Citation Nr: 22018162 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 18-04 704 DATE: March 28, 2022 ORDER A rating in excess of 20 percent for gastritis is denied. Prior to December 11, 2019, a rating of 30 percent, but no more, for an acquired psychiatric disorder, diagnosed as insomnia (insomnia), is granted. From December 11, 2019 to May 27, 2021, a rating of 70 for insomnia is granted. From May 27, 2021, a rating in excess of 70 percent for insomnia is denied Entitlement to a rating in excess of 20 percent for a low back disability, diagnosed as lumbosacral strain with degenerative arthritis (a low back disability) is denied. Entitlement to a rating in excess of 10 percent for left leg radiculopathy is denied. Entitlement to a rating in excess of 10 percent for right leg radiculopathy is denied. FINDINGS OF FACT 1. During the period on appeal, the evidence of record does not demonstrate weight loss or anemia. 2. Prior to December 11, 2019, the Veteran's insomnia is manifested by no more than occasional decrease in work efficiency; reduced reliability and productivity is not shown. 3. From December 11, 2019, the Veteran's insomnia is manifested by no worse than deficiencies in most areas; total impairment is not shown. 4. During the period on appeal, the Veteran's low back disability pain and limitation of forward flexion of the thoracolumbar spine to greater than 30 degrees but not greater than 60 degrees; limitation of motion to 30 degrees or less, and incapacitating episodes due to IVDS were not shown. 5. During the period on appeal, the Veteran's lower extremity radiculopathy produced no worse than mild symptoms. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for gastritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.27, 4.114, Diagnostic Code 7304. 2. Prior to December 11, 2019, the criteria for a rating of 30 percent, but no more, for insomnia have been met. 38 U.S.C. §§ 1110, 1155; 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.126, 4.130, Diagnostic Code 9434. 3. From December 11, 2019 to May 27, 2021, the criteria for a rating of 70 percent, but no more, for insomnia have been met. 38 U.S.C. §§ 1110, 1155; 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.126, 4.130, Diagnostic Code 9434. 4. From May 27, 2021, the criteria for a rating in excess of 70 percent for insomnia have not been met. 38 U.S.C. §§ 1110, 1155; 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.126, 4.130, Diagnostic Code 9434. 5. Entitlement to a rating in excess of 20 percent for a low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242. 6. The criteria for a rating in excess of 10 percent for right leg radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 7. The criteria for a rating in excess of 10 percent for left leg radiculopathy have not been met. 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 served on active duty from September 1983 to April 1995. Increased Rating The Veteran is in receipt of a 20 percent rating for gastritis under DC 7304, an initial rating of 10 percent prior to May 27, 2021, and 70 percent from that date for insomnia under DC 9434, and an initial rating of 20 percent for a low back disability. However, the new claim was not filed until November 2014, at which time each appeal period begins. The Veteran asserts that his symptoms are severe enough to merit increased ratings for each of these service-connected disabilities. Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of staged ratings are required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Further, "[w]here 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." 38 C.F.R. § 4.7. 1. Entitlement to an increased rating for gastritis Under Diagnostic Code 7304, a 10 percent rating is assigned for mild gastric ulcers with symptoms recurring once or twice a year. Moderate symptoms with episodes of severe symptoms, recurring two or three times a year, and averaging 10 days in duration; or with continuous moderate manifestations are assigned a 20 percent rating. A 40 percent rating is given when ulcers result in moderately severe disability with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging about 10 days or more in duration at least four or more times a year. Finally, a schedular maximum 60 percent evaluation is warranted for severe ulcers with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis, or melena, with manifestations of anemia and weight loss productive of definite impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7304. In this case, the Veteran is in receipt of a 20 percent rating due to continuous moderate manifestations. However, a rating in excess of 20 percent is not warranted. During the appeal period, the Veteran's gastritis does not show manifestations of anemia or weight loss. Furthermore, episodes of gastritis did not approach 10 days or more in duration. Indeed, his December 2014 VA examiner noted dysphagia, pyrosis, reflux, and regurgitation. While the report shows continuous abdominal pain, 4 or more yearly episodes of recurrent nausea (4 or more/year, 1-9 days), transient vomiting, (4 or more/year, less than 1 day) and periodic