Citation Nr: 22017743 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 19-25 654 DATE: March 26, 2022 ORDER Entitlement to service connection for residual scar of the left side of face is denied. Entitlement to an initial rating in excess of 20 percent for lumbar disc herniation with spondylosis prior to October 19, 2020, is denied. Entitlement to a rating in excess of 40 percent for lumbar disc herniation with spondylosis from October 19, 2020, is denied. Entitlement to an initial 20 percent rating for residual burn scars of the left upper arm and shoulder is granted. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left sciatic nerve prior to March 10, 2022, is denied. Entitlement to a 20 percent rating for radiculopathy of the left sciatic nerve from March 10, 2022, is granted. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right sciatic nerve prior to March 10, 2022, is denied. Entitlement to a 20 percent rating for radiculopathy of the right sciatic nerve from March 10, 2022, is granted. REMANDED Entitlement to an initial rating in excess of 10 percent for painful motion of the left hip is remanded. Entitlement to an initial compensable rating for limitation of flexion, left hip is remanded. Entitlement to an initial compensable rating for limitation of abduction/adduction, left hip is remanded. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that the Veteran has had a residual burn scar of the left side of face at any time during or approximate to the pendency of the claim. 2. Prior to October 19, 2020, the Veteran's lumbar disc herniation with spondylosis was manifested by forward flexion to 55 degrees. 3. From October 19, 2020, the Veteran's lumbar disc herniation with spondylosis is manifest by forward flexion to 30 degrees. 4. The Veteran has three residual burn scars of the left upper arm and shoulder that are painful. 5. Prior to March 10, 2022, the Veteran's radiculopathy of the left sciatic nerve was manifest by no more than mild incomplete paralysis. 6. From March 10, 2022, the Veteran's radiculopathy of the left sciatic nerve is manifest by no more than moderate incomplete paralysis. 7. Prior to March 10, 2022, the Veteran's radiculopathy of the right sciatic nerve was manifest by no more than mild incomplete paralysis. 8. From March 10, 2022, the Veteran's radiculopathy of the right sciatic nerve is manifest by no more than moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for service connection for residual scar of the left side of face are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial rating in excess of 20 percent for lumbar disc herniation with spondylosis are not met prior to October 19, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 3. The criteria for a rating in excess of 40 percent for lumbar disc herniation with spondylosis are not met from October 19, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 4. The criteria for an initial 20 percent rating for residual burn scars of the left upper arm and shoulder are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. 5. The criteria for an initial rating in excess of 10 percent for radiculopathy of the left sciatic nerve are not met prior to March 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 6. The criteria for a 20 percent rating for radiculopathy of the left sciatic nerve are met from March 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 7. The criteria for an initial rating in excess of 10 percent for radiculopathy of the right sciatic nerve are not met prior to March 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 8. The criteria for a 20 percent rating for radiculopathy of the right sciatic nerve are met from March 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from August 1970 to August 1976. He testified before the undersigned Veterans Law Judge during an October 2021 hearing. This matter is on appeal from a December 2017 rating decision. Service connection for radiculopathy of the sciatic nerves of the bilateral lower extremities as secondary to the service-connected lumbar spine disability was granted in an October 2020 rating decision. Since the Veteran is seeking the highest rating available for his lumbar spine, and as bilateral lower extremity radiculopathy disorders are manifestations of that disability, the Board of Veterans' Appeals (Board) concludes that the ratings assigned to the bilateral lower extremities are before it on appeal. Additional evidence has been added to the claims file; the Veteran waived agency of original jurisdiction (AOJ) review of additional evidence during his October 2021 hearing. 38 C.F.R. §§ 19.37, 20.1304(c). Service Connection 1. Entitlement to service connection for residual scar of the left side of face The Veteran contends that he has a residual scar of the left side of his face after he was injured by an ammunition explosion during service. October 2021 Hearing Transcript at 5. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a residual scar of the left side of his face, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The November 2017 VA examiner evaluated the Veteran and determined that, while he had an in-service injury, he did not have a diagnosis of a residual scar of the left side of the face. The examiner opined that there was no objective evidence to support his claim, and no diagnosis was warranted. Notably, the same examiner diagnosed the Veteran with his burn scars of the left upper arm and shoulder, and provided a positive medical opinion relating those to service. Further, despite treatment from October 2018 to February 2022, VA treatment records do not contain a diagnosis of a left facial scar disability. In relying on the 2017 examination to deny this claim, the Board acknowledges the Veteran's representative's June 2021 correspondence concerning the adequacy of VA examinations. The Board finds that the November 2017 examination is adequate. The examination report reflects that physical examination was performed, and the Veteran's contentions regarding the in-service injury were considered. Moreover, neither the Veteran, nor his