PARALYSIS OF THE SCIATIC NERVE

MIKE SOBIECKI · 2025 · Case ID: A25056035

MIXED

Summary

The veteran, who served from August 1977 to August 1989, appeals the denial of increased ratings for bilateral lower extremity radiculopathy affecting the sciatic and femoral nerves for specific periods and the denial of an earlier effective date for TDIU. The Board reviewed the evidence, including multiple VA examinations from November 2018, November 2020, August 2021, and October 2021, along with the veteran's lay statements. For the sciatic nerve radiculopathy, the Board found that prior to November 13, 2020, the symptoms supported a 10 percent rating for mild incomplete paralysis, agreeing with the examiner's characterization of mild severity based on objective findings. For the period after November 13, 2020, the Board found that the symptoms, including impaired reflexes and muscle strength, supported a 20 percent rating for moderate incomplete paralysis, aligning with the examiners' opinions. For the femoral nerve radiculopathy, the Board found that the symptoms, including sensory changes and impaired reflexes and muscle strength, most closely approximated the criteria for a 20 percent rating for moderate incomplete paralysis. The Board granted entitlement to TDIU from September 19, 2018, finding that the veteran's combined service-connected disabilities, including low back disability, fibromyalgia, and generalized anxiety disorder, preclude him from maintaining substantially gainful employment. The Board noted that while the veteran reported severe symptoms, objective findings and the examiners' opinions supported ratings of mild to moderate incomplete paralysis for the sciatic and femoral nerves, not warranting higher ratings. The TDIU was granted based on the combined effects of these disabilities, not a single disabling condition.

Rationale

Objective testing showed minimal sensory deficits and normal muscle strength/reflexes.; Examiner characterized the condition as mild.; Board agreed with mild characterization based on objective findings.

Special Benefit

TDIU

Docket No.

220906-276555

Full Decision Text

Citation Nr: A25056035
Decision Date: 06/27/25 Archive Date: 06/27/25

DOCKET NO. 220906-276555
DATE: June 27, 2025

ORDER

Prior to November 13, 2020, an initial rating in excess of 10 percent for right lower extremity radiculopathy (sciatic nerve), is denied.

For the period beginning November 13, 2020, a rating in excess of 20 percent for right lower extremity radiculopathy (sciatic nerve) is denied.

Prior to November 13, 2020, an initial rating in excess of 10 percent for left lower extremity radiculopathy (sciatic nerve), is denied.

For the period beginning November 13, 2020, a rating in excess of 20 percent for left lower extremity radiculopathy (sciatic nerve) is denied.

For the period beginning November 13, 2020, a rating in excess of 20 percent for right lower extremity radiculopathy (femoral nerve) is denied.

For the period beginning November 13, 2020, a rating in excess of 20 percent for left lower extremity radiculopathy (femoral nerve) is denied.

From September 19, 2018, entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted.

FINDINGS OF FACT

1. Prior to November 13, 2020, the Veteran's right lower extremity radiculopathy (sciatic nerve) results in no more than mild incomplete paralysis of the sciatic nerve.

2. Prior to November 13, 2020, the Veteran's left lower extremity radiculopathy (sciatic nerve) results in no more than mild incomplete paralysis of the sciatic nerve.

3. For the period beginning November 13, 2020, the Veteran's right lower extremity radiculopathy (sciatic nerve) results in no more than moderate incomplete paralysis of the sciatic nerve.

4. For the period beginning November 13, 2020, the Veteran's left lower extremity radiculopathy, (sciatic nerve) results in no more than moderate incomplete paralysis of the sciatic nerve.

5. For the period beginning November 13, 2020, the Veteran's right lower extremity radiculopathy (femoral nerve) results in no more than moderate incomplete paralysis of the femoral nerve.

6. For the period beginning November 13, 2020, the Veteran's left lower extremity radiculopathy (femoral nerve) results in no more than moderate incomplete paralysis of the femoral nerve.