melena, these symptoms were reported to last no more than 9 days. In fact, the episodes of transient vomiting lasted less than one day. Moreover, he denied vomiting, hematemesis, or melena during this time. Anemia is not shown during the period on appeal, as the Veteran's MCV levels both before the appeal period and in records dated December 2020, and August 2021, are within normal limits. The Veteran's weight was consistent throughout the period on appeal, and he specifically denied weight loss and showed constant weight in records dated April 2010, September 2013, August 2014, August 2015, March 2016, and March 2017. In a February 2020 statement and hearing testimony, the Veteran complained of severe daily abdominal pain, burning, bloating, belching, diarrhea, and a gnawing sensation, resulting in fatigue and lack of concentration/focus. At his May 2021 C&P examination, the Veteran reported epigastric pain, bloating, and gas. This examination demonstrates recurrent episodes of both severe and non-severe symptoms lasted ten days or more. He also reported continuous abdominal pain, only partially relieved by standard ulcer therapy. Nausea, vomiting, and melena were present. Nonetheless, the Veteran specifically denied weight loss at this examination, as well as at the subsequent July 2021 GI consult. Because anemia and weight loss have not been shown at any time during the period on appeal, a rating of 40 percent is not for application. The Veteran's symptoms are addressed by his current 20 percent rating. 2. Entitlement to an increased rating for insomnia Prior to May 27, 2021, the Veteran is in receipt of a 10 percent rating for an acquired psychiatric disorder, rated under DC 9434. He asserts that his symptoms are severe enough to merit an increased rating for this disability. The Board finds that the Veteran is entitled to a higher 70 percent rating, but only from December 11, 2019, the earliest date these symptoms are shown. The Veteran's insomnia is rated under 38 C.F.R. § 4.130, Diagnostic Code 9434, which provides the general rating formula for mental disorders. Under the applicable diagnostic criteria, a 30 percent rating is granted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran's personal appearance and hygiene; difficulty in adapting to stressful circumstances (including in work or work like settings); inability to establish and maintain effective relationships. Id. Prior to December 11, 2019 For the period prior to December 11, 2019, a rating of 30 percent, but no higher, is warranted, as the record does not indicate that the Veteran's symptoms reflect occupational and social impairment with reduced reliability and productivity First, throughout the period on appeal, the Veteran was alert, fully oriented, of pleasant demeanor, and cooperative. His speech was coherent and clear, with normal rate and tone, according to several medical providers. Examiners noted full and intact cognition. The Veteran's January 2015 VA examiner observed him as friendly, cooperative, and interactive, with articulate and spontaneous speech, and clear thought process. There were no signs of mania, psychosis, or other absence of clarity of thought, and the evidence indicates the Veteran's ability to maintain a basic level of hygiene. Despite occasionally using Nyquil as a sleep aid in place of his trazodone, a September 2013 consult report and his May 2021 C&P examiner maintain that the Veteran denied recreational drug use during this period, and his alcohol use remained within normal limits. While the Veteran undoubtedly suffers from significant disturbances of mood, these disturbances warrant a finding of, at most, occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Specifically, because of insomnia, the Veteran struggles with irritability and sudden anger. For example, a September 2013 record indicates irritability and quick anger due to lack of sleep, compounded by guilt for his flashes of anger, especially when directed to his family. To that end, the Veteran reported to his January 2015 examiner a mild startle response, a shorter temper, and diminished attention span, caused by insufficient sleep and nightmares once to twice a week. Especially given his natural self-calming ability during this period, the Board finds that these symptoms reflect no more severe symptoms than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. While the Veteran exhibited sleep impairment throughout this period, such symptoms are contemplated by a 30 percent rating under DC 9434. Likewise, the Veteran's cognitive state during the period on appeal does not warrant an increased rating, as the Veteran's impairment generally stems from his mood symptoms, rather than a cognitive deficiency. The medical evidence of record does not reflect that the Veteran's long and short-term memory or his judgment were significantly impaired during the appeal period. Finally, through the period on appeal, the Veteran has not generally had delusions or hallucinations, or suicidal or homicidal ideations. Thus, the Veteran's general cognitive state most resembles his current 30 percent rating. Based on the symptoms clinically