Citation Nr: 22018750 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 12-33 205 DATE: March 30, 2022 ORDER A disability rating of 40 percent, and no higher, from November 5, 2009 to June 17, 2016 for spondylolisthesis, L5-S1 to include degenerative disc disease (DDD), lumbar spine, is granted. FINDING OF FACT Affording the Veteran the benefit of the doubt, throughout the appeal period from November 5, 2009 to June 17, 2016, the Veteran's lumbar spine disability was manifested by functional impairment consisting of, at worse, subjective complaints of pain and objective limitation of motion to 10 degrees of flexion, without ankylosis of the thoracolumbar spine. Incapacitating episodes were not shown. CONCLUSION OF LAW From November 5, 2009 to June 17, 2016, the criteria for a disability rating of 40 percent, and no higher, for the Veteran's lumbar spine disability were met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code (DC) 5239. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from July 1980 to December 1986. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois which, in part, continued a 20 percent disability rating for the Veteran's lumbar spine disability. The Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge (VLJ) in May 2016. A transcript of the hearing is associated with the claims file. This case was previously before the Board in June 2016 at which time it was remanded for additional development. Thereafter, by rating decision dated in October 2018, the RO increased the lumbar spine disability rating from 20 percent to 40 percent disabling effective June 18, 2016. Subsequently, in February 2019 the case was, again, remanded for additional development. In January 2021, the Board, in part, denied a disability rating greater than 20 percent for the Veteran's lumbar spine disability prior to June 18, 2016 and denied a disability rating greater than 40 percent thereafter. The Veteran then appealed the Board's January 2021 decision to the United States Court of Appeals for Veterans Claims (Court). In December 2021, the Veteran and VA's Office of General Counsel filed a Joint Motion for Partial Remand (Joint Motion), in which both parties to the Joint Motion requested that the Court vacate and remand the Board's January 2021 decision denying a disability rating higher than 20 percent for the Veteran's lumbar spine disability prior to June 18, 2016. Notably, the January 2021 decision denying a disability rating greater than 40 percent for the Veteran's lumbar spine disability beginning June 18, 2016 was not disturbed. Procedural Background The Veteran seeks a higher disability rating for his service-connected lumbar spine disability prior to June 18, 2016. By way of history, service treatment records (STRs) show complaints of intermittent low back pain associated with lifting heavy loads in March 1986. The assessment was grade I spondylolisthesis by X-ray. A subsequent June 1986 STR shows pars defect, L5 and a July 1986 STR shows spondylosis interarticularis, L5 with history of back injuries one year earlier and three months earlier in parachute jumps. The Veteran's December 1986 separation examination shows a diagnosis of grade I spondylolisthesis. By rating decision dated in June 1988, the RO granted service connection for spondylolisthesis of L-5 on S-1, assigning a 10 percent disability rating effective December 13, 1986. Subsequently, by rating decision dated in May 2000, the RO increased the Veteran's disability rating for the spine from 10 to 20 percent disabling effective November 18, 1999. The Veteran filed the current claim for an increased rating in November 2009. In the February 2010 rating decision that is the subject of this appeal, the RO continued the 20 percent rating previously assigned. The Veteran disagreed with this decision and perfected this appeal. Thereafter, by rating decision dated in October 2018, the RO increased the lumbar spine disability rating from 20 percent to 40 percent disabling effective June 18, 2016. As above, the December 2021 Joint Motion vacated and remanded the Board's January 2021 decision denying a disability rating higher than 20 percent for the Veteran's lumbar spine disability prior to June 18, 2016 but did not disturb the decision denying a disability rating greater than 40 percent for the Veteran's lumbar spine disability beginning June 18, 2016. Legal Criteria Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court also has issued the opinion of Correia v. McDonald, 28 Vet. App. 158 (2016), which clarifies additional requirements that VA examiners should address when assessing musculoskeletal disabilities, holding specifically, that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. In addition, assignment of a disability rating should take into account consideration of limitation of functional ability during flare-ups or when a joint is used repeatedly over a period of time. See DeLuca, supra. Specifically, in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court stated that flare-ups must be considered in providing an estimate of additional functional loss based on range of motion. Unfortunately, the guidance on how to evaluate flare-ups has not been particularly clear. As a consequence, it is determined that the holding in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), will be expanded and flare-ups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Back disabilities may be evaluated under either of two general rating formulas. One applies to intervertebral disc syndrome (IVDS), and is based upon the duration of incapacitating episodes. The other general rating formula involves the General Rating Formula for Diseases and Injuries of the Spine. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is assigned 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 requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating will be assigned with evidence of unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating requires evidence of unfavorable ankylosis of the entire spine. Pertinent to this appeal, Note (1) of the rating schedule indicates that the agency is to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Also, from Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Alternatively, the Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted when there are incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating is warranted when there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months; and a 40 percent rating is warranted when there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted when there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, DC 5243, Note (1). Analysis Evidence relevant to the level of severity of the Veteran's lumbar spine disability prior to June 18, 2016 includes VA examination reports dated in January 2010 and November 2015. During the January 2010 VA spine examination, the Veteran reported that his lumbar spine disability had progressively worsened over the years but he denied any surgery or steroid injections. According to the Veteran, this disability affected his performance at his job. The Veteran reported experiencing constant sharp pain in the low back on a daily basis with a severity of 6/10. This pain radiated down both legs during flare-ups. The Veteran also experienced tingling, weakness, and numbness in his legs and feet on a weekly basis. The Veteran's lumbar spine disability flared up by bending, lifting, walking, weather, and overuse. This was improved by rest and medication. During flare-ups, the pain was a 11/10 in severity. The Veteran stated that these flare-ups can last for two to three hours up to all day and can occur on a weekly to monthly basis. After repetitive use or during a flare-up, the range of motion and function of his low back are additionally moderately more limited by pain, weakness, incoordination, and fatigability, of which pain has the major functional impact. As it usually is not possible to examine the Veteran during a flare-up or after significant repetitive use, the above report was based solely upon the Veteran's estimation and approximation of how additionally limited the range of motion is during a typical flare-up or after performing significant repetitive bending. There was no objective finding of additional limitation of movement following brief repetitive use testing with three repetitions during examination of the Veteran. The Veteran stated that, over the past year, he had had incapacitating episodes of low back pain, approximately three over the past year. Each of these episodes lasted two to three hours and were treated with medication and rest. With regard to functional limitations, it was noted that the Veteran's disability affected walking and standing. He could only walk between 14 and one mile and felt unsteady but did not fall. He could stand for up to one hour. The Veteran denied the use of assistive devices for his disability. He treated the pain with over-the-counter medication on a daily basis without side effects but with little help. The Veteran was employed but felt that his lumbar spine disability affected his occupational duties causing pain with walking and standing, decreased concentration, need for more frequent rest breaks, and being assigned light duty. His disability also affected his daily and recreational activities by causing limitations on chores, driving, shopping, hunting, fishing, sports, and exercise. On physical examination, the Veteran's posture was normal. Gait was slightly antalgic with a normal stance phase, bilaterally. He was able to rise onto his toes and heels with a complaint of pain. He was also able to rise from a squat with difficulty and a complaint of pain. He was able to tandem walk with unsteadiness. Romberg test was negative for instability while standing with his feet together and eyes closed. There was diffuse tenderness to palpation over the lower lumbar spine, right and left sacroiliac joints, right and left sciatic notches and adjacent right and left paraspinal muscles. There was palpable spasm but no surgical scars indicative of previous back surgery. Range of motion testing of the lumbar spine revealed flexion to 70 degrees (with pain beginning at 45 degrees), extension to 20 degrees (with pain beginning at 20 degrees), right lateral flexion to 20 degrees (with pain beginning at 20 degrees), left lateral flexion to 20 degrees (with pain beginning at 20 degrees), right lateral rotation to 20 degrees (with pain beginning at 20 degrees), and left lateral rotation to 20 degrees (with pain beginning at 20 degrees). Repetitive use testing with three repetitions showed no change. It was noted that, during a flare-up, the effective functional range of motion for his lumbosacral spine was additionally limited 0 to 45 degrees of flexion and 20 degrees of extension due to increased pain. The range of motion of the lumbar spine was also additionally limited to 0 to 20 degrees of lateral bending in each direction and from 0 to 30 degrees of lateral rotation in each direction due to increased pain. Neurologic examination revealed deep tendon reflexes as 2 + bilaterally at the patellar tendons. Deep tendons were difficult to elicit, bilaterally, at