Citation Nr: 22012823 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 14-30 668 DATE: March 7, 2022 ORDER Entitlement to a disability rating in excess of 10 percent prior to March 2, 2020, and in excess of 20 percent thereafter for a thoracolumbar spine disability is denied. Entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the right lower extremity is denied. Entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity is denied. FINDINGS OF FACT 1. Prior to March 2, 2020, the Veteran's degenerative arthritis of the thoracolumbar spine was characterized by forward flexion greater than 60 degrees and a combined range of motion greater than 120 degrees, without incapacitating episodes; muscle spasm or guarding severe enough to result in an abnormal gait; abnormal spinal contour such as scoliosis, reversed lordosis, or; abnormal kyphosis. 2. Effective March 2, 2020, the Veteran's degenerative arthritis with intervertebral disc syndrome of the thoracolumbar spine is characterized by forward flexion to greater than 30 degrees, without favorable ankylosis or incapacitating episodes due to intervertebral disc syndrome. 3. The Veteran's radiculopathy with sciatic nerve involvement of the right lower extremity results in no more than moderate impairment of the right lower extremity. 4. The Veteran's radiculopathy with sciatic nerve involvement of the left lower extremity results in no more than moderate impairment of the left lower extremity. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent prior to March 2, 2020, and in excess of 20 percent thereafter for degenerative disc disease of the lumbosacral spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5235-43. 2. The criteria for entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40-45, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40-45, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1988 to July 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). These issues were previously remanded by the Board in February 2020 and July 2021 for additional development. That development has been accomplished and these issues are back before the Board. Also perfected for appellate review and remanded by the Board in July 2021 was the issue of entitlement to service connection for a disability other than sleep apnea manifested by fatigue. In a November 2021 rating decision, the Veteran was granted service connection for insomnia. Thus, this issue is no longer on appeal before the Board. See Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). Increased Rating Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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 required for that rating. 38 C.F.R. § 4.7. 1. Entitlement to a disability rating in excess of 10 percent prior to March 2, 2020, and in excess of 20 percent thereafter for a thoracolumbar spine disability The Veteran seeks a disability rating in excess of 10 percent prior to March 2, 2020 and in excess of 20 percent thereafter for a thoracolumbar spine disability. He asserts this disability has worsened in severity and an increased rating is therefore warranted. With any form of arthritis or other orthopedic disorders, painful motion is an important factor of disability. Joints that are actually painful, unstable, or misaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. 38 C.F.R. § 4.59; see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). While pain alone does not constitute functional loss, the Court has clearly indicated that the Board must consider the effects of pain, particularly as to any adverse impact on the normal working movements of the body. Mitchell, 25 Vet. App at 44 (noting that although "pain itself does not rise to the level of functional loss," pain which "affects some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance,'" may constitute functional loss). Additionally, the Board must consider pain on both active and passive motion of the affected joint, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158 (2016). In Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017), the Court noted that the VA Clinician's Guide instructs examiners when evaluating certain musculoskeletal conditions to obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from a Veteran. The Veteran's lumbosacral spine disability is rated under Diagnostic Code (DC) 5237, for a lumbosacral strain. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. The General Rating Formula for Diseases and Injuries of the Spine provides the following: With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine 100 Unfavorable ankylosis of the entire thoracolumbar spine 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 20 Forward flexion of the thoracolumbar spine 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 10 Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43. Spinal disabilities may also be rated under DC 5243, for intervertebral disc syndrome (IVDS). Intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months warranted a 60 percent rating. With incapacitating episodes having a total duration of at least 4 weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted. With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months, a 20 percent rating is warranted. With incapacitating episodes having a total duration of at least 1 week but less than 2 weeks during the past 12 months, a 10 percent rating is warranted. An "incapacitating episode" is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note 1. Upon receipt of the Veteran's claim, a June 2012 VA examination was performed. Degenerative disc disease of the thoracolumbar spine