Citation Nr: A25035441 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 230524-349655 DATE: April 17, 2025 ORDER An effective date earlier than June 18, 2014, for the grant of service connection for thoracolumbar spine degenerative arthritis, intervertebral disc syndrome (IVDS) is denied. An effective date earlier than June 18, 2014, for the grant of service connection for left lower extremity sciatic nerve radiculopathy is denied. An effective date earlier than June 18, 2014, for the grant of service connection for right lower extremity sciatic nerve radiculopathy is denied. An effective date earlier than October 14, 2011, for the grant of service connection for left ankle arthritis is denied. An effective date earlier than October 14, 2011, for the grant of service connection for left foot plantar fasciitis is denied. An initial disability rating of 40 percent, but no higher, for the service-connected thoracolumbar spine degenerative arthritis, IVDS, for the entire period on appeal, is granted. An initial disability rating in excess of 10 percent for the service-connected left lower extremity sciatic nerve radiculopathy before March 5, 2021, is denied. A disability rating in excess of 40 percent for the service-connected left lower extremity sciatic nerve radiculopathy from March 5, 2021, is denied. An initial disability rating in excess of 10 percent for the service-connected right lower extremity sciatic nerve radiculopathy before March 5, 2021, is denied. A disability rating in excess of 20 percent for the service-connected right lower extremity sciatic nerve radiculopathy from March 5, 2021, is denied. An initial disability rating in excess of 10 percent for the service-connected left foot plantar fasciitis from October 14, 2011, to December 10, 2016, is denied. A disability rating in excess of 10 percent for the service-connected right foot pes planus with right 5th metatarsal joint arthritis before December 10, 2016, is denied. A disability rating of 50 percent, but no higher, for the service-connected right foot pes planus with right 5th metatarsal joint arthritis and left foot plantar fasciitis from December 10, 2016, is granted. An initial disability rating in excess of 10 percent for the service-connected left ankle arthritis with instability before December 6, 2018, is denied. A disability rating in excess of 20 percent for the service-connected left ankle arthritis with instability from December 6, 2018, is denied. A disability rating in excess of 20 percent for the service-connected right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis from December 10, 2016, is denied. A total disability rating based on individual unemployability (TDIU) from June 18, 2014, is granted. FINDINGS OF FACT 1. The October 1999 rating decision denied service connection for a lumbosacral spine condition. The November 2005 unappealed Board decision confirmed the denial. 2. The August 2012 rating decision denied service connection for lumbar strain because new and material evidence has not been received. The Veteran did not appeal the denial and did not submit new and material evidence within one year of the notification of the denial. 3. There is no unadjudicated claim, formal or informal, for service connection for thoracolumbar spine degenerative arthritis subsequent to the August 2012 rating decision and prior to the June 18, 2014, informal claim. 4. Service connection for right and left lower extremity sciatic nerve radiculopathy was granted secondary to the service-connected thoracolumbar spine degenerative arthritis, IVDS. 5. The October 1999 rating decision denied service connection for a bilateral ankle condition and bilateral foot condition. The November 2005 unappealed Board decision confirmed the denials. 6. There is no unadjudicated claim, formal or informal, for service connection for a left ankle disability and left foot plantar fasciitis subsequent to the October 1999 rating decision and prior to the October 14, 2011, claim. 7. During the entire period on appeal, the Veteran's service-connected thoracolumbar spine degenerative arthritis, IVDS manifested in an overall disability picture more nearly approximating favorable ankylosis (or functional equivalent thereof) of the entire thoracolumbar spine, when considering functional loss due to flare-ups and with repetitive use over time. The overall disability picture did not more nearly approximate unfavorable ankylosis (or functional equivalent thereof) of the entire thoracolumbar spine. 8. For the period on appeal before March 5, 2021, the Veteran's left lower extremity sciatic nerve radiculopathy manifested in no worse than mild incomplete paralysis of the sciatic nerve. Moderate incomplete paralysis has not been shown. 9. For the period on appeal from March 5, 2021, the Veteran's left lower extremity sciatic nerve radiculopathy manifested in no worse than moderately severe incomplete paralysis. 10. For the period on appeal before March 5, 2021, the Veteran's right lower extremity sciatic nerve radiculopathy manifested in no worse than mild incomplete paralysis of the sciatic nerve. Moderate incomplete paralysis has not been shown. 11. For the period on appeal from March 5, 2021, the Veteran's right lower extremity sciatic nerve radiculopathy manifested in no worse than moderate incomplete paralysis. 12. For the period on appeal from October 14, 2011, to December 10, 2016, the Veteran's left foot plantar fasciitis did not manifest in severe marked deformity, swelling on use, or characteristic callosities. 13. For the period on appeal before December 10, 2016, the Veteran's service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis manifested in no worse than moderate symptoms. Moderately severe symptoms were not shown. 14. For the period on appeal from December 10, 2016, the evidence is at least evenly balance as to whether the Veteran's service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot plantar fasciitis manifested in pronounced symptoms bilaterally, warranting a 50 percent disability rating. This is the maximum available rating available for the Veteran's foot disability. 15. For the period on appeal before December 6, 2018, the Veteran's left ankle arthritis manifested by dorsiflexion to 20 degrees and plantar flexion to 45 degrees with pain, stiffness, weakness, resulting in no worse than moderate limitation of motion. 16. For the period on appeal from December 6, 2018, the Veteran's left ankle arthritis with instability did not manifest in ankylosis or functional equivalent thereof, os calcis or astragalus, or astragalectomy. 17. For the period on appeal from December 10, 2016, the Veteran's right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis did not manifest in ankylosis or functional equivalent thereof, os calcis or astragalus, or astragalectomy. 18. From June 18, 2014, the Veteran met the schedular criteria threshold for a TDIU and was precluded from securing and following substantially gainful employment due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The October 1999 and August 2012 rating decisions denying service connection for a low back disability are final. 38 U.S.C. § 7105; 38 C.F.R. § 19.20, 19.22, 19.32, 19.52. 2. The criteria for the assignment of an effective date earlier than June 18, 2014, for the grant of service connection for thoracolumbar spine degenerative arthritis, IVDS, left lower extremity sciatic radiculopathy, and right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 5101, 5110, 7105; 38 C.F.R. §§ 3.1, 3.156, 3.303, 3.400. 3. The October 1999 rating decision denying service connection for a bilateral ankle condition is final. 38 U.S.C. § 7105; 38 C.F.R. § 19.20, 19.22, 19.32, 19.52. 4. The criteria for the assignment of an effective date earlier than October 14, 2011, for the grant of service connection for left ankle arthritis have not been met. 38 U.S.C. §§ 5101, 5110, 7105; 38 C.F.R. §§ 3.1, 3.156, 3.303, 3.400. 5. The criteria for the assignment of an effective date earlier than October 14, 2011, for the grant of service connection for left plantar fasciitis have not been met. 38 U.S.C. §§ 5101, 5110, 7105; 38 C.F.R. §§ 3.1, 3.156, 3.303, 3.400. 6. For the entire period on appeal, the criteria for a disability rating of 40 percent but no higher, for the service-connected thoracolumbar spine degenerative arthritis, IVDS have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.655, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242. 7. For the period on appeal before March 5, 2021, the criteria for an initial disability rating in excess of 10 percent for the service-connected left lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, Code 8520. 8. For the period on appeal from March 5, 2021, the criteria a disability rating in excess of 40 percent for the service-connected left lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, Code 8520. 9. For the period on appeal before March 5, 2021, the criteria for an initial disability rating in excess of 10 percent for the service-connected right lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, Code 8520. 10. For the period on appeal from March 5, 2021, the criteria for a disability rating in excess of 20 percent for the service-connected right lower extremity sciatic nerve radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, Code 8520. 11. For the period on appeal from October 14, 2011, to December 10, 2016, the criteria for an initial disability rating in excess of 10 percent for the service-connected left foot plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 3.321, 4.71a, Diagnostic Code 5276. 12. For the period on appeal before December 10, 2016, the criteria for an initial disability rating in excess of 10 percent for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5003-5284. 13. For the period on appeal from December 10, 2016, the criteria for a 50 percent disability rating, but no higher, for the right foot pes planus with right 5th tarsometatarsal joint arthritis with left foot plantar fasciitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.71a, Diagnostic Code 5276. 