Citation Nr: 22015589 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 16-57 730 DATE: March 18, 2022 ORDER Entitlement to service connection for a bilateral eye condition is denied. Entitlement to an initial rating in excess of 20 percent prior to June 23, 2021 and in excess of 30 percent after June 23, 2021 for degenerative disc disease of the cervical spine is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for lumbar strain prior to October 24, 2019, a rating in excess of 20 percent for lumbar strain for the period from October 24, 2019, to June 23, 2021, and in excess of 40 percent for degenerative disc disease of the lumbar spine after June 23, 2021, is remanded. FINDINGS OF FACT 1. A bilateral eye disability for VA compensation purposes did not manifest during service and is not otherwise related to service. 2. The evidence prior to June 23, 2021, demonstrates the Veteran's degenerative disc disease of the cervical spine was manifested by no worse than forward flexion limited to 30 degrees. 3. Since June 23, 2021, the Veteran's degenerative disc disease of the cervical spine is manifested by no worse than forward flexion greater than 15 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a bilateral eye condition have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for entitlement to an initial rating in excess of 20 percent for degenerative disc disease of the cervical spine prior to June 23, 2021 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5243. 3. The criteria for entitlement to a rating in excess of 30 percent after June 23, 2021 for degenerative disc disease of the cervical spine have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1991 to November 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions in June 2014 and February 2016. A June 2020 rating decision granted an increased 20 percent rating for lumbar spine strain and an August 2021 rating decision granted an increased 40 percent rating for degenerative disc disease of the lumbar spine effective June 23, 2021, and an increased 30 percent rating for degenerative disc disease of the cervical spine effective from June 23, 2021. The case, in pertinent part, was remanded for additional development in March 2019 and December 2020. The Veteran did not respond to a January 2019 request that she clarify her desire for a Board hearing. The Board finds that her February 2017 VA Form 9 indicating that she did not want a Board hearing supersedes her February 2015 hearing requests. The Board also notes that in correspondence received by VA in December 2020, prior to re-certification of the appeal, the Veteran withdrew her appeal as to the issue of entitlement to a total disability rating based upon individual unemployability due to service-connected disability. The correspondence included identifying information sufficient for withdrawal. See 38 C.F.R. § 19.55. The August 2021 rating decision also established service connection for right upper extremity radiculopathy claims and noted the matter was ancillary to the increased rating issue on appeal. The Board notes that awards for secondary service connection are not claims for increased compensation and are not part and parcel of a claim for increased compensation for the primary condition. See Gudinas v. McDonough, 34 Vet. App. 25 (2021). Service Connection for a Bilateral Eye Condition Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term "disability" for VA compensation purposes refers to the functional impairment of earning capacity rather than the underlying cause of the impairment and it is noted that pain alone may be a functional impairment. See Saunders v. Wilkie, 887 F.3d 1356, 1364-68 (Fed. Cir. 2018). Congenital or developmental defects, such as refractive error of the eye, are not diseases or injuries within the meaning of applicable legislation. 38 C.F.R. § 3.303(c). VA General Counsel Precedent Opinion has held that service connection may be granted for a congenital or developmental disability shown to have resulted from a defect that was subject to a superimposed disease or injury during service. VAOPGCPREC 82-90 (July 18, 1990). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). Compensation may be established for any incremental increase in disabilityany additional impairment of earning capacityin nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increaseregardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. The Veteran contends that she has a bilateral eye condition as a result of active service. She reported that she was diagnosed as being nearsighted during active service and provided eyeglasses. She also asserted that her eye condition was linked to her neck injury in service. Service treatment records include diagnoses of compound myopia/simple myopia in March 1993. The Veteran complained of decreased distant visual acuity over the past few months. The examiner noted her ocular health was within normal limits. The Veteran's October 1996 separation examination revealed distant vision of 20/40, bilaterally, and correctable to 20/20. The examiner noted she reported a history of eye problems identified as wearing eyeglasses. An October 2019 VA eye conditions examination found the Veteran did not have an eye diagnosis other than congenital or developmental errors of refraction. The examiner found she had myopia that was a development error of refraction and was unrelated to any in-service event, disease, or trauma. There was no objective evidence to support a diagnosis for the claim of an eye condition, myopia (nearsightedness), at that time. Thus, the Veteran's claimed eye condition, myopia, was less likely than not subject to a superimposed disease or injury during her military service that resulted in disability apart from the congenital or developmental defect. VA treatment records dated in December 2019 included diagnoses of myopia and presbyopia. Ocular health was normal upon examination. VA