Citation Nr: A25030833 Decision Date: 04/03/25 Archive Date: 04/03/25 DOCKET NO. 240611-446589 DATE: April 3, 2025 ORDER Entitlement to an initial disability rating in excess of 40 percent for service-connected degenerative disc disease (DDD) with intervertebral disc syndrome (IVDS) and spinal stenosis of the lumbar spine is denied. Entitlement to an initial disability rating of 20 percent, but no higher, for service-connected radiculopathy of the right lower extremity is granted. Entitlement to an initial disability rating in excess of 20 percent for service-connected meniscal tear of the right knee is denied. Entitlement to an initial disability rating in excess of 10 percent for service-connected right knee strain based on limitation of extension is denied. FINDINGS OF FACT 1. The Veteran's service-connected DDD of the lumbar spine with IVDS and spinal stenosis is not manifested by unfavorable ankylosis, symptoms which more nearly approximate ankylosis, additional uncompensated neurologic disability manifestations, or incapacitating episodes of IVDS requiring prescribed bed rest. 2. The Veteran's radiculopathy of the right lower extremity is manifested by pain, paresthesias, diminished reflexes, weakness, and numbness in the foot and leg, which more nearly approximates moderate incomplete paralysis of the sciatic nerve. 3. The Veteran's right knee meniscal tear is manifested by frequent episodes of pain, locking, crepitus, and effusion into the joint. 4. The Veteran's right knee strain is manifested by extension limited to no greater than zero degrees. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 40 percent for service-connected DDD of the lumbar spine with IVDS and spinal stenosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for an initial disability rating of 20 percent, but no higher, for service-connected radiculopathy of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, DC 8520. 3. The criteria for an initial disability rating in excess of 20 percent for meniscal tear of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.27, 4.71a, DC 5258. 4. The criteria for an initial disability rating in excess of 10 percent for right knee strain based on limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 2001 to July 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2024 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction (AOJ), which, inter alia, awarded service connection for the following: DDD of the lumbar spine with IVDS and spinal stenosis and assigned an initial 40 percent disability rating, effective from August 4, 2023; radiculopathy of the right lower extremity at 10 percent from August 4, 2023; meniscal tear of the right knee at 20 percent from August 4, 2023; and right knee strain based on limitation of extension at 10 percent from August 4, 2023. In June 2024, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), in which she elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the February 2024 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Here, the Board notes that on her June 2024 10182, the Veteran included a statement indicating that her combined rating should be 80 percent rather than 60 percent. The February 2024 rating decision on appeal awarded service connection and compensable ratings for multiple disabilities: the low back disability (40 percent), right meniscal tear (20 percent), right knee limitation of extension (10 percent), and right lower extremity radiculopathy (10 percent). While adding these ratings would, indeed, result in an 80 percent rating, when VA combines multiple disability ratings, they are not simply added together. Rather, the law provides a formula based on the Combined Ratings Table which often is lower than the sum of individual ratings. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, the higher rating 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. When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods as to the pending claims. In all cases, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr, at 308 (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence"). The Board has considered all evidence of record as it bears on the issues before it. See 38 U.S.C. § 7104(a) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C. § 5107(b) ("Secretary shall consider all information and lay and medical evidence of record in a case"). Although the Board has an obligation to provide reasons and bases supporting these decisions, there is no need to discuss, in detail, the extensive evidence of record. The Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The United States Court of Appeals for Veterans Claims (Court) has emphasized that when assigning a disability rating it is necessary to consider limitation of a joint's functional ability due to flare-ups, fatigability, incoordination, and pain on movement, or when it is used repeatedly over a period of time functional loss due to flare-ups, fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). In Mitchell, the Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; see also Correia v. McDonald, 28 Vet. App. 158, 169-170 (2016). 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 select 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. As Veteran's claim of entitlement to service connection for the lumbar spine, radiculopathy, and right knee disabilities was received in August 2023, the Board will consider the issues on appeal under only the revised rating criteria, which became effective on February 7, 2021. 