Citation Nr: 21042796 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-18 138 DATE: July 13, 2021 ORDER 1. Resolving all doubt in the Veteran's favor, a 20 percent evaluation, but no higher, for service-connected lumbar myositis, claimed as low back pain is granted effective March 27, 2009. 2. Entitlement to a 10 percent evaluation, but no higher, for service-connected left lower extremity radiculopathy is granted effective April 1, 2009. 3. Entitlement to a 10 percent evaluation, but no higher, for service-connected right lower extremity radiculopathy is granted effective April 1, 2009. 4. Entitlement to an evaluation in excess of 40 percent for left lower extremity radiculopathy after January 22, 2020 is denied. 5. Entitlement to an evaluation in excess of 40 percent for right lower extremity radiculopathy after January 22, 2020 is denied. FINDINGS OF FACT 1. From March 27, 2009, the Veteran's back disability manifested by pain and limitation of flexion of the thoracolumbar spine to, at most, 60 degrees. 2. Beginning April 1, 2009, the Veteran's bilateral lower extremity lumbar radiculopathy was not manifested by moderate incomplete paralysis of the sciatic nerve. 3. After January 22, 2020, the Veteran's bilateral lower extremity lumbar radiculopathy is not manifested by severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. CONCLUSIONS OF LAW 1. From March 27, 2009, the criteria for a disability rating in excess of 20 percent for a lumbar spine disability have not been met. 38 U.S.C. § 1137, 1155; 38 C.F.R. §§ 4.1, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5243. 2. The criteria for an initial disability evaluation of 10 percent, but no higher, for left lower extremity lumbar radiculopathy have been met from April 1, 2009 to January 21, 2020. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8520. 3. The criteria for an initial disability evaluation of 10 percent, but no higher, for right lower extremity lumbar radiculopathy have been met from April 1, 2009 to January 21, 2020. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8520. 4. The criteria for a disability rating in excess of 40 percent for radiculopathy of the bilateral lower extremities for the period beginning January 22, 2020, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from March 1998 to March 2006. These matters come before the Board of Veterans' Appeals (Board) on appeal from June 2010 and April 2015 rating decisions. In November 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the electronic claims file. In accordance with a November 2019 Board remand, treatment records were obtained and associated with the clams file and VA examinations were scheduled so they may be considered in deciding this appeal. See Stegall v. West, 11 Vet. App. at 268. After consideration of this evidence and these facts, the Board finds that there was substantial compliance with the Board directives as the underlying purpose of the remand was to obtain competent evidence regarding the claims for bilateral hearing loss and tinnitus. As such, the Board finds the purposes of the development directed in the remand have meet met and, as such, there was substantial compliance with the Board's instructions. See Stegall, 11 Vet. App. 268, 270-71 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Consistent with the facts found, the rating may be higher or lower for segments of the time under review on appeal, i.e., the rating may be "staged." See Fenderson v. West, 12 Vet. App. 119 (1999). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify."). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). A veteran as a layperson is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau at 1372). The Veteran contends that the back disability warrants a higher rating evaluation throughout the appeal period. The Veteran is presumed to be seeking the maximum possible evaluation. AB v. Brown, 6 Vet. App. 35 (1993). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. The Veteran's service-connected back disability is rated under the General Rating Formula for Diseases and Injuries of the Spine, Diagnostic Code 5021-5243, indicating myositis rated by analogy to lumbosacral strain. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, DCs 5021, 5243. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. Here, the first four digits, 5021, represent the diagnostic used to rate the Myositis of the Spine. The second four digits after the hyphen, 5243, represent the diagnostic code for rating IVDS. Where functional loss due to pain on motion is alleged, 38 C.F.R. §§ 4.40 and 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). A finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis, thereby providing for the possibility of a rating based on painful motion of a joint, regardless of whether the painful motion stemmed from joint or periarticular pathology. The Court held that pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Id. The Court explained in Mitchell that, pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. §§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Consequently, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board notes, however, that the Court has held that 38 C.F.R. § 4.40 does not require a separate rating for pain but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). In determining the disability evaluation, VA has a duty to acknowledge and consider all regulations, which are potentially applicable, based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Under the rating schedule, IVDS (preoperatively or postoperatively) is to be rated either under the Formula for Rating Intervertebral Disc Syndrome based on incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in the higher rating when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, DC 5243. The General Rating Formula for Diseases and Injuries of the Spine provides that, 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, the following ratings will apply. A 20 percent rating is assigned 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 assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine (for DCs 5235 to 5243). The criteria also include the following provisions: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): 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. 