Citation Nr: 22012003 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 17-47 889 DATE: March 2, 2022 ORDER Entitlement to a rating in excess of 10 percent prior to March 16, 2015; in excess of 20 percent prior to June 7, 2017; and in excess of 40 percent thereafter for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is denied. Entitlement to a 40 percent rating from June 7, 2017, for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is granted. Entitlement to an initial rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for left lower extremity radiculopathy is denied. Entitlement to a 20 percent rating from March 16, 2015, for left lower extremity femoral nerve radiculopathy is granted. FINDINGS OF FACT 1. Prior to March 16, 2015, the Veteran's lumbar spine disability is manifest by forward flexion to no less than 75 degrees, a combined range of motion to no less than 130 degrees, and tenderness along the paraspinous muscles of the lumbar spine and sacroiliac joints without guarding or muscle spasm. 2. From March 16, 2015, to June 7, 2017, the Veteran's lumbar spine disability is manifested by forward flexion to no less than 50 degrees, a combined range of motion to no less than 140 degrees, and muscle spasm and localized tenderness resulting in abnormal gait or abnormal spinal contour. 3. From June 7, 2017, the Veteran's lumbar spine disability is manifested by forward flexion to no less than 25 degrees, a combined range of motion to no less than 50 degrees, and localized tenderness and muscle spasm not resulting in abnormal gait or spinal contour. 4. Prior to March 16, 2015, the Veteran's left lower extremity radiculopathy is manifest by no more than mild incomplete paralysis of the sciatic nerve. 5. From March 16, 2015, the Veteran's left lower extremity radiculopathy is manifest by no more than moderate incomplete paralysis of the sciatic and femoral nerves. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to March 16, 2015; in excess of 20 percent prior to June 7, 2017; and in excess of 40 percent thereafter for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. The criteria for a 40 percent rating from June 7, 2017, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 3. The criteria for an initial rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for left lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 4. The criteria for a separate 20 percent rating for left lower extremity femoral nerve radiculopathy have been met from March 16, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1982 to March 1987. This matter comes before the Board of Veterans' Appeals (Board) from an October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript is of record. The Board remanded this matter in November 2021 for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Ratings 1. Entitlement to a rating in excess of 10 percent prior to March 16, 2015; in excess of 20 percent prior to June 7, 2017; and in excess of 40 percent thereafter for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is denied. 2. Entitlement to a 40 percent rating from June 7, 2017, for degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression is granted. 3. Entitlement to an initial rating in excess of 10 percent prior to March 16, 2015, and in excess of 20 percent thereafter for left lower extremity sciatic nerve radiculopathy is denied. 4. Entitlement to a separate 20 percent rating from March 16, 2015, for left lower extremity femoral nerve radiculopathy is granted. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 ; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings may be appropriate. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The criteria for evaluating spine disabilities were amended effective February 7, 2021. The Veteran's back disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237, which was not amended. Diagnostic Code 5237 is rated pursuant to the General Rating Formula for Disease and Injuries of the Spine (General Formula). Under the General Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. 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 combined range of motion 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. Id. at Note 2. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. Under DC 8526, mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; severe incomplete paralysis is rated 30 percent disabling. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). 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. Evidence VA treatment records dated in July 2011 reflect findings of sciatica, disc disease, sprains and strains of other and unspecified parts of back, and low back pain as active problems. An October 2011 VA examination reflects diagnoses of left lower extremity radiculopathy and lumbar spine degenerative disc disease. During the examination, the Veteran reported lower back pain and the feeling that his legs are weak. The Veteran denied flare-ups that impact the function of the thoracolumbar spine. Objectively, range of motion testing revealed forward flexion to 90 or greater degrees with painful motion beginning at 75 degrees; extension to 15 degrees with no objective evidence of painful motion; bilateral lateral flexion to 15 degrees