7. From September 19, 2018, the Veteran's service-connected disabilities render him unable to secure and follow a substantially gainful occupation.

CONCLUSIONS OF LAW

1. Prior to November 13, 2020, the criteria for a rating in excess of 10 percent for right lower extremity radiculopathy (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Codes 8520, 8720.

2. Prior to November 13, 2020, the criteria for a rating in excess of 10 percent for left lower extremity radiculopathy (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Codes 8520, 8720.

3. For the period beginning November 13, 2020, the criteria for a rating in excess of 20 percent for right lower extremity radiculopathy (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Code 8520.

4. For the period beginning November 13, 2020, the criteria for a rating in excess of 20 percent for left lower extremity radiculopathy (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§
extremity radiculopathy (sciatic nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Code 8520.

5. For the period beginning November 13, 2020, the criteria for a rating in excess of 20 percent for right lower extremity radiculopathy (femoral nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Code 8526.

6. For the period beginning November 13, 2020, the criteria for a rating in excess of 20 percent for left lower extremity radiculopathy (femoral nerve) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, Diagnostic Code 8526.

7. From September 19, 2018, the criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.25.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1977 to August 1989.

This case is before the Board of Veterans' Appeals (Board) on appeal from September 2021 and November 2021 Supplemental Claim rating decisions issued by a VA Regional Office (RO), which is an agency of original jurisdiction (AOJ).

By way of background, a November 2020 rating decision granted service connection for radiculopathy of the lower extremities affecting the sciatic and femoral nerves. The Veteran filed a higher level review request in April 2021 disagreeing with the initial ratings and affective dates. He also reported that his initial increased rating claims included an inferred claim for entitlement to a TDIU. A September 2021 higher-level review rating decision adjudicated the initial rating for the femoral nerve, but did not discuss its effective date. Adjudication of the sciatic nerve was deferred because the higher-level reviewer discovered a pre-decisional duty to assist error that required correction; specifically, that an examination evaluating the severity of the sciatic nerve was required. Such examination was obtained, and the AOJ issued a November 2021 rating decision that adjudicated an increased rating for the sciatic nerve. Similar to the adjudication of the femoral nerve in the prior decision, effective dates were not discussed.

In the September 6, 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. The Veteran attempted to appeal the initial ratings and effective dates of both the sciatic and femoral nerves from the November 2021 rating decision. The Board recognizes, however, that the femoral nerve was actually adjudicated in the September 2021 rating decision, as noted above. Resolving this discrepancy in the light most favorable to the Veteran, the Board finds that the appeal stems from both the September 2021 and November 2021 rating decisions.

As the Veteran selected the Evidence Submission docket, the evidentiary record before the Board will consist of the evidence of record at the time of the respective decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision and prior to the date the Board received the VA Form 10182, or
noted above. Resolving this discrepancy in the light most favorable to the Veteran, the Board finds that the appeal stems from both the September 2021 and November 2021 rating decisions.

As the Veteran selected the Evidence Submission docket, the evidentiary record before the Board will consist of the evidence of record at the time of the respective decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

MISSED ISSUE

In his September 2022 Form 10182, the Veteran requested an effective date prior to November 30, 2020, for left and right lower extremity radiculopathy (femoral nerve). As discussed above, this was an issue to which he had previously requested higher-level review, but the subsequent higher-level review decision was non-responsive in this regard. The AOJ did not adjudicate these issues. Therefore, they are not before the Board. The Veteran may resubmit the review request to the AOJ.

INCREASED RATINGS

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during active military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Each disability must be considered from the point of view of the veteran working or seeking to work. 38 C.F.R. § 4.2. 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.

Neurological impairment affecting the sciatic nerve is evaluated under 38 C.F.R. § 4.124a Diagnostic Codes 8520 (paralysis), 8620 (neuritis) and 8720 (neuralgia), using the criteria under Diagnostic Code 8520.