the Achilles tendons. Straight leg raising test was negative, bilaterally. The Veteran stated that there was no pain radiating down his leg during his seated straight leg raising test. Strength was 5/5 in bilateral lower extremities. Sensation was intact to light touch in bilateral lower extremities. X-ray of the lumbar spine showed grade I anterolisthesis of L5 on S1, with at least unilateral right spondylolysis at L5 as well as multilevel degenerative changes, most pronounced at L5/S1. The examiner diagnosed chronic low back strain; spondylolysis, grade 1, L5-S1; and DDD, lumbar spine. During the November 2015 VA examination, the examiner continued a diagnosis of spondylolisthesis and also noted a diagnosis of sciatica, bilateral lower extremities (beginning in 2015). The Veteran reported that experienced constant back pain, rated as 5/10 in severity, as well as stiffness from the back to the neck with loss of range of motion/mobility. He treated this with pain medication and denied surgery, injections, chiropractic care, and physical therapy. The Veteran reported experiencing flare-ups of the lumbar spine, described as 10/10 in severity and aggravated by weather changes, prolonged sitting/standing, walking, flying, driving in a car for long distances, and repetitive lifting/bending. These flare-ups are alleviated by medication and rest. He also reported experiencing functional loss associated with the lumbar spine disability, described as limitations with walking, standing, sitting, and repetitive lifting/bending. Range of motion testing of the lumbar spine revealed flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 15 degrees, left lateral flexion to 8 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 20 degrees. There was evidence of pain with weight bearing as well as objective evidence of localized tenderness or pain on palpation of the lumbar spine and bilateral SI (sacroiliac) joints. The Veteran was able to perform repetitive-use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. With regard to repetitive use over time, the Veteran's spine was examined after repetitive use over time. Significantly, it was noted that pain, fatigue, weakness, lack of endurance, and incoordination significantly limited functional ability with repeated use over a period of time but the examiner was unable to describe this in terms of range of motion as there was no additional loss of motion but range of motion was slower and more difficult due to increased pain. The Veteran's spine was not examined during a flare-up and the examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss during flare-up. The examiner noted that pain, fatigue, weakness, lack of endurance, and incoordination significantly limited functional ability with flare-ups but the examiner was unable to describe this in terms of range of motion as there was no additional loss of motion but range of motion was slower and more difficult due to increased pain. There was muscle spasm, guarding, and localized tenderness of the thoracolumbar spine which resulted in abnormal gait or abnormal spinal contour. Additional factors contributing to disability of the lumbar spine included less movement than normal, weakened movement due to muscle or peripheral nerve injury, instability of station, disturbances of locomotion, interference with sitting, and interference with standing. Muscle strength testing was normal and there was no muscle atrophy. Reflex examination was slightly abnormal, described as hypoactive. Sensory examination was normal and straight leg raising test was negative. There was radiculopathy resulting in mild constant pain of the bilateral lower extremities, moderate intermittent pain of the right lower extremity, mild intermittent pain of the left lower extremity, and mild numbness of the left lower extremity. The Veteran's radiculopathy was found to involve the L4/L5/S1/S2/S3 bilateral nerve roots (sciatic nerves) and was found to be of moderate severity on the right and mild severity on the left. There was no ankylosis of the spine. There were no other neurologic abnormalities and there was no IVDS. The Veteran occasionally used a brace and regularly used a cart with excessive walking in the grocery store to assist with locomotion due to his back disability. There was no functional impairment of the lumbar spine such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent physical findings, to include scars. Imaging studies revealed arthritis but there was no thoracic vertebral fracture with loss of 50 percent or more of height. With regard to functional impact, the examiner wrote that the Veteran's lumbar spine disability impacted his ability to work as the Veteran lost his job in April 2015 working as a plant manager for over 20 plus years. While outside the appeal period ending June 17, 2016, the Board will also consider a June 18, 2016 VA spine examination which was the basis for the increased disability rating effective that date. During the June 2016 VA examination, the examiner continued a diagnosis of spondylolisthesis, L5-S1, to include DDD of the lumbar spine and also noted a diagnosis of radiculopathy of the bilateral lower extremities (beginning in 2016). The Veteran reported that he continued to treat his back pain with oral medication, a TENS unit, and physical therapy but denied epidural injections. He experienced pain and stiffness. The Veteran reported experiencing flare-ups of the lumbar spine, described as increased pain and stiffness. He also reported experiencing functional loss associated with the lumbar spine disability, specifically