Citation Nr: 22019941 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 09-41 803 DATE: April 3, 2022 ORDER Entitlement to an initial 20 percent rating for thoracolumbar spine disability (thoracolumbar strain, bilateral L5 spondylosis, Grade 1 L5 on S1 anterolisthesis) from November 19, 2008, to December 12, 2021, is denied. Entitlement to an initial 10 percent rating for right knee disability (right knee medial meniscus tear status post partial arthroscopic meniscectomy) under Diagnostic Code 5259 is denied. Entitlement to a separate 10 percent rating, but no higher, for right knee limitation of flexion under Diagnostic Code 5260 is granted from November 27, 2009, to December 12, 2021, is granted subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial 10 percent rating for right ankle disability (healed right ankle fracture) from November 19, 2008, to December 12, 2021, is denied. Entitlement to an initial compensable rating for abdominal incisional hernia is denied. Entitlement to an initial 20 percent rating for right lower extremity radiculopathy with sciatic nerve involvement is granted, granted subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial 20 percent rating for left lower extremity radiculopathy with sciatic nerve involvement is granted, granted subject to the law and regulations governing the payment of monetary benefits. REMANDED Entitlement to an initial 20 percent rating for thoracolumbar spine disability since December 13, 2021, is remanded. Entitlement to an initial 10 percent rating for right knee disability since December 13, 2021, is remanded. Entitlement to an initial 10 percent rating for right ankle disability since December 13, 2021, is remanded. FINDINGS OF FACT 1. From November 19, 2008, to December 12, 2021, the Veteran's thoracolumbar spine disability was not manifested by forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. 2. From November 19, 2008, to November 26, 2009, the Veteran's right knee disability was manifested by tenderness to palpation over medial joint line and painful motion. 3. From November 27, 2009, to December 12, 2021, the Veteran's right knee disability was manifested by a small amount of edema, tenderness to palpation, clicking, and painful motion. 4. Prior to December 13, 2021, the Veteran's right ankle disability more nearly approximated moderate, and not marked, limitation of ankle motion. 5. The Veteran's abdominal incisional hernia has not been manifested by a small or large postoperative ventral hernia that is not well supported by a belt under ordinary conditions or a healed ventral hernia or postoperative wounds with weakening of abdominal wall and indication for a supporting belt. 6. During the entire appeal period, the Veteran's right lower extremity radiculopathy resulted in moderate incomplete paralysis of the sciatic nerve. 7. During the entire appeal period, the Veteran's left lower extremity radiculopathy resulted in moderate incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. Prior to December 13, 2021, the criteria for an initial 20 percent rating for thoracolumbar spine disability were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5239. 2. Prior to December 13, 2021, the criteria for an initial 10 percent rating for right knee disability were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5259. 3. From November 27, 2009, the criteria for a separate 10 percent rating, but no higher, for right knee painful motion, were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 4. Prior to December 13, 2021, the criteria for an initial 10 percent rating for right ankle disability were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 5. The criteria for an initial compensable rating for abdominal incisional hernia have not been met. U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.114, Diagnostic Code 7339. 6. The criteria for an initial rating of 20 percent, but no higher, for right lower extremity radiculopathy with sciatic nerve involvement have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 7. The criteria for an initial rating of 20 percent, but no higher, for left lower extremity radiculopathy with sciatic nerve involvement have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the Marine Corps from November 1990 to November 2003 and in the Army from August 2005 to November 2008. These matters were originally on appeal from a December 2008 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Louisville, Kentucky. The matters were previously before the Board of Veterans' Appeals (Board) and remanded in May 2012 and November 2021. Increased Rating 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. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, 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. The Veteran is appealing the original assignment of disability evaluations following awards of service connection for a thoracolumbar spine disability, a right knee disability, a right ankle disability, an abdominal incisional hernia, and bilateral lower extremity sciatic nerve disability. As such, it is not the present level of disability which is of primary importance, but rather the entire period is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. [Include any other relevant Note(s).] At the outset, the Board finds the VA examinations prior to December 13, 2021, taken in conjunction with records of medical treatment and lay statements of symptoms, are an adequate basis upon which to determine the extent and severity of the Veteran's thoracolumbar spine, right knee, and right ankle disabilities. To the extent that the examinations may have failed to assess whether additional functional limitation or range of motion loss occurred with repeated use over time or with flare ups, the examinations still have probative value for determining the Veteran's symptoms during the period on appeal as the Veteran's lay statements sufficiently suggest the impact of flare-ups and repeated use over time on his condition. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (holding "Furthermore, even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight."). 1. Entitlement to an initial 20 percent rating for thoracolumbar spine disability prior to December 13, 2021 The Veteran contends that he is entitled to a higher rating for his thoracolumbar spine disability; on his Notice of Disagreement received in August 2009, the Veteran noted that he was issued a full upper body brace due to the severity of his condition. On his VA Form 9, Appeal to the Board of Veterans' Appeals, received in October 2009, he noted that he had erectile dysfunction and bowel incontinence due to his thoracolumbar spine and that he had pain and had been issued an upper body immobilizing brace. The Veteran's thoracolumbar spine disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5239. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Id. at Note 2. The Veteran underwent VA examination in September 2008, prior to his discharge from active duty, at which time he reported constant low back aching pain rated as a 3 out of 10 which radiated into his posterior thighs. The Veteran denied any periods of flareups and denied bowel and bladder incontinence. The Veteran denied using a cane, crutch, or walker and was noted to be unable to use a thoracolumbar brace or orthosis. The Veteran reported that he could walk at least three miles. Physical examination demonstrated flexion from zero to 75 degrees, extension from zero to 25 degrees, left lateral flexion from zero to 30 degrees, right lateral flexion from zero to 30 degrees, left lateral rotation from zero to 25 degrees, and right lateral rotation from zero to 25 degrees. There was no pain with any motion and no additional loss of motion on repetitive use testing. There was no objective evidence of pain on motion, muscle spasm, or weakness. Muscle strength was normal with no evidence of muscle atrophy, reflexes were normal, and sensation was intact. Straight leg raise was negative. X-ray of the thoracolumbar spine demonstrated spondylosis at L5 with grade 1 spondylolisthesis of L5 on S1. The Veteran was diagnosed as having thoracolumbar strain, bilateral L5 spondylosis, and grade 1 L5 on S1 anterolisthesis. The examiner found no objective clinical evidence that function was additionally limited by pain, fatigue, weakness, incoordination or lack of endurance with repetitive motion testing. VA treatment records indicate that in November 2008, the Veteran was seen for low back pain. On physical examination demonstrated flexion to 60 degrees, extension to 15 degrees, and right and left lateral bending to 15 degrees. Percussion and palpation revealed no evidence of spasm. Straight leg raising showed very little tightness of the hamstring musculature. In February 2009, the Veteran presented with increased pain approximately three weeks prior when he took his children sledding and that he twisted his back while walking. At that time, he was issued a plastic body/shell to decrease motion involving his lumbar spine, he was prescribed oxycodone and gabapentin for back. The Veteran underwent lumbar epidural steroid injections in April 2009 and June 2009. In July 2009, the Veteran reported that the June 2009 injection only provided approximately one month of relief. The Veteran underwent VA examination in November 2009 at which time he reported constant dull low back pain rated at a 4 out of 10 and sharp excruciating low back pain rated 8 to 9 out of 10 during flareups. The Veteran also reported stiffness, weakness, fatigability, spasms, numbness & tingling in the lower extremities (hips/buttocks, lower legs, feet). The Veteran reported that flareups occurred approximately every two weeks and were of one to two days duration. The Veteran noted that during flareups, he was only able to sit and watch television; he reported using a back brace during flareups. The Veteran denied any problems with his bowel or bladder. The Veteran denied any incapacitating episodes in the prior 12-month period. Physical examination demonstrated normal and symmetric musculature, no vertebral or paravertebral tenderness, mild scoliosis and some flattening of the lumbar region. Flexion was from zero to 70 degrees with pain at 60 degrees, extension from zero to 11 degrees with pain at 10 degrees; right lateral flexion from zero to 15 degrees with pain at 10 degrees, left lateral flexion from zero to 17 degrees with pain at 15 degrees, right lateral rotation from zero to 15 degrees, and left lateral rotation from zero to 15 degrees. There was no additional loss of motion on repetitive use testing, no tenderness to palpation, no objective evidence of spasm, and no evidence of weakness. The Veteran was diagnosed as having chronic lumbago with straightening of the normal lumbar lordosis, chronic grade 1 spondylolisthesis L5 on S1 with bilateral pars defect, chronic degenerative changes of the lumbar spine, and chronic congenital mild scoliosis. VA treatment records include numerous visits to the pain clinic. In June 2011, physical examination of the lumbar spine showed no evidence of spasm; motion was limited with flexion to 50 degrees, extension to 5 degrees, and lateral bending to 5 degrees. The Veteran was prescribed long-acting morphine sulfate SA 15 mg twice a day; he was noted to have Percocet at home which could help with break-through pain. In August 2011, the Veteran report that he stopped taking his morphine approximately two weeks prior and that his back pain had worsened. Physical examination showed mild limitations with endpoint causing pain. In September 2011, motion involving the lumbosacral spine showed some hesitancy to full flexion with reproduction of his pain, as did extension. He noted that he was taking 5 to 6 tablets a day of Percocet; and was restarted on his morphine. In March 2012, the Veteran reported that his low back pain had worsened a month prior while bending on the instructions of a chiropractor for SSA disability evaluation; there had no change in the pain since that time. In June 2012, the Veteran reported low back pain with radiation to buttocks and posterior thigh brought on by activities which required bending and stooping activities. Physical examination demonstrated flexion to 50 degrees, extension 5 degrees, and lateral bending 5 degrees. The Veteran underwent VA examination in September 2012 at which time he stated that flareups occurred with too much movement regarding walking, standing, or too much exertion. Physical examination of the thoracolumbar spine demonstrated flexion from zero to 60 degrees with pain at 50 degrees, extension from zero to 15 degrees with pain at 10 degrees; right lateral flexion from zero to 20 degrees with pain end of maneuver, left lateral flexion from zero to 15 degrees with pain at end of maneuver, right lateral rotation from zero to 20 degrees with pain at end of maneuver, and left lateral rotation from zero to 20 degrees with pain at end of maneuver. There was no additional loss of motion on repetitive use testing, no tenderness to palpation, no objective evidence of spasm, and no evidence of weakness. The examiner noted that he could not portray flareups in terms of additional degrees of motion lost as the Veteran did not exhibit a flareup during the examination. VA treatment records indicate that the Veteran was seen in July 2014 for pharmacy assessment at which time he stated that when he mowed the lawn and had increased activity, he experienced worsening pain in his low back. He rated his back pain as two to three out of 10. There was extensive discussion regarding long-term opiate use and risks as well as ultimately transitioning to improving function without the use of opiates if possible. The physician noted that she did not think opiates were indicated at that time given the Veteran's diagnosis