eye conditions examination in March 2021 included bilateral refractive myopia and presbyopia. It was noted the Veteran received a diagnosis of refractive myopia in approximately 1991 when she entered service and that presbyopia was diagnosed recently in 2019. The examiner found it was less likely that the claimed disorder was incurred in or caused by the claimed in-service injury, event, or illness. The examiner also found that the claimed condition was less likely proximately due to or the result of the Veteran's service-connected condition. It was noted that the development of presbyopia was age related and unrelated to any degenerative disc condition. The present diagnoses of refractive myopia and presbyopia were mild, refractive, and not related to the service-connected lumbar or cervical spine disabilities. The examiner stated that there were no other ocular diagnoses, and that myopia and presbyopia were separate from trauma or any other superimposed disease, military trauma, or in-service condition or event. As to aggravation, it was noted that the diagnosed conditions were refractive errors and were not considered ocular pathologies and that the current severity was not greater than the baseline. Based upon the evidence of record, the Board finds that a bilateral eye disability for VA compensation purposes did not manifest during service and that the persuasive of the evidence fails to establish that a present disability is etiologically related to service. The Veteran's myopia and presbyopia are refractive errors considered congenital or developmental defects, not diseases or injuries, within the meaning of applicable VA legislation. See 38 C.F.R. § 3.303(c). The March 2021 VA opinions are persuasive that the Veteran's myopia and presbyopia are refractive errors that have not been subjected to a superimposed disease or injury during service. The provided opinions substantially complied with the prior Board remand orders. The examiner is shown to have reviewed the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Consideration has also been given to the Veteran's personal assertions that she has eye disabilities as a result of active service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issues in this case fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disabilities at issue are not conditions that are readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In conclusion, the Board finds the persuasive evidence is against the claim for entitlement to service connection for a bilateral eye condition. The claim is denied. Rating for Degenerative Disc Disease of the Cervical Spine Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. This Rating Schedule is primarily a guide in the rating of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. For the application of this schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Over a period of many years, a veteran's disability claim may require re-ratings in accordance with changes in laws, medical knowledge and his or her physical or mental condition. It is essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Evaluation of disabilities based upon manifestations not resulting from service-connected disease or injury and the pyramiding of ratings for the same disability under various diagnoses is prohibited. 38 C.F.R. § 4.14. VA regulations provide for separate ratings based on separate disabilities, not separate symptoms. See Cullen v. Shinseki, 24 Vet. App. 74, 81-82 (2010). 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. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021). VA must consider claims for a higher rating pursuant to the former and revised regulations after February 7, 2021. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). It is noted, however, that the applicable rating criteria associated with Diagnostic Codes 5242 and 5243 and General Rating Formula for Diseases and Injuries of the Spine are unchanged. Disabilities of the spine, including the cervical spine under Diagnostic Code 5242, are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a. Under the General Formula, a 100 percent rating is provided for unfavorable ankylosis of the entire spine. A 40 percent rating is provided for unfavorable ankylosis of the entire cervical spine. A 30 percent rating is provided for forward flexion of the cervical spine to 15 degrees or less, or with favorable ankylosis of the entire cervical spine. A 20 percent rating is provided for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 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. When rating diseases and injuries of the spine, any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For VA compensation purposes, normal forward flexion of the cervical spine is 0 to 45 degrees, extension is 0 to 45 degrees, left and right lateral flexion are 0 to 45 degrees, and left and right lateral rotation are 0 to 82 degrees. Normal combined range of motion of the cervical spine is 340 degrees. Normal ranges of motion for each component of spinal motion provided are the maximum usable for calculating the combined range of motion. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The rating criteria for intervertebral disc syndrome (IVDS) require rating of the disability either on the total duration of incapacitating episodes resulting from intervertebral disc syndrome over the past 12 months, or by combining under 38 C.F.R. § 4.25 separate ratings of its chronic orthopedic and neurologic manifestations with rating for all other disabilities, whichever method results in the higher rating. A 60 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least six weeks during the past 12 months. A 40 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 20 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. 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. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Id. Such evidence may include facial expression, such as wincing, muscle spasm, and crepitation. See 38 C.F.R. § 4.59. Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45. Consideration of a higher rating for functional loss, to include during flare ups, due to these factors accordingly is warranted for Diagnostic Codes predicated on limitation of motion. DeLuca v. Brown, 8 Vet. App. 202 (1995). Pain itself does not constitute functional loss, and painful motion does not constitute limited motion for the purposes of rating under Diagnostic Codes pertaining to limitation of motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Pain must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss. Id. An adequate orthopedic examination should record the range of motion for pain on active motion and passive motion and in weight-bearing and nonweight-bearing, address the necessary findings to evaluate functional loss during flare-ups, or clearly explain why the required testing cannot be completed or is not necessary. See Correia v. McDonald, 28 Vet. App. 158 (2016). The provisions of 38 C.F.R. §§ 4.40, 4.45 apply when considering whether limitation of motion of a joint has resulted in the functional equivalence of joint ankylosis. Chavis v. McDonough, 34 Vet. App. 1, 11 (2021). An examination does not need to be conducted during an actual flare-up in order to account for additional functional impairment. Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017). Instead, examiners are asked to estimate the functional impairment experienced during a flare-up, considering all competent evidence of functional loss that is available in the record. Id. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant. However, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 4.3. The Veteran contends that higher ratings are warranted for her service-connected cervical spine disability. In correspondence to reopen her service connection claim received by VA in February 2009, she complained of chronic neck pain and stiffness with numbness and tingling in the shoulders. VA examination in August 2012 included a diagnosis of degenerative disc disease of the cervical spine with a date of diagnosis in 1994. It was noted the Veteran was unsure of any particular injury and that since onset she experienced episodes of severe stiffness and pain several times per week. She reported flare-ups with trouble turning her head and moving her neck almost every day. She described intermittent aching, pulsating pain with occasional tingling in the left hand. Range of motion studies revealed forward flexion, extension, and right lateral flexion to 45 degrees or greater with no objective evidence of painful motion. Left lateral flexion was to 45 degrees or greater with objective evidence of painful motion at that point. Right lateral rotation was to 80 degrees or greater with no evidence of painful motion. Left lateral rotation was to 80 degrees or greater with evidence of painful motion at that point. Repetitive-use testing revealed forward flexion, extension, and right and left lateral flexion to 45 degrees or greater. Right and left lateral rotation was to 80 degrees or greater. There was no additional limitation in range of motion following repetitive-use testing. There was functional loss due to excess fatigability and pain on movement. There was guarding or muscle spasms that did not result in abnormal gait or spinal contour. Strength was 5/5 in the upper extremities with no evidence of muscle atrophy. Deep tendon reflexes and sensation to light touch were normal. There were signs of radiculopathy with mild intermittent pain and mild paresthesias and/or dysesthesias in the left upper extremity. The examiner found the Veteran did not have IVDS. It was noted that a May 2011 VA magnetic resonance imaging (MRI) study revealed reverse lordosis at C5 and degenerative disc disease at C5-6. The cervical spine condition did not impact her ability to work. An August 2012 private chiropractor report noted the Veteran complained of occasional mild to moderate pain in the cervical spine with radiating pain to the right forearm. She estimated her neck pain at level four. Objective examination revealed medium pain to the cervical spine. Maximum cervical compression testing is positive. VA treatment records include a January 2015 report noting an examination revealed the Veteran's neck was supple with no paraspinal muscle tenderness. The diagnoses included neck pain. A February 2015 MRI study of the cervical spine that revealed straightening of the cervical lordosis. There was a small central disc protrusion at C5-C6 and peripheral annular fissure with mild central stenosis. There was no severe neural foraminal encroachment. In a February 2015 statement the Veteran reported having constant pain and stiffness in the neck. She stated she used over-the-counter medication creams to loosen up her neck and shoulders regularly. She asserted that she no longer had a curve to her neck which caused muscle tightening in the neck and shoulders. In her February 2015 VA Form 9 she reported she had been prescribed muscle relaxant medication including for her cervical spine disorder. In a February 2017 VA Form 9 she described having stiffness in the jaw and the base of her head and upper neck. VA examination in October 2019 included a diagnosis of degenerative disc disease of the cervical spine with degenerative joint disease. It was noted the Veteran complained of progressive, recurrent pain since 1994. She described current symptoms of constant right-sided tightness with right hand weakness and intermittent numbness and tingling in the hands. She reported flare-ups of worsening pain and tightness in the neck with tingling in the right hand. Range of motion studies revealed forward flexion to 30 degrees, extension to 45 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 20 degrees. Pain noted on examination caused functional loss. There was mild tenderness