a limited ability to stand and walk for long periods. Range of motion testing of the lumbar spine revealed flexion to 10 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. It was noted that the Veteran was unable to perform activities above and below the waist. There was objective evidence of localized tenderness or pain on palpation of the lumbar paraspinals, described as moderate to severe. There was no objective evidence of pain with weight bearing. The Veteran was unable to perform repetitive-use testing with three repetitions due to severe pain. With regard to repetitive use over time, the Veteran's spine was not examined after repetitive use over time and the examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner noted that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over a period of time but the examiner was unable to describe this in terms of range of motion as the Veteran was not examined after repeated use over time. The Veteran's spine was not examined during a flare-up and the examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss during flare-up. The examiner noted that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups but the examiner was unable to describe this in terms of range of motion as the Veteran was not examined during a flare-up. There was muscle spasm, guarding, and localized tenderness of the thoracolumbar spine, described as increased pain and stiffness, but this did not result in abnormal gait or abnormal spinal contour. There were no additional factors contributing to disability of the lumbar spine. Muscle strength testing was slightly abnormal, described as "active movement against some resistance," and there was no muscle atrophy. Reflex examination was normal with the exception of the right knee, which was hypoactive. Sensory examination was normal for the bilateral upper anterior thigh (L2) and thigh/knee (L3/L4) but decreased for the bilateral lower leg/ankle (L4/L5/S1) and foot/toes (L5). Straight leg raising test was negative. There was radiculopathy resulting in moderate constant pain, paresthesias and/or dysthesias, and numbness. The Veteran's radiculopathy was found to involve the L4/L5/S1/S2/S3 bilateral nerve roots (sciatic nerves) and was found to be of moderate severity. There was no ankylosis of the spine. There were no other neurologic abnormalities and there was no IVDS. The Veteran constantly used a cane to assist with locomotion due to low back and knee pain. There was no functional impairment of the lumbar spine such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. There were no other pertinent physical findings, to include scars. Imaging studies were not performed. With regard to functional impact, the examiner wrote that the Veteran's lumbar spine disability impacted his ability to work as it affected his ability to stand and walk for long periods and affected his ability to lift and carry items. VA and private treatment records dated through June 20120 show findings similar to those noted above but are negative for range of motion testing. In this case, the Board will afford the Veteran the benefit of the doubt and find that a disability rating of 40 percent, and no higher, is warranted for the Veteran's lumbar spine disability from November 5, 2009 to June 17, 2016. As above, a 40 percent rating requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Notably, beginning June 18, 2016, the Veteran's lumbar spine disability is shown to have met the criteria for a 40 percent disability rating based on flexion limited to 10 degrees. While the Veteran was shown to have flexion to 40 degrees during the November 2015 VA examination and flexion to 70 degrees during the January 2010 VA examination, which does not warrant a 40 percent disability rating, as was noted in the December 2021 Joint Motion, the January 2010, November 2015, and June 2016 VA examination reports are inadequate pursuant to Mitchell, Sharp, and/or Correia. Specifically, with regard to Mitchell, the VA examiners failed to specify during what point of range of motion pain results in functional loss in the January 2010, November 2015, and June 2016 examination reports. Notably, all three examiners stated that the Veteran experienced pain that caused functional loss, but none of the examiners specified at what point during range of motion the Veteran's pain resulted in functional loss. Simply noting that pain was present does not say enough for the Board to know whether pain was pervasive throughout range of motion (more disabling) or occurred only at the end of range of motion (less disabling). See DeLuca, 8 Vet.App. at 206. With regard to Sharp, both the January 2010 and June 2016 VA examinations are inadequate as the examiner failed to provide an adequate opinion on the degree of functional loss the Veteran would experience during a period of flared symptoms and after repeated use. See Sharp, 29 Vet.App. at 34-35 (finding a medical opinion inadequate that "declined to offer an opinion as to function loss during flares 'without directly observing function under these circumstances'" because the examiner "failed to ascertain adequate information" and provide an estimate or explain why the examiner could not do so). Here, the January 2010 VA examiner noted that the Veteran suffered from flares "of which pain has the major functional impact," regarding range of motion limitations, but failed to describe such limitations in range of motion measurements. The June 2016 VA examiner noted that he was unable to describe the Veteran's flares in terms of range of motion measurements because he "[wa]s not