Citation Nr: 22018330 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 15-02 801 DATE: March 28, 2022 ORDER From September 26, 2012, an increased 20 rating (but not higher) for a back condition is granted. From September 26, 2012, to August 18, 2014, an initial 10 percent rating (but not higher) for sciatic radiculopathy of the left lower extremity is granted. From August 19, 2014, to December 18, 2021, a rating in excess of 10 percent for sciatic radiculopathy of the left lower extremity is denied. From December 19, 2021, a rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity is denied. From September 26, 2012, to August 18, 2014, a rating in excess of 10 percent for femoral radiculopathy of the left lower extremity is denied. From August 19, 2014, to December 18, 2021, an increased 10 percent rating (but not higher) for femoral radiculopathy of the left lower extremity is granted From December 19, 2021, a rating in excess of 20 percent for femoral radiculopathy of the left lower extremity is denied. FINDINGS OF FACT 1. The probative evidence of record during the period on appeal, including multiple VA examinations, supports a finding that the Veteran's forward flexion of the thoracolumbar spine was limited to 60 degrees when factoring in painful motion. 2. From September 26, 2012, to August 18, 2014, the probative evidence of record, including a November 2012 VA examination, supports a finding that the Veteran had mild incomplete paralysis of the left sciatic nerve. 3. From August 19, 2014, to December 18, 2021, the probative evidence of record does not support a finding that the Veteran has more than mild paralysis of the left sciatic nerve. 4. From December 19, 2021, the probative evidence of record does not support a finding that the Veteran has more than moderate paralysis of the left sciatic nerve. 5. From September 26, 2012, to August 18, 2014, the probative evidence of record does not support a finding that the Veteran has more than mild paralysis of the left femoral nerve. 6. From August 19, 2014, to December 18, 2021, the probative evidence of record indicates that the Veteran displayed mild paralysis of the left femoral nerve. 7. From December 19, 2021, the Board finds that the probative evidence of record does not support a finding that the Veteran has more than moderate paralysis of the left femoral nerve. CONCLUSIONS OF LAW 1. From September 26, 2012, the criteria have been met for an initial 20 percent disability rating for a service-connected back condition. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic codes (DC) 5235-5243. 2. From September 26, 2012, to August 18, 2014, the criteria have been met for a disability rating of 10 percent for sciatic radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8520. 3. From August 19, 2014, to December 18, 2021, the criteria have not been met for a disability rating in excess of 10 percent for sciatic radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8520. 4. From December 19, 2021, the criteria have not been met for a disability rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8520. 5. From September 26, 2012, to August 18, 2014, the criteria have not been met for a disability rating in excess of 10 percent for femoral radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8526. 6. From August 19, 2014, to December 18, 2021, the criteria have been met for a disability rating of 10 percent for femoral radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8526. 7. From December 19, 2021, the criteria have not been met for a disability rating in excess of 20 percent for femoral radiculopathy of the left lower extremity. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.71a, 4.124a, DC 5242-5243, 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1988 to July 1990, January 2003 to January 2005, January 2008 to August 2008, and February 2009 to March 2010. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in December 2012, February 2014, and December 2014. These matters were before the Board in July 2018 and were remanded for further development. Increased Rating 1. From September 26, 2012, an increased 20 percent rating for a back disability is granted. Legal Criteria Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran's service-connected back and neck conditions are currently rated under DC 5235-5243. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, these diagnostic codes were not changed. 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. Id. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine limited to 30 degrees or less, or, for favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Any associated objective neurologic abnormalities are to be evaluated separately, under an appropriate diagnostic code. Id. at Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, normal extension is zero to 30 degrees, normal left and right lateral flexion is zero to 30 degrees, and normal left and right lateral rotation is zero to 30 degrees. Id. at Note (2). The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. Id. All measured ranges of motion are to be rounded to the nearest five degrees. Id. at Note (4). When assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must, in addition to applying schedular criteria, also consider evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-207 (1995). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar 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). Evaluations for IVDS are to be performed either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, Note 6. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent disability rating is assigned for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. 