with painful motion beginning at 10 degrees; and bilateral lateral rotation to 10 degrees with painful motion beginning at 10 degrees. The Veteran was able to perform repetitive-use testing without additional loss of range of motion. The examiner noted pain on movement and interference with sitting, standing, and/or weight-bearing as contributing factors of disability. He endorsed tenderness along the paraspinous muscles of the lumbar spine and sacroiliac joints without guarding or muscle spasm. Sensory examination reflected normal left lower extremity sensation to light touch testing; however, straight leg testing was positive. The examiner noted mild intermittent left lower extremity pain. The examiner noted involvement of the sciatic nerve and indicated the severity was mild. The examiner indicated the Veteran had intervertebral disc syndrome (IVDS) without incapacitating episodes over the past 12 months. A March 2015 VA examination report reflects diagnoses of lumbsacral strain, degenerative arthritis of the spine, IVDS, sciatica, and lumbar disc protrusion. The Veteran described his flare-ups as constant discomfort of lower back, pain, weakness, and instability in left lower extremity. He also described his functional loss or impairment as pain, weakness, instability of lower extremities, loss of movement/mobility, and loss of exercise tolerance. Objectively, range of motion testing revealed forward flexion to 60 degrees, extension to 10 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees. Repetitive use testing resulted in forward flexion to 50 degrees, extension to 10 degrees, and bilateral lateral flexion and rotation to 20 degrees. The examiner indicated pain, fatigue, weakness, and lack of endurance significantly limit functional ability with repeated use over a period of time and during a flare-up. The examiner indicated resulting range of motion would be the same as following repetitive use testing. Muscle spasm and localized tenderness resulting in abnormal gait or abnormal spinal contour were also noted. The examiner indicated less movement than normal, weakened movement, instability of station, disturbance of locomotion, interference with sitting, and interference with standing as additional factors contributing to disability. Sensory examination revealed decreased thigh/knee, lower leg/ankle, and foot/toes sensation to light touch. The examiner noted mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. The examiner found involvement of the femoral and sciatic nerves. The examiner indicated the Veteran did not have ankylosis of the spine or IVDS. A March 2015 peripheral nerves examination reported reflects a diagnosis of sciatica. The examiner noted mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. Muscle strength was normal, and he had no muscle atrophy. Deep tendon reflexes were normal except for left ankle, which was hypoactive. Sensory examination revealed decreased thigh/knee, lower leg/ankle, and foot/toes sensation to light touch. The examiner noted trophic changes, including shiny skin and loss of hair laterally. The examiner found moderate incomplete paralysis of the left sciatic nerve, moderate incomplete paralysis of the external popliteal nerve, and moderate incomplete paralysis of the musculocutaneous (superficial peroneal) nerve. A June 2017 VA examination reflects diagnoses of degenerative disc disease and herniated nucleus pulposus with L5 nerve root compression and lumbar radiculopathy. The Veteran continued to report worsening back pain with radiation into left lower extremity. He described constant pain with intermittent flare-ups of severe pain. He also reported difficulty with prolonged standing, walking, sitting, and bending. Objectively, range of motion testing revealed forward flexion to 60 degrees, extension to 10 degrees, bilateral lateral flexion to 15 degrees, and bilateral lateral rotation to 20 degrees. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The examiner indicated being unable to say whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time or during a flare-up. The examiner noted muscle spasm resulting in abnormal gait or abnormal spinal contour due to hypertonicity of the lumbar paraspinal muscles. Less movement than normal, instability of station, disturbance of locomotion, interference with sitting, and interference with standing were noted as contributing factors of disability. Normal muscle strength and knee deep tendon reflexes were found; however, hypoactive left ankle deep tendon reflexes were noted. Sensory examination found decreased thigh/knee, lower leg/ankle, and foot/toes sensation to light touch. The examiner noted mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness of the left lower extremity. The examiner noted involvement of the left femoral and sciatic nerve roots and moderate severity. While the Veteran has IVDS, the examiner noted he had no episodes of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The June 2017 peripheral nerve examination additionally revealed trophic changes, including smooth skin on the left lateral lower leg with loss of hair. The examiner noted moderate incomplete paralysis of the left sciatic nerve, moderate incomplete paralysis of the external popliteal nerve, and moderate