Citation Nr: 22017667 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 16-24 020A DATE: March 25, 2022 ORDER Entitlement to a rating higher than 20 percent for herniated nucleus pulposus with degenerative disc disease of the lumbar spine (hereinafter "lumbar spine disability") is denied. Beginning March 20, 2015, a 10 percent rating, but no higher, for radiculopathy of the right sciatic nerve is granted. Beginning January 27, 2020, a 20 percent rating, but no higher, for radiculopathy of the left sciatic nerve is granted. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) for the appeal period prior to June 24, 2019, is remanded. FINDINGS OF FACT 1. The Veteran's lumbar spine disability is manifested by forward flexion of the thoracolumbar spine to 40 degrees at worst, without evidence of unfavorable ankylosis of the entire thoracolumbar spine or entire spine, or intervertebral disc syndrome (IVDS) with incapacitating episodes. 2. Beginning March 20, 2015, associated neurological impairment in the right sciatic nerve has been no more than mild. 3. Beginning January 27, 2020, associated neurological impairment in the left sciatic nerve has been no more than moderate. 4. Beginning June 9, 2021, associated neurological impairment has been mild at worst in the right femoral nerve, and moderate, at worst, in the left femoral nerve. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating higher than 20 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.59, 4.71a, Diagnostic Code (DC) 5243 (2021). 2. Beginning March 20, 2015, the criteria for a 10 percent rating, but no higher, for radiculopathy of the right sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.123, 4.124a, DC 8520 (2021). 3. Beginning January 27, 2020, the criteria for a 20 percent rating, but no higher, for radiculopathy of the left sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.123, 4.124a, DC 8520 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1986 to June 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs Regional Office (RO) which increased the rating for the Veteran's lumbar spine disability to 20 percent disabling. The RO also granted service connection for left lower extremity radiculopathy of the sciatic nerve and assigned a 10 percent rating, effective July 23, 2013. In September 2019, the RO increased the rating for the left lower extremity radiculopathy of the sciatic nerve to 40 percent, effective June 24, 2019. In November 2019, the RO granted service connection for right lower extremity radiculopathy of the sciatic nerve and assigned a 10 percent rating, effective June 24, 2019. In March 2020, the RO decreased the rating for the left lower extremity radiculopathy of the sciatic nerve to 10 percent, effective January 27, 2020. In the March 2020 rating decision, the RO also awarded a TDIU, effective June 24, 2019; however, this is not a full grant of the benefit sought as it was not assigned from the date of claim of the underlying increased rating claim. Entitlement to a TDIU prior to June 24, 2019, is still on appeal. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993) (the Veteran is presumed to be seeking the maximum benefit available unless he expressly indicates otherwise). As will be discussed in the REMAND portion of the decision, the issue of entitlement to a TDIU for the rating period on appeal prior to June 24, 2019 is remanded for further development. In February 2021, the Veteran testified in a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. In April 2021, the Board remanded the claim for further development. Thereafter, in a July 2021 rating decision, the RO granted service connection for right lower extremity radiculopathy of the femoral nerve and assigned a 10 percent rating; granted service connection for left lower extremity radiculopathy of the femoral nerve and assigned a 20 percent rating; and increased the rating assigned for left lower extremity radiculopathy of the sciatic nerve to 20 percent, all ratings were assigned effective June 9, 2021. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the claimant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Rating Claim Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria."). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Entitlement to a rating higher than 20 percent for herniated nucleus pulposus, L4 and L5 with degenerative disc disease 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 Veteran's herniated nucleus pulposus, L4 and L5 with degenerative disc disease is currently rated as 20 percent disabling under DC 5243 which contemplates IVDS. 38 C.F.R. § 4.71a. He seeks an increased rating as his lumbar spine disability is increasingly painful. Regulatory amendments effective February 7, 2021, DC 5243 clarified that DC 5243 is only for application when there is disc herniation with compression and/or irritation of the adjacent nerve root. Under DC Code 5243 for IVDS, a 20 percent rating is warranted for incapacitating episodes with a total duration of at least two weeks but less than four weeks during the past 12 months. A rating of 40 percent is warranted for incapacitating episodes with a total duration of at least four weeks but less than six weeks during the past 12 months. A maximum rating of 60 percent is warranted for incapacitating episodes with a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, IVDS Formula. For these purposes, an incapacitating episode is defined as 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). Under Diagnostic Code 5242, a 20 percent rating is provided for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note (2). For VA compensation purposes, unfavorable ankylosis is a condition in which 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. Id. at Note (5). The Court has recently held that the requirement of ankylosis in the General Rating Formula for Diseases and Injuries of the Spine can be met with evidence of the functional equivalent of ankylosis, i.e., functional immobility of the joint, during a flare-up. See Chavis v. McDonough, 34 Vet. App. 1 (2021). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate DC. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). Upon review of the evidence of record, the Board finds that a rating in excess of 20 percent is not warranted for the Veteran's service-connected lumbar spine disability. VA treatment notes dated in May 2013 show complaints of joint pains. The Veteran had no muscle spasms. He had full range of motion of the lower extremities and walked independently, without a limp. The diagnosis was osteoarthritis, degenerative joint disease, and intermittent low back pain. During a June 2013 evaluation, spinal and paraspinal tenderness of the lumbar spine was demonstrated. The Veteran indicated that he took Tylenol or ibuprofen for pain. In March 2014, the Veteran complained of shooting pain down his left leg. During an April 2014 VA peripheral nerves examination, the examiner confirmed a diagnosis of lumbar radiculopathy that was analogous to mild incomplete paralysis of the left sciatic nerve. He had moderate symptoms of intermittent pain, paresthesias and numbness in the lower left extremity. The examiner noted that there was no evidence of radiculopathy in the right lower extremity. In an April 2014 statement in support of his claim, the Veteran reported that he experienced shooting pains down his left leg. In a July 2014 lay statement, J.P. stated that she has observed the Veteran continually shift in a chair to find a comfortable position due to pain in his buttocks, that his left leg appears to drag due to pain and that he is unable to walk normally or help around the house. The Veteran uses a heating pad to try to alleviate the pain. In August 2014, the Veteran was afforded a VA spine examination, at which time the examiner confirmed diagnoses of degenerative arthritis of the spine, spinal stenosis of L3-L4, L4-L5 and L5-S1, and lumbar radiculopathy. His symptoms included low back pain and pain down his left leg from the center of his buttocks to his toes daily for ten-minute intervals, which limited his ability to stand, sit, walk, and lift. The Veteran indicated that he was unable to climb stairs or bend. He reported flare-ups that lasted for ten minutes. On examination, forward flexion of the thoracolumbar spine was 90 degrees or greater, with pain at 40 degrees; extension was 25 degrees, with pain at 15 degrees; right lateral flexion was 25 degrees, with pain at 15 degrees; left lateral flexion was 20 degrees, with pain at 15 degrees; and right and left lateral rotation were 15 degrees with pain. The Veteran was able to perform repetitive-use testing with 3 repetitions with forward flexion to 90 degrees or greater, extension to 25 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation to 15 degrees. The Veteran had functional loss or impairment of the thoracolumbar spine due to less movement than normal, weakened movement, excess fatigability, pain on movement, instability of station, disturbance of locomotion, interference with sitting, standing and/or weight-bearing, and lack of endurance. The Veteran had pain to palpation of the paraspinous bilateral gluteus. Muscle spasm and guarding of the thoracolumbar spine resulted in abnormal gait or abnormal spinal contour. Muscle strength testing of the lower extremities was normal, bilaterally, and there was no muscle atrophy. Reflex examination was normal, bilaterally, except for the Veteran's left ankle which was hypoactive. Sensory testing was normal. bilaterally. Straight leg raising test was positive on the left. The Veteran had mild intermittent pain in the right lower extremity and moderate intermittent and constant pain and numbness, and severe paresthesias in the left lower extremity. The examiner noted that the Veteran had moderate radiculopathy