Citation Nr: 22019232 Decision Date: 03/31/22 Archive Date: 03/31/22 DOCKET NO. 18-09 474 DATE: March 31, 2022 ORDER An initial rating higher than 70 percent for post-traumatic stress disorder (PTSD) with major depressive disorder (MDD) is denied. An initial 20 percent rating for right lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to February 11, 2019, is granted. An initial 40 percent rating for right lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, is granted. An initial 20 percent rating for left lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to the present, is granted. An initial rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, is denied. FINDINGS OF FACT 1. Throughout the entire period on appeal, the Veteran's PTSD with MDD manifested by, at worst, occupational and social impairment with deficiencies in most areas. 2. For the period from August 26, 2013 to February 11, 2019, the Veteran's right lower extremity radiculopathy, sciatic nerve, manifested as moderate incomplete paralysis. 3. For the period from February 12, 2019 to the present, the Veteran's right lower extremity radiculopathy, sciatic nerve, manifested as moderately severe incomplete paralysis. 4. For the period from August 26, 2013 to February 11, 2019, the Veteran's left lower extremity radiculopathy, sciatic nerve, manifested as moderate incomplete paralysis. 5. For the period from February 12, 2019 to the present, at worst, the Veteran's left lower extremity radiculopathy, sciatic nerve, manifested as moderately severe incomplete paralysis. CONCLUSIONS OF LAW 1. Throughout the entire period on appeal, the criteria for an initial rating higher than 70 percent for PTSD with MDD have not been meet. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. For the period from August 26, 2013 to February 11, 2019, the criteria for an initial 20 percent rating for right lower extremity radiculopathy, sciatic nerve, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.124a, DC 8520. 3. For the period from February 12, 2019 to the present, the criteria for a 40 percent rating for right lower extremity radiculopathy, sciatic nerve, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.124a, DC 8520. 4. For the period from August 26, 2013 to February 11, 2019, the criteria for an initial 20 percent rating for left lower extremity radiculopathy, sciatic nerve, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.124a, DC 8520. 5. For the period from February 12, 2019 to the present, the criteria for a rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.124a, DC 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 2010 to January 2012. The Veteran is in receipt of a total disability rating based on individual unemployability due to service-connected disabilities, effective July 28, 2016. This matter was before the Board of Veterans' Appeals (Board) in June 2021 when the issues were remanded for the Regional Office (RO) to obtain relevant outstanding Social Security Administration (SSA) records, and to provide the Veteran with a new VA examination to determine the current severity of her service-connected radiculopathy of the bilateral lower extremity. In accordance with the June 2021 Board remand, the Veteran's SSA medical records were associated with her claims file, and she was provided a VA peripheral nerves condition examination in November 2021. Further development having been completed in accordance with the June 2021 Board remand; the matter is once again before the Board. After review of the evidence, the Board has determined the following: An initial rating higher than 70 percent for PTSD with MDD will be denied because the evidence does not show that the condition resulted in total occupational and social impairment, at any time during the period on appeal. Initial 20 percent ratings, but not higher, for bilateral lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to February 11, 2019, will be granted because, the evidence shows that the conditions manifested as moderate incomplete paralysis during the period. An initial 40 percent rating, but not higher, for right lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, will be granted because, the evidence shows that the condition manifested as moderately severe incomplete paralysis during the period. An initial rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, will be denied because, at worst, the evidence shows that the condition manifested as moderately severe incomplete paralysis during the period. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where an increase in an existing disability rating based on established entitlement to compensation is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. 38 C.F.R. § 4.2: Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Regulations require that where there is a question as to which of two evaluations is to 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. After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert at 54. 1. An initial rating higher than 70 percent for PTSD with MDD is denied. The Veteran contends that her PTSD with MDD is worse than contemplated by her 70 percent rating under DC 9411, throughout the entire period on appeal. For the following reasons, a rating higher than 70 percent is not warranted, at any time during the period on appeal, and the claim is denied. Under DC 9411, 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 ideation; 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 personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. §§ 4.130, DC 9411. A 100 percent rating is warranted for total occupational and social impairment with symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, own name. Id. The criteria set forth in the rating formula for mental disorders do not constitute an exhaustive list of symptoms, but rather are examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, the Veteran must demonstrate the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely based on social impairment. 