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 cervical spine is 340 degrees and 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. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, a 10 percent rating is warranted for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months and a 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. An evaluation can be had either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities under 38 C.F.R. § 4.25, whichever method resulted in the higher evaluation. The Board acknowledges that VA has recently revised portions of the rating criteria for the musculoskeletal system, effective February 7, 2021. 82 F.R. 35719. There was no change in the rating criteria for Diagnostic Code 5237-5242. Diagnostic Code 5243 changed only to the extent that it is assigned only when there is a disc herniation with compression and/or irritation of the adjacent nerve root. See 38 C.F.R. § 4.71a , Diagnostic Code 5243. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. In this case, an April 2015 rating decision granted service-connection for radiculopathy of the bilateral lower extremities and assigned an initial 10 percent disability evaluation for each leg, effective September 19, 2012. In a September 2020 Rating Decision, the bilateral lower extremity lumbar radiculopathy was increased to 40 percent for each leg, effective January 22, 2020. The respective ratings for radiculopathy were under Diagnostic Code 8520. Radiculopathy of the lower extremities is rated based on the degree of paralysis of the sciatic nerve under 38 C.F.R. § 4.124a, DC 8520. Under this code, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis of the sciatic nerve; a 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy; and an 80 percent rating is assigned for complete paralysis of the sciatic nerve, which contemplates foot dangles and drops, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated in proportion to the impairment of motor, sensory, or mental function. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, and sensory disturbances. 38 C.F.R. § 4.120. The schedule of ratings does not define the terms "moderate" and "severe;" rather than applying a mechanical formula to make a determination, the Board evaluates all of the evidence such that decisions are "equitable and just." 38 C.F.R. § 4.6. The term "incomplete paralysis," with respect to nerve injuries, indicates a degree of loss or impaired function substantially less than the type pictured for "complete paralysis" given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. See Id. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating to be assigned for neuralgia, usually characterized by a dull and intermittent pain of typical distribution so as to identify the nerve, will be that equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. 1. Increased Ratings for the Service-Connected Back Disability. The Veteran contends that the lumbar spine disability was more disabling than is reflected by the 10 percent evaluation in place at the time of his claim for an increase was filed, and more disabling than the 20 percent after December 22, 2009. After review of the lay and medical evidence, the Board finds that a 20 percent evaluation, but no higher is warranted for the service-connected back disability from March 27, 2009, the date of the claim for an increase. In March 2009, the Veteran filed an increased rating claim for the service-connected back. He indicated that the back disability had worsened. In June 2009, the Veteran underwent a VA examination to determine the severity of the service-connected back disability. He reported sharp, agonizing, severe, continuous pain with intermittent exacerbations 3-4 times per day. He estimated the pain in the service-connected back was a 3-4/10 generally and at its worst was a 7-8/10. The Veteran reported that during a flare-up there was no additional loss of range of motion in the back and reported no bowel or bladder symptoms. On examination, the Veteran had no guarding, spasm, weakness, or tenderness. His gait and posture were normal as was strength testing. No ankylosis was present and range of motion testing revealed forward flexion of 90 degrees with pain at 90 degrees and extension of 30 degrees with pain at 30 degrees. A July 2009 rating decision continued the Veteran's 10 percent evaluation. In December 2009, the Veteran filed a notice of disagreement with the assigned evaluation. In January 2010, the Veteran underwent an additional VA examination to determine the severity of the service-connected back. He reported the back had become progressively worse. On examination, the Veteran had no guarding, spasm, or tenderness on the left side but did on the right side. His gait and posture were normal. No ankylosis was present and range of motion testing revealed forward flexion of 50 degrees and extension of 20 degrees with no additional range of motion lost after repetitive testing. He reported no time lost from work in the last 12 months. A June 2010 rating