Citation Nr: 22041371 Decision Date: 07/19/22 Archive Date: 07/19/22 DOCKET NO. 17-47 717 DATE: July 19, 2022 ORDER Entitlement to service connection for left foot nerve damage, diagnosed as left lower extremity radiculopathy (LLE radiculopathy) is denied. A disability rating higher than 20 percent for thoracic scoliosis prior to February 18, 2022 is denied. A disability rating higher than 40 percent for thoracic scoliosis from February 18, 2022 is denied. A disability rating higher than 10 percent for right lower extremity (RLE) sciatic radiculopathy associated with thoracic scoliosis is denied. A compensable disability rating for urinary/bladder incontinence associated with thoracic scoliosis is denied. A compensable disability rating for bowel incontinence associated with thoracic scoliosis is denied. REMANDED Entitlement to a rating greater than 20 percent for left carpal tunnel syndrome (CTS) is remanded. Entitlement to a rating greater than 20 percent for right CTS is remanded. FINDINGS OF FACT 1. The Veteran is not shown to have LLE radiculopathy. 2. Prior to February 18, 2022, the Veteran's thoracic scoliosis was manifested by chronic pain resulting in forward flexion to at least 50 degrees when considering additional functional loss and/or impairment; the disorder was not manifested by radiculopathy, ankylosis, or incapacitating episodes of intervertebral disc syndrome (IDS) requiring bed rest as defined under VA law. 3. Since February 18, 2022, the Veteran's thoracic scoliosis is manifested by chronic pain resulting in forward flexion to 30 degrees when considering additional functional loss and/or impairment; it is not shown to result in ankylosis of the spine, or incapacitating episodes of IDS requiring bed rest as defined under VA law. 4. Since February 18, 2022, the Veteran's thoracic scoliosis is manifested by mild RLE radiculopathy, occasional urinary incontinence that did not require the use of absorbent materials/appliance and bowel incontinence without leakage. CONCLUSIONS OF LAW 1. The criteria for service connection for LLE radiculopathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303 3.310. 2. Prior to February 18, 2022, the criteria for a 20 percent disability rating, but not higher, for thoracic scoliosis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237-5243. 3. Since February 18, 2022, the criteria for a disability rating higher than 20 percent for thoracic scoliosis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5237-5243. 4. The criteria for a disability rating higher than 10 percent for RLE radiculopathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8520. 5. The criteria for a compensable disability rating for urinary incontinence are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.115a, 4.115b, DC 7542. 6. The criteria for a compensable disability rating for bowel incontinence are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, DC 7332. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 2008 to June 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The issues were remanded in September 2021 for additional development. Since then, service connection has been granted for RLE radiculopathy, bladder incontinence and bowel incontinence associated with thoracic scoliosis. The Agency of Original Jurisdiction's (AOJ) grant of service connection for these issues constitutes a full award of benefits sought on appeal. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). The Veteran has not yet initiated an appeal with respect to the ratings or effective dates assigned and the one-year period to submit a Notice of Disagreement (NOD) has not yet lapsed. Service Connection The Veteran is seeking service connection for LLE radiculopathy. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Continuity of symptomatology may also provide a basis for a grant of service connection for those diseases defined as "chronic" by VA. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013. Service connection may be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 446 (1995) (en banc). In order to establish service connection for a claimed secondary disorder, there must be medical evidence of a current disability; evidence of a service-connected disability; and medical evidence of a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-7 (1995). Although the Veteran claims to have LLE radiculopathy, the primary impediment to a grant of service connection is the absence of a current disability. Although service treatment records note complaints of left foot tingling with exercise in October of 2009, physical examination in 2010 showed no abnormalities. As such, there is no evidence of LLE radiculopathy during military service. There is also no evidence of continuity of symptoms in the immediate years after service to enable an award of service connection under the provisions pertaining to "chronic diseases." Walker, 708 F.3d at 1338. In fact, during the neurological portion of a November 2013 back examination there was no objective evidence of radiculopathy, nerve damage, or degenerative disc disease and the Veteran made no complaints of radicular pain in the LLE. The earliest objective evidence of any pertinent symptoms or complaints is found many years after service. A VA back examination in January 2017, shows the Veteran reported numbness and tingling in both feet, but there were no findings of radiculopathy and neurological examination showed no abnormalities in the lower extremities. The neurological portion of the