38 C.F.R. § 4.126(b). An October 2013 VA treatment record shows that the Veteran reported she had sleep problems, anxiety, mind racing, difficulty relaxing, flashbacks, anger dyscontrol, irritability, feeling a sense of urgency, guilt, feelings related to death of friends, anxiety in large groups, headaches, memory problems, concentration problems, and distractibility. A February 2014 VA mental health note shows that the Veteran reported symptoms of intrusive memories, hypervigilance, hyperarousal, and avoidance. A September 2014 VA psychiatry note shows that the Veteran reported having fitful sleep, worsening concentration and memory, distractibility, occasional depressed mood, and anger at times - but, generally controlled. She reported that she and her spouse are doing well together. However, the examiner noted that the Veteran has not been dangerous or threatening. During the January 2015 VA PTSD examination, the Veteran reported the following: almost daily depressed mood, lasting nearly all day; disinterest in almost all activities; insomnia and loss of energy; lack of motivation; feelings of worthlessness; guilt; hopelessness; helplessness; poor attention and concentration; difficulty with decision making; recurrent thoughts of death, without suicidal ideation; high anxiety and worry; feelings of being on edge; tenseness; and irritability. She reported that when her anxiety becomes overwhelming, she has symptoms of the following: accelerated heart rate, shaking, shortness of breath, chest pain, dizziness, chills and flushes, a fear of dying, and tingling sensations in her hands and feet. The examiner noted that the Veteran's disorder results in occupational and social impairment with reduced reliability and productivity. The examiner noted the following symptoms attributable to her disorder: depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long-term memory; flattened affect; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; impaired impulse control, such as unprovoked irritability with period of violence; and neglect of personal appearance and hygiene. A January 2015 VA psychiatry note shows that the Veteran reported symptoms of mood swings, anger, depressed mood, and poor short-term memory with forgetfulness. A January 2015 VA treatment note shows that the Veteran reported the following: trouble staring and completing daily activities; non association with anyone outside of her family; no participation in any leisure or recreational activities; when depressed, an inability to maintain personal hygiene or eat for days; her spouse and brother take care of homemaking and living, mostly; drives only when she must, but she does not like to drive; and she was laid off from employment and told that she would not be brought back due to her medical conditions (physical and mental). The examiner noted that the Veteran is independent in her ability to live without supervision or concern from others, and she can manage her finances independently. A February 2015 VA psychiatry note shows that the Veteran denied suicidal and homicidal thoughts, as well as auditory and visual hallucinations. The examiner noted that the Veteran has no internal preoccupation. During the August 2015 VA PTSD examination, the Veteran reported that her depression feels like "a black hole that can last for a month." She reported that she has been with her spouse for four years, they have a good marriage, and her spouse is supportive. She reported that the couple do not have children, but they are seeking fertility treatment. However, she reported that her depression and PTSD impacts their relationship significantly. In particular, she stated that she has a lot of anger that is out of proportion with it cause. She also stated that she does not do a very good job empathizing when she hurts the feelings of her spouse, and she has difficulty validating her own feelings. The Veteran's spouse stated that, at times, the Veteran's anger seems to come out of nowhere. The Veteran also reported having a relationship with her brother and mother. The Veteran reported that she is very isolative and chooses to remain at home. She stated that she spends a lot of time on the computer and doing her homework as a full-time student in a social services program at a local community college. She reported that she is doing well in school, but she needs to sit in the back of the room near the door when in-class. She stated that she does all she can to remain at home and she is not comfortable in public. However, she stated that her spouse attempts to get her out of the house. In particular, she reported a recent outing when she needed to get drunk beforehand so she could tolerate the crowd, and that she self-medicates in this way just to get through the stressful times. The Veteran's spouse reported that she binges on alcohol and has blackouts. Her spouse stated that the Veteran's last binge was two weeks previously when she became very angry and verbally abusive while attending a concert; the Veteran