Citation Nr: 22016889 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 19-03 481A DATE: March 23, 2022 ORDER Entitlement to a disability rating in excess of 20 percent for thoracolumbar strain is denied. Entitlement to a disability rating of 20 percent, but no more, for left lower extremity sciatic nerve radiculopathy from November 18, 2021 is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's thoracolumbar strain manifests as forward thoracolumbar flexion of 30 to 60 degrees, but not forward thoracolumbar flexion of 30 degrees or less, ankylosis, or incapacitating episodes of intervertebral disc syndrome (IVDS). 2. On and after November 18, 2021, the Veteran's left lower extremity femoral nerve radiculopathy manifests as moderate incomplete paralysis of the nerve, but not moderately severe incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for thoracolumbar strain have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.71a, Diagnostic Codes 5242-5237 (2021). 2. With resolution of reasonable doubt in the Veteran's favor, on and after November 18, 2021, the criteria for a rating of 20 percent, but no higher, for left lower extremity sciatic nerve radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.124a, Diagnostic Code 8526 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from June 2005 to June 2009, including service in Iraq. The Veteran testified before the undersigned Veterans Law Judge during a March 2021 hearing and a transcript is of record. These matters are on appeal from an October 2017 rating decision. In an October 2021 decision, the Board remanded the back claim to afford the Veteran an additional VA examination. The Veteran was afforded a VA examination for back conditions in November 2021. That examination is adequate with regard to the claims being decided below because it was based upon consideration of the Veteran's pertinent medical history, his lay assertions and current complaints, and because it describes his back symptoms in detail sufficient to allow the Board to make fully informed determinations. Barr v. Nicholson, 21 Vet. App. 303 (2007) (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994)). It also address his flare-ups, including an estimate of range of motion during flare-ups. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist with regard to the issues being decided below. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Thoracolumbar Strain The Veteran contends that his thoracolumbar strain warrants a rating higher than that currently assigned. It is currently rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5237, with a 10 percent rating from June 20, 2009 to August 16, 2017 and a 20 percent rating on and after August 17, 2017. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 (2021). 38 C.F.R. § 4.71a, Diagnostic Code 5242 pertains to degenerative arthritis of the spine and 38 C.F.R. § 4.71a, Diagnostic Code 5237 pertains to lumbosacral or cervical strain. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4 (2021). Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. "Staged" ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). When entitlement to compensation has already been established and an increased rating is at issue, the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed. Id. at 509; see also 38 U.S.C. § 5110(b)(3) (2012); 38 C.F.R. § 3.400(o)(2) (2020). VA received the Veteran's claim for an increased rating on August 17, 2017. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. In determining the appropriate rating for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Factors of joint disability include increased or limited motion, weakened movement, excess fatigability, incoordination, and painful movement, including during flare-ups and after repeated use. DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995); 38 C.F.R. § 4.45. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40. Additionally, "pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system." Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Pain in a particular joint may result in functional loss, but only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance. Id.; 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.59, painful joints are entitled to at least the minimum compensable rating for the joint. In this case, at least the minimum compensable rating has been in effect for this disability during the entire appeal period. 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."). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that are more favorable to the Veteran will be applied. Whether under the prior or amended criteria, Diagnostic Codes 5237 and 5242 both provide for rating under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). Under both the prior and amended criteria, Diagnostic Code 5242 also refers to Diagnostic Code 5003, which pertains to degenerative arthritis generally. Under the amended criteria, Diagnostic Code 5242 adds a reference to Diagnostic Code 5010, which pertains to traumatic arthritis. Under both the prior and amended criteria, Diagnostic Code 5003 provides, when limitation of motion is noncompensable under the appropriate Diagnostic Code, for a 10 percent rating for each major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2021). Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. For rating purposes, the lumbar spine is considered a group of minor joints. 38 C.F.R. § 4.45. As the Veteran is already in receipt of a 20 percent rating based on limitation of motion throughout the period on appeal, an increased rating under Diagnostic Code 5003 is not applicable. Further discussion of Diagnostic Code 5003 is not warranted. Under the prior criteria, Diagnostic Code 5010 provided for rating as degenerative arthritis. Under the amended criteria, Diagnostic Code 5010 provides for rating as limitation of motion, dislocation, or other specified instability under the affected joint. As the Veteran is already in receipt of a 20 percent rating based on limitation of motion throughout the period on appeal, an increased rating under Diagnostic Code 5010 is not applicable. Further discussion of Diagnostic Code 5010 is also not warranted. The General Formula specifies that the criteria and ratings apply with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area affected by residuals or injury or disease. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243 (2021). The General Formula was not affected by the amended criteria. With regard to the thoracolumbar spine, under the General Formula, a 20 percent rating is warranted for forward flexion of greater than 30 degrees but not greater than 60 degrees, a combined range of thoracolumbar motion not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Id. A 40 percent rating is warranted for forward flexion of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. Id. at Note (5). Unfavorable ankylosis is a condition which 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. Id. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is from zero to 90 degrees, extension is from zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are from zero to 30 degrees. Id. at Note (2). 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. Id. In addition, the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, under both the prior and amended criteria, allows for the assignment of rating criteria based on the frequency and extent of incapacitating episodes during the preceding 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2021). For VA rating purposes, 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. Id. at Note (1). The Veteran was afforded a VA examination for back conditions in September 2017. The clinician diagnosed multilevel lumbosacral degenerative joint disease without evidence of a left or right radiculopathy. The Veteran reported increasing tightness in his low back, particularly after sitting or leaning over for a long time. He reported pain approximately two days a week. He also reported occasional brief shooting pain when climbing a ladder. He did not report pain, numbness, or tingling in his legs, other than rare left knee "shooting" pain that the clinician considered to be a knee symptom and not a back symptom. (The Veteran's patellofemoral syndrome of the left knee is separately service-connected and its rating is not currently before the Board.) The Veteran did not report flare ups. He reported functional impairment in the form of needing to avoid bad lifting techniques, to get help when lifting heavy things, to avoid deadlifts due to pain on the following day, and to avoid jumping from high surfaces. On examination, thoracolumbar motion was reported as forward flexion to 75 degrees, extension to 20 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. The range of motion did not itself contribute to functional loss. Pain was noted on forward flexion, extension, and right and left lateral rotation but did not cause functional loss. There was no evidence of pain with weight bearing. There was objective evidence of tightness and tenderness to palpation. Ranges of motion were the same on repetition. The examination did not take place immediately after repetitive use over time but, under those circumstances, the clinician found that forward flexion would be limited to 60 degrees and all other ranges of motion would be limited to 20 degrees. Passive range of motion testing was deemed medically inappropriate because it was "technically not feasible in a safe and reasonable manner." There was no objective evidence of pain on non-weight bearing. There was guarding, but it did not result in abnormal gait or spinal contour. There were no additional factors contributing to disability. Strength was normal, with no muscle atrophy. Reflexes were normal. Sensory examination was normal. Straight leg raising tests were negative. There was no radicular pain or any other sign or symptom of radiculopathy. There was no ankylosis. There were no other neurologic abnormalities. The Veteran did not have IVDS. The Veteran did not report using any assistive devices. The clinician found that the Veteran's low back disability would not have any impact on his ability to work. In his November 2017 Notice of Disagreement (NOD), the Veteran reported limited range of motion, muscle spasms causing an abnormal gait, and spondylosis. In his February 2019 substantive appeal (VA Form 9), the