on the left side with involvement of the sciatic nerve roots. There was no ankylosis of the spine. There were no other neurologic abnormalities or findings. The Veteran did not have IVDS or use an assistive device for locomotion. X-rays showed evidence of moderate spondylosis of the composite lumbar spine with L3-L4, L4-L5 and L5-S1 intervertebral disc diseases. VA treatment records dated from January 2015 to December 2019 show continuing reports of low back pain, prescriptions for pain medication and occasional spinal tenderness. A magnetic resonance image (MRI) conducted in January 2015 showed evidence of degenerative disc disease, facet arthropathy, and ligamentous hypertrophy causing severe spinal stenosis with evidence of nerve root impingement at several levels including L5 and S1. In March 2015, at a neurology consultation, the Veteran reported constant back pain with tingling, bilaterally, down his legs to his calves and feet. He had a limping gait and deep tendon reflexes (DTRs) were +1 except for +2 on the left patellar. In May 2015, the Veteran reported dull pain in his back radiating to his lower legs down from his buttocks. Straight leg raising was negative, bilaterally, and "FABER" test was positive. In December 2015, the Veteran reported low back pain radiating down his lower legs from his buttock to his foot. The examiner noted tenderness over the lumbar spinal region and positive bilateral facet joint tenderness, greater on the left. The examiner noted that the Veteran presented with chronic lower back pain, with a likely radicular component given symptoms secondary to spinal stenosis, and that the back pain was likely facet arthropathy, bilaterally. In September 2016, the Veteran reported pain from levels 5 out of 10 to 12 out of 10. Range of motion of the low back showed fingertips to the mid tibia with lumbar flexion, mild axial pain with side bending, and decreased lumbar extension limited by pain. The Veteran had lumbar facet joint injections. In June 2018, the Veteran was seen for acute complaints of back pain estimated as 10/10. There were no numbness, bowel or bladder disturbances, or tenderness to palpation over the spine. There was tightness and spasm over the paraspinal muscles. In August 2019, the Veteran had acupuncture treatment for low back pain. In October and December 2019, it was noted that the Veteran ambulated with a cane. In September 2019, the Veteran underwent a VA peripheral nerves examination, at which time the examiner confirmed a diagnosis of left leg neuropathy that was analogous to moderately severe incomplete paralysis of the sciatic nerve in the left lower extremity. The Veteran reported extreme pain in the back of his legs at his heels. The examiner also noted moderate incomplete paralysis of the sciatic nerve in the right lower extremity. There were findings of severe constant and intermittent pain, parasthesia, and numbness in the left lower extremity and moderate constant and intermittent pain, parasthesia, and numbness in the right lower extremity. Reflexes in the lower extremities were hypoactive and sensory examination was absent in the left thigh/knee, left lower leg/ankle, and left foot/toes. At a November 2019 VA peripheral nerves examination, the examiner confirmed diagnoses of right and left lower extremity radiculopathy that was analogous to mild incomplete paralysis of the sciatic nerves in the right and left lower extremities. There were findings of moderate intermittent pain in the right and left lower extremities. Muscle strength, reflex and sensory examinations were normal, bilaterally. In January 2020, the Veteran underwent another VA peripheral nerves examination, at which time the examiner confirmed a diagnosis of right and left lower extremity radiculopathy that was analogous to moderate incomplete paralysis of the sciatic nerves. Right and left femoral nerves were normal. The Veteran reported shooting pains in his legs, down to his feet. The Veteran had moderate symptoms of intermittent pain in the right and left lower extremities. Muscle, reflex, and sensory examinations were normal. At the hearing in February 2021, the Veteran testified that he was in pain due to his back disability and had difficulty sitting or standing for long periods of time and moving or walking to a car. In June 2021, the Veteran underwent an additional VA spine examination, at which time the examiner rendered diagnoses of intervertebral disc syndrome, spinal stenosis and left lower extremity radiculopathy. The Veteran reported pain running down his left leg, causing pain, numbness, and tingling. He also reported pain in the back on the right. The Veteran reported daily flare-ups which were severe in nature. Flare-ups lasted all day and were precipitated by liftin, bending, or sitting for extended periods. He reported that he had to lay down during flare-ups and not do anything which could be for two to three