incomplete paralysis of the musculocutaneous nerve. Finally, the examiner noted that the peripheral neuropathy symptoms affect weight bearing, balance, and ambulation activities. In compliance with the Board's November 2021 remand directives, an addendum examination was obtained in November 2021. The Veteran reported daily low back pain and tightness that radiates to the left leg frequently. He also reported intermittent flare-ups of increased pain with prolonged sitting, standing, bending, and lifting. He indicated his flare-ups last 24 to 72 hours that include increase difficulty with prolonged sitting, standing, bending, and lifting. Range of motion testing revealed forward flexion to 50 degrees, extension to 10 degrees, bilateral lateral flexion to 15 degrees, and bilateral lateral rotation to 15 degrees. The examiner indicated pain, fatigability, and lack of endurance significantly limit functional ability with repeated use over time and during flare-ups. The examiner described such limitation as forward flexion to 25 degrees, extension to 5 degrees, and bilateral lateral flexion and rotation to 5 degrees. The examiner noted localized tenderness and muscle spasm not resulting in abnormal gait or spinal contour. Sensory examination revealed decreased thigh/knee, lower leg/ankle, and foot/toes sensation to light touch. The examiner noted moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The examiner also noted involvement of the sciatic nerve roots. While the Veteran has IVDS, the examiner indicated he had no episodes of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Lumbar Spine Analysis In June 2011, the Veteran filed an increased rating claim for his degenerative disc disease and herniated nucleus pulposus with left L5 nerve root compression. Therefore, the period on appeal begins June 29, 2010, one year prior to receipt of the Veteran's claim. The evidence of record weighs against a rating in excess of 10 percent prior to March 16, 2015; and in excess of 20 percent from March 16, 2015 to June 7, 2017. A 40 percent rating, but no higher, is granted from June 7, 2017. As a preliminary matter, the Board notes that the October 2011 and March 2015 examinations were not fully compliant with the requirements set forth by Correia, 28 Vet. App. at 158. The June 2017 examination was not fully compliant with the requirements set forth by Sharp, 29 Vet. App. at 33. However, these reports do contain some relevant findings that were considered herein. Prior to March 16, 2015, the evidence reflects forward flexion to no less than 75 degrees and/or a combined range of motion to no less than 130 degrees. The record also demonstrates tenderness along the paraspinous muscles of the lumbar spine and sacroiliac joints without guarding or muscle spasm. Prior to March 16, 2015, there is no evidence of forward flexion less than 60 degrees, a 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. From March 16, 2015, to June 7, 2017, the evidence reflects forward flexion to no less than 50 degrees and/or a combined range of motion to no less than 140 degrees. The record also demonstrates muscle spasm and localized tenderness resulting in abnormal gait or abnormal spinal contour. During this period, there is no evidence of forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. From June 7, 2017, however, the evidence reflects forward flexion to no less than 25 degrees and/or a combined range of motion to no less than 50 degrees. The record also demonstrates localized tenderness and muscle spasm not resulting in abnormal gait or spinal contour. In reaching this conclusion, the Board acknowledges the June 2017 VA examiner did not provide the estimated loss of range of motion manifested as a consequence of a flare ups; however, during the November 2021 VA examination the Veteran reported losing about 50 percent of his range of motion. Extrapolating that information to the June 2017 VA examination findings, the Veteran's forward flexion would reasonably be 30 degrees when functional loss due to pain is considered, which is consistent with a 40 percent rating. See 38 C.F.R. § 4.7. However, from June 7, 2017, there is no evidence to support a finding of unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine. The competent medical evidence of record indicates the Veteran has not had ankylosis of the spine at any time during the appeal period. Therefore, a rating in excess of 40 percent is not warranted for this period. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, fatigability, weakness, and pain during flare-ups and with repetitive use over time; however, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by his lay statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or the combined range of motion of the thoracolumbar spine not greater than 120 degrees prior to March 16, 2015; forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine prior to June 7, 2017; and/or unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine thereafter. Consideration has also been given to assigning a rating under the Formula for Rating IVDS Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Regarding neurological impairment, the Veteran has already been granted service connection for bilateral lower extremity