38 C.F.R. § 4.71a. A 20 percent disability rating is assigned for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. Id. A 40 percent disability rating is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Id. A 60 percent disability rating is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Id. Factual Background At a November 2012 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 90 degrees of forward flexion with painful motion beginning at 60 degrees, 0 to 30 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 30 degrees of left lateral bending, and 0 to 30 degrees of right lateral bending. The Veteran was able to perform three repetitions without any additional loss of range of motion. The Veteran reported flare-ups, but the examiner did not indicate whether the examination was being conducted during a flare-up. The physician indicated that the Veteran did not have IVDS of the thoracolumbar spine. At a February 2014 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 90 degrees of forward flexion, 0 to 30 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 30 degrees of left lateral bending, and 0 to 30 degrees of right lateral bending. The Veteran was able to perform three repetitions without any additional loss of range of motion. The Veteran reported flare-ups, but the examiner did not indicate whether the examination was being conducted during a flare-up. At an August 2014 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 90 degrees of forward flexion with objective evidence of pain at 60 degrees, 0 to 30 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 30 degrees of left lateral bending, and 0 to 30 degrees of right lateral bending. The Veteran was able to perform three repetitions without any additional loss of range of motion. The examiner indicated that the Veteran was not being examined during a flare-up or after repeated use over time and in the absence of further objective evidence, they were unable to determine additional functional loss without resorting to conjecture. The physician indicated that the Veteran did not have IVDS of the thoracolumbar spine. At an October 2016 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 75 degrees of forward flexion, 0 to 25 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 20 degrees of left lateral flexion, and 0 to 30 degrees of right lateral flexion. The Veteran was able to perform three repetitions without any additional loss of range of motion. The physician explained that the Veteran was not being examined during a flare-up or after repeated use over time and that they could not accurately determine limitation in range of motion without resorting to mere speculation. The physician indicated that the Veteran had IVDS of the thoracolumbar spine but that it did not cause any incapacitating episodes which required prescribed bedrest in the past 12 months. At a February 2020 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 75 degrees of forward flexion, 0 to 25 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 25 degrees of left lateral flexion, and 0 to 25 degrees of right lateral flexion. The Veteran was able to perform three repetitions without any additional loss of range of motion. There was no evidence of pain with weight-bearing. The physician explained that the Veteran was not being examined during a flare-up or after repeated use over time and that they had no basis to offer additional losses of lower back function or motion when it comes to repetitive use or during a flare-up. The physician indicated that the Veteran had IVDS of the thoracolumbar spine but that it did not cause any incapacitating episodes which required prescribed bedrest in the past 12 months. At a December 2021 VA examination, upon range of motion testing of the lumbar spine, the Veteran displayed 0 to 90 degrees of forward flexion, 0 to 30 degrees of extension, 0 to 30 degrees of left lateral rotation, 0 to 30 degrees of right lateral rotation, 0 to 30 degrees of left lateral flexion, and 0 to 30 degrees of right lateral flexion. Passive range of motion testing of the back was not performed because it was not feasible to do so in a safe manner. After performing three repetitions, forward flexion of the Veteran's back was limited to 80 degrees. There was no evidence of pain with weight-bearing. The Veteran was not being examined during a flare-up, but the physician estimated that pain, fatigability, and lack of endurance from a flare-up would limit the Veteran's forward flexion to 70 degrees, extension to 25 degrees, right lateral flexion to 25 degrees, left lateral flexion to 25 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 25 degrees. The Veteran was not being examined immediately after repeated use over time, but the physician estimated that pain and fatigability would limit the Veteran's forward flexion to 80 degrees. Analysis The Board finds that the probative evidence of record during the period on appeal supports a finding that the Veteran's forward flexion of the thoracolumbar spine was limited to 60 degrees when factoring in painful motion as evidenced by the November 2012 and August 2014 VA examinations. See DeLuca supra. Accordingly, the Veteran meets the criteria for an increased 20 percent rating for his back condition throughout the entire period on appeal. What remains for consideration is whether a still higher 40 percent rating is warranted for the Veteran's back condition. The Board finds that the probative evidence of record during the period on appeal does not support a finding that the Veteran's forward flexion of the thoracolumbar spine was limited to 30 degrees or less, even when factoring in the Veteran's flare-ups and repetitive use over time. Additionally, the evidence of record does not support a finding that the Veteran had ankylosis of the thoracolumbar spine. The Board also finds that the probative evidence of record indicates that the Veteran did not experience any incapacitating episodes due to his IVDS. As such, the Board finds a rating in excess of 20 percent for the Veteran's service-connected back condition is not warranted. 