exam showed the Veteran retained normal 5/5 strength in his lower extremities with no muscle atrophy and sensory examination was also normal. Deep tendon reflexes were all normal at 2+ bilaterally and straight leg raising test was negative. The examiner indicated that the Veteran had no other neurologic abnormalities such as bowel or bladder problems. A VA peripheral nerve conditions examination in April 2017 was also negative for findings of a LLE neurological disorder. The Veteran reported back pain and numbness at the bottoms and arches of both feet. Examination revealed normal 5/5 strength in the lower extremities with no muscle atrophy and sensory examination was also normal. Deep tendon reflexes were all normal at 2+ bilaterally and straight leg raising test was negative. The examiner indicated that the Veteran had no other neurologic abnormalities such as bowel or bladder problems. There were also no signs or symptoms of radicular pain or radiculopathy. The Veteran's gait was normal and there were no trophic changes. During a VA back examination in February 2022, the Veteran also reported left lower extremity pain, paresthesias/dysesthesia, and numbness. The neurological portion of the exam showed the Veteran retained normal 5/5 strength in his lower extremities with no muscle atrophy and sensory examination was also normal. Deep tendon reflexes were all normal at 2+ bilaterally. Straight leg raising test was positive and the examiner indicated that the Veteran had bowel and bladder problems. There were no signs or symptoms of radiculopathy. The Veteran's gait was normal and there were no trophic changes. See also Peripheral Nerves Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire (DBQ). In a March 2022 addendum opinion, the examiner reported that while the Veteran reported symptoms suggestive of LLE radiculopathy during the 2022 back examination there is no evidence of it in the record and a 2019 Electrodiagnostic (EMG/NCS) was negative for evidence of active left lumbosacral radiculopathy, plexopathy, sciatic, fibular, or tibial mononeuropathy. There was also no evidence of polyneuropathy effecting the left lower limb or radiculopathy. See Medical Opinion DBQ. Based on the evidence in this case, the Board finds that the Veteran does not currently have LLE radiculopathy to include a showing of chronic functional impairment. Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 refers to the functional impairment of earning capacity). The objective evidence does not show a diagnosis of LLE radiculopathy at the time of the filing of the claim or during the pendency of the claim. Multiple evaluations of the Veteran's LLE complaints failed to reveal an underlying pathology. The March 2022 VA examiner's opinion is the most probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The claims file contains no competent medical evidence refuting it. Under these circumstances, the Board concludes that there is insufficient evidence to support a determination that the Veteran has LLE radiculopathy. While symptoms such as leg pain and numbness are capable of lay observation, the matter of diagnosing radiculopathy is beyond what a layperson can reasonably be expected to have competence in accomplishing. The determination of whether a symptom or symptoms actually constitute a disorder is one more suited to the realm of medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Consequently, the Veteran's opinion as to the presence of LLE radiculopathy is not competent evidence and greater probative value is placed on the conclusion of the VA examiners' determination that a diagnosis is not warranted. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328 (1997) (holding that the VA's and the Court's interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed); see also Gilpin v. West, 155 F.3d 1353 Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). So, without competent evidence of a current disability, service connection cannot be awarded for LLE radiculopathy. Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Based on the foregoing, the Board finds that the evidence is persuasively against the claim. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Increased Rating The Veteran seeks an increased evaluation for his service-connected thoracic scoliosis and associated RLE radiculopathy and bladder/bowel incontinence. Disability ratings are determined by comparing a veteran's present symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Thoracic Scoliosis The Veteran's thoracic scoliosis is currently rated as 40 percent disabling under DC 5242 effective February 18, 2022. Prior to that date, it was rated as 20 percent disabling. There is also separate 10 percent disability rating in effect for associated radiculopathy of the RLE and separate noncompensable disability ratings were granted for associated bowel and bladder problems. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov 30, 2020). These amendments revised Diagnostic Codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. Id. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable will be applied. The criteria for rating disabilities of the spine are listed under DCs 5235 to 5243. The code for intervertebral disc syndrome (DC 5243), permits rating under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher rating when all disabilities are combined. 