radiculopathy and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. In conclusion, the evidence of record persuasively weighs against higher evaluations for the service-connected back disability rated 10 percent prior to March 16, 2015; and 20 percent from March 16, 2015 to June 7, 2017. A 40 percent rating, but not higher, is warranted from June 7, 2017. Sciatic and Femoral Nerve Radiculopathy, Left Lower Extremity-Analysis First, the Board notes a separate rating under Diagnostic Code 8520 is not warranted for right lower extremity radiculopathy prior to November 23, 2021, as the evidence of record does not demonstrate right lower extremity sciatic nerve radiculopathy. The first objective evidence of right lower extremity radiculopathy comes from the November 2021 VA examination. In the absence of a clinical diagnosis and objective findings, a separate compensable rating is not warranted prior to November 23, 2021. See 38 C.F.R. § 4.124a, Diagnostic Code 8520. The evidence weighs against higher evaluations for the service-connected left lower extremity radiculopathy affecting the sciatic nerve, which is currently rated 10 percent prior to March 16, 2015; and 20 percent thereafter. Prior to March 16, 2015, the evidence of record demonstrates mild intermittent left lower extremity pain. During this period, the record generally reflects active movement against some resistance to normal muscle strength and normal to hypoactive reflexes. This finding is most analogous to a 10 persistent rating under Diagnostic Code 8520 for mild incomplete paralysis of the sciatic nerve. From March 16, 2015, the evidence demonstrates that the sciatic nerve impairment was manifested by mild constant pain; moderate intermittent pain; moderate paresthesias and/or dysesthesias; mild numbness of the left lower extremity; trophic changes, including shiny skin and loss of hair; normal muscle strength; and normal to hypoactivity deep tendon reflexes. Moderate incomplete paralysis of the left sciatic nerve, moderate incomplete paralysis of the external popliteal nerve, and moderate incomplete paralysis of the musculocutaneous (superficial peroneal) nerve are also noted. The record also reflects a slight limp to the left side. These findings are most analogous to a 20 percent rating under Diagnostic Code 8520 for moderate incomplete paralysis of the sciatic nerve. While the evidence reflects trophic changes, such as loss of hair, and a slight limp, the Board notes the March 2015 and June 2017 VA examiners found the Veteran's symptoms to be only moderate in severity, which the Board finds to be persuasive evidence against a rating in excess of 20 percent. The Board acknowledges the lay assertions of sensory disturbance and pain. However, the lay statements of record do not report symptoms more analogous to a higher rating during either period. The Board finds the Veteran is entitled to a separate, 20 percent rating under Diagnostic Code 8526 for moderate incomplete paralysis of the femoral nerve however. Since March 16, 2015, the evidence shows mild to moderate symptoms of the left lower extremity, including decreased sensation of the left thigh/knee. The VA examiner at the peripheral nerve examination noted involvement of L2/L3L/L4 nerve roots (femoral nerve). A separate rating under Diagnostic Code 8526 is not warranted prior to March 16, 2015, as the evidence of record does not demonstrate femoral nerve radiculopathy. Indeed, the October 2011 VA examination reflects a normal sensory examination of the upper anterior thigh and thigh/knee. The first objective evidence of femoral nerve impairment comes from the March 2015 VA examination. In the absence of a clinical diagnosis and objective findings, a separate compensable rating is not warranted prior to March 16, 2015. See 38 C.F.R. § 4.124a, DC 8526. Finally, the Board notes that the sciatic nerve branch encompasses the sciatic nerve, external popliteal nerve, musculocutaneous nerve, anterior tibial nerve, internal popliteal nerve, and posterior tibial nerve. The March 2015 and June 2017 VA examinations indicate moderate incomplete paralysis of the external popliteal nerve and the musculocutaneous nerve. Thus, consideration has also been given to assigning a rating under Diagnostic Code 8521 for external popliteal nerve and Diagnostic Code 8522 for musculocutaneous nerve; however, the evidence does not demonstrate that the criteria for a higher rating under either diagnostic code have been met. Moreover, assigning separate ratings under these codes based on the evidence of record demonstrating incomplete paralysis of the external popliteal nerve and musculocutaneous nerve would constitute impermissible pyramiding because the functions associated with those nerves are not separate and distinct. In conclusion, the evidence of record persuasively weighs against an increased rating for the Veteran's service-connected left lower extremity sciatic nerve radiculopathy rated 10 percent prior to March 16, 2015; and 20 percent thereafter. The evidence persuasively weighs in favor of a separate 20 percent rating for left lower extremity femoral nerve radiculopathy from March 16, 2015. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, 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.