Citation Nr: 22010071 Decision Date: 02/22/22 Archive Date: 02/22/22 DOCKET NO. 18-03 080 DATE: February 22, 2022 ORDER Entitlement to an increased evaluation for degenerative disc disease of the cervical spine higher than 10 percent prior to June 28, 2012, and higher than 20 percent thereafter, is denied. Entitlement to an increased rating higher than 20 percent for radiculopathy of the right upper extremity is denied. Entitlement to an increased rating higher than 20 percent for radiculopathy of the left upper extremity is denied. FINDINGS OF FACT 1. Prior to June 28, 2012, the Veteran's degenerative disc disease of the cervical spine was manifested by pain, with forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees. 2. From June 28, 2012, the Veteran's degenerative disc disease of the cervical spine was productive of forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees, and without incapacitating episodes. 3. The Veteran's radiculopathy of the right upper extremity is manifested by mild incomplete paralysis. 4. The Veteran's radiculopathy of the left upper extremity is manifested by mild incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation higher than 10 percent prior to June 28, 2012, and higher than 20 percent thereafter, for cervical spine disability have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.2, 4.7, 4.10, 4.14, 4.21, 4.40, 4.41, 4.45, 4.59, Diagnostic Code 5237. 2. The criteria for a disability rating higher than 20 percent for radiculopathy of the right upper extremity have not been met. 38 U.S.C. §§ 1155, 107; 38 C.F.R. § 4.124a, Diagnostic Code 8510. 3. The criteria for a disability rating higher than 20 percent for radiculopathy of the left upper extremity have not been met. 38 U.S.C. §§ 1155, 107; 38 C.F.R. § 4.124a, Diagnostic Code 8513. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from August 1964 through August 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, a Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. In October 2020, the Board denied entitlement to an increased evaluation for degenerative disc disease of the cervical spine higher than 10 percent prior to June 28, 2012, and higher than 20 percent thereafter. The Veteran appealed the Board's October 2020 decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a January 2021 Order by the Court in accordance with a Joint Motion for Remand (JMR), the issue was remanded to the Board for additional development and adjudication. 1. Entitlement to an increased evaluation for degenerative disc disease of the cervical spine higher than 10 percent prior to June 28 ,2012, and higher than 20 percent thereafter. The Veteran is seeking entitlement to an increased evaluation for his degenerative disc disease of the cervical spine. Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76460, 76462 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8143 (Feb. 4, 2021). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period before and after the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating under the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals considering laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the agency of original jurisdiction. In Disabled American Veterans v. Sec. of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) specifically upheld the validity of 38 C.F.R. § 19.9(b)(2) (now as noted renumbered as 38 C.F.R. § 20.904(d)(2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claim. The Veteran's cervical spine has been rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5242-5237. As for the changes effective February 7, 2021 under 38 C.F.R. § 4.71a, DC 5242 and 5243 were not to the rating schedule itself but added instruction to classify disabilities associated with IVDS under DC 5243 and all other intervertebral disc disabilities under 5242. As such, DC 5242 now reflects "Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010);" DC 5243 now reflects "Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve route; assign diagnostic code 5242 for all other disc diagnoses." Thus, the changes do not impact the general rating formula and evaluation of the disability under the pre- and post-February 7, 2021, regulations are not warranted. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), a 10 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 where forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees; or where forward flexion of the cervical spine is greater than 15 degrees, but not greater than 30 degrees; or where the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or where the combined range of motion of the cervical spine is not greater than 170 degrees; or where muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted where forward flexion of the cervical spine is 15 degrees or less; or where there is favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or where forward flexion of the thoracolumbar spine is limited to 30 degrees or less; or where there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Note 1 to this rating schedule states that any associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are to be evaluated separately under appropriate diagnostic codes. In the alternative, an evaluation can be assigned under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Intervertebral disc syndrome is to be evaluated either under the new general rating formula for diseases and injuries of the spine or under the formula for rating intervertebral disc syndrome based on incapacitating episodes, whichever method results in a higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. For intervertebral disc syndrome manifested by incapacitating episodes having a total duration of at least six weeks during the past 12 months, a 60 percent evaluation is warranted; with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent evaluation is warranted; with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent evaluation is warranted; and with incapacitating episodes having a total duration of at least one weeks but less than two weeks during the past 12 months, a 10 percent evaluation is warranted. Note 1 of that code provides that, for purposes of evaluations 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. Evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss in light of 38 C.F.R. § 4.40, taking into account any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flareups. 