38 C.F.R. § 4.71a. Prior to the regulatory change under the General Rating Formula for Disease and Injuries of the Spine, a 20 percent evaluation is appropriate where there is 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 is 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 evaluation for forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation 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, DC 5235-5242. Any associated neurological abnormalities (e.g., bowel or bladder impairment) are evaluated separately under the appropriate diagnostic code. See Note 1. Normal forward flexion of the thoracolumbar segment of the 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 rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. See Note 2, General Rating Formula for Disease and Injuries of the Spine, 38 C.F.R. § 4.71a, Plate V. The Board notes that the General Rating Formula for Diseases and Injuries of the Spine is unaffected by the February 7, 2021 regulatory changes. However, DC 5242 is expanded to include degenerative arthritis, and degenerative disc disease other than intervertebral disc syndrome. Prior to the regulatory change, under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks in the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks, but less than six weeks in the past 12 months; and a 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, DC 5243. As of February 7, 2021, under the amended criteria, DC 5243 is only assignable when there is disc herniation with compression and/or irritation of the adjacent nerve root; DC 5242 is to be assigned for all other disc diagnoses. prior to February 18, 2022 In support of the Veteran's 2016 claim for increase is a January 2017 VA examination, where he reported worsening back pain that made it difficult to bend, twist or lift more than 20 pounds. Range of motion showed forward flexion to 50 degrees, extension to 20 degrees, lateral flexion to 15 degrees bilaterally, and rotation to 30 degrees bilaterally with no additional limitation following repetitive testing. Pain weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. Guarding and muscle spasms did not result in abnormal gait or spinal contour. The neurological portion of the exam showed the Veteran retained normal 5/5 strength in his lower extremities with no muscle atrophy and deep tendon reflexes were all normal at 2+ bilaterally, sensory examination was normal and straight leg raising test was negative. There was no evidence of radicular pain nor any other signs/symptoms due to radiculopathy. X-rays reflect multilevel degenerative disc disease. Subsequently dated treatment records show no indication of a worsening in range of motion or incapacitating episodes. There are also no neurological symptoms noted, no days of prescribed bed rest for intervertebral disc syndrome, and no findings or history to suggest any bladder or bowel dysfunction. An entry dated in April 2019 shows the Veteran denied any bowel or bladder symptoms. An entry dated in January 2020 show the Veteran reported that about two weeks ago he started to have some bladder incontinence. See Salt Lake City VA Medical Center and Ogden VA Clinic from 2017 to 2022. The Board finds that while the foregoing evidence supports a 20 percent disability rating, a higher evaluation is not warranted. To merit the assignment of the next highest (40 percent) rating, the evidence must show forward flexion of 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. The evidence during in this case shows neither. There are no specific findings of ankylosis, and the measurable range of lumbar spine motion indicates that the Veteran does not have ankylosis, much less unfavorable ankylosis, or a disability akin to an individual with ankylosis as required for a 40 percent, 50 percent, or 100 percent rating. With respect to both time periods, the Board has also considered the impact of functional loss on the Veteran's range of motion of the thoracolumbar spine, but the clinical findings do not suggest that range of motion would change to the degree required for higher ratings due to pain, or after repetitive use, or with weight bearing, or during flare-ups. Because the range of motion findings show that the Veteran has substantial range of spine motion, even with consideration of these factors, there is no indication the lumbar spine disability suffers any significant or additional functional loss beyond that contemplated by the 20 and 40 percent ratings assigned. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board has also considered whether separate evaluations are warranted for any objective neurologic manifestations of the Veteran's thoracic scoliosis. Prior to February 2022, there was no clinical evidence of radiculopathy or other neurologic abnormalities such as bowel or bladder problems. Evaluations have generally been negative for any deficits as the Veteran has consistently had normal muscle strength, sensation, reflexes, and negative straight leg raising bilaterally. Accordingly, the evidence does not support the award of a separate evaluation for any objective neurological manifestations prior to this date. since February 18, 2022 The Veteran's 40 percent evaluation is based on findings from a February 2022 VA examination report. The Veteran reported worsening back pain, stiffness, decreased range of motion, and frequent flare-ups. He also reported numbness and tingling in both lower extremities. Range of motion testing showed forward flexion to 35 degrees, backward extension to 20 degrees, lateral flexion to 20 degrees bilaterally, and rotation to 20 degrees bilaterally with no additional limitation following