1. Entitlement to an initial disability rating in excess of 40 percent for service-connected DDD of the lumbar spine with IVDS and spinal stenosis. In this matter, the Veteran's lumbar spine disability is rated under DC 5242 (degenerative arthritis), which provide that the disability be rated either under the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. IVDS is rated under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating. 38 C.F.R. § 4.71a, DC 5243. The revisions to the musculoskeletal system, effective February 7, 2021 indicated that this diagnostic code should only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root; DC 5242 is to be assigned for all other diagnoses. The Formula for Rating IVDS Based on Incapacitating Episodes provides a 20 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. Note (1) to DC 5243 provides that, for purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine were not changed by the revisions to the musculoskeletal system, effective February 7, 2021. Under the applicable criteria, limitation of motion of the lumbar and cervical spine is rated under the General Rating Formula for General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Pursuant to the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: 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 is not greater than 120 degrees; or, muscle spasms 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 when forward flexion of the thoracolumbar spine is 30 degrees or less or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Following the criteria, Note (1) provides: evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2) provides that normal forward flexion of the thoracolumbar spine is to zero to 90 degrees and extension and left and right lateral flexion and rotation of the thoracolumbar spine are all 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. Each range of motion measurement is to be rounded to the nearest five degrees. Note (3) provides that in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4) requires that each range of motion measurement be rounded to the nearest five degrees. Note (5) provides that for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6) provides that disabilities of the thoracolumbar spine segments must be separately evaluated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. In this matter, the Veteran was service-connected for DDD of the lumbar spine with IVDS and spinal stenosis in a February 2024 rating decision, which assigned a 40 percent disability rating, effective from August 4, 2023. She disagreed with the assigned initial rating and this appeal follows. For the reasons set forth below, the Board finds that a higher initial disability rating is not warranted for the Veteran's service-connected lumbar spine disability. Private treatment records dated in May 2023 show that the Veteran demonstrated symptoms consistent with right piriformis syndrome and low back pain. Private treatment records dated in July 2023 noted the Veteran's report of right-sided buttock and leg pain, radiating down her leg. She indicated that her toes go numb. She reported that she has had three rounds of steroid shots. Private treatment records dated in August 2023 noted that the Veteran "has dealt with low back pain for many years, but more recently over the course of the last three to four months, she has been having increased pain in her right buttock and right leg." The Veteran reported that she has completed treatment including medications, chiropractic case, and physical therapy. She continues to have severe right leg pain. She stated that her leg seems to be weak and dragging, at times. The treatment provider diagnosed right-sided L4-L5 lumbar spinal stenosis and right lower extremity radiculopathy with weakness. The Veteran was noted to have an antalgic gait. Private treatment records dated later in August 2023 noted that the Veteran is seeking treatment for severe pain breaking through her Celebrex. The treatment provider noted that the Veteran underwent magnetic resonance imaging (MRI), which showed impingement of the right L5 nerve root with severe spinal canal stenosis. She is scheduled for lumbar decompression surgery. The treatment provider indicated that the Veteran is "experiencing cramping, shooting, stabbing, tingling, and numbing pain. The pain radiates into the lower leg and foot. The pain gets worse when leaning forward, sitting, prolonged standing, walking long distances, walking short distances, and any activity. The pain is constant without alleviating factors." The treatment provider indicated that, upon physical examination, the Veteran exhibited mild paraspinal tenderness with diminished flexion and extension due to discomfort. Muscle strength was 5/5 in the lower extremities. Sensation to light touch was intact bilaterally. Reflexes were noted to be diminished at the patella and Achilles, bilaterally. The Veteran had "markedly positive" straight leg raise testing on the right. The treatment provider indicated that the Veteran exhibited a normal gait. In August 2023, the Veteran underwent right L4-L5 decompression consisting of right L4 hemilaminectomy and right L5 partial laminectomy for decompression of central canal, lateral recesses, and neural foramen. In an August 2023 statement, the Veteran reported that she has "explored everything imaginable to find relief" for her lumbar spine disability. She explained, "[i]n the attempt to strengthen my back, many workouts end up triggering muscle spasms." She pushes through the pain with over-the-counter medications including Motrin and Tylenol, which she reported do not provide much relief. She also indicated that steroid shots do not provide much relief either. The Veteran explained, "I am unable to sit or stand for a long period of time. The constant pain makes it unbearable to