Neurological impairment affecting the femoral nerve is evaluated under 38 C.F.R. § 4.124a Diagnostic Codes 8526 (paralysis), 8626 (neuritis) and 8726 (neuralgia), using the criteria under Diagnostic Code 8526.

For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves. When the involvement is wholly sensory, the rating should be for the mild, or at most the moderate degree. Id.

Neuritis 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. The maximum rating which may be assigned for neuritis not characterized by such organic changes 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
the moderate degree. Id.

The regulations specifically provide that when rating peripheral nerve injuries and residuals related thereto, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, and / or sensory disturbances. 38 C.F.R. § 4.120. Consideration is also given to loss of reflexes, muscle atrophy, sensory disturbances, and pain. See 38 C.F.R. §§ 4.123, 4.124.

Under Diagnostic Codes 8520 and 8720, for incomplete paralysis, a 10 percent disability rating is assigned for mild incomplete paralysis. A 20 percent disability rating is assigned for moderate incomplete paralysis. If the condition is considered "moderately severe," a 40 percent disability rating is provided, and a 60 percent rating is warranted for conditions considered "severe, with marked muscular atrophy." An 80 percent rating is warranted for complete paralysis of the sciatic nerve, manifested by the foot dangled and dropped, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520, Diagnostic Code 8720.

Under Diagnostic Code 8526, for incomplete paralysis, a 10 percent disability rating is assigned for mild incomplete paralysis. A 20 percent disability rating is assigned for moderate incomplete paralysis, and a 30 percent rating is warranted for conditions considered "severe, with marked muscular atrophy." A 40 percent rating is warranted for complete paralysis of the femoral nerve, manifested by paralysis of the quadriceps extensor muscles. 38 C.F.R. § 4.124a, Diagnostic Code 8526.

The Board acknowledges the VA Adjudicative Procedures Manual M21-1 (hereinafter M21-1) contains guidance relevant to the adjudication of the issue currently on appeal. Specifically, Part V, Subpart iii, Chapter 12, Section A.2.c of the M21-1 provides "general guidelines" for the terms "mild," "moderate," "moderately severe," and "severe" in the context of evaluating incomplete paralysis of upper and lower peripheral nerves. "Mild" is described as the lowest level of evaluation based on the symptoms, however, slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment. Generally, "mild" is limited to a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area and / or a very minimal reflex or motor abnormality.

"Moderate" is described as the "maximum evaluation reserved for the most significant cases of sensory-only impairment. Symptoms will likely be described and medically graded as significantly disabling." The M21-1 further elaborates other "sign / symptom combinations" that may fall into the moderate category: combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and / or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

The "Moderately severe" evaluation level is only applicable for involvement of the sciatic nerve and is described as motor and / or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Atrophy may be present with moderately severe peripheral neuropathy.

"Severe" is expected to include motor and / or reflex impairment (for example atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes may be seen with severe longstanding neuropathy. Even though severe incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs / symptoms resembling some of those expected in cases of complete paralysis of the
is described as motor and / or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Atrophy may be present with moderately severe peripheral neuropathy.

1. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy (sciatic nerve), prior to November 13, 2020

2. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy (sciatic nerve), prior to November 13, 2020

The Board finds that prior to November 13, 2020, a rating in excess of 10 percent is not warranted for right lower extremity radiculopathy (sciatic nerve) or left lower extremity radiculopathy (sciatic nerve).

On VA back conditions examination in November 2018, muscle strength testing was normal. Reflex examination was normal in the right and left knees and ankles. Sensory examination was normal in the upper anterior thigh on the right and left, the thigh and knee on the right and left, and the lower leg and ankle on the right and left, but sensation to light touch was decreased in the foot/toes on the right and left. Straight leg raising test was positive on the right and left, but muscle strength testing was normal in the right and left legs. There was no muscle atrophy. The Veteran reported symptoms of radiculopathy, including moderate intermittent pain (usually dull) and severe numbness in the right and left lower extremities. The examiner opined that the Veteran had mild radiculopathy in the right and left lower extremities, affecting the sciatic nerve. See November 2018 VA Back Conditions Disability Benefits Questionnaire (DBQ).