of mild/moderate degenerative disc disease. Morphine dose was decreased to 7.5 mg twice a day. The Veteran was seen in chiropractic clinic in April 2016 with complaints of low back pain and bilateral leg pain rated as 3 out of 10. Physical examination demonstrated thoracic paraspinal pain and spasm, lumbosacral paraspinal tenderness, and sciatic notch on the right. Flexion was limited to 75 to 80 degrees, extension 5 to 20 degrees, right lateral flexion 30 to 35 degrees, left lateral flexion 30 to 35 degrees, right lateral rotation 30 to 35 degrees, and left lateral rotation 30 to 35 degrees. In May 2018, the Veteran was seen by primary care physician as a new patient due to his moving states. At that time, the Veteran noted having chronic low back pain with good relief after treatment with VA chiropractor. The Veteran was seen by his primary care physician in July 2019, January 2020 at which time there was no decreased range of motion, inflammation, or tenderness of the spine or in the paraspinal region. The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for his thoracolumbar spine disability. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain during flare-ups. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Prior to December 13, 2021, flexion of the thoracolumbar spine was consistently above 30 degrees; and at its worst, when the Veteran's physician found it necessary to prescribe morphine for the Veteran's pain, flexion was to 50 degrees. As noted above, normal forward flexion of the thoracolumbar spine is zero to 90 degrees. At no time during the period prior to December 13, 2021, did the Veteran suggest that during a flare-up he lost more than 50 percent of his motion on flexion. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, there is no evidence that prior to December 13, 2021, the Veteran had been prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Based on the foregoing, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for his thoracolumbar spine disability prior to December 13, 2021. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to an initial 10 percent rating for right knee disability prior to December 13, 2021 The Veteran contends that he is entitled to a higher rating for his right knee disability; on his Notice of Disagreement received in August 2009, the Veteran noted that he was issued a knee brace due to instability in his knee as well as a cane to help keep balance. The Veteran's right knee disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5259. The Board notes that effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg; however, Diagnostic Code 5259 was unchanged. Under Diagnostic Code 5259, a 10 percent rating is warranted for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, Diagnostic Code 5259. As the Veteran is in receipt of the highest schedular rating for dislocation of symptomatic removal of semilunar cartilage, there is no basis to award a higher evaluation. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Disabilities of the knees are evaluated pursuant to the criteria within 38 C.F.R. § 4.71a , including Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). 38 C.F.R. § 4.71a, Diagnostic Code 5256 provides for a 30 percent rating (and even higher ratings) for ankylosis of a knee in a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. Ankylosis is immobility and consolidation of a joint due to disease, injury, surgical procedure. Nix v. Brown, 4 Vet. App. 462, 465 (1993); and Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). According to Diagnostic Code 5257, other impairment of the knee, to include recurrent subluxation or lateral instability, provides for a 10 percent rating when there is evidence of slight recurrent subluxation or lateral instability of a knee; a 20 percent rating when there is evidence of moderate recurrent subluxation or lateral instability; and a 30 percent rating when there is evidence of severe recurrent subluxation or lateral instability. The words "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. Pursuant to 38 C.F.R. §§ 4.40 and 4.45, pain is inapplicable to ratings under Diagnostic Code 5257 because it is not predicated on loss of range of motion. See Johnson v. Brown, 9 Vet. App. 7, 11 (1996). 38 C.F.R. § 4.71a, Diagnostic Code 5258 provides for a 20 percent rating for a dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the knee joint. Under Diagnostic Code 5260, a noncompensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees. Under Diagnostic Code 5261, a noncompensable rating will be assigned for limitation of extension of the leg to 5 degrees; a 10 percent rating will be assigned for limitation of extension of the leg to 10 degrees; a 20 percent rating will be assigned for limitation of extension of the leg to 15 degrees; a 30 percent rating will be assigned for limitation of extension of the leg to 20 degrees; a 40 percent rating will be assigned for limitation of extension of the leg to 30 degrees; and a 50 percent rating will be assigned for limitation of extension of the leg to 45 degrees. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Compensating a claimant for separate functional impairment under Diagnostic Code 5257 and 5003 does not constitute pyramiding. VAOPGCPREC 23-97 (July 1, 1997) held that arthritis and instability of the same knee may be rated separately under Diagnostic Codes 5003 and 5257. Subsequently, VAOPGCPREC 9-98 further explained that if a Veteran has a disability rating under Diagnostic Code 5257 for instability of the knee, and there is also x-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. See also VAOPGCPREC 9-04 (holding that separate ratings under Diagnostic Code 5260 for limitation of flexion of the knee and Diagnostic Code 5261 for limitation of extension of the knee may be assigned). At the September 2008 VA examination, the Veteran reported right knee pain rated as five out of 10 over the medial aspect of the knee as well as stiffness, swelling, popping, and catching. He denied erythema, calor, instability or giving way, episodes of lacking, fatigability, and lack of endurance. The Veteran also denied periods of flareups. Physical examination of the right knee demonstrated no erythema, calor, soft tissue swelling, ecchymoses, joint effusion. The right knee was stable to varus and valgus stress at zero and 30 degrees. There was a negative anterior drawer, Lachman, posterior drawer, and McMurray. Muscle strength was normal. There was no tenderness to palpation over medial joint line or lateral joint line. The Veteran's gait was normal; and there was no erythema or calor of the right knee, no callosities or breakdown of the right foot, and no unusual shoe wear pattern of the right shoe. Right knee motion from zero to 125 degrees active and zero to 130 degrees passive. Motion was pain past 120 degrees. There was no additional loss of motion on repetitive use