localized at C5-7. There was no evidence of pain with weight bearing. There was no additional loss of motion after repetitive-use testing. The examiner noted that pain caused functional loss with repeated use over time and during flare-ups described in terms of range of motion as forward flexion to 30 degrees, extension to 40 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 10 degrees. There was no evidence of guarding or muscle spasm to the cervical spine. Strength was 5/5 in the upper extremities with no evidence of muscle atrophy. Deep tendon reflexes and sensation to light touch were normal. There was no evidence of ankylosis. There were no signs of radiculopathy, and the examiner found the Veteran did not have IVDS. There was objective evidence of pain with non-weight bearing. Passive range of motion studies could not be performed or were not medically appropriate. The cervical spine condition impacted her ability to work in that she had some difficulty using very small instruments. An October 2019 X-ray study revealed degenerative disc change at C5-6, minimal posterior spurring at C5 leading to some spondylosis, and reversal of the normal cervical lordosis. VA treatment records include reports noting treatment for cervicalgia. A March 2020 report noted a physical examination of the neck revealed no tenderness or stiffness. A January 2021 report noted the Veteran reported a decrease in cervical pain since beginning occupational therapy. It was noted she had no functional deficits. VA examination in January 2021 included a diagnosis of degenerative arthritis of the cervical spine. It was noted the Veteran complained of intermittent neck pain and occasional right arm numbness. She did not report any flare-ups of the cervical spine. Range of motion studies revealed forward flexion to 40 degrees, extension to 40 degrees, right lateral flexion to 40 degrees, left lateral flexion to 40 degrees, right lateral rotation to 75 degrees, and left lateral rotation to 75 degrees. Pain noted on examination caused functional loss. There was no evidence of pain with weight bearing. There was no additional loss of motion after repetitive-use testing. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over time and was described in terms of range of motion as forward flexion to 30 degrees, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 50 degrees, and left lateral rotation to 50 degrees. It was noted the Veteran denied having symptom flare-ups. There was no evidence of localized tenderness, guarding, or muscle spasm to the cervical spine. Strength was 5/5 in the upper extremities with no evidence of muscle atrophy. Deep tendon reflexes were normal. Sensation to light touch was decreased in the right hand and fingers but was otherwise normal to the bilateral upper extremities. There was no evidence of ankylosis. There were signs or symptoms of radiculopathy with mild right upper extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. Involvement to the right C5/C6 nerve roots was mild. The examiner found the Veteran did not have IVDS or other neurologic abnormalities related to the cervical spine. No assistive devices were used as a result of the disorder. There was objective evidence of pain with non-weight bearing. Passive range of motion studies could not be performed in a safe and reasonable manner. The cervical spine condition impacted her ability to work in that she had lost one week or less of work time in the past 12 months and had difficulty maintaining a bent position and performing neck flexion in her occupation as a dental hygienist. A June 2021 VA examination included diagnoses of degenerative disc disease other than IVDS, IVDS, spinal stenosis, and cervical radiculopathy of the bilateral upper extremities. The examiner noted that cervical radiculopathy of the bilateral upper extremities and spinal stenosis were new diagnosis based upon diagnostic study. It was also noted the Veteran complained of moderately worsening neck pain and stiffness since 1994 with current symptoms of radiating pain from the neck down into the arms, primarily on the right, and numbness to the fingers. She described flare-ups of lost strength in the arms and tingling on extended activity. She reported her flare-ups occurred twice per month and lasted two days. She estimated the severity of flare-ups as 9 on a 10-point scale. During flare-ups she stated she was unable to hold or grip with her hands. Active range of motion studies revealed forward flexion to 20 degrees, extension to 20 degrees, right lateral flexion to 35 degrees, left lateral flexion to 35 degrees, right lateral rotation to 45 degrees, and left lateral rotation to 45 degrees. Passive range of motion studies were performed as was the same as active range of motion. Pain was noted to all motion with no loss of motion other than as reported. There was evidence of pain that caused functional loss with weight bearing and active and passive motion. There was no evidence of pain on non-weight bearing and no objective evidence of crepitus or localized tenderness. There was no additional loss of motion after repetitive-use testing. Pain and weakness significantly limited functional ability with repeated use over time and during flare-ups. The examiner estimated range of motion due to the functional limitation as forward flexion to 15 degrees, extension to 15 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 40 degrees, and left lateral rotation to 40 degrees. There was no evidence of localized tenderness or guarding to the cervical spine. There was muscle spasm and tightness to the neck that did not result in abnormal gait or abnormal spinal contour. Weakened movement and less movement than normal were noted as additional factors contributing to disability. Strength was 4/5 in the upper extremities with no evidence of muscle atrophy. Deep tendon reflexes and sensation to light touch were normal. There was no evidence