Veteran referred generally to his VA treatment records but did not cite any specific record or explain what in those records would support a higher rating. During the March 2021 hearing, the Veteran's representative contended that, although the criteria for a 40 percent rating were not met, the Veteran's symptoms were more accurately reflected by a 40 percent rating. The representative did not explain which symptoms were the basis for this contention. The Veteran testified that he had been receiving massage therapy since 2018 and that he had missed one to two weeks of work due to his low back symptoms over the past 12-24 months, with the longest episode lasting about three days. He also testified that his symptoms had generally worsened since 2017. He did not report any symptoms in his lower extremities. The Veteran was afforded a VA examination for back conditions in November 2021. The clinician diagnosed degenerative disc disease other than IVDS, thoracolumbar strain, and radiculopathy of the left lumbar region. The Veteran reported progressively worsening low back pain and decreasing range of motion but denied any recent emergency room visits, hospitalizations, or surgeries related to his back condition. He also reported having recently switched from active homebuilding to a supervisory role due to back issues. He reported a constant dull ache, occasionally waking with increased pain, increased pain triggered by movements such as twisting, randomly intermittent shooting pain in the lower right lumbar region, and occasional shooting pain down his left leg. He reported flare ups twice a month lasting approximately one to two days at a time, precipitated by longer days with increased activity. During flare ups, the Veteran reported that he had sharp constant pain, that movement of any kind would cause painful back spasms, and that he had to sit or lay on the couch for a couple of hours. He characterized them as moderate to severe. During flare ups, he reported functional impairment in the form of decreased ability to perform repetitive forward bending, heavy lifting, prolonged walking, prolonged standing, and prolonged running. Outside of flare ups, he reported functional impairment in the form of difficulty driving or sitting for more than two hours at a time or lean forward for any period of time. On examination, thoracolumbar motion was reported as forward flexion to 50 degrees, extension to 25 degrees, right lateral flexion to 25 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 15 degrees. The range of motion contributed to functional loss by limiting repetitive forward bending, heavy lifting, prolonged walking, prolonged standing, and prolonged running. Pain was noted on all ranges of motion. Passive range of motion testing was not performed because it was "not feasible to do this in a safe and reasonable manner." On active motion, pain impacted ability to perform repetitive forward bending, heavy lifting, prolonged walking, and prolonged standing. There was no objective evidence of crepitus. There was moderate pain to palpation and tenderness to palpation. Ranges of motion were the same on repetition. Because the clinician specifically stated that the examination took place both immediately after repeated use over time and during a flare up, ranges of motion under those circumstances were as described above. Repetition over time caused functional loss due to pain and weakness and flare ups caused functional loss due to pain, fatigability, and weakness. There was tenderness on palpation and muscle spasm, but it did not result in abnormal gait or spinal contour. There was no guarding. There were no additional factors contributing to disability. Strength was normal, with no muscle atrophy. Reflexes were normal. Sensory examination was normal. Straight leg raising tests were negative on the right and positive on the left. There was no radicular pain or any other sign or symptom of radiculopathy in the right lower extremity. In the left lower extremity, the Veteran reported moderate intermittent pain and mild paresthesias and/or dysesthesias, but no constant pain or numbness. There were no other signs or symptoms of radiculopathy in the left lower extremity. The clinician found that the left femoral nerve was affected. There was no ankylosis. There were no other neurologic abnormalities. The Veteran did not have IVDS. The Veteran did not report using any assistive devices. The clinician found that the Veteran's low back disability would have an impact on his ability to work by impacting his ability to perform repetitive forward bending, heavy lifting, prolonged walking, prolonged standing, and climbing ladders. The clinician also noted that the Veteran had missed one to two weeks of work over the past 12 months due to his low back symptoms. The most persuasive evidence weighs against finding that the Veteran's low back disability warrants a rating in excess of 20 percent during the period on appeal. The November 2021 VA examination took place both immediately after repetition over time and during a flare up and, under those circumstances, forward flexion was 50 degrees. The record contains no finding of a lower range of forward flexion during the period on appeal. The Board