spend time with my kids, I would love to be able ot watch my son play baseball, but sitting in the bleachers aggravates it and standing doesn't help either." The Veteran was afforded a VA back examination in January 2024 at which time the examiner confirmed diagnoses of DDD, IVDS, spinal stenosis, and right sciatic radiculopathy. She underwent a microdiscectomy at L4-L5. The Veteran reported that her current symptoms include sharp lower back pain. Her symptoms are treated with steroid injections, back surgery, physical therapy, acupuncture, and electrostimulation. The Veteran endorsed flare-ups of lumbar spine symptoms that occur daily with a duration of one to two hours. Her flare-ups are characterized by tightness and tension, and are precipitated by physical activity, manual labor, and prolonged standing. Her flare-ups are alleviated by moving her back around and sitting. The examiner characterized the Veteran's flare-ups as moderate in severity. The Veteran reported the following functional loss due to her lumbar spine disability: "picking up something heavy off the ground, can't run, harder to drive." The examiner noted that the Veteran's range of motion contributes to functional loss by "unable to fully bend for kneeling." Range of motion testing revealed forward flexion to 20 degrees, extension to 5 degrees, right lateral flexion to 10 degrees, and left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 5 degrees with pain throughout motion. The examiner reported that passive range of motion was medically contraindicated. There was no evidence of crepitus. The Veteran has moderate localized tenderness at the mid-thoracic to lumbosacral spine. There was no additional limitation of motion on repetitive use testing. The examiner reported that the procured evidence does not suggest that pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability of the Veteran's lumbar spine with repeated use over time or during flare-ups. The Veteran has muscle spasms and guarding that do not result in abnormal gait or abnormal spinal contour. The examiner identified additional factors contributing to disability including interference with sitting and standing, and less movement than normal. The examiner stated that the Veteran has limited range of motion of the lumbar spine and is unable to stand or sit for a prolonged amount of time. Muscle strength was 3/5 at right hip flexion, 4/5 at right knee extension, 4/5 at right ankle plantar flexion, 4/5 at right ankle dorsiflexion, and 4/5 at right great toe extension. Muscle strength of the left lower extremity was intact. There was no evidence of muscle atrophy in either lower extremity. Reflexes were 2+ throughout the bilateral lower extremities. Sensation to light touch was decreased at right upper anterior thigh, right thigh/knee, right lower leg/ankle, and right foot/toes. Sensation to light touch was intact in the left lower extremity. The Veteran was unable to perform straight leg raise testing due to discomfort. The examiner indicated that the Veteran endorsed mild intermittent pain, mild paresthesias, and mild numbness in the right lower extremity. The examiner reported that there is involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve). The examiner explained, "[d]iminished sensation and weakness of right lower extremity support signs of right lower extremity radiculopathy." There was no ankylosis. The examiner indicated that the Veteran has IVDS, but has not experienced any episodes that require bed rest prescribed by a physician and treatment by a physician in the past twelve months. The Veteran uses a back brace. The examiner reported that the Veteran's lumbar spine disability does impact her ability to perform occupational tasks. The examiner explained that the Veteran's lumbar spine disability "would make it difficult to perform strenuous tasks involving lifting, bending, prolonged walking, or prolonged standing." Applying the facts in this case to the criteria set forth above, the Board finds that an initial disability rating in excess of 40 percent is not warranted for the Veteran's service-connected DDD of the lumbar spine with IVDS and spinal stenosis from the date of service connection. Specifically, the lay and clinical evidence indicate that the Veteran's disability was not manifested by unfavorable ankylosis of the entire thoracolumbar spine or the entire spine, as defined in Note (5) to the General Rating Formula for Diseases and Injuries of the Spine. Range of motion testing conducted during the entire period on appeal shows that the Veteran's lumbar spine was not fixed in flexion or extension. Critically, there is no clinical documentation that the Veteran had been unable to move her lumbar spine and, as such there is no documentation that there had been ankylosis or symptoms indicative of the functional equivalent of ankylosis. The record does not show that the Veteran exhibited difficulty walking because of a limited line of vision, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation; or neurological symptoms due to nerve root stretching. Finally, the record does not contain lay or clinical evidence reflecting that the Veteran's disability is productive of the functional equivalent of ankylosis. As such, a higher disability rating based upon unfavorable ankylosis of the thoracolumbar spine, or of the entire spine, is not warranted based upon the diagnostic criteria from the date of service connection. The Board notes that the Veteran reported significant pain, including during flare-ups, as a result of her lumbar spine disability. See 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1996). These symptoms have been considered in assigning the 40 percent