2. From September 26, 2012, to August 18, 2014, an initial 10 percent rating (but not higher) for sciatic radiculopathy of the left lower extremity is granted. Legal Criteria Sciatic radiculopathy is rated under DC 8520, for paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Under DC 8520, where paralysis is incomplete, a 10-percent rating is warranted where the severity is mild; a 20-percent rating is warranted where the severity is moderate; a 40-percent rating is warranted where the severity is moderately severe; and, a 60-percent rating is warranted where the severity is severe with marked muscular atrophy. An 80-percent rating, which is the highest rating available under these criteria, is warranted where paralysis is complete; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, DC 8520. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The words mild, moderate, and severe as used in the various DCs are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. 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. Factual Background At a November 2012 VA examination, the conducting physician indicated that the Veteran had mild numbness of the left lower extremity. The physician further indicated that the Veteran's sciatic nerve was the nerve root affected by radiculopathy. The physician indicated that the Veteran had mild radiculopathy of the left sciatic nerve. Sensory examination of the Veteran's lower extremities produced normal results. Straight leg raising test was negative. Reflex examination of the Veteran's lower extremities produced normal results. Muscle strength testing of the Veteran's lower extremities produced normal results. At a February 2014 VA examination, the conducting physician indicated that the Veteran had mild intermittent pain and numbness of the left lower extremity. Sensory examination of the Veteran's lower extremities indicated decreased sensation for lighting touch. The Veteran had a normal gait and no trophic changes. Straight leg raising test was negative. Reflex examination of the Veteran's lower extremities produced normal results. Muscle strength testing of the Veteran's lower extremities produced normal results. The physician indicated that the Veteran's left sciatic nerve was normal. Analysis At the outset, the Board notes that the Veteran's increased rating claim for sciatic radiculopathy stems from his increased rating claim for his back condition filed on September 26, 2012. The probative evidence of record, including a November 2012 VA examination, indicates that the Veteran had mild incomplete paralysis of the left sciatic nerve. Accordingly, the Board finds that from September 26, 2012, to August 18, 2014, an initial 10 percent rating (but not higher) for sciatic radiculopathy of the left lower extremity is granted. What remains for consideration is whether a still higher 20 percent rating is warranted for the Veteran's sciatic radiculopathy of the left lower extremity. The Board finds that the probative evidence of record is against a finding that the Veteran has more than mild paralysis of the left sciatic nerve and thus he does not meet the criteria for a 20 percent rating. 3. From August 19, 2014, to December 18, 2021, a rating in excess of 10 percent for sciatic radiculopathy of the left lower extremity is denied. Factual Background At an August 2014 VA examination, the conducting physician indicated that the Veteran had mild numbness of the left lower extremity. The physician further indicated that the Veteran's sciatic nerve was the nerve root affected by radiculopathy. The physician indicated that the Veteran had mild radiculopathy of the left sciatic nerve. Sensory examination of the Veteran's lower extremities indicated produced normal results. The Veteran had a normal gait and no trophic changes. Straight leg raising test was negative. Reflex examination of the Veteran's lower extremities produced normal results. Muscle strength testing of the Veteran's lower extremities produced normal results. At an October 2016 VA examination, the conducting physician indicated that the Veteran had moderate numbness and intermittent pain but no constant pain or paresthesias and/or dysesthesias of the left lower extremity. The physician further indicated that the Veteran's sciatic nerve was the nerve root affected by radiculopathy. The physician indicated that the Veteran had mild radiculopathy of the left sciatic nerve. The Veteran had decreased sensation to light touching of the lower leg/ankle. Straight leg raising test was negative. The Veteran had hypoactive deep tendon reflexes upon examination. Muscle strength testing of the Veteran's lower extremities produced normal results. At a February 2020 VA examination, the conducting physician indicated that the Veteran had moderate intermittent pain and mild numbness and paresthesias and/or dysesthesias of the left lower extremity. The physician further indicated that the Veteran's sciatic nerve was the nerve root affected by radiculopathy. The physician indicated that the Veteran had mild radiculopathy of the left sciatic nerve. The Veteran displayed decreased sensation of the left lower leg/ankle. Straight leg raising test was negative. The Veteran had hypoactive deep tendon reflexes upon examination. Analysis The Board finds that there is no indication of record that the Veteran has more than mild paralysis of the left sciatic nerve and thus he does not meet the criteria for a 20 percent rating. While the Veteran displayed moderate numbness, intermittent pain, and paresthesias and/or dysesthesias of the left lower extremity at the February 2020 VA examination, he did not have any symptoms of constant pain. Additionally, all of the VA examinations during this specific period on appeal indicate that the Veteran had mild radiculopathy of the left sciatic nerve rather than moderate. Accordingly, an increased 20 percent rating for sciatic radiculopathy of the left lower extremity for this specific period on appeal is denied. 