observed, the Veteran has experienced some of the relevant symptoms that might support a rating in excess of 30 percent. For example, he has exhibited disturbances of mood and motivation and sleep disturbances. In the Board's view, this assertion lacks sufficient specificity to warrant an increased rating. The criteria for the next-higher 50 percent rating depict a level of impairment, when viewed as a whole, that is more severe than the symptoms displayed by the Veteran. Thus, the Board is unable to assign a rating higher than 30 percent. Next, although the general rating formula provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should not be limited to only these symptoms, but should also consider any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such, the Board has also considered the extent to which there are other indications of total occupational and social impairment, to include social and occupational inadaptability. In this regard, it is clear that the Veteran's service connected insomnia impacts his social and occupational functioning. Nevertheless, the evidence does not indicate that a rating in excess of 30 percent is warranted. The Veteran's social functioning seems to be, at worst, commensurate with his current rating. The Veteran reports verbal outbursts directed toward his wife and children, which he sought help controlling. The Veteran's anger has affected his familial and social relationships, as well as the Veteran's work with students. He seeks control, and would typically walk away from situations where he does not have it. The Board finds that the disruption to his life is, at worst intermittent, and does not reflect occupational or social impairment with reduced reliability or productivity. From December 11, 2019 The Veteran is in receipt of a 70 percent rating, reflecting occupational and social impairment with deficiencies in most areas, effective May 27, 2021, the date of his most recent C&P examination. However, in a December 2019 questionnaire, the Veteran reported symptoms of increased severity. The Board finds that a 70 percent rating is warranted from December 22, 2019, the date the evidence shows entitlement to a higher rating. However, a rating of 100 percent for insomnia is not warranted for any period. In a December 2019 questionnaire, the Veteran continues to relate flashes of anger and panic attacks, but also adds that he cries very easily. This report indicates anhedonia and apathy, agoraphobia, claustrophobia, and very frequent panic attacks. In fact, the Veteran reported more than ten panic spells in the previous month. His answers reflect that nearly every day in the previous two weeks, he felt nervous, anxious or on edge; unable to stop worrying; trouble relaxing; easily annoyed or irritable. more than half days, difficulty sitting still; and afraid something awful might happen. This set of symptoms fits into the example of "near continuous panic" portrayed in the 70 percent criteria. The questionnaire reflects that in the previous two weeks it had been very difficult but not impossible, to work, take care of things at home, and get along with others. Some history of audio and visual hallucinations was reported as well. For several days in the previous two weeks, the Veteran felt little interest or pleasure in doing things, feeling down depressed hopeless, appetite variance, a feeling he has let family down, trouble concentrating, and thoughts about being better off dead. Nearly every day, the Veteran had sleeping difficulty. These symptoms made work, home, and getting along with others somewhat difficult. In this survey, the Veteran reported constant anxiety, suicidal thoughts, constant panic attacks, ringing in the ears, severe insomnia, significant memory deficiency, increased anger, serious paranoia, circumlocutory speech, impaired judgment, and abstract thinking. Lay statements indicate that these symptoms affect him constantly, and he has no control over them. The Board notes indications of suicidal thoughts and possible audio and visual hallucinations per February 2020 lay statements. Despite the importance of closely monitoring these symptoms, they have not led to the type of symptoms that would trigger a 100 percent rating. Similarly, the Veteran's possible indication of audio visual hallucinations at certain times does not, in the Board's view, trigger a finding of total impairment. While the Veteran stated these symptoms made his occupational and social functioning "somewhat difficult," the Board finds that they reflect no worse than deficiencies in most areas. During this period, the Veteran reports sleeping difficulty nearly every day. Such sleeping difficulty continued through this period, according to February 2020 statement and hearing testimony. Moreover, the Veteran contemplated suicide several times. The Veteran's May 2021 VA examination report further demonstrates how the Veteran's insomnia compounded his poor focus and concentration, as well as his confidence and anxiety. Due to insomnia, the Veteran was depressed, emotional, and tearful. He reported lashing out, with panic attacks about once a week. Even with medication, the