repetitive testing. Passive range of motion was the same as active. There was pain with light palpation of the entire spine. The estimated range of motion after repeated use over time as forward flexion to 30 degrees, backward extension to 15 degrees, lateral flexion to 15 degrees bilaterally, and rotation to 15 degrees bilaterally. There was no change during flare-ups and guarding and muscle spasm did not result in abnormal gain or spinal contour but there were additional factors contributing to disability including interference with sitting/standing, disturbance of location and weakened movement due to pain and stiffness. The Veteran did not have incapacitating episodes of IDS that required prescribed bed rest in the past 12 months and did not use any assistive devices to aid with walking. The Veteran states that he has taken off approximately 4 weeks off of work in the last 12 months for his severe back pain due to the prolonged sitting required at his job. The neurological portion of the exam showed the Veteran retained normal 5/5 strength in his lower extremities with no muscle atrophy and deep tendon reflexes were all normal at 2+ bilaterally, sensory examination was normal and straight leg raising test was positive. The Veteran reported moderate to severe constant pain in the lower extremity, moderate paresthesias and/or dysesthesias and moderate numbness. There were no other signs or symptoms of radiculopathy. The examiner indicated the sciatic nerve on the right was involved. The Veteran also reported occasional urinary and bowel incontinence during severe back spasms. Id. After reviewing the record, the Board finds that a higher evaluation for the Veteran's thoracic scoliosis are not met. For this period, he is receiving a maximum schedular 40 percent evaluation based on limitation of motion and a higher rating requires ankylosis. However, there are no specific findings of ankylosis. The Veteran's measurable range of motion following repeated use over time and flare-ups testing indicates that the lumbar spine is not fixed in flexion or extension or in a neutral position (zero degrees). 38 C.F.R. § 4.71a, General Formula, Note 5. Further, the Veteran has not described or presented evidence of any specific functional loss or impairment consistent with that contemplated by ankylosis. See Chavis v. McDonough, 34 Vet. App. 1, 20 (2021) (holding that the requirement of ankylosis in the context of a claim for an increased rating for the back can be demonstrated by evidence of the functional equivalent of ankylosis). So, while spine motion is limited, neither the lay nor medical evidence reflects the functional equivalent of ankylosis warranting a 50 percent evaluation or higher. The Board has also considered whether separate evaluations are warranted for any objective neurologic manifestations of the Veteran's thoracic scoliosis. Beginning February 18, 2022, the AOJ granted a separate 10 percent rating for RLE radiculopathy and associated with the Veteran's thoracic scoliosis. There are also separate noncompensable disability ratings for associated bladder and bowel incontinence. See February 2022 rating decision. RLE radiculopathy Under DC 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve. A 20 percent rating requires moderate incomplete paralysis; a 40 percent rating requires moderately severe incomplete paralysis, and a 60 percent rating requires severe incomplete paralysis with marked muscular atrophy. An 80 percent evaluation is warranted for complete paralysis; 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. Neuritis of the sciatic nerve is rated under DC 8620, and neuralgia of the sciatic nerve is rated under DC 8720. 38 C.F.R. § 4.124a. 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. Id. See also Miller v. Shulkin, 28 Vet. App. 376, 380 (2017) (non-sensory manifestations are not necessarily rated at a higher level). 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, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Although the rating criteria do not define "mild," "moderate," and "severe" according to MERRIAM WEBSTER, the term "mild" is defined as "gentle in nature or behavior" or "not being or involving what is extreme." See www.merriam-webster.com/dictionary/mild (last accessed July 10, 2022). "Moderate" is defined as "tending toward the mean or average amount or dimension" or "limited in scope or effect." See www.merriam-webster.com/dictionary/moderate (last accessed last accessed July 10, 2022). "Severe" means "causing a lot of physical pain or suffering" or "of a great degree." See www.merriam-webster.com/dictionary/severe (last accessed last accessed July 10, 2022). It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Applying the regulations to the facts in the case, the Board finds that the criteria for a rating higher than 10 percent are not met as the Veteran's RLE symptoms have been wholly sensory. Despite reports of pain, burning, and numbness, sensory function of the RLE was entirely normal. The record largely reflects no evidence of decreased muscle strength, muscle atrophy, or diminished reflexes that would warrant a higher rating or demonstrate more than a mild degree of incomplete paralysis of the sciatic nerve. Given the evidence as outlined above, the Board finds that the current 10 percent rating adequately reflects the Veteran's RLE radiculopathy and assignment of a higher evaluation based on moderate incomplete paralysis is not appropriate. Bladder Incontinence The Veteran's associated bladder symptoms are