The Board finds that, prior to November 13, 2020, the radiculopathy of the right and left lower extremities is best rated as mild and a higher rating is not warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8520, 8720. Although the Veteran reported on examination in November 2018 that he experienced moderate intermittent pain (usually dull) and severe numbness in the right and left lower extremities, objective testing showed only decreased sensation in the feet/toes, but normal sensation in the thighs, knees, lower leg, and ankle. Muscle strength and reflexes were normal. The condition is considered wholly sensory, and the examiner considered it to be, overall, of mild severity. The Board agrees with this characterization given the minimal symptoms noted on objective testing. The Board also acknowledges the Veteran's subjective severe numbness and moderate intermittent pain, but ascribes more weight to the objective test results, which showed more mild severity. The Board also notes that such symptoms are wholly sensory in nature and are appropriate for a 10 percent rating for mild incomplete paralysis of the sciatic nerve.

Based upon the above, the Board finds that the Veteran's overall symptoms support a finding of mild incomplete paralysis of the sciatic nerve in the right and left lower extremities. Therefore, ratings in excess of 10 percent are not warranted for the period prior to November 13, 2020.

3. Entitlement to an initial rating in excess of 20 percent for right lower extremity radiculopathy (femoral nerve)

4. Entitlement to an initial rating in excess of 20 percent for left lower extremity radiculopathy (femoral nerve)

In the aforementioned November 2020 rating decision, the RO granted 20 percent initial ratings for right and left lower extremity radiculopathy (femoral nerve), effective November 13, 2020, under DC 8526. The Veteran appealed these initial ratings. See April 2021 HLR request and September 2022 VA Form 10182.

The Board finds that a rating in excess of 20 percent is not warranted for right or left lower extremity radiculopathy of the femoral nerve under DC 8526 at any time during the period on appeal.

On VA back conditions examination in November 2020, reflex examination was normal in the right and left knees and ankles. Sensory examination showed sensation to light touch was decreased in the upper anterior thigh, the thigh
initial ratings for right and left lower extremity radiculopathy (femoral nerve), effective November 13, 2020, under DC 8526. The Veteran appealed these initial ratings. See April 2021 HLR request and September 2022 VA Form 10182.

The Board finds that a rating in excess of 20 percent is not warranted for right or left lower extremity radiculopathy of the femoral nerve under DC 8526 at any time during the period on appeal.

On VA back conditions examination in November 2020, reflex examination was normal in the right and left knees and ankles. Sensory examination showed sensation to light touch was decreased in the upper anterior thigh, the thigh and knee, the lower leg and ankle, and the foot and toes on the right and left. Straight leg raising test was positive on the right and left, and muscle strength testing was decreased to 4/5 in hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension on the right and left. There was no muscle atrophy. The Veteran reported symptoms of radiculopathy, including moderate constant pain (may be excruciating at times) in the right and left lower extremities, moderate paresthesias and/or dysesthesias in the right and left lower extremities, and moderate numbness in the right and left lower extremities. The examiner opined that the Veteran had moderate radiculopathy in the right and left lower extremities, affecting the femoral and sciatic nerves. See November 2020 VA Back Conditions DBQ.

On VA back conditions examination in August 2021, reflex examination showed deep tendon reflexes were hypoactive in the right and left knees and ankles. Sensory examination was normal on the right and left. Straight leg raising test was positive on the right and left, but muscle strength testing was normal in the right and left lower extremities. There was no muscle atrophy. The Veteran reported symptoms of radiculopathy, including moderate intermittent pain (usually dull) in the right and left lower extremities, mild paresthesias and/or dysesthesias in the right and left lower extremities, and mild numbness in the right and left lower extremities. The examiner noted that the Veteran's radiculopathy affected the femoral nerve, but he did not opine on the level of incomplete paralysis present for the right or left lower extremity. See August 2021 VA Back Conditions DBQ.