38 C.F.R. § 4.14. CAVC has held that "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." See Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Rather, pain may result in functional loss, but only if it limits the ability to "perform the normal working movements of the body with normal excursion, strength, speed, coordination[, or] endurance." Id. (quoting 38 C.F.R. § 4.40). Additionally, CAVC, in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight bearing and, if indicated, with range of motion measurements of the opposite undamaged joint. Turning to the evidence of record, in November 2006, the Veteran underwent an exam. He reported constant neck pain, with soreness throughout the day. He reported pain between the shoulder blades, without weakness, stiffness, fatigue, or lack of endurance. He reported posterior trapezius interscapular pain, right greater than left, with tingling sensation down the right side of his arm. He did not report flare ups. He reported a cough can irritate his neck. The last time he received bed rest for his back was when he was hospitalized for his neck problems in 1988. He reported when driving he must shift his arm from right to left due to the sensation of stiffness in his neck. He denied toilet, eating, grooming, or hygiene impairment. On examination there was no edema or swelling. He had normal cervical lordosis. He had an anterior cervical scar which was healed. Palpating the entire upper torso and spine were negative for spasm. There was no palpable hardening in the neck or trapezius areas. Range of motion testing was flexion to 50 degrees, extension to 40, right side bending to 20, left side bending to 25, right rotation to 55, and left to 60. The examiner stated the range of motion was not additionally limited by pain, fatigue, weakness, or lack of endurance following repetitive use or during a flare up. At an August 2009 visit at the Ladner Clinic, the Veteran had neck and bilateral arm pain, and he reported pain as constant, aching, burning, stabbing, tingling, and numbing in nature. He was noted as having a right shoulder cuff tear, and cervical post laminectomy syndrome. On examination he had normal cervical lordosis. An MRI was done, and the examiner stated he had a history of cervical radiculitis. In a May 2010 private treatment note completed by Dr. A. J., it was noted the Veteran had decreased left and right lateral bending, decreased extension and a scar. SSA records were reviewed and document an evaluation in June 2010. The Veteran was assessed as having cervical and lumbar post laminectomy syndrome. As to his cervical spine, he was noted as having decreased right lateral bending. In June 2012, the Veteran underwent another examination. He did not report flare ups of the cervical spine. Range of motion testing revealed flexion to 25 degrees, extension to 20 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 60 degrees, left lateral rotation to 65 degrees, with no objective evidence of painful motion. Following three repetitions he had flexion to 25, extension to 20, right lateral flexion to 15, left lateral flexion 10, right lateral rotation to 60, and left lateral rotation to 65. He had no guarding or muscle spasms of the cervical spine. Muscle strength testing was normal. Sensory examination was normal, and he had no radiculopathy. There were no neurologic findings. He did not have IVDS. His condition had no impact on his ability to work. In a January 2013 statement from Energy Spinal centers, a clinician explained the Veteran had cervical disc syndrome. He was experiencing sharp stabbing pain along with numbness and tingling. He also had headaches, pain and stiffness in the neck, insomnia due to pain, and numbness in his digits. He was having problems doing everyday activities such as bending, walking, or standing for long periods of time, difficulty falling and staying asleep due to the severity and intensity of the pain. A November 2015 MRI of the cervical spine revealed a cervical herniated disc, left side radiculopathy, and carpal tunnel syndrome. VA treatment records show he had a cervical spine fusion in December 2017. He was to do a sponge bath for 3 days post-surgery. He was to wear a c-collar while laying down. He went to physical therapy and reported an improvement in symptoms. An MRI revealed the fusion, with left and right foraminal stenosis at C3-4, and C4-5. The Veteran underwent an examination in December 2019. He was diagnosed with degenerative disc disease of the cervical spine and was noted as having history of neck fusion. He reported a constant aching pain and sharp pain with certain movements and activities, particularly activities that require repetitive head and neck movements or trying to reach overhead, mostly to the left side. He reported his neck sometimes locks. He reported neck pain that occasionally shoots to his arms. He was taking gabapentin, Celebrex, and acetaminophen for treatment. He denied flare-ups of the spine. Functional impairment was described as having to turn his whole body and putting up mirrors to help him. He reported not being able to sit straight or lean forward very long. Range of motion testing revealed flexion to 30 degrees, extension to 30 degrees, right lateral flexion to 25 