testing. The examiner found no objective clinical evidence that function was additionally limited by pain, fatigue, weakness, incoordination or lack of endurance with repetitive motion testing. The Veteran was diagnosed as having right knee medial meniscus tear, status post right partial right knee medial meniscectomy, arthroscopic. The examiner specifically noted that the Veteran was not limited in performing any of the activities of being a soldier due to his right knee disability, and that the Veteran confirmed he could continue being a soldier despite his right knee. VA treatment records indicate that in June 2009, the Veteran was seen with complaint that his right knee pain felt like his knee was going to explode. At the November 27, 2009, VA examination, the Veteran reported right knee pain, weakness, stiffness, instability, locking up and fatigability. The Veteran reported that he required a knee brace during flareups. The Veteran noted that functional limitations related to flareups necessitated his having to staff of his knee and rest. Physical examination demonstrated right knee range of motion from zero to 105 degrees with pain starting at 95 degrees. There was no additional loss of motion on repetitive use testing. There was a small amount of edema at the medial aspect of the right knee as well as mild tenderness to palpation at that location. There was clicking in the right knee but no instability; and there was negative drawer and McMurray. The Veteran was diagnosed as having right knee meniscal tear with arthroscopic repair in 2006 and chronic right knee arthralgia. The examiner noted that the Veteran's right knee mildly affected his activities and moderate-to-severely affected his activities during a flareup. At the September 2012 VA examination, the Veteran stated that his knee occasionally became sore spontaneously and that it popped. He stated that because of the soreness, he would wear his brace. Physical examination demonstrated right knee motion from zero to 110 degrees. There was no additional loss of motion on repetitive use testing. The examiner noted that he could not portray flareups in terms of additional degrees of motion lost as the Veteran did not exhibit a flareup during the examination; however, the examiner noted that the Veteran did not demonstrate any tenderness of the right knee on palpation nor pain during range of motion measurements. The question of whether separate ratings could be assigned under 5257, 5258, 5259, 5260, and/or 5261 was addressed by the Court in Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Lyles, a veteran was in receipt of a rating for instability and a separate rating for limitation of range of motion, but also sought a third separate rating for a meniscal disability. The Court held "that evaluation of a knee disability under [Diagnostic Codes] 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under [Diagnostic Code] 5258 or 5259," as such is a fact specific inquiry. Id., 29 Vet. App. at 114-115. The Board notes that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis, and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Initially, the Board notes that the Veteran does not contend, and the evidence does not demonstrate right knee ankylosis, impairment of tibia or fibula, or genu recurvatum to warrant consideration under Diagnostic Codes 5256, 5262, or 5263, respectively. In addition to the symptoms noted above, the Veteran reported having right knee instability at the November 2009 VA examination although he denied having instability or giving way in September 2008; and on physical examination, no objective evidence instability was found in September 2008 or November 2009. Thus, the Board gives greater probative weight to the medical findings that the right knee was stable to varus and valgus stress at zero and 30 degrees in September 2008 and that there was no instability in the November 2009. Although the VA examiners noted the Veteran's reports of right knee instability and brace use, their opinions were made after physical examination and instability testing and determined instability was not present. As such, Diagnostic Code 5257 does not allow for a separate or higher rating. Diagnostic Code 5258 is not for application because the Veteran's meniscus has partially been removed, and any symptoms from his current meniscal disability are fully contemplated by the evaluation provided under Diagnostic Code 5259. Considering Diagnostic Code 5260, the Veteran's right knee flexion was, at worse, 105 degrees with pain at 95 degrees at the November 2009 VA examination. Although right knee flexion was limited, his limitation of motion did not meet the criteria for a compensable rating under Diagnostic Code 5260. Similarly, a higher or separate rating under Diagnostic Code 5261 based on limitation of extension is also not warranted. As reflected above, the Veteran's right knee extension was consistently full at zero degrees which warrants a noncompensable rating under Diagnostic Code 5261. Nonetheless, the evidence shows that the Veteran's right knee flexion was painful at 120 degrees in September 2008 and at 95 degrees in November 2009. A review of the evidence reflects that prior to November 27, 2009, although the Veteran reported right knee symptoms of stiffness, swelling, popping, and catching, physical examination only demonstrated tenderness to palpation over medial joint line and painful motion. Thus, the only objective right knee residual identified during the September 2008 VA examination was pain. The Board, therefore, finds that there were no residual symptoms of the Veteran's right knee disability prior to November 27, 2009, other than knee joint pain which was already compensated under Diagnostic Code 5259. On November 27, 2009, however, physical examination demonstrated a small amount of edema, tenderness to palpation, clicking, and painful motion. Thus, as edema and clicking were objectively identified as a residual of the Veteran's right knee disability, a separate 10 percent rating is warranted under Diagnostic Code 5260 from November 27, 2009, for limited, yet noncompensable, flexion of the right knee due to pain. See 38 C.F.R. §§ 4.40, 4.45; See also DeLuca, 8 Vet. App. at 202. A higher rating is not warranted under Diagnostic Code 5260. At its worst, the Veteran still had flexion at 105 degrees with pain at 95 degrees. In order for a higher rating to be assigned, flexion would require limitation of 30 degrees or less. As noted above, normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. At no time during the period prior to December 13, 2021, did the Veteran suggest that during a flare-up he lost more than 75 percent of his motion on flexion. In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 10 percent for right knee disability under Diagnostic Code 5259 prior to December 13, 2021, but supports a separate 10 percent rating for right knee painful motion under Diagnostic Code 5260 from November 27, 2009. 