The examination findings noted above do not reflect symptomatology approximating more than moderate incomplete paralysis of the femoral nerve of the right or left lower extremity at any time during the period on appeal. In this regard, on examination, the Veteran reported mild and moderate symptoms of radiculopathy. However, sensory examination was normal except on back conditions examination in November 2020, when sensation to light touch was decreased in the right and left lower extremities. Deep tendon reflexes were hypoactive in the right and left knees and ankles on reflex examination in August 2021, but reflex examination was normal on examination in November 2020. Straight leg raising test was positive on the right and left throughout the appeal period, indicative of radiculopathy in the right and left lower extremities. However, muscle strength testing was essentially normal except for a slight reduction in muscle strength to 4/5 on examination in November 2020, and there was no muscle atrophy, trophic changes, foot drop, or complete foot paralysis found on examination at any time during the appeal. These are the sort of significant sensory changes and reflex or motor changes of a lower degree characteristic of moderate incomplete paralysis, as described above. Therefore, the Board finds that the Veteran's sensory impairment as well as impaired reflexes and muscle strength most nearly approximate the criteria corresponding to a 20 percent rating for moderate incomplete paralysis of the femoral nerve.

5. Entitlement to a rating in excess of 20 percent for right lower extremity radiculopathy (sciatic nerve), for the period beginning November 13, 2020

6. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy (sciatic nerve), for the period beginning November 13, 2020

The Board finds that for the period beginning November 13, 2020, a rating in excess of 20 percent is not warranted for right or left lower extremity radiculopathy of the sciatic nerve under DC 8520.

The November 2020 and August 2021 VA back conditions examination have been discussed above and will not be repeated here.

On VA peripheral nerves examination in October 2021, reflex examination showed deep tendon
iculopathy (sciatic nerve), for the period beginning November 13, 2020

6. Entitlement to a rating in excess of 20 percent for left lower extremity radiculopathy (sciatic nerve), for the period beginning November 13, 2020

The Board finds that for the period beginning November 13, 2020, a rating in excess of 20 percent is not warranted for right or left lower extremity radiculopathy of the sciatic nerve under DC 8520.

The November 2020 and August 2021 VA back conditions examination have been discussed above and will not be repeated here.

On VA peripheral nerves examination in October 2021, reflex examination showed deep tendon reflexes were hypoactive in the right and left knees and ankles. Sensory examination was normal on the right and left. Muscle strength testing was normal in the right and left knees and in dorsiflexion of the left ankle, but it was decreased to 4/5 in the right and left ankles in plantar flexion and in dorsiflexion of the right ankle. There was no muscle atrophy. The Veteran reported symptoms of radiculopathy, including severe intermittent pain (usually dull) in the right lower extremity, moderate intermittent pain (usually dull) in the left lower extremity, moderate paresthesias and/or dysesthesias in the right and left lower extremities, and moderate numbness in the right and left lower extremities. The examiner opined that the Veteran had moderate radiculopathy in the right and left lower extremities, affecting the femoral and sciatic nerves. The examiner also noted that on VA back conditions examination in September 2021, the Veteran had radiculopathy in the right and left lower extremities affecting the sciatic and femoral nerves. See October 2021 VA Peripheral Nerves DBQ.