days at a time. Functional loss/impairment was described as not being able to do anything, pick up items, get dressed, and difficulty driving. Upon physical examination, passive and active range of motion of the lumbar spine revealed forward flexion to 60 degrees; extension to 10 degrees; right lateral flexion to 20 degrees; left lateral flexion to 15 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 15 degrees. Pain was noted on examination and caused functional loss. There was pain with weight-bearing and all motion, and tenderness on palpation of the paravertebral border of a well-healed incision of L4-5 that radiated to the left and bilaterally into the buttocks and down the leg. After repetitive-use testing, range of motion revealed forward flexion to 50 degrees; extension to 5 degrees; and lateral flexion and lateral rotation to 15 degrees, bilaterally. The examiner noted that there was functional loss due to pain, fatigability, and weakness. The Veteran was not examined during a flare-up or after repeated use over time, but the examiner estimated that the Veteran would have forward flexion to 50 degrees; extension to 5 degrees, and lateral flexion and rotation to 10 degrees, bilaterally, due to pain, fatiguability, and weakness. The Veteran had guarding which resulted in abnormal gait. There was localized tenderness without spasms along the old incisional region of L4-5. There were no additional contributing factors of disability. Muscle strength was normal on the right and showed active movement against some resistance (4/5) on the left. There was no evidence of muscle atrophy. Reflex examination was normal, bilaterally. Sensory examination was normal throughout on the right and in the thigh on the left but decreased on the left in the thigh/knee, lower leg/ankle, and foot/toes. Straight leg raising test was positive, bilaterally. Symptoms of radiculopathy included mild constant pain in the right lower extremity and moderate constant pain, paresthesias, and numbness in the left lower extremity. The examiner noted involvement of the femoral and sciatic nerves on the left. There was no evidence of ankylosis or any other neurologic abnormalities. IVDS did not result in any episodes of acute signs or symptoms requiring bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran used a cane regularly, bilaterally, for assistance with locomotion. The examiner estimated that the Veteran's back disability would cause one to two weeks work time lost in the last 12 months. In an August 2021 addendum, upon review of the claims file, the June 2021 VA examiner noted that the Veteran had additional pain and radiculopathy from the time of the July 2013 VA examination that occurred daily and ongoing throughout the day. The pain increased with activity, was sharp and radiating in nature from the paravertebral region to the bilateral buttocks, and the severity of pain due to repeated use over time and flare-ups was estimated at 8/10. Flare-ups of back pain affected the Veteran's ability to stand or sit for long periods of time and his ability to life and drive which decreased his quality of life. The Board finds that there is no evidence of any physician-prescribed bed rest for a total duration of at least four weeks but less than six weeks during the past 12 months to award a higher rating. This finding is most recently reflected on the February 2021 VA lumbar spine examination. The criteria for a rating greater than 20 percent for the Veteran's lumbar spine disability under the General Rating Criteria are not met. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, fatigability, weakened movement, repetitive use, flare-ups, and pain during repetitive use and flare-ups. However, even considering the Veteran's lay reports of symptoms, pain and noted functional loss would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The Board also considered the possibility of awarding a higher rating with consideration of 38 C.F.R. §§ 4.40 and 4.45. Even taking into consideration the holding in Chavis, the Board finds that the Veteran's demonstrated functional loss is not the functional equivalent of ankylosis. In this case, although the Board acknowledges the Veteran's reports of symptoms of limited ability to stand, sit, walk, and lift, there is no indication of limited motion of the spine that is comparable to any type of immobility. In this case, he was still able to perform forward flexion and his forward flexion was limited to 40 degrees, at worst. Also, to the extent that the Veteran has experienced functional loss due to pain, he has not alleged functional impairment comparable to that experienced by an individual with immobility of part of the spine. His symptoms are fully contemplated by the assigned schedular rating. Furthermore, the Veteran was also able to perform after repetitive use testing, even with objective evidence of pain, the motion noted above to 40 