rating. Critically, as detailed above, there is no evidence to support additional functional limitations such as would warrant evaluations in excess of 40 percent. For example, the January 2024 VA examiner noted the Veteran's description of functional impairment including during flare-ups, but specifically reported that the procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limit the Veteran's functional ability during flare-ups. Accordingly, the evidence of record does not support a higher disability rating for the Veteran's service-connected lumbar spine disability. Because the Veteran retained motion and exhibited none of the symptoms delineated in Note (5) to the General Rating Formula for Diseases and Injuries of the Spine, a rating in excess of 40 percent based on functional loss, including during flare-ups and with repeated use over time, is not warranted. In reaching this decision, the Board acknowledges that it cannot consider the ameliorative effects of medication. Jones v. Shinseki, 26 Vet. App. 56 (2012). However, because the Veteran reports that treatment, which includes medication as needed for pain, does little to relieve her lumbar spine disability symptoms, there are no ameliorative effects to discount. See, e.g., the VA examination report dated January 2024; see also the Veteran's statement dated August 2023. While the Board is required to consider the effect of the Veteran's pain when making a rating determination, and has done so in this case, the Rating Schedule does not provide for a separate rating for pain. Rather, it provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. Spurgeon v. Brown, 10 Vet. App. 194 (1997). In this case, the Veteran is already being adequately compensated for pain and the resulting functional loss. Therefore, a higher disability rating is not warranted under the schedular criteria. The Board recognizes that the Veteran has been diagnosed with IVDS of the lumbar spine; however, there is no documentation that she was prescribed physician ordered bed rest at any time during the appeal period. 38 C.F.R. § 4.71a, DC 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1. The Board thus finds that rating the thoracolumbar spine disability under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes does not afford the Veteran. In addition, as indicated above, Note 1 of the General Rating Formula for Disease and Injuries of the Spine instructs to evaluate any associated objective neurological abnormalities separately, under an appropriate Diagnostic Code. To this end, the Veteran is in receipt of a separate rating for radiculopathy of the right lower extremity, which will be addressed below. The most probative evidence reflects that the Veteran does not exhibit any additional neurological impairment due to her service-connected lumbar spine disability, to include left lower extremity radiculopathy. The Board has considered the August 2023 private treatment record noting diminished reflexes in the lower extremities, bilaterally. However, only right radiculopathy was identified at that time and the January 2024 VA exam identified only right sciatic radiculopathy. There is no clinical evidence of a diagnosis of left radiculopathy. The Board therefore finds that the evidence of record is persuasively against the assignment of an initial disability rating in excess of 40 percent for service-connected DDD of the lumbar spine with IVDS and spinal stenosis. As the evidence weighs significantly and substantially against the claim, it is denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to an initial disability rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity. As indicated above, in the February 2024 rating decision, the RO granted service connection for right lower extremity sciatic radiculopathy and assigned a 10 percent disability rating, effective from August 4, 2023. The Veteran disagreed with the assigned initial disability rating and this appeal follows. The Veteran's service-connected radiculopathy of the right lower extremity is rated under Diagnostic Code 8520. Under DC 8520, a maximum schedular rating of 80 percent is awarded for complete paralysis of the sciatic nerve. With complete paralysis, the foot dangles and drops, there is no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. When there is incomplete paralysis, a 60 percent rating is in order for severe disability with marked muscular atrophy. Moderately severe incomplete paralysis warrants a 40 percent evaluation, and moderate incomplete paralysis warrants a 20 percent rating. Finally, mild incomplete paralysis warrants a 10 percent rating. See 38 C.F.R. § 4.124a, DC 8520. 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 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). Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Although the Board has at times attempted to define these terms using dictionary definitions, those definitions are problematic because they "do little to explain the Board's understanding of these terms and do not 'disclos[e] that benchmark it employed to reach [its] conclusion.'" Casey v. McDonough, No. 21-7569, 2023 U.S. App. Vet. Claims LEXIS 98, *5 (Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018)) (discussing the Board's attempt to define the terms slight, mild, moderate, and severe in DC 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). With regard to DC 8520, although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing the analysis, [they] are not alone sufficient to explain the Board's decision absent an articulated connection to specific evidence." Lemon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims LEXIS 1998, *7 (Dec. 16, 2022) (mem