being examined during a flare-up." With regard to Correia, it was noted that none of the VA examinations comply with Correia as they do not include the results of range of motion testing on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint in compliance with 38 C.F.R. § 4.59. The Board has considered whether obtaining a retrospective opinion is warranted to address the deficiencies noted in the with regard to Mitchell, Sharp, and Correia. Notably, obtaining a retrospective medical opinion may be necessary in certain instances "if a disability rating cannot be awarded based on the available evidence." See Chotta v. Peake, 22 Vet. App. 80, 85 (2008). However, the available evidence from the period on appeal does not appear to adequately address this caselaw such that a retrospective opinion would be difficult to provide and non-probative. As such, the Board will afford the Veteran the benefit of the doubt and find that a disability rating of 40 percent, and no higher, is warranted for the Veteran's lumbar spine disability from November 5, 2009 to June 17, 2016. While neither the January 2010 nor the November 2015 VA examinations comply with Sharp and that none of the VA examinations comply with either Mitchell or Correia, the Veteran is already in receipt of a rating for his low back disability that contemplates the maximum loss of range of motion and favorable ankylosis, and that the only way he may receive a higher schedular rating is by demonstrating unfavorable ankylosis. Thus, entitlement to an increased rating may only be demonstrated by showing that the back is fixed in one particular position rather than in another. This rating criterion does not involve assessment of range of motion, as the Veteran's ability to move his low back would necessarily preclude a finding of unfavorable ankylosis. The Board therefore finds that a remand of this claim in order to obtain an examination that complies with Mitchell, Sharp, or Correia would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (concluding that remand is unnecessary where it "would result in this Court's unnecessarily imposing additional burdens on the [Board] with no benefit flowing to the veteran"). As for the potential for a disability rating even higher than 40 percent, the Board concludes that a disability rating greater than 40 percent for the Veteran's lumbar spine disability is not warranted. As above, a rating higher than 40 percent based on orthopedic impairment requires a finding of ankylosis. Ankylosis is defined in general as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Colayong v. West, 12 Vet. App. 524 (1999) (citing Dorland's Illustrated Medical Dictionary (28th ed. 1994) at 86). For VA compensation purposes, unfavorable ankylosis is a condition in which the thoracolumbar spine, or the entire spine, is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). There is no evidence that the Veteran's spine is fixed in position, or ankylosed, or that even with flare ups, he has experienced the functional equivalent of ankylosis. Significantly, the Veteran had flexion to 10 degrees during the June 2016 VA examination. The Board has also considered whether any other diagnostic codes might serve as a basis for an increased rating. In this regard, DC 5003 addresses degenerative arthritis. However, in this case, the maximum evaluation possible under DC 5003 is 10 percent, as only one major joint or group of minor joints is involved in this claim. Therefore, it does not allow for a higher evaluation. Also, the Veteran was not diagnosed with IVDS prior to June 18, 2016 and, even if he had, the evidence is negative for any incapacitating episodes requiring bedrest by a physician both prior to and beginning June 18, 2016. Furthermore, while the Veteran experiences radiculopathy of the lower extremities secondary to his lumbar spine disability, the Veteran is separately rated for these disabilities. There are no other applicable codes available for consideration. In denying an even higher disability rating for the Veteran's lumbar spine disability, the Board has considered the Veteran's statements that his lumbar spine disability is worse, as well as his report of pain. While he is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions regarding whether his symptoms meet the next higher rating criteria under VA regulations. Such competent evidence concerning the nature and extent of the Veteran's lumbar spine disability has been provided by the medical personnel who have examined him during the current appeal. The medical findings (as provided in the examination reports and clinical records) directly address the criteria under which this disability is evaluated. The specific clinical measures of ranges of motion, including examiners' findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran's report of pain and limitation of function. Thus, the overall evidence does not show that pain or other factors have resulted in additional functional limitation or limitation of motion such as to enable a finding that the disability picture more nearly approximates the next-higher disability rating from November 5, 2009 to June 17, 2016. Despite the Veteran's contention of a debilitating lumbar spine disability, the disability ratings assigned herein indicate a significant impact on his functional ability. Such disability evaluation assigned by VA recognizes his painful motion. The critical question in this case, however, is whether the problems he has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board April Maddox, 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.