degrees, left lateral flexion to 20 degrees, right lateral rotation to 45 degrees, and left lateral rotation to 30 degrees. Pain was noted on examination that caused functional loss. He had pain in all ranges of motion. There was objective evidence of moderate localized tenderness or pain on palpation at the left side of the neck. There was no pain with weight bearing. There is no additional loss of function or range of motion after three repetitions. He was not examined immediately after repetitive use over time, and the examination was deemed medically consistent with his statements describing functional loss with repetitive use over time. Pain limited functional ability with repeated use over time, and the examiner concluded there was no further loss anticipated during this scenario, only an increase in symptoms, thus no ROM estimate was warranted. As for flare-ups, the examination was deemed neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during a flare up. Pain, weakness, fatigability, and incoordination did not significantly limit functional ability during a flare-up. The Veteran did not report functional loss associated with flare ups. The Veteran does not have guarding or muscle spasms of the cervical spine. He had some decreased sensation; however, he did not have cervical radiculopathy. He had no associated neurologic abnormalities. He did not have ankylosis or IVDS. He had a scar at the front of the neck, that measured 5.0 cm by 0.2 cm. Functional impact was described as decreased ability in performing activities that require repetitive neck or head movement. There was no objective evidence of pain when the neck is used in non-weight bearing. Passive range of motion was the same as active range of motion, with the objective evidence of pain the same as in active range of motion. The preponderance of the above evidence demonstrates that the Veteran is not entitled to an evaluation higher than 10 percent prior to June 28, 2012, or higher than 20 percent at any time during the pendency of this claim. The Veteran is competent to report on symptoms, and the Board has considered his complaints in reaching this decision. The Veteran is not competent; however, to determine whether this cervical spine disability meets the criteria for a higher rating. Even considering the Veteran's subjective complaints of pain, the evidence of record does not show any additional limitation of motion or functional impairment that would support an evaluation higher than 10 percent prior to June 28, 2012, or higher than 20 percent thereafter. For the period prior to June 28, 2012, his flexion was at worse to 50 degrees. There were no reports of flare-ups. There was no indication of additional limitation following repetitive use or during a flare-up. Although he was noted in May and June 2010 of having decreased right and left lateral bending as well as decreased extension, this evidence is not determinative of a worse disability picture. The Veteran's reduced flexion of 50 degrees was measured and even so, still does not meet the requirement of a compensable evaluation. Though he did not have limitation of motion that meets the requirements of a compensable evaluation, he reported painful and decreased motion. A minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. §§ 4.59. A rating higher than 10 percent is not warranted as there is no evidence showing limitation of motion that reaches the level contemplated by a 20 percent rating prior to June 28, 2012. The Board is sympathetic to the Veteran's reports of decreased motion and pain, however, there is no indication prior to June 28, 2012, that his limitation of motion more nearly approximates flexion of the spine greater than 15 degrees but not greater than 30 degrees. For the period from June 28, 2012, his flexion was at worse to 25 degrees. To meet the criteria for a 30 percent rating, the range of flexion would have to be limited to 15 degrees or less or favorable ankylosis of the entire cervical spine under diagnostic code 5237. At the June 2012 examination, there was no additional limitation in range of motion following three repetitions, and he denied flare-ups. In 2019, the examiner indicated there is no additional loss of function or range of motion after three repetitions. As for following repetitive use over time, the examination was deemed medically consistent with his statements describing functional loss with repetitive use over time. The Board has considered the Court's holding that VA may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 61 (2012). The rating criteria listed under Diagnostic Code 5237 for limitation of cervical spine motion fail to contemplate the effects of pain medication on the Veteran's cervical spine. The Veteran has undergone treatment for his cervical spine throughout the period on review. Of note, at the December 2019 examination the Veteran reported taking Gabapentin, Celebrex, and Acetaminophen. However, the Board emphasizes that this decision is not based on any finding that the Veteran's medication provided relief, but rather it is based on the fact that the necessary symptoms and manifestations for the cervical spine are not demonstrated by the evidence of record regardless of any medication the Veteran takes. The evidence simply does not demonstrate the necessary findings for a higher 20 percent rating for the cervical spine, with or without medication. The functional impact was explained in 2006 as having to switch arms while driving due to pain and numbness. It is noted the Veteran was later diagnosed with a right shoulder cuff tear. At the 2006 exam he denied toilet, eating, grooming, or hygiene impairment. At the 2012 examination the examiner indicated his condition had no impact on his ability to work. At a 2013 visit, the impact was noted as difficulty bending, walking, or standing