does not remember the incident. The Veteran reported that she last worked in September 2014 when she was let go due to back problems. She denied ever being hospitalized for a psychiatric condition and/or any residential or intensive treatment for PTSD. The examiner noted that the Veteran's mental disorder results in occupational and social impairment with reduced reliability and productivity. The examiner noted the following symptoms attributable to her PTSD and MDD: depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood; and suicidal ideation. The examiner noted that the Veteran can manage her financial affairs. The examiner opined that the Veteran is capable of gainful employment in a work environment where she is working independently, can limit her stress, and does not have to tolerate a crowded area for a sustained period. The examiner noted that the Veteran's presentation at the examination suggests that she is functioning at a level comparable to that during the VA examination in January 2015. A February 2016 VA treatment record shows that the Veteran complained of poor memory. Specifically, she reported that her spouse and brother told her that she often repeats herself. She also reported that she is frequently distracted when attempting to complete schoolwork. She reported that her GPA recently declined from 3.75 to 3.2. The examiner noted no evidence of a thought disorder, psychotic symptoms, or hallucinations or delusions. A March 2016 VA treatment record shows that the Veteran reported increasing anxiety, and difficulty with initiating and maintaining sleep. She denied having panic attacks. She reported having a normal appetite. She reported that her energy is low and her ability to concentrate is poor and interfered with college assignments. She did not report suicidal or homicidal ideation, intent, or plan. A March 2017 VA psychiatry note shows that the Veteran was well groomed, had fair insight and judgement, and had fair impulse control. The examiner noted that the Veteran was anxious and distracted. The Veteran denied auditory and visual hallucinations, and suicidal and homicidal ideation. During an April 2017 VA mental health assessment, the examiner observed the Veteran as appropriately groomed. The examiner noted that the Veteran's thought process was logical, and goal directed. She denied hallucinations and delusions, and suicidal or homicidal ideation. During the April 2017 VA PTSD examination, the Veteran reported that she was in contact with her family. However, she reported that she was separated from her spouse for one year and that she lived with her niece. She reported that she had friends, but she does not like to go out much. She reported that she was a full-time college student, but that her emotional problems interfere with her schoolwork, to include problems with memory, concentration, and anxiety. The Veteran reported the following symptoms: feeling "closed in" and having panic attacks and depression; feeling so depressed that she wants to stay in bed at times; anxiety resulting in feeling on edge; constantly losing items; taking wrong turns while driving in familiar places; forgetting the names of persons in her past; difficulty with sleeping and nightmares, and sleeping about three to four hours nightly; a lack of energy and motivation; sadness and tearfulness; an inability to tolerate being around crowds because of bad anxiety; mood swings; irritability; short-temperedness; and defensiveness. The Veteran reported that when anxious, she has shortness of breath and rapid heart rate. The Veteran reported that when visiting family during Christmas, she had a panic attack because she felt closed in. When in a restaurant, she reported that must sit facing a door and cannot sit with people behind her. She also reported that sounds and noises overwhelm her, include thunder, fireworks, and thunder. The examiner noted that the Veteran's symptoms cause occupational and social impairment with reduced reliability and productivity. The examiner noted the following symptoms attributable to her disorder: depressed mood; anxiety; panic attacks that occur weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long-term memory; flattened affect; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a worklike setting; impaired impulse control, such as unprovoked irritability with period of violence; and neglect of personal appearance and hygiene. The examiner noted that the Veteran can manage her financial affairs. The examiner noted that the Veteran denied hallucinations or delusions, and suicidal or homicidal ideation. The examiner noted that the Veteran's reasoning and judgment were intact, and her memory was adequate. A July 2017 VA treatment record shows that the Veteran was observed as neatly dressed and groomed. She had good eye contact; her motor activity was within normal limits; she was engaging and pleasant; she was oriented to person, place, and time; her recent and remote memory was intact; she had full range of affect; she denied past and present suicidal and homicidal thoughts; her thoughts were goal directed and logical; she had no perceptual disturbances; she had fair insight and judgement; and she had no cognitive impairments. However, the examiner noted that the Veteran reported ongoing difficulty with concentration, and difficulty with getting to sleep due to "racing thoughts." A December 2017 VA mental health note shows that the Veteran reported struggling in school due to anxiety, and problems with memory. A July 2018 