14. For the period on appeal before December 6, 2018, the criteria for a disability rating in excess of 10 percent for the left ankle arthritis with instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 15. For the period on appeal from December 6, 2018, the criteria for a disability rating in excess of 20 percent for the service-connected left ankle arthritis with instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 16. For the period on appeal from December 10, 2016, a disability rating in excess of 20 percent for the service-connected right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003-5271. 17. From June 18, 2016, the criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.102, 3.400, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from October 1994 to February 1998. This matter is before the Board of Veterans' Appeals (the Board) on appeal from a May 2022 Department of Veterans Affairs (VA) Regional Office (RO) Higher Level Review (HLR) rating decision. By way of history, a September 2021 rating decision denied entitlement to a TDIU. In September 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: HLR, and requested review of the September 2021 rating decision. In May 2022, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2022 decision. The May 2022 rating decision revised the prior February 2018 rating decision, and granted an effective date of June 18, 2014, for the assignment of a 10 percent disability rating for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot plantar fasciitis, based on a clear and unmistakable error (CUE), and assigned a 30 percent disability rating from December 10, 2016; granted the effective date of December 10, 2016 for the assignment of a 20 percent disability rating for the service-connected right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis based on a CUE; granted an effective date of June 18, 2014 for the grant of service connection for thoracolumbar spine degenerative arthritis, IVDS based on a CUE, and assigned a 10 percent disability rating from June 18, 2014, and a 20 percent disability rating from February 18, 2016; granted an effective date of June 18, 2014 for the grant of service connection for the left lower extremity sciatic nerve radiculopathy based on a CUE, and denied disability rating higher than 10 percent before March 5, 2021 and higher than 40 percent from March 5, 2021 and thereafter; granted an effective date of June 18, 2014 for the grant of service connection for the right lower extremity sciatic nerve radiculopathy based on a CUE, and denied disability rating higher than 10 percent before March 5, 2021 and higher than 20 percent from March 5, 2021 and thereafter; denied entitlement to an effective date earlier than October 14, 2011 for the grant of service connection for left ankle arthritis with instability, and denied a disability ratings higher than 10 percent before December 6, 2018, and in excess of 20 percent from December 6, 2018 and thereafter; denied entitlement to an effective date earlier than October 14, 2011 for the grant of service connection for left foot planar fasciitis, and denied disability rating in excess of 10 percent before December 10, 2016, when the evaluation was closed and combined with the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis; and, denied TDIU. In the May 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the September 2021 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Earlier Effective Dates The statutory and regulatory guidelines for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. The effective date of an evaluation and an award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date the claim was received, or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. For claims or appeals filed on or after March 24, 2015, a claim for benefits must be submitted on a standardized form. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686 (Sept. 25, 2014) (eff. Mar. 24, 2015). Claims or appeals pending before VA on that date are to be decided based on the regulations as they existed prior to the amendment. Standard Claims and Appeals Forms, 79 Fed. Reg. 57,660, 57,686. 1. Entitlement to an effective date earlier than June 18, 2014, for the grant of service connection for thoracolumbar spine degenerative arthritis, IVDS. 2. Entitlement to an effective date earlier than June 18, 2014, for the grant of service connection for left lower extremity sciatic nerve radiculopathy. 3. Entitlement to an effective date earlier than June 18, 2014, for the grant of service connection for right lower extremity sciatic nerve radiculopathy. In this case, the Veteran filed his original claim for service connection for bilateral foot, bilateral ankle, and lumbosacral spine condition. The October 1999 rating decision denied the claims, finding that the incurred claimed conditions were not incurred or aggravated by service. The Veteran was notified of the rating decision and his appellate rights in October 1999. The Veteran timely appealed the rating decision. The Statement of the Case was issued in November 1999, and the Veteran's VA Form 9 was accepted as timely in October 2000. Following a Board remand, the claims were denied in a November 2005 Board decision. The Veteran did not appeal the November 2005 Board decision to the United States Court of Appeals for Veterans Claims. As the November 2005 Board decision affirmed the October 1999 rating decision, it became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. Next, in May 2012, the Veteran submitted a claim for service connection for lower back condition. The claim was denied in an August 2012 rating decision, which found that new and material evidence has not been received. The Veteran was notified of the rating decision and his appellate rights in August 2012. He did not appeal the decision and did not submit new and material evidence within one year of the notification of the decision. Therefore, the August 2012 rating decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. On June 18, 2014, the Veteran's informal claim for service connection for lumbar strain was received. The May 2022 rating decision on appeal assigned June 18, 2014, as the effective date for grant of service connection for thoracolumbar spine degenerative arthritis, IVDS. As noted above, relevant regulations provide that the latter of the date entitlement arose and the date of the claim, is considered the effective date for service connection. Thus, regardless of whether entitlement to service connection for thoracolumbar spine degenerative arthritis, IVDS, an effective date earlier than date of the claim, in this case June 18, 2014, for the grant of service connection is not warranted. In other words, because the October 1999 and August 2012 rating decisions became final, and because no new and material evidence was submitted within one year of the last final August 2012 denial, the date of the claim is the June 18, 2014, claim for service connection which was eventually granted. As the claim upon which service connection was granted was received more than one year following the Veteran's February 1998 separation, the effective date for the grant of service connection cannot be the day following his separation from active service, or any other day within the year following his separation. Rather, by law, the correct effective date is June 18, 2014. With respect to effective dates for grant of service connection for left and right lower extremity sciatic nerve radiculopathy, the disabilities were granted secondary to the service-connected thoracolumbar spine degenerative arthritis, IVDS. Because they were granted secondary to the service-connected thoracolumbar spine degenerative arthritis, the effective date for the grants cannot be earlier than the effective date for the grant of service connection for thoracolumbar spine arthritis. See 38 C.F.R. §§ 3.310, 3.400. In light of the foregoing, there is no legal basis to assign an effective date earlier than June 18, 2014, for the grant of service connection for thoracolumbar spine degenerative arthritis, IVDS, left lower extremity sciatic nerve radiculopathy, and right lower extremity sciatic nerve radiculopathy. Accordingly, the claims for an earlier effective date for grants of service connection are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Entitlement to an effective date earlier than October 14, 2011, for the grant of service connection for the left ankle arthritis. 5. Entitlement to an effective date earlier than October 14, 2011, for the grant of service connection for left foot plantar fasciitis. As noted above, the October 1999 final rating decision denied service connection for a bilateral ankle condition and bilateral foot condition. The denial was affirmed by the Board in November 2005. The next communication regarding left ankle arthritis and left foot is the October 14, 2011, informal claim. In light of the foregoing, there is no legal basis to assign an effective date earlier than October 14, 2011, for the grant of service connection for left ankle arthritis and left foot plantar fasciitis. Accordingly, the claims for an earlier effective date for grants of service connection are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 INCREASED RATING Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. 38 U.S.C. § 1155. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id.; see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The determination of whether an increased disability rating is warranted is to be based on a review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the Veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). Indeed, the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It thus follows that actually painful, unstable, or malaligned joints due to healed injury are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the United States Court of Appeals for Veterans Claims (Court) rejected VA's argument that § 4.59 requires painful motion, such that the mere presence of joint pain is not sufficient. Id. at 428-29. The Court held that under § 4.59, "the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint," explaining that § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that § 4.59 does not require "objective" evidence but can be satisfied with lay and other non-medical evidence. Id. at 429. However, a Veteran may be entitled to a higher disability evaluation than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes "additional functional loss i.e., 'the inability...to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and endurance' including as due to pain and/or other factors" or "reduction of a joint's normal excursion of movement in different planes, including changes in the joint's range of movement, strength, fatigability, or coordination." Lyles v. Shulkin, 29 Vet. App. 107, 117-18 (2017) (quoting 38 C.F.R. § 4.40 and citing 38 C.F.R. § 4.45); Mitchell v. Shinseki, 25 Vet. App. 32, 36-37 (2011); DeLuca v. Brown, 8 Vet. App. 202, 205-07 (1995). The Board considers not only the criteria of the currently assigned diagnostic codes, but also the criteria of other potentially applicable diagnostic codes. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. However, the evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." See 38 U.S.C. § 1155; Brady v. Brown, 4 Vet. App. 203, 206 (1993). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, if a Veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). Additionally, in deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, 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). Finally, where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions will be equitable and just as contemplated by the requirements of the law. 38 C.F.R. § 4.6. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (the benefit-of-the-doubt rule applies if the competing evidence is in approximate balance). 6. Entitlement to a disability rating in excess of 10 percent for the service-connected thoracolumbar spine degenerative arthritis, IVDS, before February 18, 2016, and in excess of 20 percent from February 18, 2016. The Veteran's service-connected thoracolumbar spine degenerative arthritis, IVDS is rated as 10 percent disabling from June 18, 2014, under 38 C.F.R. § 4.71a, Diagnostic Code 5237 for lumbosacral or cervical strain, and as 20 percent disabling from February 18, 2016 under 38 C.F.R. § 4.71a, Diagnostic Codes 5003-5237. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. In this case, Diagnostic Code 5003 rates degenerative arthritis and instructs to evaluate on the basis of limitation of motion of the affected parts. Diagnostic Code 5237 is rated under the General Rating Formula for Diseases and Injuries of the Spine. Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. The General Rating Formula provides a 10 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is 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 is warranted if forward flexion of the thoracolumbar spine is limited to 30 degrees or less or for 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. Note (1) states any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be evaluated 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 ROM refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined ROM of the thoracolumbar spine is 240 degrees. Each ROM measurement is to be rounded to the nearest five degrees. Note (3) states 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 ROM of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal ROM stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the ROM is normal for that individual will be accepted. Note (4) provides that each ROM measurement is to be rounded to the nearest five degrees. Note (5) states 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. Diagnostic Code 5243 requires evaluations of intervertebral disc syndrome (IVDS) (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS, whichever method results in the higher evaluation when all disabilities are combined under §4.25. Under the formula for evaluation of IVDS, ratings are assigned based on duration incapacitating episodes during the past 12 months. 38 C.F.R. §4.71a, IVDS Formula. For these purposes, an incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). The Board notes that effective February 7, 2021, VA amended the schedule of ratings for musculoskeletal disabilities. 85 Fed. Reg. 76,453 (Nov. 30, 2020) (eff. Feb. 7, 2021). However, this amendment did not change the rating criteria contained in the General Formula. Id. While the amendment did change the language contained in Diagnostic Code 5242 and 5243, these changes simply provided clarification that Diagnostic Code 5242 should be utilized for disc disease other than intervertebral disc syndrome and that Diagnostic Code 5243, governing intervertebral disc syndrome specifically, should be used only when there is disc herniation with compression and/or irritation of the adjacent nerve root. Id. at 76,462. As the amendment did not substantively change the rating criteria utilized in rating the Veteran's spine disability, the Board will not address the amendment further herein. When evaluating a disability under VA's General Rating Formula for Diseases and Injuries of the Spine, the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis i.e., functional loss consistent with that contemplated by ankylosis. See Chavis v. McDonough, 34 Vet. App. 1 (2021); 38 C.F.R. §§ 4.40, 4.45; Mitchell, 25 Vet. App. at 32; DeLuca, 8 Vet. App. at 202. The provisions of 38 C.F.R. § 4.40 and 4.45 are also applicable when evaluating joint disabilities and their manifestations, including ankylosis. These sections direct adjudicators to determine whether the joint demonstrates less movement than normal and ankylosis is specifically identified among the possible causes of less movement. Moreover, § 4.40 provides that "functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion." Accordingly, the Court in Chavis found that the application of 38 C.F.R. § 4.40 and 4.45 permits consideration under the General Rating Formula of an evaluation based on ankylosis if a claimant's functional loss is consistent with that contemplated by ankylosis or if it is the functional equivalent of ankylosis. Turning to the evidence of record, a September 2014 private imaging report from Temecula Valley Imaging Wildomar, indicates that the Veteran had straitening of the normal lordotic curvature which may be secondary to spasm, and moderate degenerative disc disease of the L5-S1. An October 2014 private report from Canyon Lake Urgent and Family Care indicates that the Veteran was seen in August 2014 after being referred for chronic right ankle and low back pain. The Veteran's medical records and reports and treatments for back pain were summarized. The report linked the Veteran's back pain to his right ankle disability. A February 2016 VA examination report indicates that the Veteran had degenerative arthritis of the spine, spinal stenosis, and IVDS. The Veteran reported onset of symptoms in 2012, indicating that his condition stayed the same. He reported pain where he is unable to move most of the time. He reported flare ups of worsening pain, and needing medication to get through his flare ups. He reported sometimes being unable to move due to pain. Forward flexion was to 60 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Pain causing functional loss was noted on all range of motion testing. There was evidence of pain with weight bearing, and evidence of moderate diffuse localized tenderness or pain on palpation at the L1-S1. The Veteran was unable to perform repetitive use testing with at least three repetitions due to pain. The examiner concluded that pain, weakness, and lack of endurance significantly limit functional ability with repeated use over time and during flare ups, and estimated that range of motion measurements would be the same. The Veteran was noted to have muscle spasm, localized tenderness, and guarding, resulting in abnormal gait or spinal contour. Less movement than normal, weakened movement, disturbance of locomotion, interference with sitting, and interference with standing were listed as additional contributing factors. The Veteran was not noted to have muscle atrophy. Sensory and reflex examinations were normal. There was no ankylosis noted, and the Veteran was not noted to have IVDS episodes requiring bed rest prescribed by a physician. Imaging showed mild spinal stenosis. Under functional impact, the Veteran was noted to be unable to run, jump, squat, climb, crawl, or lift repetitively. A January 2017 VA imaging report indicates that the Veteran had mild multilevel degenerative changes of the lumbar spine, mild posterior disc bulge at L4-5 with mild bilateral facet disease and mild central canal stenosis. He was also noted to have mild bilateral neural foramina stenosis at L4-5. A January 2017 affidavit from the Veteran indicates that he experienced daily lower back, right ankle, and right foot pain, which causes him to have an altered gait. He attested to mobility issues due to pain. He also indicated that he had difficulties with activities, such as getting in and out of the shower, getting dressed, and participating in activities with his wife. A September 2017 private independent medical evaluation from Dr. J.L. indicates that the Veteran developed worsening back pain that requires chronic pain management. A February 2018 VA imaging report indicates that the Veteran had normal alignment of the lumbar spine, multilevel degenerative changes more prominent at L4-5 and L5-S1 with mild to moderate disc space narrowing. There was no evidence of acute fracture and subluxation