The examination findings noted above do not reflect symptomatology approximating more than moderate incomplete paralysis of the sciatic nerve of the right or left lower extremity during this period. In this regard, on examination, the Veteran reported mild, moderate, and severe symptoms of radiculopathy. Sensory examination was normal except on back conditions examination in November 2020, when sensation to light touch was decreased in the right and left lower extremities. Deep tendon reflexes were hypoactive in the right and left knees and ankles on reflex examination in August 2021 and October 2021, but reflex examination was normal on examination in November 2020. Straight leg raising test was positive on the right and left throughout the appeal period, indicative of radiculopathy in the right and left lower extremities. However, muscle strength testing was essentially normal except for a slight reduction in muscle strength to 4/5 on examination in November 2020 and October 2021, and there was no muscle atrophy found on examination at any time during the appeal. Therefore, the Board finds that the impaired reflexes noted on examination in August 2021 and October 2021 and the impairment of muscle strength noted on examination in November 2020 and October 2021 do not reflect symptomatology approximating more than moderate incomplete paralysis of the sciatic or femoral nerves of the right or left lower extremities at any time during the appeal period. Moreover, the November 2020 VA back conditions examiner and October 2021 VA peripheral nerves conditions examiner opined that the Veteran's right and left lower extremity radiculopathy was moderate.

The Veteran reported severe intermittent pain (usually dull) in the right lower extremity on examination in October 2021. Reflexes were hypoactive in the right and left legs, but there was no evidence of trophic changes, muscle atrophy, or complete paralysis. The Board finds the Veteran's lay statements of record to be competent and credible and are afforded much probative value. However, as noted above, when the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. Although the Veteran reported subjective symptoms in the moderate or severe range, objective testing revealed sensory symptoms of decreased-but not absent-sensation, as well as the non-sensory symptoms of partial loss of muscle strength and reflexes in the left and right lower extremities. It also revealed that the Veteran had no atrophy, trophic changes, foot drop, or complete paralysis. These are the sort of significant sensory changes and reflex or motor changes of a lower degree characteristic of moderate incomplete paralysis, as described above. As such, the Board relies on the examiners' characterization and finds that the Veteran's radiculopathy of the left and right lower extremities at the time of the October 2021 peripheral nerves examination resulted in no worse than moderate
subjective symptoms in the moderate or severe range, objective testing revealed sensory symptoms of decreased-but not absent-sensation, as well as the non-sensory symptoms of partial loss of muscle strength and reflexes in the left and right lower extremities. It also revealed that the Veteran had no atrophy, trophic changes, foot drop, or complete paralysis. These are the sort of significant sensory changes and reflex or motor changes of a lower degree characteristic of moderate incomplete paralysis, as described above. As such, the Board relies on the examiners' characterization and finds that the Veteran's radiculopathy of the left and right lower extremities at the time of the October 2021 peripheral nerves examination resulted in no worse than moderate incomplete paralysis of the sciatic nerve, which warrants a 20 percent rating under Diagnostic Code 8520.

VA treatment records do not reveal evidence of more than moderate incomplete paralysis of the right or left lower extremities affecting the sciatic nerve during this period.

Based upon the above, the Board finds that the Veteran's overall symptoms support a finding of moderate incomplete paralysis of the sciatic nerve in the right and left lower extremities. Therefore, ratings in excess of 20 percent are not warranted for the period beginning November 13, 2020.

In reaching the determinations above, the Board also acknowledges that the VA may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 2 Vet. App. 56, 61 (2012). VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, Vet. App., No. 23-1798, 2025 U.S. App. Vet. Claims LEXIS 327, *1 (Mar. 12, 2025). The rating criteria listed under Diagnostic Code 8520 and Diagnostic Code 8526 do not contemplate the ameliorative effects of medication on the Veteran's bilateral lower extremity sciatic and femoral radiculopathy nerve disabilities. The Veteran reported treating his back and lower leg pain with Norco and Lyrica. However, there is no indication that the medical examiners considered the ameliorative effects of medication in rendering the findings in the VA examination reports, and the Board has not otherwise done so.

7. Entitlement to a TDIU

The Veteran has raised entitlement to a TDIU in connection with his increased rating claims. The Board will consider a TIU from September 19, 2018, the earliest effective date of service connection for a disability on appeal. The Board also notes that he is not service-connected for any disability prior to September 19, 2018. For the reasons that follow, the Board finds that a TDIU is warranted.