Veteran achieved only about 5 hours of sleep, and his constant waking disturbed not only himself but his wife, who has not slept in his bed for three years. The Veteran attributes the emotional effects of lack of sleep to outbursts at work. While these symptoms seem worse than those experienced prior to December 22, 2019, they do not warrant a rating in excess of 70 percent. The Veteran's depression, impaired concentration, and sleep impairment are all addressed in the Veteran's current rating. Furthermore, his cognition, impulse-control and judgment were observed to be intact. There was no obvious thought process, content, or communication impairment observed during the assessment. Based on the symptoms clinically observed, the Veteran has experienced some of the relevant symptoms that might support a rating in excess of 70 percent. For example, he has mentioned near-continuous panic and hyper startle reflex. In the Board's view, this assertion lacks sufficient specificity to warrant an increased rating. The criteria for the next-higher 100 percent rating depict a level of impairment, when viewed as a whole, that is more severe than the symptoms displayed by the Veteran. Indeed, the evidence does not show that any hallucinations are persistent, that he is in any danger of hurting others, let alone persistent danger, or that his symptoms have led to persistent disorientation or memory loss. While these symptoms are only examples, and not dispositive of a finding of total impairment, the Board is unable to assign a rating higher than 70 percent. The evidence of impact on the Veteran's social and occupational functioning does not indicate that a rating in excess of 70 percent is warranted. The Veteran's social functioning seems to be, at worst, commensurate with his current rating. Despite his insomnia and the attendant occupational and social difficulties, the Veteran reported being married for about 16 years, with two children. The Veteran reported that he does not socialize with anybody outside of his family, and that his relationship with his children and wife is affected by his insomnia and anger, to the point where they are afraid of his emotional reactions and threatening to leave him. The Veteran describes eventually becoming paranoid, agitated, and moody, his fuse triggered by most stimuli. Occupationally, a February 2020 buddy statement recounts the Veteran becoming involved in altercations with peers and at least ten students at work. Indeed, the Veteran, a shop teacher, told his May 2021 VA examiner that he stopped teaching in December 2020, citing his insomnia, explosive irritability and anger, some unspecified AV hallucinations and flashbacks, nightmares, and inability to focus. He took an administrative position; while he initially reported still having difficulty with stress, despite receiving fewer responsibilities and being paid 75 percent of his previous salary by June 2021, the Veteran denied problems with focus. While the Veteran is paid 75 percent of his previous salary for part-time work, there is no indication that this is protected employment. The Board thus finds that the Veteran's social and occupational deficiencies are compensated by his current rating for insomnia. In other words, the Veteran has not exhibited total impairment during the period on appeal. As such, his symptoms do not merit a rating in excess of 70 percent. 3. Entitlement to a rating in excess of 20 percent for a low back disability, diagnosed as lumbosacral strain with degenerative arthritis (a low back disability) The Veteran claimed a worsening in his back pain in a new November 2014 claim and timely February 2016 NOD. 38 C.F.R. § 4.71a , DC 5242 applies a general rating that is applicable for most spine disabilities. Under this rating formula, a 20 percent rating is warranted when the evidence shows: Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; Combined range of motion of the thoracolumbar spine not greater than 120 degrees; Muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis; or Intervertebral disc syndrome with incapacitating episodes having a total duration of at least two weeks, but less than four weeks, during the past 12 months. A 40 percent rating is warranted when the evidence shows: Forward flexion of the thoracolumbar spine to 30 degrees or less; or Favorable ankylosis of the entire thoracolumbar spine; or Intervertebral disc syndrome with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Id. A 50 percent rating is warranted when the evidence shows unfavorable ankylosis of the entire thoracolumbar spine. Id. Ankylosis is the "immobility and consolidation of a joint due to disease, injury, or surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). The term "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. 38 C.F.R. § 4.71a , DC 5243, Note 2. Additionally, an "incapacitating episode" is "a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician." 38 C.F.R. § 4.71a , DCs 5237, 5243, Note 1. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. 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). 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. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 38 C.F.R. § 4.71a. 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, to the extent the diagnostic codes applicable in this appeal were affected by the amendments to 38 C.F.R. § 4.71a , the Board has considered the rating criteria prior to February 7, 2021 and the new rating criteria from February 7, 2021.From that date, the Veteran does not meet the specific ranges of motion required for a 20 percent rating under the new criteria. As such, only the prior criteria are applied. Based on the evidence of record, a rating in excess of 20 percent is not warranted. Specifically, in an August 2014 PM&R record, the Veteran complained of sharp, radicular, burning pain, rated 7/10. At his November 2014 C&P examination, the Veteran reported once or twice weekly flare-ups lasting about 2 and a half hours after awakening. The Veteran demonstrated forward flexion of 90 degrees, which was not limited by pain until repetitive use testing, after which it was only limited to 85 degrees. These symptoms suffice to entitle the Veteran to a 20 percent rating based on limited range of motion. To be awarded the next highest 40 percent rating for thoracolumbar range of motion, these flare-ups would have to limit the Veteran's range of motion to 30 degrees forward flexion, 30 degrees farther than his initially measured limitation of motion. The Board finds it unlikely that the Veteran's twice-a-week flare-ups would limit his motion some 55 degrees required for the next higher rating. Moreover, the Veteran endorsed full muscle strength, no atrophy, normal reflexes (except for hypoactive reflexes in both knees and the left ankle, absent reflexes in the right ankle, and decreased sensation in the left ankle to light touch), and no ankylosis. Based on the Veteran's observable range of motion and his statements, the Board finds it unlikely that flare-ups limited the Veteran's range of motion, such that the next higher rating is for contemplation. In a February 2016 NOD, the Veteran mentioned increased back pain along with numbness and weakness in the legs. At his February 2020 VA examination, the Veteran demonstrated chronic low back pain with acute flare-ups, severe pain and numbness going into the legs. While the Veteran's forward flexion was limited to 30 degrees, the bare threshold for a higher 40 percent rating, the Board finds that this measurement was a temporary outlier, and not indicative of the Veteran's general range of motion during the period on appeal. Indeed, at the veteran's May 2021 C&P examination, the Veteran's forward flexion was again closer to normal, measured at 80 degrees, with pain noted on weight bearing, active and passive motion, and moderate-severe tenderness/pain on palpation of the low back. Pain and lack of endurance in repetitive use testing limited forward flexion to 75 degrees. As for repeated use over time, the examiner, based on a review of the medical record, the Veteran's lay statements, and her medical expertise, estimated limitation of forward flexion to 65 degrees. Similarly, pain and lack of endurance on severe flare-ups, occurring 1-3 times per week and lasting 4-6 hours, limited the Veteran's forward flexion to an estimated 55 degrees well in excess of the 30 degrees required for the next-higher 40 percent rating. Even in cases of flare-ups, the statements and medical evidence surrounding the Veteran's range of motion measurements do not indicate that his forward flexion approached 30 degrees during the period on appeal. Accordingly, a rating in excess of 20 percent is not for application. Neurological Impairment When evaluating the extent of a Veteran's spine disability, the Board is required to consider whether a separate evaluation is warranted for any associated neurological abnormality including, but not limited to, bowel or bladder impairment, neurological impairment in the extremities or other such disorders, which are to be evaluated under the appropriate diagnostic code. See 38 C.F.R. § 4.71 (a), Note 1. 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 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). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. The Veteran is presently in receipt of a 10 percent disability rating for neurological symptoms in each leg, from November 11, 2010. However, the new claim was not filed until November 2014, at which time the appeal period begins. In this case, Board finds that a rating in excess of 10 percent for either leg is not warranted. At the beginning of the appeal period, in an August 2014 note, the Veteran complained of sharp, severe pain down the right side, radiating into the testicles, worsened by bending or sitting. He reported similar symptoms at his November 2014 C&P examination. While moderate, constant pain was noted in both lower extremities, the examiner rated the radiculopathy, on the whole, as mild. In his February 2016 NOD, the Veteran complained of pain, numbness, and weakness in the legs. At his February 2020 VA examination, the Veteran complained of severe pain and numbness into the legs. The examination report notes moderate radiculopathy, characterized