noted. It was noted that pain clinic consultation was placed, and that the Veteran was to continue to treat his back with diclofenac gel and ibuprofen. A May 2021 VA examination report indicates that the Veteran had degenerative arthritis. It was noted that the Veteran has treated his back pain with facet injections, and nerve block acupuncture. Current symptoms were reported as tenderness, soreness, shooting pain, burning and grinding. The Veteran reported impact of his symptoms as very limiting and debilitating at times. He reported severe daily flare ups lasting hours, and precipitated by movement like bending over, as well as lifting heavy and light items. The Veteran reported flare ups being alleviated by laying down and CBD. He reported being unable to walk, exercise, and do daily activities due to pain. Range of motion itself was noted to contribute to functional loss, as the Veteran was noted to be weak with repetitive range of motion. Forward flexion was to 45 degrees, extension to 15 degrees, right latera flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Pain was noted on right and left lateral flexion. Passive range of motion testing showed the same results with evidence of pain. There was no crepitus noted, and no localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions and no additional loss of range of motion. It was noted that the Veteran was being examined immediately after repeated use over time and during a flare up, and that no additional limitations other than those already recorded were noted. There was no ankylosis noted. The Veteran was not noted to have incapacitating episodes of IVDS. The Veteran was noted to constantly use a brace and a walker, due to degenerative arthritis, pain, and unsteady gait. Imaging results were cited. For functional impact, it was noted that the Veteran reported having a lot of pain and having difficulty bending and doing things involving his back. Based on the foregoing, and with resolution of all reasonable doubt in the Veteran's favor, the criteria for an initial 40 percent disability rating, but no higher, for the service-connected thoracolumbar spine degenerative arthritis, IVDS, are more nearly approximated for the entire period on appeal. A rating under Diagnostic Code 5242 is more appropriate given the finding of degenerative arthritis. In this regard, the evidence is at least evenly balanced as to whether the Veteran's disability picture during flare ups and with repeated use over time, manifests in the functional equivalent of favorable ankylosis of the thoracolumbar spine. During the February 2016 and May 2021 VA examinations, the examiner did not find forward flexion limited to 30 degrees or less, or that the Veteran had ankylosis. However, during the February 2016 VA examination, the Veteran was unable to perform repeated use testing due to pain. Further, during the same examination, he reported being unable to move due to pain during a flare up. While the examiner estimated range of motion to be the same with repeated use over time, and during flare ups, the finding is of diminished probative value given the Veteran's reports. During the May 2021 VA examination, the Veteran reported his back pain is very limiting and debilitating at times. Finally, the Veteran was found to have problems with bending and movements involving his back. In other words, the Veteran reported being unable to move due to pain, and the February 2016 examiner found that he was unable to perform additional range of motion testing due to pain. Resolving all reasonable doubt in the Veteran's favor, the February 2016 and May 2021 VA examination reports contain findings that more nearly approximate the functional equivalent of favorable ankylosis of the thoracolumbar spine during flare-ups and after repeated use over time. As noted above, ankylosis is defined as stiffening or fixation of a joint, which manifests in immobility of part of the spine. Further, VA regulations define favorable ankylosis as fixation of a spinal segment in neutral position (0 degrees). During the February 2016 VA examination, the Veteran was unable to perform additional range of motion testing, and it is reasonable to estimate that this represents a range of motion fixation at 0 degrees with repeated use over time. The Veteran also reported being unable to move sometimes during flare ups due to pain. Further, during the May 2021 VA examination, he described his flare ups as daily and severe. Thus, the Veteran's symptoms during flare ups and with repeated use over time more nearly approximate functional equivalent of favorable ankylosis of the thoracolumbar spine, warranting a 40 percent disability rating for the entire period on appeal. A disability rating in excess of 40 is not warranted for the period on appeal. In order to warrant the next higher 50 percent disability rating under Diagnostic Code 5242, the evidence would have to show unfavorable ankylosis (or functional equivalent thereof) of the entire thoracolumbar spine. Unfavorable ankylosis is denied as a condition in which the entire thoracolumbar spine is fixed in flexion or extension, resulting in an additional difficulty, such as walking, due to limited sightline. Here, the evidence does not show that the Veteran's limitation of motion caused his thoracolumbar spine to be fixed in flexion or extension, or any of the results as outlined in the VA regulation. While the Veteran reported being unable to move his back due to pain during flare ups or with repeated use, there is no indication that his back was fixed, or stuck in one place. Accordingly, a higher disability rating under Diagnostic Code 5242 is not warranted. While the Veteran reported his daily flare ups as being severe and sometimes being unable to move, as well as trouble with physical activities, there is no indication that there were incapacitating episodes requiring physician-prescribed bed rest having a total duration of at least 6 weeks in the past 12 months. Accordingly, a higher rating under Diagnostic Code 5243 is not warranted. The Veteran is separately rated for radiculopathy, which is adjudicated below. There is no other neurological involvement, and thus, a separate rating is not warranted. Staged ratings were considered. However, as the Veteran's overall disability picture remained largely the same throughout the period on appeal, they are not applicable here. For the foregoing reasons, an initial disability rating of 40 percent, but no higher, is granted for the service-connected thoracolumbar spine degenerative arthritis, IVDS, for the entire period on appeal. 7. Entitlement to an initial disability rating in excess of 10 percent for the service-connected left lower extremity sciatic nerve radiculopathy before March 5, 2021, and a rating in excess of 40 percent from March 5, 2021, and thereafter. 8. Entitlement to an initial disability rating in excess of 10 percent for the service-connected right lower extremity sciatic nerve radiculopathy before March 5, 2021, and a rating in excess of 20 percent from March 5, 2021, and thereafter. The Veteran's left lower extremity sciatic nerve radiculopathy is each rated as 10 percent disabling from June 18, 2014, and as 40 percent disabling from March 5, 2021, under 38 C.F.R. § 4.124a, Diagnostic Code 8520. His right lower extremity radiculopathy is rated as 10 percent disabling from June 18, 2014, and as 20 percent disabling from March 5, 2021, under 38 C.F.R. § 4.124a, Diagnostic Code 8520. 38 C.F.R. § 4.124a governs disability ratings for neurological disabilities. The criteria provides that when rating peripheral nerve injuries and residuals, the rater should consider the relative impairment of motor function, trophic changes, and/or sensory disturbances. Attention should be given to the site and character of the injury. 38 C.F.R. § 4.124a. Diagnostic Code 8520 pertains to the sciatic nerve. A 20 percent disability rating is warranted for moderate incomplete paralysis. A 40 percent rating is warranted for moderately severe incomplete paralysis. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted for complete paralysis of the nerve (the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost). Neuritis and neuralgia of the sciatic nerve is rated under diagnostic codes 8620 and 8720. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124. The term "marked" is not defined in the regulation. When a regulation includes ambiguous or subjective terms, the Board must define such term. See Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018). The Merriam-Webster dictionary defines "marked" as "having a distinctive or emphasized character." See https://www.merriam-webster.com/dictionary/marked (last visited January 2, 2025). 