notes the Veteran's representative's argument that the Veteran's symptoms are more closely analogous to the criteria for a 40 percent rating than a 20 percent rating. The representative acknowledged that the "entire criteria" needed for a 40 percent rating were not met. This argument is unpersuasive. First, a separate or higher rating is not warranted based upon functional impairment due to the factors set forth in 38 C.F.R. §§ 4.40 and 4.45. These sections do not contain rating criteria. The rating criteria for the Veteran's disability are set forth in 38 C.F.R. § 4.71a. The examples of functional impairment are used to understand the Veteran's disability, but "...whatever the background, an applicant for disability benefits is rated based on the criteria set forth in 38 C.F.R. § 4.71a." Thompson, 815 F.3d at 786. The Veteran's disability does not meet the criteria established for a 40 percent rating, and therefore a 40 percent rating cannot be assigned. Alternatively, under the General Formula forward flexion of 31 to 60 degrees warrants a 20 percent rating and 50 degrees is closer to 60 than it is to 30. In addition, no examiner or treatment provider has found ankylosis and, given the existence of a range of thoracolumbar motion, the most persuasive evidence weighs against a finding that the Veteran has symptoms analogous to ankylosis of the thoracolumbar spine as defined above. "Ankylosis" is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 92 (33rd ed. 2020). The Veteran retains more than half of his forward flexion, even during a flare-up. He lost only 5 degrees of extension and right lateral flexion, and 10 degrees of left lateral flexion and right lateral rotation. He retains half of his left lateral rotation. These ranges of motion, even during a flare-up, are not the functional equivalent of the inability to move his thoracolumbar spine. The Board has additionally considered whether a higher rating is warranted under the formula for rating IVDS based on incapacitating episodes. There is no evidence of IVDS or of incapacitating episodes as defined above having a duration of at least four weeks in twelve months during the period on appeal. For this reason, a rating in excess of 20 percent based on incapacitating episodes caused by IVDS is not warranted. The Board therefore finds that there are no other potentially applicable Diagnostic Codes by which a higher rating can be assigned. The Board has considered the Veteran's lay statements. The Veteran is competent to report his own observations with regard to the symptoms of his low back disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, nothing in the Veteran's lay statements provides a basis for assigning a higher rating because the Veteran does not report that the predominant state of his thoracolumbar motion during the period on appeal has been a forward flexion of 30 degrees or less, or ankylosis of the thoracolumbar spine as defined above. In addition, the Board considered whether a higher rating is warranted under the regulations relating to additional functional loss due to pain, weakness, fatigability, incoordination, and other factors under DeLuca, 8 Vet. App. at 204-07; 38 C.F.R. §§ 4.40, 4.45. There is nothing to indicate that the Veteran's pain causes functional impairment equivalent to forward flexion of 30 degrees or less or ankylosis of the thoracolumbar spine. Any associated objective neurologic abnormalities caused by the Veteran's low back disability, including, but not limited to, bowel or bladder impairment are to be evaluated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a at Note (1). The Board will discuss the Veteran's left lower extremity radiculopathy below. The Veteran has not reported any right lower extremity radiculopathy symptom and no examiner or treatment provider has found right lower extremity radiculopathy. There is no other probative evidence of additional neurologic abnormalities caused by the Veteran's low back disability. 2. Left Lower Extremity Sciatic Nerve Radiculopathy As a result of the November 2021 VA examination in connection with this appeal, VA has separately granted service connection for the Veteran's left lower extremity sciatic nerve radiculopathy. It is currently rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520, for paralysis of the sciatic nerve, with a 10 percent rating on and after November 18, 2021, the date of the most recent VA examination. Because the General Formula specifies that any associated objective neurologic abnormalities caused by the Veteran's low back disability are to be evaluated separately under an appropriate Diagnostic Code, the Board finds that it must consider the Veteran's radiculopathy for the same period as was under consideration for the lumbar spine disability, i.e., the period on and after August 17, 2017. See 38 C.F.R. § 4.71a at Note (1); Chavis v. McDonough, 34 Vet. App. 1 (2021). The Diagnostic Code assigned by the November 2021 rating decision is incorrect. Diagnostic Code 8520 is for the sciatic nerve. At the November 2021 VA examination, the examiner specifically identified that the nerve involved was the femoral nerve. The record does not show that the sciatic nerve was impacted. Therefore, the RO