VA treatment record shows that the Veteran reported brief death wishes a few years previously, without attempts or plans. The Veteran reported having flashbacks and nightmares, but none in last year. The Veteran had no thoughts of hurting others. She reported mild depression and anxiousness. She denied hallucinations and delusions. The examiner noted that the Veteran had good memory, fair insight and judgement, and good impulse control. During the February 2019 VA PTSD examination, the Veteran reported that she has a good relationship with her partner and daughter, an improved relationship with her parents, and a good relationship with all siblings but for one sister. However, she reported having no friends with whom she socializes. She also reported that she no longer trusts anyone, and she finds herself isolated. The Veteran reported that she has depressive-related symptoms, including dysphoric mood, isolation/social withdrawal, anhedonia, hopelessness, worthlessness, and irritability. She denied suicidal and homicidal ideation. However, she has occasional thoughts about not wanting to be alive, the last of which occurred a few months previously. She also reported experiencing anxiety-related symptoms, including excessive apprehension and worry, concentration problems, memory deficits, sleep disturbances consisting of difficulty falling and staying asleep, nightmares, flashbacks/re-experiencing events, intrusive memories, hypervigilance, hyperstartle response, and avoidance behaviors. She reported that she does not deal with stress as well as she did previously. She reported panic attack symptoms including palpitations, breathing difficulties, trembling, "tunnel vision," nausea, and a fear of dying. She reported that panic is often triggered by certain environmental stimuli, such as music being too loud or too much stimulation causing feelings of being overwhelmed. The examiner noted that the Veteran denied manic symptomatology and thought disorder symptoms. The Veteran reported that her anxiety, sleeping disturbance, and depressive episodes have increased in intensity and frequency since her last VA examination. The examiner noted that the disorder results in occupational and social impairment with reduced reliability and productivity. The examiner noted the Veteran had a depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near-continuous panic or degression affecting the ability to function independently, appropriately, and effectively; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long-term memory; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a worklike setting. The examiner noted that the Veteran also has symptoms of nightmares, flashbacks, intrusive memories, hypervigilance, hyperstartle response, and avoidance behaviors, all of which are related to her mental disorders. A May 2019 VA mental health crisis intervention note shows that the Veteran reported that after moving to live with her father and stepmother in Florida, her stepmother told her that she had to leave. The Veteran reported she was concerned that this situation may cause her to have a mental breakdown. She reported that in the previous two months, she has had thoughts about not wanting to be alive. However, she denied ever attempting suicide and denied any current thoughts of suicide. A February 2020 VA psychiatry note shows that the examiner noted no risk factors for suicidal or homicidal ideation. The examiner observed the Veteran as alert, had good eye contact with appropriate affect, had intact judgement, and she was appropriately dressed. The Veteran's mood was anxious. The examiner noted no evidence of a thought disorder, perceptual abnormalities, or hallucinations. A May 2020 VA primary care note shows that the Veteran reported that she needs additional therapy because her anxiety and PTSD are worsening. However, a separate May 2020 VA pain management consultation shows that the Veteran denied suicidal ideation but stated that she thinks of it at times. A July 2020 VA psychology note shows that the Veteran reported symptoms of sleep problems/nightmares, depressed mood, panic attacks, anxiety, irritability, racing thoughts, hypervigilance, and conflict with family members. Another July 2020 VA psychology note shows that the Veteran reported that she enjoys walks, playing guitar, learning/going to school, spending time with family, and watching movies. During the September 2020 VA PTSD examination, the Veteran reported the following symptoms: insomnia, recurrent distressing combat memories, dreams with awakening, dysphoria, hypervigilance, hyperarousal, irritability, decreased concentration, social anxiety with isolating and avoidant behaviors, depressed mood with anxious helplessness, decreased energy and motivation, and emotional detachment. She reported that she sleeps restlessly and lightly, approximately three to five hours nightly, with sleep disrupted by notable hypervigilance, motor restlessness, somatic pains (low back and legs), perseverative worrisome thinking about life stressors, shortness of breath, and recurrent distressing combat dreams. She reported daytime fatigue, irritability, and decreased concentration. The Veteran reported that she lives with her spouse and daughter. She has occasional superficial electronic contacts with her parents, but is estranged from siblings and other family members, and has become more cut off from former friends. She reported that she spends most of her time at home, often alone, serving as caretaker of the home and her