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 8526 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 Diagnostic Code 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 Diagnostic Code 8526, 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 v. Wilkie, 30 Vet. App. 257, 264 (2018). Clearly relevant to this case are M21-1 provisions regarding evaluations of paralysis of the femoral 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. Additionally, 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. Also, 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. Turning to the evidence of record, the February 2016 VA examination report indicates that the Veteran had mild lower extremity intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness bilaterally. He was noted to have sciatic nerve involvement which was mild in severity. An April 2021 VA examination report indicates that the Veteran had moderate right lower extremity constant pain, paresthesias and/or dysesthesias, and numbness. On the left, he was noted to have severe lower extremity constant pain, paresthesias and/or dysesthesias, and numbness. Muscle strength was normal and there was no muscle atrophy. Reflex and sensory examination was normal. He was noted to have moderate incomplete paralysis of the right sciatic nerve and moderately severe incomplete paralysis of the left sciatic nerve. It was noted that the Veteran's left lower extremity sciatic nerve radiculopathy impacted his ability to ambulate normally, that he used a walker, and that it also impaired memory and concentration due to significant pain. The May 2021 VA examination report with respect to back indicates that the Veteran had mild bilateral constant lower extremity radicular pain, moderate intermittent lower extremity pain, and mild bilateral lower extremity numbness. Before March 5, 2021 For the period on appeal before March 5, 2021, an initial disability rating in excess of 10 percent is not warranted for the left or right lower extremity sciatic nerve radiculopathy. In this regard, the February 2016 VA examiner found that the Veteran's lower extremity radiculopathy more nearly approximated mild incomplete paralysis. Sensory and reflex examinations were normal. Moreover, although the determination is not binding on the Board, the VA examiner's characterization of the degree of impairment was mild. 38 C.F.R. § 3.100 (a) (delegating the Secretary's authority "to make findings and decisions... as to the entitlement of claimants to benefits" to, inter alia, VA "adjudicative personnel"); 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present.") The evidence of record does not reflect more significant case of sensory-only impairment or symptoms such as marked muscular atrophy, motor or reflex impairment at a grade reflecting a moderate level or higher of limitation, such as weakness or diminished or hyperactive reflexes, trophic changes, or other symptoms more nearly approximating the moderate, incomplete paralysis as required for 20 percent disability ratings at any point during the appeal period. Thus, the evidence of record reflects that the left and right lower extremity sciatic nerve radiculopathy symptoms more nearly approximate mild, incomplete paralysis for the period on appeal before March 5, 2021. Accordingly, an initial disability rating in excess of 10 percent is not warranted for the left and right lower extremity sciatic radiculopathy before March 5, 2021. From March 5, 2021 With respect to left lower extremity sciatic radiculopathy, and after carefully considering the evidence and the applicable schedular criteria, to include consideration of the M21-1 guidance provided above, the Board finds that the lay and medical evidence does not establish that the Veteran experienced severe paralysis with marked muscular atrophy of the left lower extremity sciatic nerve radiculopathy. Nor is there credible evidence of complete paralysis of any of the nerve roots pertaining to the left lower extremity. Accordingly, a disability rating in excess of 40 percent is not warranted from March 5, 2021. With respect to right lower extremity radiculopathy, a disability rating in excess of 20 percent from March 5, 2021, is not warranted. In this regard, the April 2021 and May 2021 VA examination reports show that the Veteran's radiculopathy manifests no worse than moderate incomplete paralysis. In other words, severe, or incomplete paralysis is not shown. Accordingly, a disability rating in excess of 20 percent for is not warranted from March 5, 2021. 9. Entitlement to a disability rating in excess of 10 percent for the service-connected left foot plantar fasciitis from October 14, 2011, to December 10, 2016. 10. Entitlement to a disability rating in excess of 10 percent for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot plantar fasciitis before December 10, 2016, and in excess of 30 percent from December 10, 2016. 11. Entitlement to a disability rating in excess of 10 percent for the service-connected left ankle arthritis with instability before December 6, 2018, and in excess of 20 percent from December 6, 2018. 12. Entitlement to a disability rating in excess of 20 percent for the service-connected right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis from December 10, 2016. Relevant to the period on appeal covered by the claims, the Veteran's service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot plantar fasciitis is rated as 10 percent disabling from June 18, 2014, under Diagnostic Codes 5003-5284, and as 30 percent disabling from December 10, 2016, under Diagnostic Code 5276. His left foot plantar fasciitis is rated as 10 percent disabling under Diagnostic Code 5276 from October 14, 2011, to December 10, 2016, at which point the rating was severed and the evaluation was combined with right foot pes planus. The Veteran's right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis is rated as 20 percent disabling from December 10, 2016, under Diagnostic Codes 5003-5271. His left ankle arthritis with instability is rated as 10 percent disabling from October 14, 2011, and as 20 percent disabling from December 16, 2018, under Diagnostic Code 5271. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Prior to February 7, 2021, Diagnostic Code 5010 provides that arthritis due to trauma, substantiated by x-ray findings, is to be rated under Diagnostic Code 5003 as degenerative arthritis. 38 C.F.R. § 4.71a. Degenerative arthritis established by x-ray findings will be rated based on limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Note 1 provides that the 20 percent and 10 percent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Effective February 7, 2021, Diagnostic Code 5010 provides that posttraumatic arthritis is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Under Diagnostic Code 5284 (same before and after the February 7, 2021, regulatory change), other foot injuries are rated as 10 percent disabling when moderate, 20 percent disabling when moderately severe, and 30 percent disabling when severe. With actual loss of use of the foot, a 40 percent rating is assigned. 38 C.F.R. § 4.71a. VA's General Counsel has determined that Diagnostic Code 5284 is a general diagnostic code under which a variety of foot injuries may be rated; that some injuries to the foot, such as fractures and dislocations for example, may limit motion in the subtalar, midtarsal, and metatarsophalangeal joints; and that other injuries may not affect range of motion. Thus, General Counsel concluded that, depending on the nature of the foot injury, Diagnostic Code 5284 may involve limitation of motion. VAOPGCPREC 9-98. Words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 C.F.R. §§ 4.2, 4.6. The Board notes that "mild," as relevant to a physical condition, is defined as "not severe" or temperate; with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive." Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed January 25, 2021). "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect." Id. "Severe" is defined as "very painful or harmful" or "of a great degree." Id. The term "severe" is used throughout the rating schedule to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Within the context of Diagnostic Codes which establishes a successive, tiered rating structure, it represents the highest or most extreme level. Certain sections of the Rating Schedule use the term "marked" which the Board equates as similar to "severe." Under Diagnostic Code 5276 (same before and after the February 7, 2021, regulatory change), a noncompensable (0 percent) rating is assigned where the flatfoot is mild with symptoms relieved by built-up shoe or arch support. A 10 percent rating is assignable for moderate impairment with weight-bearing line over or medial to great toe, inward bowing of the tendo Achilles, pain on manipulation and use of the feet. A 30 percent rating is assignable for severe bilateral impairment manifested by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; and a 20 percent increased rating is assigned for these symptoms if occurring unilaterally. A 50 percent rating is warranted when the evidence shows that flatfeet are pronounced in nature, with symptoms such as marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, and lack of improvement after use of orthopedic shoes or appliances. See 38 C.F.R. § 4.71a, DC 5276. Prior to the regulatory change, Diagnostic Code 5271 assigned a 20 percent rating, the highest rating available, for marked limitation of motion of the ankle and a 10 percent rating for moderate limitation of motion of the ankle. 38 C.F.R. § 4.71a, Diagnostic Code 5271 (2020). The regulatory change amended the Diagnostic Code to define marked limitation of motion as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion and to define moderate limitation of motion as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion. 38 C.F.R. § 4.71a, Diagnostic Code 5271 (February 7, 2021). The normal range of motion of the ankle is dorsiflexion from 0 to 20 degrees and plantar flexion from 0 to 45 degrees. 38 C.F.R. § 4.71, Plate II. Notably, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. However, a 10 percent rating can be assigned for the ankle joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). As of February 7, 2021, under the amended criteria in Diagnostic Code 5271, an ankle disability receives a 10 percent rating for severity which is defined as less than 15 degrees dorsiflexion or less than 30 degrees. A 20 percent rating is awarded for an ankle of marked severity which is defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. Once again, a 20 percent rating is the highest rating available. Moreover, as of February 7, 2021, Diagnostic Code 5269 was added for rating plantar fasciitis. A 10 percent disability rating is warranted for other plantar fasciitis, either unilateral or bilateral. 38 C.F.R. § 4.71a, DC 5269. A 20 percent rating is warranted for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. A 30 percent disability rating is warranted for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. 