was diagnosed. On range of motion testing, he had forward flexion to 90 degrees, extension to 30 degrees, lateral flexion to 30 degrees bilaterally, and lateral rotation to 30 degrees bilaterally. The examiner found no objective evidence of painful motion. Repetitive motion did not result in any additional limitation of motion. On objective examination, the Veteran's thoracolumbar spine did not exhibit localized tenderness or pain to palpation, and no guarding or muscle spasm was observed. An abnormal gait or spinal contour was not noted. Muscle strength was 5/5, and reflexes and sensory responses were within normal limits at all points in the lower extremities. No muscle atrophy was observed. Straight leg raising was negative on the left and right. The examiner did not diagnose radiculopathy or ankylosis. Intervertebral disc syndrome was also not present, and the examiner found no evidence of incapacitating episodes. The Veteran did not require any assistance devices for ambulation. An x-ray of the lumbosacral spine noted degenerative changes, but the vertebral body heights and intervertebral disc spaces were within normal limits. Regarding any effect on the Veteran's employability, the examiner noted no functional impairment. The Veteran was independent in all activities of daily living. Another VA examination was afforded the Veteran in June 2015. On range of motion testing, he had forward flexion to 90 degrees, extension to 30 degrees, lateral flexion to 30 degrees bilaterally, and lateral rotation to 30 degrees bilaterally. Pain was noted by the examiner on examination of the Veteran, but this pain did not result in any functional loss. Repetitive motion did not result in any additional limitation of motion. No additional impairment was noted with flare-ups. On objective examination, the Veteran's thoracolumbar spine exhibited localized tenderness, guarding, or muscle spasm, but this did not result in any abnormal gait or spinal contour. Some disturbance of locomotion and interference with standing was observed. Muscle strength was 5/5, and reflexes and sensory responses were within normal limits at all points in the lower extremities. No muscle atrophy was observed. Straight leg raising was negative on the left and right. The examiner did not diagnose radiculopathy or ankylosis. Intervertebral disc syndrome was also not present, and the examiner found no evidence of incapacitating episodes. The Veteran did not require any assistance devices. Regarding any effect on the Veteran's employability, the examiner noted lifting limitations were present. The Veteran was independent in all activities of daily living. Again in January 2017, the Veteran was afforded a VA orthopedic examination of his thoracolumbar spine. Initial range of motion testing indicated forward flexion to 90 degrees, extension to 30 degrees, lateral flexion to 30 degrees bilaterally, and lateral rotation to 30 degrees bilaterally. Pain was noted with range of motion but did not result in additional functional loss, according to the examiner. No objective evidence of localized pain or tenderness on palpation was reported. No additional limitation of motion was noted with repetitive motion or due to repeated use over time. Additionally, no additional limitation of motion or functional loss was noted to result from such factors as pain, fatigue, weakness, lack of endurance, or incoordination. While the Veteran exhibited guarding and muscle spasm, these did not result in any abnormal gait or spinal contour. Muscle strength was 5/5 at all points in the lower extremities, and no muscle atrophy was present. Reflexes were 2+ at the knees and ankles bilaterally, and reflexes were within normal limits at the thighs, knees, ankles, and toes bilaterally. Straight leg raising was negative bilaterally. No radiculopathy was present. The Veteran was also without ankylosis or other neurological abnormalities. Intervertebral disc syndrome was not present. The Veteran did not require assistance devices for ambulation. Regarding any effect on the Veteran's employability, the examiner noted lifting limitations were present. Next, the Veteran was afforded a VA examination of his spine in March 2020. He reported his back "locked up" on occasion, making standing upright difficult. On initial range of motion testing, he had forward flexion to 75 degrees, extension to 20 degrees, lateral flexion to 20 degrees bilaterally, and lateral rotation to 20 degrees bilaterally. Pain was reported across all ranges of motion. The Veteran was, however, without pain on weightbearing, and no localized tenderness or pain on palpation was present. Repetitive motion or repeated use over time did not result in any additional limitation of motion. Passive range of motion testing was not medically-indicated, according to the examiner. Regarding functional impairment due to such factors as pain, weakness, and lack of endurance, the examiner stated forward flexion would be further limited to 50 degrees, extension to 10 degrees, and lateral rotation and flexion all limited to 10 degrees each bilaterally. No guarding or muscle spasm was observed. Muscle strength testing was 5/5 at all joints in the lower extremities, and no muscle atrophy was present. Reflexes were hypoactive at both knees but normal at the ankles. Sensory response was decreased at the thigh, knee, ankle, and toes on the right and at the ankle and toes on the left. Straight leg testing was negative bilaterally. Radiculopathy was present, according to the examiner, with mild intermittent pain, paresthesias and/or dysesthesias, and numbness. The Veteran was without ankylosis or other neurological