representative, have asserted that this particular examination was inadequate. Additionally, in finding no current disability, the Board acknowledges the Veteran's testimony regarding a scar. The Veteran testified that his reported scar is "not so bad" and "was down the left side of my face" (emphasis added). A physical examination in 2017 did not detect a facial scar despite scars being diagnosed on other parts of the body from the same in-service explosion injury. Moreover, the Veteran's testimony using the past tense suggests that any left facial scar that might have existed in service is no longer there. While the Veteran believes that he has a diagnosis of a residual scar of the left side of the face, the Board reiterates that an objective physical examination during this appeal failed to show any scarring of the left side of the face. Moreover, there is insufficient lay or medical evidence to suggest that any facial skin symptoms reach the level of functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In the absence of proof of a disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, the Board gives more probative weight to the competent medical evidence failing to show a diagnosis of residual scar of the left side of the face, and the appeal must be denied. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. In making the below determinations, the Board notes that 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 (2017). Moreover, as the Veteran has not specifically contended, nor does the evidence show that these disabilities render him unemployable, the issue of entitlement to a total disability rating based on individual unemployability (TDIU) has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). In finding that TDIU has not been raised by the record, the Board acknowledges the representative's June 2021 correspondence that generally discusses, without outrightly claiming, TDIU arising in connection with a claim pending before VA. However, the Veteran's contentions throughout this appeal, including his October 2021 hearing testimony, do not indicate that he has reported specifically being unemployable due to his lumbar spine, bilateral radiculopathy, burn scars, and left hip disabilities. Consequently, the Board reiterates that entitlement to TDIU, as part and parcel of the increased rating claims in this appeal, has not been raised by the record. Additionally, for all claims adjudicated below, the Board finds that the VA examinations and any accompanying opinions provided to the Veteran during this appeal are adequate for rating purposes as they are predicated on interviews with the Veteran; reviews of the record; and physical examinations. Again, the Board acknowledges the representative's June 2021 correspondence regarding the adequacy of examinations. As addressed in more detail below, the November 2017, October 2020, and March 2021 examinations for the lumbar spine reflect consideration of DeLuca factors. The examination reports also address the functional impacts of the lumbar spine disability, as well as the Veteran's current symptoms, showing that they are reflective of his ordinary, everyday life. The October 2020 and March 2022 examinations discussing the Veteran's radiculopathy also show that they are reflective of his ordinary, everyday life. Regarding the Veteran's burn scars, the November 2017 examination likewise addresses the functional impact of that disability, showing that it is reflective of his ordinary, everyday life. The examination report also reflects that a physical examination was performed, and the Veteran's statements regarding his disability were considered. Moreover, the June 2021 correspondence concerning the adequacy of examinations does not specifically address the examinations provided to the Veteran during this appeal. Rather, this correspondence makes argument in general as to any examination provided by VA, and does not raise why, in particular, the examinations afforded to the Veteran during this appeal are not adequate. Consequently, the Board reiterates that the examinations provided to the Veteran in adjudicating the decisions below are adequate for rating purposes. 2. Entitlement to an initial rating in excess of 20 percent for lumbar disc herniation with spondylosis prior to October 19, 2020 The Veteran contends that he is entitled to a higher rating because of the severity of his flare-ups. October 2021 Hearing Transcript at 3-4. The Veteran's lumbar spine disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for the lumbar spine disability prior to October 19, 2020. The Board acknowledges the Veteran's lay reports of symptoms, including functional impact of difficulty and pain with bending, and with prolonged sitting, standing, and walking. However, even considering the Veteran's lay reports of symptoms, the degree of additional limitation reflected by the statements that he experienced flare-ups three to four times a month that were moderate in severity and lasted for three to four days, 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 Veteran was provided a VA examination in November 2017. He had forward flexion to 55 degrees, unchanged by repetition. No pain or other functional loss was noted on examination. The examiner reported that they could not opine as to loss of range of motion with repeated use over time and during flare-ups without resorting to mere speculation because there was no conceptual or empirical basis for making such a determination without directly observing function under those conditions. The Board finds that this opinion is adequate, as the examiner's rationale of the lack of a conceptual or empirical basis for rendering such opinion is sufficient explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board acknowledges the assertion that the Veteran's symptoms during a flare-up are like ankylosis, and that he is unable to move about once a week due to flare-ups. However, even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate fixation of a spinal segment in neutral position (zero degrees). The 2017 examination showed no functional loss, and the Veteran reported that his flare-ups were only moderate in severity. The Veteran also reported to the examiner that he did not have any current treatment for his back, and that previous treatment was over the counter pain medication, which he had to stop taking for other medical reasons. In light of his report to the examiner that his flare-ups were moderate in severity, and considering that no treatment was needed, the Board is unable to conclude that the Veteran has symptoms approximating ankylosis warranting a higher rating. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The 2017 examination specifically shows that the Veteran did not have IVDS. Regarding neurological impairment, service connection for radiculopathy of the bilateral sciatic nerves was granted effective March 19, 2020. The Veteran currently has a separate claim pending in the modernized review system, also known as the Appeals Modernization Act (AMA), for earlier effective dates for the grants of service connection for radiculopathy of the bilateral sciatic nerves. The Veteran has not asserted having other neurological abnormalities during this period. In light of the earlier effective date claim, and as the Veteran does not contend having other neurological abnormalities, the Board will not address neurological impairment for this period. Based on the foregoing, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for his lumbar spine disability prior to October 19, 2020. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). 3. Entitlement to a rating in excess of 40 percent for lumbar disc herniation with spondylosis from October 19, 2020 The Veteran contends that he is entitled to a higher rating because of the severity of his flare-ups. October 2021 Hearing Transcript at 3-4. The Veteran's lumbar spine disability continues to be rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. The General Rating Formula for Diseases and Injuries of the Spine was discussed above, and will not be repeated. The Board finds that the evidence of record persuasively weighs against a rating in excess of 40 percent for the lumbar spine disability from October 19, 2020. The Board acknowledges the Veteran's lay reports of symptoms, including limited standing and walking for long periods, stiffness, and difficulty with heaving lifting and bending, and that there was functional loss due to pain and lack of endurance. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he experienced severe flare-ups two to three times a week that lasted all day would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. The Veteran was provided VA examinations in October 2020 and March 2022. The Veteran had forward flexion to 35 degrees before and after repetition at the 2020 examination. The examiner opined that with repeated use over time, forward flexion would be limited to 30 degrees. No flare-ups were reported at that examination. The 2022 examination shows forward flexion to 60 degrees before repetition and 55 degrees after repetition. The examiner opined that forward flexion would be limited to 50 degrees with repeated use over time, and to 45 degrees during flare-ups. The Board acknowledges the assertion that the Veteran's symptoms during a flare-up are like unfavorable ankylosis. However, even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate the entire spine fixed in flexion or extension and one of the additional symptoms set forth in Note 5. Even with flare-ups, the 2022 examiner opined that forward flexion would be to 45 degrees, warranting only a 20 percent rating. Neither of the examinations shows any of the symptoms set forth in Note 5 of 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 dysaphia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine at Note 5. The Veteran's own testimony does not show such symptomatology. Consequently, the Board is unable to conclude that the Veteran's symptoms during a flare-up warrant a rating in excess of 40 percent. Consideration has also been given to assigning a rating under the Formula for Rating IVDS Based on Incapacitating Episodes. However, both examinations show that the Veteran does not have IVDS. There is also no evidence of traumatic paralysis (the recently enacted Diagnostic Code 5244). Regarding neurological impairment, the Veteran has been granted service connection for radiculopathy of the bilateral sciatic nerves, which is discussed below. The lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. For the foregoing reasons, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 40 percent for the lumbar spine disability from October 19, 2020. As the evidence of record persuasively weighs against a rating in excess of 40 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). 4. Entitlement to an initial compensable rating for residual burn scars of the left upper arm and shoulder The Veteran contends that he is entitled to a higher rating because the scars itch and are occasionally painful. October 2021 Hearing Transcript at 5. The Veteran's residual burn scars are rated under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Codes 7804 and 7805 were not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate Diagnostic Code. The Board finds that the evidence of record persuasively weighs against the assignment of a compensable rating for the Veteran's burn scars under Diagnostic Code 7805 as there are no other disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04. The Veteran was provided a VA examination in October 2017, which showed that his scars were asymptomatic. However, when affording the Veteran the benefit-of-the-doubt, the Board concludes that an initial 20 percent rating is warranted under Diagnostic Code 7804. Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. The Veteran testified that his scars are occasionally painful. October 2021 Hearing Transcript at 5. The 2017 VA examination shows that he has three scars on his left upper arm/shoulder. Consequently, due to the Veteran's testimony of pain, as he has three burn scars on the left upper extremity, a 20 percent rating, but no higher, is warranted under Diagnostic Code 7804. In finding that a rating even higher than 20 percent is not warranted, the Board has considered the other Diagnostic Codes for scars. The 2017 examination shows that his burn scars are not of the head, face, or neck, are not deep and nonlinear, and are not associated with underlying soft tissue damage. Although they are superficial and not associated with underlying soft tissue damage, they do not cover an area or areas of 144 square inches or greater. Therefore, Diagnostic Codes 7800, 7801, and 7802, both prior to and from August 13, 2018, are inapplicable. In conclusion, the Board finds that the evidence of record persuasively weighs in favor an initial 20 percent rating, but no higher, for the Veteran's residual burn scars of the left upper arm and shoulder. The appeal is granted to that extent. 5. Entitlement to initial ratings in excess of 10 percent for radiculopathy of the left and right sciatic nerves prior to March 10, 2022 The Veteran contends that he is entitled to higher ratings. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). Regarding impairment of motor functions, the October 2020 VA examination shows motor strength of 5/5 throughout the bilateral lower extremities, except for hip flexion of the left lower extremity of 4/5. Regarding trophic changes, none were shown at the 2020 examination. Regarding sensory disturbance, the 2020 examination shows normal sensation to light touch bilaterally. The Veteran did not have paresthesias and/or dysesthesias, or numbness bilaterally. Regarding loss of reflexes, the 2020 examination showed normal reflexes of 2+ bilaterally except for left knee hypoactive reflexes of 1+. Regarding pain, the 2020 examination shows mild intermittent pain bilaterally, and no constant pain. Regarding muscle atrophy, none was shown at the 2020 examination. Regarding complete paralysis, the 2020 examination did not show that either foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Based on the above, the Board finds that the left lower extremity disability is primarily manifested by impairment of motor functions, sensory disturbance, loss of reflexes, and pain. The right lower extremity disability is primarily manifested by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the left lower extremity disability is manifest by trophic changes, muscle atrophy, or complete paralysis. The most probative evidence of record is against finding that the right lower extremity disability is manifest by impairment of motor functions, loss of reflexes, trophic changes, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment for both lower extremities is most analogous to mild incomplete paralysis. The 2020 examiner also opined that the Veteran's bilateral lower extremity disabilities are mild in severity. No functional impact of the lower extremity disabilities was reported at this examination. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claims for initial ratings in excess of 10 percent for the bilateral lower extremity disabilities prior to March 10, 2022. As the evidence of record persuasively weighs against initial ratings in excess of 10 percent prior to March 10, 2022, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b). 6. Entitlement to ratings in excess of 20 percent for radiculopathy of the left and right sciatic nerves from March 10, 2022 The Veteran contends that he is entitled to higher ratings. The criteria for 38 C.F.R. § 4.124a, Diagnostic Code 8520 were discussed above and will not be repeated. Regarding impairment of motor functions, a March 2022 VA examination shows muscle strength of 5/5 bilaterally. Regarding trophic changes, none were shown at the 2022 examination. Regarding sensory disturbance, the 2022 examination shows decreased sensation to light touch throughout the bilateral lower extremities. The Veteran had moderate paresthesias and/or dysesthesias and moderate numbness bilaterally. Regarding loss of reflexes, the 2022 examination shows normal reflexes of 2+ bilaterally. Regarding pain, the 2022 examination shows no constant pain, but moderate intermittent pain. Regarding muscle atrophy, none was shown at the 2022 examination. Regarding complete paralysis, the 2022 examination does not show that either foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. Based on the above, the Board finds that the disabilities are primarily manifest by sensory disturbance and pain. The Board also finds that the most probative evidence of record is against a finding that the disabilities are manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, and complete paralysis. Considering that the Veteran had moderate intermittent pain and moderate sensory disturbance, when affording him the benefit of the doubt, the Board concludes that 20 percent ratings for moderate incomplete paralysis of the left and right lower extremities from March 10, 2022, the date of the examination showing such symptoms, is warranted. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the evidence of record persuasively weighs in favor of 20 percent ratings, but no higher, from March 10, 2022, for the Veteran's bilateral lower extremity disabilities. To this extent, the appeal is granted. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for painful motion of the left hip is remanded. 2. Entitlement to an initial compensable rating for limitation of flexion, left hip is remanded. 3. Entitlement to an initial compensable rating for limitation of abduction/adduction, left hip is remanded. During the October 2021 hearing, the Veteran asserted that, contrary to an October 2020 hip VA examination showing no flare-ups, he experienced at least weekly flare-ups of his left hip disabilities. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his left hip disabilities. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected painful motion of the left hip, limitation of flexion of the left hip, and limitation of abduction/adduction of the left hip. The most up-to-date Disability Benefits Questionnaire should be utilized. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.