3. Entitlement to an initial 10 percent rating for right ankle disability prior to December 13, 2021 The Veteran contends that he is entitled to a higher rating for his right ankle disability; on his Notice of Disagreement received in August 2009, the Veteran noted that he was issued a brace and was having burning pain and stiffness. On his VA Form 9, received in October 2009, he noted that he had marked limitation of motion, had constant pain, and had been issued an ankle brace. On his VA Form 9 received in October 2009, he noted pain, that his knee was locking up, and that he wore a knee brace. The Veteran's right ankle disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271, for limitation of motion of the ankle. Effective February 7, 2021, VA amended the rating criteria for Diagnostic Code 5271. 85 Fed. Reg. 76,453 (Nov. 30, 2020). As this regulatory change was enacted during the pendency of this appeal, the Board will consider both the old and new versions of the rating criteria from the effective date and apply the version most favorable to the Veteran. Under the former criteria, a 10 percent rating is warranted for moderate limited motion of the ankle and a 20 percent rating is warranted for marked limited motion of the ankle. Id. Under the new criteria, a 10 percent rating is warranted for moderate limited motion of the ankle (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion.) A 20 percent rating is warranted for marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.) For purposes of VA compensation, normal dorsiflexion of the ankle is zero to 20 degrees and normal ankle plantar flexion is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate II. Although not effective until February 7, 2021, the Board finds the definitions of "moderate" and "marked" found in the amended Diagnostic Code 5271 criteria instructive. The words "moderate" and "marked" as defined by Merriam-Webster's dictionary, help define these terms as "average in amount, intensity, quality, or degree," and "clearly noticeable; evident," respectively. See www.merriam-webster.com/dictionary/marked. Thus, prior to February 7, 2021, the Board will apply the words "moderate" and "marked" as found under Diagnostic Code 5271 in the most favorable light whether applying the Merriam-Webster dictionary definition in light of the evidence or in light of the range of motion instructions found in the amended version of Diagnostic Code 5271. For purposes of VA compensation, normal dorsiflexion of the ankle is zero to 20 degrees and normal ankle plantar flexion is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate II. At the September 2008 VA examination, the Veteran reported mild right ankle pain rated as three out of 10 over the medial, anterior, and lateral aspects of the ankle as well as stiffness, intermittent swelling, and recurrent instability or giving way. He denied weakness, popping, catching, locking, fatigability, and lack of endurance. The Veteran also denied periods of flareups. Physical examination of the right ankle demonstrated no soft tissue swelling, ecchymoses, or varus or valgus malangulation. There was no tenderness to palpation over the medial malleolus, the anterior joint line, or the lateral malleolus. The Veteran's gait was normal; and there was no erythema or calor of the right ankle, no callosities or breakdown of the right foot, and no unusual shoe wear pattern of the right shoe. Right ankle dorsiflexion was zero to 15 degrees active and zero to 20 degrees passive; and plantar flexion was zero to 30 degrees active and zero to 35 degrees passive. There was no pain with any motion and no additional loss of motion on repetitive use testing. The examiner found no objective clinical evidence that function was additionally limited by pain, fatigue, weakness, incoordination or lack of endurance with repetitive motion testing. The Veteran was diagnosed as having healed right ankle fracture with restricted residual range of motion. VA treatment records indicate that in June 2009, the Veteran was seen with complaint of right ankle pain on and off for prior six months but unbearable for the prior month. At the November 2009 VA examination, the Veteran reported right ankle pain, weakness, swelling, and constant popping. Physical examination demonstrated right ankle dorsiflexion from zero to 10 degrees and plantar flexion from zero to 38 degrees. There was a 2-degree loss of motion on repetitive use testing on dorsiflexion but no additional loss of motion on repetitive use testing on plantar flexion. There was no instability of the right ankle but there was crepitus; there was negative talar and drawer of the right ankle. The Veteran was diagnosed as having chronic right ankle arthralgia status post right ankle fracture. At the September 2012 VA examination, the Veteran stated that his right ankle flared up spontaneously at which time he would wear a brace. Physical examination demonstrated right ankle dorsiflexion from zero to 10 degrees and plantar flexion from zero to 40 degrees. There was no pain or additional loss of motion noted on repetitive use testing. The examiner noted that he could not portray flareups in terms of additional degrees of motion lost as the Veteran did not exhibit a flareup during the examination. The Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for right ankle disability. The Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for right ankle disability because, at its worst, dorsiflexion measured 10 degrees and plantar flexion measured 30 degrees. Even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation reflected by the statements would not result in symptoms more nearly approximating marked limited motion or less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. As noted above, normal dorsiflexion of the ankle is zero to 20 degrees and normal ankle plantar flexion is zero to 45 degrees. At no time during the period prior to December 13, 2021, did the Veteran suggest that during a flare-up he lost more than half of his motion on dorsiflexion or plantar flexion. In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's appeal for a rating in excess of 10 percent for right ankle disability. As the evidence of record persuasively weighs against a rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 776. 4. Entitlement to an initial compensable rating for abdominal incisional hernia The Veteran contends that he is entitled to a higher rating for his abdominal incisional hernia; on his Notice of Disagreement received in August 2009, the Veteran noted that he had a bulging scar and muscle spasms. On his VA Form 9 received in October 2009, he noted that he had bulging in abdominal well and weaking in the abdominal area where mesh was placed. The Veteran's abdominal incisional hernia has been rated under 38 C.F.R. § 4.114, Diagnostic Codes 7399-7339. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. When an unlisted condition is encountered requiring rating by analogy, the diagnostic code will be "built up" as follows: the first two digits will be selected from that part of the rating schedule most closely identifying the part, or system of the body involve, and the last two digits will be "99" for all unlisted conditions. Diagnostic Code 7339 provides a noncompensable rating for postoperative ventral hernia with healed postoperative wounds with no disability and a belt not indicated. A 20 percent rating is assigned for a small postoperative ventral hernia that is not well supported by a belt under ordinary conditions or a healed ventral hernia or postoperative wounds with weakening of abdominal wall and indication for a supporting belt. A 40 percent rating is assigned for a large postoperative ventral hernia that is not well supported by a belt under ordinary conditions. A 100 percent rating is assigned for a massive persistent postoperative ventral hernia with severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. 38 C.F.R. § 4.114. At the September 2008 VA examination, it was noted that the Veteran developed a hernia after a surgery for colon cancer; and in May 2008, he had repair of a large ventral incisional hernia utilizing mesh. It was noted that the Veteran had a small remaining hernia above the superior edge of the incision in the midline which was 2 inches by 2 inches in size. Physical examiner demonstrated that the hernia above the level of the midline incision was mildly symptomatic, it was reducible, and it was not inoperable. A computerized tomography (CT) scan of the abdomen in July 2009 showed multiple fat containing ventral wall hernias. VA treatment records indicate that he was seen by his primary care physician in November 2009 at which time the physician noted that the Veteran had a longstanding umbilical hernia without change which was large and easily reducible. At the November 2009 VA examination, the Veteran's abdomen was nontender and nondistended; there was no organ enlargement, ventral hernia, mass, or tenderness. There was an umbilical hernia visible. At the September 2012 VA examination, the examiner noted that the Veteran had a ventral hernia and an umbilical hernia. The Veteran stated that the hernias had been surgically corrected with the use of mesh but had returned with the development of the umbilical hernia and another located at the superior aspect of his old abdominal scar in the epigastric area. The examiner noted that the Veteran underwent abdominal wall herniorrhaphy with placement of mesh in 2008 and that following surgical repair, the Veteran had recurrent hernias (small and large ventral hernias) which appeared operable and remediable. The examiner noted that the Veteran's superior incisional hernia was 1.8 centimeters in diameter and the umbilical hernia was 3.4 centimeters in diameter. There was no indication for a supporting belt. The examiner stated that the Veteran's umbilical hernia would be well supported by a belt under ordinary conditions but was not required and that there was no need for support of the superior small ventral incisional hernia. The examiner stated that there was no weaking of the abdomen by examination and no need for a supporting belt. VA treatment records indicate that the Veteran was seen by his primary care physician in January 2014 at which time physical examination of his abdomen showed a midline hernia easily reducible along incision line. In December 2016, the Veteran was seen with complaints of abdominal pain, distension, nausea, and non-bloody emesis. On physical examination, the Veteran demonstrated a 4-centimeter reducible umbilical hernia with other less obvious midline defects. The Veteran was diagnosed as having recurrent fat-containing umbilical hernia along the inferior margin of the mesh in the midline and status post supraumbilical ventral hernia repair with mesh. The Veteran underwent VA examination in December 2021 at which time he described a chronic umbilical hernia which was protruding but reducible and not painful. On physical examination, there was a large healed postoperative ventral hernia with wounds and weaking of abdominal wall. In addition, from the ventral hernia repair, there was a small midline defect palpable in the abdominal wall that is nontender with no palpable protrusion. Initially, the Board notes that the Veteran's disability is a postoperative ventral hernia; as such, it is not an unlisted condition. A ventral hernia refers to any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall. Umbilical and incisional hernias are specific types of ventral hernias. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernias/ventral-abdominal-hernia. In this case, the disability before the Board is an incisional hernia The Board finds that the Veteran's ventral hernia symptomatology does not warrant a compensable rating. Although the Veteran was noted to have a large hernia in September 2012 and weakening of the abdominal well in December 2021, at no time during the appeal period has the Veteran's hernia been noted to be "not well supported by a belt under ordinary conditions" or with "indication for a supporting belt." The September 2012 and December 2021 VA examiners noted that there was no indication for a supporting belt for either the superior incisional hernia which was 1.8 centimeters in diameter or for the umbilical hernia which was 3.4 centimeters in diameter. The September 2012 VA examiner specifically opined that the umbilical hernia would be well supported by a belt under ordinary conditions but was not required and that there was no need for support of the superior small ventral incisional hernia. In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's appeal for a compensable rating for abdominal incisional hernia. As the evidence of record persuasively weighs against a rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, 21 F.4th at 776. 5. Entitlement to an initial compensable rating for right lower extremity radiculopathy with sciatic nerve involvement 6. Entitlement to an initial compensable rating for left lower extremity radiculopathy with sciatic nerve involvement The Veteran contends that he is entitled to a higher ratings for his sciatic nerve pain; on his Notice of Disagreement received in August 2009, the Veteran noted that he has constant sciatic nerve pain. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). As noted above, at the September 2008 VA examination, the Veteran reported constant low back aching pain rated as a three out of 10 which radiated into his posterior thighs. Physical examination demonstrated that motor strength was normal, reflexes were normal except for trace in the ankles, and sensory testing revealed decreased pin sensation in fingers and toes. The examiner diagnosed the Veteran with peripheral neuropathy most likely related to chemotherapy for treatment of colon cancer. VA treatment records indicate that in November 2008, neurological examination of the lower extremities revealed reflexes to be symmetric except there was absence of both Achilles. Manual muscle testing revealed normal strength and muscle tone was normal. Sensation was grossly intact, and position sense was present. As noted above, at the November 2009 VA examination, the Veteran reported numbness & tingling in the lower extremities (hips/buttocks, lower legs, and feet). The examiner noted that the nerves affected in the lower extremities were L4-5, S1 left foot bilateral sciatic nerves. Lower extremity muscle strength was normal, reflexes were normal, and straight leg raise was positive for low back pain but negative for posterior thighs. There was decreased sensation to vibration of the left leg, decreased sensation to monofilament to bilateral feet, and positioning and vibration were intact in the lower extremities. The Veteran was diagnosed as having chronic peripheral neuropathy of extremities secondary to chemotherapy. At the VA pain clinic in May 2011, June 2011, August 2011, September 2011, physical examinations demonstrated normal reflexes, muscle strength, and sensation. In March 2012, there was no radiation, no lower extremity weakness, and no bowel or bladder trouble. In June 2012, straight leg raising revealed mild tightness of the hamstring musculature; neurological examination was within normal limits in regard to reflexes, manual muscle testing, and sensation; and muscle tone was normal. At the September 2012 VA examination, the Veteran described intermittent pain in the lower extremities and numbness in his feet. Physical examination demonstrated severe intermittent pain and mild paresthesias and/or dysesthesias, and numbness of the lower extremities. The examiner was asked to express an opinion as to whether the Veteran's sciatic nerve deficits were less than mild, moderate, moderately severe, or severe to which she answered, "It is my medical opinion that the veteran's nerve deficit of the lower extremities is mild by neurological examination." As noted above, the Veteran was seen in chiropractic clinic in April 2016 at which time deep tendon reflexes were normal in the patellar, left Achilles, and hamstrings but hypoactive in the right Achilles. Lower extremity dermatome testing was normal; and muscle strength testing was normal. The Veteran underwent EMG in July 2016 at which time the nerve conduction studies and needle examination of the lower extremities were normal. In May 2017, the Veteran was seen by his primary care nurse practitioner at which time physical examination demonstrated normal muscle strength, reflexes, and sensation in the lower extremities. At the December 2021 VA examination, the Veteran reported radicular symptoms in both legs from the buttocks down the posterior thighs only occasionally extending to the calves. The Veteran reported intermittent radicular pain as well as paresthesias and numbness in the bilateral lower extremities which typically did not extend below the knee and are located in the posterior thighs. Physical examination demonstrated mild constant pain, paresthesias and/or dysesthesias, and numbness of the lower extremities. Muscle strength and reflexes were normal; there was decreased sensation in the thighs (L3/4) and lower legs/ankles (L4/L5/S1). The examiner noted that the lateral thighs and lateral lower legs also demonstrated decreased sensation. Straight leg raising was position. There were no trophic changes, and the Veteran's gait was normal. The examiner noted that the Veteran's lower extremity radicular symptoms included constant pain of mild severity, intermittent pain usually dull of moderate severity, paresthesias and/or dysesthesias of mild severity, and numbness of mild severity. The VA examiner noted that service connection had been established for both peripheral neuropathy of the bilateral lower toes due to residuals from colon cancer treatment with chemotherapy as well as left and right sciatic nerve injuries secondary to his back condition. The examiner noted that the two disabilities could cause overlapping symptoms; and she noted that her attempt to distinguish which findings were due to each disability were somewhat speculative. The examiner noted that the Veteran's subjective complaints were that the chemotherapy induced peripheral neuropathy caused numbness and paresthesias in his feet and that his back condition caused radiculopathy with numbness, paresthesias and pain in the bilateral lower extremities from his buttocks to his posterior thighs, only occasionally extending below the knee. The examiner opined that sensory examination to light touch revealed decreased sensation in the bilateral feet most likely due to his peripheral neuropathy and decreased sensation in the bilateral thighs and lower legs is most likely due to his lumbar radiculopathy (sciatic nerve condition). Based on the above, the Board finds that the Veteran's lumbar spine radiculopathy with sciatic nerve involvement has been primarily manifested by subjective reports of pain in the bilateral lower extremities from the buttocks to the posterior thighs and objective findings of decreased sensation in the bilateral thighs and lower legs warranting a 20 percent rating for each lower extremity for the entire appeal period. As noted above, Veteran reported pain radiating into posterior thighs at the September 2008 VA examination; numbness and tingling in the hips, buttocks, and lower legs at the November 2009 VA examination; intermittent radiating pain into buttocks, posterior aspect of thighs, and posterior aspect of lower legs as well as tingling in proximal anterolateral aspect of thighs at the September 2012 VA examination; and intermittent radicular pain as well as paresthesias and numbness in the bilateral lower extremities typically located in the posterior thighs at the December 2021 VA examination. In addition, the December 2021 VA examiner noted that the severity of the intermittent pain, the symptom most consistently reported by the Veteran, was moderate. A rating higher than 20 percent, however, is not warranted. In this case, the most probative evidence of record indicates that the Veteran's lumbar spine radiculopathy is not manifest by impairment of motor functions, trophic changes, loss of reflexes, or muscle atrophy. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis of the sciatic nerve as the involvement is wholly sensory. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the evidence of record supports a 20 percent rating, but no higher, for lumbar spine radiculopathy with sciatic involvement of each lower extremity. REASONS FOR REMAND 1. Entitlement to an initial 20 percent rating for thoracolumbar spine disability since December 13, 2021 2. Entitlement to an initial 10 percent rating for right knee disability since December 13, 2021 3. Entitlement to an initial 10 percent rating for right ankle disability since December 13, 2021 As noted above, the Board remanded the case in November 2021 for additional development; specifically to provide the Veteran with VA examinations from appropriate clinicians to determine the current nature and severity of his back, right knee, and right ankle disabilities. During the December 2021 VA examination, the Veteran reported having flareups of the back, knee, and right ankle as well as functional loss or functional impairment of the back, right knee, and right ankle after repeated use over time. With respect to the Veteran's lumbar spine, the examiner noted that the Veteran reported flare-up and described flareups although he was unable to estimate a frequency as they are mostly activity-based as well as weather-based. The Veteran reported a duration which ranged from one day to several days and described his pain as a constant aching pain on a daily basis with throbbing shooting pain during flareups. The Veteran reported that during a flareup he was unable to walk his dogs and has difficulty standing to do dishes or cook, he could not stand for more than a few minutes or sit for more than a few minutes and usually stayed in bed and watched TV during a flareup. The examiner noted that when asked about his range of motion during a flare-up, he stated that his back was "basically done" and that he did not do any bending or movements that he did not have to do. The examiner also noted that the Veteran reported having functional loss or functional impairment including but not limited to after repeated use over time. The examiner reiterated that the Veteran reported that during a flareup he was unable to walk his dogs and has difficulty standing to do dishes or cook, he could not stand for more than a few minutes or sit for more than a few minutes and usually stayed in bed and watched TV during a flareup. Again, the examiner noted that when asked about his range of motion during a flare-up, he stated that his back was "basically done" and that he did not do any bending or movements that he did not have to do. The examiner also added that when not in a flare-up, the Veteran endorsed increased pain with prolonged walking for more than a few minutes and prolonged sitting. With respect to the Veteran's right knee, the examiner noted that the Veteran reported flareups and that he reported a mild constant pain in the right knee described as a dull ache with occasional worsening shooting pain in the right knee during flareups. The examiner noted that the Veteran reported that he was unable to estimate a frequency or duration for his flareups as it depended on the weather (noting increased pain with cold rainy damp weather) and his activity level "like if I stepped in a hole or stepped wrong and twisted it or something." The examiner also noted that the Veteran reported having functional loss or functional impairment including but not limited to after repeated use over time. The examiner noted that the Veteran reported some limitations with squatting noting that he would "probably end up on the floor" and also noted some difficulty with stairs but admitted that it was difficult to delineate the knee limitations from his more significant back pain with limitations. With respect to the Veteran's right ankle, the examiner noted that the Veteran reported flare-ups approximately one to two times per week lasting from a few hours to one and one-half days and occurring randomly. The examiner noted that the Veteran described his pain during a flareup as a shooting pain and reported that during a flareup he would "limp around" and take "short steps" and tried to "flat foot" it and keep the weight off the ankle because it felt like it was crunching or pinching. The Veteran described treatment for right ankle pain as including the use of heat and that his right ankle pain was worse with cold, rainy, damp weather. The examiner also noted that the Veteran reported having functional loss or functional impairment including but not limited to after repeated use over time. The examiner reiterated that the Veteran reported that during a flareup he would "limp around" and take "short steps" and tried to "flat foot" it and keep the weight off of it because it felt like it was crunching or pinching. The examiner found that the procured evidence (statement from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination limited functional ability with repeated use over time or with flare-ups. Although the examiner noted that the Veteran was not being examined immediately after repeated use over time or during a flare-up, he stated, "After examination of the veteran, listening to their complete history and current subjective complaints, combined with a review of the available records, I have no basis to offer additional losses of function or motion when it comes to repetitive use or during a flare-up." With respect to the Veteran's lumbar spine, as noted above, when asked about his range of motion during a flare-up, he stated that his back was "basically done" and that he did not do any bending or movements that he did not have to do. The Board finds that the Veteran has provided credible evidence that during a flare-up, he experienced additional loss of function of his lumbar spine. With respect to the Veteran's right knee, as noted above, the Veteran reported some limitations with squatting noting that he would "probably end up on the floor" and also noted some difficulty with stairs. The Board finds that the Veteran has provided credible evidence that during a flare-up, he experienced additional loss of function of his right knee. With respect to the Veteran's right ankle, as noted above, the Veteran reported that during a flareup he would "limp around" and take "short steps" and tried to "flat foot" it and keep the weight off. The Board finds that the Veteran has provided credible evidence that during a flare-up, he experienced additional loss of function of his right ankle. As the VA examiner did not provide an explanation as to the procured evidence (statement from the Veteran) did not suggest pain, fatigability, weakness, lack of endurance, or incoordination limited functional ability with repeated use over time or with flare-ups, the December 2021 DBQ does not contain sufficient information. Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician, preferably an orthopedist, to determine the current severity of the Veteran's thoracolumbar spine, right knee, and right ankle disabilities. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing and must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. (Continued on next page) If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). J. LEE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Olson, Patricia 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.