38 C.F.R. § 4.71a, DC 5269. Note (1) provides a 40 percent disability rating for plantar fasciitis with actual loss of use of the foot. Id. Note (2) provides if a veteran has been recommended for surgical intervention, but is not a surgical candidate, the Veteran's plantar fasciitis shall be evaluated under the applicable 20 percent or 30 percent criteria. Id. Turning to the evidence of record, the February 2012 VA examination report indicates that the Veteran was not diagnosed with flat feet. He was noted to have chronic foot pain. There was no Morton's neuroma, metatarsalia, hammertoes, hallux valgus, hallux rigidus, pes cavus, and malunion or nonunion of tarsal or metatarsal bones noted. There was no bilateral weak foot noted. The examiner indicated that the Veteran's foot condition did not have an impact on his ability to work. With respect to tibiotalar arthritis, the Veteran reported flare ups on the daily, associated with increased walking and standing. Right ankle plantar flexion was to 45 degrees or greater, and right ankle dorsiflexion was to 20 degrees or greater. The Veteran was able to perform repetitive use testing with three repetitions and no additional range of motion loss and no additional functional loss. Muscle strength testing was normal and there was no localized tenderness or pain on palpation. There was no ankylosis. The examiner found that the Veteran's right ankle tibiotalar arthritis did not limit his ability to work. A March 2012 private treatment note from Dr. J.C.'s office indicates that the more the Veteran is on his feet, the more pain he has. The Veteran reported that he has previously treated his foot pain with injections, which provide some temporary relief. It was noted that neither foot could be passively dorsiflexed to 90 degrees. He was diagnosed with bilateral plantar fasciitis, and bilateral acute medial inferior calcaneal bursitis. In July 2012, the Veteran underwent a VA examination for his claim. He was diagnosed with right ankle tibiotalar arthritis and plantar fasciitis. The Veteran reported some pain along the posterior aspect of his medial ankle and was noted to be wearing night splints. He reported ankle flare ups, consisting of soreness along the lateral aspect of his foot and numbness along the plantar aspect of his foot, which happened when he is up and walking. Right ankle plantar flexion was to 45 degrees or greater, right ankle dorsiflexion was to 10 degrees. Left ankle plantar flexion was to 45 degrees or greater, and left ankle dorsiflexion was to 20 degrees or greater. The Veteran was able to complete repetitive use testing with no additional range of motion loss and no additional functional loss. The Veteran was noted to have right side localized tenderness or pain on palpation of the ankle. Muscle strength testing was normal. There was no ankylosis and no additional conditions. It was noted that the Veteran occasionally used crutches for ankle and back pain. The examiner found that the Veteran's foot and ankle disabilities did not impact his ability to work. In February 2015, the Veteran underwent a VA examination for his feet. He was noted to have right foot pes planus and right foot pain on manipulation of the foot. There was no characteristic callouses, no extreme tenderness of plantar surfaces, no decreased longitudinal arch height on weight bearing, no objective evidence of marked deformity of one or both feet, no marked pronation, the weightbearing line did not fall over or medial to the great to, no lower extremity deformity other than pes planus causing alteration of the weight bearing line, no inward bowing of the achilles tendon, and no marked inward displaced and severe spasm of the achilles tendon. His right foot arthritis was noted to be of moderate severity and chronically compromise weight bearing. It was also noted that it required arch supports, custom orthotic inserts, or shoe modifications. He was noted to have pain on movement, weight bearing, swelling, disturbance of locomotion, and interference with standing, all on the right side. He was not noted to have other additional functional loss with repeated use over time on either foot. He was noted to use braces regularly. The examiner found that the Veteran's foot disabilities did not impact his ability to work. In December 2018, the Veteran underwent a VA examination for feet. He was diagnosed with right foot pes planus, right foot hallux valgus, right foot arthritis, and right foot plantar fasciitis. He reported his right foot pain as throbbing, soreness, tingling, burning, and feeling like it is tearing. He reported flare ups as worsening pain, and indicated that overall, his pain does not allow him to walk or stand for periods of time, affecting his knees and back. He was noted to have right foot pain on use and on manipulation. He was also noted to have extreme tenderness of the right plantar surface and decreased right longitudinal arch height on weight bearing. There was no objective evidence of marked deformity and no marked pronation. Right foot weight bearing line was noted fall over or medial to the great toe. There was no deformity other than pes planus that was causing alteration of the weight bearing line. There was no inward bowing of the achilles tendon, and no marked inward displacement and severe spasm of the achilles tendon. The Veteran's right foot hallux valgus was noted to be mild. It was noted that the Veteran had right foot arthritis and plantar fasciitis, with severe pain at lateral right foot and under plantar arch with ambulation. Right foot severity was noted to be moderately severe. The Veteran's right foot disability was not noted to chronically compromise weight bearing or require ach supports. Right foot pain on movement, pain on weight-bearing and disturbance of locomotion were noted to contribute to the Veteran's disability, and he was noted to have antalgic gait on examination. Right foot pain with ambulation was noted to significantly limit functional ability with flare ups and repeated use over time. The Veteran was noted to regularly use ankle braces and crutches for ankle and foot pain. Under functional impact, it was noted that the Veteran was impaired in performing physical activities, including prolonged walking, prolonged standing, running, jumping, and heavy carrying. It was noted that there was no impact on sedentary activities of employment. Also in December 2018, the Veteran was afforded a VA examination the right ankle arthritis. The Veteran reported constant ankle pain, feeling like the ankle is tearing, and spraining it at least 4 to 5 times per year. He reported flare ups, including right ankle swelling, numbness, tingling, foot falling asleep, being very painful to stand after 5 minutes, decreased range of motion, and weakness. The Veteran did not report any flare ups of the left ankle. Right ankle dorsiflexion was to 0 degrees and plantar flexion was to 30 degrees. Decreased flexibility was noted to contribute to functional loss bilaterally. Moderate localized tenderness or pain on palpation was noted bilaterally. There was no crepitus bilaterally. Left ankle dorsiflexion was to 0 degrees and left ankle plantar flexion was to 40 degrees. The Veteran was able to perform repetitive use testing without additional range of motion and functional loss. Fatigue and weakness were noted to contribute to functional loss of the right ankle with repeated use over time and during flare ups. This was estimated as right dorsiflexion to 0 degrees and right plantar flexion to 25 degrees. Right ankle additional contributing factors were listed as less movement than normal, weakened movement, and disturbance of locomotion. Left ankle additional contributing factors were listed as less movement than normal. Muscle strength testing showed a reduction to on the right ankle, and there was no muscle atrophy noted. There was no ankylosis bilaterally. Right ankle testing showed instability o dislocation, with left ankle being normal. The Veteran was noted to regularly use ankle braces and crutches for ankle and foot pain. The examiner listed the same functional impact as the foot VA examination report. In September 2019, the Veteran was afforded a VA examination for the ankles. He was diagnosed with bilateral ankle arthritis, including bilateral ligament instability. He reported flare ups several times per week, triggered by walking, including soreness, numbness, burning, and swelling. Right ankle dorsiflexion was to 20 degrees, and planar flexion was to 45 degrees. Pain, not itself contributing to functional loss, was noted on exam. There was no objective evidence of crepitus. The Veteran's left ankle was not tested, and it was noted that it was not medically appropriate to do so at it was in an immobilizer due to blood clots. It was noted that the Veteran was able to perform repetitive use testing without additional loss of range of motion or loss of function. The examiner indicated that pain and weakness significantly limited functional ability with repeated use over time and estimated that this would result in right ankle dorsiflexion to 10 degrees and right ankle plantar to 10 degrees. Pain and weakness were also noted to significantly limit functional ability during flare ups, and the examiner estimated that this would result in dorsiflexion to 12 degrees and plantar flexion to 12 degrees. Right ankle muscle strength testing was normal, and the Veteran was not noted to have right ankle muscle atrophy. There was no right ankle instability noted. It was noted that the Veteran was using a scooter due to a non-service connected left achilles tendon rupture. Imaging results were cited, and for functional impairment, the Veteran reported weakness and instability, ambulation of no more than 2,000 steps and standing for no more than 5-10 minutes. Examiner noted that right ankle condition worsened, and that he uses over the counter medication for pain. It was further noted that there was evidence of pan on passive range of motion, and no evidence of pain in weight-bearing. In