dec) (Toth, J.). As explained in Lemon, these regulations leave gaps in defining the relevant terms that are filled by VA's Adjudication Manual, M21-1. The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases," Overton, 30 Vet. App. at 264. Clearly relevant to this case are M21-1 provisions regarding evaluations of paralysis of the sciatic nerve. The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. iii, ch. 12, sec. A.2.c. And moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. And the M21-1 provides that a moderately severe evaluation (that is, a 40 percent rating) is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id. Atrophy may, but need not, be present for a moderately severe rating. As concluded by the Court in Lemon, given the relevance of these provisions to rating disabilities of the peripheral nerves, "the Board's failure to mention the M21-1's relevant guidance in this area constitutes clear error." Lemon, at *7-*8. See also Bethea, 2 Vet. App. at 254. The Board has therefore reviewed the M21-1 definitions and finds them instructive in the instant case. Here, private treatment records dated in May 2023 show that the Veteran demonstrated symptoms consistent with right piriformis syndrome. Private treatment records dated in July 2023 noted the Veteran's report of right-sided buttock and leg pain, radiating down her leg. The treatment provider documented the Veteran's description of pain the right-side of her buttock region, "which radiates all the way down her leg into the posterior and lateral side of her calf. Her toes go numb. She takes Aleve every day. She has had three rounds of steroids." In the Veteran's August 2023 claim, she stated that she experiences "numbness, tingling, and weakness, down [her] legs and feet." Private treatment records dated in August 2023 noted that the Veteran "has been having increased pain in her right buttock and right leg." She reported that she has completed treatment including medications, chiropractic case, and physical therapy. She continues to experience severe right leg pain. She stated that her leg seems to be weak and dragging, at times. The treatment provider diagnosed right-sided L4-L5 lumbar spinal stenosis and right lower extremity radiculopathy with weakness. The Veteran was noted to have an antalgic gait. Private treatment records dated later in August 2023 noted that the Veteran is seeking treatment for severe pain breaking through her Celebrex. The treatment provider noted that the Veteran underwent magnetic resonance imaging (MRI), which showed impingement of the right L5 nerve root with severe spinal canal stenosis. She is scheduled for lumbar decompression surgery. The treatment provider indicated that the Veteran is "experiencing cramping, shooting, stabbing, tingling, and numbing pain. The pain radiates into the lower leg and foot. The pain gets worse when leaning forward, sitting, prolonged standing, walking long distances, walking short distances, and any activity. The pain is constant without alleviating factors." The treatment provider indicated that, upon physical examination, the Veteran exhibited mild paraspinal tenderness with diminished flexion and extension due to discomfort. Muscle strength was 5/5 in the lower extremities. Sensation to light touch was intact bilaterally. Reflexes were noted to be diminished at the patella and Achilles, bilaterally. The Veteran had "markedly positive" straight leg raise testing on the right. The treatment provider indicated that the Veteran exhibited a normal gait. In August 2023, the Veteran underwent right L4-L5 decompression consisting of right L4 hemilaminectomy and right L5 partial laminectomy for decompression of central canal, lateral recesses, and neural foramen. In an August 2023 statement, the Veteran reported that she has "explored everything imaginable to find relief" for her lumbar spine disability. She explained, "[i]n the attempt to strengthen my back, many workouts end up triggering muscle spasms." She pushes through the pain with over-the-counter medications including Motrin and Tylenol, which she reported do not provide much relief. She also indicated that steroid shots do not provide much relief either. The Veteran explained, "I am unable to sit or stand for a long period of time. The constant pain makes it unbearable to spend time with my kids, I would love to be able ot watch my son play baseball, but sitting in the bleachers aggravates it and standing doesn't help either." The Veteran was afforded a VA back examination in January 2024 at which time the examiner confirmed a diagnosis of right sciatic radiculopathy. Muscle strength of the right lower extremity revealed 3/5 at hip flexion, 4/5 at knee extension, 4/5 at ankle plantar flexion, 4/5 at ankle dorsiflexion, and 4/5 at great toe extension. There was no evidence of muscle atrophy. Reflexes were 2+ throughout the right lower extremity. Sensation to light touch was decreased at right upper anterior thigh, right thigh/knee, right lower leg/ankle, and right foot/toes. The Veteran was unable to perform straight leg raise testing due to discomfort. The examiner indicated that the Veteran endorsed mild intermittent pain, mild paresthesias, and mild numbness in the right lower extremity. The examiner reported that there is involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve). The examiner explained, "[d]iminished sensation and weakness of right lower extremity support signs of right lower extremity radiculopathy." There was no ankylosis. The examiner reported that the Veteran's lumbar spine disability to include radiculopathy of the right lower extremity impacts her ability to perform occupational tasks. The examiner explained that the