PARALYSIS OF SCIATIC NERVE

Summary

The Veteran, an Army Veteran who served from November 1969 to February 1972, appeals the denial of an increased disability rating for radiculopathy of the left lower extremity. The Veteran is currently rated at 10 percent for left leg radiculopathy and contends that his right leg radiculopathy, rated at 20 percent, should be rated equally. The Board reviewed two VA examinations. The April 2017 examination concluded mild incomplete paralysis in the left leg, but the RO requested a new examination due to lack of muscle testing. The November 2017 VA examination noted mild pain, paresthesias, and numbness in the left leg, with normal muscle strength and reflexes, concluding mild incomplete paralysis, possibly related to a recent stroke. The February 2018 examination found no pain in the left leg, normal strength, reflexes, and sensation, but characterized the condition as mild incomplete paralysis in the RIGHT leg. The Board found that the evidence, including two VA examinations characterizing the condition as mild, did not support a rating higher than the current 10 percent. The Board noted the lack of significant sensory changes, reflex or motor changes, or muscle weakness, and that no provider characterized the condition as moderate or severe. Therefore, the Board denied the claim for an increased rating.

Rationale

Both VA examinations concluded mild incomplete paralysis in the left leg.; Veteran had normal muscle strength, reflexes, and sensation in the left leg.; Evidence did not support symptoms more severe than mild incomplete paralysis.

Full Decision Text

Citation Nr: 22061069
Decision Date: 11/01/22	Archive Date: 11/01/22

DOCKET NO. 18-11 762
DATE: November 1, 2022

ORDER

Entitlement to a rating in excess of 10 percent for radiculopathy of the left lower extremity is denied.

FINDING OF FACT

The Veteran's radiculopathy of the left lower extremity is productive of no more than mild incomplete paralysis.

CONCLUSION OF LAW

The criteria for entitlement to a rating in excess of 10 percent for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 4.124a, DC 8520.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Army from November 1969 to February 1972.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO).

Entitlement to a rating in excess of 10 percent for radiculopathy of the left lower extremity

In a May 2017 rating decision, the RO granted the Veteran service connection for radiculopathy of his left leg and assigned a rating of 10 percent. The Veteran seeks a higher rating. He is currently rated 20 percent disabled for radiculopathy in his right leg, and he contends that both of his legs should be rated equally. 

The Veteran is rated under Diagnostic Code (DC) 8520, which contemplates paralysis of the sciatic nerve. 38 C.F.R. § 4.124a. Under this diagnostic code, ratings of 10 percent, 20 percent, and 40 percent are assignable for incomplete paralysis which is mild, moderate, or moderately severe in degree. Id. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. Id. Complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Id.

Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

In this case, the Board finds that the Veteran is not entitled to a rating in excess of 10 percent for radiculopathy of his left leg. The medical evidence of record shows that the Veteran's radiculopathy symptoms are not equal in both legs, and that his left leg symptoms most nearly approximate mild incomplete paralysis. 

In April 2017, a VA examiner reviewed the Veteran's medical records and concluded that the Veteran had mild incomplete paralysis in his left leg. However, the RO determined that because the examiner did not conduct muscle strength, reflex, or sensory testing, a new examination was necessary.

The Veteran was given an in-person VA examination in November 2017. The examiner noted that the Veteran reported experiencing severe lower back pain with pain radiating down his left leg beginning in April 2017. The Veteran reported pain shooting down his left leg, especially at night. During the examination, the Veteran reported mild symptoms of pain, tingling, and numbness in his left leg. 

The VA examiner observed that the Veteran had mild pain, mild paresthesias and/or dysesthesias (meaning abnormal, unpleasant touch sensations with or without stimuli), and mild numbness in his left leg. The examiner observed that the Veteran had normal muscle strength throughout his left leg and no muscle atrophy. The examiner noted that the Veteran had decreased sensation in his left leg and concluded that this was at least as likely as not related to a stroke that the Veteran had recently suffered. Overall, the examiner concluded that the Veteran had mild incomplete paralysis in his left leg.

The Veteran was given another in-person VA examination in February 2018. The examiner noted that while the Veteran reported constant pain in his back and throughout his right leg, he reported no radiation of pain down his left leg. The Veteran reported some tingling and numbness in his left leg less frequently than in his right leg. The examiner observed that the Veteran had normal strength, reflexes, and sensation in his left leg. The examiner also observed that the Veteran had no pain in his left leg, and experienced mild p
 decreased sensation in his left leg and concluded that this was at least as likely as not related to a stroke that the Veteran had recently suffered. Overall, the examiner concluded that the Veteran had mild incomplete paralysis in his left leg.

The Veteran was given another in-person VA examination in February 2018. The examiner noted that while the Veteran reported constant pain in his back and throughout his right leg, he reported no radiation of pain down his left leg. The Veteran reported some tingling and numbness in his left leg less frequently than in his right leg. The examiner observed that the Veteran had normal strength, reflexes, and sensation in his left leg. The examiner also observed that the Veteran had no pain in his left leg, and experienced mild paresthesias and numbness. She concluded that the Veteran had mild incomplete paralysis in his right leg.

The Board concludes that the Veteran's current 10 percent rating is appropriate, as the evidence suggests that the Veteran's symptoms are mild. Words such as "mild," "moderate," "moderately severe," and "severe" are not defined in the Rating Schedule. Though the Board is not bound by the VA Adjudication Procedures Manual M21-1, we may use it as a benchmark for evaluating the degree of severity of a neurological impairment. Chavis v. McDonough, 34 Vet. App. 1, 17-18 (2021). The manual provides that a rating of mild may be warranted where the disability is limited to sensory deficits that are lower graded, less persistent, or affecting a small area. M21-1, V.iii.12.A.2.c.

Both VA examiners who have examined the Veteran have concluded that he experiences mild incomplete paralysis in his left leg. The Veteran was found to have mild paresthesias and numbness in both examinations. He was found to have mild pain in the April 2017 examination and no pain in the February 2018 examination, which is consistent with the Veteran's reports to the examiners. While the Veteran was found to have decreased sensation in April 2017, his sensation, and reflexes were found to be normal in February 2018. The Veteran's muscle strength was found to be normal in both examinations. This evidence reflects that the Veteran's symptoms are lower graded and less persistent, consistent with a finding that the Veteran experiences mild incomplete paralysis in his left leg.

Critically, the record lacks evidence of symptoms such as significant sensory changes, reflex or motor changes, or reflex impairment such as weakness or diminished reflexes. Id. Here, the Veteran has not described his symptoms as significantly disabling, nor have the examiners found them to be so, and no significant sensory changes or muscle weakness have been found to exist. While the April 2017 examination noted decreased sensation in the Veteran's left leg, the February 2018 examination found normal sensation. Taken together, these examinations do not reflect an overall disability picture that warrants a higher evaluation than the already assigned 10 percent. Further, no treating or examining provider has ever characterized the Veteran's left lower extremity radiculopathy as moderate, moderately severe, or severe, and as noted above, both VA examiners, with whom the Veteran met in person, characterized the condition as mild. 

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Based on this evidence, the Board concludes that the Veteran's symptomatology is accounted for by the already assigned 10 percent evaluation, and the claim for increase must be denied.

 

 

Z. Sahraie

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Moore, Thomas J.

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.