degrees. As such, the current rating adequately compensates him for his pain with limited motion, and a higher rating is not warranted under DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). Associated Neurologic Impairment In addition to consideration of the orthopedic manifestations of the low back disability, VA regulations require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate DC. Under DC 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve; 20 percent for moderate incomplete paralysis; 40 percent for moderately severe incomplete paralysis; 60 percent for severe incomplete paralysis with marked muscular atrophy; and 80 percent for complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. Under DC 8526, a 10 percent rating is warranted for mild incomplete paralysis of the femoral nerve; 20 percent for moderate incomplete paralysis; 30 percent for severe incomplete paralysis; 40 percent for complete paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a, DC 8526. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 2011 (2018) ("DC 8520 does not define 'mild,' 'moderate, ''moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Rather than applying a mechanical formula, the Board must instead evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Right Sciatic Nerve Involvement The Veteran is in receipt of a 10 percent rating for right lower extremity radiculopathy of the sciatic nerve under DC 8520, effective June 24, 2019. Based on review of the evidence, both lay and medical, the Board finds that a rating of 10 percent, but no higher is warranted under DC 8520 for right lower extremity radiculopathy of the sciatic nerve beginning earlier, from March 20, 2015. As indicated above, the medical evidence reflects the Veteran's repeated reports regarding radicular symptoms beginning in the low back and radiating down the back of the legs, including the right leg. See March 20, 2015 neurology consultation, VBMS Capri, received September 30, 2019. This radicular pain into his lower extremities is an observable symptom that the Veteran is competent to report. Layno v. Brown, 6 Vet. App. 465, 469 (1994). This 10 percent rating is warranted under DC 8520 for mild incomplete paralysis of the right sciatic nerve. Evidence prior to that date reveals no complaints of right lower extremity radiculopathy or radiating pain. A rating in excess of 10 percent is not warranted at any time as the evidence reflects that the Veteran's sciatic radiculopathy of the right lower extremity has been no more than mild, as reflected by the evidence as a whole, to include the normal reflex, strength, and sensory testing, except for decreased DTRs and sensory on one occasion in September 2019. There was one episode of a positive straight leg raise test in June 2021. Right Femoral Nerve Involvement The Veteran is in receipt of a 10 percent rating for right lower extremity radiculopathy of the femoral nerve, under DC 8526, effective June 9, 2021. With respect to femoral nerve of the right lower extremity, the Board notes that there is no evidence to support a compensable rating prior to June 9, 2021, or a rating higher than 10 percent from June 9, 2021. Specifically, there were no complaints or findings regarding femoral pain or radiculopathy in the right lower extremity; his complaints were limited to the back of the leg. His femoral impairment is not shown to be worse than mild in nature. Left Sciatic Nerve Involvement The Veteran is in receipt of a 10 percent rating from July 25, 2013, a 40 percent rating from June 24, 2019 to June 26, 2020, a 10 percent rating from January 27, 2020 to June 8, 2021, and a 20 percent rating thereafter, for sciatic radiculopathy of the left lower extremity. On review, the Board does not find evidence to support the assignment of ratings higher than those already assigned for sciatic radiculopathy of the left lower extremity prior to January 27, 2020. Prior to June 24, 2019, the evidence collectively reflects no more than mild radiculopathy of the sciatic nerve of the left lower extremity. While the Veteran complained of radiating pain of varying intensity throughout the period, and a finding of positive straight leg raising in August 2014 and occasional tightness or spasm over the paraspinal region, there were also multiple physical findings of negative straight leg raising, and normal sensory and reflex examinations. From June 24, 2019 to January 26, 2020, the Board find that a rating higher than 40 percent is not warranted for sciatic. There is no evidence of any muscle atrophy of the left lower extremity. While the Veteran reported severe pain and numbness, this level of symptomatology is recognized by the 40 percent rating for a moderately severe disability. However, the Board finds that a rating of 20 percent for left lower extremity sciatic radiculopathy has been met for the period from January 27, 2020, but no higher. His January 