Veteran's lumbar spine disability "would make it difficult to perform strenuous tasks involving lifting, bending, prolonged walking, or prolonged standing." As indicated above, the Veteran is in receipt of a 10 percent initial disability rating for radiculopathy of the right lower extremity. Based upon the evidence of record set forth in pertinent part above, the Board finds that an initial rating of 20 percent, but no higher, is warranted for radiculopathy of the right lower extremity from the date of service connection. To this end, the Board notes that evidence shows objective neurological symptoms that support a disability rating analogous to moderate incomplete paralysis of the sciatic nerve of the right lower extremity such that a 20 percent rating is most closely approximated. Specifically, the medical evidence dating from the Veteran's July 2023 and August 2023 private treatment records through her January 2024 VA examination demonstrates that the symptomatology associated with her sciatic radiculopathy was characterized by intermittent pain, paresthesias/dysesthesias, and numbness in the right lower extremity. Diminished reflexes were also noted. The Veteran's private treatment records dated in August 2023 documented her report of pain and weakness with a sensation of dragging of the right lower extremity. Subsequent August 2023 private treatment records noted the Veteran's report of cramping, shooting, and stabbing pain in the right lower extremity with numbness and tingling. Reflexes were noted to be diminished along the patellar and Achilles. See the private treatment records dated in August 2023. Notably, the January 2024 VA examiner identified reduced muscle strength, as well as decreased sensation to light touch throughout the right lower extremity. Critically, there was no evidence of objective muscle wasting, atrophy, or tremors in the right lower extremity. Given the overall characterization of the symptoms and disability, the Board find that the criteria for 20 percent a disability rating for radiculopathy of the right lower extremity is approximated from the date of service connection, August 4, 2023. Although she exhibited some reduced muscle strength and diminished reflexes at times, it was not at a grade reflecting a high level of limitation or disability, particularly given the overall impairment of mild as characterized by the January 2024 VA examiner. The Veteran exhibited no other objective findings, including muscle atrophy, bradykinesia, rigidity, tremors, skin symptoms, etc. The Board further finds that the evidence is persuasively against a conclusion that the criteria for the next higher 40 percent disability rating for sciatic radiculopathy of the right lower extremity was met at any time from the date of service connection. The clinical evidence of record did not demonstrate a neurological disability manifested by moderately severe or greater, incomplete paralysis of the sciatic nerve. No examiner or treatment provider characterized the Veteran's disability as more than moderate. Additionally, the objective findings noted on examination did not reflect significant motor or reflex impairment. There was no atrophy of the right lower extremity. The Board also acknowledges assertions made by the Veteran concerning pain, numbness, tingling, and weakness, but these assertions do not reflect symptoms that more nearly approximate the moderately severe incomplete paralysis required for disability ratings in excess of 20 percent under DC 8520. A higher 60 percent disability is also not warranted under DC 8520 because there is no evidence of severe symptoms of the right lower extremity with marked muscular atrophy. To this end, although a (3/5 at right hip and 4/5 at right knee, ankle, and great toe) reduction in muscle strength was recorded in the Veteran's right lower extremity, marked muscle atrophy was not identified. In reaching this decision, the Board acknowledges that it cannot consider the ameliorative effects of medication. Jones, supra. However, because the Veteran reports that treatment, which includes medication as needed for pain, does not help relieve her right lower extremity radiculopathy, there are no ameliorative effects to discount. See, e.g., the VA examination report dated January 2024; see also the Veteran's statement dated August 2023. In light of the foregoing, the Board concludes that the Veteran's radiculopathy of the right lower extremity more closely approximates a 20 percent disability rating, but no higher, from the date of service connection. 3. Entitlement to an initial disability rating in excess of 20 percent for service-connected meniscal tear of the right knee. 4. Entitlement to an initial disability rating in excess of 10 percent for service-connected right knee strain based on limitation of extension. In this matter, the Veteran is assigned a 20 percent disability rating for meniscal tear of the right knee under DC 5258 and a separate 10 percent rating for right knee strain based on limitation of extension under DC 5261 from the date of service connection, August 4, 2023. The Board notes that the Veteran is also service-connected for right knee strain based on limitation of flexion and assigned a noncompensable initial rating under DC 5260. However, in the June 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran did not express disagreement with the assigned disability rating for right knee disability based upon limitation of flexion; as such, the assigned rating for limitation of flexion of the right knee will not be addressed in this Board decision. DC 5258 provides that a 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, DC 5258. DC 5259 provides that a 10 percent rating is warranted for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, DC 5259. Under DC 5261, a 10 percent disability rating is warranted for extension limited to 10 degrees. A 20 percent disability rating is assigned for extension limited to 15 degrees. A 30 percent disability rating is assigned for extension limited to 20 degrees. A 40 percent disability rating is assigned for extension limited to 30 degrees; and a 50 percent disability rating is assigned for extension limited to 45 degrees. See 38 C.F.R. § 4.71a. In addition, separate ratings may be assigned for compensable limitation of both flexion and extension. See VAOPGCPREC 09-04 (separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint). The general rating schedules for limitation of motion of the knee are set forth in 38 C.F.R. § 4.71a, DCs 5260 and 5261. Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Under the revised criteria, which are applicable here, the DC 5257 indicated that knee, other impairment of should be rated as follows: Recurrent subluxation or instability: For unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation, a 30 percent disability rating is warranted. For one of the following a 20 percent disability rating is warranted: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider pre-scribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. For sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation, a 10 percent disabling rating is warranted. Patellar instability: For a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker a 30 percent disabling rating is warranted. For a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker, a 20 disability rating is warranted. For a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker, a 10 percent disability rating is warranted. Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). As indicated above, the Veteran was service-connected for meniscal tear of the right knee in a February 2024 rating decision, which assigned a 20 percent disability rating, effective August 4, 2023. The rating decision also assigned a separate 10 percent rating for right knee strain based on limitation of extension, effective August 4, 2023. The Veteran disagreed with the assigned initial right knee meniscal tear and limitation of extension ratings and this appeal follows. For the reasons set forth below, the Board finds that higher initial disability ratings are not warranted for the Veteran's service-connected meniscal tear of the right knee and right knee strain based on limitation of extension. In an August 2023 statement, the Veteran reported that she experiences right knee pain. She stated that she has "become reliant on knee sleeves, slipping them on whenever I need to lift something. It's as if my knee might give out at any moment." She reported that she must hold onto railings and has difficulty with stairs. She stated, "[t]here have been moments at home when my knee causes me to stumble and trip." She described constant right knee discomfort that is usually followed by swelling. She stated that she is unable to sit or stand for a long period of time. Private treatment records dated in July 2023 documented the Veteran's report of right posterior knee pain. The Veteran was afforded a VA knee examination in January 2024 at which time the examiner confirmed diagnoses of right knee strain and right meniscal tear. The examiner noted the Veteran's report of "constant knee pain behind the patella." The Veteran indicated that her right knee symptoms have been treated with chiropractic manipulation and physical therapy. The Veteran endorsed daily flare-ups of right knee symptomatology that last for hours and are manifested by stiffness. She indicated that her flare-ups are precipitated by waking up and getting up, and are alleviated by ice and heat. The Veteran reported that her flare-ups are of moderate severity and cause difficulty going up stairs. The Veteran endorsed frequent right knee effusion. Range of motion testing revealed flexion to 110 degrees and extension to zero degrees with pain throughout movement. Passive range of motion was the same as active. The examiner reported that there was pain on active and passive motion, which does not result in/cause functional loss. The examiner noted that the Veteran had crepitus of the right knee. There was objective evidence of moderate localized tenderness at the patellar tendon. There was no additional limitation of motion on repetitive use testing. The examiner reported that the procured evidence suggest that pain significantly limits functional ability with repeated use over time and during flare-ups. The examiner estimated that with repeated use over time and during flare-ups, flexion was additionally limited to 60 degrees and extension was unchanged at zero degrees. The examiner noted that mild swelling additionally contributed to the Veteran's right knee disability. There was no evidence of atrophy, ankylosis, instability, or recurrent patellar instability. The examiner reported that the Veteran does have a meniscal condition which manifests in frequent episodes of joint locking, pain, and effusion. She has not had any right knee surgery. The Veteran reported the occasional use of a right knee brace. The examiner indicated that the Veteran's right knee disability does impact her ability to perform occupational tasks; specifically, "[c]ondition would make it difficult for strenuous tasks involving prolonged walking or prolonged standing." An x-ray of the right knee performed in February 2024 revealed "[m]ild degenerative changes in the patellofemoral compartment." As indicated above, the Veteran is currently assigned a 10 percent initial