for long periods of time, and difficulty falling asleep due to pain. At the 2019 visit functional impairment was described as having to turn his whole body and putting up mirrors to help him. He reported not being able to sit straight or lean forward very long. Pain was noted on examination that causes functional loss. Regarding Correia criteria, at the 2019 examination there was no noted objective evidence of pain when the back is used in non-weight bearing, and passive range of motion was the same as active range of motion. There was objective evidence of pain that was the same as that in active range of motion. The Court has established that flare-ups must be considered. However, as with DeLuca, guidance on how to evaluate flare-ups has not been particularly clear. Therefore, this Veterans Law Judge expands upon the wisdom advanced in Mitchell. Flare-ups must be quantifiable and must result in limitation of motion or function beyond that contemplated by the already provided evaluation. In addition, because there is a regulation addressing stabilization of ratings, the flare-up must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time. The Veteran denied experiencing flare-ups in 2006 and in 2012. At the 2019 examination, though he denied experiencing flare-ups, the examiner stated the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare up. Pain, weakness fatigability or incoordination did not significantly limit functional ability with a flare-up. Accordingly, there is no basis on which to warrant a higher evaluation based upon flare-ups. There is no persuasive evidence that prior to June 28, 2012, his flexion was greater than 15 degrees, but not greater than 30 degrees. There is no evidence that from June 28, 2012, he had forward flexion of the cervical spine is 15 degrees or less; or where there is favorable ankylosis of the entire cervical spine. It is noted he had a spinal fusion in December 2017. Records following this fusion indicate he went to physical therapy and reported an improvement in symptoms. Further, at the 2019 examination he did not have a worsening of symptoms. In sum, 38 C.F.R. § 4.1 provides that the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illness proportionate to the severity of the several grades of disability. The Veteran's reports of exacerbation or flare-ups did not result in limitation of motion or function beyond that contemplated by the already provided evaluation and are not of sufficient duration to warrant a change in evaluation without violating the spirit of Mitchell, the spirit of 38 C.F.R. § 4.1, and the rule regarding stabilization of ratings. Higher evaluations are also available for intervertebral disc syndrome. The Veteran has not been diagnosed with IVDS, and there is no probative evidence showing treatment for incapacitating episodes, or that he has been prescribed bed rest by a physician. As such throughout the entire period on appeal, a higher evaluation under DC 5243 is not warranted. Effective February 2021, the criteria for evaluation under DC 5243, was revised to indicate intervertebral disc syndrome is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Here, there is no such indication of disc herniation with compression and/or irritation of the adjacent nerve root, and accordingly a higher evaluation under the new criteria is not warranted. At no time during the pendency of the appeal, have there been findings of ankylosis or symptoms approximating ankylosis. The Board notes that ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). See also 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, NOTE (5) (defining ankylosis as fixation of a joint in a particular position). Given the limitation of motion noted by the VA examiners (including negative findings of ankylosis), and VA medical providers, the Board finds that at no time during the course of the appeal has the Veteran had ankylosis of the spine or symptoms approximating ankylosis of the cervical spine. The assigned 10 then 20 percent ratings adequately contemplate the Veteran's level of impairmentincluding consideration of functional impairment during flare-ups or following repetitive motion. As such, a higher evaluation is not warranted due to functional loss. Note (1) of 38 C.F.R. § 4.71a also instructs the rater to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. In the present case there have been no reports of bowel or bladder complaints. Aside from radiculopathy, discussed below, objective neurological evaluations have consistently been normal. With respect to his cervical spine scar, the Veteran was granted a noncompensable evaluation for his cervical spine scar in March 2020. Throughout the rating period, the Veteran's scar has been described as linear, not painful, and not unstable. 38 C.F.R. § 4.118. A compensable evaluation is warranted if the scar is painful or unstable. There is no indication the scar has been painful or unstable, hence further discussion is not warranted. Accordingly, entitlement to an evaluation higher than 10 percent prior to June 28, 2012, and higher than 20 percent thereafter for the cervical spine disability is not warranted. 2. Entitlement to an increased rating higher than 20 percent for radiculopathy of the right upper extremity. 