decision increased the evaluation for the service-connected back to 20 percent, effective December 22, 2009. The Veteran filed a notice of disagreement indicating that he could not walk 50 feet and used a cane to ambulate. In September 2012, the Veteran underwent a general medical examination that included testing of the service-connected back. Range of motion testing revealed flexion of 5 degrees and extension of 5 degrees with pain at the endpoints that was unchanged after repetitive testing. The VA examiner indicated that the Veteran's range of motion seemed out of proportion to his condition and questioned his effort on strength testing. In January 2020, the Veteran reported for a VA examination to determine the severity of the back. The Veteran's spouse indicated that she had a paper stating the Veteran was 100 percent service connected and did not need to be examined anymore. The Veteran declined the examination. VA treatment records throughout the appeal period show varying reports of symptoms throughout the appeal period. Specifically, the Veteran has reported periods of pain and some periods of relief from medications and a TENS unit. Here, the preponderance of the evidence shows that throughout the appeal period, the symptoms of the Veteran's back disability do not more clearly approximate the criteria for a 40 percent rating. As noted above, a 20 percent rating is assigned 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 assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. As an initial matter the Board's finding in this decision are based predominately on VA treatment records and the lay testimony of record. Specifically, the Board finds both the September 2012 and January 2020 VA examinations inadequate for rating purposes. First, the September 2012 VA examiner indicated that the Veteran's range of motion readings seemed out of proportion to his condition and questioned his effort on strength testing. This specifically calls into question the range of motion testing conducted during that examination because the VA examiner contemporaneously recording the values questioned their validity. Here, the Board has only prior examination to compare the September 2012 examination because, as discussed below, a subsequent examination is inadequate as well. After review of the record, the Board finds no range of motion readings that resemble those of the September 2012 examination, and therefore, combined with the September 2012 VA physicians questions as to the validity of readings during the exam, the Board finds the September 2012 VA examination inadequate. Next, in January 2020, the Veteran declined to undergo a VA examination. The Board observe that, while it is not a formal withdraw, during the examination the Veteran's spouse indicated that she had a paper stating the Veteran was 100 percent service connected and did not need to be examined anymore, indicating at least cursory satisfaction with the Veteran's level of disability rating at that time. Further, this statement indicates that a remand for another examination would only result in additional burdens on VA with no benefit flowing to the Veteran. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). Similarly, requesting retroactive opinions on the range of motion and functional impairment of the Veteran's back over a period of over a decade would similarly not result in an adequate examination for the Board to base a decision on. Specifically, the Board would be asking a physician to speculate on functional impacts over an almost thirteen-year period based on information that is already available to the Board. The Board has considered whether a disability rating higher than 20 percent is warranted for the period beginning March 27, 2009, based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint and finds that it is not. Although the Veteran's symptoms included pain on movement and flare-ups the loss in range of motion even after three repetitions of testing do not more closely approximate 30 degrees. Specifically, the lowest credible recorded range of motion is 90 degrees. In sum, even considering the effects of pain, the Board finds no lay or medical evidence that approximates forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. In other words, any additional limitation due to pain does not more nearly approximate a finding of forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Accordingly, the 20 percent rating contemplates the functional loss due to pain and less movement. There is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness or incoordination for this period of the appeal. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 206-07. Finally, the Board has considered the Veteran's lay statements including reports of an inability to move due to the service-connected back. While the Veteran is always competent to report symptoms that come to him through his senses, the Board finds nowhere in the lay statements that would reach an approximation of forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. To be sure statements such as "I freeze" (see November 2018 Board Hearing at page 3) and "I can barely move" (see January 2020 VA examination) lack enough specificity to allow the Board to make a reasonable approximation as those statements could only indicate ankylosis of the spine, which neither the Veteran nor the Board can diagnosis, and the record does not support at any point during the appeal period. To the extent the indicating an inability to move is ankylosis, the Board notes that a diagnosis of ankylosis of the spine is a medical one, and out of the scope of what lay evidence may diagnose. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (holding that a lay witness is competent to testify to that which the witness has actually observed and is within the realm of her personal knowledge). Moreover, the Board finds these statements inconsistent with the medical treatment records throughout the period on appeal. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). As such, the Board is unable to grant a higher evaluation for the service-connected back based on the lay evidence alone, or the lay evidence factored with the medical evidence. Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the spine. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. A higher rating is not warranted under Diagnostic Code 5243. Although the Veteran was found to have IVDS, there is no medical evidence of incapacitating episodes having a total duration of at least four weeks, or physician-prescribed bed rest, which is the requirement for an incapacitating episode. See 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note 1. Increased ratings based upon separate neurological disabilities related to the lumbar spine are addressed in the Radiculopathy and Other Neurological Symptoms sections below. In sum, the preponderance of the evidence is against the award of a rating in excess of 20 percent for the Veteran's lumbar spine disability for the period of appeal from March 27, 2009. As a preponderance of the evidence is against the award of an increased evaluation for this period of the appeal, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. 2. Increased Evaluation for Service-Connected Radiculopathy. By history, an April 2015 rating decision granted service connection for bilateral lower extremity radiculopathy evaluated at 10 percent disabling, effective September 19, 2012. A September 2020 rating decision granted an increased evaluation to 40 percent for the bilateral lower extremity radiculopathy. After review of the evidence, both lay and medical, the Board finds that a 10 percent evaluation for bilateral lower extremity radiculopathy is warranted from April 1, 2009 to September 8, 2020, and a 40 percent evaluation, but higher, thereafter. As above, radiculopathy of the lower extremities is rated based on the degree of paralysis of the sciatic nerve. Under this code, a 10 percent rating is assigned for mild incomplete paralysis of the sciatic nerve; a 20 percent rating is assigned for moderate incomplete paralysis of the sciatic nerve; a 40 percent rating is assigned for moderately severe incomplete paralysis of the sciatic nerve; a 60 percent rating is assigned for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. As an initial matter, the Board finds that the Veteran is entitled to a separate initial compensable rating for the service-connected bilateral lower extremity radiculopathy, from April 1, 2009. Specifically, an April 2009 VA consult showed a provisional diagnosis of L5 radiculopathy that was later confirmed through testing. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds the Veteran's effective date for service connection for bilateral lower extremity radiculopathy, should be April 1, 2009. Next, the Board notes that VA treatment records show continued reports of bilateral lower extremity radiculopathy in varying degrees. For example, in June 2014, the Veteran denied significant radicular symptoms. The Board also finds for the period of April 1, 2009 to September 9, 2020, the Veteran's radiculopathy, bilateral lower extremities were appropriately rated at 10 percent disabling, representative of a mild level of impairment. Specifically, during this period, the Veteran began by reporting intermittent radiation down the legs, with tingling, and numbness in the toe. During the September 2012 VA examination, the Veteran had a positive bilateral straight leg test and was found to have moderate radiculopathy in the right lower extremity and mild radiculopathy in the left lower extremity. As such, an evaluation is excess of 10 percent is not warranted for the period from April 1, 2009 to January 21, 2020. Next, turning to the rating period following September 9, 2020, the Board will not disturb the assigned 40 percent disability rating. However, as discussed above, the January 2020 VA examination is inadequate for rating purposes because the VA examiner was unable to conduct the evaluation. Therefore, it is unclear what the objective evidence referenced in the September 2020 rating decision was referring to with regards to the bilateral lower extremity radiculopathy. However, despite that, the Board notes that the VA examiner indicated the Veteran had no muscular atrophy which is observable and does not require testing. A review of the record shows no findings of muscle atrophy at any point and therefore no marked atrophy of the lower extremities can exist. As such, the Board finds that an evaluation in excess of 40 percent after September 9, 2020, is not warranted. Other Neurological Symptoms The record does not support a separate rating for any additional neurological disabilities during any period of the appeal. The record contains no evidence of bowel or bladder abnormalities that result from the Veteran's service-connected back disability. The Veteran has also had no surgeries on the back that would produce a scar warranting a separate evaluation. Accordingly, separate evaluations are not warranted for any other neurological conditions. Other Considerations Neither the Veteran nor his/her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (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). H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Teague, 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.