daughter with diminished ability to do either. The Veteran reported that she recently dropped out of college due to her mental health conditions. The examiner noted that the Veteran's mental disorders result in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, and thinking and/or mood. The examiner noted the following symptoms attributable to her mental disorder: depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near-continuous depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; impaired impulse control, such as unprovoked irritability with period of violence; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The examiner noted that the Veteran was alert, attentive, cooperative, engaging, and appropriate, with a moderately severe anxious and depressed affect, and moderately depressed mood. Her cognitive and intellectual functioning were normal, with good insight and judgment. The examiner noted that the Veteran can manage her financial affairs. Throughout the entire period on appeal, a higher, 100 percent rating, is not warranted. The evidence shows that the Veteran has consistently denied delusions and hallucinations, her thought process has been characterized as logical and goal directed, and her insight and judgment has been characterized as good/fair. The evidence also shows that the Veteran has, for the most part, been able to maintain relationships with her significant other, daughter, parents, and siblings. Although the evidence shows, at times, the Veteran has endorsed having thoughts of death, she has consistently denied suicidal ideation and she has consistently denied suicide attempts. The evidence shows angry outbursts; however, the evidence does not show that the Veteran has caused harm to others. The evidence also does not show memory loss such that the Veteran is unable to remember her name or the names of her relatives. In addition, as recently as July 2020, the Veteran reported that she enjoys walks, playing guitar, learning/going to school, spending time with family, and watching movies. Thus, the evidence does not meet the level of severity, frequency or duration which would warrant a higher evaluation at any time during the period on appeal. In conclusion, a higher, 100 percent rating, for PTSD with MDD, is not warranted at any time during the period on appeal, and the claim is denied. 38 C.F.R. § 4.130, DC 9411. 2. An initial 20 percent rating for right lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to February 11, 2019, is granted. 3. An initial 40 percent rating for right lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, is granted. 4. An initial 20 percent rating for left lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to the present, is granted. 5. An initial rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, is denied. The Veteran contends that her service-connected right and left lower extremity radiculopathy, sciatic nerve, conditions are worse than that which is contemplated by her current staged ratings, throughout the entire period on appeal, under DC 8520. For the following reasons, initial 20 percent ratings, but not higher, for bilateral lower extremity radiculopathy, sciatic nerve, from August 26, 2013 to February 11, 2019, are warranted, and the claims are granted; a 40 percent rating, but not higher, is warranted for right lower extremity radiculopathy, sciatic nerve, from February 12, 2019 to the present, and the claim is granted; and a rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, is not warranted, from February 12, 2019 to the present, and the claim is denied. Under DC 8520, a 10 percent evaluation is warranted for mild incomplete paralysis; a 20 percent evaluation is warranted for moderate incomplete paralysis; a 40 percent evaluation is warranted for moderately severe incomplete paralysis; a 60 percent evaluation is warranted for severe, with marked muscular atrophy, incomplete paralysis; and the highest evaluation of 80 percent evaluation is warranted for complete paralysis where 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. 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 should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. The words "mild," "moderate" and "severe" are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are "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. Rather, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. February 2012 VA treatment records show that the Veteran reported low back pain with constant radiating pain to her right buttock and leg, which she described as seven out of ten in-severity and, at worst, ten out of ten. A September 2013 VA treatment record shows that the Veteran reported low back pain, radiating to her right buttock and knee, that is throbbing and stabbing. She reported that her pain comes and goes; her current pain level was seven out of ten. An October 2013 VA treatment record shows that the Veteran reported pain to her right leg, traveling to her right foot with numbness. A May 2014 private medical record shows that the Veteran reported a history of sciatica and herniated lumbar spine discs at L5-S1. She reported increased low back pain over the preceding three days, radiating to the bilateral posterior thigh, buttocks, and toes. A straight leg raising test was positive bilaterally at 60 degrees. An August 2014 VA operative note shows that the Veteran reported a history of sharp, stabbing pain to her right leg. However, she reported that those symptoms had since cleared up and reported