of ankylosis. There were signs or symptoms of radiculopathy with mild bilateral upper extremity intermittent pain, paresthesias and/or dysesthesias, and numbness. Involvement was to the bilateral C5/C6 nerve roots. The examiner found the Veteran had IVDS without episodes that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. There were no other neurologic abnormalities related to the cervical spine. No assistive devices were used as a result of the disorder. The condition impacted the Veteran's ability to perform any type of occupational task with one to two weeks of work time lost in the past 12 months and limitations in bending/twisting of the neck, pushing, pulling, carrying, and lifting moderate objects overhead. It was noted she also had difficulty with gripping, carrying, lifting, turning knobs, opening doors, dressing, grooming, writing, and typing due to numbness, tingling, and paresthesias of the upper extremities. Based upon the evidence of record, the Board finds the Veteran's service-connected degenerative disc disease of the cervical spine prior to June 23, 2021, was manifested by no worse than forward flexion limited to 30 degrees. The overall evidence of record during this period is persuasive as to this matter. It is noted that service connection is separately established for radiculopathy of the upper extremities. Although the August 2012 examination report did not record the range of motion for pain on active motion and passive motion or address the necessary findings to evaluate functional loss during flare-ups, there is no indication that a retrospective medical opinion could be reasonably expected to substantiate the claim for an earlier increased rating. The October 2019 VA examination is found to have adequately considered the extent of functional loss with repeated use over time and during flare-ups described in terms of range of motion with forward flexion to 30 degrees. A similar finding was noted upon VA examination in January 2021 with an estimated forward flexion limitation to 30 degrees with repeated use over time. Therefore, a rating in excess of 20 percent for the service-connected cervical spine disability prior to June 23, 2021, is not warranted. The Board further find that since June 23, 2021, the Veteran's degenerative disc disease of the cervical spine is manifested by no worse than forward flexion greater than 15 degrees. There is no evidence of unfavorable ankylosis of the entire spine. Nor does the overall evidence demonstrate a functional equivalence of joint ankylosis to the spine. The June 2021 VA examiner is shown to have adequate assessed the Veteran's degree of functional impairment including with repeated use over time and during flare-ups. Therefore, a rating in excess of 30 percent for the service-connected cervical spine disability since June 23, 2021, is not warranted. The Board notes that an adequate discussion of functional loss includes consideration of manifest functional loss during flare-ups. Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). 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 VA regulations under 38 C.F.R. § 3.344(a) and 38 C.F.R. § 4.1 address the stabilization of ratings, flare-ups 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 degrees of disability specified by VA examination in this case are, overall, considered adequate to compensate for considerable loss of working time from exacerbations or illness proportionate to the severity of the several grades of disability. Any reports indicative of exacerbation or flare-ups are found to be not quantifiable nor of sufficient duration to warrant a change in evaluation without violating the spirit of Mitchell and the provisions of 38 C.F.R. § 4.1 and 38 C.F.R. § 3.344(a) regarding stabilization of ratings. The Board acknowledges that the Veteran is competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, lay persons are not competent to identify a specific level of disability. It is also noted that competent evidence concerning the nature and extent of the Veteran's service-connected disabilities have been provided by VA medical professionals who have examined her. These medical findings directly address the criteria under which the disability is evaluated, including whether a specific symptom caused a level of impairment required for a higher disability rating. The Board accords these medical findings greater weight than any subjective complaints of increased symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). Therefore, the Board finds that the evidence persuasively weighs against the claim for any higher or separate ratings for the Veteran's service-connected cervical spine disability. The claim is denied. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for lumbar strain prior to October 24, 2019, a rating in excess of 20 percent for lumbar strain for the period from October 24, 2019, to June 23, 2021, and in excess of 40 percent for degenerative disc disease of the lumbar spine after June 23, 2021, is remanded. Although this issue was previously remanded, the record shows that pertinent evidence was added to the record subsequent to the issuance of a December 2021 supplemental statement of the case (SSOC). A VA examination addressing the lumbar spine disability was conducted in January 2022. The appeal must thereby be remanded for the Agency of Original Jurisdiction (AOJ) to review this evidence before the Board can issue a decision. See 38 C.F.R. § 19.31 (a SSOC will be furnished to the Veteran when additional pertinent evidence is received after the most recent SSOC has been issued). The matters are REMANDED for the following action: Send the Veteran a Supplemental Statement of the Case addressing all evidence pertinent to the lumbar spine issue added to the file since December 2021. If necessary, after allowing her time to respond, return the case to the Board. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.