, but no higher, is warranted from January 5, 2016. GERD prior to February 28, 2018 The Veteran seeks an initial compensable evaluation for GERD prior to February 21, 2018. Notably, the parties to the JMR specified that the Veteran did not challenge the award of a 30 percent evaluation from February 28, 2018. The Veteran's GERD is evaluated pursuant to diagnostic code (DC) 7399-7346. Notably, gastroesophageal reflux disease (GERD) is not a listed disability in the rating schedule. When an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. According to the policy in the schedule, when a disability is not specifically listed, the Diagnostic Code will be "built up," meaning that the first 2 digits will be selected from that part of the schedule most closely identifying the part of the body involved, and the last 2 digits will be "99." 38 C.F.R. § 4.27. For example, Diagnostic Code 7399 is used to identify unlisted digestive system disabilities. Regulations provide that ratings under Diagnostic Codes 7301 through 7329, 7331, 7342, and 7345 to 7348, inclusive, will not be combined with each other. 38 C.F.R. § 4.114. Rather, a single rating will be assigned under the diagnostic code that reflects the predominant disability picture, with elevation to the next higher rating where the severity of the overall disability warrants such elevation. DC 7346, for hiatal hernia (to which GERD is found to be analogous), provides a 10 percent disability rating for two or more of the symptoms indicated for a 30 percent disability rating but with less severity. A 30 percent disability rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A maximum schedular 60 percent disability rating is warranted for symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. A December 2012 record from Womack Army Medical Center indicates the Veteran's report of heartburn two to three times per week. He denied nausea and vomiting. On VA examination in February 2015, the diagnosis was GERD. The Veteran denied weight loss, dysphagia, hematemesis, and melena. He endorsed heartburn. The examiner noted that the Veteran took Prilosec. He noted that the Veteran experienced pyrosis (heartburn) and reflux. There was no indication of esophageal stricture, spasm, or diverticula. The examiner indicated that diagnostic testing had not been performed. He concluded that GERD did not impact the Veteran's ability to work. In May 2015, the Veteran stated that he experienced heartburn, vomiting, chest pain, and pain radiating into his arms. He also indicated that he had developed a cough. A January 2014 VA treatment record indicates that the Veteran denied vomiting and diarrhea. He also denied those symptoms in August 2015 and March 2016. In March 2017, review of systems reflected the Veteran's denial of dysphagia, dyspepsia, chest pain, cough, abdominal pain, and irregular bowel movements. At that time, the Veteran reported that his GERD was well controlled with Nexium, and he denied epigastric pain, hematemesis, and melena. In September 2017, a VA provider noted that the Veteran had a history of GERD with good results from Protonix. Review of systems indicated no anorexia, nausea, vomiting, or diarrhea. There was no abdominal pain. Having reviewed the evidence relating to the Veteran's gastrointestinal disability, the Board has concluded that an initial evaluation of 10 percent is warranted for the period prior to February 28, 2018. In this regard, the Board notes that the objective evidence indicates that the Veteran's symptoms during this period consisted of pyrosis (heartburn) and reflux. Moreover, the Veteran reported in May 2015 that he had experienced vomiting and chest pain. The Board notes, however, that the evidence pertaining to this period does not indicate that the Veteran experienced symptoms that were productive of considerable impairment of his health. Notably, the Veteran reported in 2012 that he had heartburn one or two times per week. Additionally, the February 2015 VA examiner indicated that this disability did not impact the Veteran's ability to work. Thus, for this period, the Board concludes that an evaluation of 10 percent, but no higher, is warranted. The Board acknowledges the Veteran's reported gastrointestinal symptoms and their impact during the period under consideration; however, it finds that the overall disability picture does not more nearly approximate the criteria for the next higher evaluation. The Board thus concludes that the 10 percent evaluation assigned herein for this disability is appropriate. REASONS FOR REMAND Evaluation of Right Lower Extremity Radiculopathy The Veteran's right lower extremity sciatic radiculopathy has been evaluated as 10 percent disabling prior to November 15, 2016 and as 20 percent disabling from that date. Additionally, in May 2021, the AOJ awarded a separate evaluation for right lower extremity femoral nerve radiculopathy and assigned a 20 percent evaluation, effective April 21, 2021. In the August 2020 JMR, the parties agreed that the Board erred when it concluded that the Veteran's symptoms were wholly sensory, and did not address documented non-sensory symptoms. They specified that the November 2012 VA examination indicated reduced muscle strength on hip flexion, and that the October 2018 examiner indicated hypoactive deep tendon reflexes. They also specified that this symptomatology was not wholly sensory, and pointed out that the Board did not discuss why such would not warrant higher evaluations. In its February 2021 remand, the board directed that the Veteran be afforded a neurological examination. It specified that the examiner should provide an opinion addressing any manifest non-sensory symptoms attributable to the Veteran's right lower extremity radiculopathy, including the findings of reduced hip muscle strength in 2012 and hypoactive deep tendon reflexes in 2018. On examination April 2021, these findings and their significance were not addressed. Accordingly, an additional examination is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination to address the severity of his service-connected right lower extremity radiculopathy. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's radiculopathy, to include specification of the nerves involved. A specific opinion must be provided addressing the significance and etiology of any manifest non-sensory symptoms attributable to right lower extremity radiculopathy, including VA examination findings of reduced hip muscle strength in November 2012 and hypoactive deep tendon reflexes in October 2018. 2. Then, readjudicate the Veteran's claim. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.