current symptoms of tightness to her bilateral buttock. An August 2015 VA surgery operative note shows a diagnosis of lumbar radiculopathy. A lumbar epidural steroid injection procedure was performed. The Veteran reported low back pain that radiates down the posterolateral aspect of the bilateral lower extremity. The examiner noted that the Veteran has pain, dysesthesias, and weakness in her bilateral lower extremities. A February 2016 VA surgery operative report shows that the Veteran reported pain, dysesthesias, and weakness to the bilateral lower extremity. An April 2016 VA emergency department note shows that the Veteran complained of low back pain, radiating to her right hip, and bilateral leg. Normal sensation was noted to the bilateral lower extremity, and the Veteran's gait was noted as steady. The Veteran denied bilateral lower extremity numbness, tingling, and weakness. A November 2016 private treatment record shows that the Veteran reported low back pain, radiating to her bilateral hip, and right lower extremity weakness. The examiner noted that deep tendon reflexes on patella and achilles were two out of four bilaterally. Muscle strength and sensation were normal bilaterally. A January 2017 VA triage note shows that the Veteran reported pain all over, which she described as nine out of ten in-severity, to include leg pain described as localized to the bilateral knee. The assessment was myalgia. A February 2017 private treatment record shows that the Veteran reported low back pain, radiating to her right lower extremity. She reported numbness, tingling, sharp shooting pain, weakness, and dull aching pain in the right lower extremity that is worsened when walking. The right lower extremity had decreased sensation to light touch, and the left lower extremity had normal sensation to light touch. Deep tendon reflexes were two out of four bilaterally, and muscle strength was normal bilaterally. A November 2017 private medical record shows bilateral sciatica with progressive leg weakness, and numbness and tingling in the right leg. A March 2018 private medical record shows that the Veteran reported low back pain, radiating to her bilateral hip worse on the left side. She reported constant aching, throbbing, pain. No neurological deficits of the bilateral lower extremity were noted. The August 2018 VA back examination shows bilateral lower extremity radiculopathy with involvement of the sciatic nerve roots. The Veteran had normal muscle strength, reflexes, and sensation to light touch bilaterally. The straight leg raising test was negative. The Veteran had mild intermittent pain bilaterally, which was noted as usually dull. No numbness, constant pain, or paresthesias or dysesthesias was noted. The examiner noted that the bilateral lower extremity sciatic radiculopathy was mild in-severity. The February 2019 VA back examination shows bilateral lower extremity radiculopathy with involvement of the sciatic nerve roots. The Veteran had decreased muscle strength of four out of five in the bilateral hip and knee. Her muscle strength was further decreased to two out of five in the left ankle on plantar flexion and dorsiflexion, and great toe extension. She had normal reflexes of the right knee/ankle, and hypoactive reflexes of the left knee/ankle. The right lower extremity had normal sensation to light touch, while the left lower extremity had decreased sensation to light touch on all areas tested. The straight leg raising test revealed positive results bilaterally. The examiner noted severe and intermittent pain, paresthesias and/or dysesthesias, and numbness bilaterally. The examiner noted that the left lower extremity also had weakness and intermittent twitching of the foot. The examiner noted that the bilateral lower extremity sciatic radiculopathy was mild in-severity. During the November 2021 VA peripheral nerves conditions examination, the examiner noted a diagnosis of bilateral lower extremity radiculopathy, sciatic nerve, with moderate incomplete paralysis. Upon examination, the examiner noted the following symptoms bilaterally: moderate constant pain, paresthesias and/or dysesthesias, and numbness. Muscle strength was normal, five out of five, on all areas tested, without muscle atrophy. Reflexes were normal on all areas tested. Decreased sensation to light touch was noted of the bilateral upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. Trophic changes were denied. The Veteran had normal gait. In terms of functional impact, the examiner noted that the legs have pain, tingling, and numbness that results in difficulty with prolonged walking. For the period from August 26, 2013 to February 11, 2019, higher, 20 percent ratings, for bilateral lower extremity radiculopathy of the sciatic nerve are warranted. The severity of the Veteran's disorder has manifested as moderate incomplete paralysis during the period, which is commensurate with a 20 percent evaluation under DC 8520. VA treatment records show that the Veteran has undergone many lumbar epidural steroid injections to treat her bilateral lumbar radiculopathy during the period. February 2012 VA treatment records show that the Veteran reported that she has constant radiating pain to her right buttock and leg, described as seven out of ten in-severity and, at worst, ten out of ten. However, the September 2013 VA treatment records shows that the Veteran reported that she has intermittent radiating pain to her right buttock and knee, described as seven out of ten in-severity. The February 2017 private