Citation Nr: 21042474 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-15 508 DATE: July 13, 2021 ORDER Entitlement to an initial disability rating of 10 percent for radiculopathy of the femoral nerve of the left lower extremity from May 23, 2014, to January 12, 2016, is granted. Entitlement to an initial disability rating of 10 percent for radiculopathy of the femoral nerve of the right lower extremity from May 23, 2014, to January 12, 2016, is granted. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the right lower extremity for the entire appeal period is denied. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the left lower extremity for the entire appeal period is denied. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the right lower extremity is denied. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the left lower extremity is denied. Entitlement to a disability rating in excess of 10 percent for left metatarsalgia is denied. Entitlement to a disability rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with intervertebral disc disorder (IVDS) from May 23, 2014, to February 21, 2018, is denied. Entitlement to a disability rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with IVDS since June 1, 2018, is denied. FINDINGS OF FACT 1. From May 23, 2014, to January 12, 2016, the Veteran's radiculopathy of the femoral nerve of the left lower extremity was manifest by mild incomplete paralysis. 2. From May 23, 2014, to January 12, 2016, the Veteran's radiculopathy of the femoral nerve of the right lower extremity was manifest by mild incomplete paralysis. 3. Throughout the entire appeal period, the Veteran's radiculopathy of the femoral nerve of the right lower extremity has been manifest by no more than mild incomplete paralysis. 4. Throughout the entire appeal period, the Veteran's radiculopathy of the femoral nerve of the left lower extremity has been manifest by no more than mild incomplete paralysis. 5. The Veteran's radiculopathy of the sciatic nerve of the right lower extremity is manifest by no more than mild incomplete paralysis. 6. The Veteran's radiculopathy of the sciatic nerve of the left lower extremity is manifest by no more than mild incomplete paralysis. 7. The Veteran's left metatarsalgia is rated as 10 percent disabling, which is the maximum schedular rating permitted for unilateral anterior metatarsalgia. 8. The Veteran's left metatarsalgia disability is manifest by no more than moderate symptoms. 9. From May 23, 2014, to February 21, 2018, the Veteran's degenerative joint and disc disease of the lumbar spine with IVDS was manifest by forward flexion limited to, at worst, 65 degrees, and by combined range of motion of the thoracolumbar spine to, at worst, 195 degrees, even with consideration of his functional loss. The degenerative joint and disc disease of the lumbar spine with IVDS was not manifest by muscle spasm, guarding, or incapacitating episodes during this period. 10. Since June 1, 2018, the Veteran's degenerative joint and disc disease of the lumbar spine with IVDS has not been manifest by incapacitating episodes or unfavorable ankylosis. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating of 10 percent for radiculopathy of the femoral nerve of the left lower extremity from May 23, 2014, to January 12, 2016, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8726. 2. The criteria for an initial disability rating of 10 percent for radiculopathy of the femoral nerve of the right lower extremity from May 23, 2014, to January 12, 2016, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8726. 3. The criteria for a disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the right lower extremity have not been met for the entire appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8726. 4. The criteria for a disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the left lower extremity have not been met for the entire appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8726. 5. The criteria for a disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8720. 6. The criteria for a disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8720. 7. The criteria for a rating in excess of 10 percent for left metatarsalgia have not 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 5276. 8. The criteria for a rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with IVDS from May 23, 2014, to February 21, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5243. 9. The criteria for a rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with IVDS since June 1, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from March 2009 to June 2010 and from May 2012 to May 22, 2014. These issues are on appeal from September 2014 and March 2016 rating decisions. In May 2019, the Veteran testified before the undersigned Veterans Law Judge at a hearing. In September 2019 and February 2021, the Board of Veterans' Appeals (Board) remanded this appeal for further development. INCREASED RATINGS Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity in civil occupations. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § Part 4. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where a veteran appeals the initial rating assigned for a disability at the time that service connection for that disability is granted, evidence contemporaneous with the claim and with the initial rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous . . . ." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. Where an increase in the disability rating is at issue, the "present level" of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where VA's adjudication of an increased rating claim is lengthy, a claimant may experience multiple distinct degrees of disability that would result in different levels of compensation from the time the increased rating claim was filed until a final decision on that claim is made. Thus, VA's determination of the "present level" of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased rating claim has been pending. