Citation Nr: A21004927 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 200415-77858 DATE: March 3, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for lumbar strain, degenerative arthritis of the spine, spinal stenosis is denied. A separate rating of 20 percent, but not higher, for right lower extremity radiculopathy is granted. A separate noncompensable rating for left lower extremity radiculopathy is granted. A separate noncompensable rating for voiding dysfunction is granted. Entitlement to service connection for a cervical spine disorder is granted. Entitlement to service connection for right upper extremity radiculopathy is granted. Entitlement to service connection for left upper extremity radiculopathy is granted. Entitlement to service connection for right knee degenerative arthritis is granted. Entitlement to service connection for left knee degenerative arthritis is granted. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for diabetes mellitus type II is remanded. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran’s lumbar strain was manifested by, at worst, forward flexion of the thoracolumbar spine to 35 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without intervertebral disc syndrome (IVDS) requiring medically prescribed bedrest or ankylosis. 2. Throughout the period on appeal, the Veteran’s lumbar strain has been productive of neurological impairment of the right lower extremity that resulted in disability analogous to moderate incomplete paralysis of the sciatic nerves and without moderately severe incomplete paralysis of the femoral nerve. 3. Throughout the period on appeal, the Veteran’s lumbar strain has been productive of neurological impairment of the left lower extremity that was asymptomatic. 4. Throughout the period on appeal, the Veteran’s lumbar strain has been productive of neurological impairment that resulted in disability analogous to occasional bowel and bladder incontinence without voiding dysfunction associated with his lumbar spine disorder requiring the wearing of absorbent materials which must be changed less than two times per day. 5. Resolving all doubt in favor of the Veteran, his cervical spine disorder is etiologically related to his active service. 6. Resolving all doubt in favor of the Veteran, his right upper extremity radiculopathy is etiologically related to his active service. 7. Resolving all doubt in favor of the Veteran, his left upper extremity radiculopathy is etiologically related to his active service. 8. Resolving all doubt in favor of the Veteran, his right knee degenerative arthritis is etiologically related to his active service. 9. Resolving all doubt in favor of the Veteran, his left knee degenerative arthritis is etiologically related to his active service. 10. Resolving all doubt in favor of the Veteran, his tinnitus is etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for a lumbar strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5242. 2. The criteria for a separate 20 percent rating for right lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8526. 3. The criteria for a separate noncompensable for left lower extremity radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8526. 4. The criteria for a separate noncompensable rating for voiding dysfunction have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.115a, Diagnostic Code 7527. 5. The criteria for service connection for a cervical spine disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for right upper extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for left upper extremity radiculopathy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for right knee degenerative arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 9. The criteria for service connection for left knee degenerative arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 10. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Coast Guard from June 1983 to September 1983 and in the United States Army from April 1985 to September 1992. This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of a February 2019 rating decision based on new and relevant evidence. In August 2019, the agency of original jurisdiction (AOJ) issued a supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In September 2019, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an August 2019 rating decision. In November 2019, the AOJ determined that duty to assist errors had been committed and ordered additional development. In March 2020, the AOJ issued the HLR decision, which considered the evidence of record at the time of the initial rating decision as well as evidence obtained subsequent to finding that there was a duty to assist error. The Veteran timely appealed the March 2020 AMA rating decision and selected the Direct-Level Review lane when he submitted his VA Form 10182 Notice of Disagreement. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Evidence, namely private treatment records and a duplicate lay statement from the Veteran’s wife, was added to the claims file by VA during a period of time when new evidence was not allowed. As the Board is deciding the claims for an increased rating for a lumbar spine disorder; and claims for service connection for a cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, tinnitus, right lower extremity radiculopathy, and left lower extremity radiculopathy may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board notes that in a November 2019 AMA rating decision, the AOJ found the following: the Veteran had a military occupational specialty (MOS) of multichannel radio operator; and he had current diagnoses for cervical disc disease with multilevel cervical canal stenosis, diabetes mellitus, hypertension, left knee osteoarthritis, left lower extremity lumbar radiculopathy, right knee osteoarthritis, right lower extremity lumbar radiculopathy, and tinnitus. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). Increased Rating Claim The Veteran asserts that his lumbar strain is more severe than currently contemplated by the current rating assigned. In that regard, the Veteran contends that his lumbar spine disorder range of motion warrants a 40 percent rating. See Third Party Correspondence, April 7, 2020. Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran’s case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claims. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the present case, the Veteran’s claim for an initial rating claim for his lumbar spine disorder stem from a claim filed in January 2018 with an evidentiary window closing at the issuance of the March 2020 rating decision, prior to the February 2021 effective date for these amendments. Therefore, the February 2021 musculoskeletal criteria do not apply to the Veteran’s claims on appeal and the appropriate criteria are discussed below. The Veteran’s lumbar spine disorder rated under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain, 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 warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, 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 unfavorable ankylosis of the entire cervical spine; or, 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 schedular maximum 100 percent rating is warranted for unfavorable ankylosis of the entire spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal 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. See Note (2); see also Plate V. Additionally, the General Formula requires any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, be evaluated under an appropriate diagnostic code. See Note (1). A 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. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). Turning to the evidence of record, at a January 2020 VA examination, the Veteran reported current symptoms of his lumbar spine disorder included increased pain in his back when he bends over, inability to do any heavy lifting, and pain that radiated down his right leg. He was not currently treating his lumbar spine disorder. The Veteran endorsed flare-ups of his lumbar spine disorder that was manifested by an inability to bend, occurring a few times a day, that was severe, and lasted a few minutes in duration. He reported functional loss or functional impairment that was described as an inability to do any heavy lifting, and an inability to walk or stand for extended periods. Upon physical examination, range of motion measurements were as follows: forward flexion was to 40 degrees; extension was to 15 degrees; right lateral flexion was to 20 degrees; and left lateral flexion, and bilateral lateral rotation were to 15 degrees each. Range of motion itself was shown to contribute to a functional loss due to the Veteran’s inability to do heavy lifting, and walk or stand for prolonged periods of time. Pain was noted on examination and caused a functional loss on all range of motion movements. There was no evidence of pain with weight-bearing. There was objective evidence of localized tenderness of the low back, moderate in severity, and demonstrated with grimacing. During the January 2020 examination, the Veteran was able to perform repetitive-use testing with at least three repetitions and there was additional loss of function or range of motion after three repetitions. Range of motion measurements following repetition were as follows: forward flexion was to 35 degrees; and extension, bilateral lateral flexion, and bilateral lateral rotation were to 15 degrees each. Pain was noted on examination and caused a functional loss. The Veteran was not examined immediately after repetitive use over time, and the examination was medically consistent with his statements describing a functional loss with repetitive-use over time. Pain was shown to significantly limit functional ability with repeated-use over time and the examiner was able to describe this in terms of range of motion. The examination was not conducted during a flare-up, and the examination was medically consistent with his statements describing a functional loss during a flare-up. Pain was shown to significantly limit functional ability during a flare-up and the examiner was able to describe this in terms of range of motion. Range of motion measurements following repetitive-use and during flare-up were as follows: forward flexion was to 35 degrees; and extension, bilateral lateral flexion, and bilateral lateral rotation were to 15 degrees each. During the January 2020 VA examination, the Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Additional factors contributing to disability included disturbance of locomotion that was described as walking with a limp. Muscle strength testing was normal, and the Veteran did not have muscle atrophy. Reflex examination testing results were normal. Sensory examination testing showed decreased sensation to light touch in the bilateral lower leg/ankle and bilateral foot/toes. Straight leg raising test was negative bilaterally. The Veteran was shown to have radicular pain or signs and symptoms due to radiculopathy that included moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the right lower extremity. The examiner found the Veteran had moderate right lower extremity radiculopathy and did not have left lower extremity radiculopathy. The Veteran did not have ankylosis of the spine. He had occasional urinary and bowel incontinence due to spinal stenosis. The Veteran did not have IVDS. He denied the use of any assistive devices as a normal mode of locomotion. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging studies documented arthritis, without vertebral fracture with loss of 50 percent or more of height. The examiner noted the Veteran’s lumbar spine disorder impacted his ability to work due to inability to do heavy lifting, and inability to walk or stand for prolonged periods; the examiner noted the Veteran was employed in medical staffing. Passive range of motion of the spine was not performed, and was not feasible to do in a safe and reasonable manner. Nonweight-bearing assessment was not applicable. There was no objective evidence of pain when the spine was in a nonweight-bearing position at rest. Opposing joint assessment was not applicable because the spine does not have an opposing joint. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his low back. A review of the treatment notes of record does not show the Veteran to have symptoms of a lumbar spine disability worse than those reported at the VA examinations of record and noted above. Based on the foregoing, the Board finds that a rating in excess of 20 percent rating for a lumbar strain is not warranted. The Veteran’s forward flexion of the thoracolumbar spine was found to be to 35 degrees, at worst, during the January 2020 VA examination, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the thoracolumbar spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. In this regard, the Veteran reported pain, difficulty with heavy lifting, and difficulty with prolonged walking and standing. However, even in considering the Veteran’s subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 20 percent assigned. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. Additionally, the Veteran’s examinations have been consistently negative for ankylosis and the Veteran has retained range of motion in the lumbar spine. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996); Lewis v. Derwinski, 3 Vet. App. 259 (1992) (indicating that ankylosis is complete immobility of the joint in a fixed position, either favorable or unfavorable); see January 2020 VA examination report (indicating the Veteran did not have ankylosis of the spine at any time). Therefore, the Board finds that, at no time during the appeal period has the Veteran’s service-connected lumbar strain resulted in ankylosis warranting a higher rating. The Board has considered whether a higher evaluation could be assigned for any period on appeal under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran has had incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that the Veteran has a diagnosis of IVDS that resulted in medically prescribed bedrest. Specifically, the Veteran did not have a diagnosis of IVDS. See January 2020 VA examination report. Accordingly, a higher or separate rating is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court of Appeals for Veterans’ Claims (Court’s) holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the VA examiner did not test the opposite joint; however, the spine does not have an opposite joint. The VA examiner indicated there was no interference with weight-bearing and pain was noted on examination. Regarding repeated use over time and flare-ups, the Board notes that VA examiner conducted repetitive-use testing and range of motion measurements as noted above. Additionally, the Veteran was able to describe his symptoms during a flare-up and the impact of such. Specifically, the examiner elicited information from the Veteran regarding the severity, frequency, duration and functional loss manifestations of flare-ups. Therefore, the Board finds that all information required for rating purposes was provided. In this regard, the Board notes that the examiner clearly noted that the Veteran specifically reported pain, limited bending over, difficulty with walking and standing prolonged periods, and inability to do heavy lifting. There is no other indication from the record, to include the Veteran’s own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. As the Veteran has not endorsed those symptoms, the Board finds the examination of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. 