2020 VA examination showed that the left lower extremity sciatic radiculopathy was characterized as moderate incomplete paralysis by the examiner. In June 2021, the Veteran had left lower extremity strength of 4/5 and decreased sensory examination The examiner noted moderate constant pain, paresthesias and numbness. The Board finds this to be consistent with an overall moderate level of impairment from January 27, 2020. However, the evidence does not show that the Veteran had moderately severe incomplete paralysis or severe incomplete paralysis in the absence of findings of a severe level of symptomatology or muscle atrophy. Therefore, a rating higher than 20 percent is not warranted for the left lower extremity sciatic nerve from January 27, 2020. Left Femoral Nerve Involvement The Veteran is in receipt of a 20 percent rating for radiculopathy of the left femoral nerve from June 9, 2021. On review, the Board does not find evidence to support the assignment of a rating higher than the already assigned 20 percent rating for femoral radiculopathy of the left lower extremity. Prior to the June 9, 2021 VA examination, there were no complaints or findings of femoral pain or radiculopathy in the left lower extremity. The Veteran's complaints centered solely on radiating pain down the back of his left leg. However, at the June 2021 VA examination, the examiner noted involvement of the femoral nerve and the Veteran's symptomatology was noted to be moderate in nature. Ultimately, the evidence does not show that the Veteran had severe incomplete paralysis in the absence of findings of a severe level of symptomatology. Therefore, a rating higher than 20 percent is not warranted for the left lower extremity femoral nerve from June 9, 2021. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Entitlement to a TDIU, to include on an extraschedular basis, is remanded. An award of a TDIU is in effect from June 24, 2019. For the appellate period prior to June 24, 2019, the Veteran is service connected for herniated nucleus pulposus, L4 and L5 with degenerative disc disease (20 percent), radiculopathy of the left lower extremity associated with herniated nucleus pulposus, L4 and L5 with degenerative disc disease (10 percent), and generalized anxiety disorder (noncompensable). The combined evaluation for the service-connected disabilities is 30 percent. Thus, the Veteran does not meet the schedular requirements for consideration of TDIU prior to June 24, 2019, under 38 C.F.R. § 4.16(a). Nevertheless, under Roberson v. Principi, 251 F.3d 1378 (2001) and Rice v. Shinseki, 22 Vet. App. 447 (2009), there is also a duty imposed on VA to consider TDIU even when the schedular criteria are not met. VA policy is that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). While the Board does not have the authority to assign an extraschedular TDIU in the first instance, see Bowling v. Principi, 15 Vet. App. 1, 14 (2001), the Board does have the authority to decide whether a claim should be referred to the Under Secretary for Benefits or the Director of Compensation and Pension Services. See Barringer v. Peake, 22 Vet. App. 242 (2008). Here, the available evidence raises a reasonable possibility that the Veteran's service-connected disabilities may have precluded him from obtaining and maintaining substantially gainful employment prior to June 24, 2019. The Veteran has reported that he last worked in 2008 and asserts that his low back disability interferes with his ability to work. VA examiners in April 2014 and August 2015 noted that the Veteran's lumbar spine disability impacted his ability to work. At his hearing in February 2021, the Veteran testified that his back disability interfered with his employment as a truck driver causing him to quit his job. Social Security Administration disability report of award shows that the Veteran has been awarded disability benefits, in part, due to his service-connected disabilities, as of November 30, 2010. However, records from the Social Security Administration (SSA) were not associated with the claims file. Based on the foregoing, the Board finds that referral for extraschedular consideration is warranted. Accordingly, the matter is REMANDED for the following action: 1. Contact the SSA and request copies of SSA's determination on the Veteran's claim for SSA disability benefits, as well as copies of the complete medical records considered in that determination. A copy of any response from SSA, including any records obtained and/or a negative reply, should be included in the claims file. 2. Refer the claim for a TDIU for the appellate period prior to June 24, 2019 to the Director of Compensation Service for consideration of an extraschedular TDIU. 3. Thereafter, readjudicate the TDIU claim for the period prior to June 24, 2019. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beach, Julia M. 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.