should have assigned Diagnostic Code 8526, which is for the femoral nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8520 pertains to paralysis of the sciatic nerve. Under Diagnostic Code 8520, paralysis of the sciatic nerve is rated as follows: complete paralysis (80 percent); severe incomplete paralysis with marked muscular atrophy (60 percent); moderately severe incomplete paralysis (40 percent); moderate incomplete paralysis (20 percent); and mild incomplete paralysis (10 percent). Diagnostic Code 8526 pertains to paralysis of the femoral nerve. Under Diagnostic Code 8526, paralysis of the femoral nerve is rated as follows: complete paralysis (40 percent); severe incomplete paralysis (30 percent); moderate incomplete paralysis (20 percent); and mild incomplete paralysis (10 percent). For all diseases of the peripheral nerves, when the involvement is wholly sensory, the rating should be for the mild or, at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" in 38 C.F.R. § 4.124(a). The Board finds that the Diagnostic Code for the Veteran's left lower extremity radiculopathy should be changed from 8520 to 8526. The Board may change the Diagnostic Code because the Veteran's rating is not protected since it has not been in effect for 20 years or more. See Murray v. Shinseki, 24 Vet. App. 420, 426 (2011). Additionally, service connection is not being severed for his left lower extremity radiculopathy because the code is being changed to more accurately determine the benefit to which he is entitled. Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). His femoral nerve is impacted, not his sciatic nerve. Diagnostic Code 8526 is therefore more accurate. This is not prejudicial to the Veteran, because the evidence of record at this time does not show that he has impairment of the left sciatic nerve. Additionally, changing the Diagnostic Code from 8520 to 8526 does not result in an alteration in the amount of his benefits payment. A 20 percent rating under both codes is for moderate incomplete paralysis. The Board has described the evidence of record regarding the Veteran's left lower extremity radiculopathy above. Based on that evidence, the Board does not find that a rating for left lower extremity radiculopathy is warranted prior to November 18, 2021. For initial rating claims and increased rating claims, "the effective date can be no earlier than the date it was factually ascertainable" that a veteran's disability was diagnosed or worsened. Swain v. McDonald, 27 Vet. App. 219, 224 n. 4 (2015). The effective date should not be "assigned mechanically" as of the date of an examination. Id. at 224. There must be a factual basis for choosing an earlier date. The record contains no mention of left lower extremity symptoms prior to the November 2021 VA examination, with the exception of left knee symptoms reported during the September 2017 VA examination. As stated above, the Veteran's left knee disability is separately service-connected and its rating is not currently before the Board. The information in the November 18, 2021 VA examination does not allow the Board to factually ascertain when the radiculopathy began. Therefore, November 18, 2021 is the appropriate effective date for the award. However, the Board finds that, affording the Veteran the benefit of the doubt, his left lower extremity sciatic nerve radiculopathy warrants a rating of 20 percent on and after November 18, 2021. The November 2021 VA examiner did not quantify the overall severity of his radiculopathy but characterized one of his symptoms as moderate. The Board therefore finds that the Veteran's low back disability was manifested by left lower extremity radiculopathy of moderate severity on and after November 18, 2021. (Continued on the next page) The most persuasive evidence described above also shows that the Veteran's left lower extremity radiculopathy does not warrant a rating in excess of 20 percent during the period on appeal. The Veteran's radiculopathy symptoms are wholly sensory, and therefore a 20 percent rating is the maximum rating that can be assigned. 38 C.F.R. § 4.124a. Non sensory impairment can include symptoms such as "a reflex abnormality, [or] weakness or muscle atrophy." Miller v. Shulkin, 28 Vet. App. 376, 380 (2017). The Veteran's strength and reflexes were normal on both VA examination reports, there were no sensory deficits, and no symptoms were of more than moderate severity. The Veteran's VA treatment records do not show non sensory radiculopathy symptoms. This is collectively indicative of incomplete paralysis of no more than moderate severity. The Board has considered the Veteran's lay statements. The Veteran is competent to report his own observations with regard to the symptoms of his left lower extremity radiculopathy. See Jandreau, 492 F.3d at 1376-77. Nothing in those statements is consistent with a finding of more than moderate incomplete paralysis. The Board also notes that the November 2021 VA examiner considered the Veteran's lay reports in characterizing the level of intermittent pain as moderate and of paresthesias and/or dysesthesias as mild. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ryan Frank, 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.