by moderate, intermittent, dull pain, and mild numbness and paresthesias and/or dysesthesias. Next, the Veteran's May 2021 VA examiner demonstrated unaffected muscle strength, hypoactive reflexes in both knees and the left ankle, and absent right ankle reflexes. The Veteran's sensation was decreased in the left lower leg and ankle. The examiner noted constant moderate pain. The Veteran's statements indicate that the functional impairment indicated above is related to mechanical back symptoms, rather than the above-described neurological symptoms. Further, the symptoms described at the beginning of the appeal period appear to have mitigated. Thus, the Board finds that the Veteran's symptoms warrant 10 percent ratings for mild symptoms. Because the Veteran's symptoms for this period do not rise to the level of "moderate," a 20 percent rating is not warranted. The Board has also considered whether the Veteran has any bowel or bladder complications. No neurological symptoms not discussed above, to include bladder or bowel dysfunction, were noted in the Veteran's medical treatment records. The Board acknowledges that the Veteran uses an assistive device due to his low back disability. However, 38 C.F.R. § 4.120 contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker." Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). The Board finds that the evidence does not warrant a rating in excess of 10 percent for right or left leg radiculopathy. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 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. Other Considerations In considering the appropriate disability rating, the Board has also considered the Veteran's statements that his disabilities are worse than the rating he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his acquired psychiatric disability according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). On the other hand, such competent evidence concerning the nature and extent of the Veteran's insomnia has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. Therefore, based on the evidence of record, the Board determines that a 70 percent rating is warranted for the Veteran's insomnia for this period. The Board also finds that consideration for an extraschedular evaluation, a component of a claim for an increased rating, is not warranted. Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). In considering whether an extraschedular rating may be warranted, VA must first determine whether the available applicable schedular rating criteria are inadequate because they do not contemplate the Veteran's level of disability and symptomatology. If the rating criteria are inadequate, VA must then determine whether the Veteran exhibits an exceptional disability picture indicated by other related factors such as marked interference with employment or frequent periods of hospitalization. If such related factors are exhibited, then referral must be made to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the evidence does not indicate that Veteran's disability picture could not be adequately contemplated by the applicable schedular rating criteria discussed above. See Mittleider v. West, 11 Vet. App. 181 (1998). Specifically, the schedular criteria for gastritis contemplate the Veteran's frequent need for restroom breaks, and his low tolerance for stress and working with the public. While the Veteran's duties shifted in December 2020 from teaching to administrative, and while his pay was reduced, the Veteran's rating adequately compensated for "deficiencies in most areas." Moreover, while a schedular rating for psychiatric disorders is not necessarily limited to the enumerated symptoms in the general rating formula, no relevant symptoms have been excluded in the Board's analysis. See Mauerhan, 16 Vet. App. at 444. As such, the Veteran's symptoms are not so unusual that they are outside the schedular criteria. Therefore, given that the applicable schedular rating criteria are more than adequate in this case, the Board need not consider whether the Veteran's disability picture includes exceptional factors, and referral for consideration of the assignment of a disability evaluation on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Lastly, while the Veteran's changed duties reflect fewer job duties, with 75 percent of his previous pay, the Board finds insufficient evidence to warrant investigation into whether his employment is in a "protected environment," as envisioned in 38 C.F.R. § 4.16(a)(5). Accordingly, TDIU is not currently for adjudication. For the foregoing reasons, a rating in excess of 20 percent prior to May 11, 2021 for gastritis is denied. A rating of 30 percent, but no more, for insomnia prior to December 11, 2019 is granted. A rating of 70 percent, but no more, is granted from December 11, 2019 to May 27, 2021. From that date, a rating in excess of 70 for insomnia is denied. Finally, entitlement to a rating in excess of 20 percent for a low back disability, diagnosed as lumbosacral strain with degenerative arthritis (a low back disability) is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Maskatia