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that VA has amended the rating criteria for musculoskeletal system 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. 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. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). 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 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) ("[I]t 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; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the U.S. Court of Appeals for Veterans Claims (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 an initial compensable disability rating for radiculopathy of the femoral nerve of the left lower extremity from May 23, 2014, to January 12, 2016. 2. Entitlement to an initial compensable disability rating for radiculopathy of the femoral nerve of the right lower extremity from May 23, 2014, to January 12, 2016. The Veteran contends that he is entitled to compensable disability ratings from May 23, 2014, to January 12, 2016, for his radiculopathy of the femoral nerves of the bilateral lower extremities because he had numbness and stabbing pain of his legs. See Board hearing transcript, page 12. He also reported losing his balance and using a cane because of his legs. Id. Diagnostic Code 8526 provides the rating criteria for paralysis of the femoral nerve, and therefore neuralgia (Diagnostic Code 8726) of that nerve. Under Diagnostic Code 8726, a 10 percent rating is warranted for mild incomplete paralysis of the femoral nerve. A 20 percent rating is warranted for moderate incomplete paralysis of the femoral nerve. A 30 percent rating is warranted for severe incomplete paralysis of the femoral nerve. A 40 percent rating is warranted for complete paralysis of the femoral nerve. 38 C.F.R. § 4.124a. At the June 2014 VA examination, the Veteran did not have any radicular pain or signs or symptoms due to radiculopathy. His straight leg raising test was negative bilaterally. His sensory examination was normal. Pain in the legs was not documented at the examination. However, VA treatment records dated during this period document numbness and tingling into the bilateral lower extremities. See, e.g., February 2015 and March 2015 VA treatment record. Based on the lay and medical evidence described above, the Board finds the disabilities are primarily manifest by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the disabilities were manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, and complete paralysis from May 23, 2014, to January 12, 2016. The Board thus finds that the levels of impairment are most analogous to mild incomplete paralysis. In conclusion, the Board finds that the preponderance of the evidence supports the Veteran's claims for initial disability ratings of 10 percent for his radiculopathy of the femoral nerve of the bilateral lower extremities from May 23, 2014, to January 12, 2016. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The claims are granted. 3. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the right lower extremity since January 13, 2016. 4. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the femoral nerve of the left lower extremity since January 13, 2016. Based on the Board's grants of 10 percent disability ratings from May 23, 2014, to January 12, 2016, the Veteran is now in receipt of 10 percent disability ratings for the entire appeal period for his radiculopathy of the femoral nerves of the bilateral lower extremities. 38 C.F.R. § 4.124a, Diagnostic Code 8526. The Veteran asserts that he is entitled to higher ratings for his radiculopathy of the femoral nerves of the bilateral lower extremities for the entire appeal period because he has numbness and stabbing pain of his legs. See Board hearing transcript, page 12. He also reported losing his balance and using a cane because of his legs. Id. Regarding impairment of motor functions, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Regarding trophic changes, these were not documented at the VA examinations or treatment records during the appeal period. Regarding sensory disturbance, the Veteran had a normal sensory examination at the June 2014, January 2016, April 2018, and January 2020 VA examinations. His straight leg raising tests were negative bilaterally at these examinations. VA treatment records document numbness and tingling into the bilateral lower extremities. See, e.g., February 2015 and March 2015 VA treatment record. He had a normal sensory examination in the right lower extremity and a decreased sensory examination in the left lower extremity at the March 2021 examination. At the March 2021 VA spine examination, the straight leg raising test was negative in the right lower extremity, but positive in the left lower extremity. Regarding loss of reflexes, the Veteran had normal reflexes at the January 2016, January 2020, and March 2021 VA examinations. Regarding pain, the Veteran did not have any radicular pain or signs or symptoms due to radiculopathy of the bilateral lower extremities at the June 2014, April 2018, January 2020, and March 2021 VA examinations. At the January 2016 VA examination, the bilateral lower extremities were not manifested by constant pain, but were manifested by mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. The January 2016 VA examiner determined that the severity of the radiculopathy of the bilateral lower extremities was best characterized as mild. At the January 2020 and March 2021 VA examinations, the Veteran did not have any symptoms attributable to any peripheral nerves condition. Regarding muscle atrophy, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Regarding complete paralysis, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Also, the March 2021 VA examiner found the Veteran's femoral nerve symptoms to be resolved. Based on the above lay and medical evidence, the Board finds that the disabilities are primarily manifest by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the disabilities are manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the levels of impairment are most analogous to mild incomplete paralysis. The Board acknowledges that the Veteran uses an assistive device due to his radiculopathy. However, 38 C.F.R. § 4.120 "contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker." Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, separate or higher ratings under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claims for initial disability ratings in excess of 10 percent for radiculopathy of the femoral nerve of the bilateral lower extremities for the entire appeal period. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The claims are denied. 5. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the right lower extremity. 6. Entitlement to an initial disability rating in excess of 10 percent for radiculopathy of the sciatic nerve of the left lower extremity. The Veteran contends that he is entitled to higher ratings for his radiculopathy of the sciatic nerves of the bilateral lower extremities because he has numbness and stabbing pain of his legs. See Board hearing transcript, page 12. He also reported losing his balance and using a cane because of his legs. Id. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. Regarding impairment of motor functions, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Regarding trophic changes, these were not documented at the VA examinations or treatment records during the appeal period. Regarding sensory disturbance, the Veteran had a normal sensory examination at the June 2014, January 2016, April 2018, and January 2020 VA examinations. His straight leg raising tests were negative bilaterally at these examinations. VA treatment records document numbness and tingling into the bilateral lower extremities. See, e.g., February 2015 and March 2015 VA treatment record. He had a normal sensory examination in the right lower extremity and a decreased sensory examination in the left lower extremity at the March 2021 examination. At the March 2021 VA spine examination, the straight leg raising test was negative in the right lower extremity, but positive in the left lower extremity. Regarding loss of reflexes, the Veteran had normal reflexes at the January 2016, January 2020, and March 2021 VA examinations. Regarding pain, the Veteran did not have any radicular pain or signs or symptoms due to radiculopathy of the bilateral lower extremities at the June 2014, April 2018, January 2020, and March 2021 VA examinations. At the January 2016 VA examination, the bilateral lower extremities were not manifested by constant pain, but were manifested by mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. The January 2016 VA examiner determined that the severity of the radiculopathy of the bilateral lower extremities was best characterized as mild. At the January 2020 and March 2021 VA examinations, the Veteran did not have any symptoms attributable to any peripheral nerves condition. Regarding muscle atrophy, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Regarding complete paralysis, this symptom was not documented at the VA examinations or in the treatment records during the appeal period. Also, the March 2021 VA examiner found that the Veteran's left lower extremity was manifested by mild incomplete paralysis. Based on the above lay and medical evidence, the Board finds that the disabilities are primarily manifest by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the disabilities are manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the levels of impairment are most analogous to mild incomplete paralysis. The Board acknowledges that the Veteran uses an assistive device due to his radiculopathy. However, 38 C.F.R. § 4.120 "contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker." Spellers, 30 Vet. App. at 218. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claims for initial disability ratings in excess of 10 percent for his radiculopathy of the sciatic nerves of the bilateral lower extremities. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to a disability rating in excess of 10 percent for left metatarsalgia. The Veteran generally asserts that he is entitled to a higher rating for his left metatarsalgia. The Veteran's left metatarsalgia is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5279, which provides a maximum 10 percent rating for unilateral or bilateral anterior metatarsalgia (Morton's disease). Diagnostic Code 5279 was not changed by the February 7, 2021, amendments. 38 C.F.R. § 4.71a. As the Veteran is in receipt of the highest schedular rating for unilateral or bilateral anterior metatarsalgia, there is no basis to award a higher rating. The Veteran's left metatarsalgia is currently rated under Diagnostic Code 5279 (metatarsalgia) but was previously rated as a left foot strain under Diagnostic Code 5284 (residuals of other foot injuries). 38 C.F.R. § 4.71a. Diagnostic Code 5284 was not changed by the February 7, 2021, amendments. 38 C.F.R. § 4.71a. Under Diagnostic Code 5284, a 10 percent rating is warranted for moderate other foot injuries. A 20 percent rating is warranted for moderately severe other foot injuries. A 30 percent rating is warranted for severe other foot injuries. A Note to Diagnostic Code 5284 instructs that with actual loss of use of the foot rate as a maximum 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5284. According to MERRIAM WEBSTER, "moderate" means "tending toward the mean or average amount or dimension". See www.merriam-webster.com/dictionary/moderate. "Severe" means "of a great degree". See www.merriam-webster.com/dictionary/severe. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left metatarsalgia. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain on weight-bearing and pain during repeated use over time. However, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the statements that he does not experience flare-ups would not result in symptoms more nearly approximating moderately severe other foot injuries. For instance, at the June 2014 VA examination, the Veteran reported that his left foot was stable and his experienced pain in his left foot occasionally. At the January 2016 VA examination, he described sharp pain in left foot that increased with carrying heavy weight and standing for more than 60 minutes. He was unable to run or walk long distances. He had a hard time finding shoes that did not irritate his condition. The VA examiner found that the Veteran's pain limited his ability walk or stand for prolonged periods. At the March 2021 VA examination, the Veteran reported dull left foot pain with numbness and tingling. He was unable to do prolonged walking. The treatment records do not provide any evidence contrary to that obtained at the VA examinations. The Board finds that this evidence establishes that the Veteran's left foot is best characterized as moderate, which warrants his current 10 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5284. In conclusion, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left metatarsalgia. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. Here, the Veteran's disability is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. Additionally, the evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code. The Board notes that the Veteran has other foot symptoms. However, the evidence of record is against a finding that the disabilities have distinct manifestations from those that are already being compensated. See 38 C.F.R. § 4.14. In this regard, in a September 2018 VA treatment record, mild pes cavus of the left foot was documented. These symptoms were not reported at the prior VA foot examinations in June 2014 and January 2016. The March 2021 VA examiner reviewed the September 2018 VA treatment record and found that there was no evidence of pes cavus or pes planus on examination. Thus, based on the lack of findings at the VA examinations, the Board finds that the mild pes cavus of the left foot is contemplated under Diagnostic Code 5284 and the moderate characterization of the left foot. Also, the Board notes that at the March 2021 VA foot examination, the Veteran reported numbness and tingling of his left foot. At the March 2021 VA foot examination, the VA examiner found that the Veteran has paresthesia due to back radiculopathy in response to the Veteran's reports of numbness and tingling in his left foot. The Veteran is currently service-connected for radiculopathy of the sciatic and femoral nerves of the bilateral lower extremities. At his March 2021 VA peripheral nerves examination, decreased sensation in the left foot was observed by the VA examiner; however, only the sciatic nerve was found to be affected. The Board finds that the Veteran's symptoms of numbness and tingling of the left foot are currently contemplated under his 10 percent rating under Diagnotic Code 5284 for a moderate left foot disability and under his already service-connected radiculopathy disabilities. As the Veteran already has the maximum schedular disability rating, the appeal is denied. In conclusion, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for left metatarsalgia. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 8. Entitlement to a disability rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with IVDS from May 23, 2014, to February 21, 2018. The Veteran contends that he is entitled to a higher rating for his lumbar spine disability because he has to use pain pills, Ben-Gay muscle rub, and Dimethyl Sulfoxide for his back pain. See September 2015 Veteran statement. He also reported not being able to do household chores when he got home from work because of his back pain and missing time from work because of his back pain. Id. At his Board hearing, he described flare-ups of his lumbar spine from 2014 to 2018. See Board hearing transcript, page 11. The Veteran's degenerative joint and disc disease of the lumbar spine with IVDS is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, for IVDS. Diagnostic Code 5243 provides that IVDS is to be rated 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 results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. Effective February 7, 2021, Diagnostic Code 5243 was amended to read: "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses." The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted 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 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, 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. Id. at Note 1. Under the General Rating Formula for Diseases and Injuries of the Spine, 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. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with IVDS based on incapacitating episodes from May 23, 2014, to February 21, 2018. The Veteran does not have IVDS and/or the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. At the June 2014 VA examination, the VA examiner found that the Veteran does not have IVDS. At the January 2016 VA examination, the examiner determined that the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The treatment records dated during this period do not provide evidence contrary to that provided at the VA examinations. The preponderance of the evidence is also against a rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with IVDS under the General Rating Criteria from May 23, 2014, to February 21, 2018. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he does not experience flare-ups of the thoracolumbar spine would not result in limitation of motion more nearly approximating 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. At the June 2014 VA examination, the Veteran's forward flexion of the lumbar spine was limited to, at worst, 90 degrees and his combined range of motion of the thoracolumbar spine was 195 degrees. At the January 2016 VA examination, his forward flexion of the lumbar spine was limited to, at worst, 65 degrees and his combined range of motion of the thoracolumbar spine was 240 degrees. Additionally, the Veteran did not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. At the June 2014 and January 2016 VA examinations, the Veteran did not have guarding or muscle spasms of the lumbar spine. The treatment records dated during this period do not provide evidence contrary to that provided at the VA examinations. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for degenerative joint and disc disease of the lumbar spine with IVDS from May 23, 2014, to February 21, 2018. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 9. Entitlement to a disability rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with IVDS since June 1, 2018. The Veteran asserts that he is entitled to a higher rating for his lumbar spine disability since June 1, 2018, because his back hurts every day and he occasionally misses work because of his pain and doctors' appointments. See May 2019 Board hearing transcript, pages 6-7. He is no longer able to touch his toes and it is painful when he bends over. Id. at 8. He uses a back brace. Id. The Veteran's degenerative joint and disc disease of the lumbar spine with IVDS is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, for IVDS. Diagnostic Code 5243 provides that IVDS is to be rated 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 results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. Effective February 7, 2021, Diagnostic Code 5243 was amended to read: "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses." The Formula for Rating IVDS Based on Incapacitating Episodes provides that 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 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note 1. Under the General Rating Formula for Diseases and Injuries of the Spine, 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. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Unfavorable ankylosis is defined as "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." Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id. The Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with intervertebral disc disorder based on incapacitating episodes since June 1, 2018. The Veteran does not have IVDS and/or the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. At the January 2020 VA examination, the VA examiner found that the Veteran did not have IVDS. At the March 2021 VA examination, the VA examiner diagnosed the Veteran with IVDS. The examiner determined that the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The treatment records dated since June 1, 2018, do not provide evidence contrary to that provided at the VA examinations. The preponderance of the evidence is also against a rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with IVDS under the General Rating Criteria since June 1, 2018. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, fatigue, and weakness with repeated use over time, and pain, fatigue, and weakness with flare-ups. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that his mild flare-ups occur, at worst, every other day would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. Even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate the entire spine fixed in flexion or extension and one of the additional symptoms set forth in Note 5. Additionally, at the January 2020 and March 2021 VA examinations, the VA examiners found that the Veteran does not have ankylosis of the spine. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 40 percent for degenerative joint and disc disease of the lumbar spine with IVDS since June 1, 2018. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Other Considerations Regarding neurological impairment secondary to the service-connected lumbar spine disability, the Veteran has already been granted service connection for radiculopathy of the bilateral lower extremities of the sciatic and femoral nerves. Service connection has also been granted for erectile dysfunction and residual surgical scar, status post lumbar spine surgery. The Veteran has argued that he has a bladder disorder due to his service-connected lumbar spine disability. Also, at the January 2016 VA examination, the Veteran reported that he is unable to sense if he needs to urinate at times due to his service-connected radiculopathy. In this regard, a medical opinion has been obtained. In an April 2018 medical opinion, the VA examiner determined that the Veteran's bladder condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected disabilities. The examiner reasoned that the Veteran's urinary condition is consistent with common benign prostatic hyperplasia and not a neurological condition that one would expect to have demonstrated improvement or change with his more recent neurosurgery of his spine which corrected his disc condition. There are no other medical opinions of record. In the June 2018 rating decision, service connection for neurogenic bladder was denied. The Veteran did not submit a Notice of Disagreement. The Board finds that a separate neurological rating for a bladder disorder secondary to the service-connected disabilities is not warranted. Additionally, the January 2016, April 2018, January 2020, and March 2021 VA examiners found that the Veteran did not have any other neurologic abnormalities or findings related to his thoracolumbar spine. The lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with the service-connected disabilities on appeal. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). For instance, at the May 2019 Board hearing, the Veteran and his representative stated that they were not asking the Board to consider a claim of entitlement to a total disability rating for individual unemployability. See Board hearing transcript, page 5. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shauna M. Watkins, 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.