treatment record shows that the Veteran reported dull aching pain to the right lower extremity. The March 2018 private medical record shows that the Veteran reported constant, aching, throbbing pain, radiating to the bilateral hip. The August 2018 VA back examination shows mild intermittent pain bilaterally, which was described as usually dull. The April 2016 VA emergency department note shows that the Veteran denied bilateral lower extremity numbness, tingling, and weakness. The February 2017 private treatment record shows that the Veteran reported numbness, tingling, sharp shooting pain, and weakness bilaterally. The November 2017 private medical record shows reported progressive bilateral leg weakness, and numbness and tingling in the right leg. The August 2018 VA back examination shows no numbness, constant pain, or paresthesias or dysesthesias bilaterally. For the period from August 26, 2013 to February 11, 2019, the Veteran has described her pain as constant at times, and intermittent at other times. She has described her pain level as seven out of ten and, at worst, ten out of ten; she has also described her pain as dull. She has both denied and endorsed symptoms of numbness, tingling, and weakness during the period. The Veteran has also undergone many lumbar epidural steroid injections to treat her bilateral lumbar radiculopathy during the period. As noted above, the August 2018 VA examiner noted that the disorder was mild in severity, with symptoms of mild intermittent pain bilaterally, described as usually dull, without numbness, constant pain, or paresthesias or dysesthesias. However, the remainder of the evidence during the period, considered together with the need for many lumbar epidural steroid injections to treat her bilateral lumbar radiculopathy, tends to support a disability picture that is most aptly characterized as moderate. As the evidence shows that the Veteran's symptoms are most aptly characterized as moderate during the period, higher, 20 percent ratings, are warranted under DC 8520, during the period, and the claims are granted. However, higher, 40 percent ratings, are not warranted as the evidence does not show moderately severe incomplete paralysis of the right or left lower extremity at any time during the period and, to this extent, the claims are denied. For the period from February 12, 2019 to the present, a higher, 40 percent rating, but not higher, is warranted for right lower extremity radiculopathy, sciatic nerve, as the severity of the condition has shown to have manifested as moderately severe incomplete paralysis during the period. DC 8520. Although the February 2019 VA examiner characterized the right lower extremity sciatic radiculopathy as mild in-severity, the examination shows symptoms of severe constant and intermittent pain, paresthesias and/or dysesthesias, and numbness. The November 2021 VA the examiner characterized the right lower extremity sciatic nerve radiculopathy as resulting in moderate incomplete paralysis, with symptoms of moderate constant pain, paresthesias and/or dysesthesias, and numbness. Given this evidence, the Veteran's symptoms are most aptly characterized as moderately severe during the period. Therefore, a higher, 40 percent rating, is warranted under DC 8520 during the period, and the claim is granted. However, a rating higher than 40 percent is not warranted as the evidence does not show muscular atrophy or complete paralysis of the right lower extremity at any time during the period and, to this extent, the claim is denied. For the period from February 12, 2019 to the present, a higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, is not warranted, as the severity of the condition has shown to have manifested no worse than moderately severe incomplete paralysis during the period, which is commensurate with a 40 percent evaluation under DC 8520. The evidence does not show muscular atrophy or complete paralysis of the left lower extremity at any time during the period. As the evidence shows that the Veteran's symptoms are most consistently characterized as moderately severe during the period, a rating higher than 40 percent is not warranted under DC 8520 at any time during the period, and the claim is denied. The Board has considered the Veteran's lay statements. See Layno, 6 Vet. App. 465, at 470. To the extent that the Veteran has argued that higher ratings for right and left lower extremity radiculopathy, sciatic nerve, are warranted, these assertions are outweighed by more probative evidence provided by the examinations of qualified medical professionals. See Jones, 7 Vet. App. 134, at 137-138. As such, her lay statements do not provide any basis upon which to assign any higher ratings. (CONTINUED ON THE NEXT PAGE) In conclusion, for the period from August 26, 2013 to February 11, 2019, higher, 20 percent ratings, but not higher, for bilateral lower extremity radiculopathy, sciatic nerve, are warranted, and the claims are granted; for the period from February 12, 2019 to the present, a higher, 40 percent rating, but not higher, is warranted for right lower extremity radiculopathy, sciatic nerve, and the claim is granted; and for the period from February 12, 2019 to the present, a rating higher than 40 percent for left lower extremity radiculopathy, sciatic nerve, is not warranted, and the claim is denied. To the extent that the claims have been denied, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Timothy T. Emmart The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.