4. From December 19, 2021, a rating in excess of 20 percent for sciatic radiculopathy of the left lower extremity is denied. Factual Background At a December 2021 VA examination, the conducting physician indicated that the Veteran had moderate intermittent pain, moderate numbness and moderate paresthesias and/or dysesthesias of the left lower extremity. The physician further indicated that the Veteran's sciatic and femoral nerves were affected by radiculopathy. The Veteran displayed decreased sensation of the left lower extremities. Straight leg raising test was negative. The Veteran had normal deep tendon reflexes upon examination. Analysis The Board finds that there is no indication of record that the Veteran has more than moderate paralysis of the left sciatic nerve and thus he does not meet the criteria for a 40 percent rating. The Veteran did not display any severe symptoms of constant pain, intermittent pain, numbness, and paresthesias and/or dysesthesias of the left lower extremity at the December 2021 VA examination. Rather, the examination indicated that the Veteran's symptoms were moderate in nature. Accordingly, an increased 40 percent rating for sciatic radiculopathy of the left lower extremity for this specific period on appeal is denied. 5. From September 26, 2012, to August 18, 2014, a rating in excess of 10 percent for femoral radiculopathy of the left lower extremity is denied. Legal Criteria Under DC 8526, a 10 percent rating is warranted for mild and incomplete paralysis of the femoral nerve; a 20 percent rating is warranted for moderate incomplete paralysis; a 30 percent rating is warranted for severe incomplete paralysis; and a 40 percent rating is warranted for complete paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a The words mild, moderate, and severe as used in the various DCs are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. 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. Factual Background At a November 2012 VA examination, the conducting physician did not find any radiculopathy of the left femoral nerve. At a February 2014 VA examination, the conducting physician indicated that the Veteran's had mild radiculopathy of the left femoral nerve. Analysis The Board finds that the probative evidence of record, including November 2012 and February 2014 VA examinations, does not support a finding that the Veteran has more than mild paralysis of the left femoral nerve during this specific period on appeal. Accordingly, an increased 20 percent rating for femoral radiculopathy of the left lower extremity for this specific period on appeal is denied. 6. From August 19, 2014, to December 18, 2021, an increased 10 percent rating (but not higher) for femoral radiculopathy of the left lower extremity is granted. Factual Background At an August 2014 VA examination, the conducting physician indicated that the Veteran's left femoral nerve was normal. At an October 2016 VA examination, the conducting physician indicated that the Veteran had radiculopathy of the femoral nerve but did not opine as to severity. At a February 2020 VA examination, the physician did not indicate any findings pertaining to the severity of the radiculopathy of the Veteran's left femoral nerve. Analysis The Board finds that the probative evidence of record supports a finding that as of August 19, 2014, to December 18, 2021, the Veteran displayed mild paralysis of the left femoral nerve. The August 2014 examiner's findings that the Veteran's left femoral nerve was not affected by radiculopathy conflicts with the February 2013, October 2016 and December 2021 VA examinations which indicate that he had radiculopathy of the femoral nerve. Accordingly, the Board finds that the probative evidence of record supports a finding that the Veteran displayed mild radiculopathy of the left femoral nerve from August 19, 2014, to December 18, 2021. As such, an increased 10 percent rating is granted. What remains for consideration is whether a still higher 20 percent rating is warranted for the Veteran's femoral radiculopathy of the left lower extremity. The Board finds that during this specific period on appeal, the probative evidence of record does not support a finding that the Veteran had more than mild paralysis of the left femoral nerve and thus he does not meet the criteria for a 20 percent rating. 7. From December 19, 2021, a rating in excess of 20 percent for femoral radiculopathy of the left lower extremity is denied. Factual Background As indicated above, at a December 2021 VA examination, the conducting physician indicated that the Veteran had moderate intermittent pain, moderate numbness and moderate paresthesias and/or dysesthesias of the left lower extremity. The physician further indicated that the Veteran's femoral nerve was affected by radiculopathy. The Veteran displayed decreased sensation of the left lower extremities. Straight leg raising test was negative. The Veteran had normal deep tendon reflexes upon examination. Analysis The Board finds that the probative evidence of record does not support a finding that the Veteran has more than moderate paralysis of the left femoral nerve and thus he does not meet the criteria for a 40 percent rating. The Veteran did not display any severe symptoms of constant pain, intermittent pain, numbness, and paresthesias and/or dysesthesias of the left lower extremity at the December 2021 VA examination. Rather, the examination indicated that the Veteran's symptoms were moderate in nature. Accordingly, an increased 40 percent rating for femoral radiculopathy of the left lower extremity for this specific period on appeal is denied. J. LEE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexander Bahus 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.