Total disability ratings for compensation may be assigned when a veteran is unable to secure and follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component simply 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. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.; see Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment). Factors such as age or impairment by non-service-connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19.

The Veteran is service-connected for generalized anxiety disorder, evaluated as 70 percent disabling; fibromyalgia, evaluated as 10 percent disabling from September
, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.; see Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment). Factors such as age or impairment by non-service-connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19.

The Veteran is service-connected for generalized anxiety disorder, evaluated as 70 percent disabling; fibromyalgia, evaluated as 10 percent disabling from September 19, 2018 and as 40 percent disabling from August 20, 2021; degenerative arthritis of the spine, evaluated as 20 percent disabling; radiculopathy of the left lower extremity (sciatic nerve), evaluated as 10 percent disabling from September 19, 2018 to November 13, 2020 and as 20 percent disabling thereafter; radiculopathy of the right lower extremity (sciatic nerve), evaluated 10 percent disabling from September 19, 2018 to November 13, 2020 and as 20 percent disabling thereafter; radiculopathy of the lower right extremity (femoral nerve), evaluated as 20 percent disabling; and radiculopathy of the left lower extremity (femoral nerve), evaluated as 20 percent disabling. He has a combined rating of 80 percent from September 19, 2018, 90 percent from November 13, 2020, and as 100 percent from August 20, 2021. Accordingly, the Veteran meets the criteria for schedular consideration of a TDIU. 38 C.F.R. § 4.16(a).

A November 2018 VA fibromyalgia examination shows that the Veteran's fibromyalgia did not impact his ability to work. See November 2018 VA Fibromyalgia Disability Benefits Questionnaire (DBQ).

During a November 2018 VA back conditions examination, the Veteran reported that he last worked in 2015 as an airplane technician for eight years and quit due to issues with his spouse. It was noted that his back condition precluded him from doing physical labor, but he would be able to do sedentary jobs.

On VA mental disorders examination in December 2018, the Veteran reported that he stopped working in 2015 because his ex-wife was after him for alimony and had been trying to get money from him from 2009 - 2014 and had obtained a court order to garnish his paycheck and took him to court. This was very stressful for the Veteran. The examiner concluded that the Veteran's anxiety disorder resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.

In his April 2019 VA Form 21-8940, the Veteran reported that he was prescribed narcotics for severe chronic pain from his fibromyalgia and kidney stones that prevented him from working or driving.

An October 2019 Request for Employment Information in Connection with Claim for Disability Benefits indicates that the Veteran last worked in July 2018 as a self-employed avionics technician. He reported that no concessions were made for him during his employment and noted that he stopped working due to health issues and that he was attempting to get disability.

On VA fibromyalgia examination in November 2020, it was noted that the Veteran had difficulty performing work tasks, such as house or yard work, due to chronic pain.

On VA back conditions examination in November 2020, it was noted that the Veteran was unable to walk, stand, or run for more than 5 - 10 minutes without pain.

On VA mental disorders examination in August 2021, the Veteran now reported that he last worked in July 2018 as an aviation maintenance specialist, and that he left his job due to health issues related to tumors up and down his spine, which were benign but caused pain in his lower back. The examiner concluded that the Veteran's anxiety disorder resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication.

On VA fibromyalgia examination in August 2021, the Veteran reported that chronic pain impaired her ability to concentrate and to stand, walk, lift or carry objects, or sit for prolonged periods of time. The examiner was asked to comment on the effect of the Veteran's service-connected and/or claimed disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations, taking into consideration
related to tumors up and down his spine, which were benign but caused pain in his lower back. The examiner concluded that the Veteran's anxiety disorder resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication.

On VA fibromyalgia examination in August 2021, the Veteran reported that chronic pain impaired her ability to concentrate and to stand, walk, lift or carry objects, or sit for prolonged periods of time. The examiner was asked to comment on the effect of the Veteran's service-connected and/or claimed disabilities on his or her ability to function in an occupational environment and describe any identified functional limitations, taking into consideration all forms of work, including sedentary work. The examiner repeated the Veteran's reports noted above that chronic pain impaired her ability to concentrate and to stand, walk, lift or carry objects, or sit for prolonged periods of time. The examiner did not specifically state whether the Veteran would be able to perform physical or sedentary work.