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. Here, the Veteran has been shown to have occasional urinary and bowel incontinence due to spinal stenosis, and as a result of his lumbar spine disorder. Accordingly, resolving all doubt in favor of the Veteran, the Board finds that the Veteran has had voiding dysfunction associated with his lumbar spine disorder, that did not require the wearing of absorbent materials which must be changed less than two times per day. In this regard, the Veteran has not alleged, and the evidence does not show, that he requires the wearing of absorbent materials at any time due to his occasional urinary and bowel incontinence. As such, the Board concludes that the evidence supports entitlement to a separate noncompensable rating under Diagnostic Code 7527 for voiding dysfunction. Additionally, the record shows complaints of radiating pain into the right lower extremity. The Veteran reported low back shooting pains on the lower right extremity at his January 2020 VA examination. Moreover, the examiner noted the Veteran had radicular pain or signs and symptoms due to radiculopathy that included moderate constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the right lower extremity; and found the Veteran had moderate right lower extremity radiculopathy and did not have left lower extremity radiculopathy. Accordingly, resolving all doubt in the Veteran’s favor, the Board finds that, based on the lay and medical evidence, the Veteran has had neurologic impairment in his right lower extremity associated with his lumbar spine disorder. As such, the Board concludes that the evidence supports entitlement to a separate 20 percent rating under Diagnostic Code 8526 for moderate incomplete paralysis of the femoral nerve in the right lower extremity. However, a higher rating of 30 percent is not warranted as there is clearly no evidence of radicular impairment to a severe degree. See 38 C.F.R. § 4.124a. The Board finds that the Veteran’s impairment in the sciatic nerve is wholly sensory, as the Veteran has not been found to have any problems with motor functioning or atrophy or any non-sensory symptoms associated with neurological impairment. The Board finds that sciatic impairment is best described as moderate because of the lack of findings of atrophy or motor or reflex symptomatology. The Board finds that the weight of the evidence is in the Veteran’s favor and a separate 20 percent rating for moderate incomplete paralysis of the right femoral nerve is warranted. Finally, as noted above, the Veteran has been shown to have a diagnosis of left lower extremity lumbar radiculopathy; and the Board is bound by that favorable finding. See Rating Decision, November 12, 2019. A review of the lay and medical evidence shows the Veteran’s left lower extremity radiculopathy is asymptomatic. Specifically, the Board notes that at his January 2020 VA examination, the examiner did not find any signs or symptoms with respect to his left lower extremity. As such, the Board concludes that the evidence supports entitlement to a separate noncompensable rating under Diagnostic Code 8526 for asymptomatic radiculopathy of the left lower extremity. However, a higher rating of 10 percent is not warranted as there is clearly no evidence of radicular impairment to a mild degree. See 38 C.F.R. § 4.124a. The Board finds that the Veteran’s impairment in the sciatic nerve is wholly sensory, as the Veteran has not been found to have any problems with motor functioning or atrophy or any non-sensory symptoms associated with neurological impairment. The Board finds that sciatic impairment is best described as asymptomatic because of the lack of findings of any symptoms or signs of radiculopathy, nor of atrophy or motor or reflex symptomatology. The Board finds that the weight of the evidence is in the Veteran’s favor and a separate noncompensable rating for left lower extremity radiculopathy is warranted. The Veteran’s belief that he is entitled to a higher rating for his lumbar strain is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board acknowledges the statements of the Veteran that his lumbar spine disorder warrants a 40 percent rating. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board finds, however, that neither the Veteran’s statements, nor medical evidence demonstrates that the criteria for higher ratings have been met during any period on appeal. Specifically, as noted above, the Veteran’s range of motion is described, and the Veteran has not been shown to have ankylosis of the spine at any time. In addition, the Veteran was able to describe his symptoms during flare-ups, following repetitive-use, the impact of his symptoms on his daily life, and the severity, frequency, duration and functional loss manifestations of flare-ups. The Board also acknowledges that the Veteran’s VA treatment records note complaints of and treatment for his back. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. This argument is therefore without merit. Consideration has been given to assigning a staged rating. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned, and the disability has been stable throughout the appeal period. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran is currently employed in medical staffing. The Veteran has not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due solely to his service connected lumbar strain. As such, a Rice claim is not raised. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 20 percent for a lumbar strain, and the claim must be denied. However, the Board finds that a separate noncompensable rating is warranted for voiding dysfunction secondary to a lumbar strain, a separate 20 percent rating for right lower extremity neurological impairment secondary to a lumbar strain and a separate noncompensable rating for left lower extremity neurological impairment secondary to a lumbar strain are warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Service Connection Claims The Veteran seeks to establish service connection for cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus. Specifically, the Veteran seems to assert that the VA examinations are inadequate; that his tinnitus is due to his MOS as a multichannel radio operator, and due to his service with the air defense artillery unit and loud weapons fire; and states that he developed such disorders during active service. See Third Party Correspondence, April 7, 2020; see also VA Form 20-0996 Request for Higher-Level Review, September 2, 2019. I. Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). II. Pertinent Evidence The Veteran’s service treatment records are silent for complaints of, treatment for, and diagnoses related to his neck, radiculopathy or peripheral neuropathy, knees, and tinnitus. At a January 2019 VA examination for the Veteran’s tinnitus, the examiner diagnosed tinnitus and opined that an opinion as to the nature and etiology of tinnitus could not be provided without resorting to speculation. An April 2019 statement was submitted by the Veteran’s wife. In her statement, she stated that the Veteran’s claimed conditions started during his military service and had progressively worsened following service. An April 2019 private etiology opinion by Dr. M.F. was submitted. At that time, Dr. M.F. noted that the Veteran worked for six years as a multichannel communications system operator during service and that the job included repetitive heavy manual work. She opined that “in the absence of any recent trauma after military discharge, it is more likely than not that his previous line of work is the cause of” the Veteran’s acquired osteoarthritis of both knees, cervical disc disease and cervical canal stenosis, and lumbar degenerative changes. An April 2019 private etiology opinion by Dr. E.C. was submitted. At that time, Dr. E.C. noted the Veteran’s history, and opined that the pain in both shoulders and arms, and his tinnitus were “acquired during his military service.” In this regard, Dr. E.C. noted that there was no trauma following separation from active service, nor did the Veteran have any serious illnesses to explain his radicular pain and tinnitus. Moreover, Dr. E.C. noted that since discharge from active service, the Veteran experienced intermittent pain in his arms and shoulders, with numbness of the hands and toes. Dr. E.C. diagnosed, in pertinent part, cervical and lumbar radiculopathy; tinnitus, traumatic; and multiple disc bulging, mild to moderate. At a December 2019 VA examination for the Veteran’s tinnitus, the VA examiner opined that an opinion as to the nature and etiology of tinnitus could not be provided without resorting to speculation. In a separate December 2019 VA examination report, the VA examiner opined that the Veteran’s tinnitus was less likely than not incurred in or caused by the in-service injury, event, or illness. In this regard, the examiner noted that there was no significant shift in hearing thresholds while in the military, that hearing was normal at the time of examination and there was no documentation found of report of onset of tinnitus while in military service. At a January 2020 VA examination for the Veteran’s neck, the VA examiner opined the Veteran’s cervical strain was less likely than not incurred in or caused by the claimed in-service injury, event or illness. In this regard, the examiner noted that there was no evidence of the onset of degenerative arthritis of the thoracolumbar spine and spinal stenosis during service and that diagnosis was made in August 2018, over 26 years after discharge from active service. Moreover, the examiner noted that there was no evidence of onset of cervical strain during active service and the diagnosis was made at the examination, over 27 years after discharge from active service. At a January 2020 VA examination for the Veteran’s knees, the VA examiner opined the Veteran’s right and left knee degenerative arthritis was less likely than no incurred in or caused by the claimed in-service injury, event, or illness. In this regard, the examiner noted that there was no evidence of right and left knee conditions or osteoarthritis during service; there was no chronicity of right and left knee conditions thereafter; and the diagnosis of right and left knee osteoarthritis was made on April 2019, over 27 years after discharge from active service. At a January 2020 VA examination for the Veteran’s peripheral neuropathy, the VA examiner opined that the Veteran’s peripheral neuropathy was less likely than not incurred in or caused by the claimed in-service injury, event or illness. In this regard, the examiner noted that there was no evidence of diagnosed peripheral neuropathy during service; that diagnosis was made at the time of the examination; and there was no documentation of chronicity of care for a peripheral neuropathy condition after service. III. Analysis Turning to the question of whether there is an etiological relationship between the Veteran’s cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus and service, the Board notes that the record contains multiple etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (stating that the probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board will consider each of these opinions below. First, the Board considers the April 2019 private etiology opinions submitted by Dr. M.F. and Dr. E.C. These opinions have clear conclusions and supporting data, as well as reasoned medical explanations connecting the Veteran’s cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus to service. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Notably, Drs. M.F. and E.C. noted the Veteran’s MOS, statements and contentions regarding the onset and continuity of his service, his lack of trauma following service, and the continued symptomatology following service. These opinions are therefore afforded great probative weight. Next, the Board considers the January 2019 and December 2019 VA opinions of record with respect to tinnitus. The Board finds the January 2019 and December 2019 VA opinions with respect to the Veteran’s tinnitus inadequate to decide the claim because the opinions failed to provide an opinion as to the nature and etiology of his tinnitus. Specifically, the examiners found an opinion could not be provided without resorting to mere speculation, but did not explain why. Jones v. Shinseki, 23 Vet. App. 382, 391 (2010). Additionally, the Board finds the separate December 2019 VA opinion inadequate to decide the claim for entitlement to service connection for tinnitus because the examiner did not provide supporting rationale for the conclusions reached, and did not adequately address the Veteran’s lay statements and contentions regarding the onset and continuity of his tinnitus. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). These opinions are therefore afforded little, if any, probative weight. Finally, the Board considers the January 2020 VA opinions of record with respect to the Veteran’s cervical spine, knees, and upper extremity peripheral neuropathy. The Board finds the January 2020 VA opinions inadequate to decide the claims because examiner did not provide supporting rationale for the conclusions reached, and did not adequately address the Veteran’s lay statements and contentions regarding the onset and continuity of his cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, and left knee degenerative arthritis. Barr v. Nicholson, supra; Stefl v. Nicholson, supra; Nieves-Rodriguez v. Peake, supra. These opinions are therefore afforded little, if any, probative weight. In sum, the Veteran has competently and credibly reported symptoms of cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus that began during active service and have continued since. The Veteran has current diagnoses of cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus. There is no competent medical opinion of record against the claims. Rather, there are probative private opinions from April 2019 indicating the Veteran’s cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus is more likely than not as a result of his active service. Moreover, there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant’s case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose). Accordingly, the Board finds that the preponderance of the evidence is for the claims and entitlement to service connection for cervical strain, right upper extremity radiculopathy, left upper extremity radiculopathy, right knee degenerative arthritis, left knee degenerative arthritis, and tinnitus is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND Service Connection Claims – Hypertension and Diabetes Mellitus The Veteran seeks to establish service connection for hypertension and diabetes mellitus. Specifically, the Veteran seems to assert that the VA examinations are inadequate that his hypertension and diabetes mellitus are due to his MOS as a multichannel radio operator. See Third Party Correspondence, April 7, 2020. The Veteran was afforded a VA examination for his claimed hypertension and diabetes mellitus in January 2020. At that time, the examiner opined the Veteran’s hypertension and diabetes mellitus were less likely than not incurred in or caused by the claimed in-service injury, event or illness. In this regard, the examiner noted the Veteran’s MOS of multichannel radio operator. The examiner opined that manual labor in and of itself is not a cause or risk factor for hypertension and that manual labor does not lead to diabetes mellitus. The Board finds the January 2020 VA opinions incomplete to decide the claim. In this regard, the examiner did not provide adequate supporting rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, supra. As such, remand is required to obtain opinions as to the nature and etiology of the Veteran’s hypertension and diabetes mellitus. The failure to obtain etiology opinions constitutes a pre-decisional duty to assist error. The matters are REMANDED for the following action: Schedule the Veteran for examinations by an appropriate clinician to determine the nature and etiology of his hypertension and diabetes mellitus. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension and/or diabetes mellitus had its onset during service or is at least as likely as not related to an in-service injury, event, or disease? The examiner should be sure to address the significance, if any, of the Veteran’s MOS as a multichannel radio operator, and his contentions that such MOS caused his claimed hypertension and diabetes mellitus. (Continued on the next page)   A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, Associate 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.