3. Entitlement to an increased rating higher than 20 percent for radiculopathy of the left upper extremity. The Veteran is in receipt of service connection for right upper extremity radiculopathy with a 20 percent evaluation effective June 9, 2004 and left upper extremity radiculopathy with a 20 percent evaluation effective June 9, 2004. In October 2020, the Board remanded the issue of entitlement to service connection for a bilateral upper extremity disability. In a September 2021 decision, the RO granted service connection for right upper extremity radiculopathy effective June 2004. In January 2022, the RO granted service connection for left upper extremity radiculopathy effective June 9, 2004. The Veteran's right upper extremity radiculopathy is evaluated under Diagnostic Code 8510. The Veteran's left upper extremity radiculopathy is evaluated under Diagnostic Code 8513. The Veteran is right-handed, as such, his major side is his right side. Diagnostic Code 8510 provides ratings for paralysis of the upper radicular group of nerves (fifth and sixth cervicals). Diagnostic Code 8510 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the upper radicular group, with all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected, is rated 70 percent disabling on the major side and 60 percent on the minor side. 38 C.F.R. § 4.124a. Diagnostic Code 8513 provides ratings for paralysis of all radicular groups of nerves. Diagnostic Code 8513 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 40 percent disabling on the major side and 30 percent on the minor side; and severe incomplete paralysis is rated 70 percent disabling on the major side and 60 percent on the minor side. Complete paralysis of all radicular groups is rated 90 percent disabling on the major side and 80 percent on the minor side. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured 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 should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. In rating peripheral nerve injuries and their residuals, the Board notes that attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. The words "mild," "moderate," and "severe" are not defined in the above rating criteria. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6 Based on the evidence of record, the Board finds that a rating higher than 20 percent for the right lower and left upper extremity radiculopathy is not warranted. At the November 2006 examination he reported neck pain and soreness, that travels between the shoulder blades. He reported posterior trapezius interscapular pain, right greater than left, with tingling sensation down the right side of his arm. At an August 2009 visit at the Ladner Clinic, the Veteran had neck and bilateral arm pain, and he reported pain as constant, aching, burning, stabbing, tingling, and numbing in nature. He was noted as having a right shoulder cuff tear, and cervical post-laminectomy syndrome. An MRI was done, and the examiner stated he had a history of cervical radiculitis. At the June 2012 examination, sensory examination was normal, and he had no radiculopathy. There were no neurologic findings. In a January 2013 statement from Energy Spinal centers, a clinician explained the Veteran had cervical disc syndrome. He was experiencing sharp stabbing pain along with numbness and tingling. He also had headaches, pain and stiffness in the neck, insomnia due to pain, and numbness in his digits. A November 2015 MRI of the cervical spine revealed a cervical herniated disc, left side radiculopathy, and carpal tunnel syndrome. In December 2019, he reported neck pain that occasionally shoots to his arms. He had some decreased sensation; however, he did not have cervical radiculopathy. He had no associated neurologic abnormalities. In March 2021, the Veteran underwent an examination addressing his bilateral upper extremity complaints. He was diagnosed with bilateral cervical radiculopathy. The examiner indicated the left upper extremity and right upper extremity cervical radiculopathy was proximately due to the service-connected cervical spine disability. The Veteran is in receipt of service connection for his cervical spine disability effective June 9, 2004. He is in receipt of service connection for his bilateral upper extremity radiculopathy associated with the cervical spine effective June 9, 2004. As his radiculopathy is granted secondary to the cervical spine, it follows that an earlier effective date prior to the grant of service connection for the cervical spine is not warranted. The Veteran's symptoms have been no more than mild in nature; therefore, a rating higher than 20 percent is not warranted. Based on a comprehensive review of the record, the Board finds that the Veteran's left and right upper extremity cervical radiculopathy does not warrant a rating in excess of 20 percent for either extremity. The Veteran's left and right upper extremity nerve disorder has resulted in, at its worst, "mild" incomplete paralysis of the left and right upper radicular group nerves. Given that the Veteran is right hand dominant, the Board finds that the previously assigned 20 percent ratings were appropriate for "mild" incomplete paralysis affecting his left (minor) and right (major) upper radicular group nerves. At times he has been found to have radiculopathy and other times there has been no indication of radiculopathy. His symptoms have primarily been those of pain, numbness, and tingling. Having considered the evidence of record, including the examination reports, VA treatment records, and private treatment records, the Board concludes that the Veteran's left and right upper extremity radiculopathy has never resulted in "moderate" incomplete paralysis of the left and right upper radicular group nerves. Similar to the discussion in cervical spine section above, these findings are not based on any ameliorative effects of medication he takes to treat his bilateral upper extremity radiculopathy. Accordingly, the evidence of record does not support the assignment of increased disability ratings for the Veteran's service-connected left and right upper extremity radiculopathy. The claims on appeal must be denied. The Veteran has not raised any other issues, nor have any other issues been raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (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 records). H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.