abnormalities. The examiner also diagnosed intervertebral disc syndrome, but did not indicate any incapacitating episodes were present. The Veteran required no assistance devices. He reported 0-1 weeks per year lost at work due to his lumbosacral spine disability, but stated he no longer worked in a position requiring physical labor, based on his spinal impairment. Most recently, the Veteran underwent VA examination in September 2021. He reported incapacitating episodes occurring several times per month during which his back "locked up" and he could not stand upright. These lasted for hours, according to the Veteran, and were characterized by sharp debilitating pain. On range of motion testing, he had forward flexion to 75 degrees, extension to 10 degrees, lateral flexion to 20 degrees on the right and 15 degrees on the left, and lateral rotation to 20 degrees on the right and 15 degrees on the left. Pain with left lateral rotation and left lateral flexion was noted by the examiner on examination of the Veteran, but this pain did not result in any functional loss. Pain was also reportedly present with weightbearing and with active motion, according to the examiner. Repetitive motion resulted in forward flexion further limited to 60 degrees, with no change in extension, lateral rotation, or lateral flexion. With repeated use over time, the examiner opined that extension would be further limited to 5 degrees, with lateral rotation to 15 degrees on the right and 10 degrees on the left, and lateral flexion to 15 degrees on the right and 10 degrees on the left. Passive range of motion testing was medically contraindicated, according to the examiner. On objective examination, the Veteran's thoracolumbar spine exhibited localized tenderness and muscle spasm, which resulted in abnormal gait or spinal contour. Some disturbance of locomotion and interference with sitting and standing was observed. Muscle strength was 5/5 for the lower extremities, with the exception of 4/5 muscle strength on extension of the knees. Deep tendon reflexes were absent in the lower extremities bilaterally, and sensory responses were decreased at all points in the lower extremities. No muscle atrophy was observed. Straight leg raising was positive on the left and right. Radiculopathy was also present, with moderate constant pain and mild numbness and paresthesias and/or dysesthesias bilaterally. Ankylosis was not present. Intervertebral disc syndrome was diagnosed, but no incapacitating episodes were noted by the examiner. The Veteran did not require any assistance devices. Regarding any effect on the Veteran's employability, the examiner noted lifting beyond 20 pounds was prohibited, along with prolonged standing or sitting. The Veteran was independent in all activities of daily living. Considering first the period prior to March 2, 2020, when the Veteran has been assigned a 10 percent disability rating, the Board finds the evidence to be against an increased rating for this period. According to the June 2012, June 2015, and January 2017 VA examination reports, the Veteran did not have 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, as would warrant the next higher rating of 20 percent. Additionally, the VA examiners did not find the Veteran experienced further limitation of motion in any direction following repetitive motion as would warrant an increased rating, with or without weightbearing, or due to such factors as pain, fatiguability, incoordination, weakness, or pain on motion. Therefore, even when considering pain, weakened movement, excess fatigability, and incoordination, including during flare-ups, the Board finds the preponderance of the evidence is against the grant of a higher rating based upon limitation of flexion of the lumbosacral spine. While the various VA examination and outpatient treatment reports reflected reported pain on motion, the VA examiners specifically performed repetitive testing and found no additional functional loss which would support a higher rating. In this regard, the Court has clearly indicated that painful motion does not equate to limited motion. In fact, the Court considered the argument that pain throughout all ranges should warrant the maximum rating and found that the "Secretary has persuasively argued that such an interpretation would lead to absurd results." Mitchell, 25 Vet. App. at 41, 43. Without any evidence of functional loss from the reported pain, an increased evaluation based solely on pain is not warranted. 38 C.F.R. §§ 4.45, 4.71a, Diagnostic Codes 5235-43. Finally, the examination reports are negative for intervertebral disc syndrome of the lumbar spine for this period, and thus an increased initial rating on that basis is likewise not warranted. The Board has also considered whether separate ratings may be awarded for this period based on any objective neurological abnormalities resulting from the Veteran's degenerative disc disease of the lumbosacral spine. See 38 C.F.R. § 4.71a, Note (1). Review of the record indicates that, in the present case, separate compensable ratings are not warranted for this period for either lower extremity based on radiculopathy. Next, the Board must consider a disability rating in excess of 20 percent effective March 2, 2020. After considering the totality of the record, the Board finds the evidence to be against a disability rating in excess of 20 percent at any time during the pendency of the appeal. At no time has the Veteran's degenerative disc disease resulted in forward flexion limited to 30 degrees or less, or favorable ankylosis of the lumbosacral spine. Even taking into account additional limitation of motion