April 2021, the Veteran was afforded a VA examination for the ankles. He was noted to have left ankle arthritis with instability. He reported severe daily flare ups, precipitated by walking, sitting, bending. He indicated that his left ankle flare ups were alleviated by nothing. The Veteran was unable to perform range of motion testing, and the examiner noted that further evaluation is not possible due to significant pain and fear of pain with additional movements. The Veteran was not noted to have muscle atrophy. There was no ankylosis noted. Under functional impact, the examiner indicated that the Veteran was unable to bear weight on the left ankle, affecting his mobility and gait, and requiring an ankle boot and knee scooter for all ambulatory activities. Additionally, in April 2021, the Veteran was afforded a VA examination for feet. He was diagnosed with left foot plantar fasciitis. He reported numbness, throbbing, shooting, and swelling pain in the left foot. He also reported daily left foot flare ups, described as severe and lasting several hours per day. Flare ups were noted to be alleviated by laying down only partly. They were noted to be precipitated by just walking and stepping to start the day. He was noted to have left foot pain accentuated on use, and left foot pain accentuated on manipulation. There was no indication of swelling on use and no characteristic calluses. He was noted to have extreme tenderness of left foot plantar surface. There was no decreased longitudinal arch height, no marked deformity, no marked pronation, and no conditions associated with flat feet. He was noted to have left foot plantar fasciitis not relieved with non-surgical treatment. The examiner noted that the Veteran's plantar fasciitis cannot be thoroughly evaluated including functional loss, as the Veteran is unable to bear weight due to his leg pain. Pain and interference with standing were noted to contribute to functional loss, and it was noted that the Veteran reported being unable to bear any weight on the left foot and ankle due to pain. He was noted to have pain with weight bearing, and was noted to use braces, walker, and a posture device for his neck and left lower leg condition. For functional impact, the examiner noted the Veteran's reports of being unable to bear any weight on the left lower extremity, in conjunction with reported leg clot, achilles injury, knee injury, as well as radiculopathy. Left foot plantar fasciitis As noted above, the Veteran's left foot plantar fasciitis is rated as 10 percent disabling under Diagnostic Code 5276 from October 14, 2011, to December 10, 2016, at which point the disability rating was combined with right foot pes planus. Notably, for this period on appeal, the disability is rated by analogy to Diagnostic Code 5276, for flat feet. As Diagnostic Code 5269 for plantar fasciitis was not yet added during this period on appeal, a rating under Diagnostic Code 5269 is not yet available. Here, the evidence shows that the Veteran had bilateral plantar fasciitis. See March 2012 private treatment note. However, the evidence does not show that the Veteran had unilateral or bilateral severe plantar fasciitis. Accordingly, a disability rating in excess of 10 percent is not warranted from October 14, 2011, to December 10, 2016. In this regard, the February 2012 and February 2015 VA examination reports did not show that the Veteran had objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities, unilaterally or bilaterally. The Board acknowledges the Veteran's reports of foot pain and limitations with standing. The Board does not wish to minimize his symptoms or assertions. However, he has not shown the requisite findings for a rating in excess of 10 percent for the service-connected left foot plantar fasciitis from October 14, 2011, to December 10, 2016. In evaluating this claim, the Board has considered other DCs pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the U.S. Court of Appeals for the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under DCs which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). However, other DCs are not applicable and would not warrant a higher disability rating. Additionally, in adjudicating the Veteran's claim for an increased rating, great consideration has been given to the lay statements of record. While the Board finds that the Veteran is competent to provide statements regarding his symptomatology, there is, however, nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding his specific level of disability according to the appropriate DCs. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Accordingly, an initial disability rating in excess of 10 percent for the service-connected left foot planar fasciitis from October 14, 2011, to December 10, 2016, is denied. Right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot plantar fasciitis As noted above, the Veteran's right foot pes planus with right 5th tarsometatarsal joint arthritis is rated as 10 percent disabling from June 18, 2014, under Diagnostic Codes 5003-5284, and as 30 percent disabling from December 10, 2016 under Diagnostic Code 5276, at which point the ratings we combined with left foot plantar fasciitis. For the period on appeal before December 10, 2016, a rating in excess of 10 percent is not warranted. In this regard, the lay and medical evidence shows that that the Veteran's right foot did not manifest by moderately severe or sever symptoms or resulted in a severe functional impairment. Indeed, the evidence shows the Veteran's right foot pain is of moderate severity, including pain on movement, flare ups, weight bearing, swelling, and disturbance of locomotion. See February 2015 VA examination report. The examiner likewise did not find that the Veteran's right foot pain interfered with his ability to work. Other diagnostic codes were considered, and were not applicable and would not result in a higher disability rating. Accordingly, a disability rating in excess of 10 percent before December 10, 2016, for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis is denied. For the period on appeal from December 10, 2016, a 50 percent rating, but no higher is warranted for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot pes planus. In this regard, the December 2018 VA examination report shows that the Veteran had right foot pain on use and on manipulation, extreme tenderness of the right plantar surface, and decreased longitudinal arch height on weight bearing. The April 2021 VA examination report indicates that the Veteran had left foot pain accentuated on use, and left foot pain accentuated on manipulation. He was also noted to have extreme tenderness of the left foot plantar surface. Notably, during this examination, the Veteran was noted to be unable to bear any weight on his left foot. Moreover, the Veteran reported lack of improvement after use of orthopedic shoes or appliances. Thus, the evidence is at least evenly balanced as to whether the Veteran's right foot pes planus with right 5th tarsometatarsal joint arthritis and left foot pes planus manifests in symptoms such as marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and sever spasm of the tendo Achillis on manipulation, and lack of improvement after use of orthopedic shoes or appliances. While the Veteran was not noted to have marked pronation on exam, he met several of the criteria for a 50 percent rating bilaterally (such as extreme tenderness of plantar surfaces and symptoms not improved by orthotics or appliances). This is the maximum rating available under Diagnostic Code 5276 and no other diagnostic code governing foot disabilities provides a rating in excess of 50 percent. Thus, even with consideration of the February 2021 criteria amendments discussed above, a 50 percent disability rating is warranted from December 10, 2016. The Board has considered whether assigning a separate rating for symptoms of pain due to bilateral plantar fasciitis would be appropriate. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). While the Veteran's service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis includes plantar fasciitis, the Board finds that the symptoms associated with plantar fasciitis are contemplated by the rating assigned under DC 5276. The record on appeal contains no indication, nor has the Veteran contended, that his bilateral plantar fasciitis has distinct manifestations from those that are not already being compensated and thus, a separate rating would amount to prohibited pyramiding. See 38 C.F.R. § 4.14. In adjudicating the Veteran's claim for an increased rating, great consideration has been given to the lay statements of record. While the Board finds that the Veteran is competent to provide statements regarding his symptomatology, there is, however, nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding his specific level of disability according to the appropriate DCs. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). In summary, a disability rating in excess of 10 percent before December 10, 2016, is not warranted for the service-connected right foot pes planus with right 5th tarsometatarsal joint arthritis. For the period on appeal from December 10, 2016, a maximum schedular 50 percent disability rating, but no higher, is warranted. Left ankle arthritis with instability For the period no appeal before December 6, 2018, a disability rating in excess of 10 percent for the service-connected left ankle arthritis with instability is not warranted. In this regard, the evidence does not show that the Veteran's left ankle arthritis with instability resulted in marked, or severe, limitation of motion. At worst, left ankle dorsiflexion was to 20 degrees or greater, and plantar flexion was to 45 degrees, with no additional functional loss with repeated use over time. While the Veteran reported left ankle flare ups consisting of soreness and numbness, there is no indication that the Veteran's flare ups resulted in marked limitation of motion. In other words, for this period on appeal, the evidence shows that the Veteran's left ankle arthritis caused some limitation in the range of motion. However, the evidence does not show that any such limitation was marked, or severe, even with consideration of flare ups and repeated use over time. As previously noted, the Board notes that great consideration has been given to the lay statements of record. While the Board finds that the Veteran is competent to provide statements regarding his symptomatology, there is, however, nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding specific level of disability according to the appropriate DCs. See Barr, 21 Vet. App. at 308; Layno, 6 Vet. App. at 469; 38 C.F.R. § 3.159 (a)(1). The Board has also carefully considered criteria of other potentially applicable DCs and finds the currently assigned DC best describes and approximates the Veteran's symptomatology. It has also contemplated staged ratings but finds that they are not applicable here. Therefore, a disability rating in excess of 10 percent is not warranted before December 6, 2018. For the period on appeal from December 6, 2018, a disability rating in excess of 20 percent is not warranted for the service-connected left ankle arthritis with instability. Here, the Veteran is in receipt of the highest schedular rating for limited motion of the ankle, and there is no basis to award a higher rating. The Board as considered whether any other diagnostic codes related to ankle disabilities would provide for an assignment of a high rating. However, none are applicable. Diagnostic Code 5270 governs evaluations for ankylosis. In this case, the VA examination reports showed that the Veteran did not have actual ankylosis. He also did not have functional equivalent thereof. The evidence showed that while the Veteran had pain, soreness, and flare ups, the symptoms did not more nearly approximate immobility or consolidation of the ankle joint at any point during the period on appeal. Moreover, there is no evidence of any malunion of the os calcis or astragalus or any astragalectomy of either ankle. Thus, no separate or higher disability ratings are warranted on the basis of any such impairment at any time. See 38 C.F.R. § 4.71a, Diagnostic Codes 5272-5274 (in effect prior to and since February 7, 2021). Therefore, from December 6, 2018, a disability rating in excess of 20 percent for the service-connected left ankle arthritis with instability is denied. Right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis For the period on appeal from December 10, 2016, the Veteran's right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis is rated as 20 percent disabling, which is the highest schedular rating for limited motion of the ankle. There is no basis to award a higher rating. Diagnostic Code 5270 governs evaluations for ankylosis. In this case, the VA examination reports showed that the Veteran did not have actual ankylosis. He also did not have functional equivalent thereof. The evidence showed that while the Veteran had pain, soreness, and flare ups, the symptoms did not more nearly approximate immobility or consolidation of the ankle joint at any point during the period on appeal. Moreover, there is no evidence of any malunion of the os calcis or astragalus or any astragalectomy of either ankle. Thus, no separate or higher disability ratings are warranted on the basis of any such impairment at any time. See 38 C.F.R. § 4.71a, Diagnostic Codes 5272-5274 (in effect prior to and since February 7, 2021). Therefore, from December 10, 2016, a disability rating in excess of 20 percent for the service-connected right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis is denied. 13. Entitlement to a TDIU. The Board finds that the record and the Veteran's lay assertions reasonably raise the issue of whether a TDIU is warranted. The Board has jurisdiction to consider entitlement to a TDIU as part of the underlying increased rating claim. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009); Payne v. Wilkie, 31 Vet. App. 373 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018). TDIU is considered reasonably raised when a veteran submits medical evidence of a disability, makes a claim for the highest rating possible, and submits evidence of service-connected unemployability. Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001). A total disability rating for compensation purposes may be assigned based on individual unemployability, that is when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities. If there is only one service-connected disability, it must be rated 60 percent or more; if there are two or more service-connected disabilities, at least one disability must be rated 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). A substantially gainful occupation has been defined as "an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the Veteran actually works and without regard to the Veteran's earned annual income." Faust v. West, 13 Vet. App. 342 (2000). Substantially gainful employment is defined as work that is more than marginal, which permits the individual to earn a "living wage." Id. Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16. Marginal employment is defined as an amount of earned annual income that does not exceed the poverty threshold determined by the U.S. Census Bureau. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Marginal employment may also be held to exist, on a facts-found basis (including but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Although VA has not defined what constitutes work "in a protected environment," the Board nevertheless must consider its applicability on a facts-found basis. Cantrell v. Shulkin, 28 Vet. App. 382 (2017). Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the Court defined the term "unable to secure and follow a substantially gainful occupation" as having two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the following: the Veteran's history, education, skill, and training; whether the Veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue. The Board underscores that entitlement to a total disability rating must be based solely on the impact of the Veteran's service-connected disabilities on his ability to keep and maintain substantially gainful employment. See 38 C.F.R. § 4.16. In reaching such a determination, the central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Moreover, the responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner, rather, a medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran was granted a 40 percent evaluation for his low back disability as of June 18, 2014, pursuant to the instant Board decision. His other service-connected disabilities include posttraumatic stress disorder, rated as 100 percent disabling from November 23, 2016; migraines associated with PTSD, rated as 50 percent disabling from November 23, 2016; left lower extremity sciatic nerve radiculopathy, rated as 10 percent disabling from June 18, 2014, and as 40 percent disabling from May 5, 2021; right foot pes planus with right 5th metatarsal joint arthritis and left foot plantar fasciitis (previously rated separately), rated as 10 percent disabling from June 18, 2014, and as 50 percent disabling from December 10, 2016; left ankle arthritis with instability, rated s 10 percent disabling from October 14, 2011, and as 20 percent disabling from December 6, 2018; right lower extremity sciatic nerve radiculopathy, rated as 10 percent disabling from June 18, 2014, and as 20 percent disabling from March 5, 2021; left foot plantar fasciitis, rated as 10 percent disabling from October 14, 2011 to December 10, 2016; right tibiotalar arthritis of the right ankle and flexior hallucis longus tenosynovitis, rated as 10 percent disabling from March 16, 1999, and as 20 percent disabling from December 10, 2016. The Veteran has a 70 percent combined evaluation as of June 18, 2014. The Board finds that TDIU is warranted as of June 18, 2014, the effective date of the service connection grant for the low back disability. As of this date, the Veteran meets the percentage requirements for a schedular TDIU under 38 C.F.R. § 4.16(a) and he is unable to secure or follow a substantially gainful occupation because of his service-connected disabilities. The Veteran's May 2017 VA Form 21-8940, Application for increased compensation based on unemployability, indicates that he was last self-employed, and stopped working in 2012. His highest level of education was listed as four years of college. The September 2017 independent medical evaluation from Dr. J.L. indicates that the Veteran as likely as not is unable to secure and follow substantially gainful employment, including sedentary employment, due to his numerous service-connected musculoskeletal disabilities, including low back, bilateral ankles, and bilateral feet. It was noted that sedentary employment still requires physical capabilities, such as sitting down for prolonged period of time, and some lifting. Dr. J.L. went on to state that the Veteran's back and other disabilities prevented him from performing those tasks, including walking, sitting, lifting, and standing, even at sedentary level. After reviewing the evidence of record, the Board finds that the Veteran was unable to secure or follow a substantially gainful employment as of June 18, 2014, the effective date of the service connection grant for the low back disability. Thus, the Board finds that TDIU is warranted, effective June 18, 2014. (Continued on the next page) ? The Veteran is already in receipt of special monthly compensation (SMC) under 38 U.S.C. § 1114(s) from November 13, 2016. Given the TDIU grant in this matter, the effective date of the SMC is from June 18, 2014. DUSTIN L. WARE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kuksova, Kseniya 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.