On VA back conditions examination in August 2021, the Veteran reported that he was unable to sit or lie down for very long, stand or walk for more than short periods, or bend to lift. The examiner opined that pain and loss of motion from the Veteran's back disability impaired his ability to stand, walk, or sit for long periods, or to bend, lift, or carry heavy objects. The examiner did not specifically state whether the Veteran would be able to perform physical or sedentary work.

In a February 2022 statement, the Veteran reported that he was employed until July 2018, at which time he stopped working due to his service-connected health issues, including his back disability, which caused pain and other limitations that were so severe he could no longer work. He was unable to lift more than a few pounds, could not stand for more than a few minutes, was unable to stay in one position for prolonged periods of time, and occasionally would need to lie down during the day. He also alleged that his anxiety had become debilitating, which made it very difficult for him to concentrate or keep a regular schedule.

An October 2021 VA peripheral nerves examination shows that the Veteran's lower extremity radiculopathy did not impact his ability to work.

The ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical question, but rather a determination that must be made by an adjudicator. See 38 C.F.R. § 4.16(a); Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2014). The Board finds that the Veteran's low back disability, fibromyalgia, and generalized anxiety disorder cause significant functional and occupational impairment and preclude the Veteran from maintaining substantially gainful employment. In this regard, the Board finds that the Veteran's low back disability and fibromyalgia would present a significant obstacle to maintaining employment as an aviation maintenance technician or in similar occupations because they would prevent him from performing labor intensive tasks that require standing, walking, bending, lifting, and carrying. Furthermore, although it was noted on VA back conditions examination in November 2018 that he would be able to do sedentary work, since his discharge from the military, the Veteran has only worked labor-intensive, physically demanding jobs, including working on fishing boats in Alaska for 12 years, working on irrigation systems at a golf course for 4 and a half years, and working as an airplane maintenance technician for 8 years, before he stopped working in 2018. There is no evidence of record showing that he has ever worked consistently in any other field or participated in any type of vocational training to reestablish employment after he stopped working in 2018. . The Board also finds that the Veteran's reported debilitating anxiety and problems with concentration due to his anxiety disorder would also pose a significant risk to the Veteran of harming himself or others while working.

Based on the evidence noted above, and resolving all reasonable doubt in his favor, the Board finds that the Veteran's service-connected disabilities, together, preclude him from securing or maintaining substantially gainful employment, and the criteria for entitlement to a TDIU have been met since September 19, 2018, the date his current claims for service connection were received, and the date he met the schedular criteria for TDIU.

A TDIU is not warranted for the period beginning August 20, 2021, the date a 100 percent combined rating is in effect. TDIU has been awarded based on the Veteran's combined service-connected disabilities. The evidence does not show that any single disability would warrant a TDIU from August 20, 2021
doubt in his favor, the Board finds that the Veteran's service-connected disabilities, together, preclude him from securing or maintaining substantially gainful employment, and the criteria for entitlement to a TDIU have been met since September 19, 2018, the date his current claims for service connection were received, and the date he met the schedular criteria for TDIU.

A TDIU is not warranted for the period beginning August 20, 2021, the date a 100 percent combined rating is in effect. TDIU has been awarded based on the Veteran's combined service-connected disabilities. The evidence does not show that any single disability would warrant a TDIU from August 20, 2021, and in his TDIU application, he specifically noted multiple, service-connected disabilities as the cause of his unemployability. An award of a TDIU based on the combined effects for multiple disabilities cannot be used to satisfy the requirement of a single disability rated as totally disabling. See Buie v. Shinseki, 24 Vet. App. 242 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008).

Mike Sobiecki

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board F. Yankey, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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