due to such factors as pain and lack of endurance during flare-ups, the 2020 and 2021 VA examiners determined the Veteran had forward flexion to at least 50 degrees. No additional limitation of motion as would warrant a 40 percent rating was found to result from such factors as weakness, incoordination, or fatiguability. While the VA examinations reflected reported pain on motion, the examiners specifically performed repetitive testing and found no additional functional loss which would support a higher disability rating. In this regard, the Court has clearly indicated that painful motion does not equate to limited motion. In fact, the Court considered the argument that pain throughout all ranges should warrant the maximum rating and found that the "Secretary has persuasively argued that such an interpretation would lead to absurd results." Mitchell, 25 Vet. App. at 41, 43. Without any evidence of functional loss from the pain, an increased evaluation based solely on pain is not warranted. 38 C.F.R. §§ 4.45, 4.71a, Diagnostic Codes 5235-43. The Board has also considered whether separate ratings may be awarded for any objective neurological abnormalities resulting from the Veteran's lumbosacral strain. See 38 C.F.R. § 4.71a, Note (1). For this period, the Veteran has already been awarded separate compensable ratings for radiculopathy of the lower extremities. Evaluation of the Veteran's lumbosacral spine disability under the criteria for intervertebral disc syndrome also would not result in a higher evaluation, as the 2019 VA examination was negative for intervertebral disc syndrome. The 2020 and 2021 VA examiners both did diagnose intervertebral disc syndrome, but found no incapacitating episodes resulting therefrom. Hence, this finding would not result in a higher rating. In conclusion, the evidence is against a disability rating in excess of 10 percent prior to March 2, 2020, and in excess of 20 percent thereafter for the Veteran's degenerative disc disease of the lumbosacral spine. As the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the right lower extremity 3. Entitlement to a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity The Veteran seeks an initial disability rating in excess of 20 percent each for sciatic radiculopathy of the right and left lower extremities. He asserts these disabilities have worsened in severity, and increased ratings are warranted. The Veteran's radiculopathy of the lower extremities is rated under Diagnostic Code (DC) 8520, for impairment of the sciatic nerve. This code provides the rating criteria for paralysis of the sciatic nerve. Mild incomplete paralysis of the lower extremity warrants a 10 percent rating. A 20 percent rating requires moderate incomplete paralysis. A 40 percent rating requires moderately severe incomplete paralysis. A 60 percent rating requires severe incomplete paralysis, with marked muscular atrophy. An 80 percent rating is awarded for complete paralysis. When there is complete paralysis, the foot dangles and droops, there is no active movement possible of the muscles below the knees, or flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, DC 8520. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of 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 only sensory, the rating should be for the mild or, at most, the moderate degree. 38 C.F.R. § 4.124a. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. Special consideration should be given to any psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, and injury to the skull. 38 C.F.R. § 4.120. The words "mild," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Rating Schedule. 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. In the present case, the totality of the record is against a disability rating in excess of 20 percent at any time during the pendency of this appeal. The evidence of record does not reflect moderately severe or severe impairment resulting from incomplete paralysis of the sciatic nerves of the right or left lower extremity. According to the 2020 VA examination report, the Veteran was without any deficit in muscle strength in either lower extremity. Reflexes were hypoactive at the bilateral knees but normal at the ankles. Sensory response was decreased at the thigh, knee, ankle, and toes on the right and at the ankle and toes on the left. The Veteran was without constant pain, and his intermittent pain, numbness, paresthesias, and/or dysesthesias were only mild. The Veteran was also able to ambulate unaided, without the need for any assistance device. On VA examination in 2021, while the Veteran had absent reflexes bilaterally and decreased sensory response at the bilateral hips, knees, ankles, and toes, muscle strength of the lower extremities was within normal limits at the hips, ankles, and toes, and 4/5 at the knees. Moderate constant pain was also reported, but his numbness, paresthesias, and/or dysesthesias were only mild. The Veteran was also able to ambulate unaided, without the need for any assistance device. Overall, the evidence is clearly against a finding of moderately severe or severe impairment resulting from incomplete paralysis of the sciatic nerves of the right or left lower extremity. In conclusion, the evidence is against disability ratings in excess of 20 percent, for the Veteran's radiculopathy of the right and left lower extremities. As the evidence is against the award of increased ratings for these disabilities, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). J. CONNOLLY Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thomas D. Jones, 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.