rated under DC 7542 for neurogenic bladder with voiding dysfunction. A 20 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed less than 2 times per day. A 40 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. A 60 percent rating is warranted for voiding dysfunction requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. See 38 C.F.R. § 4.115a. The current 0 percent disability rating is based, in part on findings from a February 2022 VA examination. The Veteran reported intermittent urinary incontinence secondary to severe back pain during intense flare-ups that does not require the wearing of absorbent material or the use of an appliance. The voiding dysfunction does not cause increased urinary frequency or obstructed voiding. See Urinary Tract (Including Bladder and Urethra) Conditions (Excluding Male Reproductive System) Disability Benefits Questionnaire. A compensable rating for the Veteran's urinary incontinence would require urine leakage requiring the wearing of absorbent materials or the use of an appliance. The VA examination specifically noted that these manifestations are not demonstrated, and there is otherwise no clinical evidence of record indicating that the manifestations required for a compensable disability are met under DC 7542 at no period during the appeal. Bowel Incontinence The Veteran's associated bowel symptoms are rated under DC 7332 for rectum and anus, impairment of sphincter control. A noncompensable rating is warranted for healed or slight impairment, without leakage. A 10 percent rating is warranted for constant slight, or occasional moderate leakage. A 30 percent rating is warranted for occasional involuntary bowel movements, necessitating wearing of pad. A 60 percent is warranted for extensive leakage and fairly frequent involuntary bowel movements. A 100 percent rating is warranted for complete loss of sphincter control. 38 C.F.R. § 4.114. The current 10 percent disability rating is based, in part on findings from a February 2022 examination. The Veteran reported intermittent fecal incontinence secondary to severe back pain during intense flare-ups that does not require taking continuous medication. There were no attributable findings, signs, or symptoms. See Rectum and Anus Conditions Disability Benefits Questionnaire. A compensable rating for the Veteran's fecal incontinence would require constant leakage. The February 2022 VA examination specifically noted that this was demonstrated, and there is otherwise no clinical evidence of record indicating that the manifestations required for a compensable evaluation are met under DC 7332 at no period during the appeal. Additional Considerations With respect to the entire appeal period, the Board also finds that higher evaluations are not warranted under the criteria for IDS, as there is no evidence of incapacitating episodes which required bed rest prescribed by a physician. The Board acknowledges the Veteran's account of taking off approximately 4 weeks off of work in the last 12 months for severe back pain. However, what is lacking is objective documentation that any physician prescribed bed rest or that the Veteran was treated by a physician for any period approaching a total duration of even one week during a 12-month period. Thus, an increased evaluation under DC 5243 is not for assignment. See 38 C.F.R. § 4.71a. Based on the foregoing, the Board finds that the evidence is persuasively against the claims for increased ratings for the Veteran's service-connected thoracic scoliosis and associated neurological impairment. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th 776. REASONS FOR REMAND The Veteran is in receipt of separate 20 disability ratings for CTS of the bilateral upper extremities under DC 8513, for paralysis of all radicular groups. 38 C.F.R. § 4.124a. Evidence relevant to the severity of the CTS includes findings from an April 2017 VA examination report. At that time the examiner indicated that there was mild impairment of both the median and ulnar nerves bilaterally. See Peripheral Nerves Condition DBQ, dated April 27, 2017. However, when examined by VA in February 2022, the examiner indicated impairment of the median nerve only. See Peripheral Nerves Condition DBQ, dated February 18, 2022. A subsequent Exam Scheduling Request shows the AOJ requested an additional medical opinion to clarify whether there is ulnar nerve damage as well and if so to indicate its symptoms and severity. In a March 2022 addendum, the examiner confirmed bilateral cubital tunnel, which is ulnar nerve impairment, but stated that its severity could not be determined without examination of the Veteran. When VA undertakes to provide an examination or opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that a new examination is necessary to identify the appropriate nerve(s) or radicular group(s) affected by the Veteran's service-connected bilateral CTS and the current symptoms and severity. The matters are REMANDED for the following action: Schedule the Veteran for an examination to assess the severity of his service-connected CTS of the bilateral upper extremities. Any appropriate evaluations, studies, and testing deemed necessary should be conducted, and the results included in the examination report. The examiner must use the appropriate DBQ. The examiner must describe all sensory and functional impairment reasonably attributable to the median and ulnar nerve damage. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Bryant 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.