disability rating for right knee strain based on limitation of extension under DC 5261. Based on the evidence of record, as detailed in pertinent part above, the Board finds that a disability rating in excess of 10 percent for limitation of extension is not warranted. The January 2024 VA examiner confirmed extension to zero degrees to include with repetitive use testing. Moreover, treatment records do not document limitation of extension of the right knee to less than zero degrees. Accordingly, the Board finds that the Veteran's right knee extension did not meet the criteria for an initial rating in excess of 10 percent, even with consideration of additional functional loss. The Board has carefully considered the Veteran's reports of significant right knee pain and stiffness which increases during flare-ups. Critically, however, functional loss must be rated under the diagnostic code pertaining to limitation of motion of the affected joint, pursuant to 38 C.F.R. § 4.40; Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991) (noting that functional loss due to pain is to be rated at the same level as where motion is impeded); DeLuca v. Brown, 8 Vet. App. 202, 205-06 (noting that the disabling effect of painful motion must be considered when rating joint disabilities) (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (stating that functional loss caused by pain must be rated at the same level as if that functional loss were caused by some other factor that actually limited motion)); c.f., Petitti v. McDonald, 27 Vet. App. 415 (2015). Although the January 2024 VA examiner determined that the evidence of record suggested that pain significantly limits the Veteran's functional ability with repeated use over time and during flare-ups, the examiner estimated that the Veteran would maintain extension to zero degrees. The Veteran has not reported, and the record does not contain, additional evidence showing greater loss of extension. Hence, there is no basis upon which to assign a higher rating based on additional limitation due to functional factors. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 202; Mitchell, 25 Vet. App. at 32. Additionally, the Veteran is assigned a separate 20 percent rating for meniscal tear of the right knee under DC 5258 for dislocated semilunar cartilage with frequent episodes of pain, locking, and effusion. 38 C.F.R. § 4.71a, DC 5258. The January 2024 VA examiner diagnosed the Veteran with a meniscal tear of the right knee and identified symptoms of locking, pain, crepitus, and effusion in the knee joint. The Board notes that 20 percent is the maximum schedular disability rating available under DC 5258; therefore, a higher disability rating for right knee meniscal tear under DC 5258 is not available. See 38 C.F.R. § 4.71a. The Board has also considered whether a separate rating for the right knee disability under DC 5257 is warranted. To this end, the Board recognizes that the Veteran reported that she wears a sleeve to help with her right knee disability and experiences a sensation that her knee "might give out at any moment." See the Veteran's statement dated August 2023, and the VA examination report dated January 2024. To this end, the Board notes there is no indication that the Veteran's right knee brace (sleeve) was prescribed by a treatment provider. Moreover, clinical evidence of record, including examination and treatment records, shows that no instability was present upon testing of the right knee joint, nor was subluxation. Additionally, the record shows that the Veteran has not had a ligament tear or sprain, either repaired or unrepaired. The Board has considered the Veteran's statements that she occasionally experiences a sensation that her right knee may give out, but finds that the objective findings on stability testing, together with the evidence discussed above documenting the absence of a ligament tear or sprain, persuasively establish that the criteria for a compensable rating are not met under 5257. Regarding the remaining potentially applicable diagnostic codes, no higher or separate evaluations are for assignment for the Veteran's right knee disability. The Veteran's right knee disability did not more nearly approximate ankylosis, as flexion to at least 60 degrees and extension to zero degrees was documented during the appeal period, even during flare-ups and with functional loss. Accordingly, the evidence does not demonstrate that the Veteran's right knee exhibited limitation of motion that was the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021); see 38 C.F.R. § 4.71a, DC 5256. Moreover, the evidence does not demonstrate a knee replacement and/or impairment of the tibia and fibula for the Veteran's right knee. 38 C.F.R. § 4.71a, DCs 5055, 5262. Thus, higher or separate evaluations are not warranted as to the right knee. In reaching this decision, the Board acknowledges that it cannot consider the ameliorative effects of medication. Jones, supra. However, because the Veteran reports that treatment, which includes medication as needed for pain, does not help relieve her right knee disability, there are no ameliorative effects to discount. See, e.g., the VA examination report dated January 2024; see also the Veteran's statement dated August 2023. The Board therefore finds that the evidence of record is persuasively against the assignment of initial disability ratings in excess of 10 percent for right knee strain based on limitation of extension and 20 percent for meniscal tear of the right knee. Thus, they are denied. 38 U.S.C. § 5107(b); see also Lynch, supra. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. K. Buckley, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.